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Weight Management Course Dr A Blazos, 15/1/2001 Measuring Usual Food Intake The food diary method requires that patients write down everything they consume over a period of 4 days or more. Ideally, a weekend day should be included since food intake can change significantly from weekdays to weekends. This method is very good for making patients aware of their food intake, however, patients may start to choose healthier foods or they may eat less (to make recording easier!) As a result, the clinician may not end up getting a good picture of the patients usual food intake when this method is used. If food intake changes simply because it is being recorded then the clinician will not understand what aspects of the patient’s past food intake may have contributed to the patient’s current health problems. 1 Weight Management Course Dr A Blazos, 15/1/2001 Assessing Nutritional Adequacy of Usual Food Intake Nutrient approach (12345+ food pyramid) + Food approach (food variety score, cultural models of eating) The basic model provides 1500 kcal per day. For greater energy intakes, the extra energy should come from cereals, vegetables or fruits. A novel feature of this guide is that it addresses indulgences - one is allowed 2 indulgences (or a total of 300kcal) a day on 1500kcal. Indulgences are not included on energy intakes below 1500kcal e.g weight loss diets. Even though it is not evident in this pyramid, 6g of margarine/oil is allowed for each serving of cereal. In other words, for 5 serves of cereal, 30g added fat is allowed in the diet to achieve recommended fat intake. The brown bars represent the average number of serves of each food group consumed by Australians in 1995. 2 Weight Management Course Dr A Blazos, 15/1/2001 Obesity Treatment - Practical Food Intake Tips Imagine your plate. How much is covered by meat? If it is more than one-fifth of the plate, it may be too much. A rough guide is two-fifths vegetables, two-fifths potato/rice/pasta/bread (select types with a low glycaemic index) and one-fifth meat/fish/chicken. These principals apply to heart disease, cancer, obesity and diabetes. Recommended changes for people needing to lose weight, diabetes, high blood lipids are the same as those encouraged for all Australians for optimum health. Rather than thinking of it as a short term 'diet' it is better to re-educate patients to make long term healthy food choices. To lose weight, it seems that very small changes to energy intake are needed over a long period of time, rather than a drastic reduction that cannot be sustained. For many patients with chronic conditions such as heart disease or diabetes, or even patients who are at risk of developing them, a small amount of weight loss (e.g 5-10kg) is enough to reverse adverse effects of being overweight, such as high blood pressure, high cholesterol and glucose intolerance and even artery elasticity is reversible with weight loss. Weight loss will be achieved on 1300-1500 kcal/day for most patients if combined with 1/2 to 1 hour of walking daily (does not have to be in one session - can accumulate over the day in several sessions - see module on Obesity). This is a modest energy restriction, but sustainable in the long term. Lower energy intakes may result in faster weight loss, but are harder to keep in the long term and can result in nutrient 3 Weight Management Course Dr A Blazos, 15/1/2001 deficiencies. The 12345 pyramid (see Module on Assessment of Usual Food Intake) provides about 13001500 kcal as long as indulgences are reduced to one or less/ day. Another approach to weight loss is to establish how many calories your patient usually consumes and deduct 500 kcal - this should result in 0.5 kg weight loss per week. 1 kg of fat is equivalent to about 7500 calories. Evidence suggests that small frequent meals (e.g 5-6/day) as opposed to 3 larger meals appears to be associated with greater food variety, lower body fat, blood glucose and lipid levels and may be more effective in assisting weight loss. Alternatively, there is evidence that avoiding large meals in the evening and having the main meal at lunch time can also assist weight loss (Wahlqvist, Kouris-Blazos, Appetite 1999; 32: 23-32). People with diabetes are used to thinking about the glycaemic index, they use it to help control their blood sugar levels. But until now, we have not really been aware of its significance for people without diabetes. Even though sugar per se has not been linked with any diseases of affluence, diets with a high glycaemic load have been associated with an increased risk of diabetes, obesity (especially abdominal/visceral obesity) and heart disease. All patients can be advised to consume at least ONE low glycaemic index food at each meal. Read this on-line summary about the Glyceamic index: http://www.healthyeating.org/general/glycaemic_index.htm And an on-line table of GI of foods http://www.healthyeating.org/general/GI-Table.htm To read this article and view table off-line click here 4