OBESITY MANAGEMENT AND DIET THERAPY

NURS 2018

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

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:

Dietary Guidelines for Americans, 2005

Key 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.

Dietary Guidelines for Americans, 2005

Key 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.

Dietary Guidelines for Americans, 2005

Key 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.

Dietary Guidelines for Americans, 2005

Key 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-grain products 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.

Dietary Guidelines for Americans, 2005

Key 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.

Dietary Guidelines for Americans, 2005

Key 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.

Dietary Guidelines for Americans, 2005

Key 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.

Dietary Guidelines for Americans, 2005

Key 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.

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

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

2009

A caloric deficit of 500 can be done by:

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.

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.

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.

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.

CDC’s Recommended Strategies to Prevent ObesityStrategies to Promote the Availability of Affordable

Healthy Food & Beverages1. Increase availability of healthier food and beverage

choices in public service venues2. Improve availability of affordable healthier food and

beverage choices in public service venues3. Improve geographic availability of supermarkets in

underserved areas4. Provide incentives to food retailers to locate in

and/or offer healthier food and beverage choices in underserved areas

5. Improve availability of mechanisms for purchasing foods from farms

CDC’s Recommended Strategies to Prevent Obesity

Strategies to Support Healthy Food and Beverage Choices

6. Provide incentives for the production, distribution, and procurement of foods from local farms

7. Restrict availability of less healthy foods and beverages in public service venues

8. Institute smaller portion size options in public service venues

9. Limit advertisements of less healthy foods and beverages

10. Discourage consumption of sugar-sweetened beverages

CDC’s Recommended Strategies to Prevent ObesityStrategy to Encourage Breastfeeding

11. Increase support for breastfeeding

Strategies to Encourage Physical Activity or Limit Sedentary Activity Among Children and Youth12. Require Physical Education in schools13. Increase the amount of physical activity in

PE programs in schools14. Increase opportunities for extracurricular

physical activity15. Reduce screen time in public service venues

CDC’s Recommended Strategies to Prevent Obesity

Strategies to Create Safe Communities That Support Physical Activity16. Improve access to outdoor recreational facilities17. Enhance infrastructure supporting bicycling18. Enhance infrastructure supporting walking19. Support locating schools in residential neighborhoods20. Improve access to transportation21. Zone for mixed-use development22. Enhance personal safety where people are or could be

physically active23. Enhance traffic safety in areas where persons are or could

be physically activeStrategy to Encourage Communities to Organize for Change

24. Participate in community coalitions or partnerships to address obesity

ReferencesCenters 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.

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