This is a public domain document from the state of Vermont with excellent points on portion control. 20 years ago, a typical bagel was 3” and 140 calories. Today, a typical bagel is 6” and 360 calories.
The larger bagel is an extra 200 calories. Eating 22 extra calories a day equals a weight gain of 23 pounds a year.
As we welcome the new year 2014, it is important to make a resolution to reduce portions as even cutting down by by a small amount a day can add up.
The other very important and often misunderstood aspect of the foods is the glycemic index of foods. For example, a typical bagel has a very high glycemic index of over 70 percent leading what is called "sugar rush" and "sugar crash". This phenomenon is so common that this is what drives the hunger in most people! This also leads to insulin resistance, metabolic syndrome, prediabetes, and diabetes.
How does glycemic index affect us?
Your body quickly digests the starches found in bagels, which causes your blood sugar levels to rise quickly and a few hours later, it leads to the crash. The higher the glycemic index of a food, the more it affects your blood sugar levels. Table sugar or sucrose has a glycemic index of 60, while the glycemic index of bagels averages 70 - a bagel is worse than even sugar. A breakfast rich in high-glycemic foods such as bagels can predispose you to weight gain, type 2 diabetes and heart problems.
In fact, Sumo wrestlers in Japan intentionally eat high glycemic diet for rapid weight gain, and there are reports that body builders in USA are intentionally using this principle of insulin resistance leading quick weight gain for their benefit by using insulin. According to the CDC, a third of all US adults are prediabetic or insulin resistant, and another third have some degree of it!
According to Dr. Prab R. Tumpati, MD, founder of W8MD medical weight loss centers of America, our obsession with low fatty foods as advocated by the failed food pyramid in fact contributed to our expanding waist lines by way of increased insulin resistance which in turn causes weight gain!
If you are overweight or obese, have excess belly fat, or have metabolic syndrome, pre-diabetes, or diabetes, and need help losing weight with health insurance, w8md medical weight loss centers of America can help! Check out our youtube channel with 52 weeks of weight loss and wellness videos at http://www.youtube.com/w8md
Top 10 tips to lose weight fast and never get it backNuman Rao
If you have tried everything to lose weight and nothing works for you, we tell you two dozen tricks that you have to carry out to succeed and achieve your weight goa
Proven measures to lose weight very low calorie diets vlcd and low calorie di...Prab Tumpati
Very low calorie diets and low calorie diets for weight loss are one of the most commonly used and most effective of all the measures for weight loss. Given the risks associated with very low calorie diets, it has to be done only under the supervision of a trained and licensed physician familiar with treatment of obesity.
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Thank you.
W8MD Medical Weight Loss Centers
Obesity and overweight measures to help lose weight and community strategies ...Prab Tumpati
As the nation fights an epidemic of Obesity, here are some of the measures at the level of the community from Centers For Disease Control.
If you are overweight or obese and trying to lose weight, you are not alone. According to statistics, up to 70 percent of the adult population in the United States are either overweight or obese. Our countries approach of blaming the victim for obesity does not help.
Please feel free to share this free, public domain information.
Thank you.
W8MD Medical Weight Loss Centers
Top 10 tips to lose weight fast and never get it backNuman Rao
If you have tried everything to lose weight and nothing works for you, we tell you two dozen tricks that you have to carry out to succeed and achieve your weight goa
Proven measures to lose weight very low calorie diets vlcd and low calorie di...Prab Tumpati
Very low calorie diets and low calorie diets for weight loss are one of the most commonly used and most effective of all the measures for weight loss. Given the risks associated with very low calorie diets, it has to be done only under the supervision of a trained and licensed physician familiar with treatment of obesity.
Please feel free to share this free, public domain information
Thank you.
W8MD Medical Weight Loss Centers
Obesity and overweight measures to help lose weight and community strategies ...Prab Tumpati
As the nation fights an epidemic of Obesity, here are some of the measures at the level of the community from Centers For Disease Control.
If you are overweight or obese and trying to lose weight, you are not alone. According to statistics, up to 70 percent of the adult population in the United States are either overweight or obese. Our countries approach of blaming the victim for obesity does not help.
Please feel free to share this free, public domain information.
Thank you.
W8MD Medical Weight Loss Centers
Delivered for the 25th Annual Convention of the Philippine Association for the Study of Overweight and Obese (PASOO) at the EDSA Shangri-la Hotel in Manila.
Keep Moving: Julie Kendrick for Renew MagazineJulie Kendrick
The CDC Control and Prevention (CDC) says that while genetics play a role in susceptibility to disease (such as obesity or diabetes), it’s also true that lifestyle may help prevent these diseases. Here are three seniors who are crushing it -- including Supreme Court Justice Ruth Bader Ginsberg.
Fat and Skinner From The Branch Out SeriesBrian Curley
CE Course:
http://learn.centralreach.com/tree/fat-skinner-webinar-1-ce-credit-for-bcba-cert/2903277/
Join Dr. Michael J. Cameron Ph-D, BCBA-D and renowned Author/Journalist David H. Freedman as we explore how to establish behavioral patterns that promote weight loss, exercise adherence and overall health and fitness.
Putting in place an employee wellbeing programme can seem overwhelming for anyone with this responsibility in their organisation. Should you focus on mental health? Exercise? Offer free fruit? There is an endless range of options, but how do you know whether the option you’ll end up choosing will deliver results? How will these be measured? Will they justify the investment? and will employees engage with it in the first place?
In this report we share the insights we've gained In the five years we’ve been delivering nutrition-centred wellbeing programmes, working with employees and their leadership teams including CEOs, HR, finance, Benefits & Reward, Estates, Health & Safety as well as occupational health.
- Our 4 pillar nutrition-centred wellbeing methodology - a strategic, structured approach to wellbeing which aims to maximise engagement and achieve measurable outcomes.
- Case studies
- 'How Nutrition-smart is your workplace' scorecard
Delivered for the 25th Annual Convention of the Philippine Association for the Study of Overweight and Obese (PASOO) at the EDSA Shangri-la Hotel in Manila.
Keep Moving: Julie Kendrick for Renew MagazineJulie Kendrick
The CDC Control and Prevention (CDC) says that while genetics play a role in susceptibility to disease (such as obesity or diabetes), it’s also true that lifestyle may help prevent these diseases. Here are three seniors who are crushing it -- including Supreme Court Justice Ruth Bader Ginsberg.
