Hélène Charlebois, RDHC Nutrition Inc. Consulting & Wellness

Weight Management Specialist Certified in Adult Weight Management

Level 1 & 2 Academy of Nutrition & Dietetics (ADA)

Waisting AwayTM 2012

Empowering “FUTURE” Health Professionals Empowering “FUTURE” Health Professionals with Weight Management Knowledge / Research with Weight Management Knowledge / Research

/ Practice for Health at ANY Size!/ Practice for Health at ANY Size!

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).

www.hcnutrition.com

• 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

The 5 A’s of Obesity Management is a set of practical tools to guide primary care practitioners in obesity counseling and management:

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 Options30 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 before midnight- most sleep before 530 am•No 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 & 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

Food and in

+Making Changes –are they ready?

• For what?

• Healthier living

• Healthier being

• Disease prevention

• Disease state management

They came to you…

level of readiness

• Ask the question

• Easy to lose weight but not easy to keep the weight off

• Must be ready to make lifestyle lifetime changes

More in Behavior section

WHY? HOW?HOW?

+Clean up your House

• House needs to be a ”Positive Health Environment”

• Set up for SUCCESS

• Food availability is too high

• Make it healthy

• Get rid of your trigger foods – unsafe foods

DANGER FOODS

• Look into kitchen cupboards, fridge, pantry

• Purge “unhealthy” foods

• Office; desk drawer

Replace with healthier food options

WHY? HOW?

+Successful Set Up

• Must keep great tasting healthy foods around you

• At all times

• Increases your rate of success

• Studies show… “out of sight out of mind”

• Fruit & Veggie shopping

• Bagged, trays, frozen, fresh, canned…it all counts• Keep some everywhere

• Lean meats

• Desk drawer

• Legumes- new recipes

WHY? HOW?

+Choose only whole / sprouted grains

Why? Change the box!

• Eating whole grain, sprouted, high fiber foods

• Keep you fuller, longer

• Low GI

• Are healthier for you

• Refined processed starches digest quickly

How?

• Stick to whole grain, whole wheat product

• Pasta, brown rice, crackers, cereal

• No white rice-why?

• Try different grains• Sprouted grains

+No bagels??? No bananasNo white potatoes

Why? Change the box!

• Bagels- +300 calories• Available: low GI / 150 calories

• Bananas and potatoes are favorites so take them out… make a change… you’ll be amazed!

How?

• Choose whole grain breads/ english muffins

• Have any other fruit and any other vegetable.. Try to think outside the box… variety is key

+Eat low GI Foods

• Keeps you fuller, longer

• Generally higher fiber and healthier foods

• Control blood sugars

• Control cholesterol level

• Gives some boundaries

Take with a “grain of salt”

• 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

Why? How?

+Meal Balancing

• Nutritionally adequate

• All nutrients

• More even distribution of starch and protein

• See chart and guidelines

• HEP sheet

• Protein at all meals

• More even distribution of starch to protein

• Up to 25% protein

• Have protein with PM snack

WHY? HOW?

+No Starch at Supper

• Reducing the total calorie intake

• Less cals at supper and beyond is key

• Starch at supper =• Lots of calories

• We LOVE starch

• Insulin and belly fat

• HS more sedentary

• Replace your starches with vegetables

• Use spaghetti squash

• Use a bed of corn instead of rice

• Use bean sprouts instead of pasta

• Sweet potato/yams are great

• Ok for starchy vegetables

• Legumes are great!

WHY? HOW?

+Journaling

• Awareness

• Understanding

• Patterns

• Accountability

But… most HATE journaling!

• See the CFC sheet

• Same as the “meal balancing”

• Journaling sheet• Create own

• Journaling book / on line

• www.myfitnesspal.com

• APPS : The Future!

WHY? HOW?

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

• Small snack = eat less at meal times

• Do not “rip the fridge door off”

• Up to 40% total daily calories• Too often• Too much-portions• Too calorie dense

• The 4th Meal!

• Plan a small snack 1 hour before meals

• AM= 80 calories• Yogurt, fruit

• PM = 100 -150 calories• This is the important one• Protein + fruit/veg

• HS = 100 -150 calories• Sweet/salty tooth

WHY? HOW?

+Calorie Distribution

• Calories count

• Recent research; all diets work in the short term

• More even distribution throughout the day

• See chart and guidelines

• HEP sheet

WHY? HOW?

Meal Balancing

Protein

Fruit Starch

Protein Starch

2 Vegetables

FruitProtein + fruit

100-150calories

Protein Starch

2 Vegetables

Meal balancing = It is important to have a protein at each meal; starches should be whole grains.

