Waisting Away TM 2012 Empowering “FUTURE” Health Professionals with Weight Management Knowledge / Research / Practice for Health at ANY Size! Hélène Charlebois, RD HC Nutrition Inc. Consulting & Wellness Weight Management Specialist Certified in Adult Weight Management Level 1 & 2 Academy of Nutrition & Dietetics (ADA) Research - Information • Academy of Nutrition & Dietetics AND Weight Management Training level 1 & 2 + new certification • ADA Weight Management DIPG • Canadian Obesity Guidelines • CON – Canadian Obesity Network • • Summit – attend & present on line newsletter, research • DC Obesity Learning Retreat • Blogs by Dr Arya Sharma and Yoni Freedhoff • • • Dr. Sharma's Obesity Notes » blog [[email protected]] Weighty Matters [[email protected]] New - points towards IASO’s Specialist Certification for Obesity Professional Education (SCOPE). The 5 A’s of Obesity Management is a set of practical tools to guide primary care practitioners in obesity counseling and management: • Ask for permission to discuss weight and explore readiness for change • Assess obesity elated health risk and potential “root causes” of weight gain • Advise on obesity risks, discuss benefits treatment options • Agree on realistic weight-loss expectations and on a SMART plan to achieve behavioral goals • Assist in addressing drivers and barriers, offer education and resources, refer to provider, and arrange follow-up What are DIETS? • Billions and billions of $$$ • All diets work • Recent research – 75 years of dieting • Most weight loss is in the 1st 6 months • Skills Treating Patients • • What Docs say? Recommend to lose 21% of their weight UNREALISTIC ! Treat distress not depression On line – 80% want an in home diet plan Apps – in 2010 = $910 million Getting the church involved But… obesity cost was 4.6 Billion in 2008 (usa) and increase of 20% from 2000 • • • • • • • Weigh 1x/week; do something about weight gain Planned and structured; eat similar foods Low calories/fat; 1800 cals + 30% fat Eat breakfast Eat out less than 3 x/wk; fried foods less than 1x/wk Active1 hour per day – simply move more! Less than 10 hours per week of “screen watching” Measuring Obesity • Waist • Men = 102 cm ; women = 88 cm • High risk: men = 90 cm ; women = 80cm South Asian & Aboriginal = High Risk • Hip • Waist to hip • Anthropometric • BIA – In Body – BOD POD- DEXA • How to measure??? Bariatric Surgery • • • Restriction of food • Less eating – size of a golf ball • Less food • How to deal with comfort eating Malabsorptive • Malnourishment – pre and post • Macro / micronutrients Neural & Hormonal • Pathways Bariatric Surgical Options 30 to 80% loss EBW Expanding in Canada Surgery - 5 different procedures Adjustable Gastric Banding Roux en Y gastric bypass – less 50% EBW/ 1st yr Biliopancreatic Diversion/duodenal switch Sleeve Gastrectomy Gastric Ballooning / Endo Barrier What about Fatty Liver Disease? Correcting for Vitamin D deficiency Bypass- 80% ebw • 2 Multivitamin mineral for life • Iron , folic acid and B12 (1200 mmg) • • • Take Vitamin C 500 mg with Iron 300 mg 1 to 3/day Calcium 1200-2000 mg elemental calcium • Liquid or tabs – Citrate is best • No take more than 500 mg at a time • Take even if 2-4 servings of dairy per day Vitamin D – make sure in Calcium Supp. • At least 1000 IU/day • Protein = calculate needs 0.8-1.0 g per kg; 0.91 g/kg actual body weight; 1.5-2.1 g/kg ideal body weight • B12 over time – doc to assess 500 mcg sublingual Why the Weight Loss in Surgical Patients? • At 1 month = decrease in gut hormones then stable • GLP1, incretins, GIP, Amylin, Glucagon, Proinsulin, • • C peptide At months 2 to 12 = decrease FBS, insulin, • decrease in food and absorption Stomach + intestines = largest endocrine system ‘CURE’ for diabetes? Staging System – Dr.A Sharma Need for a better diagnostic system • 0 – obese but not risk factors • 1 – subclinical factors, mild symptoms • 2 – chronic disease, mobility limitations • 3 – end organ damage- significant limits • • Impairment of well being 4 – severe disabilities Hormones affecting weight • Hunger stimulus • • • Hedonic Homeostatic Appetite • Do food addictions exist? Cortisol - brain • Fight or flight hormone • Sleep deprived • Screen watching • Makes you hungry • Increases belly fat • Sleep patterns •Sleep •No before midnight- most sleep before 530 am eating after 8pm + Sleep Deprived Less sleep Increase hedonic stimuli = Increase food consumption Decrease leptin