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Title: Waisting Away Weight Management Strategies Author: Helene Charlebois Last modified by: STFX Created Date: 4/1/2012 4:32:02 PM Document presentation format – PowerPoint PPT presentation

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Title: H


1
Waisting AwayTM 2012 Empowering FUTURE Health
Professionals with Weight Management Knowledge /
Research / Practice for Health at ANY Size!
  • Hélène Charlebois, RD
  • HC Nutrition Inc. Consulting Wellness
  • Weight Management Specialist
  • Certified in Adult Weight Management
  • Level 1 2 Academy of Nutrition Dietetics
    (ADA)

2
Research - Information
  • Academy of Nutrition Dietetics AND
  • Weight Management Training level 1 2 new
    certification
  • ADA Weight Management DIPG
  • Canadian Obesity Guidelines
  • CON Canadian Obesity Network
  • Summit attend present
  • on line newsletter, research
  • DC Obesity Learning Retreat
  • Blogs by Dr Arya Sharma and Yoni Freedhoff
  • Dr. Sharma's Obesity Notes blog
    amsharm_at_ualberta.ca
  • Weighty Matters yonifreedhoff_at_gmail.com
  • New - points towards IASOs Specialist
    Certification for Obesity Professional Education
    (SCOPE).
  • www.hcnutrition.com

3
The 5 As of Obesity Management is a set of
practical tools to guide primary care
practitioners in obesity counseling and
management
  • Ask for permission to discuss weight and explore
    readiness for change
  • Assess obesity elated health risk and potential
    root causes of weight gain
  • Advise on obesity risks, discuss benefits
    treatment options
  • Agree on realistic weight-loss expectations and
    on a SMART plan to achieve behavioral goals
  • Assist in addressing drivers and barriers, offer
    education and resources, refer to provider, and
    arrange follow-up

4
What are DIETS?
  • Billions and billions of
  • All diets work
  • Recent research 75 years of dieting
  • Most weight loss is in the 1st 6 months
  • Skills

5
Treating Patients
  • What Docs say?
  • Recommend to lose 21 of their weight
  • UNREALISTIC !
  • Treat distress not depression
  • On line 80 want an in home diet plan
  • Apps in 2010 910 million
  • Getting the church involved
  • But obesity cost was 4.6 Billion in 2008 (usa)
    and increase of 20 from 2000

6
National Weight Control Registry
www.nwcr.wsfor sustainable weight loss
  • Weigh 1x/week do something about weight gain
  • Planned and structured eat similar foods
  • Low calories/fat 1800 cals 30 fat
  • Eat breakfast
  • Eat out less than 3 x/wk fried foods less than
    1x/wk
  • Active1 hour per day simply move more!
  • Less than 10 hours per week of screen watching

7
Measuring Obesity
  • Waist
  • Men 102 cm women 88 cm
  • High risk men 90 cm women 80cm
  • South Asian Aboriginal High Risk
  • Hip
  • Waist to hip
  • Anthropometric
  • BIA In Body BOD POD- DEXA
  • How to measure???

8
Bariatric Surgery
  • Restriction of food
  • Less eating size of a golf ball
  • Less food
  • How to deal with comfort eating
  • Malabsorptive
  • Malnourishment pre and post
  • Macro / micronutrients
  • Neural Hormonal
  • Pathways

9
Bariatric Surgical Options30 to 80 loss EBW
  • Expanding in Canada
  • Surgery - 5 different procedures
  • Adjustable Gastric Banding
  • Roux en Y gastric bypass less 50 EBW/ 1st yr
  • Biliopancreatic Diversion/duodenal switch
  • Sleeve Gastrectomy
  • Gastric Ballooning / Endo Barrier
  • What about Fatty Liver Disease?
  • Correcting for Vitamin D deficiency

10
Bypass- 80 ebw
  • 2 Multivitamin mineral for life
  • Iron , folic acid and B12 (1200 mmg)
  • Take Vitamin C 500 mg with Iron 300 mg 1 to 3/day
  • Calcium 1200-2000 mg elemental calcium
  • Liquid or tabs Citrate is best
  • No take more than 500 mg at a time
  • Take even if 2-4 servings of dairy per day
  • Vitamin D make sure in Calcium Supp.
  • At least 1000 IU/day
  • Protein calculate needs 0.8-1.0 g per kg 0.91
    g/kg actual body weight 1.5-2.1 g/kg ideal body
    weight
  • B12 over time doc to assess 500 mcg sublingual

11
Why the Weight Loss in Surgical Patients?
  • At 1 month decrease in gut hormones then stable
  • GLP1, incretins, GIP, Amylin, Glucagon,
    Proinsulin,
  • C peptide
  • At months 2 to 12 decrease FBS, insulin,
  • decrease in food and absorption
  • Stomach intestines largest endocrine system
  • CURE for diabetes?

