Weight loss 2

Strategies for SuccessfulStrategies for Successful Weight LossWeight Loss

Compiled, Modified or Created By*Compiled, Modified or Created By*

Louisville Metro Department ofLouisville Metro Department ofPublic Health & WellnessPublic Health & Wellness* Created Slides 1,2,4,5, 10 & 15-55

www.louisvilleky.gov/healthFIND PRINTER-FRIENDLY EDUCATIONAL MATERIALS AT:

www.louisvilleky.gov/Health/Printer+Friendly+Educational+Materials

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Suggested Handouts at this website: Healthy Snack Ideas Light Substitutions Grocery Purchase Guide Tips for Dining Out My Food Diary Week of Healthy Menus “Lite Bites” Cookbook

http://www.louisvilleky.gov/Health/Printer+Friendly+Educational+Materials

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This image of the Statue of Liberty shows the current trend in our nation.

Background:Background:

Where are we?Where are we?

How did we get here?How did we get here?

How can we win? How can we win?

Where Are We?Where Are We?

~65% ~65% of adults in U.S. are of adults in U.S. are overover--weightweight(BMI 25(BMI 25--29) or 29) or obeseobese (BMI 30+)(BMI 30+)

In 1994, this figure was In 1994, this figure was ~55%~55%

Since 1980, the rate of Since 1980, the rate of obesityobesity has has doubled doubled (from 15% to 30%)(from 15% to 30%)

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Obesity Trends Among U.S. Adults – Behavioral Risk Factor Surveillance Survey (BRFSS), 1991-2002. See Body Mass Index Chart in “Week of Healthy Menus” to find your own BMI & the range it falls in.

1998

Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2007

(*BMI ≥30, or about 30 lbs. overweight for 5’4” person)

2007

1990

No Data <10% 10%–14%

15%–19% 20%–24% 25%–29% ≥30%

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The obesity epidemic is growing rapidly.

50 years

Modified from R Unger

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Notice what a drastic change has occurred in only 50 years. Here are the big culprits: sedentary lifestyle and lots of fast foods.

Impact of ObesityImpact of Obesity

MMedical edical CostsCosts

ObesityObesity

Quality of LifeQuality of Life

Comorbid Comorbid DiseasesDiseases

DisabilityDisability

↑↑ MortalityMortality ↑↑

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Because obesity impacts so many areas, it is important to turn the tide. Each one of us can help to lower the cost of healthcare and improve our quality of life by adopting a healthy lifestyle.

The Metabolic SyndromeThe Metabolic Syndrome

Abdominal ObesityMenWomen

Triglycerides

HDL cholesterolMenWomen

Blood pressure

Fasting glucose

Waist circumference>40 in>35 in

>150 mg/dl

HDL cholesterol<40 mg/dl<50 mg/dl

>120/>80 mmHg

>100 mg/dl

Risk FactorRisk Factor Defining LevelDefining Level

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As waist circumference reaches a certain size, the cluster of health problems referred to as the metabolic syndrome (or “Syndrome X”) begins to show up.

How did we get here?How did we get here?

Introduction of New, Larger Portions in the Introduction of New, Larger Portions in the U.S., 1970U.S., 1970--19991999

70

60

50

40

30

20

10

01970-74 1975-79 1980-84 1985-89 1990-94 1995-99

Year

Num

ber

of L

arge

-Siz

e Po

rtio

ns In

trod

uced

Young and Nestle. Am J Public Health 2002

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Current portions are 2-3 times the size we should be eating. Ask for a “Go Bag” at the beginning of the meal or share your meal.

Computers & GamesEmail, InternetTV, Cable, RemoteHome MoviesSpectator SportsElevatorsEscalatorsPhones, Cell PhonesCars, Buses, TrainsDrive-ThruSnow Blowers

Use the Stairs MorePark Farther Away or WalkWatch TV Less or Exercise

While WatchingDo Less Passive Activities

Effects of Technological Advances

Healthy Choices Unhealthy Environment

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Probably computers, computer games and the internet are culprits that have added insult to injury by further reducing physical activity in more recent history.

