Waisting Away

Waisting Away
TM 2012
Empowering “FUTURE” Health Professionals
with Weight Management Knowledge / Research
/ Practice for Health at ANY Size!
Hélène Charlebois, RD
HC Nutrition Inc. Consulting & Wellness
Weight Management Specialist
Certified in Adult Weight Management
Level 1 & 2 Academy of Nutrition & Dietetics (ADA)
Research - Information
•
Academy of Nutrition & Dietetics AND
Weight Management Training level 1 & 2 + new certification
•
ADA Weight Management DIPG
•
Canadian Obesity Guidelines
•
CON – Canadian Obesity Network
•
•
Summit – attend & present
on line newsletter, research
•
DC Obesity Learning Retreat
•
Blogs by Dr Arya Sharma and Yoni Freedhoff
•
•
•
Dr. Sharma's Obesity Notes » blog [amsharm@ualberta.ca]
Weighty Matters [yonifreedhoff@gmail.com]
New - points towards IASO’s Specialist Certification for Obesity
Professional Education (SCOPE).
The 5 A’s of Obesity Management is a set of
practical tools to guide primary care practitioners
in obesity counseling and management:
• Ask for permission to discuss weight and explore readiness for
change
• Assess obesity elated health risk and potential “root causes” of
weight gain
• Advise on obesity risks, discuss benefits treatment options
• Agree on realistic weight-loss expectations and on a SMART plan to
achieve behavioral goals
• Assist in addressing drivers and barriers, offer education and
resources, refer to provider, and arrange follow-up
What are DIETS?
•
Billions and billions of $$$
•
All diets work
•
Recent research – 75 years of dieting
•
Most weight loss is in the 1st 6 months
•
Skills
Treating Patients
•
•
What Docs say?
Recommend to lose 21% of their weight
UNREALISTIC !
Treat distress not depression
On line – 80% want an in home diet plan
Apps – in 2010 = $910 million
Getting the church involved
But… obesity cost was 4.6 Billion in 2008 (usa) and increase of
20% from 2000
•
•
•
•
•
•
•
Weigh 1x/week; do something about weight gain
Planned and structured; eat similar foods
Low calories/fat; 1800 cals + 30% fat
Eat breakfast
Eat out less than 3 x/wk; fried foods less than 1x/wk
Active1 hour per day – simply move more!
Less than 10 hours per week of “screen watching”
Measuring Obesity
•
Waist
•
Men = 102 cm ; women = 88 cm
•
High risk: men = 90 cm ; women = 80cm
South Asian & Aboriginal = High Risk
•
Hip
•
Waist to hip
•
Anthropometric
•
BIA – In Body – BOD POD- DEXA
•
How to measure???
Bariatric Surgery
•
•
•
Restriction of food
•
Less eating – size of a golf ball
•
Less food
•
How to deal with comfort eating
Malabsorptive
•
Malnourishment – pre and post
•
Macro / micronutrients
Neural & Hormonal
•
Pathways
Bariatric Surgical Options
30 to 80% loss EBW

Expanding in Canada

Surgery - 5 different procedures

Adjustable Gastric Banding

Roux en Y gastric bypass – less 50% EBW/ 1st yr

Biliopancreatic Diversion/duodenal switch

Sleeve Gastrectomy

Gastric Ballooning / Endo Barrier

What about Fatty Liver Disease?

Correcting for Vitamin D deficiency
Bypass- 80% ebw
•
2 Multivitamin mineral for life
•
Iron , folic acid and B12 (1200 mmg)
•
•
•
Take Vitamin C 500 mg with Iron 300 mg 1 to 3/day
Calcium 1200-2000 mg elemental calcium
•
Liquid or tabs – Citrate is best
•
No take more than 500 mg at a time
•
Take even if 2-4 servings of dairy per day
Vitamin D – make sure in Calcium Supp.
•
At least 1000 IU/day
•
Protein = calculate needs 0.8-1.0 g per kg; 0.91 g/kg actual
body weight; 1.5-2.1 g/kg ideal body weight
•
B12 over time – doc to assess 500 mcg sublingual
Why the Weight Loss in
Surgical Patients?
•
At 1 month = decrease in gut hormones then stable
•
GLP1, incretins, GIP, Amylin, Glucagon, Proinsulin,
•
•
C peptide
At months 2 to 12 = decrease FBS, insulin,
•
decrease in food and absorption