Fat and Skinner From The Branch Out SeriesBrian Curley
CE Course:
http://learn.centralreach.com/tree/fat-skinner-webinar-1-ce-credit-for-bcba-cert/2903277/
Join Dr. Michael J. Cameron Ph-D, BCBA-D and renowned Author/Journalist David H. Freedman as we explore how to establish behavioral patterns that promote weight loss, exercise adherence and overall health and fitness.
Putting in place an employee wellbeing programme can seem overwhelming for anyone with this responsibility in their organisation. Should you focus on mental health? Exercise? Offer free fruit? There is an endless range of options, but how do you know whether the option you’ll end up choosing will deliver results? How will these be measured? Will they justify the investment? and will employees engage with it in the first place?
In this report we share the insights we've gained In the five years we’ve been delivering nutrition-centred wellbeing programmes, working with employees and their leadership teams including CEOs, HR, finance, Benefits & Reward, Estates, Health & Safety as well as occupational health.
- Our 4 pillar nutrition-centred wellbeing methodology - a strategic, structured approach to wellbeing which aims to maximise engagement and achieve measurable outcomes.
- Case studies
- 'How Nutrition-smart is your workplace' scorecard
California medical weight management provides a medical weight loss program which is completely medical supervised and containing three steps including: Simple Consistent Weight Loss, Transition to Weight Management, Transition to Weight Management.
Assessment Methods For Nutritional StatusDrSindhuAlmas
By the end of this lecture the you should be able:
To know the different methods for assessing the nutritional status To understand the basic anthropometric techniques, applications, & reference standards
For this evaluation prepare a power point presentation about your ShainaBoling829
For this evaluation prepare a power point presentation about your health promotion initiative. The length would equal the sections of your paper. For example, if your paper contains 8 sections, your presentation will be 8 slides plus the introduction and references, totaling 10 slides.
1. Describe the health problem. Using data and statistics support your claim that the issue you selected is a problem. What specifically will you address in your proposed health promotion program? Be sure your proposed outcome is realistic and measureable. (1-2 slides).
2. Describe the vulnerable population and setting. What are the risk factors that make this a vulnerable population? Use evidence to support the risk factors you have identified. (1-2 slides).
3. Present your health promotion/disease prevention theoretical framework or conceptual model that would best serve as the framework guiding the proposal. Provide rationale for your selection which includes discussion of the concepts of the selected model. (1 slide).
4. Present your health promotion program using an evidence-based intervention. Include a thorough discussion of the specifics of this intervention which include resources necessary, those involved, and feasibility for a nurse in an advanced role. Be certain to include a timeline. (1-2 slides)
5. Describe your intended outcomes. Describe the outcomes in detail concurrent with the SMART goal approach. (1-2 slides).
6. Present your plan for evaluation for each outcome. (1-2 slides).
7. Thoroughly describe possible barriers/challenges to implementing the proposed project as well as strategies to address these barriers/challenges. (1-2 slides).
Follow the rule of 7 of professional presentations: Use no more than 7 lines of text per slide, with around 7 words per line. Explanations would be added to the notes sections or as a separate paper.
Running head: ASSIGNMENT 2
ASSIGNMENT 2
Assignment 2 SMART Goal Planning Form
Nutrition
Florida National University
Alina Rivero
Health Promotion and Role Development in Advanced Nursing Practice
Professor: Alexander Garcia Salas
February 16, 2022
Smart Goal Planning Form
When children are knowledgeable about the adverse effects of unhealthy nutrition on their health and the risk of complications brought by their diabetes conditions, there will be reduction of the risks and other associated complications to ensure that healthy body weight and a low BMI are attained by consumption of healthy diets within three months.
Running head: HEALTH PROMOTION PROGRAM 2
HEALTH PROMOTION PROGRAM 2
Health Promotion Program
Alina Rivero Paret
Florida National University
April 09, 2022
Obesity is defined as a disorder that involves excess fat that leads to an increase in the risk of health issues. This condition results from the consumption of more calories than those which are burned through exercise activities or normal daily activities. A person is confirmed to be having obes ...
Wellsource designs a revamped and improved Medicaid health assessment that streamlines the process and increases end user communication by up to 50%. For more information visit: http://www.wellsource.com/company-news/Wellsource-Designs-Medicaid-Health-Risk-Assessment.html
Patient activation: New insights into the role of patients in self-managementMS Trust
This presentation by Helen Gilburt, Fellow at The King's Fund, looks at why some people are active at managing their health while others are quite passive, and how levels of patient activation impact on health outcomes.
It was presented at the MS Trust Annual Conference in November 2014.
KY HIMSS Leveraging Innovative Ways to Connect with Patients at Covenant Care...PreventScripts
Leveraging Innovative Way to Connect with Patients at Covenant Care Practices- Our experience using a mobile pre-visit assessment, Clinical Decision Support, and remote Monitoring Tools to engage and improve health outcomes in "Rising Risk" patients
Heal and Cure is a physician supervised medical wellness & primary care center. We offer Insurance Covered medical services for wellness and healthy living, weight loss or weight management, and primary care – all under the supervision of Board Certified, Award Winning physicians.
Since 2003, Heal n Cure has been mirroring the recommendations of the U.S. Preventive Services Task Force* (USPSTF) for the screening and management of obesity and diabetes. Over the years, we have aligned our weight management program – “Inspire Core Wellness”, based off the Task Force’s findings. The program has delivered impressive results in reversing all modifiable health risk factors.
The USPSTF recommends that overweight and obese patients should be referred to a comprehensive, multicomponent weight loss program with 12 to 26 sessions in the first year. The Inspire Core Wellness program implements the USPSTF recommendations and has delivered impressive outcomes.
The Nevada Cancer Institute demonstrates the real-world application of workplace practices that foster employee well-being and organizational performance in this "Employer Experience" session from the APA Practice Organization's 2009 Psychologically Healthy Workplace Conference. Presenter: Hilary Meade, M.Ed., CHES, Wellness Coordinator.
Running Head DIET AND PHYSICAL ACTIVITY.Diet and Physical Act.docxtodd271
Running Head: DIET AND PHYSICAL ACTIVITY.
Diet and Physical Activity.
Diet and Physical Activity.
04/11/2019
Diet and Physical Activity.
The body requires a healthy diet and once at a time physical activity to ensure healthy lives, but contrary to that unhealthy diets and inactivity contribute to chronic diseases such as diabetes, cancer or cardiovascular diseases. Improving diets and physical activity will actually reduce disease and deaths on the target community that is currently is something World Health Organization started an initiative for member states to adopt diet, physical activity, and disease prevention.
