What is the protocol for Behavioral Treatment for Obesity?
- Weekly for 4-6 months then bi-weekly. 2.
Group sessions with 10-15 people. 3. 60-90 minute sessions. 4. Private measures of weight. 5. Pt. to provide brief report of goals/successes. 6 New weight mgt skill taught with each session. 7. Goal weight loss .5 to 1 kg/week, ultimate goal 10%
Describe the Look Ahead Structure for behavioral treatment of obesity.
3 group session plus 1 individual session for months 1-6. 2 group sessions plus 1 individual for months 7-12. Then for years 2-4 1 individual session /month + contact by phone or email and optional group sessions.
Describe Intensive Behavioral Therapy for obesity for Medicare and Medicaid Beneficiaries?
If competent they can receive 1 face to face session weekly for month 1. Then 1 face to face every other week for month 2-6. Then 1 face to face session a month for months 7-12 If they achieve 3kg weight loss in the first 6 months. If they do not meet the 3kg weight loss by month 6 they will be reassessed for readiness and new BMI after additional 6 months.
So this is 14 sessions in 6 months. Must have 3 kg weight loss in 6 months.
AHA/TOS weight loss guidelines are ?
- 3-5% weight loss to reduce risk of DM, TG, A1C, BG, CV risk
- Calorie deficit : Women 1200 to 1500 and men 1500 to 1800
- <800 must be medically supervised.
- 14 sessions in 6 months
What are the principle components of an effective high-intensity, on-site comprehensive lifestyle intervention?
- Prescription of a moderately reduced-calorie diet, 2. increased physical activity, 3. the use of behavioral strategies to facilitate adherence to diet and activity recommendations.
What is a reduced calorie diet /energy deficit?
1200 to 1500 for women and 1500-1800 for men.
Physical activity is prescribed as?
> 150 minutes or 30 minutes 5 days/week. Higher levels of PA are 200-300 minutes/week, recommended to maintain “lost” weight or minimize weight regain in the long term >1 year.
Behavior Therapy is described as?
regular self monitoring of food intake, PA, and weight. Also encouraged to maintain lost weight with addition of frequent (weekly or more) monitoring of body weight.
Comprehensive lifestyle intervention usually produce an average weight loss of ?
8 kg in 6 months.
Medicare/Medicaid 5 A framework?
Assess- assess behavioral risk
Advise- give clear, specific behavior advice
Agree-(collaborate and agree on treatment)
Assist- aid the pt. in achieving agreed upon goals.
Arrange- schedule a f/u in person/phone to assist and adjust.
What is ACT therapy (Acceptance and Commitment Therapy)
ACT develops psychological flexibility and is a form of behavioral therapy that combines mindfulness skills with the practice of self-acceptance. mindfulness-based behavioral therapy. ACT teaches mindfulness skills as an effective way to handle these private experiences.
ACT, the aim is to transform our relationship with our difficult thoughts and feelings, so that we no longer perceive them as “symptoms.” Instead, we learn to perceive them as harmless, even if uncomfortable, transient psychological events.
What are the principles of ACT therapy?
- Diffusion
- Acceptance
- Contact with the present moment
- The Observing Self
- Values
- Committed Action
The USPSTF recommends that children aged ? Or older should be screened for obesity?
- there is insufficient evidence for screening less than 6 years old
You can decrease risk of obesity after birth by?
Breast feeding and later introduction of solid foods
What are obese children at increased risk for?
Type II DM, Asthma, NAFLD, CVD risk and anesthesia risk
What is the age a child can start to use Orlistat?
12 years and older
Should you use skin folds and waist circumference measurements on children?
No
OSA can lead to what? In children. What is the % of OSA in obese Children?
Right Ventricular Hyperpertrophy and Pulmonary Hypertension.
Up to 20% of Obese children have OSA.
What are the three goals of weight management?
- prevent further weight gain
- Producing weight loss, food restriction and PA.
- Maintaining weight loss, re-achieve energy balance…people try to just keep restricting food but substantial increases in PA are most likely needed.
Stages of obesity/ AACE/ACE approach to the diagnosis and evaluation of patients with obesity
BMI =/<25 : normal healthy weight
Stage 0: Overweight with a BMI >25-29.9 or Obese BMI >30
Stage 1: Obesity (BMI >/= 25 but one or more complications mild to moderate in severity and that can be treated effectively with moderate degree of weight loss
Stage 2: Obesity (BMI >/= 25 but at least one complication that is severe and may need more aggressive weight loss therapy to be effective.
In the AACE/ACE position for approach to diagnosis, eval and treat pt’s with obesity what is the Prevention strategies?
- If you are normal weight, eating healthy, health education, PA and Sleep hygiene
- If you are in Stage 0: Intensive lifestyle behavioral therapy, sleep hygiene and “maybe medications”
- If you are Stage 1 or 2: Intensive lifestyle behavioral therapy, sleep hygiene, weight loss meds, ? Bariatric surgery and may need therapy specific for complications.
Prevention and treatment of childhood obesity Stages are?
- Stage 1: Prevention and PCP office
- Stage 2: Structured weight management program.
- Stage 3: Multiplidiciplinary team and weight management center
- Stage 4: Tertiary care.
Prevention and treatment of childhood obesity?
- Calculate and plot the BMI (every visit)
- Assess, medical eval, growth history, family history
- Behavior risk: sedentary, eating behaviors, PA level etc
- Attitude: family support, motivation
- Prevention:
BMI < 85th percentile then identify outstanding issues and review
BMI >85th percentile then move to the stages of prevention.
Stage 1 Prevention and treatment of obesity in children?
- Limit sugar beverages
- > 5 fruits and veggies /day. AGE 2-16 gets 2 cups, A 17 -18 4 cups /day
- Limit TV
- Breakfast daily
- Limit restaurants and eating out
- Limit portions
- Family meals 5-6 x/week
- ALLOW children to regulate meal size.