Stomach + intestines = largest endocrine system

‘CURE’ for diabetes?
Staging System – Dr.A Sharma
Need for a better diagnostic system
•
0 – obese but not risk factors
•
1 – subclinical factors, mild symptoms
•
2 – chronic disease, mobility limitations
•
3 – end organ damage- significant limits
•
•
Impairment of well being
4 – severe disabilities
Hormones affecting weight
•
Hunger stimulus
•
•
•
Hedonic
Homeostatic
Appetite
•
Do food addictions exist?
Cortisol - brain
•
Fight or flight hormone
•
Sleep deprived
•
Screen watching
•
Makes you hungry
•
Increases belly fat
•
Sleep patterns
•Sleep
•No
before midnight- most sleep before 530 am
eating after 8pm
+
Sleep Deprived

Less sleep

Increase hedonic stimuli =
Increase food consumption

Decrease leptin

Increase ghrelin & cortisol

Trying to reach glucose
homeostasis

Kids - teens
Insulin - pancreas
•
Stores body fat
•
High insulin levels = burns carbohydrates
•
Low insulin levels = burns fat
•
Therefore, we will burn more fat if eat less carbs
Dopamine – brain
= Opioid syndrome
•
The “chocolate” hormone
•
Hypothesis
•
Cravings- sweet tooth
•
Similar to endorphins
•
Obese = decreased receptors = decreased
bliss point
Serotonin
•
Brain
•
Decrease in winter
•
Feel good hormone
•
Estrogen link
•
Low serotonin
•
•
Decreased hunger
•
Increased anger
SSRIs
Ghrelin – gut – hunger hormone
•
Controls weight
•
Controls glucose homeostasis
•
Hunger and appetite
•
The ONLY hunger hormone
Leptin- protein-hypothalmus
•
Appetite suppressant
•
Controls appetite
•
Energy in Energy out gene
•
Produced by fat tissue
•
Obese has high leptin but it is resistant
NEEDED: a system that will “sensitize”
Dopamine Link?
Incretin- GLP1 – intestine
•
Increase insulin secretion
•
Decrease appetite
•
Decrease glucagon
•
•
Decrease sugar production by the liver
Gets insulin ready
New diabetes medication = Victoza,Byetta
% Weight Loss
•
Diet & Exercise- Lifestyle 3 - 5 - 10 %
•
Pharmacotherapy 5 – 10 - 15 %
•
Bariatrics 20 - 30- +++ % up to 80% EBW
+
Food - the nutrient link is broken
Food and in
Food & Ingredients


Increase quantity of high
quality foods
Decrease quantity of low
quality foods
Ready to EAT

