Live Healthy! Weight Management, Nutrition Counseling, and Physical Activity: How Wellness Fits Into the Puzzle
Learning Objectives • Identify three changes you can implement to improve students’ nutrition- and exercise-related behaviors • List three staff members to recruit for collaboration • Describe results from various research studies on nutrition, exercise, and health behavior change • Describe components of the Behavioral Ecological Model
What’s Coming? • Healthy Eating and Active Lifestyles • Policy changes • Live Healthy! campaign • Guidance for each staff member on center • Curriculum to educate students • Guidance to change the center’s culture • Webinars • Launch, competitions, quarterly campaigns
The Triumvirate • Three powerful individuals, each a triumvir • The core: health and wellness, recreation, and food service
Who Else? • Social Development • Instructors • CD/Administration • Finance • SGA • Community Connections • Others
But… …Today, it’s not about them. “[Insert higher power of choice] grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.” -Reinhold Niebuhr
Today, we are talking about how you can help students be the best they can be. (Whether you are a nurse, psychologist, social worker, substance abuse provider, physician, or counselor)
…And We Are Moving Those who sit most of the day have larger waists than those who sit less. Jogging does not offset an otherwise sedentary lifestyle. Lack of muscle contraction for long periods of time may short-circuit unhealthy molecular signals causing metabolic diseases. Chronic sitting results in tight hamstrings, flat back, kyphosis, and weakened iliopsoas muscles. Source: Judson O. (2010). Stand up while you read this! The New York Times. Retrieved online from http://opinionator.blogs.nytimes.com/2010/02/23/stand-up-while-you-read-this/. Hamilton, M.T., Hamilton, D.G., & Zderic, T.W. (2007). Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes. 56(11), 2655-2667.
What Does Underwear Have to Do With It? • NEAT - Nonexercise Activity Thermogenesis – physical activity other than volitional exercise (ADL, fidgeting…) • Interindividual differences • Lean individuals have higher NEAT and increase NEAT if overeat
Nonexercise Activity Thermogenesis (NEAT) and Exercise Comparison From: Hamilton, M.T., Hamilton, D.G., & Zderic, T.W. (2007). Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes. 56(11), 2655-2667.
Game Break! True or False? Educating students 1:1 about making healthy choices is more effective than changing cafeteria policies to promote healthy choices.
False Interventions that target the culture and policy are more effective than interventions that try to change individual behaviors.
Live Healthy! Assess, counsel, Advocate
Assessment • BMI – ratio of weight to height • Waist circumference • Intake form • Food journaling • Exercise journaling
Discuss Food Journals • What made it easier to eat well? • What made it more challenging? • How might you use this information on center?
Game Break! True or False? A healthy BMI range is different for different ethnic groups.
TRUE People of Asian decent experience obesity-related diseases at a lower BMI than those of European heritage. An optimum BMI for those of African decent is under debate. Source: Rakugi, H. & Ogihara, T. (2005). The metabolic syndrome in the Asian population. Current Hypertensive Reports. 7(2), 103-109. Van Houten, B. (2004). Optimal BMI for black women undertermined. OB/GYN News. Retrieved online from: http://findarticles.com/p/articles/mi_m0CYD/is_20_39/ai_n6346067/.
Live Healthy! Assess, counsel, Advocate
Game Break! True or False? Health care providers should deliver a directive message to their overweight patients to help them lose weight.
FALSE A directive style often backfires.
“Due to the sensitive topic and the team not wanting to hurt anyone's feelings, no pictures were taken to show signs of obesity...” AOL Search—signs of obesity
Why Motivational Interviewing Style? • Respectful • Accepting • Encouraging • Mobilizing
“Just because students know how to eat healthy, does not mean they will. Food preference is linked to culture, feelings, and although teaching nutrition is important, changing behavior and attitudes is often more important.” Nutrition Education, Food and Nutrition, Job Corps Community Website, 2010
Communication Styles • Aggressive — “I’m superior and right.” • Passive — “I’m weak or ‘shaky.’” • Assertive — “Although you and I have our differences, you are equally right to express yourself.”
