Weight Control and Nutrition

Weight Control

Treatment Options: Popular Diets

Diets high in carbohydrates and moderate fat and protein

• Examples: DASH Diet, Weight Watchers (WW)

• Energy deficits between 500-1000 kcals/day

• Macronutrient distribution: 55-60% carbohydrate, 20-30% fat, and 15-20% protein

Diets low in carbohydrates and high in fat and protein

• Examples: Atkins, Paleo, Sugar Busters

• Advocate carbohydrate restriction instead of calorie restriction.

• Promote ketosis – using fat as an energy source

• Long-term health benefits are currently unknown

Detox Diets (Diet Cleanse or Juicing)

• Recommendations:

  • Liquid diets, fasting, or removing processed foods and other specific foods (sugar, gluten, dairy, etc.)

• Efficacy:

  • Lack of research to support their use

• Dangers:

  • Lack of energy

  • Overeating once going off the diet

• Body's natural detoxification process:

  • Toxins excreted through urine, feces, respiration, and sweat

  • Liver, kidneys, skin, and lungs help remove toxins daily

• Importance of a healthy diet:

  • Rich in fiber, fruits, and vegetables

  • Adequate fluid consumption

Intermittent Fasting

• Techniques:

  • Alternate day fasting

  • Modified fasting

  • Time-restricted fasting

• Efficacy:

  • Long-term effects not yet known

  • Some results are contradictory

• Negative effects:

  • Hunger, decreased concentration, overeating after a fast

  • Nutrient deficiencies

• Not recommended for:

  • Individuals with diabetes

  • Pregnant or breastfeeding women

  • Anyone with a history of eating disorders

Treatment Options: Characteristics of Successful Weight Loss and Weight Maintenance

Characteristics of Successful Weight Loss and Weight Maintenance

• Set realistic goals

• Gradual weight loss recommended: \frac{1}{2} to 2 pounds per week

• Calorie intake: >1200 kcals a day (Difficult to obtain necessary nutrients if below 1200 kcals a day)

• Goal setting should be:

  • Specific

  • Reasonable

  • Measurable

The Math

• To lose one pound, you must create a deficit of 3500 kcal.

• To lose a pound in 1 week (7 days), cut back on kcal intake and increase physical activity to create a deficit of about 500 kcal per day.

• -500 \text{ kcal} \times 7 \text{ days} = -3500 \text{ kcal} \approx 1 \text{ pound of weight loss}

Characteristics of Successful Diets

• Eat smaller portions of energy-dense foods.

• Encourage low energy density foods like fruits, vegetables, whole grains, and lean proteins.

• Encourage a variety of foods.

• Maintain food records.

• Incorporate behavioral modification.

Exercise

• May need 60-90 minutes per day (does not have to be continuous).

• Activity Monitors – Measure daily steps (aim for 10,000 steps per day).

• Exercise with others.

• Find an activity you enjoy.

• Incorporate activity into your daily life by parking farther away or walking to a coworker's desk instead of emailing.

National Weight Loss Registry

• Weight loss of > 30 pounds maintained for > 1 year

• 78% eat breakfast every day.

• 75% weigh themselves at least once a week.

• 62% watch less than 10 hours of TV per week.

• 90% exercise, on average, about 1 hour per day.

• Self-monitor by keeping a food log.

• Eat at restaurants only 1-2 times per week.

Treatment Options: Non-Dieting Approach

Non-Dieting Approach: Intuitive Eating

• Rejects dieting mentality.

• Diets restrict intake and encourage ignoring hunger cues.

• Diets tell us not to trust our own body and cues that we are hungry or have an appetite for a certain food.

• Diets tell us certain foods should be restricted or avoided (good and bad foods).

  • Leads to feeling guilty for eating “bad” foods.

  • These “bad” foods are everywhere, making us want those foods more – leading to feeling deprived.

Research shows dieting can:

• Increase body dissatisfaction

• Increase risk for eating disorders

• Result in weight gain when stopping diet

Key Principles of Intuitive Eating

• Not a diet or set of rigid rules.

• Less focus on weight loss.

