OBESITY TREATMENT

NURS: 2018, Diet Therapy

Objectives

At the end of this presentation students should be able to:

Describe the concept of desirable body weight relative to age, gender, and developmental variables

Use the concept of desirable weight in meeting the nutritional needs of individuals

State the socio-cultural, genetic, emotional, and lifestyle factors which contribute to obesity

Discuss principles of effective treatment of obesity

Objectives

Plan a modified calorie diet based on diet prescription for specified weight loss

Identify strategies for obesity preventionName the characteristics of effective obesity

intervention approachesDiscuss current research in obesity therapy

Treatment of Obesity

Lifestyle modification Diet

Several dietary approaches exist some that affect a single food, a nutrient group and some that affect over all energy restriction

Physical activity Inclusion of regular physical activity leads to increased

energy expenditure and favorably affects energy balance Assists both in weight loss and the prevention of weight gain Cardiorespiratory effect leads to reduced risk of mortality and

morbidity Important to note barriers, specific goals, fitness and

wellness to exercise Can accumulate physical activities in small increments

Treatment of Obesity

Lifestyle modification Behaviour modification

New behaviours that result in successful weight loss need to be incorporated into long-term lifestyle habits e.g. weight monitoring, dietary changes and regular physical activity

Identify triggers for undesired behaviours and avoiding them

Develop behavioural goals through small incremental changes

Use some tools in behaviour modification such as self-monitoring, stimulus control, cognitive restructuring.

Adjunctive Therapy

If lifestyle modification does not work than an additional approach may help to reduce weight gain and improve weight loss.

Drug therapy and dietary supplements are useful. Recommended for persons with a BMI of at least 27 with an

obesity related condition or with a BMI greater than 30. Centrally acting-

Sibutramine (Meridia)- lessens hunger and increases satiety, raises HDL levels

Orlistat (Xenical & Alli)- acts in GI tract to inhibit lipase enzyme descreasing fat absorption (30 %)

Rimonabant- increases adiponectin levels and increases satiety

Tucker & Dauffenbach, 2011; Omari & Caterson, 2007

Obesity treatment

Less commonly used drugsSome drugs that are used to treat depression

have been found to have an effect on satiety; particularly the SSRIs; centrally acting Phentermine Fluoxetine Topiramate

Peripheral action Metformin

Dietary supplements for obesity treatment

Dietary SupplementsThe most common ones contain stimulantsCommonly used (1/3 of people trying to loose weight

have tried)Stimulants include caffeine and bitter orange- may

cause increased heart rate, fainting, stroke, MINot FDA regulated as a drug but as foodNot well tested- little clinical evidence to support useSome are tainted with meds like diuretics and

sibutramineHerbal dietary supplements not recommended due to

unpredictable ingredients, effects and safety

Surgery

The recommendation linked to surgical treatment of obesity is that this procedure be reserved for individuals with BMI greater than 40 or BMI greater than 35 with accompanying obesity related conditions.

Bariatric surgery- all intestinal surgeries done to foster weight loss

There are two major groups Restrictive- which reduces the size of the gastric reservoir to 3

oz or less; either through placing bands or staples in the stomach creating a small pouch

Restrictive/malabsorptive- with this procedure a small gastric pouch is created to reduce food intake and connected to the jejunum or ileum to deliberately foster malabsorption of calories. – they also limit Ghrelin secretion which stimulates hunger

References

Frühbeck, G. (2006). Overnutrition. In M., Gibney, M. Elia, O., Ljungqvist, & J., Dowsett (Eds.), Clinical Nutrition. (pp. 30-61). Oxford, UK: Blackwell Science Ltd.

Omari, A. & Caterson, I. D. (2007). Overweight and obesity. In J. Mann & A. S. Truswell (Eds.), Essentials of human nutrition (3rd Ed.). (pp 234-248). New York, USA: Oxford University Press.

Seidell, J. C. & Visscher, T. L. S. (2004). Public health aspects of overnutrition. In M., Gibney, M. Elia, O., Ljungqvist, & J., Dowsett (Eds.), Public Health Nutrition. (pp. 167-177). Oxford, UK: Blackwell Science Ltd.

Tucker, S. & Dauffenbach, V. (2011). Nutrition and diet therapy for nurses. Boston, USA: Pearson.

Assignment

1. Students are to review the current literature regarding the diets listed and answers the questions listed below

Atkins, South Beach, Zone, CSIRO diets, MediterraneanA. Identify the calorie, nutrient and food restrictions associated with

the dietB. Discuss the advantages and disadvantages of the dietC. Classify the diet as either: low calorie, nutrient altered or novelty

2. Review the literature regarding the surgeries listed and answer the questions below

Gastric banding, adjustable banding, Roux-en-Y, Biliopancreatic diversion (BPD)

A. Describe three risks associated with each surgeryB. Identify three benefits for each surgeryC. Describe two nutrition concern associated with each surgeryD. Classify the surgery as either restrictive or

restrictive/malabsorptive

Assignment Continued

Identify 5 health risks associated with obesityDescribe the physiological effects of obesity

and the health conditionDiscuss the methods for assessing and

overweight client before nutrition intervention Describe the usefulness of the change theory

as a tool in weight management