Always RushingOver-schedulingWorking Longer HoursLess Leisure TimeFamily StressesJuggling SchedulesJuggling RolesNo Time for FamilyNo Time for Self

Plan Time to ExerciseTake Time to Eat HealthierMake Time to Cook

The Effects of Time Pressures


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How do we have so many conveniences, yet seem busier than ever? We just try to pack more into our time & are way more available to others by cell phones & email. We need to set limits.

Food AvailabilityEating Out MoreCooking LessFast FoodsLarge PortionsValue MealsAll You Can Eat BuffetsFood CourtsConvenience StoresVending MachinesGrocery Store Choices

Cook MorePlan AheadBrown Bag MoreRead LabelsBuy Healthy FoodsChoose Healthier FoodsWatch Portion SizesAsk for Go-Bag or ShareEat Only When Hungry

The Effects of Food Pressures


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Our food environment has become increasingly toxic in the calorie realm. Because environment does not usually encourage healthy eating, we must plan strategies.

How can we win this battle?How can we win this battle?

You can lose weight You can lose weight permanently.permanently.

A NATIONAL WEIGHT CONTROL A NATIONAL WEIGHT CONTROL REGISTRY (NWCR) of >5000 subjects has REGISTRY (NWCR) of >5000 subjects has been studying people whobeen studying people who•• have lost at least 30 lbs.have lost at least 30 lbs.

(average so far has been 66 lbs.)(average so far has been 66 lbs.)

•• have kept it off at least 1 yearhave kept it off at least 1 year(average duration of maintenance has been 5.5 (average duration of maintenance has been 5.5

years)years)

The NWCR &The NWCR & other research have other research have

discovered some discovered some keys keys to to successful weight loss & successful weight loss &

maintenance.maintenance.

Set an initial goal to lose Set an initial goal to lose ~10% ~10% of your beginning of your beginning weight for weight for significant health significant health benefits.benefits.

If you weigh If you weigh 200 lbs. 200 lbs. that that would be would be 20 lbs.20 lbs.

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If after losing 10%, you wish to continue losing extra weight, that is OK.

After 6 months of After 6 months of losing, try to losing, try to maintain maintain your loss for 3your loss for 3--6 6 months before losing months before losing more.more.

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Keep exercising during maintenance & add back only a modest amount of calories (usually ~200). If you start gaining, add more exercise &/or, reduce calories a bit.

If you are able to maintain If you are able to maintain your weight loss, you may your weight loss, you may repeat this cycle of 6 months repeat this cycle of 6 months loss; loss; then 3then 3--6 months of 6 months of maintenance,maintenance, until you reach until you reach your final goal.your final goal.

Aim to lose half of 1% of Aim to lose half of 1% of your weight per week.your weight per week.

If you weigh 200 lbs., If you weigh 200 lbs., that is 1 lb./week.that is 1 lb./week.

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The NWCR discovered that the best rate to lose weight is half of 1% of your weight per week. The “Week of Healthy Menus” has a calorie estimator for gradual weight loss and a week of menus at each of 4 calorie levels.

Why Gradual Weight Loss?Why Gradual Weight Loss?

Preserves muscle tissuePreserves muscle tissueMuscle increases metabolic rate & Muscle increases metabolic rate & reduces risk for diabetesreduces risk for diabetes

Prevents secretion of an appetitePrevents secretion of an appetite--increasing chemical by the stomachincreasing chemical by the stomachAllows adequate nutrition and satietyAllows adequate nutrition and satietyAllows time for skin to shrinkAllows time for skin to shrink

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It is encouraging to know that the best way to lose weight is the least difficult – gradually.

