DIMENSIONS: Well Body Program. Fundamentals

DIMENSIONS: Well Body Program Fundamentals

DIMENSIONS: Well Body Program Introduction Program Overview

Our Wellness Philosophy Leading a meaningful and fulfilling life through conscious and self-directed behaviors, focused upon living at one s fullest potential.

Eight Dimensions of Wellness Emotional Environmental Financial Intellectual Occupational Physical Social Spiritual

What is a Well Body? A Well Body is different for different people This program is designed to assist individuals to envision and actualize their unique definition of what a Well Body is to them The focus of this program is movement towards positive health behavior changes based on individual goals Weight Issues refers to obesity, overweight and underweight

Why this is important to you The physical and emotional health of an entire generation and the economic health and security of our nation is at stake. This isn't the kind of problem that can be solved overnight, but with everyone working together, it can be solved. So, let's move. First Lady Michelle Obama

DIMENSIONS: Well Body Program Discussion

DIMENSIONS: Well Body Program Module 1: Weight Issues in People with Behavioral Health Conditions

What is a Healthy Weight? Varies by height and muscle/fat mass Estimate using the Body Mass Index (BMI): Underweight Healthy Weight Overweight 18.5 25 30 Obese BMI does not measure how much lean mass or fat mass is present Percent body fat is an alternative way to assess weight

Impact of Being Underweight on Health People who are underweight are at increased risk for: Premature death Osteoporosis Poor immune function Infertility (women) Malnutrition and associated disorders

Impact of Overweight and Obesity Overweight and obesity are connected to an increase in many health risks, including: Heart disease High blood pressure Type 2 Diabetes Stroke Respiratory illnesses Osteoarthritis Cancer

Impact of Overweight and Obesity 10 leading causes of death in U.S. 1) Heart disease * 2) Cancer * 3) Chronic lower respiratory diseases * 4) Stroke * 5) Accidents 6) Alzheimer s disease 7) Diabetes * 8) Kidney disease * 9) Influenza and Pneumonia 10) Suicide* Obesity can increase risk of at least 6 of the 10 leading causes of death in the United States

Behavioral Causes of Death in U.S. 500,000 450,000 400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000 0 8,300 25,700 31,700 16,300 33,700 43,000 38,400 365,000 443,000

The Burden of Obesity Both underweight and overweight have significant health risks, but overweight and obesity are much more common in the U.S. Approximately 68% of adults in the United States are either overweight or obese. Approximately 17% of youth are obese. Rates of obesity are rising rapidly. Over the past three decades, the percentage of persons who are overweight or obese has increased by approximately 40%.

U.S. Obesity Trends

Prevalence of Obesity Rates in People with Behavioral Health Conditions 70 60 60% 50 40 30 29% 28% Behavioral Health Conditions General Population 20 18% 10 0 Men Women

Prevalence of Obesity Rates in People with Behavioral Health Conditions 5 4 3.5x 3 2 1 1x 1.5x 2x Likelihood of Obesity 0 General population Depression Bipolar Disorder Schizophrenia The likelihood of a person being overweight or obese varies by diagnosis The difference of increased likelihood between diagnoses are due to many factors

Obesity Rates by Age and Gender 100 90 Obesity rate (percent) 80 70 60 50 40 30 20 10 37.2 36.6 33.2 36 31.9 42.3 20-39 40-59 60+ 0 Men Women

Obesity Rates by Socio-economic Status The impact of socio-economic status (SES), including factors such as family income and education, on obesity rates remains unclear Some research suggests that obesity rates vary by household income and education However other studies do not find this trend The high rates of obesity across the nation suggest that obesity affects all socio-economic groups

Obesity Rates and Ethnicity Rates of obesity are high across all ethnic groups. However, obesity is more prevalent among certain racial/ ethnic groups. Reasons include: Groups differ in health-related behaviors such as diet or physical activity Groups differ in attitudes and cultural norms around body weight Groups differ in access to healthy foods and safe places to exercise

