Overview of Evidence-Based Strategies to Address Your Weight. Obesity Treatment Pyramid

Transcription

1 Overview of Evidence-Based Strategies to Address Your Weight Domenica M. Rubino, MD Obesity Treatment Pyramid Individual Circumstances & BMI and Co-morbid conditions 1

2 What can I do on my own? About ½ of people who lose weight, lose weight on their own Self-monitor: record food intake (apps/online); weigh-in, pedometer/accelerometer/apps for supporting activity, etc. Be Active Nourish your body Be realistic- a weight loss of 3-5% results in health improvements; goal of 5-10 % reasonable Find a support group/ buddy / emotional support Use Flexible-Restraint What can I do on my own? Eat breakfast Eat more fruits and vegetables Individual preference most important in following a reduced calorie diet (helps us stick to it)- No MAGIC diet. Reduce calories by daily or kcal/day for women or kcal/day for men Meal replacement bars or shakes for a meal can be helpful Set SMART goals: Specific, Measureable, Achievable, Realistic and Timely; for example I would like to be more mobile 2

3 Be Active 3-10 minute walks are as effective as 30 minutes of walking for weight loss. Increasing lifestyle activity is as effective as programmed exercise for improving weight and cardiovascular health. Also improves stress management, mood and quality of life. Weight (Resistance) training is particularly helpful for maintaining muscle mass during weight loss. Also, beneficial for those with type 2 diabetes. To maintain weight try to be active 150 min per week of moderate to vigorous activity, such as brisk walking (need more activity to maintain weight). Be Active-practical tips Find something you like. Find an exercise buddy or trainer. Get physical therapy to help recondition or work with balance/confidence issues. Speak with physician about optimizing pain management. 3

4 Need more help? Individual Counseling- dietician, exercise physiologist, obesity medicine physician, etc. Commercial programs Weight Watchers, Jenny Craig, Nutri-systems, etc. Comprehensive Weight Management Program Intensive, team-based approach 1-2 years Group support ±Meal replacements ±Medications Bariatric Surgery Consultation Medical Management Model/Comprehensive Lifestyle Intervention Weight loss intervention: ~6 + months with weekly groups and/or individual sessions; diet/activity change Maintenance: ~ 1 year + support ; regular bi-monthly or monthly contact; Face-face or telephone optimal; high level of activity. Team approach supporting development of various skills Cognitive behavioral therapy and other therapeutic approaches as needed; self-monitoring, stimulus control, and trigger/cue management. Obesity Medication-if needed 4

5 Why consider obesity medication? Indicated for those with BMI 30 or 27 with DM, HTN, sleep apnea, etc. Target mechanisms involved in protecting against weight loss. Helps support behavioral changes (hunger, impulsiveness; satiety/portion, etc.) with lifestyle intervention. Lose more weight when used with behavioral change Supports weight loss improve co-morbidities & quality of life Long term- control; helpful for maintenance Individual responsiveness and sensitivity to medication Discuss options with your physician Bariatric Surgery May be indicated for motivated people with high BMI ( 40 or those 35 with medical illnesses) who have not responded to intensive medical/behavioral treatment ± medication. Various surgical options, adjustable gastric banding, gastric sleeve and Roux-En-Y gastric bypass most commonly performed. Seek consultation for discussion of most appropriate procedure for you. Need to have ongoing comprehensive support, medical follow-up; may use medication later in maintenance. 5

6 What should I look for in a program? Promotes gradual weight-loss Teaches you how to make permanent lifestyle changes Encourages exercise and good nutrition, does not exclude major food groups; Does not propose a magic diet or the only way Does not make certain foods bad or illegal or make outlandish weight-loss claims Frequent visits with physician especially with medication while losing weight. Practices evidence-based medicine. American Board of Obesity Medicine Board Certification Thank you and Enjoy the Conference 6

7 Bariatric Surgery Options- Adjustable Gastric Band Bariatric Surgery Options- Gastric Sleeve 7

8 Bariatric Surgery Options- Roux-En-Y Gastric Bypass Tools for Maintenance Check-in/support every 2 weeks to one month Increased exercise to compensate for skeletal muscle efficiency >2500 kcal/week (200 min week) Daily weighing, act on changes?record keeping Medications may be helpful Environmental change 8