12
Staging System Dr.A Sharma
  • Need for a better diagnostic system
  • 0 obese but not risk factors
  • 1 subclinical factors, mild symptoms
  • 2 chronic disease, mobility limitations
  • 3 end organ damage- significant limits
  • Impairment of well being
  • 4 severe disabilities

13
Hormones affecting weight
  • Hunger stimulus
  • Hedonic
  • Homeostatic
  • Appetite
  • Do food addictions exist?

14
Cortisol - brain
  • Fight or flight hormone
  • Sleep deprived
  • Screen watching
  • Makes you hungry
  • Increases belly fat
  • Sleep patterns
  • Sleep before midnight- most sleep before 530 am
  • No eating after 8pm

15
Sleep Deprived
  • Less sleep
  • Increase hedonic stimuli Increase food
    consumption
  • Decrease leptin
  • Increase ghrelin cortisol
  • Trying to reach glucose homeostasis
  • Kids - teens

16
Insulin - pancreas
  • Stores body fat
  • High insulin levels burns carbohydrates
  • Low insulin levels burns fat
  • Therefore, we will burn more fat if eat less
    carbs

17
Dopamine brain Opioid syndrome
  • The chocolate hormone
  • Hypothesis
  • Cravings- sweet tooth
  • Similar to endorphins
  • Obese decreased receptors decreased bliss
    point

18
Serotonin
  • Brain
  • Decrease in winter
  • Feel good hormone
  • Estrogen link
  • Low serotonin
  • Decreased hunger
  • Increased anger
  • SSRIs

19
Ghrelin gut hunger hormone
  • Controls weight
  • Controls glucose homeostasis
  • Hunger and appetite
  • The ONLY hunger hormone

20
Leptin- protein-hypothalmus
  • Appetite suppressant
  • Controls appetite
  • Energy in Energy out gene
  • Produced by fat tissue
  • Obese has high leptin but it is resistant
  • NEEDED a system that will sensitize
  • Dopamine Link?

21
Incretin- GLP1 intestine
  • Increase insulin secretion
  • Decrease appetite
  • Decrease glucagon
  • Decrease sugar production by the liver
  • Gets insulin ready
  • New diabetes medication Victoza,Byetta

22
Weight Loss
  • Diet Exercise- Lifestyle 3 - 5 - 10
  • Pharmacotherapy 5 10 - 15
  • Bariatrics 20 - 30- up to 80 EBW

23
Food - the nutrient link is broken
  • Food and in
  • Food Ingredients
  • Increase quantity of high quality foods
  • Decrease quantity of low quality foods
  • Ready to EAT
  • Less protein, fibre, vits, mins
  • More sugar, fat salt
  • More energy

24
Making Changes are they ready?
  • WHY?

HOW?
  • HOW?
  • For what?
  • Healthier living
  • Healthier being
  • Disease prevention
  • Disease state management
  • They came to you
  • level of readiness
  • Ask the question
  • Easy to lose weight but not easy to keep the
    weight off
  • Must be ready to make lifestyle lifetime changes
  • More in Behavior section

25
Clean up your House
WHY?
HOW?
  • House needs to be a Positive Health Environment
  • Set up for SUCCESS
  • Food availability is too high
  • Make it healthy
  • Get rid of your trigger foods unsafe foods
  • DANGER FOODS
  • Look into kitchen cupboards, fridge, pantry
  • Purge unhealthy foods
  • Office desk drawer
  • Replace with healthier food options

26
Successful Set Up
  • WHY?
  • HOW?
  • Must keep great tasting healthy foods around you
  • At all times
  • Increases your rate of success
  • Studies show out of sight out of mind
  • Fruit Veggie shopping
  • Bagged, trays, frozen, fresh, cannedit all
    counts
  • Keep some everywhere
  • Lean meats
  • Desk drawer
  • Legumes- new recipes

27
Choose only whole / sprouted grains
  • Why? Change the box!
  • Eating whole grain, sprouted, high fiber foods
  • Keep you fuller, longer
  • Low GI
  • Are healthier for you
  • Refined processed starches digest quickly
  • How?
  • Stick to whole grain, whole wheat product
  • Pasta, brown rice, crackers, cereal
  • No white rice-why?
  • Try different grains
  • Sprouted grains

