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File: Nutrition Therapy Pdf 141360 | 1215 Dietary Approaches For The Traetment Of Obesity
dietary approaches for the approaches for the treatment of obesity treatment of obesity amanda hallson msc rd amanda hallson msc rd dietitian in obesity management dietitian in obesity management overview ...

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                                    Dietary approaches for the 
                                                     approaches for the 
                                           treatment of obesity
                                           treatment of obesity
                                               Amanda Hallson (MSc.,RD)
                                               Amanda Hallson (MSc.,RD)
                                            Dietitian in Obesity Management
                                            Dietitian in Obesity Management
                                                      Overview
                                                      Overview
                           • BDA Position Paper on obesity 
                           • BDA Position Paper on obesity 
                              treatment
                              treatment
                           • Historical perspective
                           • Historical perspective
                           • Current evidence base
                           • Current evidence base
                           • What works best ?
                           • What works best ?
                           • Dietary intervention in GCWMS
                           • Dietary intervention in GCWMS
                           • Nutritional resources
                           • Nutritional resources
                                              BDA Position Paper
                                              BDA Position Paper
                                  Obesity treatment: future directions 
                                  Obesity treatment: future directions 
                                     for the contribution of dietitians
                                     for the contribution of dietitians
                           First published in Journal of Human Nutrition and Dietetics 
                           First published in Journal of Human Nutrition and Dietetics 
                              (1997)
                              (1997)
                           •  Addressed strategies which dietitians could use to 
                           •  Addressed strategies which dietitians could use to 
                              promote weight loss and weight maintenance in obese 
                              promote weight loss and weight maintenance in obese 
                              adults
                              adults
                           •  Recognised that both prevention & treatment of obesity 
                           •  Recognised that both prevention & treatment of obesity 
                              are complex and difficult endeavours
                              are complex and difficult endeavours
                           •  Dietitians are well positioned to provide evidence based, 
                           •  Dietitians are well positioned to provide evidence based, 
                              independent information on nutrition & eating behaviour 
                              independent information on nutrition & eating behaviour 
                              in the management of obesity
                              in the management of obesity
                                                                                                                                                                                                                  1
                       Historical perspective
                       Historical perspective
               • Simplicity of approach
               • Simplicity of approach
               • Individuals severely restricting their energy 
               • Individuals severely restricting their energy 
                 intake
                 intake
               • Proved to be ineffective in the long term
               • Proved to be ineffective in the long term
               • Hence ethically questionable
               • Hence ethically questionable
               • Weight cycling – Binge eating disordered
               • Weight cycling – Binge eating disordered
               • Developing and evaluating different types of 
               • Developing and evaluating different types of 
                 treatment approaches  
                 treatment approaches  
               	

		
               	

		
               



               



               
               
