OBESITY-the Good, the Fat, and the Ugly

Transcription

1 OBESITY-the Good, the Fat, and the Ugly An Internist s Perspective Melinda Allen, DO, FACOI

2 Look Better Fit clothes better Feel sexier Less depression The things they are telling us

3 Long Term Health Cancer Risks Osteoarthritis Sleep Apnea Bad Fat- Inflammatory Cytokines Cholesterol Insulin Resistance and Diabetes Metabolic Syndrome Diabetes, HTN, CAD, etc.. And on and on and on and on

4 General Health and Medical History BMI- Apple or Pear? Is their estimated BMI reliable? Knowledge Base concerning their risk factors Is the patient asking you about weight loss or are you recommending it? Can they count calories, have they accessed information? What are their eating habits? Overeating, poor choices, soda pop, carb cravers, chocaholics, etc. WHOA!! Is Food Addiction apparent? Counseling recommended

5 Are they motivated to lose weight? Will they commit to a weight loss program? Their readiness score 1 to 10.. Determine their motivators and their barriers Have they been on a weight loss program in past? If so, successful or not and reason for current weight. If multiple failed attempts are they a candidate for surgery?

6 What is their general activity level? Exercise or not? And as we have heard this weekend...just movement of any kind, less down time Kirstie Ally lost her first round of weight dancing Who are their supporters? Friends, family, coworkers, children, etc. And who and what are their defeaters? Friends, family, coworkers, children, etc New job, drive time, screen time, accountabilty, Depression, health issues, arthritic issues

7 Basement Gym don t assume your patient will accept what you offer Just because they are in counseling don t assume things are better Paula. 44 year old, >400# whole family obese Cellulits, then DVT/PE, Pickwickian Syndrome, still working Progressing problems but maintaining weight (primarily difficulty walking and recurring cellulitis/copd exacerbations, pulmonary hypertension..quit working last year at 49. Sent to nutritionist and counselor

8 THE BIGGEST LOSER!! -I love it!! helps to explain that almost everyone can lose weight if they are doing the right things! -season 2011 Are you informed???? You better be.cause your patients are Now....if patient and you are ready. How much weight gained in past 12 months? Determine the calorie overage for the patient on daily average that they are overeating.

9 350 days in a year 3500 calories in a pound If a patient has gained Overeaten daily by 10# one year 100 calories 50# one year 500 calories If a patient has lost They have undereaten Determine your patients calorie requirements And what they have overeaten to pack on pounds.

10 Figure their weight loss goal Determine weight pattern over the past year. What have they done right or wrong? How many pounds to lose in what period of time? pounds in months= calories/day calories/day=patient BMR (no exercise) Can Calculate off Nutrimirror Free Tools (under Resources tab)

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12 How many pounds to lose in what period of time? pounds in months= calories/day calories/day=patient BMR (no exercise) Add 300 calories to BMR for some activity (desk job) Add 600 calories to BMR if modest activity (nursing, construction, etc) Add another 150 calories for every 30 minutes exercise patient will commit to. Total Calories Total Calories used-calories needed to lose or Quick formula for petite or average women 1500 for larger women men wanting to lose weight I never recommend less than 1200 calories/day

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14 Discuss Calories Discuss Type of Diet Low Fat, Low carb, Adkins, Mediterranean 2008 study by NEJM showed sustained weight loss over two years with all diets, but more weight loss with SOUTH BEACH diet, reduced C Reactive Protein levels, and beneficial changes in HDL and LDL levels. Benefit secondary to reduced insulin requirements. (Any diet is good) Reduced portions, better choices!!!! DIET

15 Myth #1: Calories Fuel our Bodies They Fuel Steam Engines, Mitochondria more efficient Myth #2: All Calories are created equal Carbohydrates-100 cal absorbed/5 to 10 cal used Proteins- 100 cal absorbed/20-30 cal used Fats-100 cal/4 to 5 cal used Carbs and Fat yield more usable energy Myth #3: A calorie ingested is a calorie digested Animal sources of protein are more digestible than plant sources (eat more tofu) Fiber slows digestive tract, and can block digestion of other calories. High fiber diet leaves roughly twice calories undigested

16 Myth #4: Exercise burns most of our calories Work out nuts only burn about 30% of their intake Most burn at a simmer (BMR) 2/3 rest Remaining third is burned up with daily activity Myth #5: Low calorie foods help you lose weight Some fool body (avoid artificial sweeteners) (some sugar free foods contain more fat.caution)

17 TO EXERCISE OR NOT TO EXERCISE? Do it for health! reduced amounts of abdominal fat with exercise!! 30 minutes for general health 60 minutes for weight maintenance 90 minutes for weight loss If 30 years of age- 30% should be weight training If 40 years of age- 40% should be weight training If 50+ years of age- 50% should be weight training to combat the natural decline that occurs.

18 COST TO JOIN Weight Watchers The Biggest Loser Jillian Michaels South Beach Diet NCCAM-(national center for complementary and adult medicine..nih) FREE ACCESS NIH- GO 4 Life Nutrimirror My Fitness Pal This City is Going ona Diet Food for Fit Spark People TOPS Choose My Plate. Day.blogspot.com

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30 Phentermine Phendemetrazine Topamax Qsymia Orlistat Belviq (lorcaserin) Weight loss market estimated at $60 billion/year

31 Date Name I am interested in living a fuller and healthier life style. I understand that to maintain my weight I need to eat approximately calories daily. I also understand that 100 calories daily above what I need will cause me to gain #10/year. In the same manner, if I drop my diet by 100 calories daily I will lose #10/year. I would like to lose pounds in. I agree to follow Low Carbohydrate Diet Low Fat Diet Vegetarian Diet Atkins Diet (no carbohydrate diet) I agree to reduce my daily intake of calories to. (no less than 1200 calories daily) I agree to exercise/increase activity to. If I follow the above regimen I understand that I will lose #/ week. I will weigh daily at home and return to the office to weigh twice monthly. I will keep a food diary of my daily eating habits if I am unsuccessful and bring to my next office appointment. I have been given a list of websites/local support groups to utilize for information and will join if further assistance is needed. I will take a multivitamin and B complex daily. I will return for a monthly office appointment. I am being started on. I am aware that the side effects of this medication include palpitations, rapid heart rate, constipation, dry mouth, light headedness, and may have other side effects not listed. To maximize the benefit of this medication I will follow the above regimen and understand that I must lose weight to continue to have my prescription filled. I also agree that I will take this medication for 3 weeks on and 1 week off. During the week off I will continue to limit my food intake to no more than calories to continue to maintain my weight.

32 5-2-1-to almost none!!! 3 on, 1 off Readiness score 10#/100 calories 1x4, 2x6, (6-6-6), then monthly Medicare reimbursement

33 You have given your patient information on the long term risks of obesity You have given them a calorie goal You have discussed with them a diet plan You have given them website information for diet and exercise You have given them an exercise/activity goal You have discussed medication options if applicable Now give them a weight loss goal for their return appointment AND to the grocery store they go..>>>>>>

34 Questions?