Obesity Management and Diet Therapy

1. NURS 2018 Obesity Management and Diet Therapy

2. Objectives At the end of this presentation students will be able to: • Identify strategies to manage obesity • List measures of preventing obesity • Describe current recommendations in the management of obesity

3. A Healthy Diet • Emphasizes fruits, vegetables, whole grains, fat-free or low-fat milk, & milk products; • Includes lean meats, poultry, fish, beans, eggs, and nuts • Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars. The 2005 Dietary Guidelines for Americans defines a healthy diet as one that:

4. Dietary Guidelines for Americans, 2005Key Recommendations for the General Population • 1. Adequate Nutrients Within Calorie Needs • Consume a variety of nutrient-dense foods (whole grains, fruits and vegetables, lean meats, low-fat dairy) and beverages within and among the basic food groups while choosing foods that limit the intake of saturated fats and trans fats, cholesterol, added sugars, salt, and alcohol. • Meet recommended intakes within energy needs by adopting a balanced eating pattern, such as the USDA Food Guide or the Dietary Approaches to Stop Hypertension (DASH) Eating Plan.

5. Dietary Guidelines for Americans, 2005Key Recommendations for the General Population • 2. Weight Management • To maintain body weight in a healthy range, balance calories from foods and beverages with calories expended. • To prevent gradual weight gain over time, make small decreases in food and beverage calories and increase physical activity.

6. Dietary Guidelines for Americans, 2005Key Recommendations for the General Population • 3. Physical activity • Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a healthy body weight. • Achieve physical fitness by including cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises for muscle strength and endurance.

7. Dietary Guidelines for Americans, 2005Key Recommendations for the General Population • 4. Food Groups to Encourage • Consume a sufficient amount of fruits and vegetables while staying within energy needs. • Choose a variety of fruits and vegetables each day. Select from all five vegetable subgroups (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week. • Consume 3 or more ounce-equivalents of whole-grainproducts per day, with the rest of the recommended grains coming from enriched or whole-grain products. At least half the grains should come from whole grains. • Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.

8. Dietary Guidelines for Americans, 2005Key Recommendations for the General Population • 5. Fats • Keep total fat intake between 20 - 35 percent of calories • (With most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils). • Limit intake of fats and oils high in saturated and/or trans fatty acids, and choose products low in such fats and oils. • Consume less than 10 percent of calories from saturated fatty acids • Consume less than 300 mg/day of cholesterol • Keep trans fatty acid consumption as low as possible • When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low-fat, or fat-free.

9. Dietary Guidelines for Americans, 2005Key Recommendations for the General Population • 6. Carbohydrates • Choose fiber-rich fruits, vegetables, and whole grains often. • Choose and prepare foods and beverages with little added sugars or caloric sweeteners. • Reduce the incidence of dental caries by practicing good oral hygiene and consuming sugar- and starch-containing foods and beverages less frequently. • 7. Sodium and Potassium • Consume less than 2,300 mg (approximately 1 teaspoon of salt) of sodium per day. • Choose and prepare foods with little salt. At the same time, consume potassium-rich foods, such as fruits and vegetables.

10. Dietary Guidelines for Americans, 2005Key Recommendations for the General Population • 8. Alcoholic Beverages • Those who choose to drink alcoholic beverages should do so sensibly and in moderation (≤ 1 drink for women/day and ≤ 2 drinks for men/day). • Alcoholic beverages should be avoided by individuals engaging in activities that require attention, skill, or coordination, such as driving or operating machinery. • Alcoholic beverages should not be consumed by some individuals, including: those who cannot restrict their alcohol intake, women of childbearing age who may become pregnant, pregnant and lactating women, children and adolescents, individuals taking medications that can interact with alcohol, and those with specific medical conditions.

11. Dietary Guidelines for Americans, 2005Key Recommendations for the General Population • 9. Food Safety • To avoid microbial food borne illness: • Clean hands, food contact surfaces, fruits, and vegetables. Meat and poultry should not be washed or rinsed. • Separate raw, cooked, and ready-to-eat foods while shopping, preparing, or storing foods. • Cook foods to a safe temperature to kill microorganisms. • Chill (refrigerate) perishable food promptly and defrost foods properly. • Avoid raw (unpasteurized) milk or any products made from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, unpasteurized juices, and raw sprouts.

