Video
Pros and Cons of a Plant Based Diet, a Physician's PerspectiveWeight management challenges -
actual calorie intakes. When the video is played back to the participants, they are shocked at their overconsumption of food, which they were often completely unaware of. It is important to note that such individuals are not actively being dishonest.
The misreporting is a product of the quirks of human behaviour. Such non-biological factors likely play a strong role in determining whether diet adherence is sustainable. Failing to do so may result in arriving at erroneous conclusions about the cause of initial weight loss or subsequent weight regain.
Dietary adherence is key to long-term success. Joseph Matthews — PhD Student in Muscloskeletal Physiology at Nottingham Trent University, Sport and Exercise Nutritonist, and Lecturer in Sports Therapy at University College Birmingham. Joe holds a special interest in weight loss and weight gain in combat sport athletes.
The views and opinions expressed on this site are solely those of the original authors. They do not necessarily represent the views of BMJ and should not be used to replace medical advice.
Please see our full website terms and conditions. Encourage your clients to cook different healthy meals each day for one week. Challenge them to get creative each night with new types of food and displays that surprise their friends and family.
Then have them post their meals to social media with a hashtag like chefchallenge and pick a winner from the bunch based on predetermined criteria, like most vegetables or creative presentation.
To make a sugar detox fun and engaging, you can start by setting realistic goals and incentives that motivate everyone. For example, you could develop a plan to gradually reduce sugar over a certain period.
Instead of going cold turkey, they can start by limiting sugar intake to once per day. Then once every other day, and so on. Slowly and as it becomes more of a habit they will reduce their consumption over time, possibly eliminating it altogether!
You can also turn these reduction periods into mini challenges and reward people with sugar-free treats each time they successfully lower the amount of sugar they eat per day. In this challenge,competitors create recipes from only whole food sources such as fresh produce, meat, nuts, seeds, and beans for an entire month.
Once a week, you can set up a potluck where your members bring their original recipes and compete for the best-tasting meal. At the end of the month, award prizes to those who created the most delicious and healthiest meals! Encourage your audience to replace unhealthy snacks with healthy food for a month.
Every day, they can find a healthy snack that begins with the letter of the alphabet in chronological order. For example, on day one, they might choose an apple; on day two, berries; on day three, carrots; on day four, figs; and so on.
Those who successfully find a healthy snack for every letter of the alphabet win! During a mindful eating challenge, participants focus on eating in a way that promotes savoring the experience. Have your clients write down their experience in a mindful eating journal so they can track how often they avoided overeating and truly enjoyed their meals.
Increasing water intake can help your clients feel more energized and refreshed. Consider stocking up on branded water bottles with notches indicating how much water has been consumed.
Hand out these bottles to everyone who wants to compete and a sheet to monitor their progress. Each time their water level goes down to a certain measurement, they get to add another tally mark to their sheet. At the end of the challenge, you can compare who drank the most water daily.
Regular physical activity increases calorie burning, leading to fat loss and improved overall health. Exercise also helps build muscle, further boosting metabolism and leading to greater calorie expenditure.
In addition, cardio and strength training can reduce stress levels, which lowers cortisol levels and thus decreases fat storage in the body. Most of your membership knows how beneficial exercise is, but setting a stretch fitness goal can still be intimidating.
A fitness challenge can make losing weight through exercise more accessible and enjoyable. Ask your members to grab a hula hoop and see how long they can keep it spinning around their waist.
You can make this game even more challenging by offering different size hoops or double hula hoops at once!
Challenge your clients to go for a scenic walk or trek in nature and enjoy the great outdoors every weekend for a month. They can try different paths to keep things fresh, and up the ante by adding stretching or bodyweight exercises at specific distance intervals.
Whether they take a dip in a pool, the ocean, or a lake, challenge your community to work out in the water. The only consistent predictor of later weight loss is initial weight loss within the first three months of treatment; therefore, if the patient has not lost at least 5 percent of initial weight after three months at the full medication dose, it is recommended that the medication be discontinued for lack of efficacy and the patient reevaluated [2].
There is a need to identify more reliable predictors of response, such as behavioral and biological predictors, to improve treatment matching and efficacy. In addition, research to identify new or repurposed efficacious pharmacologic treatments including combination therapy with acceptable risks is warranted.
Lack of insurance coverage and public policy contribute to the low use of pharmacotherapy. A 1 percent reduction in and year-olds in the United States with obesity and overweight will reduce the number of adults with obesity by 52, in the future and increase lifetime quality-adjusted life years by 47, years by [3].
To achieve this target, emerging consensus indicates an urgent need for effective treatment options alongside community and prevention efforts. In , the Expert Committee on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity convened by the American Medical Association in collaboration with the Health Resources and Service Administration and the Centers for Disease Control and Prevention recommended a four-stage approach based on age, weight status, presence of comorbidities, and response to treatment [4].
The support of an allied health care provider, such as a dietitian, is also included in Stage 2 treatment. Stage 3 treatment, or the Weight Management Program, is delivered by a multidisciplinary team. As outlined above, intensive treatment at a multidisciplinary program is widely accepted as the best nonsurgical option for children with obesity [5].