This health promotion activity is directed towards the local community and specifically the elderly, mainly because they are the section of the population that is likely to be attacked by such diseases, but also the other population section is affected. So, the focus will be on the physicians and nutritionists who will come in and help with this campaign. This is because the younger population like the millennials mostly focus on healthy living with going vegan or regularly visiting the gym in the pursuit of following trends. This will not be a problem for this age group.
The possible stakeholders will be both the government and the private sectors, in the sense that other workplaces have policies in place that support physical activity and proper diet for their workers for the sole purpose of productivity in the workplace. They initiatives in place that include: maybe having walking meetings, provide healthy diet solutions at the workplace by inviting nutritionists and many other ways. The expected results include a healthy community, and maybe possibly pass the message wide enough that it can be a worldwide movement that is of course after ensuring the point is taken in this local community. Hence this is the best health promotion activity for this target population because I believe knowledge is power whereby it acts as prevention, which will bring the collaboration of various professions in the clinical practice.
References
Diet and Physical Activity: a public health priority, retrieved from https://www.who.int/dietphysicalactivity/public-health-priority/en/
4/26/19, 8*54 PMRubric Assessment - NSG6002 Health Policy and Health Promotion in Advanced Nursing Practice FL01 - South University
Page 1 of 4https://myclasses.southuniversity.edu/d2l/lms/competencies/rubric/rubrics_assessment_resu…&viewTypeId=3&rubricId=98837&groupId=0&d2l_body_type=5&closeButton=1&showRubricHeadings=0
Criteria
No Evidence
0 points
Unsa!sfactory
51 points
Sa!sfactory
59 points
Proficient
66 points
Exemplary
75 points
Health Topic
Describe a single
health
promo!on/disease
preven!on
problem from the
Healthy People
2020 Objec!ves
Introduc!on to
popula!on or
problem Describe
incidence,
prevalence,
epidemiology, cost
burden etc.,
Student did not
submit assignment
Work minimally
meets assignment
expect.
Portion size changes over time and how it is affecting weight gain in america...Prab Tumpati
Portion sizes have changed dramatically over the last few decades. Studies have shown that people tend to consume more if they were fed in a bigger plate thus contributing to our expanding waist lines.
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W8MD Medical Weight Loss Centers
Portion size changes over time and how it is affecting weight gain in america...Prab Tumpati
Portion sizes have increased enormously in the last few decades in the United States. Studies have shown that eating from a bigger plate increases the chances of overeating.
Please feel free to share this free, public domain information
Thank you.
W8MD Medical Weight Loss Centers
Nih causes of weight gain and obesity and strategies and help losing weightPrab Tumpati
NIH comprehensive report on causes of weight gain, and strategies to deal with obesity and overweight.
Please feel free to share this free, public domain information
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W8MD Medical Weight Loss Centers
Nih the evidence report on obesity causes of weight gain and helpful tips for...Prab Tumpati
NIH evidence report on obesity is a comprehensive review of obesity.
Please feel free to share this free, public domain information
Thank you.
W8MD Medical Weight Loss Centers
Overweight and obesity in children and adolescentsPrab Tumpati
US surgeon generals information on overweight and obesity in children and adolescents.
Please feel free to share this free, public domain information
Thank you.
W8MD Medical Weight Loss Centers
Overweight and obesity us surgeon generals healthy weight advice for weight lossPrab Tumpati
US Surgeon Generals information on obesity and overweight and advice on healthy weight.
How can W8MD help? W8MD Medical Weight Loss Program is a medical weight loss and sleep wellness program for people who are serious about losing weight and gaining control of their health. We understand that losing weight and keeping it off is a challenge for many people and a physician trained in the new field of Obesity Medicine can help. That is why we are committed to our proven approach to medical weight loss using evidence based non surgical methods. We want to give you all the tools you need to succeed in losing weight fast and safe in Greater Philadelphia and New York City.
Our Group has helped patients achieve their goals by using a proven four-step method for safe weight loss:
•a physician-supervised diet and weight loss medication,
•a personally structured and administered exercise program,
•comprehensive behavior therapy, and
•ongoing weight maintenance support.
We can help you achieve long-lasting weight loss without feeling constantly hungry and deprived. When you resent your weight loss plan because you feel constantly hungry, it is much more difficult to maintain any significant lifelong changes. When you feel hungry, you are biologically driven to eat, and diet plans that force you to fight that biological impulse can be difficult to maintain. At W8MD Medical Weight Loss Program, we want to help you achieve lasting weight loss results and make changes that will keep you healthy for a lifetime.
W8MD Medical Weight Loss Program is dedicated to individualized, affordable treatment and as one of the very physician supervised medical weight loss programs to accept most health insurances for the weight loss physician visits. Our non-surgical medical weight loss program is based on the latest medical research and utilizes proven methods to lose weight rapidly and keep it off for a lifetime.
Our Medical Director, Dr. Prab R. Tumpati, is a highly trained and respected physician with training in Obesity Medicine, in addition to being board certified in Internal Medicine and Sleep Medicine, and is well versed in the medical treatment of overweight and obesity. Dr. Tumpati oversees all our patients and helps customize their individual weight loss treatments. We are committed to helping you lose weight as safely and efficiently as possible.
We understand that losing weight and keeping it off is a challenge for many people and a physician trained in the new field of Obesity Medicine can help. That is why we are committed to our proven approach to medical weight loss using evidence based non surgical methods. We want to give you all the tools you need to succeed in losing weight fast and safe. Call 1(800)W8MD-007 to learn more or visit http://www.w8md.com
Practical guide to evaluation and treatment of obesity overweight for physici...Prab Tumpati
This is an excellent guide from NIH to anybody interested in learning about obesity, overweight and strategies to fight obesity.
Please feel free to share this free, public domain information
Thank you.
W8MD Medical Weight Loss Centers
W8MD Medical Weight Loss Centers Of America Weight Loss ProgramPrab Tumpati
Welcome to W8MD Weight Loss Centers of America.
Did you know that 1 in 3 people have insulin resistance or are considered “pre”
diabetic which could be the main reason that people are overweight? Losing just
5-10% of your weight will help you reduce risks of heart attacks, diabetes and
even some cancers.
Under the direction of Dr. Prab Tumpati, W8MD Weight Loss Centers was
founded a year ago because of his passion to overcome obesity and to make
a difference. Dr. Tumpati has passed a written board examination in the field
of Bariatric Medicine and is also Board Certified in Sleep Medicine and Internal
Medicine. The doctor’s of W8MD partner with each patient to develop a custom
weight management program to best meet their individual needs taking into
account their medical history, lifestyle and goals.
