A holistic approach to weight management


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A holistic approach to weight management

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  3. 3. Overview<br />Definition, Prevalence & Consequences of Obesity<br />Healthy Lifestyles<br />Assessment of Obesity<br />Treatments for Obesity<br />
  4. 4. Definition<br />Obesity is an abnormal accumulation of body fat, usually 20 percent or more over an individual's ideal body weight.<br />
  5. 5. Calculating BMI<br />Calculate Body Mass Index (BMI) = <br />weight (kg)<br />height squared (meters) <br />Or…<br />weight (pounds) x 703<br />height squared (inches)<br />
  6. 6. Definition of Overweight & Obesity<br />Using BMI<br />
  7. 7. Definition of Overweight & Obesity<br />Using waist circumference<br /><ul><li>Women > 80cm
  8. 8. Men >94cm</li></li></ul><li>Prevalence of Obesity<br />Childhood and adolescent obesity increased from 5% to 16% in the last 20 years<br />Adulthood obesity increased from 12% to 21% in 10 years.<br />16 million US adults with BMI over 35<br />60 million US obese adults (BMI > 30)<br />
  9. 9. Factors predispose to obesity<br /><ul><li>Genetic – familial tendency.
  10. 10. Sex – women more susceptible .
  11. 11. Activity – lack of physical activity.
  12. 12. Psychogenic – emotional deprivation, </li></ul> depression .<br /><ul><li>Social class – poorer classes.
  13. 13. Alcohol – problem drinking.
  14. 14. Smoking – cessation smoking.
  15. 15. Prescribed drugs – tricyclic derivatives.</li></li></ul><li>Weight Gain: How Does It Happen?<br />Energy imbalance <br />calories consumed not equal to calories used <br />Over a long period of time<br />Due to a combination of several factors<br />Individual behaviors<br />Social interactions<br />Environmental factors<br />Genetics<br />
  16. 16. Weight Gain: Energy In<br />3500 calories = 1 pound<br />100 calories extra per day<br />= 36,500 extra per year<br />= 10.4 lbs weight gain<br />Question: How much is 100 calories?<br />Answer: Not very much!<br />1 glass skim milk, or<br />1 banana, or<br />1 slice cheese, or<br />1 tablespoon butter<br />
  17. 17. Health Consequences of Obesity<br />Major cause of preventable death <br />Increase in mortality from all causes<br />Increase in risk for these cancers<br />Endometrium<br />Breast<br />Prostate<br />Colon<br />Increase in risk of:<br />Hypertension<br />Dyslipidemia<br />Diabetes type 2<br />Coronary artery disease<br />Stroke<br />Gallbladder disease<br />Osteoarthritis<br />Sleep apnea & respiratory problems<br />
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  19. 19. Health Consequences of Obesity<br />Still doing nothing about that extra flab? <br />Major cause of preventable death <br />Increase in mortality from all causes<br />Increase in risk for these cancers<br />Endometrium<br />Breast<br />Prostate<br />Colon<br />Increase in risk of:<br />Hypertension<br />Dyslipidemia<br />Diabetes type 2<br />Coronary artery disease<br />Stroke<br />Gallbladder disease<br />Osteoarthritis<br />Sleep apnea & respiratory problems<br />
  20. 20. Rosalie Bradford<br />-200LBS<br />The longtime binge-eater weighed an astounding 1,199 lb, having spent 8 years immobile in bed.<br />She holds Guinness World Record for most weight lost by a woman.<br />
  21. 21. I-CARE :<br />WHAT DO WE DO?<br />
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  23. 23. Assessment <br />Assess the patient's readiness and willingness to lose weight:<br />Unfortunately those who are most concerned about their weights are not necessarily those who are at the highest health risk.<br />Those who are unable or unwilling to embark on a weight reduction program, but they are willing to take steps to avoid further weight gain or perhaps to work on other risk factors such as cigarette smoking, and they should be encouraged to do so.<br />
  24. 24. Assessment <br />Is he overweight? Obese?<br />What are his key health issues? <br />