However, such programs are resource-intensive and not universally available [6]. The findings of the USPSTF of the benefits of treatment when the intervention is of moderate to high intensity provides a strong and compelling reason for universal coverage for comprehensive, intensive behavioral treatment for obesity in children and adolescents.
Yet, poor reimbursement for childhood and adolescent obesity treatment continues to be a significant barrier to universal implementation of these treatments [7].
Advocacy around insurance reimbursement is an important gap that must be addressed before comprehensive behavioral treatment can become available to all. Policies and programs driven by multiple sectors and platforms will be integral to making any progress.
Multipronged efforts to educate the public, legislators, and health care providers on weight bias, policies, interventions, and research are necessary steps to improve reimbursement for long-term, sustainable interventions. In addition to difficulties with insurance coverage, additional costs such as those associated with travel, child care for siblings not engaged in treatment, and missed school and work days to attend frequent visits all present challenges to program participation [8,9,10].
New technologies that replace the need for face-to-face contact and yet still promote lifestyle changes may offer one approach to achieving the level of contact recommended by the USPSTF report while minimizing the burden of participation.
The use of web-based interventions, mobile apps, and text messaging has led to promising results in adult populations [11]. Although most studies report satisfaction among participants with technology-based program components, long-term significant decreases in BMI among pediatric populations were not achieved [12].
Increasing sophistication of new technologies that include artificial intelligence and passive monitoring of behaviors such as activity, caloric intake, mood, and so on to provide feedback and drive behavior change offer opportunities for further innovation.
Incorporating new technologies into treatment options may also present a chance to address disparities in outcomes, since adolescents who are minorities are as likely as or more likely than their peers to own smartphones [13].
However, creating an evidence base for the use of technology in pediatric obesity care faces the challenge of research funding cycles that move at a much slower pace than changes in the technology itself.
Solving this mismatch is an important step in helping to improve care for children with obesity. Although the prevalence of obesity overall has leveled off at approximately 35—40 percent of the US population, the subset of this population suffering from severe obesity has continued to increase see Figure 1 [14,15].
Obesity medicine, a rapidly growing specialty, represents a specialized set of knowledge and skills that focuses on nonsurgical management of patients with obesity. Figure 1 Prevalence of Growth of Severe Obesity SOURCE: Sturm, R.
Hattori, International Journal of Obesity, June ; 37 6 Reprinted with permission from Springer Nature. Very-low-calorie diet programs have been shown to be effective in achieving weight loss in severe obesity, but long-term compliance remains a challenge.
Metabolic and bariatric surgery has been considered the gold standard treatment for severe obesity and the most effective option, but there are concerns about long-term efficacy, with data demonstrating that more than 20 percent of patients experience weight regain with recurrence of comorbidities [16,17].
The addition of anti-obesity pharmacotherapy in patients with inadequate weight loss or weight regain after bariatric surgery appears to produce better efficacy. Current evidence suggests that starting medication at a weight plateau may be more effective than waiting for weight regain after bariatric surgery [18].
A concept crucial to understanding why failure rates are so high in the treatment of severe obesity is that homeostatic control of body weight by hypothalamic neurons may be damaged in diet-induced obesity [19]. In the disease of obesity, there is a disruption of this homeostasis because of impaired neurohormonal signaling.
In cases of severe obesity, it is critical to think of reasons beyond diet that may have affected this set point, such as current or prior medication usage that may have led to weight gain.
These medications include anti-psychotics, anti-depressants, anti-epileptics, insulins and insulin secretagogues, glucocorticoids, progestational hormones and implants, oral contraceptives, beta-blockers, and others [20].
Alternatives to these medicines should be considered and, if possible, changed to those that are weight neutral or to agents that can treat the underlying condition and cause weight loss at the same time.
Over-the-counter medicines and supplements should be reviewed for their potential to cause weight gain. Medication lists should be closely evaluated when patients reach plateaus or regain weight after bariatric surgery. A novel approach to the treatment of severe obesity is incorporating the use of technology.
In addition to fitness trackers, web-based programs for self-monitoring, and mobile apps, the use of technology via telemedicine and remote monitoring of patients is becoming more common. The use of Wi-Fi scales, blood pressure cuffs, and glucometers allows patient data to be transmitted to a health care provider.
A patient can receive feedback even when not attending an office visit, which may improve long-term adherence to their weight management plan.
Some centers use telemedicine to administer a weight management program and provide a more intensive behavioral intervention [20]. Another substantial barrier to providing effective care to patients with severe obesity is lack of insurance coverage. Although patient visits may be covered if comorbid conditions are present, medications often are not covered.
In , the Affordable Care Act extended coverage by private and public insurers for behavior modification for obesity and for bariatric surgery.
Approximately 50 percent of employers who provide health insurance opt in for anti-obesity medication coverage [21]. In a study published by Gomez and Stanford in , Medicare did not provide coverage of anti-obesity medicine, and eight out of 34 states examined provided some type of coverage. Coverage has expanded slightly since this publication [22].
Bariatric surgery is the most effective modality for weight loss and maintenance in patients with severe obesity, but for a number of reasons, including costs, limited access to care, and patient concerns about adverse events, use is limited to a small fraction of those who are eligible for the procedure.