28
No bagels??? No bananasNo white potatoes
  • Why? Change the box!
  • Bagels- 300 calories
  • Available low GI / 150 calories
  • Bananas and potatoes are favorites so take them
    out make a change youll be amazed!
  • How?
  • Choose whole grain breads/ english muffins
  • Have any other fruit and any other vegetable..
    Try to think outside the box variety is key

29
Eat low GI Foods
  • Why?
  • How?
  • Keeps you fuller, longer
  • Generally higher fiber and healthier foods
  • Control blood sugars
  • Control cholesterol level
  • Gives some boundaries
  • Take with a grain of salt
  • www.glycemicindex.com
  • www.diabetes.ca
  • Eat lots of whole fruits and vegetables
  • Eat whole grains
  • Eat lean meats and low fat dairy products
  • Add fiber to foods

30
Meal Balancing
  • WHY?
  • HOW?
  • Nutritionally adequate
  • All nutrients
  • More even distribution of starch and protein
  • See chart and guidelines
  • HEP sheet
  • Protein at all meals
  • More even distribution of starch to protein
  • Up to 25 protein
  • Have protein with PM snack

31
No Starch at Supper
  • WHY?
  • HOW?
  • Reducing the total calorie intake
  • Less cals at supper and beyond is key
  • Starch at supper
  • Lots of calories
  • We LOVE starch
  • Insulin and belly fat
  • HS more sedentary
  • Replace your starches with vegetables
  • Use spaghetti squash
  • Use a bed of corn instead of rice
  • Use bean sprouts instead of pasta
  • Sweet potato/yams are great
  • Ok for starchy vegetables
  • Legumes are great!

32
Journaling
  • WHY?
  • HOW?
  • Awareness
  • Understanding
  • Patterns
  • Accountability
  • But most HATE journaling!
  • See the CFC sheet
  • Same as the meal balancing
  • Journaling sheet
  • Create own
  • Journaling book / on line
  • www.myfitnesspal.com
  • APPS The Future!

33
Journaling continued
  • Make journaling effective
  • Pick your battles
  • Be realistic
  • Be flexible
  • Different journaling strategies
  • Only HS intake
  • Only activity
  • Only after lunch and beyond

34
Plan your Snacking
  • WHY?
  • HOW?
  • Small snack eat less at meal times
  • Do not rip the fridge door off
  • Up to 40 total daily calories
  • Too often
  • Too much-portions
  • Too calorie dense
  • The 4th Meal!
  • Plan a small snack 1 hour before meals
  • AM 80 calories
  • Yogurt, fruit
  • PM 100 -150 calories
  • This is the important one
  • Protein fruit/veg
  • HS 100 -150 calories
  • Sweet/salty tooth

35
Calorie Distribution
  • WHY?
  • HOW?
  • Calories count
  • Recent research all diets work in the short term
  • More even distribution throughout the day
  • See chart and guidelines
  • HEP sheet

36
Meal Balancing
Meal balancing It is important to have a
protein at each meal starches should be whole
grains. BREAKFAST300cals
LUNCH400-500cals
DINNER400-500cals

Protein Starch 2 Vegetables
Protein Fruit
Starch
Protein Starch 2 Vegetables

Protein fruit
100-150 calories
Fruit
snack
snack snack
HINT For added weight loss, no starch at supper
but load up on the veggies!
37
Calorie Distribution/Protein
  • Breakfast Starch 150 cals/20g
  • am snack 80 calories/10g
  • LunchSt.150 cals prot.150 cals/20g
  • pm snack 100 to 150 calories/10g
  • Supper St. 0 cals to 300 cals/20g
  • hs snack 100 (150) calories

38
PROTEIN - U of Texas
  • 20 to 30 grams at breakfast
  • 20 to 30 grams at lunch
  • 20 to 30 grams at supper
  • NO MORE NO LESS!
  • WHERE THE MEAT!

