NUTRITION FOR OBESITY MANAGEMENT PART I

Transcription

1 NUTRITION FOR OBESITY MANAGEMENT PART I Jennifer Brown, MSc., RD 8th Learning Retreat on the Principles and Practice of Interdisciplinary Obesity Management for Dietitians Toronto, Canada October 25-26,

2 FACULTY/PRESENTER DISCLOSURE FACULTY Jennifer Brown RELATIONSHIPS WITH COMMERICAL INTERESTS Speakers Bureau/Honoraria: DC/CON Consulting Fees: DC, AFHTO, CON, Celebrate Vitamins Other: Employee of the Ottawa Hospital Bariatric Centre of Excellence; Co-chair of OBN Dietitian Working Group

3 OBJECTIVES PART I: Applying the science of obesity and weight physiology into practice Provide education, counselling and support for your patients experiencing weight regain How to have the conversation about obesity management

4 Medical Nutrition Therapy (MNT) Nutrition Sciences/ Metabolism Evidence- Focus Based on Obesity Management health & wellness (not weight or BMI) Behaviour Change/ Counselling Exercise & Physiology Egger G, Swinburn B. BMJ. 1997;315(7016):

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6 USING HAES IN OBESITY MANAGEMENT Weight Inclusivity Health Enhancement Respectful Care Eating for Well-Being Life-Enhancing Movement

7 NEW PROPOSED DEFINITION OF OBESITY Abnormal or excess body fat that IMPAIRS health Proposed changes: 1) No longer use BMI alone to define obesity 2) Use a 3-pronged assessment: Amount of body fat Distribution of body fat Physiological impact of body fat Mechanick, JL., Hurley, DL. & Garvey, WT. Endocr Pract. (2017) 23(3):

8 Abnormal or excess body fat that IMPAIRS health Medical Nutrition Therapy (MNT) Evidence- Based Obesity Management Nutrition Sciences/ Metabolism Behaviour Change/ Counselling Exercise & Physiology Egger G, Swinburn B. BMJ. 1997;315(7016):

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10 CHRONIC DISEASE MANAGEMENT Behaviour/Life Changes Surgery Diagnosed with Obesity Structured Interventions Medications

11 AVAILABLE TREATMENT NO TREATMENT Body Weight Change (%) Life changes = 3-5% Meal replacements = 5-10% Medications = 5-10% Surgery = 15-35%* Years after weight loss

12 Mann T, et al. Am Psychol. 2007;622(3): REVIEW STUDIES - DIETS

13 VARIATION IN INDIVIDUAL RESPONSES TO DIETS Presented by Kaplan, LM. Harvard Blackburn Course in Obesity Medicine, 2016/06/22 Adapted from Gardner, CD, et al, JAMA, Courtesy of conscienhealth.org

14 VARIATION IN INDIVIDUAL RESPONSES TO MEAL REPLACEMENTS Studied: 1,500 women Age: years old All on Optifast + Behaviour/Life skills (either 6 or 12 weeks) Weights measured at end of program EVERYONE RESPONDS DIFFERENTLY Azar, M., et al. Obesity (2016); 24: Slide courtesy of Dr. Bob Dent

15 VARIATION IN INDIVIDUAL RESPONSES TO MEDICATIONS & SURGERY Presented by Kaplan, LM. Harvard Blackburn Course in Obesity Medicine, 2016/06/22. Courtesy of conscienhealth.org

16 ROUX-EN-Y GASTRIC BYPASS SURGERY Sjostrom L. J JAMA 2012; 307(1):

17 WEIGHT TRAJECTORIES AFTER RYGB Courcoulas, AP, et al. JAMA. 2013;310(22):

18 Change our understanding and outlook

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20 - Isn t eating well - Isn t able to move/exercise - Isn t sleeping well - Isn t happy 150 lbs 10 lbs

21 X X

22 LIFELONG MANAGEMENT OF OBESITY Body Weight Change (%) Meal replacements Life changes Medication Years

23 LIFELONG MANAGEMENT OF OBESITY Body Weight Change (%) Surgery Life changes Medications Years

24 CHRONIC DISEASE MANAGEMENT Behaviour/Life Changes Surgery Diagnosed with Obesity Structured Interventions Medications

25 PATIENTS ARE SCARED OF GAINING WEIGHT

26 I m able to eat more I m hungry all the time I can t stop craving. I ve gain some weight I m terrified of gaining more weight..or going back to my old habits

