What's New in Obesity Treatment

Transcription

1 NUTRI-BITES Webinar Series What's New in Obesity Treatment March 22, 2018 Presenter: James O. Hill, Ph.D. Professor Depts of Pediatrics & Medicine University of Colorado School of Medicine Moderator: James M. Rippe, MD Leading cardiologist, Founder and Director; Rippe Lifestyle Institute Approved for 1 CPE (Level 2) by the Commission on Dietetic Registration, credentialing agency for the Academy of Nutrition and Dietetics.

2 Conagra Nutrition Mission We believe that everyone deserves easy access to understandable, credible, and science-based nutrition information.

3 Webinar logistics CEUs a link to obtain your Continuing Education Credit certificate will be available on this webinar s page at and ed to you within 2 days. A recording of today s webinar and slides as a PDF will be available to download within 2 days at: The presenter will answer questions at the end of this webinar. Please submit questions by using the Chat dialogue box on your computer screen.

4 Today s Faculty James O. Hill, PhD Professor Depts of Pediatrics & Medicine University of Colorado School of Medicine Moderator: James M. Rippe, MD Leading cardiologist. Founder and Director, Rippe Lifestyle Institute

5 What's New in Obesity Treatment NUTRI-BITES Webinar Series Learning Objectives To understand that current success in long-term treatment of obesity is poor To identify reasons for poor success in long-term treatment of obesity To review new approaches and new concepts that can be incorporated into treatment programs to increase success To provide practical strategies that can be incorporated into obesity treatment programs

6 What s New in Weight Management? James O. Hill, Ph.D. Professor Pediatrics & Medicine University of Colorado School of Medicine

7 We have been seriously addressing obesity for 3 decades How are we doing?

8 Overweight BMI >30 kg/m2 Obesity BMI >25 and <30 kg/m2 Extreme Obesity BMI >40 kg/m2

9 Trends in child and adolescent overweight Age Age 6-11 Age 2-5 Note: Overweight is defined as BMI>=gender and weight-specific 95th percentile from the 2000 CDC Growth Charts. Source: National Health Examination Surveys II (ages 6-11) and III (ages 12-17), National Examination Surveys, I, II, III and , NCHS, CDC.

10 Figure 5. Trends in obesity prevalence among adults aged 20 and over (age adjusted) and youth aged 2 19 years: United States, through

11 Comparison of weight loss diets with different compositions of fat, protein and carbohydrates (n=811) WEIGHT LOSS What we are doing is not working WEIGHT Re-GAIN Sacks FS. et al. NEJM 2009;360(9)

12 We need to think about the problem in a new way If I had an hour to solve a problem, I would spend 55 minutes on understanding the problem and 5 minutes on the solution.

13 How to treat obesity Produce weight loss Help people keep weight off forever

14 What do you recommend for Jen? Height 5 7 Weight 400 lbs BMI 60 Prediabetic Elevated BP Elevated lipids Constant joint pain No friends No social life Low self-esteem Depressed Very Unhappy

15 Treatment Options Surgery % long-term success; regain in some; major life change Medications - ~7-10% most regained Devices - ~7-10% unclear Lifestyle 7-10% most regained

16 Barriers to Success Focus on weight loss rather than weight loss maintenance Diet confusion Failure to appreciate human biology Our goals are too low Failure to understand the WHY Failure to provide long-term support

17 The Energy Balance System Behavioral Factors Amount and composition of food intake Amount and type of physical activity Sleep Energy Stores Environmental Factors Food environment Physical activity environment Built environment Social environment Energy Intake Metabolic Regulation Energy Expenditure Human Biology

18 But, my metabolism is broken

19 Start with human biology

20 Metabolic flexibility in physiological situations Metabolic flexibility at the level of skeletal muscle and adipose tissue Goodpaster B and Sparks LM Cell metabolism, 2017

