Learning Objectives
Describe the state of the science in weight management research.
Articulate a realistic approach to weight management in Job Corps.
Utilize tools to help students manage their weight.
In Summary
A toxic, obesity-causing environmentGenetics that tell use to eat when
food is availableContradictory information about
what’s healthyOverly simplistic messages to eat less
and exercise more
Success Defined
Drop out rate of less than 20% 20-40% maintain weight loss Weight loss is modest, sustained, and clinically
significant 8 pounds=reduced diabetes 6 pounds=reduced BP/drugs 1.8 pounds=24% reduction in all-cause mortality
at 10.5 yrs.
Source: Powell, L.H. et al. (2007). Effective obesity treatments. American Psychologist.
62(3); 234-246.
What Makes a Program Successful?
Intensive phase followed by indefinite follow up
Meet at least once a week Specific dietary changes, calorie reduction,
and exercise combined Draw on skills of experienced behavior
professionals (self-monitoring, modeling, environmental restructuring, and group and individual support)
Source: Powell, L.H. et al. (2007). Effective obesity treatments. American Psychologist.
62(3); 234-246.
MI Questions
On a scale of 1-10, how ready do you feel to change your eating patterns or lifestyle behaviors? What would it take to move you to a [higher number]?
How is your current weight affecting your life right now? How do you feel about that?
Source: Puhl, R. (2011). The Obese Patient in the Healthcare Environment. Available at: http://www.medscape.com/viewarticle/749440?src=mp&spon=17
MI Questions
What strategies have worked for you in the past?
What makes you feel like you can continue to make progress if you decide to?
What are your obstacles? How do you think you can overcome [insert obstacle]?
MI Questions
What are your hopes for the future if you are able to become healthier?
How would your life be different if you lost weight and adopted a healthier lifestyle?
Slow gain Diet Regain Diet Regain Diet120
130
140
150
160
170
180
190
200
Yo-Yo DietsSlow Gain
Weight Cycling
Source: Cereda, E. (2011). Weight cycling is associated with body weight excess and abdominal fat: A cross-sectional study. Clinical Nutrition. [Epub ahead of print]
Benefits
Societal benefitsPopulation focusMaintaining weight is a whole lot
easier than losing weight Integration into parenting classes
Change Focus
“We focus too much on diet and not enough on physical activity; and we focus too much on losing weight and not enough on keeping it off”
Most weight loss programs focus primarily on dietary restriction, and we know those are not generally successful
(http://xnet.kp.org/permanentejournal/sum03/registry.html)
What is not a SMART goal?
Walk 5 minutes a dayJoin a sports team/dance teamGet healthyWalk 1 mile per day, 5 days a week
SMART Activity
Goal Setting WorksheetDiscussion questions
How would you use this on your center?Is anyone using this on center now?
Move It!
Sports (soccer, volleyball, softball, basketball, running club, jogging club, walking club, etc.)
Dance (hip hop dance, Greek organization stepping, Latin dance, belly dancing, urban dance, aerobics class, step class, dance competitions)
Mind/Body or Stress Reduction Activities Gym Workout Interactive Gaming [Wii Sports™ or Wii Fit™
games, video dance games like Dance, Dance Revolution (DDR)™]
Step Up to Help
Making a Difference MSNBC- Obesity Story in DC “Step up to Help”
http://www.msnbc.msn.com/id/21134540/vp/43286952#43286952
A Consideration
Need to consider the specific needs of overweight teens/young adults
Overweight children may experience negative consequences of participation in activities considered appropriate for normal-weight children
American Heart Association Childhood Obesity Research Summit: Executive Summary
Adding Healthy Choices
Source: Boutelle, K.N. et al. (2011). Nutritional quality of lunch meal purchased for children at a fast-food restaurant. Childhood Obesity. 7(4), 316-322.
Food Selection (teenson a visit to McDonald’s)
Percentage
French Fries 33.0%
Apple Dippers 0.3%
Soda 96.7%
Milk and apple juice combined 3.3%
Baked apple pie 8.6%
Fruit and yogurt parfait 0.8%
Placement Strategies
Place the most nutritious foods at the front of the line (increase 10-15%)
Use descriptive food labels (increase 27%) Give choices of vegetables Use trays (promotes salad consumption) Shrink the breakfast bowl (decrease serving by
24%) Pull the salad bar away from the wall Put fruit in colorful bowls
Source: Wansink, B. et al. (2010). Lunch line redesign. New York Times. http://www.nytimes.com/interactive/2010/10/21/opinion/20101021_Oplunch.html.
