Obesity Part 3

Question 1

What percentage of patients successfully maintain their weight loss for 1-5 years?

Answer 1

20%

Question 2

Phases of Weight Changes

Answer 2

Active Weight loss
Transition
Weight Maintenance

Question 3

Transition Phase

Answer 3

1. Congratulate (positive reinforcement)
2. Celebrate (encourage non-food treats)
3. Plan (where do they go from here?)

Question 4

National Weight Control Registry (NWCR)

Answer 4

• followed 10,000 individual

Inclusion: > 30 lbs lost and kept off for at least 1 year
Average: 66 lbs lost and kept off for 5.5 years

Findings:
- eat breakfast
- weekly weigh ins
- watch < 10 hours of TV per week
- active for 60 minutes per day

Question 5

Energy Balance

Answer 5

Weight Maintenance:
- calories consumed = calories needed
- exercise completed = recommended exercise

Question 6

Which of the macronutrients results in the greatest rise in insulin levels?

Answer 6

carbohydrates

Question 7

Leptin vs Grehlin

Answer 7

Leptin:
- energy suppressant
- decreased food intake leading to weight loss
- long term

Grehlin:
- energy stimulant
- increased food intake leading to weight gain
- short term

Question 8

YOYO Effect

Answer 8

Weight loss –> Less conflict –> less action –> weight gain –> emotional conflict –> action

Question 9

Trigger Event

Answer 9

• an event that creates the desire to lose weight

Types of Trigger Events:
- Medical Trigger (23%)
- All Time High Weight (21.3%)
- Picture (12.7%)

MEDICAL TRIGGERS RESULTED IN MORE SIGNIFICANT WEIGHT LOSS AND BETTER MAINTENANCE

Question 10

What percentage of participants recalled a trigger event?

Answer 10

83%

Question 11

Structural Tension

Answer 11

difference between where you are and where you want to be

Question 12

Different Choices

Answer 12

Fundamental Choice:
- defines our state of being
- I choose to have optimal health

Primary Choice:
- defines our health goal
- I will maintain a healthy weight

Secondary Choice:
- day to day actions we take to achieve our primary choice
- I will go to the pool 3 days per week

Question 13

Factors Associated with Weight Regain

Answer 13

Dietary Disinhibition

Decrease in physical activity

Depression

Question 14

Predictors of Success

Answer 14

B: breakfast
E: exercise

S: support
L: low fat meals every 3 hours
I: individual plan
M: monitor progress

• consistent eating pattern
• maintain level of physical activity
• minimize diet disinhibition
• time of maintenance

HIGH PROTEIN/ LOW CARB/ LOW FAT
- goal is to maintain fat free mass and preserve basal metabolic rate

Question 15

Thermogenesis

Answer 15

• energy expended to absorb, process, and store nutrients

Protein: 25-30%
Carbohydrates: 6-8%
Fat: 2-3%

Question 16

Mediterranean Diet

Answer 16

• decreased risk of death from cancer and heart disease and reduced the incidence of Alzheimer’s and Parkinson’s disease

Details:
- plant based foods
- whole grains
- replace butter with healthy fats
- herbs/spices replace salt
- more fish, less red meat
- red wine in moderation

Question 17

Monitoring Weight

Answer 17

• routine weight checks (at home or with provider)
• increases accountability
• earlier identification for slip-ups and quicker corrections

Question 18

Physical Activity

Answer 18

• maintain an exercise regimen containing aerobic and anaerobic movements
• physical activity should focus on development of lean muscle tissue by slow controlled movements

AVOID SARCOPENIA

Question 19

1 pound of muscle burns how many calories per day?

Answer 19

50-70 calories at rest

Question 20

Amount of Time to Eat Meal

Answer 20

Average American Meal: 8 minutes
Time for body to register satiety: 15-20 minutes

PUT UTENSILS DOWN BETWEEN BITES
CHEW EACH BITE 15-20 TIMES

Question 21

Dietary Fiber

Answer 21

Effects:
- lowers LDL, BG spikes, risk of colon cancer
- increases satiety
- keeps bowel movements consistent

Consideration:
- start low and go slow due to bloating
- increase water intake with fiber

CAUTION WITH DIGOXIN AND CARBAMAZEPINE

Question 22

Fiber Target Goal

Answer 22

25-50 grams per day

Question 23

US Average Fiber Intake

Answer 23

16 grams per day