Since weight and sleep go together, most of the W8MD centers are able to
address sleep issues such as snoring, obstructive sleep apnea, narcolepsy,
insomnia and restless leg syndrome to name a few.
And the best part of the program is that most insurance’s cover the doctor visits.
Check out our website at www.w8md.com to learn more about us. If you have a
little or a lot of weight to lose and want to do it without surgery, set up fees and
mandatory meal replacements or appetite suppressants, think W8MD for weight
loss.
And, if you are a physician, with an interest in helping your obese or overweight
patients, and would like to add a W8MD program at your office, please feel free
to contact us.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. Acknowledgements
This toolkit was designed for primary care practitioners,
with extensive input from the primary care community, to
support the promotion of healthier weight with patients.
The toolkit includes recommendations for the prevention,
identification, assessment and management of overweight
and obese adult patients in primary care. We thank all the
primary care practitioners in Vermont who assisted with this
effort – by responding to survey questions, participating
in pilot studies, or contacting us with suggestions. We
also thank the advisory committee members and all others
who participated in this project. We would like to especially
thank Richard Pratley, MD, who served as medical advisor
to this project and Richard Pinckney, MD, MPH, who adapted
motivational interviewing principles to the topic of
promoting healthier weight, both from the University of
Vermont College of Medicine.
This project was made possible through a collaboration between
the Vermont AHEC Network, the Vermont Department of Health,
and the University of Vermont College of Medicine and funded
in part by the Centers for Disease Control and Prevention (CDC)
under cooperative agreement #U58/CCU122788-03.
Ongoing feedback about this toolkit may be emailed to ahec@uvm.edu.
Vermont Area Health Education Centers (AHEC)
University of Vermont College of Medicine AHEC Program Office
UHC Campus, Arnold 5, 1 S. Prospect Street, Burlington, VT 05401
(802) 656-2179
www.vtahec.org
Vermont Department of Health
108 Cherry Street, PO Box 70, Burlington, Vermont 05402
(802) 863-7330
http://healthvermont.gov
First Edition 2007
This toolkit and additional resources may be copied or downloaded from www.vtahec.org or http://healthvermont.gov.
3. Table of Contents
Promoting Healthier Weight ............................................................................................................. 1
Promoting Healthier Weight Algorithm ..................................................................................... 2
Using the Weight & Health Profile and
Applying Motivational Interviewing Skills ................................................................................ 3
Weight & Health Profile with Prescription................................................................................. 7
Resources for Patients........................................................................................................................... 8
Resources for Clinicians ....................................................................................................................... 9
Preparing Your Office & Billing...................................................................................................... 10
Your Role in the Community.......................................................................................................... 12
Foundation Resources for this Toolkit ...................................................................................... 13
About Us ................................................................................................................................................... 14
Appendix: Tools ..................................................................................................................................... 15
4.
5. Promoting Healthier Weight
O
verweight and obesity have become
epidemic in our modern society. In
Vermont, over half of all adults are
overweight or obese. Moreover, the
number of adults classified as obese has increased
at an alarming rate during the last 5 years and
this segment now comprises 20% of the population.
Obesity increases risk for many chronic diseases,
including type 2 diabetes, atherosclerosis,
gynecologic abnormalities, arthritis, respiratory
disorders and certain types of cancer. In addition
to the impact on Vermonters’ quality of life, the
direct medical costs attributable to obesity exceed
$4 million annually. Thus, obesity is a significant
public health challenge in Vermont.
Although the health and functional consequences of
obesity are well known, most overweight and obese
patients experience significant challenges managing
their weight, eating a healthy diet and getting
enough physical activity. Even among highly
motivated patients, relapse is common. It is clear
that our health care system and, indeed, our society
must find new and better ways to prevent and treat
overweight and obesity. This toolkit is designed for
primary care practitioners to assist in promoting
healthier weight with adult patients.
What can you do?
• Talk to your patients about achieving and
maintaining a healthy weight. In 2000, only 2%
of overweight patients and 33% of obese patients
said they were advised by their doctor, nurse or
other health care professional, to lose weight; yet,
76% of adult patients who said they were advised
to lose weight were trying to do so.
Percent of Overweight Obese Adults in Vermont
PercenT Of OverWeighT Obese AdulTs in vermOnT
60%
Obese
Overweight
50%
40%
30%
20%
10%
1990
1992
1994
1996
1998
2000
2002
Source: http://apps.nccd.cdc.gov/brfss
• identify overweight and obese patients by
calculating the body mass index (BMI) and
assess associated conditions and risk factors.
• Regardless of weight, encourage patients to
to set achievable goals and take the small steps
toward the targets of controlling portion size,
eating at least five fruits and vegetables daily,
being physically active (at least 30 minutes on
most days of the week) and maintaining or losing
weight, as appropriate.
• Provide patients with resources, such as medical
nutrition therapy, weight maintenance/loss and
physical activity programs in your area.
• schedule a follow-up visit
This kit contains tools for prevention, as well as
tools to help assess overweight and obesity, and
set nutrition, physical activity, and weight goals
with your patients. It also provides sources of
support for patients and additional background
resources to help you and your patients manage
their weight.
When health care practitioners talk,
patients listen!
6. Promoting Healthier Weight Algorithm
Patient Encounter
Review, measure, assess, agree on next steps and set-follow-up date
Review chart for BMI and past weight, height,
nutrition, and physical activity goals/steps
Measure weight, height, calculate BMI and
assess associated health risk
BMI≥ 25
Waist 35” for women
Waist 40” for men
Brief reinforcement
• weight maintenance
• nutrition
• physical activity
no
yes
Assess associated conditions and risk
Build motivation and support
Briefly reinforce with praise for even
small improvements based on past goals
Assess
readiness for
change
Precontemplation
Not ready, not aware,
not interested
Contemplation
Thinking about it,
aware of problem
Preparation/Ready
Planning for change
Agree on next steps
Steps will vary with stage, may include:
• schedule a follow-up visit
• provide educational materials
• provide community resources
• patient commitment to a physical activity or nutrition goal
Set follow-up visit date
7. Using the Weight Health Profile and
Applying Motivational Interviewing Skills
T
he Weight Health Profile (page 7) follows
the Promoting Healthier Weight Algorithm
and is intended to help guide discussions
with patients regarding their weight,
nutrition and physical activity habits. The tool is
also provided as a 2-part NCR form. One sheet
can be given to the patient as a reminder of your
discussion. It includes a “prescription” for change
(on the front) and resources (on the back). A copy
can be retained in the chart for tracking purposes.