To Lose 1 lb. / WeekTo Lose 1 lb. / Week

Create a deficit of 500 calories:Create a deficit of 500 calories:

Walk 1 hr. (three 20Walk 1 hr. (three 20--min. miles) to min. miles) to burn ~300 caloriesburn ~300 calories

Eat 200 less calories daily if your Eat 200 less calories daily if your weight has been stableweight has been stable

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Each day we need to use up 500 more calories than we take in to lose a pound a week.

OROR……

Create a deficit of 500 calories by:Create a deficit of 500 calories by:

Walking 40 min. (2 miles) to burn Walking 40 min. (2 miles) to burn ~200 calories~200 calories


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You may prefer to sacrifice calories to do a bit less exercise. Cut out 100 calories in each of 3 meals and walk 2 miles daily for a 500 calorie deficit.

OROR……

Create a deficit of 500 calories by:Create a deficit of 500 calories by:

Walking 80 min. (4 miles) to burn Walking 80 min. (4 miles) to burn ~400 calories~400 calories


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This is a good choice for those who prefer to lose weight mainly through exercise, with little change in diet.

Bottom LineBottom Line……

89% of those in the NWCR combined 89% of those in the NWCR combined exercise with diet, which allows for exercise with diet, which allows for weight loss with modest changes in weight loss with modest changes in daily calories.daily calories.

Gradually Gradually ↑↑ exercise to 1 hour exercise to 1 hour on most days.on most days.(may break up time)

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Before starting exercise, if you have not been exercising, are over 40 or notice problems when you exercise, check first with your doctor to find out what is safe for you. When starting out, you may begin with just 5 min. of exercise several times per week. The following week, you may add 5 min. to each day that you exercise. Continue adding 5 min. each week until you reach your time goal. Once your body has grown more accustomed to exercise, you may gradually increase the number of days you exercise, as well as the pace, provided you are following your doctor’s recommendations and are listening to your body’s readiness. Breaking exercise up into 2 or 3 segments has been shown to be even more effective than doing it all at once, probably because long periods of being sedentary slow the metabolism.

How Exercise HelpsHow Exercise Helps

Burns caloriesBurns caloriesMuscleMuscle--strengthening exercise adds strengthening exercise adds muscle tissue, which burns calories 3 muscle tissue, which burns calories 3 to 4 times faster than fat tissueto 4 times faster than fat tissue↑↑ energy levelenergy level↑↑ mood & motivationmood & motivationBenefitsBenefits BP, heart, arthritis, diabetes, BP, heart, arthritis, diabetes, balance, etc.balance, etc.

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Do you feel you don’t have time to exercise? You will find that once your body gets used to exercising, you will have energy to spare, will have better sleep and will accomplish more, which helps exercise fit into your schedule.

Eat at least 3 balanced Eat at least 3 balanced meals daily, using a meals daily, using a Pyramid type of diet.Pyramid type of diet.

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A Pyramid type of diet is loosely defined here as having a variety of foods from each food group, while limiting fats and sweets. Visit MyPyramid.gov for details.

SnacksSnacks……

Successful losers averaged about 2Successful losers averaged about 2snacks daily.snacks daily.

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They chose snacks that were from the food groups & were low in fat and sugar. See the handout “Healthy Snack Ideas” for suggestions.

Eat Eat more more fruits, vegefruits, vege-- tables, whole grains, tables, whole grains, dried beans and dried beans and less less fats & sweets.fats & sweets.

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Consider how long it takes to eat the above foods in comparison to the cake, which has little nutrition or fiber and lots of fat and sugar (lots of calories taken in too quickly).

These foods are high in These foods are high in water & fiber, which water & fiber, which help the feeling of help the feeling of fullness.fullness.

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Fruits, vegetables, whole grains and dried beans also require plenty of chewing, which makes us feel more satisfied and slows down how quickly we take in calories.

Substitute low fat foods Substitute low fat foods for many high fat foods for many high fat foods to cut calories.to cut calories.

