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)
Loading flashcards...

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


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


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


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


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

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


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


Examples of "lifestyle" physical activity

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


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


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


NWCR's use of frequent self-monitoring: details

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


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


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


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 


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


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