Rita All, FNP-S Michele Czerwinski, FNP-S Julie Dillenbeck-Juers, FNP-S Obesity and Nutrition.
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Transcript of Rita All, FNP-S Michele Czerwinski, FNP-S Julie Dillenbeck-Juers, FNP-S Obesity and Nutrition.
Rita All, FNP-S
Michele Czerwinski, FNP-S
Julie Dillenbeck-Juers, FNP-S
Obesity and Nutrition
No commercial support was received for this
educational activity.
At the end of this session the learner will be able to: 1. Describe ways to reduce the risk for stroke and other cardiovascular diseases.2. Identify activity that boosts high-density lipoprotein (HDL) or "good" cholesterol and decreases unhealthy triglycerides.3. Discuss the impact of eating habits that help reduce overall caloric intake and lose weight.
Body mass index is a measure used to determine overweight and obesity.
Calculated using weight and height
Indicator of body fatness.
www.freebmicalculator.net (picture)
Adults
BMI= Mass (kg) (Height (m))2Convert pounds to kilograms (1lb=0.45kg) and
inches to meters (1inch=0.025m). The equation for BMI is weight(kg) divided by height(m) squared(kg/m2).
BMI=Mass (lb) x 704.5 (Height (in))2 Multiply the patients weight in pounds by 704.5
and then divide the results by the patients height in inches once and then for a second time
BMI Calculation Formula
Men: 106 lbs + 6 lbs/inch over 5 feet Women: 100 lbs + 5 lbs/inch over 5 feet Abdominal (android) obesity: Waist: hip
ratio >0.85 in women and > 0.95 in men (To obtain, divide waist measurement by hip measurement).
Simple Way to Determine Ideal Body Weight
Place a tape measure around your body at the top of your hipbone. This is usually at the level of your belly button.
Proper Method to Perform Waist Measurements
Overweight: An adult who has a BMI between 25 and 29.9.
Obese: An adult who has a BMI of 30 or higher.
Overweight or Obesity
Obesity related conditions include: Heart Disease Stroke Type 2 Diabetes Certain Types of Cancer These are some of the leading causes of
preventable death.
Center for Disease Control and Prevention (2013).
Consequences of Adult Obesity
Upper body also referred to as “apple shape”
Excessive body fat in the abdomen and flank areas
Greater risk for type 2 DM, CAD, stroke, and early death
More common in men
Lower body also referred to as “pear shape”
Excessive adipose tissue in the buttocks and thighs
More common in women
Dunphy, et al (2011)
Two Types of Obesity
Consequences of Obesity
Weight status is determined using an age-and-sex specific percentile for BMI rather than the BMI categories used for adults because their body composition varies as they age and varies between boys and girls.
www.nourishinteractive.com (picture).
Children
Overweight defined as a BMI at or above the 85th percentile and lower than the 95th percentile for children of the same age and sex.
Obesity defined as a BMI at or above the 95th percentile for children of the same age and sex.
Overweight or Obesity
High Blood Pressure High Cholesterol Increased Risk of
Impaired Glucose Tolerance
Insulin Resistance and Type 2 Diabetes
Sleep Apnea Joint problems and
Musculoskeletal Discomfort
Gallstones Gastro-esophageal
Reflux Greater risk of social
and psychological problems (discrimination and poor self esteem).
Fatty Liver Disease
Consequences of Childhood Obesity
Consequences
More than one-third of U. S. adults (37.5%) or 41 million women and more than 37 million men aged 20 and over are obese (CDC, 2013).
Approximately seven million boys and more than five million girls between the ages of 2-19 years are obese (CDC, 2013).
Approximately 17% of the Nations children are obese.
CDC (2013).
Statistics
Prevalence ranged from 20.5% in Colorado to 34.7% in Louisiana (CDC, 2012).
No state was less than 20%. Higher prevalence's of adult obesity were
found in the Midwest (29.5%) and the South (29.4%) (CDC, 2012).
Lower prevalence’s were in the Northeast (25.3%) and the West (25.1%) (CDC, 2012).
In 1995 most of the country had a less than 10% obesity rate; today as high as 33%.
