C:\Documents And Settings\Louay Labban Uok\Desktop\All\Obesity Management1


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A review for non-pharmacological management of obesity through diet, physical activity and lifestyle modification

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  • Here are some of the reasons I’ve been given over the years. In order of increasing politeness. Greed – implies you voluntarily stuff your face all the time because you really don’t care. Laziness – implies you can exercise weight off. That doesn’t work because if you exercise you develop an even bigger appetite. Fat people get more exercise than thin people anyway. No willpower – implies you can starve the weight off. No-one can do this unless it is enforced. Even then the weight will come back when enforcement stops. Low metabolic rate – implies thin people burn more fat than fat people. Demonstrable rubbish. There are good reasons why fat people have higher metabolic rates than thin people.
  • And its all rubbish.
  • Very difficult to eat when you’re not hungry. Most obese people have forgotten what its like not to feel hungry. They feel bloated or even nauseous after a big meal, but not satiated.
  • So how do we maintain healthy weight in children ? – it’s all about balance. Simply, if a child consumes more energy, that is, kilojoules, than they use, the extra energy is stored as body fat. It doesn’t take much extra food intake each day to result in a substantial weight gain over a year. CLICK
  • People often do not make the link between their simple habits such as drinking diet soda over regular and its impact on weight gain. By posting a simple chart, can make an impression and just may be an incentive to change a habit. It takes a decrease in 3500 calories to lose a pound. And to get there, every bit adds up. Every year, the typical American now consumes 149 pounds of caloric sweeteners, 54 gallons of soda and 200 pounds of mostly refined grains.   Between 1977 and 1996, a typical salty snack rose from 132 calories to 225 calories; French fries from 188 calories to 256 calories; a hamburger from 389 calories to 486 calories; and a soft drink from 144 to 193 calories.
  • Based on nutritional components Range from low CHO (High Pro and Fat) to low fat (high CHO) Protein sparing mod fast is low in CHO, high in PRO causing ketosis
  • Stones (nephrolithiasis) excessive urinary Calcium excretion - decrease in urinary citrate due to decrease in GI alkali absorption from high PRO and decrease in dietary alkali sources (fruits and veggies) Osteoporosis – increase in urinary Calcium loss because: High protein increases renal calcium excretion (urinary calcium loss), because calcium is used as a buffer in metabolism of animal protein. (estimated 1 gram of excess protein, 1 mg increase in urinary calcium excretion). There is increased bone resorption without affecting rate of bone formation. Renal Insufficiency High protein could potentially hasten renal failure in patients with baseline renal insufficiency
  • C:\Documents And Settings\Louay Labban Uok\Desktop\All\Obesity Management1