39
Reintroduce Starch at Supper
  • WHY?
  • HOW?
  • Because we like it!
  • There are special occasions
  • There are exceptions to every rule
  • BUT.
  • No more than 2 times per week
  • 1 cup 300 calories
  • Do not have the starch at lunch
  • OR
  • ½ cup at supper nightly
  • Must be measured
  • Reduce protein

40
Portion Distortion
  • WHY?
  • HOW?
  • Supersizing
  • More for less
  • Restaurant portions
  • The food container is simply too much
  • Our eyes are bigger than our stomachs
  • Bottom line
  • We just eat too much!
  • Label reading
  • Be visual
  • Change the plate
  • Show portions of food
  • Food models? calories
  • Measure it out
  • We are not good at eye balling
  • Load up on veggies
  • 2-3 fruit per day

41
Vegetable 1st on Plate
  • HOW?
  • WHY?
  • Our eyes are bigger than our stomachs
  • We always put more of the first item on our
    plates
  • Research Xmas
  • Put vegetables 1st on the plate
  • Then the protein
  • Lastly is starch

42
Set up Buffet
  • WHY?
  • HOW?
  • How you set up the plates
  • How you set up your counter for plate preparation
  • It makes a difference
  • Always put veg 1st
  • Then protein
  • Last starch
  • Try this at home you will be AMAZED!

43
Eat close to farm
  • WHY?
  • HOW?
  • This is my motto
  • Very simple concept
  • Farm foods are usually
  • Lower in calories
  • Higher in fiber
  • Bountiful
  • More filling
  • Keeps you fuller longer
  • More nutritious
  • Eat whole foods
  • If the food comes from the farm, eat it if the
    food leaves the farm, judge it.
  • Give some examples
  • apple vs apple sauce vs apple juice

44
Damage control
  • WHY?
  • HOW?
  • We all cheat but our patients feel guilty
    about it
  • Feel good about it
  • Plan it
  • Move on
  • 2 types of damage
  • Planned sandwich it in
  • Unplanned 48 to 72 hours revenge
  • Dont get angry get even!

45
Eating Out
  • WHY?
  • HOW?
  • Because it is part of life
  • RUIN IT!
  • Many handouts available
  • Heart Stroke Ontario
  • www.myfitnesspal.com
  • See internet
  • Plan choices on line
  • Do not take menu
  • Take away the guilt
  • Trading off choices
  • Move away from the bread
  • Order 1 item at a time
  • TRAVELLING?

46
Beverages Count
  • WHY?
  • HOW?
  • Hidden calories
  • You would not believe
  • Portion distortion
  • Single serving sizes are just too big
  • New journal
  • Snack Beverages
  • Labels for portion sizes
  • Show glasses, cups
  • Journal beverage intake for one week
  • Count calories on beverage intake
  • Clear on Calories Initiative
  • Diet pop?

47
Meal Replacements (contd)
  • Why?
  • Quick Easy
  • Controlled eating no thinking
  • Eliminate complex food choices
  • Eliminate complex meal planning

Waisting Away TM Weight Management Strategies
48
What about Protein Shakes?
  • Stomach volume detector
  • Intestine nutrient detector
  • Saliva brain nutrient detector
  • Chewing Tasting

49
Exercise / Activity
  • STRUCTURED
  • UNSTRUCTURED
  • Anti-Sedentary Movement
  • effect on weight loss?
  • Weight is Food Health is FOOD FITNESS

50
Cardio
  • What does it do?
  • Burns the visceral fat
  • Keeps the heart muscle strong
  • Is fun!
  • How to do it
  • Walk, run, bike
  • Group sports
  • Soccer, hockey
  • Family Fun
  • Skating, skiing, tobogganing , biking

51
Strength Training
  • What does it do?
  • How to do it
  • Sit ups push ups
  • Pilates yoga
  • Weights
  • Exercise ball
  • Bands
  • Gym machines
  • Use your body
  • Lunges
  • Preserves lean body mass
  • Sense of accomplishment
  • Great to keep your muscles as you age
  • Osteoporosis prevention

52
Flexibility
  • Stretching
  • Mobility
  • Motion
  • Increased quality of life (QOL)
  • HOW?
  • Morning stretches
  • Yoga

53
How much EXERCISE?
  • Health Improvement 150 minutes / week
  • Weight Loss 150 to 250 minutes / week
  • Significant Weight Loss 250 minutes/wk
  • Weight Gain Prevention (after wt loss)
  • 250 minutes / week
  • Is this unrealistic?
  • N E A T phenomenon

54
Walk at Lunch time
  • WHY?
  • HOW?
  • Only time for ones self
  • Get out of work
  • Peace of mind
  • Change of scenery
  • All around health
  • Mind
  • Body
  • Soul
  • Eat ½ lunch
  • Go for a walk
  • Eat the other ½ lunch
  • Bring runners to work
  • Bag lunch more time to walk
  • Buy lunch must get out and go for a walk but
  • www.tractivityonline.com

55
What about your Metabolic Rate?
  • You HAVE to eat LESS
  • BUT
  • You WANT to eat MORE!
  • We are not balanced!
  • Lose 1 / year

56
Pharmacotherapy
  • Xenical orlistat
  • Meridia Sibutramine- off market
  • Approval ?? Qnexa, Lorcaserin, Belvic
  • High Fibre Products
  • Why use?

