Obesity Treatment: Diet and Physical Activity Flashcards Preview

DEMS: Unit IIb > Obesity Treatment: Diet and Physical Activity > Flashcards

Flashcards in Obesity Treatment: Diet and Physical Activity Deck (15)
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1

Weight bias exists and is prevalent among clinicians

  • How do obese patients feel when they leave your office? Empowered or lectured?
  • Have you done something positive? 
  • Many have had negative experiences with health professionals
  • Almost every patient has tried at least once - may not have tried the right way or known what to do
  • 1st step in treatment is complete history
  • Best way to ask: Can we talk about your weight? 
  • Ask patients to write down what they eat

2

Appropriate applications of diet, physical activity, behavioral changes in obesity treatment

  • Calorie restriction diets = easiest way to create negative energy balance
    • Most important component of weight loss
  • In long term: balanced diet is effective as any other for losing weight and maintaining weight loss
  • Physical activity: important for preservation of fat free mass
    • Important for metabolism
    • Also improves appetite regulation, facilitates maintenance of weight loss, and increases overall health/decreases CV risk
  • Physical activity alone: generally ineffective for weight loss - need to include calorie restriction

3

Specific approaches to help obese patients change their diet: first steps

  • Don't drink calories: cut out sugar-sweetened drinks
  • Increase servings of fruit & vegetables, especially vegetables
  • Limit sweets to once per day
  • Eat multiple small meals per day
  • Reduce portion sizes of all foods by 25-33%
  • Slow the pace of eating

4

Specific approaches to help obese patients change their diet: more aggressive steps

  • Purchase self-help diet book validated with scientific research and follow eating plan
  • Use a structured meal plan (meal replacement approach)
  • Join commercial weight loss program or university-based program
  • Regular self-monitoring using dietary logs
    • Budget for calories and grams of fat

5

Amount of physical activity recommended to maintain general health/prevent weight gain

  • Vigorous activity: 30 minutes/day OR
  • Moderate activity: 60 minutes/day

6

Use of pedometers in weight loss

  • Wear for one week to get baseline steps/day
  • Set goal to increase steps by 500/day
    • 500 steps is approximately 5 minutes of brisk walking
  • Work towards 10,000-12,000 steps/day to maintain weight loss long term
  • If environment is difficult, may need a treadmill/bike/gym

7

Examples of "lifestyle" physical activity

  • Garden
  • Play with kids
  • Spend more time being active instead of sedentary

8

Things that individuals in National Weight Control Registry do to maintain reduced weight (5)

  1. Use of moderately low fat, high carb diets
  2. Frequent self-monitoring
  3. Eating breakfast
  4. Large amounts of physical activity
  5. Limiting TV viewing

9

NWCR's use of low fat/high carb diets: details

  • Subjects report diet containing:
    • 24% fat
    • 19% protein
    • 55% carbohydrate
  • Low fat diet important to keep weight off

10

NWCR's use of frequent self-monitoring: details

  • Patients weigh themselves frequently
  • Almost all weigh at least once/week
  • Many weigh themselves daily

11

NWCR's use of eating breakfast: details

  • 78% report eating breakfast 7 days/week
  • 90% eat breakfast 4 or more days/week
  • Only 4% report never eating breakfast

12

NWCR's use of large amounts of physical activity: details

  • Participants engage in high levels of physical activity to maintain weight loss
  • Average energy expediture due to physical activity ~2800 kcal/week
    • Corresponds to 1 hour/day of moderate intensity physical activity
  • Average number of steps/day = 11,000
    • Contrast with sedentary person: average = 5,000/day
  • Thought to keep metabolism high
  • Thought to improve CV health
  • Helps to preserve fat free mass

13

NWCR's use of limiting TV viewing: details

  • Relatively minimal amount of time watching TV
  • 63.5% watch < 10 hours/week
  • 38.5% watch < 5 hours/week
  • 12.5% watch > 21 hours/week

National average of American adults = 28 hours/week 

14

Differences between weight loss and weight loss maintenance 

 

  • Weight loss requires state of negative energy balance (intake < expenditure)
    • Mostly able to achieve through caloric restriction
  • Negative energy balance can't be maintained forever
    • Body adapts to caloric restriction --> lowers energy expenditure
  • Most weight loss from diet and exercise occurs in first 3-6 months
  • Weight loss maintenance: lifestyle that allows maintenance of energy balance (intake = expenditure)
    • Must be maintained indefinitely
    • Requires filling "energy gap" created by initial weight loss
      • Lower calorie intake
      • Greater physical activity
      • Combination of the two

15

Challenges of weight loss maintenance

  • Energy gap commonly in the range of several hundred calories/day
  • 24 hour energy expenditure goes down more than would be predicted by weight loss alone
  • Body tries to "defend" its higher weight
    • May account for high frequency of weight regain