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The fat in French fries more than doubles the calorie level. The same amount of potato (baked) can be seasoned with only ~20 calories by adding one of the following: ½ Tbsp. light tub margarine 1 Tbsp. light sour cream 2 Tbsp. fat free sour cream.

What are some ways I canWhat are some ways I can““nip & tucknip & tuck”” to cut calories?to cut calories?

Use Use skim or 1%skim or 1% milk, milk, fat free or light: fat free or light: cream cream cheese, sour cream, cheese, yogurt & ice creamcheese, sour cream, cheese, yogurt & ice creamUse Use light or fat freelight or fat free salad dressingssalad dressingsUse Use lean lean meatsmeatsUse Use low fat low fat cooking methods: bake, grill, broil, cooking methods: bake, grill, broil, steam, stew, poach, microwave, etc.steam, stew, poach, microwave, etc.Purchase Purchase reduced fat reduced fat crackers, snacks & dessertscrackers, snacks & dessertsReplace sugarReplace sugar--sweetened beverages with sweetened beverages with nonnon--caloric caloric ones (water, tea, coffee)ones (water, tea, coffee)Have sugary sweets only Have sugary sweets only occasionally occasionally (sm. portion)(sm. portion)Limit Limit portion sizesportion sizes

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We are fortunate that so many foods are now available in lower calorie versions so that we can cut calories without hardly noticing it. For more details, see the educational materials: “Light Substitutions”, “Grocery Purchase Guide” and “Tips for Dining Out”.

The average calorie distribution The average calorie distribution of the NWCR people was:of the NWCR people was:

19% protein19% protein56% carbohydrate56% carbohydrateonly 1% of NWCR people were on low carb dietsonly 1% of NWCR people were on low carb diets(<24% carb.); they maintained loss for shorter times(<24% carb.); they maintained loss for shorter times

24% fat24% fat1391 kcal. / day1391 kcal. / day

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This level of protein is typical of a normal balanced diet. The level of carbohydrate is that which is normally recommended, though people with diabetes may benefit from a slightly lover level (50% of calories). The fat level is moderate, but not extreme, so we can have enough of the “good” fats needed and feel satisfied. The average calorie level is enough for a well-balanced diet. Women may average a bit lower than this level, while men will average a bit more.

Risks From LowRisks From Low--Carb DietsCarb Diets

KidneyKidney stones or failure due to stones or failure due to ↑↑ proteinproteinOsteoporosisOsteoporosis from acid balance of from acid balance of ↑↑ proteinproteinCancerCancer due to due to ↑↑ animal, animal, ↓↓ plant dietplant dietDiverticulosisDiverticulosis due to due to ↓↓ fiberfiberGoutGout due to due to ↑↑ protein raising uric acid levelsprotein raising uric acid levelsHeart disease & Heart disease & ↑↑ BPBP, due to , due to ↑↑ sodium,sodium,↓↓

potassium, elevation of homocysteine,potassium, elevation of homocysteine,

↓↓

fiberfiber

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Though low-carb diets work well for weight loss, they have potential long-term health consequences. Most successful losers in the NWCR used a balanced pyramid-type of diet (not a low-carb diet).

More About FatsMore About Fats……

Aim to get ~25% of calories from fatAim to get ~25% of calories from fat(too little fat can cause gallstones & reduce (too little fat can cause gallstones & reduce absorption of vitamins A, D, E & K)absorption of vitamins A, D, E & K)

Go for the Go for the good fats: good fats: monomono-- & polyunsatur& polyunsatur--ated & omegaated & omega--33

Limit Limit saturated fats saturated fats to to << 1/3 of total fat1/3 of total fat

Look for Look for ““trans fat freetrans fat free”” margarines, margarines, crackers, baked goods, etc.crackers, baked goods, etc.

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“Good fats” are needed for nerve repair and for healthy skin. People who eat too little fat can also suffer from emotional problems, such as hostility, aggressive behavior & depression.

