Non-pharmacological management of obesity

Dr. Louay Labban, RD, FADA

Why are you obese?Why are you obese?

• Greed and uncontrolled appetiteGreed and uncontrolled appetite• Laziness and sedentary lifestyleLaziness and sedentary lifestyle• No willpowerNo willpower• Low metabolic rateLow metabolic rate• GeneticsGenetics• Eating disordersEating disorders

ALL answers are WrongALL answers are Wrong

• You’re obese because you eat You’re obese because you eat too much.too much.

But why do you eat too much?But why do you eat too much?

You eat because you’re hungry.You eat because you’re hungry.

So fat people get hungrier than thin So fat people get hungrier than thin people?people?

Obesity vicious cycle

Fat people eat more

Fat people get fatter

Fat people feel hungrier

Evolution 1

Evolution 2

Weight increase

Expenditure

Energy intake

Burger queen

Weight loss

Expenditure

Energy Intake

Normal Weight

Expenditure Energy intake

Mayo clinic 6 points strategy

• 1. Make a commitment• 2. Get emotional support• 3. Set a realistic goal• 4. Enjoy healthier foods• 5. Get active, stay active• 6. Change your lifestyle

Calories Reduction

Dietary Physical Activity

Non-drug Obesity management

Life-Style modification

Evidence for effectiveness and efficiency

LossLoss Maintenance/Maintenance/ PreventionPrevention

• DietDiet ++ ++ ++• Physical activityPhysical activity + + ++++• CombinedCombined +++ +++ +++ +++

It’s all about balance

Energy in = Energy out =Food and drinks Physical activity

Physical activity

• Light exercises that can be done easily• 30 minutes of walking a day for 5 days• Limit time spent in front of the TV or computer

and spend the time moving your body• Always opt for stairs versus elevators and

escalators• Dance

• Use your car sparingly• Encourage family members to bike to school• Ride the exercise bike while watching TV• Walking groups• Make kids play outdoors rather than watching

TV

How to burn extra 200 kcal

• Washing car for 30 minutes• Gardening for 45 minutes• Dancing for 20 minutes • Pushing a baby stroller for 30 minutes• Shooting basket for 30 minutes• Biking for 30 minutes ( 7 kcal/min )• Swimming for 20 minutes ( 11 kcal/min )

• Running for 17 minutes ( 12 kcal/min )• Sitting for 2 hr and 13 minutes ( 1.5 kcal/min )• Washing dishes for 50 minutes ( 4 kcal/min)

Daily calorie deficit

5 pounds 10 pounds 15 pounds 20 pounds 25 pounds

200 87 175 262 350 438

400 44 88 131 176 219

500 35 70 105 140 175

700 25 50 75 100 125

800 22 44 66 88 109

1,000 17 35 52 70 88

1,500 12 23 35 46 58

Expected weight loss in days

Dietary guidelines:• Decrease calories• Eat food that make you feel full• Reduce fat intake• Reduce sugar intake• increase complex CHO• Include low-fat dairy products

• Include lean meat and substitutes• Include fruits and vegetables (> 5/day)• Limit sweet drinks, alcohol, and salt• Make lunch your biggest meal• Drink 8 cups of water at least• Keep diary for food consumed and weight• Take supplements

Small Changes Each Day Add Up…

Diet over regular soda, 1 can....... 7 kg / year 1 Candy bar / day...........................13 kg / year Skim milk over whole, 1cup.......... 3.5 kg / year 1Tbs mustard instead of mayo......4.5 kg / year 2 Scoops ice cream/day................ 17 kg / year Apple juice, 8oz cup..................... 6 kg / year Orange juice, 8oz cup................... 5 kg / year

Lifestyle modification

• Meal planning• Reduce portion size• Eat breakfast always• Protein on breakfast• Encourage semi-solid meals• Healthy snacking between meals 2-3 snacks• Read the label

Reduce portion size

Healthy snacks

Fad diets

Categorization of Diets by CHO and Fat

Dean Ornish Diet<10% Fat

Pritikin Diet<15% Fat

Weight Watchers, Jenny Craig, DASH diet, Food Guide Pyramid

55-60% CHO <30% Fat

The Zone Diet40% CHO 30% Fat

Carbohydrate Addicts Diet< 30% CHO

Atkins (20-60g CHO), Protein Power (<60g CHO), VLCD-protein sparing modified fast

< 20% CHO

Riley RE. Clinics in Sports Medicine. 18(3):691-701, 1999.

• VLCD is not recommended if < 1000 kcal/day unless supervised by a health care professional

High Protein Diets:Possible Adverse Effects

• Increases in serum uric acid • Kidney stones• Osteoporosis• Chronic renal insufficiency• Ketosis• High Saturated Fat • Low Fruits, Vegetables and Grains

Conclusion• Calories reduction is the best way for weight

loss• This has to be incorporated with increased

physical activity and lifestyle modification• Reduction of 500 kcal / day can result in ½ kg

weekly or 22 kg annually

Recommendations

• Aim for slow weight loss versus rapid weight loss• Stay away from diets that promise rapid results• Balance your calories• Do not drink your calories• Increase your physical activities• Decrease your portion size

Thank you for listening