Less protein, fibre, vits, mins

More sugar, fat salt

More energy
+Making Changes –are they
ready?
HOW?
HOW?
WHY?
•
For what?
•
Ask the question
•
Healthier living
•
•
Healthier being
Easy to lose weight but not
easy to keep the weight off
•
Disease prevention
•
Must be ready to make lifestyle
lifetime changes
•
Disease state management
They came to you…
level of readiness
More in Behavior section
+
Clean up your House
WHY?
HOW?
•
House needs to be a ”Positive
Health Environment”
•
Look into kitchen cupboards,
fridge, pantry
•
Set up for SUCCESS
•
Purge “unhealthy” foods
•
Food availability is too high
•
Office; desk drawer
•
Make it healthy
•
Get rid of your trigger foods –
unsafe foods
DANGER FOODS
Replace with healthier food
options
+
Successful Set Up
WHY?
•
Must keep great tasting healthy
foods around you
•
At all times
•
Increases your rate of success
•
Studies show… “out of sight
out of mind”
HOW?
•
Fruit & Veggie shopping
•
Bagged, trays, frozen, fresh,
canned…it all counts
•
Keep some everywhere
•
Lean meats
•
Desk drawer
•
Legumes- new recipes
+
Choose only whole / sprouted
grains
Why? Change the box!
How?
•
Eating whole grain,
sprouted, high fiber foods
•
Stick to whole grain, whole
wheat product
•
Keep you fuller, longer
•
Pasta, brown rice, crackers,
cereal
•
Low GI
•
No white rice-why?
•
Try different grains
•
•
Are healthier for you
Refined processed starches
digest quickly
•
Sprouted grains
+
No bagels??? No bananas
No white potatoes
Why? Change the box!
•
Bagels- +300 calories
•
•
How?
•
Choose whole grain breads/
english muffins
•
Have any other fruit and any
other vegetable.. Try to think
outside the box… variety is
key
Available: low GI / 150 calories
Bananas and potatoes are
favorites so take them out…
make a change… you’ll be
amazed!
+
Eat low GI Foods
Why?
•
Keeps you fuller, longer
•
Generally higher fiber and
healthier foods
•
How?
•
www.glycemicindex.com
•
www.diabetes.ca
•
Eat lots of whole fruits and
vegetables
•
Eat whole grains
•
Eat lean meats and low fat dairy
products
•
Add fiber to foods
Control blood sugars
•
Control cholesterol level
•
Gives some boundaries
Take with a “grain of salt”
+ Meal Balancing
WHY?
HOW?
•
Nutritionally adequate
•
See chart and guidelines
•
All nutrients
•
HEP sheet
•
More even distribution of starch
and protein
•
Protein at all meals
•
More even distribution of starch
to protein
•
Up to 25% protein
•
Have protein with PM snack
+
No Starch at Supper
WHY?
HOW?
•
Reducing the total calorie
intake
•
Replace your starches with
vegetables
•
Less cals at supper and beyond
is key
•
Use spaghetti squash
•
Use a bed of corn instead of rice
•
Starch at supper =
• Lots of calories
•
Use bean sprouts instead of
pasta
•
We LOVE starch
•
Sweet potato/yams are great
•
Insulin and belly fat
•
Ok for starchy vegetables
•
HS more sedentary
•
Legumes are great!
+
Journaling
WHY?
HOW?
•
Awareness
•
See the CFC sheet
•
Understanding
•
Same as the “meal balancing”
•
Patterns
•
Journaling sheet
•
Accountability
But… most HATE journaling!
•
Create own
•
Journaling book / on line
•
www.myfitnesspal.com
•
APPS : The Future!
Journaling continued
•
Make journaling effective
•
Pick your battles
•
Be realistic
•
Be flexible
•
Different journaling strategies
•
Only HS intake
•
Only activity
•
Only after lunch and beyond
+
Plan your Snacking
WHY?
HOW?
•
Small snack = eat less at meal
times
•
Plan a small snack 1 hour
before meals
•
Do not “rip the fridge door off”
•
AM= 80 calories
•
Up to 40% total daily calories
•
•
Yogurt, fruit
•
Too often
•
Too much-portions
•
This is the important one
•
Too calorie dense
•
Protein + fruit/veg
The 4th Meal!
•
•
PM = 100 -150 calories
HS = 100 -150 calories
•
Sweet/salty tooth
+
Calorie Distribution
WHY?
HOW?
•
Calories count
•
See chart and guidelines
•
Recent research; all diets work
in the short term
•
HEP sheet
•
More even distribution
throughout the day
Meal Balancing
Meal balancing = It is important to have a protein at each meal; starches
should be whole grains.
BREAKFAST=300cals
Protein
Fruit
LUNCH=400-500cals
Protein
Starch
Protein
Starch
snack
Starch
2 Vegetables
2 Vegetables
Fruit
DINNER=400-500cals
Protein +
fruit
snack
100-150
calories
snack
HINT: For added weight loss, no starch at supper but load up on the veggies!
Calorie Distribution/Protein
•
Breakfast = Starch 150 cals/20g
•
am snack = 80 calories/10g
•
Lunch=St.150 cals; prot.150 cals/20g
•
pm snack = 100 to 150 calories/10g
•
Supper = St. 0 cals to 300 cals/20g
•
hs snack = 100 (150) calories
+
PROTEIN
-
U of Texas
20 to 30 grams at breakfast
20 to 30 grams at lunch
20 to 30 grams at supper
WHERE THE MEAT!
NO MORE NO LESS!
+
Reintroduce Starch at Supper
WHY?
HOW?
•
Because we like it!
•
No more than 2 times per week
•
There are special occasions
•
1 cup = 300 calories
•
There are exceptions to every
rule
•
Do not have the starch at lunch
OR
•
BUT….
½ cup at supper nightly
Must be measured
Reduce protein
+
Portion Distortion
WHY?
•
Supersizing
•
More for less
•
Restaurant portions
•
The food container is simply too
much
•
HOW?
Our eyes are bigger than our
stomachs
Bottom line
We just eat too much!
•
Label reading
•
Be visual
• Change the plate
• Show portions of food
• Food models? calories
•
Measure it out
• We are not good at eye
balling
Load up on veggies
2-3 fruit per day
+
Vegetable 1st on Plate
HOW?
WHY?
•
•
•
Our eyes are bigger than our
stomachs
We always put more of the first
item on our plates
Research Xmas
•
Put vegetables 1st on the plate
•
Then the protein
•
Lastly is starch
+
Set up Buffet
WHY?
HOW?