The tool is also available at www.vtahec.org or
http://healthvermont.gov. You may choose to
customize it for your practice.
Patient encounter
review chart
Any interaction between a health care practitioner
and a patient can provide the opportunity to
assess a patient’s weight status and provide advice,
counseling or treatment. You can use these
opportunities to review past weight, nutrition,
and physical activity goals.
• What is your mood like most of the time? Do you
feel you have the needed energy to lose weight?
(may need to assess for depression)
• Do you feel that you eat what most people would
consider a large amount of food in a short period of
time? Do you feel out of control during this time?
(may need to assess for binge eating disorders)
• Do you ever forcibly vomit, use laxatives, or engage
in excessive physical activity as a means of controlling
weight? (may need to assess for bulimia nervosa)
Build motivation and support
Praise improvements
Congratulate patients for improvements, even
small ones, since the last visit, if this was discussed.
If there has been no progress, continue with the
assessment for readiness. Many patients will make
multiple attempts before successfully initiating
behavioral change.
measure weight, height, and waist
circumference and calculate bmi
1. BMI can be calculated using the formulas:
BMI = weight (kg) ÷ height (meters)2 or
BMI = weight (lbs) x 703 ÷ height (inches)1 pt
2. BMI can also be determined from a chart in
this toolkit or with a calculator tool.
Assess Associated conditions and risk
Based on BMI, what is the patient’s risk? Is the
BMI ≥25 or is the waist circumference 35 inches
(women) or 40 inches (men)? If yes, continue
assessment. If no, brief reinforcement and
encouragement to maintain weight and healthy
nutrition and physical activity is appropriate.
Assess for presence of psychiatric issues. You can
explore psychiatric issues with patients using
some of the following questions:
3
8. Assess readiness for change
Most patients are not ready to make major lifestyle
changes when they visit a clinician’s office.
Determining how ready a patient is to make changes
can be very useful for selecting the appropriate
strategy for discussing physical activity, nutrition,
or weight loss. The stages of change model is a
tool for categorizing patient readiness.
The verbal cues provided on the chart below are
one way to determine what stage patients are in.
Other methods include asking how soon it will
be, before they will be ready to make a change.
Patients not interested in making changes in
six months are in precontemplation. Those
intending to make a change in six months are in
contemplatation. Those intending to make a
change in one month are in preparation.
For patients in precontemplation, contemplation,
and preparation, assisting their motivation can
enhance adherence to the goals that are developed.
Research has shown that an approach that supports
patients’ motivation to change works much better
than simply giving advice or putting pressure on
patients by confronting them with the dangers
of their current lifestyle. Using the method of
motivational interviewing and the technique of
reflective listening means that:
• the clinician takes an empathetic stance
• motivation comes from within the patient;
the clinician evokes it
• the patient is the expert in his/her life, and
• the patient is in charge of change
Reflective listening – how does it work?
• the patient is encouraged to speak about
nutrition, physical activity or weight loss. The
clinician can initiate this by asking permission,
“Could we talk a little about exercise and
nutrition right now?”
• the clinician reflects back to the patient his/her
words and their potential meaning to encourage
the patient to continue speaking. “It sounds like
you have tried several diets, and you are frustrated
that they didn’t give you long term results.”
• the direction the clinician takes depends on the
patient’s readiness.
• the clinician avoids “you should” type statements
in this process.
STAGES of CHANGE
ChaRaCTeRIsTIC
PaTIenT veRbal CUe
aPPROPRIaTe InTeRvenTIOn
saMPle DIalOgUe
Unaware of problem.
no interest in change.
I’m not really interested in
weight loss. It’s not a problem.
Roll with resistance.
explore barriers to change.
It sounds like you’re not ready for
weight loss right now. Maybe we
can talk about it at your next visit.
aware of problem.
I know I need to lose weight,
but with all that’s going on
in my life right now, I’m not
sure I can.
Review pros and cons of
change, discuss barriers.
Taking steps to lose weight can
be challenging. What would
make you more ready?
Preparation
Realizes benefits of
making changes and
thinking about how
to change.
I have to lose weight,
and I’m planning to do that.
Develop a plan together.
It’s great that you’re considering
losing weight. What might be
your next step?
action
actively taking steps
toward change.
I’m doing my best. This is
harder than I thought.
Praise, encourage,
reinforce – revise plan.
It’s terrific that you’re working
so hard. What is your plan to stay
on track?
Maintenance
Initial treatment goals
reached.
I’ve learned a lot through
this process.
Provide support and
guidance, with a focus
on the long term relapse
control.
What situations continue to
tempt you to overeat? What can
be helpful for the next time you
face such a situation?
Precontemplation
Contemplation
9. hOW reAdy Are yOu TO TAke The nexT sTeP?
not ready
1
ready
2
3
4
What would make you more ready?
5
6
7
What might your next steps be?
not ready (Precontemplation)
Patients who are in precontemplation can be
highly resistant to change. Clinicians need to be
able to “roll with the patient resistance” rather than
confront it. Explore the patient’s thoughts using
reflective listening so that the patient knows that
he/she has been heard, believed, and respected.
“It sounds like a good meal is something you look
forward to at the end of the day.”
Once patients have an opportunity to discuss their
frustrations regarding change, they may be more
interested in discussing the pros and cons of change
which signals a transition to the contemplation
stage. Or, the patient may not be ready. “If now is
not a convenient time for weight loss, what would it
take to be ready?” Scheduling another appointment
to discuss this further is an appropriate next step.
Thinking about it (contemplation)
Clinicians can help patients explore ambivalence,
as they wrestle with the pros and cons of their
current diet and activities and consider changes.
One technique clinicians can use is to ask patients
how ready they are: “On a scale of 1 to 10, where 10
is Ready, how ready are you to increase your daily
intake of fruits and vegetables?” or “increase your
walking to 10 minutes per day?” Explore the patient’s
responses. If a patient says “2”, ask why not “4”; or
“What it would take to move to 4?” This encourages
patients to discuss the advantages of increasing
fruits and vegetables, or increasing daily walking.
Planning/ready for change (Preparation)
Patients may become motivated and move into
8
9
10
What is your plan?
the preparation stage and commit to a plan. Or
the patient may commit to scheduling another
appointment to continue the dialogue.
Patient commitment to change –
when and how
“Aim for commitment” is a mnemonic to help
you remember the keys steps in developing and
maintaining a plan with patients:
• Ask permission to discuss a plan
• information you provide is stated in the 3rd person
• menu of options should be offered
Asking permission to discuss the plan keeps the
patient empowered and serves as validation that
the patient is in a preparation stage – it is easy to
guess wrong.