Obesity Rates and Ethnicity 2006-2008 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 35.7% 23.7% 28.7% White, Non-Hispanic Black, Non-Hispanic Hispanic

Obesity Rates and People with Medical Conditions Some medical conditions can slow metabolism or affect hormone balance Hypothyroidism Cushing s syndrome Conditions that reduce movement or physical activity can also contribute to weight gain Arthritis Conditions that cause chronic pain Disabilities that limit mobility

Desire to Lose Weight Many individuals who are overweight or obese want to achieve a healthy weight People need to support each other in their efforts to reach a healthy weight

Contributing Factors To address weight issues we need to understand: Factors that contribute to or sustain obesity These factors are different for different people

Addressing Weight Issues Factors to Consider Biological Health conditions medications Behavioral Habits, emotions, decisions Environmental Social, physical and occupational environment Biomedical approaches Behavior change strategies Policy & practice change Services should address the biological, behavioral and environmental factors that affect weight

Genetic make-up Biological Factors Chronic health problems Medication side effects Increased appetite Sedation Effects on regulation of blood sugar Increased risk for metabolic syndrome

Hunger and satiety are affected by the types of foods eaten and meal frequency Biological Factors Natural preference for foods with high energy density, such as high fat and high sugar foods

Biological Factors 400 350 Blood Sugar Levels 300 250 200 150 100 50 0 0 30 min. 1 2 3 4 5 6 Hours Healthy Eating Insulin Resistence Type 2 Diabetes

Biological Factors Sleep is important to good health Sleep restriction can lead to: Changes in hormones that affect appetite Craving energy dense foods Daytime sleepiness Difficulty managing stress and other emotions throughout the day

Behavioral Factors Habits, or routines, impact health behaviors like diet and physical activity When healthful behaviors require thought and self-discipline, they can be a challenge When healthful behaviors are part of normal daily routine, they are often easier to follow

Emotional Factors Connect certain foods, or types of food, to pleasant feelings, such as happiness Use of food to deal with negative emotions Boredom Stress Hopelessness Helplessness

Personal Factors Lack of recovery Boredom Knowledge

Financial Factors Cost of healthful food People with little time, energy and other resources are more likely to buy convenience foods Decisions based on financial resources

Social Environment Cultural eating patterns/acceptance of obesity Family norms and learned behaviors Social Isolation Behavioral Settings Access to Quality Healthcare Care

Environmental Factors Ready access to fast food and empty calorie foods Environment encourages sedentary lifestyle Type and quality of food available in behavioral health settings

Occupational Factors Workplace stress Long work hours Busy schedules No lunch break Eating at desk Exhaustion Use sugar & caffeine to stay awake Travel schedule

Policy Environment Policies that affect how we eat Agricultural subsidies Subsidized crops such as corn, sugar, soy and wheat could increase consumption of fattening food if they lower food prices Mandatory nutrition labeling Labels may guide consumers towards more healthy food choices if consumers are motivated for health and use the labels

DIMENSIONS: Well Body Program Discussion

DIMENSIONS: Well Body Program Module 2: Weight Management Strategies

Diets vs. Your Healthy Eating Plan Diet Diets are temporary. Healthy weight management requires adopting healthy habits and living a healthy lifestyle.

Your Healthy Eating Plan Controls your hunger Is pleasing & satisfying to you Meets your body s need for energy & nutrients Minimizes your risk of chronic disease

Your Healthy Weight Depends on a number of factors, including: What you eat Your genes Your lifestyle Your culture

What You Eat Your Healthy Weight Calories Consumed Calories Expended Must equal your activity level to maintain your current weight

Your Healthy Weight Your genes contribute to your weight Predisposed to weight gain Fat storage around chest and waist

Your Healthy Weight Your Lifestyle The activities you perform daily, including physical activity, television watching, alcohol use, sleep duration, eating pattern, among others