Obesity Prevalence by States
Prevalence of Obesity in States
Non-Hispanic blacks have the highest age-adjusted rates of obesity, 49.5%
Mexican-Americans, 40.4% All Hispanics, 39.1% Non-Hispanic Whites, 34.3% Adults aged 60 years and over were more likely to
be obese than younger adults. Men: No significant difference in obesity
prevalence by age. Women: 42.3% of those aged 60 and over were
obese compared with 31.9% of women aged 20-30. CDC (2012 & 2013).
Highest Groups Affected
Among non-Hispanic black and Mexican-American men, those with higher incomes are more likely to be obese than those with low incomes.
Higher income women are less likely to be obese than low-income women.
No relationship between obesity and education among men.
College educated women are less likely to be obese compared with less educated women.
CDC (2012).
Obesity and Socioeconomic Status
What Do We Do?
The Answer is…
To lose weight and keep it off, a high amount of physical activity is required.
Diet needs to be adjusted to reduce the amount of calories being consumed.
Exercise!
150 minutes of moderate intensity aerobic activity
75 minutes of vigorous-intensity aerobic activity
Or an equivalent mix of the two each week
You may need to do more than the 150 minutes to maintain your weight.
To Maintain Weight
Get Off of the Couch!
Move!
Control your weight Reduce risk of
cardiovascular disease
Reduce risk for type 2 diabetes and metabolic syndrome
Reduce risk for some cancers
Strengthens bones and muscles
Improve mental health and mood
Improves ability to do daily activities
Prevents falls if you’re an older adult
Increases chances of living longer
Benefits of Physical Activity
Boosts high-density lipoprotein (HDL) or “good” cholesterol and decreases unhealthy triglycerides.
Keeps the blood flowing smoothly, which decreases cardiovascular diseases.
Stimulates various brain chemicals that may leave you feeling happier and more relaxed.
More Benefits of Physical Activity
What Else Can We Do?
Better Nutrition!
How Do We Eat Healthy?
Food Portion Sizes
Grains: ½ Cup cooked rice or pasta=one ice cream scoop ½ Cup hot cereal=a fist 1 Pancake-a computer disk (CD) Vegetables: 1 Cup green salad= a baseball ½ Cup cooked broccoli= a light bulb 1 Baked Potato=a fist Oils: 1 Teaspoon butter or margarine=a postage stamp 1 Tablespoon salad dressing=a silver dollar
Correct Portion Sizes
Fruits: ½ Cup fresh or canned fruit=7 cotton balls ¼ Cup raisins= a large egg Dairy Products: ½ ounce cheese=3 dominoes 2 slices cheese= 2 CDs Meats, Nuts, and Beans: 2 Tablespoons peanut butter=a golf ball 3 ounces cooked meat, fish, or poultry=a deck of
cards 1 ounce nuts=1 cupped handful, 20-24 almonds or
48 pistachios.
Correct Portion Sizes, cont…
Maintain glucose and insulin levels. Avoid the negative cycle of high and low blood
sugar by eating small frequent meals. Eating smaller portions, but eating more often, will
keep glucose and insulin levels stable. Regulating glucose and insulin production usually
reduces food cravings, because your body doesn’t experience hypoglycemia.
Eating smaller portions can curve cravings and help reduce overall caloric intake and lose weight.
Eating smaller portions helps physically and financially.
Benefits of Consuming Correct Portion Sizes
CDC Recommends 3oz. Of Protein
Anyone NOT Guilty of This?
OR this???
I eat a garden
salad every day for lunch…I
don’t understand why I am gaining weight!
Would you pick up that drink if you knew?
Anything Else We Can Do?
Delete late night snacking Track what you eat and drink (food diary) Fresh foods, less prepackaged foods Meal planning and preparation Don’t eat straight from the package. Instead
serve a reasonable portion in a bowl or container. When eating out, split the entrée with your guest
or put half the meal in a “doggie bag.” To control hunger between meals, encourage
patients to eat a snack, like a piece of fruit or small salad.
Behavior Modifications
Time Constraints Lack of financial resource Fragile emotional state Poor self esteem Education Illness Dissatisfaction with life circumstances Cultural beliefs
Barriers to Healthy Eating and Exercise
On The Lighter Side…
Fuel Up and Play 360 Started by the National Dairy Council and the
National Football League to encourage healthy lifestyles in children.