Putting information about treatment options in
the 3rd person helps to keep your preferences out
of the decision making. “Research suggests that”
or “experts recommend” are good ways to begin
discussing plan options. Using this techniques, you
will find that if patients reacts negatively, they are
less likely to focus their frustration at you.
Offering patients a menu of options can
empower patients to take charge of their health.
(See Your Prescription on Your Weight Health
Profile, page 7, for examples.) Small or “baby” steps
can be useful options for patients in preparation,
or even contemplation, to prompt them to move
in the direction of change. Continued over the
long term, small steps will have more impact than
dramatic behavioral changes that are not sustained.
5
10. commitment comes in the form of a specific state
ment from patients including when and how they
will make this change. For patients in the precontem
plative and contemplative stages, the only specific
commitment may be to come to the next visit.
Research shows that patients who make commitment
statements are the most likely to make the lifestyle
change. Encouraging patients to specifically state
their plans (when and how) will help identify any
other barriers to change and solidify their intentions.
The Profile/Prescription can guide you and your
patient through these steps from review,
measurement, assessment, building motivation
and making a plan. For those in the preparation
or in the action stages, keep the focus on one
or two behaviors. How much walking is the
patient ready to do? Or will the patient swim?
How many days per week? What nutritional goal
is the patient ready to commit to? What weight
loss goal (a reasonable amount is 1-2 pounds
per week)?
Agree on next steps with all patients
Set a follow-up visit
The next step may be to schedule a follow-up
appointment to discuss physical activity, nutrition,
or weight loss further. However, some patients may
be ready to begin discussing a plan. Motivational
interviewing continues to be a good method
to use with patients in the preparation stage to
further enhance the chances that they will adhere
to the plan that is developed.
Schedule a follow-up visit so that the goal date is
clear. If appropriate, encourage patients to come
into the office for regular weigh-ins. At the next
patient encounter, continue this process of review,
measurement, assessment, and building motivation
and support toward the goal of healthier weight.
Keeping a copy of the Profile/Prescription in the
patient chart should facilitate this process.
6
11. Your Weight Health Profile
NAME
HEIgHT
ClINICIAN NAME
WEIgHT
DATE
your body mass index (BMI) _______________________
Your Prescription
your associated health risk*:
■ May be increased (BMI less than 18.5)
■ Average (BMI 18-5-24.9)
■ Increased (BMI 25-29.9)
■ High (BMI 30-34.9)
■ Very High (BMI 35-39.9)
■ Extremely High (BMI greater than 40)
(Recommend 1 to 3 small steps for next visit)
your waist circumference________ inches
High risk: ■ Men: 40 inches
■ Women: 35 inches
■ gardening
■ Other
your health conditions risk factors:
*Any of these factors may further increase your risk
■ Heart disease or stroke
■ Diabetes
■ High blood sugar
■ High cholesterol
■ High blood pressure
■ Breathing problems (including sleep apnea)
■ Family history of diabetes/heart disease
■ Poor nutrition
■ Physical inactivity
■ Tobacco use
■ Other
Your Readiness
How ready are you to take the next steps to improve
your health? ■ Not ready (precontemplation)
■ Thinking about it (contemplation)
■ Ready (preparation)
If now is not a convenient time, what would it take for
you to be ready?_________________________________
What could your next step be?
■ Physical activity
■ Nutrition
■ Weight maintenance/loss
■ Other
Produced by the Vermont AHEC Network the Vermont Department of Health, 2007.
Physical activity goal:
Recommended for everyone unless there are
specific medical reasons not to exercise.
■ Walking
■ Biking
■ Swimming
Minutes per day
Steps per day
Days per week
nutrition goal:
■ Control portion size
■ Eat fruits vegetables
■ Decrease sweetened beverages
■ Cut back on fat in diet
■ Other
Weight maintenance, prevention of further
weight gain, or weight loss goal:
(Weight loss is recommended if your BMI or waist
circumference are high, or if you have a health risk.)
■ Weight loss for next visit
■ Other
gOAl dATe:
follow-up visit
See resources on back. 8
12. Resources for Patients
chronic conditions
American Heart Association provides fitness and exercise tips, an online tool to help you begin or continue
an exercise program, shopping tips and recipes
. . . . . . . . ............................................... www.americanheart.org/presenter.jhtml?identifier=1200009
American Diabetes Association provides information on meal planning, fitness, and weight loss
. . . . . . . . .......................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . www.diabetes.org
Weight management
Information on weight management................ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . http://nutrition.gov
National Institutes of Health’s Aim for a Healthy Weight
. . . . . . . . ...................................... www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/index.htm
nutrition
The USDA’s MyPyramid allows you to determine your calorie needs and track your food intake and activity
. . . . . . . . .......................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . www.mypyramid.gov
Produce for Better Health Foundation has tips and recipes for eating more fruits and vegetables
. . . . . . . . .......................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . www.5Aday.org or
. . . . . . . . .......................................................... . . . . . . . . . . . . . . . . . . . . www.fruitsandveggiesmorematters.org
Physical Activity
For a fun tool to track your activity, log onto America on the Move . . . . . . http://aom.americaonthemove.org
American Council on Exercise’s “Fit FactsTM” offers one-page information sheets covering a range of
fitness topics................................................ . . . . . . . . . . . . . www.acefitness.org/fitfacts/fitfacts_list.aspx
vermont resources
The Healthier living Workshop is for people living with chronic conditions. This free workshop helps you
learn how to manage physical and emotional symptoms, make action plans for health improvements and
much more. Contact the Vermont Department of Health for more information . . . . . . . . . . . 1-800-464-4343 or
. . . . . . . . .............................................. http://healthvermont.gov/prevent/blueprint/selfmanage.aspx
Vermont Department of Health, Fit and Healthy Vermonters provides links to Eat for Health and
get Moving Vermont – simple tips and resources to support healthy eating and promote physical activity
. . . . . . . . .......................................................... . . . . . . . . . . . . http://healthvermont.gov/fitandhealthy.aspx
Vermont’s Department of Tourism and Marketing recreation site, includes statewide resources on biking,
hiking, snow sports, water sports and more ....... . . . . . . www.vermontvacation.com/recreation/index.asp
local resources
Vermont 211, run by United Way, links individuals to local resources on a variety of topics including nutrition
and physical activity. Dial 211 or search their database . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . www.vermont211.org
Other
8
Produced by the Vermont AHEC Network the Vermont Department of Health, 2007.