Your Healthy Weight Your Culture Teaches you about What food means What to eat How much to eat

Recipe for Healthy Weight Management Know Your Body Mass Index (BMI) Calorie Balance Portion Control Physical Activity Stay Hydrated

Body Mass Index (BMI)

Calorie Balance Key to healthy weight management Obesity epidemic linked to calorie imbalance (calories consumed > calories burned) To lose weight reduce calories from food, increase physical activity To maintain healthy weight calories consumed must equal calories burned

Calorie Balance Sex and Age Not Physically Active* Physically Active** Females 19-30 years old 2000 Total Calories Per Day 2000-2400 Total Calories Per Day Males 19-30 years old 2400 Total Calories Per Day 2600-3000 Total Calories Per Day Females 31-50 years old 1800 Total Calories Per Day 2000-2200 Total Calories Per Day Males 31-50 years old 2200 Total Calories Per Day 2400-3000 Total Calories Per Day Females 51+ years old 1600 Total Calories Per Day 1800-2200 Total Calories Per Day Males 51+ years old 2000 Total Calories Per Day 2200-2800 Total Calories Per Day *These amounts are for people who get less than 30 minutes of moderate physical activity most days. **These amounts are for people who get at least 30 minutes (lower calorie level) to at least 60 minutes (higher calorie level) of moderate physical activity most days.

Calorie Balance Even small changes can have a big effect Number of 20- Ounce Sodas Consumed Calories Per Day Calories Per Week (7 days) Calories Per Month (30 days) Calories Per Year (365 days) 1 250 1,750 7,500 91,000 2 500 3,500 15,000 182,500 3 750 5,250 22,500 273,750 4 1000 7,000 30,000 365,000 5 1250 8,750 37,500 456,250 Reminder: A reduction of 3,500 calories in a week equals weight loss of one pound of body fat

Calorie Balance 1 cup Mint Chocolate Chip Ice Cream 320 Calories 20 Potato Chips 320 Calories Large Poppy Seed Muffin 670 Calories 1 box Kraft Macaroni & Cheese 1,230 Calories

Tips for Balancing Calories Eat more whole grains, vegetables, and fruits Reduce sugar consumption Eat lean protein Moderate fast foods Moderate alcoholic beverages

Tips for Portion Control Pay attention to serving size information on nutritional labels Eat half of the meal served to you in restaurants Use smaller plates to reduce portion size Serve your food from the kitchen rather than the dining table

Portion Control Deck of cards = one serving of meat, fish or poultry Golf ball = ¼ cup dried fruits or nuts Computer mouse = one serving of a baked potato 6 Dice = one serving of cheese

Physical Activity Adults should get at least 2.5 hours moderate to intense activity per week Important for healthy weight management Relieves stress, increases energy, improves sleep, mood, and memory Make it fun! There are a variety of ways to increase physical activity

Physical Activity Reduces risk of: Cardiovascular disease Hypertension Type 2 Diabetes Metabolic syndrome Some cancers Obesity

Calories Burned During Activities Activity Calories Burned (10 Min) Cleaning 30-40 Walking (3.5 mph) 40-50 Bicycling (5.5 mph) 70-80 Playing basketball 70-80 Jogging 80-100 Swimming 80-100 Cross-country Skiing 80-100

Staying Hydrated Our bodies are 70% water Important for our bodies to function normally Good hydration helps with: Digestion Transportation of nutrients Temperature regulation Extremely important when physically active Avoid sugary beverages with empty calories (fruit juice, soda)

Food Diaries Many people are not aware of what or how much they eat Tracking food on a log or diary helps to increase awareness of eating habits Many weight loss/ weight management programs recommend keeping a food diary

Food Diaries 9:30 Eggs, scrambled White toast, butter Coffee, cream and sugar 2 1 piece 2 cups 1:00 Soup, broccoli cheddar ½ Turkey sandwich (mayo and cheese) Potato chips 1.5 cups 1 bag 4:00 Popcorn 2 cups 7:30 Cheeseburger Fries Coke 1 Large 16 oz