Offers 101 tips for educators to promote healthy eating habits and teaching nutritional concepts to improve long term health in children.
Encouraging healthy nutrition in patients- programs for children
School nutrition program- Provides well balanced breakfast and lunches to children while at school
Offers healthy meals with healthy alternative choices with appropriate serving sizes.
Encourages healthy eating habits that can be modeled while not at school.
Encouraging healthy nutrition in patients- programs for children
My Plate- Government program by the United States Departments of Agriculture and Health and Human Services
Came from the 2010 Dietary Guidelines for Americans to improve healthy nutrition
Offers better visualization than the food pyramid
Used in conjunction with other programs
Encouraging healthy nutrition in patients- programs for children
Michelle Obama◦ Let’s Move initiative- an effort to turn around the
childhood obesity trend with this generation of children.
◦ Giving parents helpful information and fostering environments that support healthy choices.
◦ Providing healthier foods in our schools. ◦ Ensuring that every family has access to healthy,
affordable food.◦ Helping kids become more physically active.◦ Announced schools will no longer be able to advertise
sugary drinks or junk food on billboards, score boards, cups, posters, or menus.
Encouraging healthy nutrition in patients- programs for Children
Let’s Move!
Let’s Move!
Usual food intake: How many sugared drinks do you drink in a day? What do you eat after meals?
Do you play organized sports? Do you take any vitamin supplements? Juice versus fruit? Fruit is best! Eat with COLOR!! How many fruits and vegetables did you eat
today? Ketchup doesn’t count!!
Conversing with young patients
United States Department of Agriculture program offered to low income families- income range based on community poverty levels
Federal grants to States for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk.
WIC programs
Nutritional diaries- 24 to 72 hour account of all foods and liquids consumed to determine average daily calorie intake and excess of calories
24 hour nutrition recalls- a verbal account of what has been consumed in the past 24 hours.
Nutritional referrals- Covered by most insurance companies, can determine where healthy choices can be made based on height/ weight and current health status.
My plate handouts- provided at each appointment visit.
Routine follow up appointments for accountability
What do we do about adult patients?
Encourage the most unprocessed form of nutrition as possible
Vitamins are helpful ‘supplement’, but not a substitute for the ‘real’ thing
“I am healthy! I take my gummy vitamin every morning!”
How many servings of fruits and veggies a day?
Put up your fingers!!
http://school.fueluptoplay60.com/documents/NASPE-101-Tips-TeachingNutrition.pdf
March is National Nutrition Month
Centers for Disease Control and Prevention:Nutrition for Everyone. (2014). Retrieved from http://www.cdc.gov/nutrition/everyone/resources/.
Centers for Disease Control and Prevention: Overweight and Obesity. (2013). Retrieved from http://www.cdc.gov/obesity.
Decrease Portion Sizes (2013). Retrieved from www.choosemyplate.gov/weight-management-calories/weight-management/better-choices/decrease-portions.html.
Gripshover, S., & Markman, E. (2013, August 24). Teaching young children a theory of nutrition: conceptual change and the potential for increased vegetable consumption. Psychological Science, 24(8):1541-53. doi: 10.1177/0956797612474827.
Mikulak, A. (2013). Getting Kids to Eat Their Veggies: A New Approach to an Age-Old Problem. Association For Psychological Science. Retrieved from https://www.psychologicalscience.org/index.php/news/releases/getting-kids-to-eat-their-veggies-study-suggests-a-new-approach-to-an-age-old-problem.html.
National Association for sports and education. (2014). Retrieved from http://school.fueluptoplay60.com/documents/NASPE-101-Tips-TeachingNutrition.pdf.
School Nutrition Organization. (2014). Retrieved from http://www.schoolnutrition.org/Content.aspx?id=94.
United States Department of Agriculture. (2013). MyPlate, Dietary Guidelines and General Nutrition. Retrieved from https://snap.nal.usda.gov/resource-library/eat-healthy-every-day/myplate-dietary-guidelines-and-general-nutrition.
References