  25. 25. Assessment <br />Measure BMI<br />Measure waist circumference<br />“Apple shape” body is higher risk for DM, CVD, HTN<br />Waist larger than 40 inches for men <br />Waist larger than 35 inches for women <br />
  26. 26. Assessment<br /><ul><li>Assess for other risk factors
  27. 27. Existing high risk disease:
  28. 28. coronary heart disease; other atherosclerotic diseases; type 2 diabetes; sleep apnea
  29. 29. Diseases associated with obesity
  30. 30. Gynecological problems; osteoarthritis; gallstones; stress incontinence
  31. 31. Cardiovascular risk factors (3 or more = high risk)
  32. 32. Cigarette smoking; Hypertension; LDL >130; HDL <35; fasting glucose = 110 to 125; family history of premature CHD; men age > 45; women age > 55
  33. 33. Other risk factors
  34. 34. Physical inactivity; elevated serum triglycerides
  35. 35. Medications associated with obesity</li></li></ul><li>Treatment Approach<br />A multi-faceted approach is best<br />Diet<br />Physical activity<br />Behavior change<br />“A” Recommendation<br />
  36. 36. Treatment Approach<br />Aim for 4 - 6 months of weight loss effort<br />Most people will lose 20 to 25 pounds <br />After 6 months, weight loss is more difficult<br />Changes in resting metabolic rate<br />Energy requirements decrease as weight decreases<br />Diet adherence wavers<br />Set goals for weight maintenance for next 6 months, then reassess.<br />
  37. 37. Dietary Therapy<br />Weight reduction with dietary treatment is in order for virtually all patients with a BMI 25-30 who have comorbidities and for all patients over BMI 30.<br />Strategies of dietary therapy include teaching about calorie content of different foods, food composition (fats, carbohydrates, and proteins), reading nutrition labels, types of foods to buy, and how to prepare foods.<br />
  38. 38. Low-Calorie Step I Diet<br />
  39. 39. Weight Maintenance: How Much Should People Eat?<br />Varies widely<br />Some averages, below<br />
  40. 40. Physical Activity<br /><ul><li>Physical activity should be an integral part of weight loss
  41. 41. Physical activity alone is less successful than a combined diet & exercise program
  42. 42. Increased activity alone </li></ul> does not decrease weight<br /><ul><li>Sustained activity does </li></ul> prevent weight regain<br /><ul><li>Reduces risk for heart disease & diabetes</li></li></ul><li>Physical Activity<br />Start slowly<br />Many obese people live sedentary lives<br />Avoid injury<br />Early changes can be activities of daily living<br />Increase intensity & duration gradually<br />Long-term goal<br />30 to 45 minutes or more of physical activity<br />5 or more days per week<br />Burn 1000+ calories per week<br />
  43. 43. Recommend Physical Activity<br />What does it take to burn <br /> 1000 calories per week?<br />Gardening <br />5 hours<br />Cycling 22 miles<br />Running <br />11 miles<br />Walking <br />12 miles<br />Dancing 3 hours<br />
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  45. 45. Behavioral Strategies<br />Keep a journal of diet & activity<br />Very powerful intervention!<br />Set specific goals re: behaviors<br />Eating<br />Activity<br />Related behaviors<br />Track improvement <br />Weigh & measure on a regular basis<br />
  46. 46. Cognitive Strategies<br /><ul><li>Focus on the goals
  47. 47. Plan meals & activity
  48. 48. Develop reminder systems
  49. 49. Anticipate temptations & plan resistance
  50. 50. Reward yourself
  51. 51. Limit quantities, but do not deprive yourself
  52. 52. Have confidence in your ability to succeed
  53. 53. Do positive self-talk</li></li></ul><li>Followup<br />Monitor weight, BP, pulse at each visit<br />Monitor waist size intermittently<br />Share progress with patient; praise efforts<br />Share lab results with patient<br />Emphasize findings associated with weight reduction<br />Focus on medical benefits<br />Most weight loss doesn’t reach individual’s ‘ideal’ (cosmetic) goal<br />
  54. 54. Thank You and Good Luck!<br />