27 STEP 1: Listen Acknowledge Ask Assess Assist WHAT TO DO WHEN PATIENTS ARE CONCERNED ABOUT WEIGHT GAIN

28 STEP 1 Stopped exercising WEIGHT GAIN What we see Poor food choices and eating habits Not following post-op behaviours WHY (root causes) Injured back Skipping breakfast Pain Working shift work Elevated stress Poor sleep hygiene

29 WHAT TO DO WHEN PATIENTS ARE CONCERNED ABOUT WEIGHT GAIN STEP 1: Listen Acknowledge Ask Assess Assist STEP 2: Determine their weight outcomes How much they lost after surgery Calculate wt trajectories How long it took them When did they notice weight increasing

30 STEP 2: DETERMINE WEIGHT OUTCOMES Calculate nadir % total weight loss Pre-intervention wt nadir wt (lowest wt) Pre-intervention wt x 100 Calculate current % total weight loss Current wt nadir wt (lowest wt) Current wt x 100

31 STEP 2: DETERMINE WEIGHT OUTCOMES Calculate nadir % total weight loss Pre-surgery wt (post-optifast) nadir wt (lowest wt) Pre-surgery wt (post-optifast) x 100 Pre-sx wt: 280 lbs Nadir wt: 175 lbs TWL = 105 lbs (38%) Calculate current % total weight loss Pre-surgery wt (post-optifast) current wt x 100 Pre-surgery wt (post-optifast) Pre-sx wt: 280 lbs Today s wt: 190 lbs TWL = 90 lbs (32%) 38% TWL 32% TWL 1-2 years post RYGB = 20-35% SG = 15-25% 15 lbs weight gain

32 STEP 2: DETERMINE WEIGHT OUTCOMES Calculate hypothetical weight trajectories Average weight gain = 0.5-2kg/year (1-4.5 lbs/yr) Pre-menopause women/men 1-5% per year ~ lbs Post-menopause women 5-7% per year ~ lbs BONUS: figure out the average weight gained/year

33 STEP 2: DETERMINE WEIGHT OUTCOMES Weight change timeline questions 1) How far post-op is the patient? 4 years 2) How long did it take to reach your lowest weight after surgery? (in months) 9 months 3) How long were you able to stay around this weight? 2 years 4) When did you start noticing your weight increasing? ~6 months ago

34 WHAT TO DO WHEN PATIENTS ARE CONCERNED ABOUT WEIGHT GAIN STEP 1: Listen Acknowledge Ask Assess Assist STEP 2: Determine their weight outcomes How much they lost after surgery Calculate wt trajectories How long it took them When did they notice weight increasing STEP 3: Assess quality of life factors Hunger/appetite Sleep Stress Energy Pain Happiness Mood Overall health

35 Step 3: Assess quality of life factors Ask patient to rate the following items on a 1-10 scale (1 = poor/low and 10 = good/high) Energy (3/10) Mood (5/10) Stress (9/10) Sleep (2/10) Pain (8/10) Hunger (8/10) Cravings (10/10) Appetite (9/10) Overall health (6/10) Other

36 Poor food choices and eating habits Injured back Skipping breakfast Stopped exercising WEIGHT GAIN Not following post-op behaviours Pain Working shift work PUT IT ALL TOGETHER Normalize weight gain Get to the root causes Use motivational interviewing to assess patients readiness Refer to health providers as needed Offer a Weight Regain Course Elevated stress Poor sleep hygiene

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38 Managing Weight Regain Course PART 1 Understanding Obesity PART 2 Hormones & Obesity PART 3 Gut Bacteria & Obesity PART 4 Lifelong Management of Obesity

39 OUTSMART THE BRAIN 1) Change your food environment 2) Make sleep a priority 3) Manage stress/coping skills 4) Eat foods high in fibre and protein 5) Be aware of food reward 6) Make the body move Adapted from Guyenet, SJ. The Hungry Brain

40 PATIENT RESOURCES The Hungry Brain: Outsmarting the Instincts that Make us Overeat by Stephan J. Guyenet CON Webinars: Time to Act on Obesity: Poodle Science:

41 Thank you Jennifer Brown, MSc., RD ext. jenniferbrownvowles

42 REFERENCES See attached list