Weight Management Strategies

Week 9: Weight Management

• This week focuses on energy balance and weight management strategies.
• The term test grades are shown with a mean score of 61.52%.
  • Grade C had the highest frequency (145) and percent (35.19).
  • Grade A had a frequency of 51 and present of 12.38
  • Grade B had a frequency of 62 and percent of 15.05
  • Grade D had a frequency of 71 and percent of 17.23
  • Grade F had the lowest frequency of 83 and percent of 20.15
• Consequences of obesity are covered from prior lectures.
• Section 1 highlights strategies for obesity prevention and treatment.
• Section 2 discusses how food intake is regulated.
• Section 3 covers weight throughout the lifecycle with case studies and focus on eating disorders (T-10, T-11).
• Supporting materials involve energy expenditure, exercise, and metabolism.
  • T-7 measures energy expenditure.
  • T-8 assesses body composition.
  • T-9 focuses on interval training.
• Canadians live in an obesogenic (tending to cause obesity) environment because it is easy to overeat and people generally live a sedentary lifestyle.
• There is tension between individual choices and the external environment.
• The opposite of obesogenic environment is leptogenic environment, which supports a healthy lifestyle.

Strategies for Reducing Obesity

• Individual choice is important and individuals require access to tools to improve lifestyle.
• Small cumulative changes can add up, "vast adori't work."
• Making the healthy choice the easy choice is key.
• Environment changes should support individual choices.
• Food industries and restaurants need to provide:
  • More nutritious foods
  • Smaller portion sizes
  • Nutrition content transparency
• Communities need recreational facilities with safe physical activity opportunities.
• Schools and businesses can improve food quality and opportunities for physical activity during the workday/school day.

Obesity in Adults: A Clinical Practice Guideline

• Obesity is a complex disease characterized by excess body fat that impairs health and reduces quality of life and can shorten lifespan..
• Weight bias, stigma on weight can be experienced by people with obesity.
• The patient journey in obesity management involves the following steps:
  • Ask permission before discussing a patient's weight.
  • Assess their story using:
    • goals that matter to the patient,
    • obesity classification via BMI and waist circumference.
    • disease severity (Edmonton Obesity Staging System).
  • Advise on management through: medical nutrition therapy, exercise (30-60 min daily), psychological support, medications and bariatric surgery.
  • Agree on goals and collaborate on personalized action plan.
  • Assist with drivers and barriers.
• The underlying causes of weight gain should be treated, focus should be on patient-centred health outcomes, not just weight loss.
• BMI is not an accurate tool for identifying obesity-related complications.
• Stigma on weight affects people's core self-belief.
• Scan the QR code on the slideshow for detailed information on obesitycanada.ca/guidelines.
• When assessing someone:
  • Understanding an individual's story and life context is important in managing obesity.
  • Ask 'what is the value-based goal that matters to the patient?' being able to play at the park with my grandchildren"
  • Assess and classify the obesity (height, weight, BMI & waist circumference).
  • Identify adiposity related complications by asking 'what ar e the root causes of weight gain'
  • Assess the severity of disease e.g. Edmonton Obesity Staging System (EOSS).

BMI Classification

• Recommended classifications for BMI from Caucasian, Euproid and North American ethnicity:
  • Underweight: BMI under 18.5
  • Normal healthy: BMI between 18.5 and 24.9
  • Overweight: BMI between 25 and 29.9
  • Obesity Classes: BMI of +30
• Recommended classifications for BMI from South, Southeast, or East Asian ethnicity:
  • Underweight: BMI under 18.5
  • Normal range: BMI between 18.5 and 22.9
  • Overweight at risk: BMI between 23 and 24.9
  • Overweight moderate risk: BMI between 25 and 29.9
  • Overweight severe risk: BMI of +30

Limitations of BMI

• It is not a direct measure of body fat, cardiovascular risk, and overall health.
• It does not indicate the distribution of body fat.
• It overestimates body fat in muscular individuals because does not account for muscle mass.
• It underestimates body fat in people who have lost muscle mass (sarcopenic obesity).
• BMI does not distinguish between men, women or ethnicity.
• BMI is less accurate in certain populations including, people aged less than 18, the elderly, or people with severe obesity, during pregnancy, or with ascites and edema.
• It over-and or underestimates body fat in certain ethnic groups.
• BMI should be measured in combination with waist circumference.
• BMI = Body weight(kg) / height(m2).

