Nutrition 8

ThiQar college of MedicineFamily & Community medicine dept.

Nutrition L8, 3rd stage/onlineby: Dr. Muslim N. SaeedJune 10th,2021

Management of obesity

Obesity is a complex multi-factorial disease that results from the positive energy balance that occurs when energy intake exceeds energy expenditure. Lifestyle and environmental factors, including excessive energy intake, high fat intake, and physical inactivity, are associated with the patho-physiology of obesity.

Diet planning

A balanced hypo-caloric diet is recommended.
•Follow the basics of healthy diet and healthy meal planning.
•Nutrition education is important about healthy choices, healthy cooking…etc.
•The easiest way is to follow my pyramid food intake pattern according to calorie level.
•Use my plate method for meal planning.


My plate

Behavioral modification

Over eating and unnecessary weight gain is thought to be a result of faulty behaviors and bad eating habits.
Strategies for behavioral modification
1)Counselling to modify eating environment like food availability and portion control, learn how to determine emotional eating.
2)Self monitoring and feed back (write down food, circumstances, hunger degree and feelings)
3)Support either family support, weight loss pal, spouse or even group therapy.

Physical activity

Engagement in physical activity promotes weight loss, however individuals should understand that exercise is responsible for only 20% of weight loss, the other 80% is about food and diet plan.
•Exercise helps lose weight through
1)Increasing calories expenditure.
2)Improves body composition and increase lean body mass
3)Improves mood and psychological status

Physical activity

30 minutes of moderate to vigorous physical activity per day for children and adults .
Physical activity contributes to weight loss, may decrease abdominal fat, and may help with maintenance of weight loss. Increased physical activity should be a key component of a weight-loss program .
Many people may need more than 150 minutes/week of moderate-intensity physical activity to maintain their weight and more than 300 minutes/week (or 42 minutes/day) to meet weight-control goals.

Treatment options

Healthy diet and physical exercise
BMI 18 to less than 25, no adjusted risk
As above + low calorie diet LCD
• BMI 25 to less than 27, moderate risk
As above
BMI 27 to less than 30, high risk
As above + medication and VLCD
BMI 30 to less than 35 ,very high risk
As above+ consider surgical interventions when obesity related co-morbidities
BMI 35 to less than 40, extremely high risk
As above + surgical interventions
BMI 40 and above, extremely high risk

Liposuction

Involves aspiration of fat deposit by means of 1-2 cm incision through which a tube passed into the adipose tissue.
* Performed in younger persons because skin still elastic.
* Its a cosmetic surgery, not a Wt reduction technique, because only approximately 2.25 Kg fat removed each time.



Bariatric surgery
-Bariatric surgery is the most effective treatment for severe obesity, producing a 30% to 70% loss of excess weight that is largely maintained over time.
Additional benefits include high remission rates of many obesity-related co-morbidities, including diabetes, dys-lipidemia, and hypertension as well as improved quality of life and a reduction in mortality.
Surgical procedures for obesity work by (1) restricting the stomach’s capacity, (2) creating malabsorption of nutrients and calories, or (3) combining both.

The most common procedures worldwide are

1-Adjustable gastric banding (AGB)
2-Roux-en-Y gastric bypass (RYGB)
3-Sleeve gastrectomy.
All procedures can be performed by laparoscopy.

1-Adjustable gastric banding (AGB)

2-Roux-en-Y gastric bypass (RYGB)

3-Laparoscopic sleeve gastrectomy (LSG)

When to consider bariatric surgery?

-BMI > 40 or more.
-BMI > 35 with obesity co-morbidity
•Type 2 DM
•Hypertension
•Hyperlipidemia
•Sleep apnea
•Depression
•GERD
•COPD (asthma)

What is the point of bariatric surgery?

1.Bariatric surgery forces reduction in calories and/or minimize absorption of calories.
2.In some procedure gherlin(hunger hormone) production is reduced.
3.Most bariatric surgery creates a feeling of nausea after eating foods high in carbs or sugar.
4.It helps people lose weight in a short period of time.