12. Calorie DeficitNeeded For Weight Loss • A calorie deficit of no more than 500 kcal/day. • This can be achievable through the combination of diet + exercise. • An example of how to create a calorie deficit of 500 kcal/day through diet + exercise would be: eating 250 kcal less per day, along with burning 250 calories through exercise

13. Calorie DeficitNeeded For Weight Loss • Eating 250 kcal less per day: • Leave out mayonnaise in a sandwich • Leave out dessert • Switch from soft drinks to water • Reduce portion sizes • Burning 250 calories through exercise: • Walk for 30 minutes • Swimming 25 yards • Bicycling for 30 minutes A caloric deficit of 500 can be done by:

14. Exercise + DietingCalorie Deficit • Initially physical activity, in combination with dieting, is an important component of weight loss. • However, after around 6 months, physical activity will not lead to substantially greater weight losses when combined with dieting. • The benefit of sustained physical activity thereafter is mainly through its role in the prevention of weight gain. • In addition, it has a benefit in reducing cardiovascular and diabetes risks beyond that produced by weight gain alone.

15. Goals for Weight LossAnd Management • The initial goal of weight loss therapy is to reduce body weight by approximately 10 percent from baseline. Once this goal is achieved, then further weight loss can be attempted, if necessary. • A reasonable time line for a 10 percent reduction in body weight is 6 months. • Experience reveals that lost weight is usually regained unless a weight maintenance program, consisting of diet therapy, physical activity and behavior therapy, is continued indefinitely.

16. Goals for Weight LossAnd Management • For overweight individuals with BMIs in the typical range of 27 to 35 kg/m2, a decrease of 300 to 500 kcal/day will result in weight losses of about ½ to 1 lb per week. • A 10 percent weight loss could be achieved within 6 months. • For more severely obese individuals (BMI > 35), deficits of up to 500 to 1,000 kcal/day will lead to weight losses of about 1 to 2 lb per week. • A 10 percent weight loss could be achieved within 6 months.

17. Goals for Weight LossAnd Management • After 6 months of weight loss treatment, the individual should be assessed. • If no further weight loss is needed, then the current weight should be maintained. • Sustained physical activity is particularly important in the prevention of weight regain. • If further weight loss is desired, another attempt at weight reduction can be made.

18. CDC’s Recommended Strategies to Prevent Obesity Strategies to Promote the Availability of Affordable Healthy Food & Beverages • Increase availability of healthier food and beverage choices in public service venues • Improve availability of affordable healthier food and beverage choices in public service venues • Improve geographic availability of supermarkets in underserved areas • Provide incentives to food retailers to locate in and/or offer healthier food and beverage choices in underserved areas • Improve availability of mechanisms for purchasing foods from farms

19. CDC’s Recommended Strategies to Prevent Obesity Strategies to Support Healthy Food and Beverage Choices • Provide incentives for the production, distribution, and procurement of foods from local farms • Restrict availability of less healthy foods and beverages in public service venues • Institute smaller portion size options in public service venues • Limit advertisements of less healthy foods and beverages • Discourage consumption of sugar-sweetened beverages

20. CDC’s Recommended Strategies to Prevent Obesity Strategy to Encourage Breastfeeding • Increase support for breastfeeding Strategies to Encourage Physical Activity or Limit Sedentary Activity Among Children and Youth • Require Physical Education in schools • Increase the amount of physical activity in PE programs in schools • Increase opportunities for extracurricular physical activity • Reduce screen time in public service venues

21. CDC’s Recommended Strategies to Prevent Obesity Strategies to Create Safe Communities That Support Physical Activity • Improve access to outdoor recreational facilities • Enhance infrastructure supporting bicycling • Enhance infrastructure supporting walking • Support locating schools in residential neighborhoods • Improve access to transportation • Zone for mixed-use development • Enhance personal safety where people are or could be physically active • Enhance traffic safety in areas where persons are or could be physically active Strategy to Encourage Communities to Organize for Change • Participate in community coalitions or partnerships to address obesity

22. Centers for Disease Control and Prevention. (2010). State Indicator Report on Physical Activity, 2010 National Action Guide. Retrieved from: http://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_2010_Action_Guide.pdf Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance — United States, 2009. Surveillance Summaries, [6-4-2010]. MMWR 2010;59(5). Centers for Disease Control and Prevention. (2010). State Indicator Report on Physical Activity, 2010 National Action Guide. Retrieved from: http://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_2010_Action_Guide.pdf Dietary Guidelines for Americans 2005. Available at: http://www.health.gov/dietaryguidelines/dga2005/recommendations.htm Kalicki, B. & Roy, H. (2009). Obesity management. Pennington Biomedical Research Center. Online lecture resource. References

23. Assignment • List three goals of weight loss • Describe five physiological benefits of weight loss • Outline 6 CDC strategies for the prevention of weight management • Describe tertiary outpatient management of obese clients