Diet counselling for obesitty
- 2. Diet Counselling For Reducing The Risks Of Obesity 2
- 3. • An abnormal or excessive accumulation of body fat • If a person’s body weight is at least 20 % higher than it should be considered obese • A very serious health problem rather than a problem of appearance • Great number of mortality rate right after smoking(cancer) • Constitutes a great threat to health may lead to diabetes, cardiovascular diseases and metabolic syndrome etc. Obesity 3
- 4. Difference between an overweight and an obese patient? • A significant difference • An adult who has a BMI of 25–29.9 kg/m2 is said to be overweight • While an adult with a BMI in excess of 30 kg/m2 is said to be obese 4 • <18.5 - underweight • 18.5 to <25.0 - healthy weight • 25.0 to <30.0 - overweight • 30.0 to <40.0 - obesity
- 5. Basic metabolic rate is low Unbalanced consumption of food and poor lifestyle High carbohydrates and high sugar intake High dietary fat intake Prefer fried, nuts, snacks and fast foods Prefer carbonated drinks and alcohols Overslept Lack of vitamin B, Calcium and Fiber Unstable blood sugar(the main reason is uncertain meal and uncertain quality Lack of exercise 5
- 7. 7 • Supplements for weight loss are numerous • People generally prefer to seek a shortcut to weight loss • The demand for such supplements, which often claim to give fast results is huge • Coupled with the fact that many of these products can be marketed as food supplements with relatively little regulatory controls, the market is rapidly expanding • The universally acknowledged way to lose weight is a calorie controlled diet with increased physical activity • Diet alone is useful, but for long-term maintenance of body weight, exercise is critical • Prevent the cyclical effect of rapid weight gain after a period of dieting
- 8. 8 • Self-monitoring and other behavioral interventions can also enhance weight loss Conventional pharmaceutical treatments such as the lipase inhibitor orlistat are also available for weight loss, but only on prescription. Orlistat works by blocking fat absorption but has unpleasant and common side-effects of faecal incontinence and flatulence
- 9. 9 Treatments Possible To Reduce Obesity Nutraceuticals : • A growing sector of the supplements market for weight loss, and there are a wide variety of products • Formulated into capsules or tablets, or even incorporated into foods or convenience style foods such as snack bars. • Several nutraceutical currently being marketed as aids to weight loss have been the subject of scientific and medical research • The major examples are L-carnitine and acetyl -L carnitine, dehydroepiandrosterone (DHEA), green tea and conjugated linoleic acid (CLA).
- 10. Dietary Treatment of Obesity Weight Management • The primary determinant of weight loss is energy deficit. • Short term weight loss by energy reduction in diets of varied macronutrient composition. • Obesity is a chronic and relapsing disease • It is the long-term efficacy of these dietary strategies in maintaining lowered weight that is of fundamental importance
- 11. 11 Types of Dietary Treatment There are several dietary strategies available both in a clinical and commercial setting. These diets vary greatly in the degree of • Caloric restriction • Relative amounts of macronutrients (protein, carbohydrate, fat) • Medical supervision • Scientific basis • Cost
- 12. 12 • These diets can be broadly divided into: • Low-calorie diets (3400 kJ (800 kcal) /day typically 3400–6300 kJ (800–1500 kcal) /day • Very low-calorie diets (<3400 kJ (800 kcal) /day Types of Dietary Treatment……………………………..
- 13. 13 Low-calorie diets • Traditionally, low-calorie diets that incorporate various methods for restricting food intake have been recommended for weight management. • Such treatment requires a period of supervision for at least 6 months • Weight loss causes a decrease in abdominal fat, the adipose tissue deposition that is associated with the highest disease risk.
- 14. 14 • Have played a central role in the dietary management of overweight and obesity. • Generally, these strategies aim to provide a macronutrient composition of 25–35% energy from fat, 45–60% from total carbohydrate, and 15–20% from protein, thereby moving individuals towards national dietary guidelines • A 10% reduction of dietary fat leads to a 3–4-kg weight loss in normal overweight subjects and 5–6-kg weight loss in the obese • A low-fat diet is equally as effective in achieving long-term weight loss in overweight and obese subjects as alternative dietary strategies
- 15. 15 • Low-fat high carbohydrate diets may have a role in weight maintenance. • Combined with physical activity and behavioral strategies, the maintenance of modest weight loss (3–4 kg) with a marked reduction in the risk of developing type 2 diabetes mellitus over a 4- year study period
- 16. 1616 • The glycemic index (GI) is a dietary concept originally developed for the therapy of diabetes, which has recently become popular despite scant evidence of its effectiveness in weight management • The GI is a property that describes the effect of carbohydrate from a given food on postprandial blood glucose. It is measured by comparing the blood glucose response of the test food with that of a reference food (usually white bread) • Low-GI foods are more slowly absorbed leading to an attenuated and prolonged insulin and metabolic response to foods; it is suggested that more moderate blood glucose and metabolic response may sustain satiety and energy balance to a greater extent than larger metabolic shifts would .
- 17. 17 High-protein diets have popularized as a means of rapid weight loss despite the lack of objective evidence in long-term efficacy and safety Typically, these diets offer wide latitude in protein food choices, and are restrictive in other food choices (mainly carbohydrate) Animal protein rather than plant protein is advocated leading to a higher intake of total fat – mainly saturated fat and cholesterol Many of the popular high-protein diets promote protein intake of 28–64% of dietary energy, which exceeds established requirement of 10–15%, and severely limit carbohydrate dietary energy to 3– 10% .