13. Resources for Clinicians
Agency for Healthcare Research and Quality Managing Obesity: A Clinician’s Aid
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .www.ahrq.gov/clinic/obesaid.pdf
American College of Physicians Resources for patients and clinicians on nutrition and physical activity
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . http://diabetes.acponline.org
American Diabetes Association A wealth of information directed at patients and health professionals in
online, print and full textbook formats. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . www.diabetes.org
American Dietetic Association General nutrition information, including brief reviews of popular diets,
such as South Beach (2006) and the Supermarket Diet (2007).. . . . . . . . . . . . . . . . . . . . . . . . . .www.eatright.org
American Family Physician 2001; 63(11):2185-6. Obesity: Assessment and Management in Primary Care.
Lyznicki, JM, Young, DC, Riggs, JA, and Davis, RM. A good review article.
American Heart Association A good source of information regarding dietary fats. . . www.americanheart.org
American Medical Association Roadmaps for Clinical Practice Series. Assessment and Management of
Adult Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . www.ama-assn.org/ama/pub/category/10931.html
Motivational Interviewing Current Research and Training Opportunities in Vermont. . . . . . www.vtahec.org
National Heart, Lung, and Blood Institute Clinical Guidelines on the Identification, Evaluation and
Treatment of Overweight and Obesity in Adult . . . . . www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm
North American Association for the Study of Obesity (NAASO) Resources for health care professionals
including latest research, and slides materials for presentations . . . . . . . . . . . . . .www.naaso.org/education
Vermont Department of Health Fit Healthy Vermonters, Preventing Obesity. The 2006 state plan including
nutrition and physical activity resources . . . . . . . . . . . . . . http://healthvermont.gov/family/fit/obesity.aspx
Weight Control Information Network Talking With Patients. Resources for primary care professionals.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . http://win.niddk.nih.gov/publications/talking.htm
14. Preparing Your Office Billing
Evaluate your office environment.
Check your equipment.
Does your furniture comfortably accommodate
overweight and obese patients? Do you measure
height and weight in a way that respects patient
privacy? Is your staff sensitive to the concerns that
people often have about their weight?
The two most critical components are accuracy
and reliability. Both scales and stadiometers
should be checked on a daily basis and calibrated
every month.
• Accuracy is defined as the degree to which a
measurement of an individual corresponds to
his or her actual weight or stature.
• Reliability is defined as the degree to which
successive measurements of the same person
agree within specified limits.
A suitable scale is a quality beam balance or
electronic scale that can be easily calibrated. It is
desirable that the scale weigh in 100 gram or 1/4
pound increments. Also, it is important that the
scale is accurate. The scale should have a function
so that it can be ‘zeroed’. Standard weights should
be available to calibrate the scale. Beam balance
scales should have ‘screw type’ provision for
immobilizing the zeroing weight. Spring balance
scales such as bathroom scales should not be
used to weigh adults.
An appropriate stadiometer for measuring height
requires a vertical board with an attached metric
rule and a horizontal headpiece that can be
brought into contact with the most superior part
of the head. The stadiometer should be able to
read to 0.1 cm or 1/8 in. Height devices attached
to scales are notably inaccurate because they do
not have a stable platform.
Have a tape for measuring
waist circumference.
Accurate measurement of waist circumference
requires a simple but accurate tool, that is, a nonstretchable, plasticized measuring
tape. It is suggested that the
tape be 1/4-1/2 inch wide.
Circumference measurements
should be taken at the level of
the iliac crest.
10
15. Measuring tape position for
waist (abdoMinal) circuMference
provide medical nutrition therapy. Services include
nutrition assessment, counseling, education, and
monitoring patient progress. Many payers will also
selectively cover medical nutrition therapy for obesity.
One of the barriers in primary care is inadequate
reimbursement for promoting healthier weight
and intervention with overweight/obese patients.
However, Medicare has recently released a set
of V codes related to care for patients with a
range of BMIs.
Medicare also offers limited reimbursement for
office visits for the evaluation and management
of obesity. As policies are currently in flux, check
with other public and private insurers to see
about reimbursement using these codes.
www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf
For most patients, BMI codes should follow the
primary diagnoses. The codes are included below.
develop a list of local resources for patients.
A simple one-page handout can serve most purposes.
A resource list has been provided in this toolkit and
on the back of Your Weight Health Profile. Local
resources, which can be added, could include
hospital support groups, weight loss groups, dietitians
and nutritionists, behavioral therapists, walking
clubs, walking trails, school and community-based
programs, and commercial weight loss programs
and gyms. The Vermont Department of Health and
your local Vermont Area Health Education Center
(AHEC) are good sources of information, as well as
the www.vermont211.org website.
develop/refine your practice processes so
that assessment, goal setting, referral and
follow-up are integrated in your practice.
Who will be responsible for calculating BMI?
How will you flag patients who have special issues?
Who will provide patients with the resource list?
use billing codes.
For patients with diagnosed diabetes or renal disease,
reimbursement is available for registered dietitians to
v codes for billing by body Mass index (bMi) category
bMi
v code
19
V85.0
19-24
V85.1
25
26
27
28
29
V85.21
V85.22
V85.23
V85.24
V85.25
30
31
32
33
34
35
36
37
38
39
40
V85.30
V85.31
V85.32
V85.33
V85.34
V85.35
V85.36
V85.37
V85.38
V85.39
V85.40
under weight
healthy weight
over healthy weight
obese
Note: If BMI is not already recorded on the patient chart, it can be
easily determined from height and weight using the Adult BMI Chart
included in the appendix of this toolkit.
11
16. Your Role in the Community
What else can you do?
advocate within your community
Health care practitioners are particularly good
role models and advocates – people trust them
because of their expertise and their focus on
health and wellness. These are some ideas for
other activities you can do to raise awareness,
promote prevention, and improve the care of
overweight and obese individuals.