BREAKFAST=300cals LUNCH=400-500cals DINNER=400-500cals

snack snack 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

NO MORE NO LESS!

WHERE THE MEAT!

+Reintroduce Starch at Supper

• Because we like it!

• There are special occasions

• There are exceptions to every rule

• BUT….

• No more than 2 times per week

• 1 cup = 300 calories

• Do not have the starch at lunch

OR

½ cup at supper nightly

Must be measured

Reduce protein

WHY? HOW?

+Portion Distortion

• Supersizing

• More for less

• Restaurant portions

• The food container is simply too much

• 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 veggies2-3 fruit per day

WHY? HOW?

+Vegetable 1st on Plate

• 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

WHY? HOW?

+Set up Buffet

How you set up the plates

How you set up your counter for plate preparation

It makes a difference

Always put veg 1st

Then protein

Last starch

Try this at home… you will be AMAZED!

WHY? HOW?

+Eat close to farm

• 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

• 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

WHY? HOW?

+Damage control

• We all “cheat” but our patients feel guilty about it

• Feel good about it

• Plan it

• Move on

• 2 types of damage

• Planned = sandwich it in

• Unplanned = 48 to 72 hours revenge

Don’t get angry get even!

WHY? HOW?

+Eating Out

• Because it is part of life

RUIN IT!

Many handouts available

‘Heart & Stroke Ontario’

www.myfitnesspal.com

See internet

Plan choices on line

Do not take menu

Take away the guilt

Trading off choices

Move away from the bread

Order 1 item at a time

TRAVELLING?

WHY? HOW?

+Beverages Count

• Hidden calories

• You would not believe

• Portion distortion

• Single serving sizes are just too big

New journal

Snack & Beverages

• Labels for portion sizes

• Show glasses, cups

• Journal beverage intake for one week

• Count calories on beverage intake

• Clear on Calories Initiative

Diet pop?

WHY? HOW?

Why?

• Quick & Easy

• Controlled eating – no thinking

• Eliminate complex food choices

• Eliminate complex meal planning

Meal Replacements (contMeal Replacements (cont’’d)d)

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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

What does it do?

• Burns the visceral fat

• Keeps the heart muscle strong

• Is fun!

How to do it

• Walk, run, bike

• Group sports• Soccer, hockey

• Family Fun• Skating, skiing,

tobogganing , biking

Cardio

• Preserves lean body mass

• Sense of accomplishment

• Great to keep your muscles as you age

• Osteoporosis prevention

• Sit ups – push ups

• Pilates – yoga

• Weights

• Exercise ball

• Bands

• Gym machines

• Use your body• Lunges

Strength Training

What does it do? How to do it

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

• Only time for one’s self

• Get out of work

• Peace of mind

• Change of scenery

• All around health• Mind• Body• Soul

• Eat ½ lunch

• Go for a walk

• Eat the other ½ lunch

• Bring runners to work

• Bag lunch = more time to walk

• Buy lunch = must get out and go for a walk but…

• www.tractivityonline.com

WHY? HOW?

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???

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.

Non-Prescription MedicationHigh Fibre Products

HOW?WHAT?

Waisting Away Waisting Away TMTM Weight Management Weight Management StrategiesStrategies

+PGX

Powder or capsules

Keeps you fuller longer

Has 3 different types of fiber Konjac-mannan ( root) Sodium alginate Xanthan gum

No dairy, corn, soy, starch, wheat, yeast

www.pgx.com.

Great as a snack PM or HS

Mix in with yogurt, applesauce, pudding

Do not let it sit too long

Individual sticks for the office; large can for the home

Veronica Kacinik [vkacinik@functionalmedicine.ca]

WHY? HOW?

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?

- Not aware of 90% of

our food choices

- 62% too busy to

sit down to eat

Think

Nourish

Live

Adjust

Awareness Journal - observations

Society on the Go!Feel – Think – EnjoyNourish – Smell – Taste

+Joint Decision Making

• Roll with the punches

• No resistance

• Empathy

• Self efficacy

• Personal goals

• It’s all about them

YOU YOUR CLIENT

Call to Action – stop, continue, start

Waisting AwayTM Manual – NEW!

Www.lowgimeals.com

http://www.1shoppingcart.com/app/?af=1488220

Nancy Guppy’s menus dietitian@chapmanslanding.com

Go to www.chicken.ca 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 talk to an RD – snack list

www.dietitians.ca meal planners, eat tracker