• Interoceptive awareness – ability to perceive physical sensations that arise within your body (hunger, fullness).

  • When we are young, we listen to these cues of hunger and fullness but learn to ignore these sensations as we get older.

• Honor your hunger

• Eat what you want in a pleasant environment. All food allowed.

• Involves rational thoughts.

How to help kids maintain intuitive eating:

• In infants, look for signs of hunger and fullness.

• Allow toddlers to self-feed (caregivers have to provide a variety of food).

• Let children pick foods for meals and determine what and how much they eat.

Treatment Options: Weight Loss Medications

Weight Loss Medications

• Criteria:

  • For individuals with BMI > 30 or >27 with obesity-related health risk

  • Lifestyle changes are still necessary

  • Need prescription for these medications

Specific Medications:

• Xenical

  • Inhibits the production of fat-digesting enzymes from the pancreas

  • Fat consumed is not digested and is excreted

  • Can lead to the loss of fat-soluble vitamins

  • Side effects: GI pain, oily stools

  • Patient must follow a low-fat diet to avoid the above symptoms

• Qsymia

  • Combination of phentermine (an appetite suppressant) and topiramate (a seizure medication)

  • Side effects: Increased heart rate and birth defects (oral clefts)

  • Must not be used during pregnancy

Treatment Options: Bariatric Surgery

Bariatric Surgery: Types of procedures

• Gastric Banding

• Gastric Bypass

• Sleeve Gastrectomy

Bariatric Surgery

• Criteria:

  • BMI > 40

  • BMI > 35 with obesity-related health concerns

  • Obesity present for min. 5 years, with several non-surgical attempts to lose weight

  • No history of alcoholism or major psychiatric disorders (person must be able to follow a special diet and follow up with medical care)

• Potential benefits:

  • Weight loss

  • Decrease in blood pressure

  • Drop in cholesterol level

  • Decrease blood glucose level

• Potential risks:

  • Regain weight

  • Infections

  • Nutrient deficiencies (Vitamin D, Vitamin B12) - requires nutrient supplementation

Behavior Modification

• Important component of any weight loss program

• Modify problem (eating) behaviors

  • Chain-breaking

  • Stimulus control

  • Cognitive restructuring

  • Contingency management

  • Self-monitoring

Chain-Breaking

• Breaking the link between two behaviors (these links can lead to excessive intake)

  • Example: Snacking while watching T.V.

Stimulus Control

• Altering the environment to minimize the stimuli for eating

• Must change the environment, puts you in charge of temptations

• Example: Not buying cookies and chips @ store and not driving by fast food

Cognitive Restructuring

• Changing your frame of mind regarding eating

• Examples:

  • Instead of thinking, "I gained 2 pounds this week, I can’t do this I am going to eat whatever I want,”
    think: “I have lost a total of 30 pounds, this was a rough week, but I know what I need to do to get back on track.”

Contingency Management

• Forming a plan of action in response to a situation

• Rehearse in advance appropriate responses to the pressure of eating at parties

Self-Monitoring

• Tracking foods eaten and conditions affecting eating

• Helps you understand your eating habits

• Important tool for changing behavior

• We tend to underestimate calories

Nutrition Attitudes and Behaviors

Why do we eat what we eat?

Why is it so hard to change eating behavior?

Food Selection

• Food preferences: taste, smell, color, and texture

• Environment: Most develop food preferences by 1-4 years of age. The environment you grow up in determines many of your food preferences

• Familiarity

• Habits

Acceptable Foods

Food Selection - Culture

• Acceptable foods: In some cultures, insects are acceptable foods, and corn is not.

• Customs: Thanksgiving, Birthdays

• Religious beliefs

• Social Situations

Nutrition Knowledge and Beliefs

• Health concerns

• Education: Students in nutrition class eat better than general students

Experiences

• Food based on learned association, not nutrition

• Comfort foods: Associated with positive experience. We tend to eat these foods when feeling discomfort (sad, depressed, stressed)

• Discomfort foods: Associated with a negative experience. We avoid these foods

Practical Considerations

• Food cost

• Advertising

• Convenience

• Availability