1. Weight Management Katie Belazis, Nicole Sagaria, Shelley Opremcak, Colleen Poling HCFN 400A November 6, 2008

2. Position Statement It is the position of the American Dietetic Association that successful weight management to improve overall health for adults requires a lifelong commitment to healthful lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activities (1)

3. Summary Assessment of obesity. Assessment of obesity. Etiology of obesity: Genetics, environment, medications, psychological status. Etiology of obesity: Genetics, environment, medications, psychological status. Goals in weight management intervention. Goals in weight management intervention. Interventions: Diets, Physical activity, pharmacotherapy, surgery, relapse prevention Interventions: Diets, Physical activity, pharmacotherapy, surgery, relapse prevention Responsibility of the Dietitian. Responsibility of the Dietitian. Role of Dietetics Professional in Team Approach to Weight Management. Role of Dietetics Professional in Team Approach to Weight Management. Costs to weight management. Costs to weight management.

4. Assessment of Obesity Overweight is defined as a BMI of 25-29.9 kg/m 2, obesity is defined as a BMI of ≥30 kg/m 2, and severe obesity is defined as ≥40 (2) Overweight is defined as a BMI of 25-29.9 kg/m 2, obesity is defined as a BMI of ≥30 kg/m 2, and severe obesity is defined as ≥40 (2) 65% of adults are classified as overweight;30% are classified as obese in America (3) 65% of adults are classified as overweight;30% are classified as obese in America (3) It is the second cause of premature death in the United States (4) It is the second cause of premature death in the United States (4)

5. Etiology of Obesity (1) Obesity develops from both genetic and environmental factors. Obesity is a very complex and multifactorial chronic disease Obesity develops from both genetic and environmental factors. Obesity is a very complex and multifactorial chronic disease Genetics: accounts for 60-80% of the predisposition of obesity Genetics: accounts for 60-80% of the predisposition of obesity Leptin Leptin Environmental: Decrease in Physical activity, advances in technology and food availability Environmental: Decrease in Physical activity, advances in technology and food availability HOW IS OVERWEIGHT AND OBESITY DEFINED?? HOW IS OVERWEIGHT AND OBESITY DEFINED??

6. Etiology of Obesity (1) Medications Medications Psychotropic medicines can also contribute to unwanted weight gain. Psychotropic medicines can also contribute to unwanted weight gain. Mood stabilizers, medicines that block histamine H1, Serotonin 5- 5HT, dopamine, several types of antidepressants Mood stabilizers, medicines that block histamine H1, Serotonin 5- 5HT, dopamine, several types of antidepressants Newer medications are allowing for alternative choices which can limit unwanted weight gain Newer medications are allowing for alternative choices which can limit unwanted weight gain Psychological status Mood state and eating behaviors are commonly related. Studies have shown that those with serotonin levels are involved with mood and behavior. Patients can learn that if they eat, then they can reduce their depressive symptoms. Seen in: Nicotine withdraw, seasonal affective disorder, premenstrual syndrome

7. Goals of Weight Management Interventions (1) Prevention of weight gain or stopping weight gain in the individual who has been seeing a steady increase in his/her weight Prevention of weight gain or stopping weight gain in the individual who has been seeing a steady increase in his/her weight Varying degrees of improvements in physical and emotional health Varying degrees of improvements in physical and emotional health Small maintainable weight losses or more extensive weight losses achieved through sensible and tolerable eating and exercise behaviors Small maintainable weight losses or more extensive weight losses achieved through sensible and tolerable eating and exercise behaviors Improvements in eating, exercise and other behaviors apart from any weight losses Improvements in eating, exercise and other behaviors apart from any weight losses

8. Interventions (1) Diet and Lifestyle Modifications Diet and Lifestyle Modifications Body knows best Body knows best Self guidance using internal clues to hunger and satiety Self guidance using internal clues to hunger and satiety External regulation through calorie restriction External regulation through calorie restriction For individuals who are able to internally control their food intake For individuals who are able to internally control their food intake What is the difference between a VLCD and a LCD? What is the difference between a VLCD and a LCD? Physical Activity It is well established that physical activity during weight loss can favorably affect energy balance and body composition To promote weight loss, it is necessary to create an energy imbalance that elicits an energy deficit (3) Combination of diet plus exercise has the greatest impact of weight loss (3) The combination has consistently been shown to convey additional health benefits by improving the metabolic parameters associated with chronic disease