How Many Fat Grams DailyHow Many Fat Grams Daily Is 25% Fat?Is 25% Fat?

Your Calorie Level Your Calorie Level x 0.027x 0.027 ==Grams of Daily Fat for Grams of Daily Fat for 25% Fat25% Fat

For For 2000 Calories2000 Calories, that is , that is 54 grams54 grams of fat.of fat.

For For 1500 Calories1500 Calories, that is , that is 40 grams40 grams of fat.of fat.

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0.027 is derived from: calorie level x 0.25 divided by 9. (There are 9 calories in 1 gram of fat.)

Where Are the Where Are the ““Good FatsGood Fats””??

Liquid oils:Liquid oils: canola, olive, soybean, canola, olive, soybean, corn, sunflower, sesame, safflower, corn, sunflower, sesame, safflower, peanut, cottonseed peanut, cottonseed (in salad (in salad dressings, many baked goods, etc.)dressings, many baked goods, etc.)

Oils in fatty fish:Oils in fatty fish: salmon, mackerel, salmon, mackerel, catfish, lake & rainbow trout, sardines, catfish, lake & rainbow trout, sardines, albacore tunaalbacore tuna

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We should strive to have 2-3 servings of fatty fish each week for heart health & other benefits, such as reduced inflammation.

Where Are the Where Are the ““Bad FatsBad Fats””??

Butterfat in Dairy Products: Butterfat in Dairy Products: Choose Choose fat free or low fat dairy products to fat free or low fat dairy products to reduce calories & prevent clogged reduce calories & prevent clogged arteriesarteriesFatty Meats, Especially Red Meats:Fatty Meats, Especially Red Meats:Stick with lean meats & trim the fat or Stick with lean meats & trim the fat or remove skin. Choose cuts with the remove skin. Choose cuts with the least white marbling. least white marbling. (Avoid frying)(Avoid frying)

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Genetics vary relating to how our bodies metabolize fats, so each person must discover how much “bad fat’ his/her body tolerates without bad effects on blood lipids (cholesterol, LDL, TRG).

Keep aKeep a Food Diary. Food Diary.

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The NWCR found that people who keep food diaries do better with weight loss. We tend to think twice before eating something if we write it down. Also, it helps us to review the day & plan strategies for improvement.

Diary may include any items below to Diary may include any items below to focus on your problem areas:focus on your problem areas:

Foods eatenFoods eatenTimeTimePortion sizePortion sizeHow cooked How cooked (baked, fried, etc.)(baked, fried, etc.)CaloriesCalories

Your moodYour moodHunger levelHunger levelSituationSituationBody PositionBody Position

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See “My food Diary” (from the printer-friendly educational materials).

Use your Food Diary to discover Use your Food Diary to discover specific habits needing change.specific habits needing change.

TRIGGER MAPSTRIGGER MAPSare an effective tool you can are an effective tool you can

use to change behavior.use to change behavior.

ate brownie

co-worker broughtbrownies

skipped breakfast

TRIGGER MAPTRIGGER MAP

Go to bed & get up 15 min. earlier

Eat a healthy breakfast

Discuss with co-workers the idea of bringing light foods & only bringing food occasionally

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The back of the “Trigger Map” handout has blank ovals. Make copies of the back to do your own trigger maps. List the behavior you want to change in the bottom oval. Fill in the previous ovals with the steps that led up to the undesired behavior. Come up with ideas for preventing each of the steps that led up to the final behavior & record these ideas with the appropriate step. Be creative! Now you have an actual strategy to overcome this behavior; not just good intentions with no plan.

Participate in onParticipate in on--going going support throughsupport through

a support groupa support group&/or a counselor&/or a counselor

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People involved in a support group &/or receiving counseling show better success.