In schools
• Promote healthy meal and beverage choices and
physical education
• Increase access to school facilities for after hours
fitness programs
create a supportive environment in
your clinic
• Staff behavior should be non-judgmental and
support change
• The physical environment (chairs, exam tables, etc.)
should comfortably accommodate larger patients
raise awareness
• Arrange interviews with the local paper and
radio station
• Offer to speak to local groups – parents, seniors,
community organizations
In the work place
• Promote healthy meal and beverage choices
• Promote worksite fitness options
In shops
• Encourage mall walking programs
With community agencies
• Hospitals – encourage nutrition and exercise
programs
• Senior centers – encourage healthy meals,
activity programs
• Support and participate in your fit and healthy
community coalition
With local government
• Support establishment of walking trails and parks
Model healthy behaviors
advocate with your legislators
• Maintain a healthy BMI, eating healthy foods and
being active
• Participate in local fitness events, such as walks,
and fun-runs
• Encourage policies that increase access to
healthcare
• Encourage policies that promote healthy
eating and physical activity
12
17. Foundation Resources for this Toolkit
t
ools in this toolkit were adapted from
these publicly available resources. We
encourage clinicians to go directly to
these resources for additional
background information and guidance.
algorithm bMi Chart
National Heart, Lung, and Blood Institute (NHLBI). Obesity Education Initiative. Clinical Guidelines on the
Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. The Evidence Report.
www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf
using the weight Health profile and Motivational interviewing
American Medical Association (AMA). Roadmaps for Clinical Practice Series: Assessment and Management
of Adult Obesity, Booklet 3. Assessing Readiness and Making Treatment Decisions. Also see Clinical Tools,
Assessment of Patient Readiness (same webpage)
www.ama-assn.org/ama1/pub/upload/mm/433/booklet3-1.pdf
Miller, W.R. and Rollnick, S. Motivational Interviewing, Second Edition: Preparing People for Change.
New York: The Guilford Press. 2002.
Rollnick, S., Mason, P., and Butler. C. Health Behavior Change: A Guide for Practitioners. Edinburgh:
Churchill Livingstone. 1999.
weight Health profile with prescription
National Heart, Lung, and Blood Institute (NHLBI). Aim for a Healthy Weight Education Kit
(for Health Professionals). Tips to Weight Loss Success.
www.nhlbi.nih.gov/health/prof/heart/obesity/aim_kit/tips.pdf
preparing your office
American Medical Association (AMA). Roadmaps for Clinical Practice Series. Assessment and Management
of Adult Obesity, Booklet 9. Setting Up the Office Environment. Also see Clinical Tools, The Office
Environment (same webpage).
www.ama-assn.org/ama1/pub/upload/mm/433/booklet9.pdf
Health Resources and Services Administration (HRSA), Accurately Weighing Measuring: Equipment.
http://depts.washington.edu/growth/module4/text/page1a.htm
serving size portion Control
American Dietetic Association. Food Nutrition Information.
www.eatright.org/cps/rde/xchg/ada/hs.xsl/nutrition.html
United States Department of Agriculture. Center for Nutrition Policy and Promotion.
www.cnpp.usda.gov
13
18. About Us
Vermont Area Health Education Centers
(AHEC) Network
Vermont Department of Health,
Fit Healthy Vermonters
AHEC is a statewide program
working to strengthen
Vermont’s community health
systems and the health of Vermonters; and is a part
nership between the Northeastern Vermont AHEC,
Champlain Valley AHEC, Southern Vermont AHEC,
and the University of Vermont College of Medicine
AHEC Program Office.
Fit Healthy Vermonters
provides a framework for
increasing physical activity
and improving nutrition. It
includes actions to be taken
by government, social service
and health agencies, communities, worksites,
schools, early childcare programs, families and
individuals. And, it calls for changes in policy
to promote and support these actions. For
information on Vermont’s obesity prevention
program, call (802) 863-7330 or visit
www.healthvermont.gov/fitandhealthy.aspx.
AHEC works to increase the supply, stability and
education of Vermont’s healthcare workforce,
and provides a link between the UVM College
of Medicine and Vermont’s communities. This
academic-community partnership is responsive
to state and local needs to train health care
providers. The Vermont AHEC Network is made up
of a program office and three regional centers:
University of Vermont AHEC Program Office
Burlington
(802) 656-2179
www.vtahec.org
Franklin
•Champlain Valley AHEC
Lamoille
•UVM AHEC Program Office
Grand Isle
Champlain Valley AHEC
St. Albans
(802) 527-1474
www.cvahec.org
Northeastern Vermont AHEC
St. Johnsbury
(802) 748-2506
www.nevahec.org
14
Caledonia
Northeastern Vermont AHEC •
Chittenden
Washington
Addison
Orange
Windsor
Rutland
Southern Vermont AHEC•
Southern Vermont AHEC
Springfield
(802) 885-2126
www.southernvermontahec.org
Essex
Orleans
Bennington
Windham
21. Serving Size Portion Control
Helping You Understand Serving Size
Portion Control
What Is A Portion?
A ‘‘portion’’ is the amount of a specific food an individual
chooses to eats for breakfast, lunch, dinner, or snack. There
is no standardized portion size. Portions can be bigger
or smaller than the servings size listed on a food label.
Portion size and serving size have different meanings.
What Is A Serving?
A ‘serving’ is a standard amount used to give advice
about how much to eat, or to identify how many
calories and nutrients are in a food.
It’s important to remember that the “serving size”
is a unit of measure and may not be the “portion”
an individual actually eats.
Why Do Portion Control?
If you are working hard to make better food choices,
but aren’t seeing the results you expected, perhaps
you need to be a bit more careful in portion control.
Overestimating portion sizes can result in extra calories
leading to weight gain.
Watching portion sizes
can help prevent those
extra pounds.
20 years ago, a typical serving of soda was
6.5 oz. and 85 calories. Today, a typical serving of soda
is 20 oz. and 250 calories.
Visuals Measures
Often it is impractical to use measuring cups and
spoons or a food scale to determine reasonable
portion sizes or serving sizes, therefore using simple
visual serving cues and measures can be helpful.
Visual Comparisons
Medium potato
=
1 cup of ice cream =
Average bagel
=
3 oz. grilled fish
=
3 oz. meat
=
1 oz. cheese
=
1 tsp. peanut butter =
computer mouse
baseball
hockey puck
size/thickness of a checkbook
a deck of cards
4 dice or a domino
large grape
Measurement Comparisons
Average-size handful = 1 oz. of chips/pretzels
Average-size index finger = about 1 oz. meat/chicken
Average-size closed fist = 4 oz. skinless chicken breast
on the bone
Average-size woman’s fist = about 1 cup
Average-size man’s fist = about 1 1/2 cups
Average-size last joint of thumb = 1 tsp. of salad
dressing, oil, butter, or cream cheese
Find a drinking glass in your cupboard that serves
8 fluid oz.; or take a permanent marker and draw a
line at the point that serves 8 oz.
Find a bowl that serves a one-cup portion; or use a
permanent marker to draw a portioning line
20 years ago, a typical bagel was 3” and 140 calories. Today, a typical bagel is 6” and 360 calories.
The larger bagel is an extra 200 calories. Eating 22 extra calories a day equals a weight gain of 23 pounds a year.