1 Adult Weight Management Training Summary The Commission on Dietetic Registration, the credentialing agency for the Academy of Nutrition and Dietetics Marilyn Holmes, MS, RDN, LDN
2 About This Presentation Only selected highlights from this course and workshop training have been included. The information presented was vast and would take multiple presentations to cover.
3 Presentation Overview Adult Weight Management Course Objectives Prevalence of Obesity Contributing Factors Health Risks Nutrition Care Process Assess Diagnose Intervene Dietary Therapy Physical Activity Behavior Therapy Monitor and Evaluate When Diet, Activity and Behavior Change Are Not Enough Weight Maintenance Resources
4 Training Course Objectives After completing the self-study module, participants will be able to: Describe the current prevalence of overweight and obesity. Identify risk factors and diseases associated with overweight/obesity. Identify genetic, biologic, and environmental contributors to weight status. Define body mass index and waist circumference, and identify indications for use. Define and distinguish among healthy weight, overweight, and obesity. Distinguish among key methods used to measure body composition. Recognize current evidence-based recommendations for assessment and treatment of weight management ADA Adult Weight Management Evidence- Based Nutrition Practice Guidelines, and the new AHA/ACC/TOS Guidelines for the Management of Overweight and Obesity in Adults.
5 Objectives (continued) Be aware of techniques (and their limitations) used to assess dietary intake in overweight and obesity. Identify behavioral predictors of successful weight maintenance based on outcomes of the National Weight Control Registry. Recognize current research evaluating the efficacy of leading popular diets and diet approaches for weight management. Identify the components of Metabolic Syndrome (Syndrome X) and its relation to obesity. Describe and begin to apply counseling skills important to successful client weight management. Be aware of emerging research, issues and non-traditional approaches to weight management. List the current public health guidelines for moderate and vigorous physical activity for adults.
6 Objectives (continued) Distinguish between the amount and type of physical activity recommended for general health benefits and for weight management. Cite the effect of sedentary behaviors on obesity. Cite at least three ways policies, environments, and/or systems can be changed at the community-level or higher to reduce or prevent obesity. Describe the rationale for and contents of the Physical Activity Toolkit for Registered Dietitians: Utilizing Resources of Exercise is Medicine. Identify resources to evaluate evidence-based information regarding dietary supplements promoted for weight loss. Describe vulnerable periods in the life course that influence risk for obesity.
7 Prevalence* of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2013
8 Factors Contributing To Weight Family History and Genetics Environment Metabolism Behavior or Habits
9 Risk Factors Related to Overweight and Obesity* Coronary heart disease Type 2 diabetes Cancers (endometrial, breast, and colon) Hypertension (high blood pressure) Dyslipidemia (for example, high total cholesterol or high levels of triglycerides) Stroke Liver and Gallbladder disease Sleep apnea and respiratory problems Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint) Gynecological problems (abnormal menses, infertility) *Overweight is defined as a body mass index (BMI) of 25 or higher; obesity is defined as a BMI of 30 or higher.
10 Registered Dietitian Delivering Efficient and Effective Care The Academy of Nutrition and Dietetics Nutrition Care Process framework for critical thinking and decision making and includes the following: Nutrition Assessment Diagnoses Intervention Monitoring/Evaluation The Nutrition Care Process is a systematic approach to providing high-quality nutrition care.
11 Assess Include: Evaluation of Body Mass Index (BMI) Waist Circumference Screen for other risk factors, as well as diseases associated with obesity, ie coronary heart disease, type 2 diabetes, etc. Patient s readiness to lose weight
12 Diagnose Points the way to intervention
13 Intervene Nutrition Plan of Care Based on Diagnosis Includes: Goals with a Focus Area Nutrition Prescription Action and Maintenance Stages
14 Intervene Weight Loss Counsel on effective lifestyle changes The patient should set SMART goals that are reachable and realistic An initial weight loss of 10% of body weight over 6 months is a recommended target Motivational interviewing and coaching support increased success
15 Intervene (continued) Reduce caloric intake by 500 to 1000 calories per day from the current level In general, diets containing 1,000 to 1,200 kcal/day should be selected for most women; a diet between 1,200 kcal/day and 1,600 kcal/day should be chosen for men. The 1,600 kcal/day may also be appropriate for women who weigh 165 pounds or more (75 kg or more), or who exercise.