Increase ghrelin & cortisol Trying to reach glucose homeostasis Kids - teens Insulin - pancreas • Stores body fat • High insulin levels = burns carbohydrates • Low insulin levels = burns fat • Therefore, we will burn more fat if eat less carbs Dopamine – brain = Opioid syndrome • The “chocolate” hormone • Hypothesis • Cravings- sweet tooth • Similar to endorphins • Obese = decreased receptors = decreased bliss point Serotonin • Brain • Decrease in winter • Feel good hormone • Estrogen link • Low serotonin • • Decreased hunger • Increased anger SSRIs Ghrelin – gut – hunger hormone • Controls weight • Controls glucose homeostasis • Hunger and appetite • The ONLY hunger hormone Leptin- protein-hypothalmus • Appetite suppressant • Controls appetite • Energy in Energy out gene • Produced by fat tissue • Obese has high leptin but it is resistant NEEDED: a system that will “sensitize” Dopamine Link? Incretin- GLP1 – intestine • Increase insulin secretion • Decrease appetite • Decrease glucagon • • Decrease sugar production by the liver Gets insulin ready New diabetes medication = Victoza,Byetta % Weight Loss • Diet & Exercise- Lifestyle 3 - 5 - 10 % • Pharmacotherapy 5 – 10 - 15 % • Bariatrics 20 - 30- +++ % up to 80% EBW + Food - the nutrient link is broken Food and in Food & Ingredients Increase quantity of high quality foods Decrease quantity of low quality foods Ready to EAT Less protein, fibre, vits, mins More sugar, fat salt More energy +Making Changes –are they ready? HOW? HOW? WHY? • For what? • Ask the question • Healthier living • • Healthier being Easy to lose weight but not easy to keep the weight off • Disease prevention • Must be ready to make lifestyle lifetime changes • Disease state management They came to you… level of readiness More in Behavior section + Clean up your House WHY? HOW? • House needs to be a ”Positive Health Environment” • Look into kitchen cupboards, fridge, pantry • Set up for SUCCESS • Purge “unhealthy” foods • Food availability is too high • Office; desk drawer • Make it healthy • Get rid of your trigger foods – unsafe foods DANGER FOODS Replace with healthier food options + Successful Set Up WHY? • Must keep great tasting healthy foods around you • At all times • Increases your rate of success • Studies show… “out of sight out of mind” HOW? • Fruit & Veggie shopping • Bagged, trays, frozen, fresh, canned…it all counts • Keep some everywhere • Lean meats • Desk drawer • Legumes- new recipes + Choose only whole / sprouted grains Why? Change the box! How? • Eating whole grain, sprouted, high fiber foods • Stick to whole grain, whole wheat product • Keep you fuller, longer • Pasta, brown rice, crackers, cereal • Low GI • No white rice-why? • Try different grains • • Are healthier for you Refined processed starches digest quickly • Sprouted grains + No bagels??? No bananas No white potatoes Why? Change the box! • Bagels- +300 calories • • How? • Choose whole grain breads/ english muffins • Have any other fruit and any other vegetable.. Try to think outside the box… variety is key Available: low GI / 150 calories Bananas and potatoes are favorites so take them out… make a change… you’ll be amazed! + Eat low GI Foods Why? • Keeps you fuller, longer • Generally higher fiber and healthier foods • How? • www.glycemicindex.com • www.diabetes.ca • Eat lots of whole fruits and vegetables • Eat whole grains • Eat lean meats and low fat dairy products • Add fiber to foods Control blood sugars • Control cholesterol level • Gives some boundaries Take with a “grain of salt” + Meal Balancing WHY? HOW? • Nutritionally adequate • See chart and guidelines • All nutrients • HEP sheet • More even distribution of starch and protein • Protein at all meals • More even distribution of starch to protein • Up to 25% protein • Have protein with PM snack + No Starch at Supper WHY? HOW? • Reducing the total calorie intake • Replace your starches with vegetables • Less cals at supper and beyond is key • Use spaghetti squash • Use a bed of corn instead of rice • Starch at supper = • Lots of calories • Use bean sprouts instead of pasta • We LOVE starch • Sweet potato/yams are great • Insulin and belly fat • Ok for starchy vegetables • HS more sedentary • Legumes are great! + Journaling WHY? HOW? • Awareness • See the CFC sheet • Understanding • Same as the “meal balancing” • Patterns • Journaling sheet • Accountability But… most HATE journaling! • Create own • Journaling book / on line • www.myfitnesspal.com • APPS : The Future! Journaling continued • Make journaling effective • Pick your battles • Be realistic • Be flexible • Different journaling strategies • Only HS intake • Only activity • Only after lunch and beyond + Plan your Snacking WHY? HOW? • Small snack = eat less at meal times • Plan a small snack 1 hour before meals • Do not “rip the fridge door off” • AM= 80 calories • Up to 40% total daily calories • • Yogurt, fruit • Too often • Too much-portions • This is the important one • Too calorie dense • Protein + fruit/veg The 4th Meal! • • PM = 100 -150 calories HS = 100 -150 calories • Sweet/salty tooth + Calorie Distribution WHY? HOW? • Calories count • See chart and guidelines • Recent research; all diets work in the short term • HEP sheet • More even distribution throughout the day Meal Balancing Meal balancing = It is important to have a protein at each meal; starches should be whole grains. BREAKFAST=300cals Protein Fruit LUNCH=400-500cals Protein Starch Protein Starch snack Starch 2 Vegetables 2 Vegetables Fruit DINNER=400-500cals Protein + fruit snack 100-150 calories snack HINT: For added weight loss, no starch at supper but load up on the veggies! Calorie Distribution/Protein • Breakfast = Starch 150 cals/20g • am snack = 80 calories/10g • Lunch=St.150 cals; prot.150 cals/20g • pm snack = 100 to 150 calories/10g • Supper = St. 0 cals to 300 cals/20g • hs snack = 100 (150) calories + PROTEIN - U of Texas 20 to 30 grams at breakfast 20 to 30 grams at lunch 20 to 30 grams at supper WHERE THE MEAT! NO MORE NO LESS! + Reintroduce Starch at Supper WHY? HOW? • Because we like it! • No more than 2 times per week • There are special occasions • 1 cup = 300 calories • There are exceptions to every rule • Do not have the starch at lunch OR • BUT…. ½ cup at supper nightly Must be measured Reduce protein + Portion Distortion WHY? • Supersizing • More for less • Restaurant portions • The food container is simply too much • HOW? Our eyes are bigger than our stomachs Bottom line We just eat too much! • Label reading • Be visual • Change the plate • Show portions of food • Food models? calories • Measure it out • We are not good at eye balling Load up on veggies 2-3 fruit per day + Vegetable 1st on Plate HOW? WHY? • • • Our eyes are bigger than our stomachs We always put more of the first item on our plates Research Xmas • Put vegetables 1st on the plate • Then the protein • Lastly is starch + Set up Buffet WHY? HOW? How you set up the plates Always put veg 1st How you set up your counter for plate preparation Then protein Last starch It makes a difference Try this at home… you will be AMAZED! + Eat close to farm WHY? • This is my motto • Very simple concept • Farm foods are usually: • Lower in calories • Higher in fiber • Bountiful • More filling • Keeps you fuller longer • More nutritious • Eat whole foods HOW? • If the food comes from the farm, eat it… if the food leaves the farm, judge it. • Give some examples • apple vs apple sauce vs apple juice + Damage control WHY? • • We all “cheat” but our patients feel guilty about it HOW? • 2 types of damage • Planned = sandwich it in • Unplanned = 48 to 72 hours revenge Feel good about it • Plan it • Move on Don’t get angry get even! + Eating Out WHY? • HOW? See internet Plan choices on line Do not take menu Take away the guilt Many handouts available Trading off choices ‘Heart & Stroke Ontario’ Move away from the bread Order 1 item at a time Because it is part of life RUIN IT! www.myfitnesspal.com TRAVELLING? + Beverages Count WHY? HOW? • Hidden calories • Labels for portion sizes • You would not believe • Show glasses, cups • Portion distortion • Journal beverage intake for one week • Single serving sizes are just too big • Count calories on beverage intake • Clear on Calories Initiative New journal Snack & Beverages Diet pop? Meal Replacements (cont’d) Why? • Quick & Easy • Controlled eating – no thinking • Eliminate complex food choices • Eliminate complex meal planning Waisting Away TM Weight Management Strategies What about Protein Shakes? Stomach = volume detector Intestine = nutrient detector Saliva = brain –nutrient detector Chewing & Tasting Exercise / Activity STRUCTURED UNSTRUCTURED Anti-Sedentary Movement % effect on weight loss? Weight is Food; Health is FOOD & FITNESS Cardio What does it do? How to do it • Burns the visceral fat • Walk, run, bike • Keeps the heart muscle strong • Group sports • Soccer, hockey • Is fun! • Family