Weight Management PDF

NUTRITION AND WEIGHT MANAGEMENT – OVERWEIGHT & OBESITY ERE ***Yo-yo dieting QUESTIONS  Question 1 Questions to ask: Is he concerned to lose weight? Did he ever try any methods to lose weight? Is he under stress? Family history when it comes to medical issu...

NUTRITION AND WEIGHT MANAGEMENT – OVERWEIGHT & OBESITY ERE ***Yo-yo dieting QUESTIONS  Question 1 Questions to ask: Is he concerned to lose weight? Did he ever try any methods to lose weight? Is he under stress? Family history when it comes to medical issues? Henri method  Question 2 Questions to ask: Why does she want to lose weight? Weight loss history? Advise her on the timeline GLOBAL PUBLIC HEALTH CRISIS What is the greatest public health threat currently in North America (and most other developed nations) today? Overweight/Obesity and related conditions The burden of chronic disease 6 of the top 10 chronic disease states in Canada are linked to obesity We are talking about enormous tax-payer (…..that’s you!…..) burden!! HOW BAD IS THE PROBLEM?  We need to be aware of the associations between parents and children.  Parental obesity is the leading predictor of childhood obesity, and  …childhood obesity increases all-cause mortality in adults  Being obese at 40 years is associated with loss of ~7 years for women, and ~6 years for men  Canada:  https://www.youtube.com/watch?v=Hw5mrMg_wA0  Is the issue what we eat? Is the issue our levels of activity? Check  Fast food and obesity videos  https://www.youtube.com/watch?v=wv_lc1p4I50  Watch – how big a role do you feel the fast food (food!) industry play is the obesity epidemic?  Food swamps versus food deserts Mother- daughter correlation: If a mother is inactive, it is more likely that the daughter will be inactive as  Hypertrophy vs hyperplasia STATISTICS Recent changes in Canada (children 7-13 years) We have seen a tripling in a generation. Happening faster than we can conduct and publish research and data. Obesity rates climbed from:  5% to 17% - boys  5% to 15% - girls DO NOT Overweight rates climbed from: have to  15% to 35% - boys memorize  15% to 29% - girls STARTLING TRENDS  We know for men and women, being a member of a high-income household is associated with a decreased likelihood of becoming obese and suffering from related chronic disease.  We know it is easier to maintain a healthy weight than it is to lose weight and return to a healthy weight.  “Canadians are going to be looking forward to a life expectancy that is shorter and associated with more problems and less pleasant outcomes than their parents.”  House of Commons Standing Committee on Health  Why? Surely we aren’t all lazy…..or are we?  “Natural Selection”  This is not how we are designed to live!!  We are not built for this “built environment”  Hunger vs Appetite STARTLING TRENDS  The problem is more severe in children and is growing more rapidly.  Poverty and obesity  https://www.youtube.com/watch?v=7MJnm5X9NN0  How would you address this issue in a counselling scenario?  Role of economics?  https://www.youtube.com/watch?v=Gk5OJBry 2ss IMMUTABLE DISORDER What is this? Immutable: Unchanging over time or unable to be changed. Do you agree or disagree that obesity is an immutable condition? How does this ‘frame’ your interactions dealing wth overweight/obese clients?  WHY IS THERE AN OBESITY CRISIS?  Causes:  Energy balance (more in than out)  Unhealthy foods are accessible  Inactivity  Complex drive toward food  Appetite vs hunger  Portion sizes – enculturation  Time, release of responsibility for food preparation  Changing use leisure time  Technology  Nutrition education/knowledge – misinformation  Body composition awareness  Day to day job energy expenditure  Food industry  Transportation technology – urban sprawl  Genetics vs environment  Obesogens OBESITY & WEIGHT MANAGEMENT Body Composition bone, muscle, organs, fluids, adipose tissue Determining Factors Homeostasis of body weight and/or body composition Controllable Factors  Lifestyle  Food? Uncontrollable Factors  Set point theory  Hormones – ghrelin, leptin, LPL/HSLPL, etc.  Genetics CANADIAN STATISTICS Stature and body mass Obesity incidence Children Genetic/familial link? Food Intake Energy expenditure has dropped as well. OBESITY  There are a myriad of physical and behavioral factors which lend themselves toward the development of the obesity “epidemic”.  We will consider some of the abnormalities in our neural, chemical, and hormonal systems which may play a role in the development of excessive body weight.  What degree of responsibility does this play? CIHR  The Canadian Institutes for Health Research  Institute of Nutrition, Metabolism, and Diabetes.  https://www.youtube.com/watch?v=p8ULvkL1k94  The only institute to designate 100% of their funds to one research area. ESSENTIAL FAT Required for normal physiological functioning Distinct from essential fatty acids Stored in small amounts throughout the body 3% in men 12% in women STORED FAT Excess energy storage Excess energy is stored primarily in the adipocytes of the body. White vs. Brown adipose tissue Subcutaneous vs. visceral fat Android vs. Gynoid adiposity Approximately 8%-24% (total fat) in men, and 21%-35% in women is associated with optimum health. ADIPOCYTES Hypertrophy & Hyperplasia Store triglycerides in quantities representing up to 95% of their volume and can grow almost without boundary. >1000 times. Storage and mobilization of TG involves hormone action. FAT STORAGE AND ADIPOSITY  Normal growth:  The greatest level of fatness occurs at ~6 months  And, again at 6 years.  Earlier development of adiposity shows a propensity toward adult obesity  Adipocyte size and number  Programmed to be fat?  (video now subscription protected)  https://www.dailymotion.com/video/x5hig62 LIPOGENESIS Where does our fat come from? CHO? Protein? Dietary Fat? Kcalories/gram Fattening power of fat Conversion factors Macronutrient utilization Suppression Lipid oxidation COENZYMES DERIVED FROM B VITAMINS PLAY MANY ROLES IN ENERGY METABOLISM LPL & HSLPL  Understand the role of these 2 enzymes.  Link with estrogens  In those who gain weight we see higher levels of LPL, which drops with weight loss.  However, with reduced weight in obese individuals, the levels of LPL increase  Variations in hormones related to food/intake – must follow(?)  SYMPATHETIC NERVOUS SYSTEM  Appetite is driven by many hormones and neurotransmitters  Dopamine is a key  As it rises, so does appetite  After a meal:  When these change, and we have a slow/stop eating message.  Starvation:  We see increased hunger and decreased satisfaction with food.  Hypothyroid = decreased metabolic rate BRAIN ‘CHEMICALS’  We are a product of our brain neurotransmitters.  We see fluctuations between individuals with regard to neurotransmitter production and response.  This is of profound importance when we deal with overweight and obese clients/patients.  Advocating for mindful eating. Considerate of scenarios around food/hunger/appetite. HORMONES AND NEUROTRANSMITTERS  As brain chemical levels change, these impact appetite:  With hunger:  Decreased endorphin levels  Decreased serotonin levels  Increased neuropeptide Y levels  Increased dopamine and decreased norepinephrine levels  Results in increased appetite  HORMONES AND  NEUROTRANSMITTERS When we eat:  During/after a meal, the hypothalamus sends a slow/stop eating message  Corticotropic-releasing factor is released  A powerful anorexic factor  Decreases appetite and intake  With starvation, we enter a hypothyroid state:  Causes both increased hunger and decreased satisfaction when eating, and reduced energy expenditure (lowered BMR). NEUROTRANSMITTERS  How do we deal with the variability in the production of neurotransmitters as they relate to hunger, appetite and intake?  What are the implications of medicating individuals to change brain chemistry?  Reward pathways  Same for food, alcohol, narcotics, caffeine, sex, etc.  We can’t impact this pathway without impacting other components of our social interaction.  Is this information useful to dietitians and their clients? How? OBESITY Now, (WELL) over 60% of Canadian adult men and 50% of adult women are overweight or obese. Increasing quickly Problem is worse among children and growing even faster.  ETIOLOGY OF OBESITY Too many factors to list Boils down to: Humans are currently built to survive in an environment which no longer exists for us (in most developed nations). Lifestyle Food industry Obesogens Leads to metabolic syndrome, which is then predictive of further disease progression. Where do we begin when counselling overweight/obese clients? OBESITY MANAGEMENT  Weight loss vs. Weight maintenance  Energy restriction was originally the only treatment initiative  Today’s model (while still not overly effective) includes lifestyle and behavior modification goals and includes many interdisciplinary healthcare team members.  To some degree, this will be a part of most ‘chronic disease’ discussions/sessions you have with clients and their families. OBESITY MANAGEMENT How do we gauge success? How should we gauge success? DIETARY MANAGEMENT RECOMMENDATIONS Diets / fad education Hunger and Satiety Cues Additional psychological influences Food and Macronutrient Education Portion Control Caloric Density Small, consistent changes Remove focus from diet Lifestyle, body acceptance Activity PHARMACOLOGIC MANAGEMENT Directed towards: Appetite suppression Satiety in the stomach Feeling of fullness Increasing thermogenesis & metabolism Interfering with fat absorption PHARMACOLOGIC MANAGEMENT  Medications are classified as either CNS-acting, or non- CNS-acting agents  CNS-acting:  Catecholamine’s (catecholaminergic)  Serotoninergic  Catecholiminergic-serotoninergic CNS-ACTING Side effects include: dry mouth, headache, insomnia, & constipation Catecholiminergic agents act in the brain to increase the availability of norepinephrine. Suppresses appetite Serotoninergic agents increase the production of serotonin Suppresses appetite The combination of medications interfere with the re-uptake of norepinephrine and serotonin. Implications? NON-CNS-ACTING Typically impact absorptive capacity Orlistat (Xenical) Side-effects SURGICAL PROCEDURES Bariatrics: the branch of medicine concerned with weight control; includes forms of surgery Usually reserved for those with BMI >40 Sx is considered only after all other options have been attempted, and failed Exercise routine Hypocaloric diet patterns Lifestyle modification Psychological counseling and family support/involvement SURGICAL PROCEDURES Failure is not reducing body fat by 50% and body weight by 1/3, with sustained weight loss/maintenance. Post-operative follow-up is crucial! Psychological counseling for self-esteem issues, depression, & motivation Should begin well before Sx Dietary & lifestyle modification is imperative. Lifelong support SURGICAL PROCEDURES Bariatrics Goal is to decrease the amount of food being consumed and absorbed Esophageal banding Forms of gastric restrictive Sx Gastroplasty Gastric bypass Jejunoileal bypass GASTRIC RESTRICTION Surgically reducing the volume within the stomach Closing off a large pocket of the stomach Bypassing a portion of the small intestine. Or both They have proven effective for weight loss Maintenance? Greatly reduces the volume of the stomach  early satiety 20-30 ml. Dumping syndrome  reinforcement? It is important that treatment does not end with Sx. What are your thoughts on bariatric procedures as a treatment for obesity? OTHER OPTIONS Archaic?  Jaw wiring  Liposuction Weight Cycling Yo-yo dieting Why does this occur?  The Skinny on Obesity:  https://www.youtube.com/watch?v=moQZd1-BC0Y  Old before my time:  https://www.youtube.com/watch?v=foH419qKudQ