Although recent studies have confirmed that bariatric surgical procedures can have beneficial effects for many obesity-related comorbid conditions, particularly type 2 diabetes, few studies have evaluated the long-term benefits and adverse effects of vertical sleeve gastrectomy, which is currently the most commonly performed bariatric surgical procedure.
There are also limited data on safety and efficacy in racial and ethnic minority populations. The overall goal of bariatric surgery is weight loss and comorbid disease remission or improvement for a patient with severe obesity, as defined by the BMI and related comorbid conditions.
Comorbid conditions, as well as functional impairments associated with moderate to severe obesity, are highly variable.
In addition, the weight loss response to standardized intervention, including lifestyle intervention and bariatric surgical procedures, is highly variable [23,24]. A personalized medicine approach would greatly improve the selection of patients from the standpoint of risk, as well as efficacy, if the factors involved in risks and the variable outcomes could be clearly identified.
Longer-term risks or complications are considerably more difficult to quantify because these bariatric surgical procedures are performed at experienced regional centers to maximize safety. When complications occur, however, the patients commonly seek care in their local medical environment.
The necessity for re-operations or revisions may or may not lead the patient to return to the original bariatric surgical center. Revisions may be performed on patients who have lost less than the desirable weight or experienced undesirable weight regain.
Conversion to a procedure associated with greater weight loss is one example of such revision. Revisions may also be done for complications. One such example is conversion of a patient who is undergoing sleeve gastrectomy to Roux-en-Y gastric bypass RYGB for the development of severe gastroesophageal reflux disease [27].
Reversals have been considerably less common, particularly after RYGB. Sleeve gastrectomy is not reversible. Laparoscopic adjustable gastric banding LAGB has been widely perceived as a reversible procedure [28], although this was not the case in the LABS consortium—at Year 7 of the study, 22 percent of LAGB had been removed [24].
Revisions may also be done for metabolic complications such as micronutrient deficiency secondary to diminished intake, vomiting, or malabsorption.
Problematic recurrent hypoglycemia, although rare, may also require reversal. Alcohol use disorder has been identified as a complication of gastric bypass [29].
The frequency and etiology of this phenomenon requires further definition. Weight Loss. As reported by LABS Consortium at Year 7, the weight loss after LAGB and RYGB was highly variable and not predictable by usual clinical characteristics before operation [24].
The institution or addition of lifestyle intervention as well as pharmacotherapy to patients desiring additional weight loss beyond that maintained by their bariatric surgical procedure is a viable intervention that requires further research.
Overall, more research is needed to determine how much weight loss is needed to accomplish a specific clinical outcome in a specific patient using a specific bariatric surgical intervention.
For example, gastric bypass has been documented to induce diabetes remission [30], although this effect is not uniform among all surgical candidates—to be able to predict such a response for an individual patient is the fundamental goal of precision medicine and the next clinical target to be embraced by the bariatric surgical community.
Policy Implications. The application of bariatric surgery to patients who meet criteria for such surgery remains as low as 2 percent or less per year in the United States [31]. More precise data are needed to identify the explanation s for this low application of bariatric surgery.
In addition, knowledge of the progress that has been made in achieving safe and efficacious outcomes in bariatric surgery is not widely known by the nonsurgical medical community.
America challrnges Herbal immunity supplements be a nation of overweight — and obese — consumers. Weiight than six managgement ten 63 percent American maagement are overweight 31 percent are overweight; 32 percent are obese. While Weight management challenges may Irresistible sweet treats more socially Manaement to be overweight, consumers realize it is a serious health issue that requires personal action. Consumers acknowledge they are primarily responsible for their own weight and are more holistic in their approaches to managing weight. More than eight in ten consumers 85 percent say they are solely responsible for their own weight. But in order to tip the scales in their favor to achieve weight loss goals and live healthier lifestyles, they must overcome any number of challenges.
In Aprilthe Weight management challenges on Sugar level monitor supplies Solutions of the National Academies of Sciences, Challegnes, and Medicine held a workshop Weihgt The Weight management challenges of Treating Obesity Wright Overweight managemeent the objective of exploring what is known about current obesity challennges Herbal immunity supplements in adults and children and the challenges mangement implementing them. Presenters Herbal immunity supplements currently available modalities, including behavioral, medical, and surgical approaches. Emerging treatment modalities, including mobile health, devices, and new pharmacologic approaches were also explored. This discussion paper highlights the challenges, remaining gaps, and promising opportunities in advancing obesity treatment. The authors discuss challenges facing children and adults with obesity, including access to treatment, risks involved with treatment, responsiveness to treatment, and the importance of multidisciplinary care teams. The authors discuss the need for policy changes to support people with obesity, connect the various sectors that affect treatment outcomes, and improve access to care; and the need for a shift in societal perception about risk factors that cause severe obesity.
und etwas ähnlich ist?
Ist Einverstanden, es ist das lustige Stück
ich beglückwünsche, Ihr Gedanke einfach ausgezeichnet
Nach meiner Meinung irren Sie sich. Schreiben Sie mir in PM, wir werden reden.