Benefits of Support GroupsBenefits of Support Groups

BondingBonding reduces feelings of loneliness reduces feelings of loneliness that can lead to eatingthat can lead to eatingGroup can Group can buildbuild many many skills skills togethertogetherGroup meets need for Group meets need for funfun better than better than food doesfood doesGroup can Group can exerciseexercise togethertogetherAccountabilityAccountability is an incentiveis an incentive

Seek Professional Counseling If:Seek Professional Counseling If:

You find you are unable to apply what You find you are unable to apply what you have learned, even after particiyou have learned, even after partici-- pating in a support group and using pating in a support group and using Trigger Maps.Trigger Maps.

Often there are Often there are underlying issues underlying issues that that need to be dealt with first before we need to be dealt with first before we can successfully overcome addictive can successfully overcome addictive problems.problems.

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Resources for Eating Disorders.

Resources for Eating DisordersResources for Eating Disorders

Academy for Eating DisordersAcademy for Eating Disorderswww.acadeatdis.orgwww.acadeatdis.orgAmerican Anorexia Bulimia Assn.American Anorexia Bulimia Assn.www.aabainc.orgwww.aabainc.orgNational Eating Disorders Assn.National Eating Disorders Assn.www.eatingdisorders.orgwww.eatingdisorders.orgOvereaters AnonymousOvereaters Anonymouswww.oa.orgwww.oa.org

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See “Resources for Eating Disorders”.

More tipsMore tips……

Stay well hydrated. To find Stay well hydrated. To find how much fluid you need daily:how much fluid you need daily:

For hot weather For hot weather ––Divide your weight by 11Divide your weight by 11

For cool weather For cool weather ––Divide your weight by 16Divide your weight by 16

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Often when we think we are hungry, we are actually thirsty. These fluids can include water, milk, <1 serving of fruit juice, tea, coffee, etc. Because many calories can come in beverages, be especially careful how many calories you drink.

HYDRATIONHYDRATION……

If you weigh 200 lbs.:If you weigh 200 lbs.:

For hot weather, this comes For hot weather, this comes to 18 cupsto 18 cups (200 / 11 = 18)(200 / 11 = 18)

For cool weather, this comes For cool weather, this comes To 12.5 cupsTo 12.5 cups (200 / 16 = 12.5)(200 / 16 = 12.5)

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18 cups is a gallon plus 2 cups. 12.5 cups is just over ¾ of a gallon.

Predictors of Predictors of LongLong--Term SuccessTerm Success

Maintenance of weight loss for over 2 Maintenance of weight loss for over 2 yearsyearsContinuing lowContinuing low--fat intakefat intakeExercising as a permanent lifestyleExercising as a permanent lifestyleContinuing healthy eating behaviors & Continuing healthy eating behaviors & restraint from overrestraint from over--eatingeating

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The National Weight Control Registry has also followed those who have regained weight to see how we can guard against that.

ItIt’’s not so hards not so hard……Lose properly & it stays off!Lose properly & it stays off!

Enjoy Enjoy healthy foodshealthy foodsReduce your Reduce your portionsportionsHave fun Have fun exercisingexercisingGet Get supportsupport or start your own groupor start your own groupWork on improving your Work on improving your habitshabits(1 at a time)(1 at a time)

DonDon’’t rusht rush……the turtle wins!the turtle wins!

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You can have a life and have fun while you move to a healthier weight. Starvation & suffering are not necessary.

MeanwhileMeanwhile…… Picture the Picture the ““New YouNew You””

As you start each new day, As you start each new day, pretend pretend you have already attained your goalyou have already attained your goal

Think of what you would need to do to Think of what you would need to do to take care of your new self take care of your new self (body, mind (body, mind & soul)& soul)

Begin to Begin to do these things do these things & & your goal your goal will become realitywill become reality!!

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Arriving at & holding a healthy weight works best with a healthy diet and an active lifestyle. Once this becomes your way of life, you will surely feel like a new person and enjoy life more.

The BallThe Ball’’ssIn Your CourtIn Your Court

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Weight Control Series Evaluation Questions

Weight loss 2

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