Medical Treatments Prescription Weight Loss Drugs Fat absorption inhibitor Orlistat For use up to 2 years Average weight loss over one year is 6 pounds Appetite suppressants Phentermine, benzphetamine, diethylpropion, phendimetrazine For short term use only (weeks) Average weight loss over one year is 9 pounds Phentermine combined with Topiramate Generates a feeling of fullness, food tastes less appealing and increases calorie burning Designed for long-term use

Medical Treatments Surgical Interventions For people with BMI over 40 or BMI over 35 with co-occurring physical conditions Gastric Restriction Gastric Bypass Combination Procedures

Websites and Free Tools www.americaonthemove.org www.choosemyplate.gov www.nutrition.gov www.healthypeople.gov www.letsmove.gov www.cdc.gov/healthyliving www.fitday.com

DIMENSIONS: Well Body Toolkits for Healthcare Providers www.bhwellness.org/toolkits/well-body- Toolkit.pdf www.bhwellness.org/toolkits/wb-toolkit-supp- Behavioral-Health.pdf

DIMENSIONS: Well Body Program Discussion

DIMENSIONS: Well Body Program Module 3: Motivational Intervention for Weight Management

Motivational Intervention 30-minute semi-structured interview Work with people to assess their readiness to start a weight management program Provide brief, personalized feedback to people about their Body Mass Index (BMI) Encourage individual to set concrete and manageable goals Discuss and list the supports they need to reach their Well Body goals

What if I meet people who are not Some people: ready to change? May feel unsure or hopeless about changing their health behaviors May have tried to manage their weight in the past and been unsuccessful May feel unsupported by people in their lives or stigmatized by their social networks

What if I meet people who are not ready to change? People may be able to: Read handouts you give them Keep track of their current food consumption Think about the benefits of weight management Describe their current eating patterns and physical activity level Remind people: To keep an open mind You will not pressure them to change They can still benefit by learning more about healthy living There are other steps they can take that can be helpful

DIMENSIONS: Well Body Program Handout Well Body Motivational Intervention

Well Body Motivational Intervention

Well Body Motivational Intervention Role Play

DIMENSIONS: Well Body Program Discussion

DIMENSIONS: Well Body Program Next Steps

DIMENSIONS: Well Body Program An evidence-based nutrition and weight management program that promotes positive health behavior change The program supports health behavior change through motivational engagement strategies, group process, community referrals, and educational activities

Who can be Well Body Program Facilitators? The Well Body Program can be led by: Peer Advocates Persons who are trained and supervised to provide services for people with a similar history or background, for example, a history of a behavioral health condition, a university student, a co-worker or colleague, among others Providers Healthcare providers who have experience with training, facilitation, or direct healthcare services

Role of the Well Body Program Facilitators Raise awareness through center in-services, lunch and learns, and trainings Conduct individual motivational interventions Facilitate Well Body groups Make referrals to other healthcare providers and community cessation services Create a positive social network

Well Body Group Overview Weekly group, 60- to 90-minutes Participants can join at anytime Some information builds on previous sessions Participants may attend as many sessions as needed

Plan-Do-Study-Act Process Act Study Plan Do Three key questions: What are we trying to accomplish? How will we know a change is an improvement? What change can we make that will result in improvement?

Steps for PDSA Process Plan: Decide what change will be made, who will do it, and when it will be done Do: Carry out the change Study: Ensure that you leave time to reflect and use experience of change to discuss results Act: Based on what you learned, what will your next plan be? What will be different? Act Study Plan Do

Change Exercise

DIMENSIONS Action Plan

Behavioral Health & Wellness Program 303.724.3713 bh.wellness@ucdenver.edu www.bhwellness.org Behavioral Health and Wellness Program BHWP_UCD