The Art of Nondefensive Communication • Eliminates defensiveness • Liberates honesty • Builds integrity • Inspires compassion
The Art of Nondefensive Communication • Drops defenses and opens up • Direct feedback without being judgmental • Express our own beliefs without being adversarial • Set firm boundaries that create expectations
Nondefensive Questions • Function is to gather information • No need to control how the student answers • Your demeanor is sincere, calm, relaxed • Asked in a neutral tone • Nonopinionated • Effect is disarming • Leaves student accountable for the response
Nondefensive Statement Format • Overt message: reporting what you hear • Covert message: reporting what you see • Interpreting cause or motive • Your own reaction to the student
Preparation for Nondefensive Statements • Acknowledge viewpoints don’t apply to all • Don’t try to convince everyone to agree • Recognize value of student’s experience • Prepare open statements
Nondefensive Predictions • How we will respond to the student’s choice? • Neutral in voice and body language • Creates security for the student and yourself
Effective Predictions • The consequences are as small as possible • The student has max. opportunity for control • The consequences are self-contained • No foreseeable ramifications we can’t tolerate
Rolling with Resistance “You’re crazy if you think I’m getting off this couch.” “My whole family is overweight. I’ll never be thin.” “I really like good food. More meat, please!”
Game Break! True or False? Genetics plays a large role in a person’s metabolism (i.e., how many calories a person burns in a day at rest).
FALSE Our genetics affect our weight, but they do not usually affect our metabolism.
Genes and Weight FTO (~55% carry A allele), leptin (mutation prevalence unknown) and MC4R (~6% mutation) are important genes Increase the attractiveness of highly-palatable foods Loss of control (LOC) of eating Never feel full Sources: Cecil, J.E., Tavendale ,R., Watt, P., Hetherington, M.M., Palmer, C.N. (2008). An obesity-associated FTO gene variant and increased energy intake in children.New England Journal of Medicine. 359(24), 2558-2566. den Hoed M, et al.(2009). Postprandial responses in hunger and satiety are associated with the rs9939609 single nucleotide polymorphism in FTO. American Journal of Clinical Nutrition. 90(5),1426-32. Farooqi IS, Keogh JM, Yeo GS, Lank EJ, Cheetham T, O’Rahilly S. Clinical spectrum of obesity and mutations in the melanocortin 4 receptor gene. New England Journal of Medicine. 2003;348:1085-95. Tanofsky-Kraff, M., Han, J.C., Anandalingam, K., Shomaker, L.B., Columbo, K.M., Wolkoff, L.E., Kozlosky, M., Elliott, C., Ranzenhofer, L.M., Roza, C.A., Yanovski, S.Z., Yanovski, J.A.(2009). The FTO gene rs9939609 obesity-risk allele and loss of control over eating.American Journal of Clinical Nutrition. 90(6),1483-8.
Why Are We Talking About This? I’m built just like my mom. • Be ready to help change the thinking “I can’t lose weight because I have a slow metabolism” • A lot of people are normal weight regardless of FTO, MC4R, leptin or any of the other 400+ genes that control obesity • Help students learn their triggers
Game Break! True or False? The same parts of the brain are responsible for both food and cocaine addiction.
TRUE Functional neuroimaging studies revealed that good smelling, looking, tasting, and reinforcing food has characteristics similar to that of drugs of abuse. Source: Liu, Y. et al. (2010). Food addiction and obesity: evidence from bench to bedside. Journal of Psychoactive Drugs. 42(2); 133-145.
How It Works • Craving, wanting, and liking occur after early and repeated exposures • Decreased sensitivity in dopamine reward system/D2 receptor density • MRI studies ID changes in the hippocamupus, insula, and caudate Sources: Liu, Y. et al. (2010). Food addiction and obesity: evidence from bench to bedside. Journal of Psychoactive Drugs. 42(2); 133-145. Pelchat. (2009). Food addiction in humans. Journal of Nutrition. 139, 620-622.
Specifically Sugar • Sugar-rich foods release euphoric endorphins and dopamine w/in nucleus accumbens as do narcotics • Craving, tolerance, withdrawal, and sensitization seen in both • Large number of AODA-dependent people, and the children of alcoholic fathers, have a sweet preference • Common genetic markers Source: Fortuna,, J.L. (2010). Sweet preference, sugar addiction and the familial history of alcohol dependence: shared neural pathways and genes. Journal of Psychoactive Drugs. 42(2), 147-151.
TEAP Specialist/Team Role • Work with students who are struggling with both addictions/cravings • Be cognizant of replacing one addiction with another • Another good reason to work closely with recreation