Post on 16-Dec-2015
transcript
Hélène Charlebois, RDHC Nutrition Inc. Consulting & Wellness
Weight Management Specialist Certified in Adult Weight Management
Level 1 & 2 Academy of Nutrition & Dietetics (ADA)
Waisting AwayTM 2012
Empowering “FUTURE” Health Professionals Empowering “FUTURE” Health Professionals with Weight Management Knowledge / Research with Weight Management Knowledge / Research
/ Practice for Health at ANY Size!/ Practice for Health at ANY Size!
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 [amsharm@ualberta.ca] • Weighty Matters [yonifreedhoff@gmail.com]
• New - points towards IASO’s Specialist Certification for Obesity Professional Education (SCOPE).
www.hcnutrition.com
• 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
The 5 A’s of Obesity Management is a set of practical tools to guide primary care practitioners in obesity counseling and management:
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 Options30 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 before midnight- most sleep before 530 am•No 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 & 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
Food and in
+Making Changes –are they ready?
• For what?
• Healthier living
• Healthier being
• Disease prevention
• Disease state management
They came to you…
level of readiness
• Ask the question
• Easy to lose weight but not easy to keep the weight off
• Must be ready to make lifestyle lifetime changes
More in Behavior section
WHY? HOW?HOW?
+Clean up your House
• House needs to be a ”Positive Health Environment”
• Set up for SUCCESS
• Food availability is too high
• Make it healthy
• Get rid of your trigger foods – unsafe foods
DANGER FOODS
• Look into kitchen cupboards, fridge, pantry
• Purge “unhealthy” foods
• Office; desk drawer
Replace with healthier food options
WHY? HOW?
+Successful Set Up
• Must keep great tasting healthy foods around you
• At all times
• Increases your rate of success
• Studies show… “out of sight out of mind”
• Fruit & Veggie shopping
• Bagged, trays, frozen, fresh, canned…it all counts• Keep some everywhere
• Lean meats
• Desk drawer
• Legumes- new recipes
WHY? HOW?
+Choose only whole / sprouted grains
Why? Change the box!
• Eating whole grain, sprouted, high fiber foods
• Keep you fuller, longer
• Low GI
• Are healthier for you
• Refined processed starches digest quickly
How?
• Stick to whole grain, whole wheat product
• Pasta, brown rice, crackers, cereal
• No white rice-why?
• Try different grains• Sprouted grains
+No bagels??? No bananasNo white potatoes
Why? Change the box!
• Bagels- +300 calories• Available: low GI / 150 calories
• Bananas and potatoes are favorites so take them out… make a change… you’ll be amazed!
How?
• Choose whole grain breads/ english muffins
• Have any other fruit and any other vegetable.. Try to think outside the box… variety is key
+Eat low GI Foods
• Keeps you fuller, longer
• Generally higher fiber and healthier foods
• Control blood sugars
• Control cholesterol level
• Gives some boundaries
Take with a “grain of salt”
• 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
Why? How?
+Meal Balancing
• Nutritionally adequate
• All nutrients
• More even distribution of starch and protein
• See chart and guidelines
• HEP sheet
• Protein at all meals
• More even distribution of starch to protein
• Up to 25% protein
• Have protein with PM snack
WHY? HOW?
+No Starch at Supper
• Reducing the total calorie intake
• Less cals at supper and beyond is key
• Starch at supper =• Lots of calories
• We LOVE starch
• Insulin and belly fat
• HS more sedentary
• Replace your starches with vegetables
• Use spaghetti squash
• Use a bed of corn instead of rice
• Use bean sprouts instead of pasta
• Sweet potato/yams are great
• Ok for starchy vegetables
• Legumes are great!
WHY? HOW?
+Journaling
• Awareness
• Understanding
• Patterns
• Accountability
But… most HATE journaling!
• See the CFC sheet
• Same as the “meal balancing”
• Journaling sheet• Create own
• Journaling book / on line
• www.myfitnesspal.com
• APPS : The Future!
WHY? HOW?
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
• Small snack = eat less at meal times
• Do not “rip the fridge door off”
• Up to 40% total daily calories• Too often• Too much-portions• Too calorie dense
• The 4th Meal!
• Plan a small snack 1 hour before meals
• AM= 80 calories• Yogurt, fruit
• PM = 100 -150 calories• This is the important one• Protein + fruit/veg
• HS = 100 -150 calories• Sweet/salty tooth
WHY? HOW?
+Calorie Distribution
• Calories count
• Recent research; all diets work in the short term
• More even distribution throughout the day
• See chart and guidelines
• HEP sheet
WHY? HOW?