Needed for the disease of Obesity???
57
Non-Prescription MedicationHigh Fibre Products
HOW?
WHAT?
  • Metamucil
  • PGX
  • Expands in stomach
  • Keeps you fuller longer
  • Less 28 kcals/day 1.7 kg per year wt loss
  • Great for between meal hunger
  • Or take before a meal to eat less
  • Mix in juice, yogurt, applesauce, pudding
  • Mix with water drink 15 minutes before your meal.

Waisting Away TM Weight Management Strategies
58
PGX
  • HOW?
  • WHY?
  • Powder or capsules
  • Keeps you fuller longer
  • Has 3 different types of fiber
  • Konjac-mannan ( root)
  • Sodium alginate
  • Xanthan gum
  • No dairy, corn, soy, starch, wheat, yeast
  • www.pgx.com.
  • Great as a snack
  • PM or HS
  • Mix in with yogurt, applesauce, pudding
  • Do not let it sit too long
  • Individual sticks for the office large can for
    the home
  • Veronica Kacinik vkacinik_at_functionalmedicine.ca

59
Other wt loss pills potions
  • RASPBERRY KETONES Slendesta
  • Pure green coffee extract
  • African Mango
  • Herbal products orange peel?
  • Chocolate Acai Chocolate with soluble fibres
  • Ephedra
  • USA commercials
  • Product availability

BANDAID SOLUTIONS!
60
Weight Maintenance-SummarizedWE must prevent
HUNGER
  • Low fat calorie conscious eating
  • Planned structured eating
  • Eat breakfast daily
  • Monitor your weight
  • High daily levels of activity
  • Less screen watching
  • Simply move more!

61
Maternal Weight Gain not anymore!Overweight
3x increase wt of baby obese 7xCON U of
O BMI over 40 safe to decrease 5 kg 4.1 kg
weight loss is optimal
62
Who is to blame?
  • The environment?
  • You?
  • Reality Obesity is a complex issue. It requires
    a collaborative approach, with health
    professionals, govt and industry. Education is
    key!
  • The NO Factor

63
Study
  • 84 hour period of TV watching
  • Keeping track of the foods that are advertised
  • Compared to the Daily Values
  • 2560 over for sugar
  • 2080 over for fat
  • 40 less for vegetable consumption
  • 32 less for dairy consumption
  • 27 less for fruit consumption

64
Neighborhood
  • FOOD DESERTS
  • More fast food choices more sick
  • and disease obese neighborhoods
  • Access to unhealthy food choices
  • Price
  • SOLUTIONS?
  • Calories on Menus? Calorie Literacy?

65
Society on the Go!Feel Think EnjoyNourish
Smell Taste
  • Think
  • Nourish
  • Live
  • Adjust
  • Awareness
  • Journal - observations
  • - Not aware of 90 of
  • our food choices
  • - 62 too busy to
  • sit down to eat

66
Joint Decision Making
  • YOU
  • YOUR CLIENT
  • Roll with the punches
  • No resistance
  • Empathy
  • Self efficacy
  • Personal goals
  • Its all about them

67
Call to Action stop, continue, start
  • Waisting AwayTM Manual NEW!
  • Www.lowgimeals.com
  • http//www.1shoppingcart.com/app/?af1488220
  • Nancy Guppys menus dietitian_at_chapmanslanding.c
    om
  • Go to www.chicken.ca Nutrition Fact Sheets
  • 6 on Tracking Weight Loss
  • General Health, Womens Health, Diabetes, Heart,
    Sodium, Screen Watching, Healthy Snacks
  • Food Journals Snack Beverage Journals

68
Websites
  • www.hcnutrition.com
  • www.obesitynetwork.ca
  • www.myfitnesspal.com
  • www.calorieking.com
  • www.nutritiondata.com
  • www.sparkpeople.com
  • www.fitday.com
  • www.glycemicindex.com
  • www.myFoodDiary.com
  • www.dietsinreview.com
  • www.eatrightontario.org talk to an RD
    snack list
  • www.dietitians.ca meal planners, eat
    tracker
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