1. Introductory Statistics: Question? Why discrepancy? Department of HHS Physical Activity Statistics (CDC, 2012):

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1 569: What You Need to Know about Your Client s Diets Fabio Comana, MA., MS., NASM CPT, CPES & PES; ACE CPT & LWMC; ACSM HFS, NSCA CSCS; CISSN National Academy of Sports Medicine fabio.comana@nasm.org 1. Introductory Statistics: Question? Why discrepancy? Department of HHS Physical Activity Statistics (CDC, 2012): NOTES U.S Physical Activity 45.3 % 45.9 % 48.1 % 48.8 % NA NA Obesity 31.1 % 32.2 % 32.7 % 33.0 % 33.8 % 51.0 % Factoid: 1995 no state reported obesity > 20%; 2010 no state reports obesity < 20% 2. Numbers and Ripple Effects U.S. Population Adults Overweight and Obese BMI ( ) BMI ( ) BMI ( 40,0) July 1, % of pop 68.0 % 33.8 % 14.3 % 5.7 % 314,000, ,012, ,848,160 80,448,056 34,035,716 13,566,684 Examples: 5 0 = 204 lbs. 5 5 = 240 lbs = 278 lbs. 6 1 = 302 lbs. Developed by Fabio Comana, MA., MS., NASM. All rights Reserved Page 1

2 3. Obesity and Health Care Costs: Overweight individuals (< 65 years) have annual medical costs ranging from % higher than normal-weight individuals. Obese individuals (< 65 years) have annual medical costs ranging from % higher than normal-weight individuals Normal Weight Obese Mean Total Health Care Expense $7,512 $10,083 Mean Inpatient Expense $2,407 $3,561 Mean Prescription Expense $1,518 $2,532 U.S. Bureau of Labor Statistics, 2011 Developed by Fabio Comana, MA., MS., NASM. All rights Reserved Page 2

3 Health Care Costs (Humana, 2010) Cost / 1 lb. being overweight 250 Kcal Difference Financial Impact Overweight / Obese Adult Population $147 billion $19.39 Walk 20 minutes lbs. x $ ,848,160 x $ One less soda */ day = $ / person 91,250 Kcal / year $ 81,814, lbs. / year $ 500K home: 163,628 people each year!! * Americans average 540 soda cans / year NOTES Ripple Effects: Less work productivity how will the U.S continue to compete in a global economy? As a heavier population: used 1,000,000,000 (1 billion) more gallons of fuel each year (2010) in transportation creates an additional 10 billion tons of CO 2 emissions. Example - Airlines: Use 350,000,000 million more gallons of fuel each year cost = $ 275,000, / year. Creates 3,800,000 tons more CO 2 emissions. Diets and Dieting ~ 45 million Americans follow diets each year spending ~ $ billion / year on weight-loss products ($ / person in U.S.) Boston Medical Center 50 % of women and 25 % of men in U.S. currently follow a diet - average duration of diet is < 6 months. Developed by Fabio Comana, MA., MS., NASM. All rights Reserved Page 3

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5 NOTES 1. Diet Failure Rates National Weight Control Registry (NWCR) Statistics: Failure Rates: 65% regain within one year, 85% regain within 3 years Women: 41 % blame lack of self-discipline and emotional eating. Men: 30% Cite 30% cite low-self-esteem, more cite external reasons restaurants, jobs, etc.). Issues: D.I.E.T * = Caloric or food reduction / restriction. Feeling Fat Cycle: Feeling of discomfort and discontent. Use food to distract, medicate, cope. Shame, self-loathing and guilt Feeling fat* Need to commit to regain control. * Fat is not an emotion Psychological Reactance Be mindful of feeling, words and use of DIET : Avoid use of narrow food definitions (i.e., good, bad). Avoid speaking in terms of detrimental vs. corrective (e.g., I know I should not eat this). Avoid negative self-talk. 2. What Commercial Diets Lack: Developed by Fabio Comana, MA., MS., NASM. All rights Reserved Page 5

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8 Behavioral Change Component What s next after Weight Goal is attained?? Result - Dieters often gain back the weight they lose, and dieting causes several psychological effects, such as stress, anxiety, lower self-esteem, depression and irritability. NOTES 3. Basic Diet Classifications Review: Developed by Fabio Comana, MA., MS., NASM. All rights Reserved Page 8

9 Low-Carbohydrate / High- Fat (Ketogenic) High-Protein / Lower-Carbohydrate (Ketogenic) High-Carbohydrate / Low-Fat Very-low Calorie Diets (VLCD) < 1,000 kcal Moderate Diets Moderate Calorierestriction Diets (VLCD) < 1,000 kcal Formula Diets Fad Diets Developed by Fabio Comana, MA., MS., NASM. All rights Reserved Page 9

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11 4. Diet and Interesting Research New Research Areas and Topics: NOTES 5. 7 New Solutions to Try for Successful Weight Loss: Most logical: Mindless versus Mindful calories is the key difference!! 1,000 2,000 calories surplus versus kcal surplus Readiness weight-loss commitment (quiestionnaire) Sabotage and self-imposed failure Importance and Self-efficacy Amplify discrepancy Create relevance Overcome Ambivalence / resistance (core values LI vs. LS) Transition from Extrinsic to Intrinsic Motivation Time frame Extrinsic stages 7 challenges (Malone & Heppner) Hunger vs. Appetite Hunger Scale Qualitative versus Quantitative tools. TEPA vs. RMR + TEF + TEPA TEPA = Exercise + PA = NEAT Studies by Katzmarzyk, et al., Levine. Weekly NEAT Process goals How NEAT are you 6. Educating Clients to Spot Fad Diet: Promote rapid weight loss. Recommend expensive meals or supplements (vitamins, minerals, etc.). Lack any behavior strategies as a component to the diet. Dictate specific rituals or limit food selections. Foods defined as "good" and "bad Elimination of major food groups or macronutrients. Restrict calories (e.g., under1,000 kcal / day). Claims that sound too good to be true. Lack of credible, long-term randomized scientific studies proving efficacy. Elimination of an essential nutrient (carbohydrates, fats, proteins). Do not include any activity or exercise. Created by individual(s) with no expertise in weight management (e.g., doctors) Use testimonials from famous / credible people or named after famous locations (e.g., doctor diets, Beverly Hills diet, etc.). Developed by Fabio Comana, MA., MS., NASM. All rights Reserved Page 11