    1. 1. Non-pharmacological management of obesity Dr. Louay Labban, RD, FADA
    2. 2. Why are you obese? <ul><li>Greed and uncontrolled appetite </li></ul><ul><li>Laziness and sedentary lifestyle </li></ul><ul><li>No willpower </li></ul><ul><li>Low metabolic rate </li></ul><ul><li>Genetics </li></ul><ul><li>Eating disorders </li></ul>
    3. 3. ALL answers are Wrong
    4. 4. <ul><li>You’re obese because you eat too much. </li></ul>
    5. 5. But why do you eat too much? You eat because you’re hungry. So fat people get hungrier than thin people?
    6. 6. Obesity vicious cycle Fat people eat more Fat people get fatter Fat people feel hungrier
    7. 7. Evolution 1
    8. 8. Evolution 2
    9. 9. <ul><li>Weight increase </li></ul>Expenditure Energy intake
    10. 10. Burger queen
    11. 11. <ul><li>Weight loss </li></ul>Expenditure Energy Intake
    12. 12. <ul><li>Normal Weight </li></ul>Expenditure Energy intake
    13. 13. Mayo clinic 6 points strategy <ul><li>1. Make a commitment </li></ul><ul><li>2. Get emotional support </li></ul><ul><li>3. Set a realistic goal </li></ul><ul><li>4. Enjoy healthier foods </li></ul><ul><li>5. Get active, stay active </li></ul><ul><li>6. Change your lifestyle </li></ul>
    14. 14. Calories Reduction Dietary Physical Activity Non-drug Obesity management Life-Style modification
    15. 15. Evidence for effectiveness and efficiency <ul><li> Loss Maintenance/ </li></ul><ul><li>Prevention </li></ul><ul><li>Diet ++ + </li></ul><ul><li>Physical activity + ++ </li></ul><ul><li>Combined +++ +++ </li></ul>
    16. 16. It’s all about balance <ul><li>Energy in = Energy out = </li></ul><ul><li>Food and drinks Physical activity </li></ul>
    17. 17. Physical activity <ul><li>Light exercises that can be done easily </li></ul><ul><li>30 minutes of walking a day for 5 days </li></ul><ul><li>Limit time spent in front of the TV or computer and spend the time moving your body </li></ul><ul><li>Always opt for stairs versus elevators and escalators </li></ul><ul><li>Dance </li></ul>
    18. 19. <ul><li>Use your car sparingly </li></ul><ul><li>Encourage family members to bike to school </li></ul><ul><li>Ride the exercise bike while watching TV </li></ul><ul><li>Walking groups </li></ul><ul><li>Make kids play outdoors rather than watching TV </li></ul>
    19. 20. How to burn extra 200 kcal <ul><li>Washing car for 30 minutes </li></ul><ul><li>Gardening for 45 minutes </li></ul><ul><li>Dancing for 20 minutes </li></ul><ul><li>Pushing a baby stroller for 30 minutes </li></ul><ul><li>Shooting basket for 30 minutes </li></ul><ul><li>Biking for 30 minutes ( 7 kcal/min ) </li></ul><ul><li>Swimming for 20 minutes ( 11 kcal/min ) </li></ul>
    20. 21. <ul><li>Running for 17 minutes ( 12 kcal/min ) </li></ul><ul><li>Sitting for 2 hr and 13 minutes ( 1.5 kcal/min ) </li></ul><ul><li>Washing dishes for 50 minutes ( 4 kcal/min) </li></ul>
    21. 23. Expected weight loss in days Daily calorie deficit 5 pounds 10 pounds 15 pounds 20 pounds 25 pounds 200 87 175 262 350 438 400 44 88 131 176 219 500 35 70 105 140 175 700 25 50 75 100 125 800 22 44 66 88 109 1,000 17 35 52 70 88 1,500 12 23 35 46 58
    22. 24. Dietary guidelines: <ul><li>Decrease calories </li></ul><ul><li>Eat food that make you feel full </li></ul><ul><li>Reduce fat intake </li></ul><ul><li>Reduce sugar intake </li></ul><ul><li>increase complex CHO </li></ul><ul><li>Include low-fat dairy products </li></ul>
    23. 25. <ul><li>Include lean meat and substitutes </li></ul><ul><li>Include fruits and vegetables ( > 5/day) </li></ul><ul><li>Limit sweet drinks, alcohol, and salt </li></ul><ul><li>Make lunch your biggest meal </li></ul><ul><li>Drink 8 cups of water at least </li></ul><ul><li>Keep diary for food consumed and weight </li></ul><ul><li>Take supplements </li></ul>
    24. 26. Small Changes Each Day Add Up … <ul><li>Diet over regular soda, 1 can ....... 7 kg / year </li></ul><ul><li>1 Candy bar / day...........................13 kg / year </li></ul><ul><li>Skim milk over whole, 1cup .......... 3.5 kg / year </li></ul><ul><li>1Tbs mustard instead of mayo......4.5 kg / year </li></ul><ul><li>2 Scoops ice cream/day................ 17 kg / year </li></ul><ul><li>Apple juice, 8oz cup..................... 6 kg / year </li></ul><ul><li>Orange juice, 8oz cup................... 5 kg / year </li></ul>
    25. 27. Lifestyle modification <ul><li>Meal planning </li></ul><ul><li>Reduce portion size </li></ul><ul><li>Eat breakfast always </li></ul><ul><li>Protein on breakfast </li></ul><ul><li>Encourage semi-solid meals </li></ul><ul><li>Healthy snacking between meals 2-3 snacks </li></ul><ul><li>Read the label </li></ul>
    26. 29. Reduce portion size
    27. 30. Healthy snacks
    28. 31. Fad diets
    29. 32. Categorization of Diets by CHO and Fat Riley RE. Clinics in Sports Medicine . 18(3):691-701, 1999. Dean Ornish Diet <10% Fat Pritikin Diet <15% Fat Weight Watchers, Jenny Craig, DASH diet, Food Guide Pyramid 55-60% CHO <30% Fat The Zone Diet 40% CHO 30% Fat Carbohydrate Addicts Diet < 30% CHO Atkins (20-60g CHO), Protein Power (<60g CHO), VLCD-protein sparing modified fast < 20% CHO
    30. 33. <ul><li>VLCD is not recommended if < 1000 kcal/day unless supervised by a health care professional </li></ul>
    31. 34. High Protein Diets: Possible Adverse Effects <ul><li>Increases in serum uric acid </li></ul><ul><li>Kidney stones </li></ul><ul><li>Osteoporosis </li></ul><ul><li>Chronic renal insufficiency </li></ul><ul><li>Ketosis </li></ul><ul><li>High Saturated Fat </li></ul><ul><li>Low Fruits, Vegetables and Grains </li></ul>
    32. 35. Conclusion <ul><li>Calories reduction is the best way for weight loss </li></ul><ul><li>This has to be incorporated with increased physical activity and lifestyle modification </li></ul><ul><li>Reduction of 500 kcal / day can result in ½ kg weekly or 22 kg annually </li></ul>
    33. 36. Recommendations <ul><li>Aim for slow weight loss versus rapid weight loss </li></ul><ul><li>Stay away from diets that promise rapid results </li></ul><ul><li>Balance your calories </li></ul><ul><li>Do not drink your calories </li></ul><ul><li>Increase your physical activities </li></ul><ul><li>Decrease your portion size </li></ul>
    34. 37. <ul><li>Thank you for listening </li></ul>