Transcript Weight Management - The Nutrition Translator

Weight Management
Katie Belazis, Nicole Sagaria,
Shelley Opremcak, Colleen Poling
HCFN 400A
November 6, 2008
Position Statement
It is the position of the American Dietetic
Association that successful weight
management to improve overall health for
adults requires a lifelong commitment to
healthful lifestyle behaviors emphasizing
sustainable and enjoyable eating practices
and daily physical activities (1)
Summary
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Assessment of obesity.
Etiology of obesity: Genetics, environment,
medications, psychological status.
Goals in weight management intervention.
Interventions: Diets, Physical activity,
pharmacotherapy, surgery, relapse prevention
Responsibility of the Dietitian.
Role of Dietetics Professional in Team Approach
to Weight Management.
Costs to weight management.
Assessment of Obesity
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Overweight is defined as a BMI of 25-29.9
kg/m2, obesity is defined as a BMI of ≥30
kg/m2, and severe obesity is defined as
≥40 (2)
65% of adults are classified as
overweight;30% are classified as obese in
America (3)
It is the second cause of premature death
in the United States (4)
Etiology of Obesity (1)
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Obesity develops from both genetic and
environmental factors. Obesity is a very
complex and multifactorial chronic disease
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Genetics: accounts for 60-80% of the
predisposition of obesity
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Leptin
Environmental: Decrease in Physical activity,
advances in technology and food availability
HOW IS OVERWEIGHT AND OBESITY
DEFINED??
Etiology of Obesity (1)
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Medications
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Psychotropic medicines can
also contribute to
unwanted weight gain.
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Mood stabilizers,
medicines that block
histamine H1, Serotonin 55HT, dopamine, several
types of antidepressants
Newer medications are
allowing for alternative
choices which can limit
unwanted weight gain
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Psychological status
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Mood state and eating
behaviors are commonly
related.
Studies have shown that
those with serotonin levels
are involved with mood and
behavior. Patients can learn
that if they eat, then they
can reduce their depressive
symptoms.
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Seen in: Nicotine
withdraw, seasonal
affective disorder,
premenstrual syndrome
Goals of Weight Management
Interventions (1)
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Prevention of weight gain or stopping weight
gain in the individual who has been seeing a
steady increase in his/her weight
Varying degrees of improvements in physical
and emotional health
Small maintainable weight losses or more
extensive weight losses achieved through
sensible and tolerable eating and exercise
behaviors
Improvements in eating, exercise and other
behaviors apart from any weight losses
Interventions (1)
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Physical Activity
 It is well established that
physical activity during
weight loss can favorably
affect energy balance and
body composition
 To promote weight loss, it
is necessary to create an
energy imbalance that
elicits an energy deficit (3)
 Combination of diet plus
exercise has the greatest
impact of weight loss (3)
 The combination has
consistently been shown to
convey additional health
benefits by improving the
metabolic parameters
associated with chronic
disease
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Diet and Lifestyle Modifications
 Body knows best
 Self guidance using internal
clues to hunger and satiety
 External regulation through
calorie restriction
 For individuals who are
able to internally control
their food intake
 What is the difference
between a VLCD and a
LCD?
Interventions (1)
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Diets
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Diets can be classified as:
starvation (0-200 kcals/day);
VLCD (200-800 kcal/day) or
low calorie (>800 kcal/day)
Starvation include fasting
VLCDs are protein-sparing,
modified fasts and reserved
for those who have a BMI >30
LCD is the most common
intervention that modifies the
macronutrient composition of
the diet
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Emphasizes portion control
and reduction of saturated
and total fat intake
Pharmacotherapy
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Pharmacotherapy research is
currently focusing on three
approaches; inhibitors of
energy intake, enhancers of
energy expenditure, and fat
mobilization stimulators
Obesity guidelines currently
recommend that drug therapy
be considered in conjunction
with nonpharmacological
therapy (5)
Interventions (1)
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Surgery
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During the past 25 years,
gastric surgery has been
shown to be the most
effective approach for
generating long-term
weight loss in extremely
heavy persons
Bariatric surgery has been
shown to be an effective
method for producing
weight loss in obese
patients and to be more
effective than dieting in
producing sustained weight
loss (6)
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Relapse Prevention
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A successful program is
often defined as one that
produces maintenance of
loss at least 5%, or 6.6 kg
of body weight
Successful maintainers
report that very careful
attention to reduced
calorie, low-fat diets,
increased levels of physical
activity, and frequent
weighing
Responsibilities of Dietitians (1)
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Dietitians should focus on long-term as well as
short-term outcomes and convey realistic
expectations
It is important for an RD to maintain currency in
their profession by continuing education and
training
RD’s need to stay within appropriate scope of
practice; they must know their limitations and
respect them; and make referrals as needed
Role of Dietetics Professional in
Team Approach to Weight
Management (1)
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The physician is usually first to see
patients in need of weight management
The RD has primary responsibilities for
assessment and recommendations related
to food behavior
The RD also interprets the results from the
initial assessment and makes appropriate,
patient-matched treatment
recommendations
Cost of Weight Management (1)
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All approaches to weight management require
comprehensive lifestyle program that focuses on
nutrition, exercise, cognitive behavioral changes
and medical monitoring to increase the
likelihood of long-term success and healthy
outcomes
Obesity must be acknowledged (by insurance
companies) as a disease for reimbursement
Should obesity be classified as a disease? Why
or why not?
Conclusion
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By maintaining activity and food intake we can
help regulate weight management, and improve
overall health.
Our society today has access to more food, with
higher calorie content, and interacts less in
physical activity, than ever before.
There are some factors that we cannot change,
but we can focus on factors that involve
environmental influences.
References
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1) American Dietetic Association. Position of the American Dietetic
Association: weight management. J ADA. 2002 1145-1155.
2) Calle, EE, Thun, MJ, Petrelli, JM, et al. Body-mass index and
mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999;
341:1097.
3) Otto AD, Jakicic JM. Physical activity considerations for the
treatment and prevention of obesity. J Clin Nutr. 2005;82:226S229S.
4) Jones N. An Investigation of obese adults’ views of the outcomes
of dietary treatment. J Hum Nutr Diet. 2007; 20: 486-494.
5) Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean
A, MacLean L. Surgery decreases long-term mortality, morbidity, and
health care use in morbidly obese patients. Annals of Surgery 2004;
240:416-424.