Presentation on theme: "Lean Choices Introduction Warren R. Peters MD. MPH Jeanne M. Peters RN."— Presentation transcript:
Lean Choices Introduction Warren R. Peters MD. MPH Jeanne M. Peters RN.
Genetic Brain Chemistry Metabolism Environmental Cultural and Psychosocial A Complex Medical Problem
PHILOSOPHIES OF OBESITY THERAPY “No one would get heavy for the fun of it. There has to be a “reason” and it is our job to jointly understand it.” “We all get heavy for different reasons. Therefore therapy must be individualized.” “This is a chronic disease and can not be currently cured. Therefore we, the patient and the provider will be treating this disease forever.” “Obesity is not fair or democratic”
POINTS OF POTENTIAL INTERVENTION Eat less Exercise more –Frequently recommended and can be useful for some. –Most patients that you see in your office will have already tried these two methods and failed. Macronutrient manipulation Alter gastric emptying Alter nutrient absorption or storage Accelerate the metabolic rate Limit food choices Avoid meal skipping Change brain chemistry – with psychology and/or drugs
GLYCEMIC INDEX/LOAD In vivo measurement of the relative effect of a single food on blood sugar over time compared to sucrose. (some indexes used white bread as a reference) Glycemic Load = Index X gms. of CHO Illustration: Popcorn has a high index but a low load due to the small amount of digestible CHO “Glycemic index and obesity” Am J Clin Nutr 2002;76 (suppl):281S-5S
LOW GLYCEMIC FOODS May not be high fiber – pasta. High fiber may be high glycemic – millet, and puffed wheat. Low glycemic foods increase satiety by delayed gastric emptying. Creates a reduction of insulin response – therefore a decrease of sodium retention and a decrease in appetite. Lipid oxidation is enhanced. Greater weight loss.
WEIGHT OF EVIDENCE “A reduced-glycemic load diet in the treatment of adolescent obesity. Arch Pediatr Adolesc Med. 2003 Aug: 157(8):725-7 “Glycemic index and satiety”. Nutr Clin Care. 2003 Jan- Apr,6(1):20-6 “The effect of high- and low-glycemic index energy restricted diets on plasma lipid and glucose profiles in type 2 diabetic subjects with varying glycemic control. J Am Coll Nutr. 2002apr;21(2):120-7. “High protein intake sustains weight maintenance after body weight loss in humans.” (18 vs.15% of energy intake resulted in 50% less weight gain) Int J Obes Relat Metab Disord. 2004 Jan;28(1):57-64.
MEAL REPLACEMENTS “More people may be heavy because they skip meals than are heavy because they over eat.” A population of “hurry”. Single mom who works full time, goes to school, and raises two kids. Eating becomes a nuisance. Medical management – Optifast. OTC – EAS, SlimFast, Atkins, even Dr. Phil.
MEAL REPLACEMENT EVIDENCE “Weight management using a meal replacement strategy: meta and pooling analysis from six studies.” Int J Obes Relat Metab Disord. 2003 May;27(5):537-49. “A novel soy-based meal replacement formula for weight loss among obese individuals: a randomized controlled clinical trial.” Int J Clin Nutr. 2003 Apr;57(4):414-22 Useful for weight loss and weight maintenance.
MEAL REPLACEMENT Meal Replacement for low-income patients. 6 months, BMI- 40 to 37 Int.J. Obes Relat Metab Disord. 2004 Dec;28(12):1575-9. One-year combination trial with type 2 Diabetics – sibutramine, low calorie diet, once daily meal replacement compared to standard care. – –7.3 kg vs. 0.8 kg loss, – –HgbA1 -0.6 vs 0.0 – –Diabetes Care.2003 Sep;26(9):2505-11
Lean Choices-Nutritional Foundation Nutrient “malnutrition” in the face of too many calories Chromium deficiency – too much sugar Stress and B vitamins Antioxidants “Vitality Gold” and “Daily for Life”
Lean Choices-Exercise Avoid muscle loss. Walk (if possible) Wait to exercise until you have lost 10-15# Upper body exercise Discouraging information – 90 minutes per day for weight loss
Lean Choices-Meal Replacement Balanced protein Low glycemic fruit –Berries –Pineapple 2% milk or “Silk” milk Morning and evening –250-280 calories
“The Baggies” 10 carrots –Crunch –Healthy carbohydrate for the brain –Indestructible 10 almonds –Healthy fats for satisfaction –Omega-3 fatty acids for brain and artery function Portable-no refrigeration Mid-morning, Mid-afternoon 120 calories ½ of Attain Bar alternative
Lean Choices-Lunch or Dinner 3 oz. of high quality, low fat protein Two vegetable servings –Green, red, –Broccoli, squash, beans, tomatoes, “greens” Grain serving –Rye bread, pasta, sprouted wheat bread, sourdough bread Fat serving –Dressing or butter Calories – 500-600 calories
The Cost Your commitment Free 12 week program One time, life long membership with Melaleuca- the wellness company - $29.00 Products – –Plan #1 $175/mo ($6.25/day) –Plan #2 $205/mo ($7.25/day) –Subtracted from your grocery bill –Plan #2 for individuals with hypertension, diabetes, or high cholesterol