NURS: 2018, Diet Therapy

1. NURS: 2018, Diet Therapy Concepts of Obesity

2. Objectives At the end of this presentation students should be able to: Describe the concept of desirable body weight relative to age, gender, and developmental variables Use the concept of desirable weight in meeting the nutritional needs of individuals State the socio-cultural, genetic, emotional, and lifestyle factors which contribute to obesity Discuss principles of effective treatment of obesity

3. Objectives Plan a modified calorie diet based on diet prescription for specified weight loss Identify strategies for obesity prevention Name the characteristics of effective obesity intervention approaches Discuss current research in obesity therapy

4. Multi-factorial influence on obesity

5. Factors influencing appetite Fruhbeck, 2006

6. Terms in weight management Normal weight- persons having BMI 18.5- 24.9 kg/m2 Overweight-adults with BMI between 25 and 29.9 kg/m2 Obesity- adults with BMI greater than 30 kg/m2 Obesity is a condition in which fat stores (adiposity) are excessive for an individual’s height, weight, gender and race to the extent that it produces adverse health outcomes.

7. Terms in weight management Underweight- adults with a BMI below 18.5 kg/m2 For children, aged, or very fit and muscular, BMI definitions are not useful as obesity measure.

8. Variables that are important to Weight • Age- • affects body composition and the presence of muscle and fat. • BMI is a measure of weight unaffected by height. • Older adults have more fat and less muscle mass due to effects of aging and sarcopenia; • children have less muscle because of developmental changes.

9. Variables that are important to Weight • Gender affects body composition. • Males generally have higher muscle content than females and may have higher assessed levels of BMI • Body Composition • Exercise leads to loss of fat mass and may overtime result in higher lean body mass with resultant higher BMI.

10. Types of obesity Defining Obesity based on causal factors Simple obesity (alimentary obesity) – this happens when a person consumes more kilojoules than the body can utilise, and accounts for approximately 95% of obesity cases. Secondary obesity results from underlying medical conditions such as Cushing’s syndrome, polycystic ovary syndrome, and insulin tumours. Other conditions can also cause secondary obesity.

11. Types of obesity Defining Obesity based on causal factors Childhood obesity – when children and adolescents are above the normal body weight for their height and age. Obese children are at risk for long-term problems such as diabetes, hypertension, thyroid problems, and high cholesterol. Even though these health complications are more common among adults, they can still affect children. Obesity can affect a child’s normal growth and development.

12. Types of Obesity Obesity may also be defined based on WHO classifications and BMI cut-off points. Seidell& Visscher, 2004

13. Treatment Goal of obesity treatment is to :- • Reduce morbidity and mortality risk and to improve cardiovascular health • Reduce the burden on the health care sector • Improve the productive sector • Tucker & Dauffenbach, 2011

14. Goals of obesity Therapy • Weight loss- set realistic goals that are achieved in stages • Change in body shape and size- (less abdominal and intra-abdominal fat) • Control of associated disorders: • Impaired glucose metabolism (diabetes, impaired glucose tolerance) • Dyslipidaemia • Hypertension • Sleep apnoea • Arthrititis • Mobility • Reduction in medications • Improved cardiovascular fitness • Improved psychological and social factors • Attainment of individual goals • Fitting into clothes • Need for, ability to have operation • Reduction in pain (Omari & Caterson, 2007)

15. Treatment Modalities • Lifestyle modifications • Diet • Physical activity • Behaviour modification • Weight loss is more likely sustained if individuals who engage in non-surgical measures continue to engage in these activities after 10% weight loss is seen. • Weight loss strategies are not suitable for every group. • Children- care take to maintain weight except if BMI is 95th percentile or above • Pregnant women- contraindicated; for obese women recommended gain is 11-20 pounds • Older persons- age does not preclude persons; care needs to be taken to preserve lean body mass

16. Treatment Modalities • Lifestyle Modifications • Diet • Weight loss occurs when calorie expenditure exceeds intake. • Dietary manipulations are the subject of many research but the data is unclear at this time; consistent is the information that calorie restriction rather than macronutrient manipulation has some effect.

17. Treatment Modalities- Low Calorie Diets Tucker & Dauffenbach, 2011

18. Treatment Modalities- Nutrient Altered Diets Tucker & Dauffenbach, 2011

19. Treatment Modalities- Novelty Diets Tucker & Dauffenbach, 2011

20. Outline for Obesity Intervention

21. References Frühbeck, G. (2006). Overnutrition. In M., Gibney, M. Elia, O., Ljungqvist, & J., Dowsett (Eds.), Clinical Nutrition. (pp. 30-61). Oxford, UK: Blackwell Science Ltd. Omari, A. & Caterson, I. D. (2007). Overweight and obesity. In J. Mann & A. S. Truswell (Eds.), Essentials of human nutrition (3rd Ed.). (pp 234-248). New York, USA: Oxford University Press. Seidell, J. C. & Visscher, T. L. S. (2004). Public health aspects of overnutrition. In M., Gibney, M. Elia, O., Ljungqvist, & J., Dowsett (Eds.), Public Health Nutrition. (pp. 167-177). Oxford, UK: Blackwell Science Ltd. Tucker, S. & Dauffenbach, V. (2011). Nutrition and diet therapy for nurses. Boston, USA: Pearson.