Chapter 7 Energy Metabolism Obesity Treatments January 31st 2011 Why Diets Don t Work Obesity is a chronic disease Treatment requires long term lifestyle changes Dieters are misdirected More concerned about weight loss than healthy lifestyle Unrealistic weight expectations Looking for a Sound Weight Loss Program Seek advice from a Registered Dietitian Figure 17 2 Control calorie intake Increase physical activity Acknowledge need for lifelong changes to maintain healthy weight Weight Loss Triad 1 Control Calories Sedentary society requires less calories Low fat high fiber approaches Most successful in long term studies No diet has a metabolic advantage Read food labels Keep a food log portion size awareness 2 Regular Physical Activity Important for weight maintenance Promotes steady weight loss Expends 100 300 kcal Boosts self esteem Add weight resistance Increase lean body mass Increase fat use Increase bone health Increase metabolic rate Physical Activity Recommendations 60 minutes day to maintain body weight 60 90 minutes day for maintenance of weight loss Pedometer Goal 10 000 steps a day What it Takes to Lose a Pound Body fat contains 3500 kcal per pound Fat storage body fat plus supporting lean tissues contains 3300 kcal per pound Must have an energy deficit of about 3300 kcal to lose a pound per week about 500 kcal day Do the Math To lose one pound you must create a deficit of 3300 kcal So to lose a pound in 1 week 7 days try cutting back on your kcal intake and increase physical activity so that you create a deficit of about 500 kcal per day 500 kcal x 7 days 3500 kcal 1 pound of weight day week loss in 1 week Know this Sound Weight Loss Program Rate of loss slow and steady 1 lb week Flexibility live life and adapt new habits Intake nutrient needs No magic no bad foods healthy pattern of intake Behavior modification lifestyle change Overall health Behavior Modification 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 Stimulus Control Altering the environment Minimize the stimuli for eating Putting you in charge of temptations Cognitive Restructuring Changing your frame of mind regarding eating walking Replacing eating due to stress with Contingency Management Forming a plan of action Response to a situation Rehearsing appropriate responses The pressure of eating at parties Self Monitoring Tracking foods eaten and conditions affecting eating Understanding your eating habits Weight Maintenance Prevent relapse Occasional lapse is fine but take charge immediately Continue to practice newly learned behavior Requires motivation movement and monitoring Have social support Encouragement from friends family professionals Diet Drugs Amphetamine Phenteramine Prolongs the activity of epinephrine and norepinephrine in the brain Decreases appetite Not recommended for long term use dependency Sibutramine Meridia Enhances norepinephrine and serotonin activity Decreases appetite Not recommended for people with HTN Orlistat Xenical Inhibits lipase fat digestion Reduces absorption of fat by 30 in the small Dietary fat is deposited in the feces with resulting intestine side effects Must still control fat intake Malabsorption of fat soluble vitamins Supplement needed at bedtime Alli Low dose of Orlistat available OTC Orlistat Xenical Treatment of Severe Obesity Very Low Calorie Diets VLCD Recommended for people 30 above their healthy weight 400 800 kcal per day Low carbohydrate and high protein Cause ketosis Lose 3 4 pounds a week Require careful physician monitoring Health risks include cardiac problems and gallstones Bariatric Surgery Adjustable Gastric Banding Reduces opening from esophagus to stomach by gastric band Decreases amount of food eaten Band can be inflated or deflated Gastroplasty Stomach Stapling Most common surgical procedure for treating severe obesity Reduces the stomach size From 4 cups to 1 oz shot glass size Overeating will result in rapid vomiting Smaller stomach promotes satiety earlier 75 will lose 50 of excess body weight Gastroplasty Criteria for Gastroplasty BMI 40 Obese for 5 years No history of alcoholism No history of major psychiatric disorder Costly procedure Follow up needed after procedure loss Requires major lifestyle changes Underweight is Also a Problem BMI of 18 5 Associated with increased deaths menstrual dysfunction pregnancy complications slower recovery from illness surgery Treatment for Underweight Intake of energy dense foods energy input Encourage regular meals and snacks Reduce activity energy output Increase portion size Strength training Fad Diets Promote quick weight loss Limited food selections Use of testimonials Cure alls Recommend expensive supplements No permanent lifestyle changes advocated Critical of the scientific community Types of Popular Diets Table 7 6 Low or restricted carbohydrates Carbohydrate focused diets Low fat approaches Novelty diets Meal replacements
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