21 Phenotypic flexibility All peripheral organs have the ability to respond to metabolic challenge, and can contribute to the regulation of metabolic flexibility Van Ommen B. Gens Nutr, 2014

22 Physical activity predicts metabolic flexibility Bergouignan A et al. J Appl Physiol 2011;111:

23 What is best way to get weight off? Any diet works as long as it creates negative energy balance Exercise helps but you have to do a lot Weight loss is time limited

24 Gardner et al. JAMA 2018 Average weight loss = 5.3 kg (5%) Average weight loss = 5.3 kg (5%) Average weight loss at 1 year = 6 kg (6%)

25 Average weight loss at 1 year = 10.8 kg (10.4%) Average weight loss at 2 year = 7.4 kg (7.1%) Average weight loss at 1 year = 10.9 kg (10.5%) Average weight loss at 2 year = 6.3 kg (6.1%) Foster et al. Ann Intern Med. 2010;153:

26 Metabolic Changes with Weight Loss Energy expenditure declines Compensatory changes in hormones/processes that facilitate fat storage Hunger increases

27 The Energy Gap Body Weight Food restriction Exercise Medications Pre-Weight Loss Metabolic Rate energy gap Post-Weight Loss Metabolic Rate Time

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29 Environmental Factors Possibly Contributing to Obesity Food is good tasting, convenient, inexpensive It is easy to eliminate most physical activity from daily life

30 Comparison of weight loss diets with different compositions of fat, protein and carbohydrates (n=811) WEIGHT LOSS WEIGHT Re-GAIN Sacks FS. et al. NEJM 2009;360(9)

31 Why is Weight Loss Maintenance Hard? Biology Environment Behavior

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33 Optimize Metabolism

34 Physical Activity Threshold for Optimal Weight Regulation Energy Intake Body Weight Unregulated Zone Regulated Zone Increase in physical activity Adapted from Mayer et. al., 1956

35 Modifying the Environment 1. Environmental change will be essential 2. Not likely that we can modify the environment sufficiently that no cognitive effort is needed What factors would make a difference if modified? What factors are modifiable? Most changes oppose biology - Eat less of foods that taste really good - Hard-wired to like sugar, fat, salt - move when you don t have to move Swimming Upstream

36 Why is Maintaining a Healthy Weight Hard? Biology Environment Behavior Motivation Only 2.7% of adults met criteria of 1) healthy diet; 2) adequate physical activity; 3) healthy weight; 4) non-smoking -Loprinzi et al. Mayo Clinic Proc 2016

37 State of Slim: TRANSFORMATIVE WEIGHT MANAGEMENT Stateofslim.com

38 Transformational Weight Management

39 Translating the Science: Development of State of Slim (SOS) SOS Based on >30 years of research National Weight Control Registry Hill/Wyatt Research Program DPP Look Ahead State of Slim Extreme Weight Loss reality show Destination Boot Camp

40 The National Weight Control Registry >10,000 participants Avg weight loss >70 lbs Avg length of maintenance > 6 years >25 publications Identify common behaviors among those most successful in weight loss maintenance

41 What they do: Commonalities among NWCR participants in weight maintenance Low fat diet, attention to calories Self-monitoring Behavioral consistency Dietary restraint Breakfast High levels of physical activity

42 Transformation BIGGER THAN WEIGHT LOSS ABC S EXTREME WEIGHT LOSS

43 47%

44 Behavior What Mindset How Transformation Motivation Why

45 Lifestyle Changes (WHAT) 1. Fix metabolism - Exercise about 1 hour/day - Sleep may contribute; need more research 2. Get the weight off 3. Fill energy gap - Weight loss driven by caloric restriction - Maintenance energy density; portion size; diet to match metabolism - Exercise tweak from 60 min/day

46 Phases of State of Slim Phase 1 get weight off dramatic change (2 weeks) Phase 2- begin fixing metabolism (6 weeks) Phase 3 maintain activity while learning to eat smart (8 weeks) Each phase addresses what, why, and how