16 Intervene (continued) Weight goals that are gradual are more likely to be lasting and yield health benefits (3, 5, or 10% loss) Weight of 190 pounds X 0.3% = 5.7pounds 190 pounds X 0.5% = 9.5 pounds 190 pounds X 10% = 19 pounds 6 month timeline for goals 1-2 pound weight loss/week Pattern will include peaks, valleys, and plateaus Weight is put on slowly and removing slowly is the best way to take it off Examples of small changes in diet and activity over time: 50 extra calories a day leads to a loss of five pounds/year Cut intake 100 calories/day, lose 10 pounds/year Walk 2 miles/day 5 days a week for a year and lose pounds Jog 20 minutes 3 times a week, lose 10 pounds/year
17 Intervene (continued) Sessions are recommended length and frequency shown to support successful interventions are: Held weekly for the first month Held bi-weekly afterwards for 5 more months Occur for 6 months all total At 6 months, re-evaluated based on weight loss and patient s desire to continue.
18 Intervene Physical Activity Physical Activity (PA) is important in weight loss It increases energy expenditure. PA is more important in weight maintenance. See the Academy of Nutrition and Dietetics A Physical Activity Toolkit for Registered Dietitians
19 Intervene - Physical Activity (continued) Recommend: 2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (i.e., brisk walking) every week and muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms) Increasing the intensity or the amount of time being physically active can have even greater health benefits and may be needed to control body weight Start slowly and work up gradually. Can start with 5 minutes. Engage in activity that is enjoyable PA can be done in 10 minute bouts
20 Intervene - Behavior Therapy Behavioral therapy supports compliance and success Strategies include: Self-monitoring Stress management Stimulus control Problem solving Contingency management Cognitive restructuring Social support
21 Monitor and Evaluate Check to see if interventions have been implemented Gather data to show Progress toward goals Resolution of nutrition diagnoses Evaluate progress with the patient
22 When Diet, Activity and Behavior Change are not Enough A goal should be prevention of further weight gain.
23 When Diet, Activity and Behavior Change are not Enough (continued) Pharmacotherapy If lifestyle changes do not promote weight loss after 6 month, consider pharmacotherapy for: Those with BMI > 30, or those who have a > 27 if concomitant obesity-related risk factors or diseases exit When using pharmacotherapy and if the patient has not lost 4.4 pounds after 4 weeks, it is not likely that the patient will benefit from continued pharmacotherapy. Currently, sibutramine and orlistat are approved by the FDA for long-term use in weight loss.
24 When Diet, Activity and Behavior Change are not Enough (continued) Weight loss surgery is an option for patients with extreme obesity. Candidates for this type of surgery should be well informed and motivated with: BMI > 40 or BMI > 35 and serious comorbid conditions Weight loss surgery provides weight loss in most patients that is sustained for more than 5 years. Following weight loss surgery, patients should be monitored for complications and lifestyle adjustments for a lifetime.
25 Maintaining Weight Loss The National Weight Control Registry collects and publishes information on thousands of people who have lost weight.
26 According to the National Weight Control Registry: Successful Weight Losers 78% Eat breakfast every day. 75% weigh themselves at least once a week. 62% watch less than 10 hours of TV per week (screen time). 90% exercise, on average, about 1 hour per day. Source: National Weight Control Registry
27 Other Keys to Support Maintaining a Healthy Weight Follow a consistent eating pattern and exercise routine Journal eating and exercise Continue to set long and short term goals that are realistic, measurable, and achievable Know change is for a lifetime
28 And.National Weight Control Registry #1 key to weight loss reported: stop thinking about weight loss as dieting and start thinking about it as a lifestyle
29 Presentation Review Adult Weight Management Course Objectives Prevalence Contributing Factors Health Risks Nutrition Care Process Assess Diagnose Intervene Dietary Therapy Physical Activity Behavior Therapy Monitor and Evaluate When Diet, Activity, and Behavior Change Are Not Enough Weight Maintenance Resources
30 References Nutrition Care Process and Model Part I: The 2008 Update. Writing Group of the Nutrition Care Process/Standardized Language Committee. J Am Diet Assoc. 2008;108(7): Nutrition Care Process and Model Part II: Using the International dietetics and Nutrition Terminology to Document the Nutrition Care Process. Writing Group of the Nutrition Care Process/Standardized Language Committee. J Am Diet Assoc. 2008;108(8): The Practical Guide Identification, Evaluation and Treatment of Overweight and Obesity in Adults. Bethesda, MD: National Institutes of Health, National Heart, Lung, Blood Institute, North American association for the Study of Obesity. 2000: NIH publication number L1-42. Weight Management Dietetic Practice Group. A Physical Activity Toolkit for Registered Dietitians: Utilizing Resources of Exercise is Medicine: National Weight Control Registry Centers for Disease Control and Prevention Centers for Disease Control and Prevention
31 Thanks As a recipient of the Adult Weight Management Tennessee Academy of Nutrition and Dietetics Scholarship, this dietetics practitioner extends a sincere word of thanks. Marilyn C. Holmes MS, RDN, LDN
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