1. Introduction to Weight Loss Counseling for Family Medicine Physicians Richa Garg, MD Department of Family Medicine University of Chicago

2. Objectives Understand how calories influence weight Demonstrate use the Harris-Benedict formula by calculating BMR Demonstrate use of activity factors to calculate individual caloric need Utilize and reference apps for healthy weight loss when counseling patients Practice creating meal plans for sample patients

3. Introduction 2 out of 3 people are overweight or obese BMI > 25kg/m 2 Most physicians have minimal training in nutrition and weight loss counseling There is a direct relationship between unhealthy weight and chronic metabolic disease Weight loss counseling from physicians has a positive impact on patient behavior

4. What are Calories Calories are a unit of measurement Correlates to the amount of energy in food 1 lb = approximately 3500 calories ProteinCarbohydratesFatsAlcohol 4cal/g 9cal/g7cal/g* https://fnic.nal.usda.gov/how-many-calories-are-one-gram-fat-carbohydrate-or-protein

5. Determining Caloric Need Harris-Benedict formula Used to determine the basal metabolic rate (BMR), also called resting energy expenditure (EER) Influenced by gender, age, and body size GenderEquation Women 655 + (4.35 x weight in pounds) + (4.7 x height in inches) - (4.7 x age in years) Men66 + (6.23 x weight in pounds) + (12.7 x height in inches) - (6.8 x age in years)

6. Determining Caloric Need 58yo female, who walks 1-2 times per week, is trying to lose weight. She is 5'4” and her current weight is 198#. What is her BMR? 655 + (4.35 x weight in pounds) + (4.7 x height in inches) - (4.7 x age in years) = BMR 655 + (4.35 x 198) + (4.7 x 64) – (4.7 x 58) = BMR 655 + 861.3 + 300.8 – 272.6 = 1544.5

7. Determining Caloric Need Active Metabolic Rate Considers caloric need based on BMR and an individual's activity level Activity factor ranges from 1.2 (sedentary) to 1.9 (extra active) BMR x activity factor = AMR Activity LevelActivity Factor Sedentary (little to no exercise)1.2 Light Activity (light exercise 1-3 days/wk) 1.375 Moderate Activity (moderate exercise 3-5 days/wk) 1.55 Very Active (hard exercise 6-7 days/wk) 1.725 Extreme Active (very hard exercise 6- 7 days/wk) 1.9

8. Determining Caloric Need BMR x activity factor = AMR 1544.5 x 1.375 = 2123 58yo female, who walks 1-2 times per week, is trying to lose weight. She is 5'4” and her current weight is 198#. What is her AMR?

9. Creating Caloric Deficits Limit weight loss to 1-2 pounds weekly This can be done by having a 500-1000 calorie deficit daily 3500-7000 calorie deficit weekly BMR should be re-calculated with substantial weight loss http://www.cdc.gov/healthyweight/images/calories/scale_caloric_balance.jpg

10. Exercise100lbs120lbs140lbs160lbs180lbs200lbs220lbs240lbs Aerobics (light) 115147173195220246271294 Aerobics (vigorous) 169203237256290327365400 Bicycling180216252288324360396432 Running (12 min mile) 180216252288324360396432 Running (10 min mile) 225270315360405450495540 Stationary Cycling 158189221252284315347378 Swimming180213247283318354387417 Walking (slow 2mph) 617489101114127140153 Walking (fast 4mph) 118140161186210235257278 Free weights125150175201225250276300 Yoga86105121139156174192209 http://www.exercisereviewsite.com/wp-content/uploads/2016/02/30-Minute-Exercise-And-Calorie-Guide.jpg

11. Exercise100lbs120lbs140lbs160lbs180lbs200lbs220lbs240lbs Aerobics (light) 115147173195220246271294 Aerobics (vigorous) 169203237256290327365400 Bicycling180216252288324360396432 Running (12 min mile) 180216252288324360396432 Running (10 min mile) 225270315360405450495540 Stationary Cycling 158189221252284315347378 Swimming180213247283318354387417 Walking (slow 2mph) 617489101114127140153 Walking (fast 4mph) 118140161186210235257278 Free weights125150175201225250276300 Yoga86105121139156174192209 http://www.exercisereviewsite.com/wp-content/uploads/2016/02/30-Minute-Exercise-And-Calorie-Guide.jpg

12. Servings vs Portions A serving is a measured amount of food or drink 1 cup of milk 1-2 slices of bread 8 potato chips A portion is the amount of food that is actually served or eaten 3 oz bag of chips has 3 servings 20 oz bottle of soda has 2.5 servings Most pre-packaged foods come in a single portion, but contain multiple servings

13. Portion Distortion https://nutritiontranslator.files.wordpress.com/2011/05/portions-have-changed.jpg

15. Free Apps My Fitness Pal Health App on iPhone Google Fit Lose It! Pact 7 minute workout Fooducate SparkPeople

16. Take Home Points Calories are the amount of energy in food The amount of protein, carbohydrate, and fat in a food item contribute to its caloric density The Harris-Benedict equation can be used to calculate a basal metabolic daily caloric need Use of an activity factor with the Harris-Benedict equation more accurately calculates daily caloric need Limit weight loss to 1-2 pounds per week There are MANY free apps to use to support weight loss

17. References Rose, S. A., P. S. Poynter, J. W. Anderson, S. M. Noar, and J. Conigliaro. "Physician Weight Loss Advice and Patient Weight Loss Behavior Change: A Literature Review and Meta-analysis of Survey Data." Int J Obes Relat Metab Disord International Journal of Obesity 37.1 (2012): 118-28. Web. US Health and Human Services National Institutes of Health United States Department of Agriculture