                Energy Intake
                                           Energy 
                                           Expenditure
                             Adipose tissue
                             Reasons…
                             Reasons…
                Availability of energy dense foods
                Availability of energy dense foods
                A move away from the traditional diet
                A move away from the traditional diet
                A decrease in cooking, menu planning and 
                A decrease in cooking, menu planning and 
                 shopping skills
                 shopping skills
                An increase in the consumption of snacks and 
                An increase in the consumption of snacks and 
                 sugar based beverages
                 sugar based beverages
                Food portion sizes
                Food portion sizes
                Significant growth in the UK market for fast food 
                Significant growth in the UK market for fast food 
                 and takeaway outlets. 
                 and takeaway outlets. 
                                                                                                                  2
                               Decrease in energy expenditure
                               Decrease in energy expenditure
                          Activity                 Kcal/week  Kcal/week 
                          Activity                 Kcal/week  Kcal/week 
                                                   1950’s                   2000
                                                   1950’s                   2000
                          Food shopping               2400 (on foot)          276 (driving)
                          Food shopping
                          Washing                   1500 (by hand)            270 (washing 
                          Washing 
                          clothes                                                machine)
                          clothes
                          Heating                   1300 (making a             Almost zero
                          Heating
                                                              coal fire)       (thermostat)
                          Making a bed                       575 (with  300 (with duvet)
                          Making a bed
                                                             blankets)
                                              Energy Balance
                          • Accumulation of only 50 - 200 kcal daily leads 
                             over 4 -10 year period to a slow and progressive 
                             weight increase 2-20kg
                          • Each extra 10kg of weight indicates an extra 
                             70,000 stored kcal
                          • A woman of average height and a BMI of 30 
                             kg/m2 has about 105,000 excess kcal stored
                                Drink           Calories         Why?           How much?
                                Drink           Calories         Why?           How much?
                             330ml fizzy drink
                             330ml fizzy drink      134          Sugar           36g = 7 tsp
                                                    134          Sugar           36g = 7 tsp
                                  Large whole
                                  Large whole       364          Sugar        42g = 10.5 tsp
                                                    364          Sugar         42g = 10.5 tsp
                                   milk vanilla 
                                   milk vanilla                    Fat         14g = 3 tsp oil
                                          latte                    Fat         14g = 3 tsp oil
                                          latte
                                  125ml white 
                                  125ml white        82         Sugar &          82g = 4 tsp
                                                     82         Sugar &          82g = 4 tsp
                                         wine
                                         wine                   alcohol
                                                                alcohol
                                   250ml fruit 
                                   250ml fruit      160          Sugar           30g = 8 tsp
                                                    160          Sugar           30g = 8 tsp
                                     smoothie
                                     smoothie
                                                                                                                                                                                                            3
                          SIGN Key Questions…
                          SIGN Key Questions…
                                  Which dietary 
                             interventions are most 
                              effective in producing 
                                and maintaining a 
                              5kg/5% weight loss at 
                                    12 months ?
                                             Classification of diet types
                                             Classification of diet types
                                 Diet Type              Description             Commercial 
                                                                                  Example
                            Energy deficit or Low     600 kcal deficit diet    Weight Watchers
                              Energy Diet (LED)
                               Low fat diet (LF)       <30% total daily      Commercial Slimming 
                                                        energy from fat          organisations
                             Very Low Fat (VLF)        <10% total daily       Ornish and LEARN
                                                        energy from fat
                             Low Calorie (LCD)           >800 – 1600        Weight Watchers
                                                                            Weight Watchers
                                                           kcals/day        /Slimming World
                                                                            /Slimming World
                              Very Low Calorie         < 800 kcals/day      Cambridge & Lighter 
                                                                            Cambridge & Lighter 
                                                                            Life (Liquids)
                                   (VLCD)                                   Life (Liquids)
                             Low Carbohydrate,               <50g                    Atkins
                               Protein Sparing        Carbohydrate/day
                            Modified Fast (PSMF) 
                          What is an energy deficit diet ?
                          What is an energy deficit diet ?
                           Theory of energy deficit diet
                           Modify type, quantity, frequency of food and drink => hypo caloric intake.
                           Weight loss 0.5 kg/ week = body fat loss 0.5 kg/ week => 3,500 kcals
                           Requires energy deficit of at  least          600 kcals per day.
                           Can be achieved by
                           •600kcal deficit, 
                           •low fat diets, 
                           •moderate energy prescription, 
                           •low or very low calorie diets, 
                           •protein-sparing modified fast
                           •low carbohydrate low fat diets
                                                                                                                                                                                                            4
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...Dietary approaches for the treatment of obesity amanda hallson msc rd dietitian in management overview bda position paper on historical perspective current evidence base what works best intervention gcwms nutritional resources future directions contribution dietitians first published journal human nutrition and dietetics addressed strategies which could use to promote weight loss maintenance obese adults recognised that both prevention are complex difficult endeavours well positioned provide based independent information eating behaviour simplicity approach individuals severely restricting their energy intake proved be ineffective long term hence ethically questionable cycling binge disordered developing evaluating different types expenditure adipose tissue reasons availability dense foods a move away from traditional diet decrease cooking menu planning shopping skills an increase consumption snacks sugar beverages food portion sizes significant growth uk market fast takeaway outlets a...

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