9. Interventions (1) Diets Diets Diets can be classified as: starvation (0-200 kcals/day); VLCD (200-800 kcal/day) or low calorie (>800 kcal/day) Diets can be classified as: starvation (0-200 kcals/day); VLCD (200-800 kcal/day) or low calorie (>800 kcal/day) Starvation include fasting Starvation include fasting VLCDs are protein-sparing, modified fasts and reserved for those who have a BMI >30 VLCDs are protein-sparing, modified fasts and reserved for those who have a BMI >30 LCD is the most common intervention that modifies the macronutrient composition of the diet LCD is the most common intervention that modifies the macronutrient composition of the diet Emphasizes portion control and reduction of saturated and total fat intake Emphasizes portion control and reduction of saturated and total fat intake Pharmacotherapy Pharmacotherapy research is currently focusing on three approaches; inhibitors of energy intake, enhancers of energy expenditure, and fat mobilization stimulators Obesity guidelines currently recommend that drug therapy be considered in conjunction with nonpharmacological therapy (5)

10. Interventions (1) Surgery Surgery During the past 25 years, gastric surgery has been shown to be the most effective approach for generating long-term weight loss in extremely heavy persons During the past 25 years, gastric surgery has been shown to be the most effective approach for generating long-term weight loss in extremely heavy persons Bariatric surgery has been shown to be an effective method for producing weight loss in obese patients and to be more effective than dieting in producing sustained weight loss (6) Bariatric surgery has been shown to be an effective method for producing weight loss in obese patients and to be more effective than dieting in producing sustained weight loss (6) Relapse Prevention A successful program is often defined as one that produces maintenance of loss at least 5%, or 6.6 kg of body weight Successful maintainers report that very careful attention to reduced calorie, low-fat diets, increased levels of physical activity, and frequent weighing

11. Responsibilities of Dietitians (1) Dietitians should focus on long-term as well as short-term outcomes and convey realistic expectations Dietitians should focus on long-term as well as short-term outcomes and convey realistic expectations It is important for an RD to maintain currency in their profession by continuing education and training It is important for an RD to maintain currency in their profession by continuing education and training RD’s need to stay within appropriate scope of practice; they must know their limitations and respect them; and make referrals as needed RD’s need to stay within appropriate scope of practice; they must know their limitations and respect them; and make referrals as needed

12. Role of Dietetics Professional in Team Approach to Weight Management (1) The physician is usually first to see patients in need of weight management The physician is usually first to see patients in need of weight management The RD has primary responsibilities for assessment and recommendations related to food behavior The RD has primary responsibilities for assessment and recommendations related to food behavior The RD also interprets the results from the initial assessment and makes appropriate, patient-matched treatment recommendations The RD also interprets the results from the initial assessment and makes appropriate, patient-matched treatment recommendations

13. Cost of Weight Management (1) All approaches to weight management require comprehensive lifestyle program that focuses on nutrition, exercise, cognitive behavioral changes and medical monitoring to increase the likelihood of long-term success and healthy outcomes All approaches to weight management require comprehensive lifestyle program that focuses on nutrition, exercise, cognitive behavioral changes and medical monitoring to increase the likelihood of long-term success and healthy outcomes Obesity must be acknowledged (by insurance companies) as a disease for reimbursement Obesity must be acknowledged (by insurance companies) as a disease for reimbursement Should obesity be classified as a disease? Why or why not? Should obesity be classified as a disease? Why or why not?

14. Conclusion By maintaining activity and food intake we can help regulate weight management, and improve overall health. By maintaining activity and food intake we can help regulate weight management, and improve overall health. Our society today has access to more food, with higher calorie content, and interacts less in physical activity, than ever before. Our society today has access to more food, with higher calorie content, and interacts less in physical activity, than ever before. There are some factors that we cannot change, but we can focus on factors that involve environmental influences. There are some factors that we cannot change, but we can focus on factors that involve environmental influences.

15. References 1) American Dietetic Association. Position of the American Dietetic Association: weight management. J ADA. 2002 1145-1155. 1) American Dietetic Association. Position of the American Dietetic Association: weight management. J ADA. 2002 1145-1155. 2) Calle, EE, Thun, MJ, Petrelli, JM, et al. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999; 341:1097. 2) Calle, EE, Thun, MJ, Petrelli, JM, et al. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999; 341:1097. 3) Otto AD, Jakicic JM. Physical activity considerations for the treatment and prevention of obesity. J Clin Nutr. 2005;82:226S- 229S. 3) Otto AD, Jakicic JM. Physical activity considerations for the treatment and prevention of obesity. J Clin Nutr. 2005;82:226S- 229S. 4) Jones N. An Investigation of obese adults’ views of the outcomes of dietary treatment. J Hum Nutr Diet. 2007; 20: 486-494. 4) Jones N. An Investigation of obese adults’ views of the outcomes of dietary treatment. J Hum Nutr Diet. 2007; 20: 486-494. 5) Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean A, MacLean L. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Annals of Surgery 2004; 240:416-424. 5) Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean A, MacLean L. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Annals of Surgery 2004; 240:416-424.