Diet and physical activity

Question 1

Caloric restriction for overweight people

Answer 1

A deficit of 500-1000 calories per day is recommended and should lead to a weight loss of approximately 1-2 pounds per week at the beginning (weight loss will slow down as the individual approaches energy balance).

The target calorie goal is based on the patient’s starting weight. A calorie target of 1200 to 1500 calories per day is generally appropriate for individuals that weight less than 250 pounds, and a target of 1500 to 1800 calories per day is generally appropriate for individuals that weigh 250 pounds or more.

Question 2

Weight bias

Answer 2

exists and is prevalent among clinicians

Question 3

Specific recommendations for pts trying to lose weight

Answer 3

First steps:

Don’t drink calories: cut out sugar-sweetened drinks

Increase servings of fruit and vegetables, especially vegetables

Avoid skipping entire meals if possible, if skipping a meal skip dinner

Move eating to earlier in the day when metabolism is higher

Reduce portion sizes of all foods by 25-33%

Slow the pace of eating (take at least 20 minutes to eat a meal)

More aggressive

Purchase a self-help diet book (one validated with scientific research) and follow the eating plan

Use a structured meal plan, such as a meal replacement approach

Join a commercial weight loss program or a university-based program

High intensity programs are recommended in the 2013 obesity treatment guidelines (AHA/ACC/TOS) = at least 14 visits/contacts over 6 months

With all of the above, self-monitoring using dietary logs including a budget for both calories and grams of fat

Question 4

Macronutrient composition of recommended diet

Answer 4

A balanced macronutrient diet is as effective as any other diet over the long term

The macronutrient-balanced diet recommended by most organizations in the United States is a low fat diet, with less than 30% of calories from fat.

Several studies have shown that low carbohydrate diets produce more short term weight loss than low fat diets, but only one study has shown that a low carbohydrate diet leads to greater weight loss after two years.

Question 5

Physical activity and weight loss

Answer 5

IMPORTANT! Especially for MAINTAINING weight loss, but need to restrict food intake too.

For most obese patients, physical activity should be initiated slowly in the form of low-level aerobic activity, such as walking.

It is also important to increase a patient’s awareness regarding the importance of expending energy through activities of daily living (lifestyle activity). Doing more physical activity throughout the day can be helpful with weight management.

Reduce sedentary activities too

Question 6

Sleep and obesity

Answer 6

Linked

Obstructive sleep apnea can make losing weight significantly more difficult.

Question 7

Tools for developing a physical activity plan for a patient

Answer 7

Be specific; don’t just say “move more”

Give them a plan that’s specific on frequency, intensity, time/duration, and type (FITT)

Frequency: Most or all days of the week
Intensity: Moderate intensity to start (start at 60% of maximum predicted heart rate)
Time/Duration: 30 minutes per day, in blocks of at least 10 minute each
Type: activities that use large muscle groups and are continuous (for example, walking)

Increasing lifestyle physical activity using pedometers is another option.

Question 8

5 strategies that NWCR participants have in common to help with weight loss maintenance.

Answer 8

1. Use of moderately low fat, high carbohydrate diets.
2. Frequent self-monitoring (weight themselves regularly)
3. Eating breakfast
4. Large amounts of physical activity
5. Limiting TV viewing

Question 9

What behavior is thought to be the single most important for patients during a weight loss program?

Answer 9

self-monitoring of diet and physical activity

Question 10

What other factors besides diet and exercise have effects on metabolism and weight/weight change?

Answer 10

Sleep duration and quality
Commuting time
Social networks/neighborhood environment
Television viewing

Question 11

What are the benefits of exercise?

Answer 11

Exercise preserves fat free mass

Exercise improves appetite regulation

Exercise facilitates maintenance of lost weight

Exercise improves overall health and reduces cardiovascular disease risk