- 18. 18 o A recent popular high-protein, low-carbohydrate diet, provides on average 27% energy from protein, 5% energy from carbohydrates, and 68% energy from fat o The diet results in the avoidance of important staple foods, such as bread, pasta, rice, potatoes, and cereals, as well as foods high in sugars o Consumption of fruits, vegetables, whole grains, and low-fat dairy products, foods associated with lowering blood pressure and protecting against cancer and heart disease, are all limited o The initial weight loss in high-protein diets is high due to fluid and glycogen loss related to low carbohydrate intake o Overall caloric restriction that is encouraged by structured eating plans, restricted range of foods allowed, and limited tolerance of high-protein foods
- 19. 19 Often promotes a misconception about weight loss by suggesting that it is not related to total energy intake but is due to exclusion of certain foods The amount of weight loss is principally associated with decreased caloric intake rather than reduced carbohydrate content Possible negative effects include increased risks of cardiovascular disease, renal disease, cancer, osteoporosis, and compromised vitamin and mineral status.
- 20. 20 Dietary strategy determines the daily energy requirement for weight loss by calculating energy expenditure, adjusting for physical activity, and subtracting an energy deficit to induce weight loss – usually 2100–2520 kJ (500–600 kcal) for 0.05 kg weight loss As a result the prescribed diet will often be in excess of 3400–6300 kJ (800–1500 kcal) The popularity of this approach relates to the findings of improved compliance in those advised on a 2520 kJ (600 kcal) deficit diet compared to a traditional fixed energy intake of 5040 kJ (1200 kcal)/day
- 21. 21 Meal replacements are another category of calorie-controlled diets include nutritional fortified shakes, snack bars, and low-calorie frozen meals An entire meal or snack is replaced with a portion controlled prepackaged meal or drink that provides approximately 840–1260 kJ (200–300 kcal) Meal replacements are designed to be eaten with additions of conventional foods that supply dietary fiber, other nutrients, additional calories, and water .
- 22. 22 Most weight loss programs that use meal replacements recommend replacing two meals and one snack a day to lose weight and then replacing one meal per day to maintain weight loss This strategy generally provides 5040–6729 kJ (1200–1600 kcal) /day and the regular meal should meet the recommendations of a healthy diet It is an effective weight-loss strategy both in the short and long term in a clinical trial setting. There is no information about the efficacy outside a clinical trial where meal replacement products need to be purchased, and are frequently discontinued at an early stage
- 23. 2 3 Very low-calorie diets are formula foods; they are designed to provide larger and more rapid weight loss than the standard low calorie diets They are commonly given in liquid form to completely replace usual food and snack intake providing in the region of 1890–3400 kJ (450–800 kcal) day1 To reduce the potential risks from loss of lean body tissue, VLCDs are enriched in protein of high biologic value and also includes the full complement of recommended daily allowance for vitamins, minerals, electrolytes, and fatty acids Diets providing such low-energy intakes are often associated with a feeling of fatigue, constipation, nausea, and diarrhea
- 24. 24 Most serious complication associated with VLCD is the development of symptomatic cholelithiasis associated with the rapid weight loss (1–2 kg week1) Weight regain is common with the reintroduction of food In the long term, VLCDs are no more effective than more modest dietary restriction.
- 25. 25 Purpose of action Policy Action Organize eating Control number of eating events Restrict eating to recognized meal and snack periods with perhaps two snacks only for children and three snacks for adolescents Eat meals, as a family whenever possible, at table rather than in front of the television Where possible, eat meals prepared at home and served on a plate rather than ready-to-eat, microwaved individual meals Be aware of the nutrient content of meals Meals prepared at home Where possible, prepare meals at home so that the cook at least is aware of the nutritional makeup of the meal Precooked/ready to eat meals Read the nutritional information given on the packet and observe not only the content/100 g but also the weight (and thus nutrient content) of the food bought and fed to each member of the family
- 26. 26 Reduce the energy content of the food intake Portion sizes Portion sizes can be reduced—using smaller plates may make this less obvious; avoid second helpings Change the form of food used to low-energy density versions Use ‘low-calorie’margarines, spreads, mayonnaise, yoghurts, soups, baked beans, etc. Use semi-skimmed milk, sugar-free fruit squashes, etc. Grill and bake and boil without added fat rather than frying foods Avoid added fats and sugars Do not add fats to vegetables when preparing them for table Avoid (or reduce) added sugar to stewed fruit dishes; sweeteners dissolved in boiled water can be used instead if necessary Reduce energy content of drinks Fruit juices, etc Eat whole fruit rather than fruit juices (which are usually many fruits compressed and often with added sugar) Use ‘low-calorie’fruit squashes Preferably drink water Avoid added sugar Tea, coffee, etc. Try to avoid sweeteners so as to accustom child to less sweet tastes Increase satiety Increase intake of foods that require chewing, that take time to eat, or that increase satiety Increase vegetable, salad, and fruit intake Increase whole-meal cereal intake.
- 27. 27 Management pathways and therapeutic responsiveness Patient encounter History of BMI ≥25 Assess risk factors Primary intervention • Diet • Physical activity • Behavioral management • Treatment strategy for weight loss and risk factor control Failure to achieve 5–10% weight loss goal Consider drug treatment if: BMI 30 or greater BMI 27 or greater with risk factors Fulfil medical criteria for drug treatment Drug treatment (following specific license requirements 12 weeks Less than 5% weight loss 5% or more weight loss Drug treatment discontinued Assess reason for failure to lose weight Other advice reinforced Other treatment options considered Continue drug treatment Monthly monitoring of weight loss and weight maintenance Duration of treatment determined by success and product licence Weight regain
- 28. 28