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48 Motivation: Alignment of Purpose (WHY) Aligning your lifestyle with your purpose Looking for connections between your life goals and your lifestyle

49 What is Your Deeper Why? Let s PEEL THE ONION Why do you want to lose weight? Continue asking why until you get to the person s deeper life goals/purpose Usually more emotional than logical

50 Changing Mindset (HOW) What I get to do versus what I am giving up Believing I have the power to change versus believing I am a victim to my life/circumstances Expecting success versus failure Choosing your Hard - new lifestyle versus obesity Developing emotional resiliency skills- bending versus breaking in rougher times Feeling fear and living in the arena Change you physical and social environment Writing your new story Finding and aligning your new life with your purpose and values Creating your new identity - TRANSFORMATION

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52 % of Grad Completers (n=107) Average weight loss = 18% -5 <0% 0 <5% 5 <10% 10 <15% 15 <20% 20 <25% 25 <30% 30 <35% 35 <40% 40 <45% % Weight Loss

53 156 pounds lost I love my life. I love who have become. I love that I no longer get winded cleaning my house or walking up a flight of stairs; in fact I love just being able to run up a flight of stairsi love that I will just randomly start dancing or roll down a hill. I really love my calves (my lower legs that is). But I can t say it enough, I LOVE LIFE!

54 State of Slim Products 16 week transformation program Year-long virtual program Next steps SOS Nation

55 X SOS Outcomes

56 SOS NATION

57 The Maintain IT Model of Health Behavior Change and Maintenance (Health Psych Rev 2018) Group-based identity Working memory Role-based identity Behavior-based identity Inhibition Shifting Personal Values Executive Function Centered Identity Δ Psychological well-being Δ Perceptual Lens Difficult to Change Health Behaviors

58 HOW TO MEASURE SUCCESS I got my life back I have more energy I have better relationships I have become the person on the outside I always was on the inside I lost weight Transformation

59 Practical Advice Fix the broken metabolism Get the weight off Provide lifestyle recommendations for keeping weight off Pay attention to the why and how Recognize that long-term support is required We need more comprehensive weight management programs Financial models Long-term engagement Long-term outcomes More than weight

60 What Happens If We Just Continue Doing What We Are Doing? The definition of insanity is doing the same thing over and over again, but expecting different results. Albert Einstein

61 Get Involved Stateofslim.com

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63 Our Transformation Team at the Anschutz Health and Wellness Center Thanks to our fantastic faculty and staff!

64 Questions?

65 What's New in Obesity Treatment NUTRI-BITES Webinar Series Based on this webinar the participant should be able to: To understand that current success in long-term treatment of obesity is poor To identify reasons for poor success in long-term treatment of obesity To review new approaches and new concepts that can be incorporated into treatment programs to increase success To provide practical strategies that can be incorporated into obesity treatment programs

66 Conagra Nutrition Nutri-Bites Webinar details A link to obtain your Continuing Education Credit certificate will be will be available on our website and ed within 2 days Today s webinar will be available to download within 2 days at: For CPE information: acontinelli@rippelifestyle.com Recent CEU webinars archived at the Conagra Nutrition website: Exploring the Evidence on Dietary Patterns: The Interplay of What We Eat and Health The Academy of Nutrition and Dietetics Evidence Analysis Library: Leveraging This Resource to Maximize Your Efficacy Mediterranean Diet Pattern and Health

67 Next Conagra Nutrition Nutri-Bites Webinars Does Tomato or Lycopene Intake Reduce the Risk of Prostate Cancer? John W. Erdman, PhD Professor Emeritus University of Illinois September 20, pm EDT/1-2pm CDT June 2018 Day and Time TBD Will Be Announced Soon

68 How are we doing? Stay on the line for a brief survey about today s Conagra Nutrition Nutri-Bites webinar: What's New in Obesity Treatment Thank you!