Chapter 19 Clients With Nutritional and Metabolic Concerns Rachel Bige P.2

Benefits of Weight Reduction Programs Used for any clients who are classified as overweight or obese -increases energy -reduces the risk of heart disease -helps reduce body fat and prevent decrease in muscle mass -decrease insulin resistance -better dietary compliance -improves mood and well being -increases self esteem and self-efficiency

Classification of Overweight and Obesity

Lifestyle Change Program for Obesity Combination of diet modification, increased physical activity, and lifestyle change Personal trainers should refer their clients to an expert dietitian who will evaluate the client and design an appropriate nutritional diet for them. Most weight loss in obese people occurs primarily because of decreased caloric intake

Lower Fat and Calorie Eating Strategies

Lifestyle Change Program (Physical Activity) Moderate levels of physical activity for 30-45 min a day, 3-5 days a week is recommended for overweight or obese clients Moderate physical activity = burns 150 calories per day, total of around 1,000 calories per week Severely obese clients may have to start with focusing on every day tasks (ex. Use the stairs not elevator) Avoids injury in addition to making the beginning exercises comfortable and tolerable

Examples of Moderate Work Outs

Lifestyle Change Support The techniques of self- monitoring, rewards, goal setting, stimulus control, and dietary behavior help the clients stick to and maintain their weight loss. Reasonable Goal for weight loss program is about 10% reduction in body weight, with a time span of about 6 months After about this long, the personal trainer will revaluate the clients goals

Motivational Strategies

Clients with Eating Disorders Anorexia Nervosa- characterized by extreme weight loss, refusal to maintain body weight, and an intense fear of gaining eight or becoming fat, includes the restriction of food intake. Bulimia Nervosa- Binge eating followed by purging behaviors, including self- induced vomiting, taking laxatives, exercising excessively to burn calories

Program For Clients Recovering From an Eating Disorder

Clients With Diabetes Type 1: includes people with insulin deficiency in the pancreas, only about 10% of patients with diabetes have type 1 Type 2: includes people with insulin resistance in peripheral tissues, is associated with old age, obesity, and lack of exercise. Before beginning an exercise program, clients with diabetes should have a medical evolution to asses their glycemic control.

Glycemic Control The risks of exercising among those with diabetes is hypoglycemia (blood glucose levels 65mg or lower) Greater risk for those with type 1 diabetes Factors that increase risk of hypoglycemia: -increased exercise intensity -longer exercise time -inadequate caloric intake before exercise -excessive insulin dose

Responding to a Client With Hypoglycemia Signs: sweating, hunger, palpitations, headache, dizziness, confusion

Study Questions (#1) Based on his calculated BMI, which of the following is the disease risk of a client who is male, 5 feet, 9 inches tall (175 cm), weighs 198 pounds; and has a waist circumference of 41 inches (104 cm)? No risk Increased High Very high

Explanation BMI: (198 lbs. / 69²) x 703 = 29.24 Waist Circumference: 41 in (104cm)

Study Questions (#2) All of the following are dietary modifications or goals that can apply to all clients who are overweight or obese EXCEPT: Set a weight loss goal of 10% of body weight for the first 6 months Change food selections that will decrease caloric and fat intake Aim for a 1 to 2 pound eight loss per week Follow a 1,200 kcal/ day food plan

Explanation All clients vary in how much caloric intake they need or should have. In general women should consume diets containing no less than 1,000 to 1,200 kilocalories per day, while med should consume a diet no lower than 1,200 kcal/day to 1,600 kcal/day. The amount of kilocalories per day also depends on how much energy the client has, if the client doesn’t have enough sufficient energy to engage in physical activity then they may need to add an additional 100 to 200 kcal/day.

Study Questions (#3) Which of the following is an undesirable blood lipid level? Total cholesterol 250 mg/dL Triglycerides: 200 mg/dL LDLs: 100 mg /dL HDLs: 50 mg/dL I only I and II only II and III only III and IV only

Explanation

Study Questions (#4) Which of the following describes a difference between type 1 and type 2 diabetes? Only clients with type 1 diabetes can have gestational diabetes Clients with type 1 diabetes are more prevalent Clients with type 2 diabetes can produce more insulin Only clients with type 2 diabetes can receive exogenous insulin

Explanation Type 1 diabetes is associated with pancreatic beta cell destruction by autoimmune process, usually leading to absolute insulin deficiency. Exogenous insulin by injection or pump is required for survival. People with type 1 diabetes produce absolutely no insulin, leading to the claim that people with type 2 diabetes produce more insulin.

Applied Knowledge Provide dietary modifications, exercise program guidelines, and lifestyle change support suggestions for a client who is obese: Diet: begin to eat lower fat and lower calorie foods, such as reducing the amount of red meat, sweets, soda, and fatty dairy, as well advising the patient to eat only when hungry, and only eat till mild fullness Exercise: the client should first be encouraged to do daily activities such as walking the dog, playing with kids, taking the stairs, etc., and then build up to moderate exercises Support: incorporate goal setting, rewards, feedback, and self- monitoring in your clients lifestyle