Edmonton Obesity Staging System (EOSS)

• EOSS can be used for obesity staging:
• Step 0: is when there's no sign of obesity-related risk factors or functional limitations.
• Step 1: Patients has subclinical risk factors such as borderline hypertension, has some mild physical, obesity-related psychological or impairment on well-being
• Step 2: When patients have established obesity-related comorbidities requiring medical intervention, moderate obesity-related psychological symptoms or moderate functional limitations impacting daily activities.
• Step 3: When patients have significant end-organ damage because of obesity-related conditions, exhibits significant psychological symptoms or signficant functional limitations.
• Step 4: When patient is in a severe or potential end stage as result of comorbidities, displaying severely disabling psychological symptoms or very high functional limitations.
• Consequences of being in stage 3 or 4 includes issues with:
• Sleep apnea
• Osteoarthritis
• Gastroesophageal reflux
• Type 2 Diabetes
• Hyperlipemia
• Hypertension
• CVD
• Endocrine disorders
• Cancer

Patient Obesity Management

• The goal of the first step, 'ask' stage is to show compassion and build patient-provider trust by seeking permission to discuss the patients' weight,
• The goal of the second step 'assess' is to understand goals that matter to the patient, assessing their obesity (BMI, waist circumference) and getting to know what may be causing it.
• To help 'assess' or create tailored needs, healthcare providers can find out what a patient needs.
• During "Advise" stage:
• Personalized counselling by a registered dietitian with a focus on healthy food choices and evidence-based nutrition therapy is essential.
• 30-60 min of moderate to vigorous activity most days should be advised.
• Key is to consider the values and goals of the patient during the advise stage.
• During the medical nutrition therapy stage (MNT):
• MNT focuses on managing chronic diseases and should be personalized by registered dietitians with long term follow-up
• Remember physical activity and nutrition are important for all canadians regardless of body size or composition.
• There are three pillars of obesity management, psychological interventions, pharmacological therapy and bariatric surgery.
• Treating the root causes of obesity is the foundation of obesity management -refer to the 4m framework - mechanical, metabolic, mental and social milieu.
• There are key messages to be aware of when dealing with, or living with obesity:
• Behaviour goals are key to improve health as long as individualized eating patterns that can be maintained, with advice from physicians and dietians.
• Eat how much is as important of what and how much you eat + be mindful.
• See a registered dietitian for individualized support.

Dietary Pattens

• Suggested dietary patterns:
• Canada's Food Guide
• Mediterranean Diet
• Vegetarian Diet
• Portfolio Diet
• Low GI diet (Low glycemic index diets)= uptake of reduced glucose.
• DASH
• Recommended weight loss to address other health issues: For patients exhibiting obesity + prediabetes aim for only 5-7% body weight loss
• To reduce risk of progression from pre-diabetes to type-2-diabetes people exhibiting obestiy + Type-2-Diabetes should aim for 7-15% body weight loss to slow development of any complications.

Energy Balance/Weight loss Tips

• The three 'A's of weightloss management are agree, assist.
• It's important to agree on realistic expectations and sustainable behaviour goals.
• "Assist" involves looking at how to assist in drivers, resources and provide education that allows for interdisciplinary teams
  • To sustain support.
• Characteristics of a healthy diet is how they are healthy, reasonable with weightloss, use physical activity and are sound, flexible
• "FAD diets" are not appropriate.

