Obesity Treatment: Diet and Physical Activity Flashcards
body adaptations to calorie restriction
initial: negative energy balance
Long term: the body lowers energy expenditure
-most weight loss is achieved in first 3-6mths
energy gap
- created by initial weight loss
- filled by lower calorie intake/ physical activity
- usual range: 700 calories/ day
fact that indicates the body defends higher weight
24hour energy expenditure goes down more than would be expected by weight loss alone
moderate calorie restriction
- deficit of 500-1000 calories/day
- 20-40% of calorie requirement for person consuming 2500 calories/ day
- achievable for several months without great difficulty
component that is predictive of success in weight loss
self-monitoring of food
recommended daily calorie deficit
500-1000 calories
1-2 pounds/ week at first
calorie target for weight
250
1200-1500
very low calorie diets
- less than 800-1000 or less than 50% of daily requirement
- more effective short term, same long term
- require medical monitoring
how to determine if provider has successfully overcome weight bias
if patient feels empowered after the encounter
considerations 4 diet plan for adult patient
- goal setting to produce small but continuous improvement in eating patterns
- goals that are specific, concrete, measurable, achievable
5 Dietary plan first steps
- cut out sugary drinks
- increase fruit and veg.
- avoid skipping meals but if you do skip dinner
- reduce portion size by 25-33%
- slow pace of eating to at least 20min/ meal
Aggressive dietary plan
- self help diet book
- structured meal plan like meal replacement
- commercial weight loss program
- recommended high intensity programs: >14 visits over 6 mths
- dietary logs with budget for calories and fat
macronutrient balanced diet
- recommended by most organizations in US
- low fat, less than 30% calories from fat
low carbohydrate diets
- short term weight loss greater than low fat
- possible greater long term weight loss after 2 years
mediterranean diet
- maybe greater weight loss than low fat diet
- difficult to follow in US
diets high and low in protein and fat
did not make a difference wrt weight loss
most important predictor of weight loss after 2 years
self monitoring
attendance with group sessions
energy density
- calories/ weight
- independent effect beyond macronutrient content
meal replacement
-additional weight loss above and beyond meal plans with same number of calories recommended
3 reasons physical activity is important for weight loss and maintenance
- fill energy gap from initial weight loss
- maintaining fat free mass/ muscle mass: determinant of 24 hour energy expenditure
- regulate appetite
regular exercise and the risk for diabetes, and coronary heart disease
-independently reduces risk beyond what is attributable to weight loss alone
lifestyle activity
- expending energy throughout energy of daily living: stairs instead of elevator
- reduce sedentary activity
-same calorie expenditure through lifestyle activity possible as with exercise
2 factors that impact weight
Sleep: adequate duration and quality of sleep –> prevent weight gain
Social environment: higher income ev ~ lower rates of severe obesity
how obstructive sleep apnea effects weight loss
- appropriate sleep helps people lose weight
- undiagnosed OSA = harder time losing weight
5 facts that support predisposition to weight gain
- reduction in 24hour energy expenditure beyond what is expected from weight loss and loss of lean body mass alone
- Increased subjective hunger
- increase in Gherlin (hunger)
- Decrease Leptin (fullness)
- fMRI: increased neural activation when shown photos of food in weight reduced individuals
why is physical activity without calorie reduction not enough for weight loss?
- activity required to burn 500-1000 calories is several hours
- but activity is a strong predictor of success in maintaining weight loss regardless of method
threshold level of exercise to maintain weight loss
about 30 min vigorous activity
60 min moderate activity
formula for calories to prevent weight gain
47kcal per (kg body weight X 0.1) -1
for 70 kg person= 328kcal
two strategies for exercise plans
- FITT: frequency- intensity- time-type
2. pedometer
FITT method
Frequency
Intensity: Moderate (60% max predicted HR)
Time
Activities: large muscle groups and are continuous
Proper use of pedometer
- baseline #steps/week
- step goal: increase by 500 steps/ day higher than baseline
- slowly increase step by 3500 steps per week/ 500 per day
To maintain long term weight loss: 10,000-12,000 steps/day
5 predictors of success in weight loss maintenance
- use of moderately low fat, high carb diets
- frequent self monitoring
- eating breakfast
- large amount of physical activity
- limited tv viewing
average energy expenditure for physical activity in successful weight loss maintenance
2800 kcal/week ~1hour of moderate intensity physical activity
-pedometer average steps/day 11,000 vs 5000 in sedentary person
tv viewing in weight loss maintenance
american average: 28hrs/week
63% 21hours/week
calorie target for weight over 250
1500-1800