How you set up the plates

Always put veg 1st

How you set up your counter for
plate preparation

Then protein

Last starch
It makes a difference
Try this at home… you will be
AMAZED!
+
Eat close to farm
WHY?
•
This is my motto
•
Very simple concept
•
Farm foods are usually:
• Lower in calories
• Higher in fiber
• Bountiful
• More filling
• Keeps you fuller longer
• More nutritious
• Eat whole foods
HOW?
•
If the food comes from the farm,
eat it… if the food leaves the
farm, judge it.
•
Give some examples
•
apple vs apple sauce vs apple
juice
+
Damage control
WHY?
•
•
We all “cheat” but our patients
feel guilty about it
HOW?
•
2 types of damage
•
Planned = sandwich it in
•
Unplanned = 48 to 72 hours
revenge
Feel good about it
•
Plan it
•
Move on
Don’t get angry get even!
+
Eating Out
WHY?
•

HOW?

See internet

Plan choices on line

Do not take menu

Take away the guilt
Many handouts available

Trading off choices
‘Heart & Stroke Ontario’

Move away from the bread

Order 1 item at a time
Because it is part of life
RUIN IT!
www.myfitnesspal.com
TRAVELLING?
+
Beverages Count
WHY?
HOW?
•
Hidden calories
•
Labels for portion sizes
•
You would not believe
•
Show glasses, cups
•
Portion distortion
•
Journal beverage intake for one
week
•
Single serving sizes are just too
big
•
Count calories on beverage
intake
•
Clear on Calories Initiative
New journal
Snack & Beverages
Diet pop?
Meal Replacements (cont’d)
Why?
•
Quick & Easy
•
Controlled eating – no thinking
•
Eliminate complex food choices
•
Eliminate complex meal planning
Waisting Away TM
Weight Management Strategies
What about Protein Shakes?
Stomach = volume detector
Intestine = nutrient detector
Saliva = brain –nutrient detector
Chewing & Tasting
Exercise / Activity
STRUCTURED
UNSTRUCTURED
Anti-Sedentary Movement
% effect on weight loss?
Weight is Food; Health is FOOD & FITNESS
Cardio
What does it do?
How to do it
•
Burns the visceral fat
•
Walk, run, bike
•
Keeps the heart muscle
strong
•
Group sports
• Soccer, hockey
•
Is fun!
•
Family Fun
• Skating, skiing,
tobogganing , biking
Strength Training
What does it do?
•
•
•
•
Preserves lean body mass
Sense of accomplishment
Great to keep your muscles as
you age
Osteoporosis prevention
How to do it
•
Sit ups – push ups
•
Pilates – yoga
•
Weights
•
Exercise ball
•
Bands
•
Gym machines
•
Use your body
• Lunges
Flexibility
•
Stretching
•
Mobility
•
Motion
•
Increased quality of life (QOL)
HOW?
Morning stretches
Yoga
How much EXERCISE?
•
Health Improvement = 150 minutes / week
•
Weight Loss = 150 to 250 minutes / week
•
Significant Weight Loss = + 250 minutes/wk
•
Weight Gain Prevention (after wt loss)
•
+ 250 minutes / week
Is this unrealistic?
N E A T phenomenon
Walk at Lunch time
+
WHY?
HOW?
•
Only time for one’s self
•
Eat ½ lunch
•
Get out of work
•
Go for a walk
•
Peace of mind
•
Eat the other ½ lunch
•
Change of scenery
•
Bring runners to work
•
All around health
•
Bag lunch = more time to walk
•
Buy lunch = must get out and
go for a walk but…
•
www.tractivityonline.com
•
Mind
•
Body
•
Soul
What about your
Metabolic Rate?
“You HAVE to eat LESS
BUT
You WANT to eat MORE!”
We are not balanced!
Lose 1% / year
Pharmacotherapy
•
Xenical – orlistat
•
Meridia – Sibutramine- off market
•
Approval ?? = Qnexa, Lorcaserin, Belvic
•
High Fibre Products
•
Why use?
Needed for the disease
of Obesity???
Non-Prescription Medication
High Fibre Products
HOW?
WHAT?


