WEIGHT MANAGMENT

How is normal weight, overweight and obese defined?

 Normal Weight:(desirable,healthy,ideal) is a weight which is appropriate for the maintenance of good health for a particular individual at a particular time. Over Weight is a weight 10-20% above average i.e;ideal body weight. or BMI > 25.

Obesity is an excess body fat with weight 20% above average. or BMI >30 .
Under Weight is weight 10-15% below average. or BMI < 18.5.

 Ideally Body Mass Index (BMI), Waist cicumference(weight distribution, and overall risk status are all considered when evaluating a clients weight status and identifying who might benefit from treatment.

 Body Mass Index :BMI is an index of weight in relation to height, calculated mathematically by dividing weight in kilograms by the square of the height in meters. E.g.; wt in kg ht in meters 2

BMI = weight in kg divided by height in meters squared. 1. Divide wt in pounds by 2.2 to convert it into kg. 2. Multiply ht in inches by 2.54 and divide the result by 100 to convert ht into meters by itself that is square it). 3. Divide wt in kg(result of step1)by the square of height in meters (result of step2).The result is BMI. E.g;wt in kg (wt in lbs =kg 2.2 ht in inches 2.54 = a 100 aa=m wt in kg = BMI m2

Ideal Body Weight: ideal wt based on height: Men :106 lbs for the first 5 feet of height and 6 lbs for each additional inch. Women :100 lbs for the first 5 feet of height and 5 lbs for each additional inch. Add or Subtract 10% depending on body frame size.

Determining Of Frame Size:

Method: Height is recorded without shoes Wrist measurement is measured just distal to the styloid process at the wrist cease on the right arm using a tape measure. The following formula is used R = ht in cm wrist circumference in cm

Frame size can be determined as follows

males r =>10.4 small r = 9.610.4 medium r = 9.6 < large

females r = >11.0 small r =10.111.0 medium r = < 10.1 large

Waist to Hip Ratio : can give an indication of risk.

waist measurement (cm) hip measurement (cm) A ratio greater than 1.0 in men & 0.8 in women Indicates risk for certain diseases.

ETIOLOGOC FACTORS : Calorie imbalance more calories than burned.1 lb fat =3500 calories. Eating 500 calories extra per day for 7 days will produce a wt gain of 1 pound. Fat cell development(hyperplasia,hypertrophy)

Genetic factors(leptin) Body frame profile: (apple (intra-abdominal/truncal obesity) verses pear shaped hips and thighs) Presence of central obesity (intra-abdominal fat) leads to an increase in the development of obesity because excess fat is converted to LDL in the liver.

Examination of body
Type: endomorph (stocky) ectomorph(tall)

Etiologic Factors(cont) Nutrition factors consumption of caloric density foods).

Level of activity Psychological status

Medication Sociocultural factors:( race gender,income,education).

Impact Of Obesity:
Alterations in glucose metabolism result in decreased insulin sensitivity, high insulin secretion, and impaired glucose tolerance, all of which further lead to weight gain. Development of cardiovascular disease occur ,including CAD,HTN,and stroke. Increasing weight leads to effect on bone support, resulting in osteoarthritis and degenerative joint disease.

 An increased incidence of disease processes occurs, ranging from gall stones (due to increased cholesterol and bile stasis) and cancer.

Goals of weight management A more appropriate goal is a modest weight loss of 5-10% of initial body weight or drop of 1 or 2 BMI units (approx 10-15 lbs below current wt). Compared with dramatic wt loss, modest wt loss is more attainable, easier to maintain over a long time. A more appropriate wt mgt goal for clients unable to lose wt is to prevent additional wt gain.

Strategies for Weight Loss and Management Nutritional therapy Increased physical activity Behavior therapy

Surgery Combination of these options..

 Nutritional Therapy: How many calories? For overwt clients a BMI of 27-35 a decrease of 300-500-calories /d will lead to -1 lb loss/week. For clients with BMI of >35 a calorie deficit of 500-1000/d will result in 1-2 lb wt loss/week.

How is Low Calorie Intake Achieved? Diets: a restricted calorie eating plan designed to achieve a wt loss. Downfalls of Dieting: Counting calories can take precedence over healthy eating. Research shows that diets( food restriction) can leave people felling unsatisfied and hungry and this may lead to binge eating once food is available.

The Diet Therapy is effective when weight loss has been maintained for a period of at least 2 yrs.
Weight control requires a lifestyle commitment with education, activity and family support.

How Should the Diet be Modified?

Balanced diet Low in fat and simple sugars High in complex CHO and fiber Moderate protein Calorie deficit of 250-500 calories / day. Avoidance of junk food ,use skim milk, avoid red meats.

Types Of Diets Very low calorie diet: consist of 800 calories /d.It is recommended for short term use(4 months) under medical supervision. Is indicated for clients with critical wt issues ;not recommended for clients who are < 30-40% IBW. Low CHO diet: is high in proteins, deplete glycogen stores, promote water loss, use fat as the primary energy source promote ketosis), promote dehydration, and lead to a decrease in energy.

 Liquid wt loss diets: are often used to effect wt loss and provide 800-1200calories/d.(OTC)preparations.
The use of Fad diets: not based on sound nutritional principles) can often lead to further health consequences.

Life style and behavior changes are needed in regard to control portion sizes, and helping the client to distinguish between hunger and food cravings.

