Transcript Lunch-N-Learn Presentation: Creighton Family Practice

Creighton Family
Practice
Birgit Khandalavala
Weight Management
All members of the medical team are
equipped to help patients with weight loss
and management-these compromise,
physical therapists, dieticians, nursing staff
and physicians- team effort.
Modest Weight loss is easily done and
most patients would be able to lose 5-10%
of their excess weightKeeping it off is the key
Why do we gain weight?
Multifactorial
Genetic conditions are rare
Obesogenic environment is the chief
cause-FOOD IS A TOXIN
Factors involved are neuro-endocrine,
behavioral and Physical Activity
One lifesaver extra a day- one pound per
year- 10 pounds per decade
WEIGHT
WEIGHT GAIN IS DUE TO MORE
CALORIES BEING CONSUMED THEN
EXPENDED
BASAL METABOLIC RATE + THERMIC
EFFECT OF FOOD + PHYSICAL
ACTIVITY (INCLUDES “NEAT” AND
PHYSICAL EXERCISE)
Where the weight rests may be the most
crucial factor-
The adipocyte
Central fat cells are the most metabolically
active producing hundreds of chemicals
Inflammation is caused by these
chemicals damaging the lining of blood
vessels
The more the number of these cells the
more the resistance to weightlossOverweight folks do not necessarily eat
more that their thinner colleagues.
Emerging hypothesis
A calorie is still a calorie
But what the body is genetically
programmed to do with that calorie is
crucial
May be converting extra sugar into fat and
depositing this centrally as oppossed to to
a more peripheral less toxic location
Fat intake does not put on more fat
WEIGHT MANAGEMENT
DIET
BEHAVIORAL CHANGE
PHYSICAL ACTIVITY- NOT ONLY
EXERCISE BUT NEAT- CAN ACCOUNT
FOR 30% MORE CALORIES BURNEDIT’S GOOD TO FIDGET( LEVINE ET AL)
WE CAN NOT REALLY CHANGE OUR
GENES – THRIFTY GENE MAY BE TO
BLAME somewhat
Modalities
“TRIM” FOR LIFE
Healthy THOUGHTS and ROUTINES have to
become a habit - no diet works - one most try
something upto 30 times before it can even
become close to a routine
INTAKE has to be closely monitored
Food journals are one of the key components
MOVEMENT- not only exercise but any activity
(Moderation- avoidance of calorie dense foods)
Putting it into action
Multipronged approach incorporating
Nutrition - low carbohydrate, higher protein
high fiber diet along the lines of South
Beach, Mediterranean diet, weight
watchers, superfoods - tries to eliminate
simple carbohydrate SUGAR.
Encouraging good fats, complex
carbohydrates and high fiber with non
animal based protein
Behavioral changes
Avoiding mindless munching’
Smaller portions- probably the most important
aspect- use a salad plate not a serving platter
Eating small frequent meals
Food journals - pieces of paper to elaborate
online clubs and cell phones
Recording mood, emotional eating , identifying
binge eating - can account for 30%
Pharmacology
Using weight neutral medications
Eliminating medications that produce weight
gain - antidepressants, oral steroids,
antipyschotics
Substitution when possible
Short term use of certain appetite suppressants
if behavior and physical activity modifications are
initiated - Meridia and Xenical are approved for
the long term
Treating insulin resistance early
Low calorie diets
Using the optifast system
Has to be closely supervised
Outcome may be the same as the less
dramatic behavioral based programs
A weight loss of 2-4 pounds a month is
excellent- especially if kept off
How Much to keep off
5% is great10% is better
Keeping off 5-10% has enormous medical
benefits
Surgery
For BMI of over 40 or 35 :
with co-morbidities
Can help pre-operatively as well
as post-operativerly - 5 step
Creighton Weight management
program is in place intense
medically supervised program
In the clinic setting
Patient evaluated for all the comorbidities - from
head to toe - including liver enzymes, diabetes
and hypertension, to reduce the risk of cardiac
disease, certain cancers and potentially even
alzheimers. Assessment for Sleep apnea.
Focus not only on weight reduction but on
decrease in body fat and especially reduction of
waist measurement - goal is less than 35 inches
in women and 40 inches in men (Caucasian)
May turn out to be the single most important
parameter.Marker of insulin resistance and
precursor of diabetes etc.
Working with your provider
How ready are you to change
How motivated are you
Realistic expectations- 5-10% with diet and exercise and
a comprehensive program
Additional 5-10% with medication
More frequent contact has been the key to long term
weight maintenance-programs are looking at 1-2 years.
Group support, family involvement is crucial-TOPS,WW
Do not focus alone on weight but other parameters as
well.Be prepared for setbacks,plan ahead .Lifelong
struggle- so make it a habit.
National weight control registry
Hoping to enroll patients in this ongoing study of
what works for thousands of patients online
registry. Has to lose at least 30 pounds and keep
it off for one year.
Meanwhile eat breakfast, exercise 45 mins. a
day at the very least, and eat small frequent
meals with constant self monitoring- it works
Good luck to TRIM for life.