OBESITY TREATMENT NURS: 2018, Diet Therapy

Objectives At the end of this presentation students should be able to: Describe the concept of desirable body weight relative to age, gender, and developmental variables Use the concept of desirable weight in meeting the nutritional needs of individuals State the socio-cultural, genetic, emotional, and lifestyle factors which contribute to obesity Discuss principles of effective treatment of obesity

Objectives Plan a modified calorie diet based on diet prescription for specified weight loss Identify strategies for obesity prevention Name the characteristics of effective obesity intervention approaches Discuss current research in obesity therapy

Treatment of Obesity Lifestyle modification  Diet  Several dietary approaches exist some that affect a single food, a nutrient group and some that affect over all energy restriction  Physical activity  Inclusion of regular physical activity leads to increased energy expenditure and favorably affects energy balance  Assists both in weight loss and the prevention of weight gain  Cardiorespiratory effect leads to reduced risk of mortality and morbidity  Important to note barriers, specific goals, fitness and wellness to exercise  Can accumulate physical activities in small increments

Treatment of Obesity Lifestyle modification  Behaviour modification  New behaviours that result in successful weight loss need to be incorporated into long-term lifestyle habits e.g. weight monitoring, dietary changes and regular physical activity  Identify triggers for undesired behaviours and avoiding them  Develop behavioural goals through small incremental changes  Use some tools in behaviour modification such as self-monitoring, stimulus control, cognitive restructuring.

Adjunctive Therapy If lifestyle modification does not work than an additional approach may help to reduce weight gain and improve weight loss. Drug therapy and dietary supplements are useful.  Recommended for persons with a BMI of at least 27 with an obesity related condition or with a BMI greater than 30.  Centrally acting-  Sibutramine (Meridia)- lessens hunger and increases satiety, raises HDL levels  Orlistat (Xenical & Alli)- acts in GI tract to inhibit lipase enzyme descreasing fat absorption (30 %)  Rimonabant- increases adiponectin levels and increases satiety Tucker & Dauffenbach, 2011; Omari & Caterson, 2007

Obesity treatment Less commonly used drugs Some drugs that are used to treat depression have been found to have an effect on satiety; particularly the SSRIs; centrally acting  Phentermine  Fluoxetine  Topiramate Peripheral action  Metformin

Dietary supplements for obesity treatment Dietary Supplements The most common ones contain stimulants Commonly used (1/3 of people trying to loose weight have tried) Stimulants include caffeine and bitter orange- may cause increased heart rate, fainting, stroke, MI Not FDA regulated as a drug but as food Not well tested- little clinical evidence to support use Some are tainted with meds like diuretics and sibutramine Herbal dietary supplements not recommended due to unpredictable ingredients, effects and safety

Surgery The recommendation linked to surgical treatment of obesity is that this procedure be reserved for individuals with BMI greater than 40 or BMI greater than 35 with accompanying obesity related conditions. Bariatric surgery- all intestinal surgeries done to foster weight loss There are two major groups  Restrictive - which reduces the size of the gastric reservoir to 3 oz or less; either through placing bands or staples in the stomach creating a small pouch  Restrictive/malabsorptive - with this procedure a small gastric pouch is created to reduce food intake and connected to the jejunum or ileum to deliberately foster malabsorption of calories. – they also limit Ghrelin secretion which stimulates hunger

References Frühbeck, G. (2006). Overnutrition. In M., Gibney, M. Elia, O., Ljungqvist, & J., Dowsett (Eds.), Clinical Nutrition. (pp ). Oxford, UK: Blackwell Science Ltd. Omari, A. & Caterson, I. D. (2007). Overweight and obesity. In J. Mann & A. S. Truswell (Eds.), Essentials of human nutrition (3 rd Ed.). (pp ). New York, USA: Oxford University Press. Seidell, J. C. & Visscher, T. L. S. (2004). Public health aspects of overnutrition. In M., Gibney, M. Elia, O., Ljungqvist, & J., Dowsett (Eds.), Public Health Nutrition. (pp ). Oxford, UK: Blackwell Science Ltd. Tucker, S. & Dauffenbach, V. (2011). Nutrition and diet therapy for nurses. Boston, USA: Pearson.

Assignment 1. Students are to review the current literature regarding the diets listed and answers the questions listed below  Atkins, South Beach, Zone, CSIRO diets, Mediterranean A. Identify the calorie, nutrient and food restrictions associated with the diet B. Discuss the advantages and disadvantages of the diet C. Classify the diet as either: low calorie, nutrient altered or novelty 2. Review the literature regarding the surgeries listed and answer the questions below  Gastric banding, adjustable banding, Roux-en-Y, Biliopancreatic diversion (BPD) A. Describe three risks associated with each surgery B. Identify three benefits for each surgery C. Describe two nutrition concern associated with each surgery D. Classify the surgery as either restrictive or restrictive/malabsorptive

Assignment Continued Identify 5 health risks associated with obesity Describe the physiological effects of obesity and the health condition Discuss the methods for assessing and overweight client before nutrition intervention Describe the usefulness of the change theory as a tool in weight management