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Lean Choices Introduction

Lean Choices Introduction. Warren R. Peters MD. MPH Jeanne M. Peters RN. A Complex Medical Problem. Genetic. Metabolism. Brain Chemistry. Cultural and Psychosocial. Environmental. PHILOSOPHIES OF OBESITY THERAPY.

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Lean Choices Introduction

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  1. Lean ChoicesIntroduction Warren R. Peters MD. MPH Jeanne M. Peters RN.

  2. A Complex Medical Problem Genetic Metabolism Brain Chemistry Cultural and Psychosocial Environmental

  3. 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”

  4. 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

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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

  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”

  12. 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

  13. Lean Choices-Meal Replacement • Balanced protein • Low glycemic fruit • Berries • Pineapple • 2% milk or “Silk” milk • Morning and evening • 250-280 calories

  14. “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

  15. 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

  16. 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

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