Adapted From: Windsor Essex Cardiac Wellness Centre Shelley Amato RD How Did I Get Here? Leading yourself to your best life, best health, best weight! SOAHAC 08/07

Working Through Emotional Eating Awareness- of emotions/overeating/challenges/triggers Willingness to change-Are you ready to lose weight? Taking action-Weight loss strategies and goal setting

Reasons for Weight Gain Diet Physical inactivity Genetics Psychological factors/coping skills Age Medications Metabolic disorders – hypothyroidism, PCOS, etc. Quitting Smoking

Focus today Triggers Coping skills Overcoming challenges

Food Availability Abundance Snacking Convenience Stores Vending Machines Processed Foods Cooking Less Eating Out More Large Portions Fast Food Choices Value Meals Food Courts All You Can Eat Buffets Eat Healthy Foods Watch Portion Sizes Cook More Eat Only When Hungry What is Shaping Our Eating Habits? Healthy ChoicesUnhealthy Environment

Elevators Escalators Telephones Snow Blowers Remote Controls Cars, Buses, Trains Computers Drive-Thru Society Television Cable Channels Video Games VCR’s: Home Movies Walk Up Stairs Park Car Farther Away Be More Active Watch TV less Do Less Passive Activities What is shaping our physical activity habits? Healthy ChoicesUnhealthy Environment

Living the Hurried Life Always Rushing Overscheduled Overdoing It Not Living in the Moment Working Longer Hours Less Leisure Time Family Stresses Juggling Schedules Juggling Roles No Time for Family No Time for Self Make Time to Exercise Make Time to Eat Healthier Make Time to Cook Make Time to Relax What is shaping our coping habits? Healthy ChoicesUnhealthy Environment

Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Nonalcoholic fatty liver disease steatosissteatohepatitiscirrhosis Coronary heart disease Diabetes Diabetes Dyslipidemia Dyslipidemia Hypertension Hypertension Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome Osteoarthritis Skin Gall bladder disease Cancer breast, uterus, cervix colon, esophagus, pancreas kidney, prostate Phlebitis venous stasis Gout Medical Complications of Obesity Idiopathic intracranial hypertension Stroke Cataracts

Classification BMI (kg/m 2 ) Risk Underweight <18.5Increased Normal 18.5–24.9 Normal Overweight 25.0–29.9 Increased Obese I 30.0–34.9 High II 35.0–39.9 Very high III  40 Extremely high Additional risks: Large waist circumference (men >40 in; women >35 in) Poor aerobic fitness Specific races and ethnic groups BMI-Associated Disease Risk Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. Obes Res 1998;6(suppl 2).

Subcutaneous Fat Abdominal Muscle Layer Intra-abdominal Fat Visceral Adiposity: The Critical Adipose Depot

All Fat Cells Are Not Created Equal Large Insulin- Resistant AdipocytesLarge Insulin- Resistant Adipocytes Adrenergic Receptors Adrenergic Receptors  Insulin-Mediated AntilypolysisInsulin-Mediated Antilypolysis Catecholamine- Mediated Lipolysis Catecholamine- Mediated Lipolysis  Small Insulin-Sensitive AdipocytesSmall Insulin-Sensitive Adipocytes Adrenergic Receptors Adrenergic Receptors  Fatty Acids 

High-Risk Waist Circumference Men:> 40 in (> 102 cm) Women:> 35 in (>88 cm)

Weight loss strategies Behaviour Changes Food intake Activity

Attributes that Predispose a Person to Successfully Change Behavior Strongly wants and intends to change for clear, personal reasons Faces a minimum of obstacles to change Has the requisite skills and self-confidence to make a change Feels positively about the change and believes it will result in meaningful benefit Perceives the change as congruent with self-image and social group norms Receives encouragement and support to change from valued persons Whitlock EP et al. Am J Prev Med 2002

Antecedent  Behavior  Consequence

Antecedents Time Places Activities Thoughts Emotions

What Makes Us Eat More? Smell Time of day Alcohol Sight Temperature Variety Refined carbohydrates

Nutritional Goal Sheet Select two or three goals that you are willing and able to make Effective goals are specific, attainable, and forgiving (less than perfect)

Goal Setting What’s realistic for you? For those that need to lose weight, reducing your weight by 5% to 10% over 6 months is a healthy and reasonable goal Be realistic about time frames too! Slow and steady weight loss has the greatest impact (about a pound a week)

Self-Monitoring Food Intake Types of foods Portion sizes Calories (reduce by 500 kcal/d) Times, places, and activities Thoughts and moods Brownell: Learn Program for Weight Control, 1998

How to Curb Your Appetite Eat fibre Brush your teeth Be consistent- eat 3 meals a day Slow down