Metamucil
PGX

Expands in stomach

Keeps you fuller longer

Less 28 kcals/day= 1.7 kg
per year wt loss

Great for between meal
hunger
 Or take before a meal to
eat less

Mix in juice, yogurt,
applesauce, pudding

Mix with water; drink 15
minutes before your meal.
Waisting Away TM
Weight Management Strategies
+
PGX
HOW?
WHY?

Powder or capsules

Great as a snack





PM or HS
Keeps you fuller longer

Has 3 different types of fiber
 Konjac-mannan ( root)
 Sodium alginate
 Xanthan gum
Mix in with yogurt,
applesauce, pudding

Do not let it sit too long

Individual sticks for the office;
large can for the home
No dairy, corn, soy, starch,
wheat, yeast

Veronica Kacinik
[vkacinik@functionalmedicine.
ca]
www.pgx.com.
Other wt loss pills & potions
•
RASPBERRY KETONES – Slendesta
•
Pure green coffee extract
•
African Mango
•
Herbal products – orange peel?
•
Chocolate – Acai –Chocolate with soluble fibres
•
Ephedra
•
USA commercials
•
Product availability
BANDAID SOLUTIONS!
Weight Maintenance-
Summarized
WE must prevent HUNGER
•
•
•
•
•
•
•
Low fat calorie conscious eating
Planned structured eating
Eat breakfast daily
Monitor your weight
High daily levels of activity
Less screen watching
Simply move more!
Maternal Weight Gain – not anymore!
Overweight = 3x increase wt of baby ; obese = 7x
CON – U of O
BMI over 40 = safe to decrease 5 kg
4.1 kg weight loss is optimal
Who is to blame?
•
•
•
The environment?
You?
Reality – Obesity is a complex issue. It requires a collaborative
approach, with health professionals, gov’t and industry.
Education is key!
The ‘NO’ Factor
Study
•
84 hour period of TV watching
•
Keeping track of the foods that are advertised
•
Compared to the Daily Values
•
2560% over for sugar
•
2080% over for fat
•
40% less for vegetable consumption
•
32% less for dairy consumption
•
27% less for fruit consumption
Neighborhood
FOOD DESERTS
More fast food choices = more sick
and disease = obese neighborhoods
•Access
to unhealthy food choices
•Price
SOLUTIONS?
Calories on Menus? Calorie Literacy?
Society on the Go!
Feel – Think – Enjoy
Nourish – Smell – Taste
- Not aware of 90% of
 Think
our food choices
 Nourish
- 62% too busy to
 Live
sit down to eat
 Adjust
 Awareness
 Journal
- observations
+
Joint Decision Making
YOU
YOUR CLIENT
•
Roll with the punches
•
Self efficacy
•
No resistance
•
Personal goals
•
Empathy
•
It’s all about them
Call to Action – stop, continue, start
Waisting AwayTM Manual – NEW!
Www.lowgimeals.com
http://www.1shoppingcart.com/app/?af=1488220
Nancy Guppy’s menus
Go
to www.chicken.ca
dietitian@chapmanslanding.com
Nutrition Fact Sheets

# 6 on Tracking Weight Loss

General Health, Women’s Health, Diabetes, Heart, Sodium, Screen
Watching, Healthy Snacks

Food Journals – Snack & Beverage Journals
Websites

www.hcnutrition.com

www.obesitynetwork.ca

www.myfitnesspal.com

www.calorieking.com

www.nutritiondata.com

www.sparkpeople.com

www.fitday.com

www.glycemicindex.com

www.myFoodDiary.com

www.dietsinreview.com

www.eatrightontario.org

www.dietitians.ca
talk to an RD – snack list
meal planners, eat tracker