Meal Serving Tips

• Pour chips into a bowl instead of eating from the bag
• Check labels for serving sizes
• Dont overeat, rather consider sharing or packing leftovers
• Switch for low fat items; milk and add fruit

When hunger strikes

• Dont get too hungry and eat breakfast
• Increase veggies and fiber with nutrient-dense intake.

Dietary Guidelines

• Sedentary (less than 30 min of exercise/day) use + 135 to165 kcal
• walking 30 minutes at 6.5 km, and active (1.45 hours) at the same km add energy or activity levels.

ABC of Behavior

• Cognitive behavioural therapy requires: (1): Antecedents or cues that lead to the behaviours (2): the behaviour itself (3): consequence.

Weight Loss Drugs and Surgeries

• Orlistat helps with fat digestion
• Liraglutide is a type-2 diabetes medication that helps control blood sugar and may suppress appetite and is now also prescribed to manage weightloss.
  • Known side effects include gall stones and constipation.
• Combination of naltrexone (an anti-addiction drug) and bupropion (anti-depressant) is helpful to those with BMIs in the 30s and comorbitidy.
• This option is the best for controlled hypertension for type-2 diabtes, dyspidemia, etc.
• During Gastric Bypass: -The Reduced stomach size and absorption leads too malnutrition
• Dumping Syndrome is from food consumption and includes diarrhea and vomiting along with changes to meals.
• The most amount of people attempting diets fail and it's difficult Why is weight loss difficult = people are not consciously able to manage and sustain their weight . 7.6 Mechanism for Regulating Body Weight.

Hormones

• The goal is designed to protect from starvation.
• Leptogenic environment is a positive.
• Set points of hunger has: Genetics in foods and energy +Fat metabolisms

Hunger VS Satiety

• Internal signals will ensure consumption, giving a feeling of fullness when mealtime ends; determines satiety.
• Set points of theory: Genetically programmed body weight which will tend to return to the baseline, in line with meal habits

Short and Long Term Regulation System

• Gut peptides come into play as meals are determined and they will influence at meals in between times Gut peptides are higher for leaner individuals, to regulate what weight may look like Leptin also influence food intake. There may hormone secreted to regulate appetite and signal to decline and reduce signals to ensure insulin release from the small intestine at the meal. This meal stimulates the process the process helps declines for smaller and smaller meals . Difference in effect of ghrelin in lean and obese subjects.
• Lean people have better body signal GLP 1 leveles also tend to be lower in obese than lean -This drug stimulates the small intestine helps the drug the treatment which prompts weight loss Adaptive thermogenesis is the main reason this is difficult It needs to set point The variation between the people with the energy helps maintain set points and changes of energy expenditure to lose vs gain ,

Key info

• Obese individuals tend to to decline basal metabolism when losing too vs gain .
• What do a mothers of the baby has diabetes has? An increased risk for obesity and can also get thirfty genes ! With weightloss what happens that is associated They decline and that comes w change

Adolenscence and Childhood.

• Chapter 15: Chapter Opener & Case Study Outcome Chapter Op is a study of 13yo and case study Felicia had weight and pressure and choleterol She has to eat exercise and cannot fix Additional 350 to450kcal in the last two trimesters. Genetically there are also children with mutations and can develop what may be from to them Increased risk of insulin is something test

• Early Factors that cause child to be at increased risk : High weight, breastfeeding, sleep.
• BMI graph 97 percenitle for those who are too Required reading focuses eating disorder s such anorexia that develops in kids , Unrealistic female body image is what the media has in store , Be sure you there are different ways can describe eating disorders Binge eating disorder Bulimia Binge /Pruge cycle : Those on steroid

The Trriads for eating disorders

• Athlete traid must have desorders of eddng , amentortia and bones. There are different strategies for each pilars Adult years : Life expectancy and aging.

Those and elderly has be recommended as 150 mins of the workout with two days of major movements . There there must be 2 days w strengthening the muslces with those who have poor motor function to prevent falls..