Increasing Physical Activity It promotes wt loss and preserve or increase lean body mass. Increase metabolic rate Reduces abdominal fat

Increase activity with or without wt loss lowers blood pressure and triglycerides, increase HDL and improve glucose tolerance.

Recommendations for Increasing Activity:

A variety of aerobic activities are available but walking is the most appropriate physical activity for obese clients. An initial goal may be to walk 30 min/d for 3 days a week, building to 45 min/d of more intense walking for at least 5 d/week. The best exercise is the one that uses the maximum number of large muscles.

Behavior Therapy
The development of a new and healthy eating program. Behavior modification ideas:

Think thin
Plan ahead Eat wisely Shop smart Change your lifestyle.

Medication Medications used to treat obesity are indicated for clients who are not able to lose 1lb per week after 6 months of lifestyle changes. Side effects include dry mouth,anorexia,insomnia,constipation,and increased diastolic blood pressure. Medications is contraindicated for clients with cardiac history, renal or liver dysfunction,hypertension,pregnancy or who are lactating.

Surgery Gastric stapling: a surgical procedure on the stomach to induce weight loss by reducing the size of the stomach; also known as gastroplasty.

 Gastric Bypass: a surgical procedure that routes food around the stomach.

Complications of gastric bypass and gastroplasty: Nausea,vomitting,bloating,heartburn,staple disruption,obstruction,dumping syndrome.

UNDERWEIGHT CLIENTS:
Underweight people and those who are extremely obese die earlier than people of normal weight -- but those who are overweight actually live longer than people of normal weight. Carrying a little extra weight may give people a longevity advantage, but there are many negative health consequences associated with being overweight and obesity. Credit: Kaiser Permanente

Credit: Kaiser Permanente Tuesday, June 23, 2009

 An underweight client has a BMI of < 18.5 with subsequent ill effects on health. Physical conditions related to disease processes or as a consequence of medical treatment can lead to development of underweight status.

 FTT(failre to thrive) infants are defined as failing to meet expected growth curves and developmental milestones and are clinically malnourished;wt and ht are below the expected percentile; these infants start out underweight and can proceed to have further wt loss or wt imbalance. Psychological conditions (anorexia,bulimia,and depression) can lead to decreased intake and poor nutrition.

Goals of Diet Therapy in Under nutrition Clients: restore weight to a reasonable level on BMI,height frame and energy requirements. Increase the intake of calories Increase the intake of high density food. Incorporate physical activity to maintain muscle tone, and gain strength. Drink fluids and include them as a source of energy e.g;milk shakes, juices.
Supplemental feeding may be required vie the enteral or parenteral route to meet dietary goals. A significant increase in calorie intake is required to effect wt gain; an extra 3500 Kcal per week is needed for a 1pound wt gain results in an extra 500 Kcal / day.

TYPES OF EATING DISORDERS ANOREXIA NERVOSA: an eating disorder resulting from a morbid fear of fatness in which the persons distorted body image is reflected as fat when the body is actually under nourished and extremely thin from self starvation. BULIMIA NERVOSA: eating disorder resulting from a persons fear of fatness in which cycles of gorging on large quantities of food are followed by self induced purging or use of diuretics to maintain normal body weight.

 Anorexia

Bulimia

 Distinguishing b/w Anorexia & Bulimia

Characteristic
Age of onset Sex

AN
13---mid 30s 95 % females

BM
17---35 85-90 % females

Body weight

85% or less of expected Ht & age.BMI of 17.5 or less.

Normal / overweight

Medical complications

Amenorrhea ,constipation, Irregular menses, high liver enzymes, low electrolyte imbalance, bone density, dental erosions,esophagitis.

Characteristics Attitude towards therapy.

AN Denial that a problem exist. Bizarre eating habits: cutting food into tiny pieces, refusal to eat certain types of food, eating very slowly,declying eating, and secretly disposing of food.

BN Secretive about bulimic behavior but willing to accept help.

Eating behavior

Sense of loss of control over eating; eating large amount of food in discrete amount of time such as two hours. Consuming thousand of Kcal of easy to eat low fiber, high fat or high CHO foods e.g;cookies,icecreams,sweet s.

Nutritional issues

PEM,low bone density, electrolyte imbalance,dehydration,vi tamin deficiencies.

Frequent purging occurs to prevent wt gain, electrolyte imbalance, Binge fasting cycle can occur eating accelerated by intense hunger that follows a rigid

period of dieting).

Characteristic Psychological

AN Claims to feel fat even when emaciated.

BN Persistent over concern with body shape and weight.

Nutritional guide lines for treatment of ANOREXIA:

Restore hydration and correct imbalance Individualize diet plans Increase food intake gradually(200 kcal/week) Include foods from each of the food group Include additional calcium to restore bone mineralization Small frequent meals Include high fiber and low sodium food( decrease constipation and fluid retention) Include multivitamin and mineral supplements Provide IV nutritional support or nasogastric tube feedings for severe cases of malnutrition and wasting. Gradually reintroduce formerly avoided or forbidden foods.

Nutritional guidelines for treatment of BULIMIA Correct electrolyte imbalance Allow to eat enough to satisfy hunger(atleast 1600 kcal/d) Prolong eating time with fruits, vegetables and salads Include wholegrain fiber foods increases bulk) Include complex CHO(increases satiety) and some fat slows gastric emptying) Maintain regular mealtimes.