The Point…
Serving healthy food increases the chances that people will eat healthy, but it doesn’t mean that people will choose it
Need some tricks
Discussion Topics and Worksheets
How Can You Eat Healthy When You Eat Out?
Navigating a Grocery StoreHealthy ChoicesFamily and Food
Types of Motivation
No Motivation
Extrinsic Motivation Intrinsic Motivation
N/A External Somewhat External
Somewhat Internal
Internal Internal
Will not make a
change on their own
External rewards and punishments, controlled by
others
Self-control,ego, avoid guilt, pride
Accepted as
personally important,
value system
Behavior is part of
the person, synthesis, outcome
based
Interested in behavior,
find enjoyment in the process
Source: Ryan RM, Deci EL. Self-Determination Theory and the Facilitation of Intrinsic Motivation, Social Development, and Well-Being. American Psychologist. 55(2000)68-78.
What Drives Eating Decisions?
Health Taste Cost Convenience
Source: O’Hagan, M. (2011). State still seeks winning strategy against childhood obesity. The Seattle Times. June 20, 2011.
The Correct Order
1. Taste2. Cost3. Convenience 4. Health
Source: O’Hagan, M. (2011). State still seeks winning strategy against childhood obesity. The Seattle Times. June 20, 2011.
What Drives Eating Decisions?
1. Taste2. Cost3. Convenience 4. Health
Source: O’Hagan, M. (2011). State still seeks winning strategy against childhood obesity. The Seattle Times. June 20, 2011.
Unhealthy=Tasty Intuition
People enjoy food more if they think it’s unhealthy
Belief about the food affects the experience
Source: Raghunathan, R. (2006). The unhealthy=tasty intuition and its effects on taste inferences, enjoyment, and choice of food products. Journal of Marketing. 70(4), 170-184.
Decadent
Healthy
Activity
Body Image WorksheetDiscussion
What did you get out of this worksheet?/What would a student get out of this worksheet?
How could you use this on center?
Education ≠ Change
“Health education is the most common approach to obesity treatment in clinical practice today despite the absence of empirical support for its efficacy. Education may be necessary but does not appear to be sufficient to promote any lasting change.”
Source: Powell, L.H. et al. (2007). Effective obesity treatments. American Psychologist.
62(3); 234-246.
Perspective Change
When knowledge alone rarely leads to behavior change what do we do?
Change your perspectiveSmall changes should become
“habits” and become a way of life
Supportive Environment Now and Later
Individuals with obesity receive numerous instructions about what to do to address their weight, but very few are given appropriate long-term guidance or support with which to follow through those instructions
Understanding the positive role of social networks may be particularly important in engaging individuals in physical activity
Source: They all work...when you stick to them
Now What?
Often times students learn basic nutritional information but why not teach them to cook?
Others may be afraid to try new foods
Navigating the Grocery Store
What we can do in Job Corps? We can use HEALs
The Grocery store fieldtrip suggestion in the heals toolkit
Navigating the Grocery StoreNavigating the Grocery Store
Step 1. Find a recipe in a cookbook or online that sounds appealing. It should be something that you feel that you would be able to make without too much difficulty. Your recipe should have at least five ingredients but not more than 10. Do not count water or salt and pepper in your ingredient list. Step 2. Make a grocery list in the chart below. Be sure to include how much of every ingredient you need in the “Amount needed” column. Before going to the store, the first two columns should be completed. Step 3. As a class, you will visit a grocery store and shop for your items. Step 4. While at the grocery store, complete the “Cost of item” column in the chart below by locating the least expensive items available to make the recipe you selected. (Make sure you look at the different brands to comparison shop. Sometimes the least expensive will be the store (generic) brand. Other times it may be the brand that comes in the smallest container that fits your needs. Sometimes it might be an item that is on sale.) Recipe name: Item Amount needed Cost of item
Total cost
Nothing Succeeds Like Success
Goal Setting: Think again to SMART goals to set yourself up for success and not failureConsecutive goals that move you ahead
in small steps are the best way to reach a distant point
Consecutive rewards keep the overall effort invigorated
Part of the WE CAN! Program from nhlbi
Rewards
Reward Success (But Not With Food!!)A movie or music CD, or a payment
toward buying a more costly itemDefine Success
Stepping on the scale daily vs. trying on an old pair of jeans you want to wear again.
Fighting the Fight
We as humans are programmed to eat, we are pleasure seekersBut if we are able to teach ONE new skill
or healthy behavior, we should consider it a success.