Fun • Skating, skiing, tobogganing , biking Strength Training What does it do? • • • • Preserves lean body mass Sense of accomplishment Great to keep your muscles as you age Osteoporosis prevention How to do it • Sit ups – push ups • Pilates – yoga • Weights • Exercise ball • Bands • Gym machines • Use your body • Lunges Flexibility • Stretching • Mobility • Motion • Increased quality of life (QOL) HOW? Morning stretches Yoga How much EXERCISE? • Health Improvement = 150 minutes / week • Weight Loss = 150 to 250 minutes / week • Significant Weight Loss = + 250 minutes/wk • Weight Gain Prevention (after wt loss) • + 250 minutes / week Is this unrealistic? N E A T phenomenon Walk at Lunch time + WHY? HOW? • Only time for one’s self • Eat ½ lunch • Get out of work • Go for a walk • Peace of mind • Eat the other ½ lunch • Change of scenery • Bring runners to work • All around health • Bag lunch = more time to walk • Buy lunch = must get out and go for a walk but… • www.tractivityonline.com • Mind • Body • Soul What about your Metabolic Rate? “You HAVE to eat LESS BUT You WANT to eat MORE!” We are not balanced! Lose 1% / year Pharmacotherapy • Xenical – orlistat • Meridia – Sibutramine- off market • Approval ?? = Qnexa, Lorcaserin, Belvic • High Fibre Products • Why use? Needed for the disease of Obesity??? Non-Prescription Medication High Fibre Products HOW? WHAT? Metamucil PGX Expands in stomach Keeps you fuller longer Less 28 kcals/day= 1.7 kg per year wt loss Great for between meal hunger Or take before a meal to eat less Mix in juice, yogurt, applesauce, pudding Mix with water; drink 15 minutes before your meal. Waisting Away TM Weight Management Strategies + PGX HOW? WHY? Powder or capsules Great as a snack PM or HS Keeps you fuller longer Has 3 different types of fiber Konjac-mannan ( root) Sodium alginate Xanthan gum Mix in with yogurt, applesauce, pudding Do not let it sit too long Individual sticks for the office; large can for the home No dairy, corn, soy, starch, wheat, yeast Veronica Kacinik [vkacinik@functionalmedicine. ca] www.pgx.com. Other wt loss pills & potions • RASPBERRY KETONES – Slendesta • Pure green coffee extract • African Mango • Herbal products – orange peel? • Chocolate – Acai –Chocolate with soluble fibres • Ephedra • USA commercials • Product availability BANDAID SOLUTIONS! Weight Maintenance- Summarized WE must prevent HUNGER • • • • • • • Low fat calorie conscious eating Planned structured eating Eat breakfast daily Monitor your weight High daily levels of activity Less screen watching Simply move more! Maternal Weight Gain – not anymore! Overweight = 3x increase wt of baby ; obese = 7x CON – U of O BMI over 40 = safe to decrease 5 kg 4.1 kg weight loss is optimal Who is to blame? • • • The environment? You? Reality – Obesity is a complex issue. It requires a collaborative approach, with health professionals, gov’t and industry. Education is key! The ‘NO’ Factor Study • 84 hour period of TV watching • Keeping track of the foods that are advertised • Compared to the Daily Values • 2560% over for sugar • 2080% over for fat • 40% less for vegetable consumption • 32% less for dairy consumption • 27% less for fruit consumption Neighborhood FOOD DESERTS More fast food choices = more sick and disease = obese neighborhoods •Access to unhealthy food choices •Price SOLUTIONS? Calories on Menus? Calorie Literacy? Society on the Go! Feel – Think – Enjoy Nourish – Smell – Taste - Not aware of 90% of Think our food choices Nourish - 62% too busy to Live sit down to eat Adjust Awareness Journal - observations + Joint Decision Making YOU YOUR CLIENT • Roll with the punches • Self efficacy • No resistance • Personal goals • Empathy • It’s all about them Call to Action – stop, continue, start Waisting AwayTM Manual – NEW! Www.lowgimeals.com http://www.1shoppingcart.com/app/?af=1488220 Nancy Guppy’s menus Go to www.chicken.ca [email protected] Nutrition Fact Sheets # 6 on Tracking Weight Loss General Health, Women’s Health, Diabetes, Heart, Sodium, Screen Watching, Healthy Snacks Food Journals – Snack & Beverage Journals Websites www.hcnutrition.com www.obesitynetwork.ca www.myfitnesspal.com www.calorieking.com www.nutritiondata.com www.sparkpeople.com www.fitday.com www.glycemicindex.com www.myFoodDiary.com www.dietsinreview.com www.eatrightontario.org www.dietitians.ca talk to an RD – snack list meal planners, eat tracker
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