What is needed before bariatric surgery?

•Medical counselling
•Psychological counselling
•Nutrition counselling
•The patient should learn about lifestyle modifications before and after surgery.


Dietary management of childhood obesity
Diet planning for obese child should include
a) Estimation of caloric needs
b)Fulfilling the dietary guidelines to ensure proper intake of all food groups therefore macro and micronutrients.
c)Using my plate method for simple illustration of balanced meals.

Behavioral and family approach

Behavioral therapy should include:
-Family
•Information
• Support
-child
• Education
•Psychological support

Behavioral modification of the child

•First check what is wrong
•24 hours recall and FFQ
•Then fix what is wrong
•Give general information about healthy eating


Encourage Physical Activity
Video games , mobiles , computers
and television are contributors to the
Widespread of childhood obesity worldwide.
Time in front of screens should not
exceed 2 hours per day.
Physical activity 60 minutes
5 times per week is recommended.

Is weight loss the main goal in children?

Goals are
1. Maintain healthy weight gain, weight loss maybe needed but not gaining further weight is a main target here, child is growing taller if you keep the current weight for 2 or 3 years , he will get taller and will not be obese anymore or at least will become less obese.
2. Modification of behavior will last long life and it is a precious goal , you are working on his/her future life as an adult and parent etc…
3.Increase the awareness of healthy diet, proper choices and the impact of food on your health.

Dietary management ofhypertension

-According to the World Health Organization
hypertension is the most common chronic
condition worldwide.
-It is a major risk factor for heart disease
affects 1 billion people, and accounts for 1 in 8
deaths each year.

Weight reduction

-Studies documented that weight is directly
related to blood pressure.
-Clinical trials showed that weight loss lowers
blood pressure, blood pressure is lowered with
weight loss even if the desired weight is not
achieved.

•Meta analysis of 25 clinical trials documented

that weight reduction by 5.1 kg results in
reduction in systolic and diastolic blood
pressure by 4.4 and 3.6 mm Hg respectively.
•Weight loss only can lead to reduction in
blood pressure and facilitate medication step
down.


Reduce sodium intake
-Most people consume too much salt on average
9 12 grams per day, or around twice the
recommended maximum level of intake.
-An estimated 2.5 million deaths could be
prevented each year if global salt consumption
were reduced to the recommended level.

Sources of sodium in diet

Table salt
-table sodium or sodium chloride is the main source
of sodium in diet, however it is not the only source
- 1/4 teaspoon salt = 575 mg sodium
- 1/2 teaspoon salt = 1,150 mg sodium
- 3/4 teaspoon salt = 1,725 mg sodium
- 1 teaspoon salt = 2,300 mg sodium

Other sources of sodium:

1. Processed meat
2. Cheese
3. Stock
4. Ready meals
5. Frozen and canned food
6. Salty snacks
7. Pickles

Recommended intake of sodium

-WHO recommends that adults consume less
than 5 grams of salt per day (almost one
teaspoon of sea salt).
-Salt reduction should be gradual to train the
taste buds to the new taste.

DASH diet

DASH diet :Dietary approach to stop hypertension
DASH diet is created by researchers of the National Institute of Health to control high blood pressure.
Dietary Approaches to Stop Hypertension:
1– High in whole grains, fruits, vegetables, and low
fat dairy
2– Adequate Calcium, Potassium, Magnesium
3– Low in red meat, sweets and sugar beverages
4– Low in saturated and trans fat, cholesterol

Other recommendations

Physical activity:
•Helps lower blood pressure and lose/ maintain
weight.
•30 minutes of moderate level activity on most
days of week.
•30 minutes at least 5 days a week
• Can divide into 10 15 minute periods
• Work up gradually


-Water :
•Adequate hydration is needed
•8-10 cups of water is recommended
-Quit smoking and avoid alcohol intake

End