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Transcript
NURS 2018
OBESITY MANAGEMENT AND DIET
THERAPY
Objectives
At the end of this presentation students will be
able to:
 Identify strategies to manage obesity
 List measures of preventing obesity
 Describe current recommendations in the
management of obesity
A Healthy Diet
The 2005 Dietary Guidelines for Americans defines a healthy diet as
one that:
 Emphasizes fruits, vegetables, whole grains, fat-free or low-
fat milk, & milk products;
 Includes lean meats, poultry, fish, beans, eggs, and nuts
 Is low in saturated fats, trans fats, cholesterol, salt (sodium),
and added sugars.
Dietary Guidelines for Americans, 2005
Key Recommendations for the General Population

1. Adequate Nutrients Within Calorie Needs
 Consume a variety of nutrient-dense foods (whole grains,
fruits and vegetables, lean meats, low-fat dairy) and
beverages within and among the basic food groups while
choosing foods that limit the intake of saturated fats and
trans fats, cholesterol, added sugars, salt, and alcohol.
 Meet recommended intakes within energy needs by
adopting a balanced eating pattern, such as the USDA Food
Guide or the Dietary Approaches to Stop Hypertension
(DASH) Eating Plan.
Dietary Guidelines for Americans, 2005
Key Recommendations for the General Population
 2. Weight Management
 To maintain body weight in a healthy range, balance
calories from foods and beverages with calories
expended.
 To prevent gradual weight gain over time, make small
decreases in food and beverage calories and increase
physical activity.
Dietary Guidelines for Americans, 2005
Key Recommendations for the General Population
 3. Physical activity
 Engage in regular physical activity and reduce
sedentary activities to promote health, psychological
well-being, and a healthy body weight.
 Achieve physical fitness by including cardiovascular
conditioning, stretching exercises for flexibility, and
resistance exercises for muscle strength and
endurance.
Dietary Guidelines for Americans, 2005
Key Recommendations for the General Population
 4. Food Groups to Encourage
 Consume a sufficient amount of fruits and vegetables while
staying within energy needs.
 Choose a variety of fruits and vegetables each day. Select from
all five vegetable subgroups (dark green, orange, legumes,
starchy vegetables, and other vegetables) several times a week.
 Consume 3 or more ounce-equivalents of whole-grain products
per day, with the rest of the recommended grains coming from
enriched or whole-grain products. At least half the grains should
come from whole grains.
 Consume 3 cups per day of fat-free or low-fat milk or equivalent
milk products.
Dietary Guidelines for Americans, 2005
Key Recommendations for the General Population
 5. Fats
 Keep total fat intake between 20 - 35 percent of calories
 (With most fats coming from sources of polyunsaturated and





monounsaturated fatty acids, such as fish, nuts, and vegetable
oils).
Limit intake of fats and oils high in saturated and/or trans fatty
acids, and choose products low in such fats and oils.
Consume less than 10 percent of calories from saturated fatty
acids
Consume less than 300 mg/day of cholesterol
Keep trans fatty acid consumption as low as possible
When selecting and preparing meat, poultry, dry beans, and milk
or milk products, make choices that are lean, low-fat, or fat-free.
Dietary Guidelines for Americans, 2005
Key Recommendations for the General Population
 6. Carbohydrates
 Choose fiber-rich fruits, vegetables, and whole grains often.
 Choose and prepare foods and beverages with little added sugars or
caloric sweeteners.
 Reduce the incidence of dental caries by practicing good oral
hygiene and consuming sugar- and starch-containing foods and
beverages less frequently.
 7. Sodium and Potassium
 Consume less than 2,300 mg (approximately 1 teaspoon of salt) of
sodium per day.
 Choose and prepare foods with little salt. At the same time,
consume potassium-rich foods, such as fruits and vegetables.
Dietary Guidelines for Americans, 2005
Key Recommendations for the General Population
 8. Alcoholic Beverages
 Those who choose to drink alcoholic beverages should do so
sensibly and in moderation (≤ 1 drink for women/day and ≤ 2 drinks
for men/day).
 Alcoholic beverages should be avoided by individuals engaging in
activities that require attention, skill, or coordination, such as
driving or operating machinery.
 Alcoholic beverages should not be consumed by some individuals,
including: those who cannot restrict their alcohol intake, women of
childbearing age who may become pregnant, pregnant and
lactating women, children and adolescents, individuals taking
medications that can interact with alcohol, and those with specific
medical conditions.
Dietary Guidelines for Americans, 2005
Key Recommendations for the General Population
 9. Food Safety
 To avoid microbial food borne illness:
 Clean hands, food contact surfaces, fruits, and vegetables. Meat and
poultry should not be washed or rinsed.
 Separate raw, cooked, and ready-to-eat foods while shopping,
preparing, or storing foods.
 Cook foods to a safe temperature to kill microorganisms.
 Chill (refrigerate) perishable food promptly and defrost foods properly.
 Avoid raw (unpasteurized) milk or any products made from
unpasteurized milk, raw or partially cooked eggs or foods containing raw
eggs, raw or undercooked meat and poultry, unpasteurized juices, and
raw sprouts.
Calorie Deficit
Needed For Weight Loss
 A calorie deficit of no more than 500 kcal/day.
 This can be achievable through the combination of diet +
exercise.
 An example of how to create a calorie deficit of 500 kcal/day
through diet + exercise would be: eating 250 kcal less per day,
along with burning 250 calories through exercise
Calorie Deficit
Needed For Weight Loss
A caloric deficit of 500 can be done by:
 Eating 250 kcal less per day:
 Leave out mayonnaise in a
sandwich
 Leave out dessert
 Switch from soft drinks to
water
 Reduce portion sizes
 Burning 250 calories through
exercise:

Walk for 30 minutes
 Swimming 25 yards
 Bicycling for 30 minutes
2009
Exercise + Dieting
Calorie Deficit
 Initially physical activity, in combination with dieting, is an
important component of weight loss.
 However, after around 6 months, physical activity will not lead
to substantially greater weight losses when combined with
dieting.
 The benefit of sustained physical activity thereafter is mainly
through its role in the prevention of weight gain.
 In addition, it has a benefit in reducing cardiovascular and
diabetes risks beyond that produced by weight gain alone.
Goals for Weight Loss
And Management
 The initial goal of weight loss therapy is to reduce body
weight by approximately 10 percent from baseline. Once
this goal is achieved, then further weight loss can be
attempted, if necessary.
 A reasonable time line for a 10 percent reduction in body
weight is 6 months.
 Experience reveals that lost weight is usually regained
unless a weight maintenance program, consisting of diet
therapy, physical activity and behavior therapy, is
continued indefinitely.
Goals for Weight Loss
And Management
 For overweight individuals with BMIs in the typical range of 27 to 35
kg/m2, a decrease of 300 to 500 kcal/day will result in weight losses of
about ½ to 1 lb per week.
 A 10 percent weight loss could be achieved within 6 months.
 For more severely obese individuals (BMI > 35), deficits of up to 500 to
1,000 kcal/day will lead to weight losses of about 1 to 2 lb per week.
 A 10 percent weight loss could be achieved within 6 months.
Goals for Weight Loss
And Management
 After 6 months of weight loss treatment, the individual should be
assessed.
 If no further weight loss is needed, then the current weight should
be maintained.
 Sustained physical activity is particularly important in the
prevention of weight regain.
 If further weight loss is desired, another attempt at weight
reduction can be made.
CDC’s Recommended Strategies to Prevent
Obesity
Strategies to Promote the Availability of Affordable Healthy Food &
Beverages
1.
Increase availability of healthier food and beverage choices in
public service venues
2.
Improve availability of affordable healthier food and beverage
choices in public service venues
3.
Improve geographic availability of supermarkets in underserved
areas
4.
Provide incentives to food retailers to locate in and/or offer
healthier food and beverage choices in underserved areas
5.
Improve availability of mechanisms for purchasing foods from
farms
CDC’s Recommended Strategies to Prevent
Obesity
Strategies to Support Healthy Food and Beverage Choices
6.
Provide incentives for the production, distribution, and
procurement of foods from local farms
7.
Restrict availability of less healthy foods and beverages in
public service venues
8.
Institute smaller portion size options in public service venues
9.
Limit advertisements of less healthy foods and beverages
10. Discourage consumption of sugar-sweetened beverages
CDC’s Recommended Strategies to Prevent
Obesity
Strategy to Encourage Breastfeeding
11. Increase support for breastfeeding
Strategies to Encourage Physical Activity or Limit Sedentary
Activity Among Children and Youth
12. Require Physical Education in schools
13. Increase the amount of physical activity in
PE programs in schools
14. Increase opportunities for extracurricular
physical activity
15. Reduce screen time in public service venues
CDC’s Recommended Strategies to Prevent
Obesity
Strategies to Create Safe Communities That Support Physical Activity
Improve access to outdoor recreational facilities
Enhance infrastructure supporting bicycling
Enhance infrastructure supporting walking
Support locating schools in residential neighborhoods
Improve access to transportation
Zone for mixed-use development
Enhance personal safety where people are or could be physically
active
23. Enhance traffic safety in areas where persons are or could be
physically active
16.
17.
18.
19.
20.
21.
22.
Strategy to Encourage Communities to Organize for Change
24. Participate in community coalitions or partnerships to address
obesity
References
Centers for Disease Control and Prevention. (2010). State Indicator Report on
Physical Activity, 2010 National Action Guide. Retrieved from:
http://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report
_2010_Action_Guide.pdf
Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance —
United States, 2009. Surveillance Summaries, [6-4-2010]. MMWR
2010;59(5).
Centers for Disease Control and Prevention. (2010). State Indicator Report on
Physical Activity, 2010 National Action Guide. Retrieved from:
http://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report
_2010_Action_Guide.pdf
Dietary Guidelines for Americans 2005. Available at:
http://www.health.gov/dietaryguidelines/dga2005/recommendations.htm
Kalicki, B. & Roy, H. (2009). Obesity management. Pennington Biomedical
Research Center. Online lecture resource.
Assignment
 List three goals of weight loss
 Describe five physiological benefits of weight
loss
 Outline 6 CDC strategies for the prevention of
weight management
 Describe tertiary outpatient management of
obese clients