Meal Balancing
Protein
Fruit Starch
Protein Starch
2 Vegetables
FruitProtein + fruit
100-150calories
Protein Starch
2 Vegetables
Meal balancing = It is important to have a protein at each meal; starches should be whole grains.
BREAKFAST=300cals LUNCH=400-500cals DINNER=400-500cals
snack snack 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
NO MORE NO LESS!
WHERE THE MEAT!
+Reintroduce Starch at Supper
• Because we like it!
• There are special occasions
• There are exceptions to every rule
• BUT….
• No more than 2 times per week
• 1 cup = 300 calories
• Do not have the starch at lunch
OR
½ cup at supper nightly
Must be measured
Reduce protein
WHY? HOW?
+Portion Distortion
• Supersizing
• More for less
• Restaurant portions
• The food container is simply too much
• 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 veggies2-3 fruit per day
WHY? HOW?
+Vegetable 1st on Plate
• 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
WHY? HOW?
+Set up Buffet
How you set up the plates
How you set up your counter for plate preparation
It makes a difference
Always put veg 1st
Then protein
Last starch
Try this at home… you will be AMAZED!
WHY? HOW?
+Eat close to farm
• 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
• 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
WHY? HOW?
+Damage control
• We all “cheat” but our patients feel guilty about it
• Feel good about it
• Plan it
• Move on
• 2 types of damage
• Planned = sandwich it in
• Unplanned = 48 to 72 hours revenge
Don’t get angry get even!
WHY? HOW?
+Eating Out
• Because it is part of life
RUIN IT!
Many handouts available
‘Heart & Stroke Ontario’
www.myfitnesspal.com
See internet
Plan choices on line
Do not take menu
Take away the guilt
Trading off choices
Move away from the bread
Order 1 item at a time
TRAVELLING?
WHY? HOW?
+Beverages Count
• Hidden calories
• You would not believe
• Portion distortion
• Single serving sizes are just too big
New journal
Snack & Beverages
• Labels for portion sizes
• Show glasses, cups
• Journal beverage intake for one week
• Count calories on beverage intake
• Clear on Calories Initiative
Diet pop?
WHY? HOW?
Why?
• Quick & Easy
• Controlled eating – no thinking
• Eliminate complex food choices
• Eliminate complex meal planning
Meal Replacements (contMeal Replacements (cont’’d)d)
Waisting Away Waisting Away TMTM Weight Management Weight Management StrategiesStrategies
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
What does it do?
• Burns the visceral fat
• Keeps the heart muscle strong
• Is fun!
How to do it
• Walk, run, bike
• Group sports• Soccer, hockey
• Family Fun• Skating, skiing,
tobogganing , biking
Cardio
• Preserves lean body mass
• Sense of accomplishment
• Great to keep your muscles as you age
• Osteoporosis prevention
• Sit ups – push ups
• Pilates – yoga
• Weights
• Exercise ball
• Bands
• Gym machines
• Use your body• Lunges
Strength Training
What does it do? How to do it
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
• Only time for one’s self
• Get out of work
• Peace of mind
• Change of scenery
• All around health• Mind• Body• Soul
• Eat ½ lunch
• Go for a walk
• Eat the other ½ lunch
• Bring runners to work
• Bag lunch = more time to walk
• Buy lunch = must get out and go for a walk but…
• www.tractivityonline.com
WHY? HOW?
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???
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.
Non-Prescription MedicationHigh Fibre Products
HOW?WHAT?
Waisting Away Waisting Away TMTM Weight Management Weight Management StrategiesStrategies
+PGX
Powder or capsules
Keeps you fuller longer
Has 3 different types of fiber Konjac-mannan ( root) Sodium alginate Xanthan gum
No dairy, corn, soy, starch, wheat, yeast
www.pgx.com.
Great as a snack PM or HS
Mix in with yogurt, applesauce, pudding
Do not let it sit too long
Individual sticks for the office; large can for the home
Veronica Kacinik [vkacinik@functionalmedicine.ca]
WHY? HOW?
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?
- Not aware of 90% of
our food choices
- 62% too busy to
sit down to eat
Think
Nourish
Live
Adjust
Awareness Journal - observations
Society on the Go!Feel – Think – EnjoyNourish – Smell – Taste
+Joint Decision Making
• Roll with the punches
• No resistance
• Empathy
• Self efficacy
• Personal goals
• It’s all about them
YOU YOUR CLIENT
Call to Action – stop, continue, start
Waisting AwayTM Manual – NEW!
Www.lowgimeals.com
http://www.1shoppingcart.com/app/?af=1488220
Nancy Guppy’s menus dietitian@chapmanslanding.com
Go to www.chicken.ca 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 talk to an RD – snack list
www.dietitians.ca meal planners, eat tracker