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Is obesity a disease? “Probably not, despite the AMA’s recent ruling” stated speaker Dr. Daniel Bessesen, University of Colorado School of Medicine who posed that question and shared his opinion. “If obesity is a disease, it should hurt your health and treating weight per se should make you better…” However, meta-analysis reveals the “obesity paradox,” that mortality is lowest with BMI 25-30 kg/m2 and mortality does not become significant until BMI is greater than 35 kg/m2. In fact, obesity appears to be ‘protective’ in patients with other serious medical conditions. And, how do we explain those with metabolically healthy obesity?
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Fast weight loss is better than slow weight loss:
New studies show that people respond better to large amounts of weight loss early in treatment. Weight loss is naturally reinforcing and patients are more likely to stick with their program if they are losing weight quickly. In other words, short term rewards always trump long term rewards. Studies show that patients regain weight at the same rate regardless of long it took to lose it.
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A calorie is not a calorie and a 3500 calorie deficit does not result in one pound lost:
A calorie deficit in one person will not result in the same amount of weight loss as in another person. And, as one loses weight, metabolism changes to compensate for this weight loss. NIDDK researcher Dr. Kevin Hall has developed a weight body simulator that helps the user better predict weight loss over time taking into account metabolic changes. It can be found on at http://bwsimulator.niddk.nih.gov and is also available as an app.
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Fitness is more important than fatness:
Some obese people have no risks for metabolic disease. This may be due to their level of fitness or ratio of muscle to fat. Sarcopenia is a greater mortality risk factor than is obesity.
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People seem have an easier time losing weight if they don’t have to make too many food decisions:
Portion controlled foods (PCF) take a lot out of day-to-day meal planning. Tried and true products such as Slim Fast still work great, but PCF can also be an apple and a sandwich, or a banana and a yogurt. However, liquid protein meals are less satisfying than meals that require chewing. Also, variety leads to increased food intake, and conversely less variety decreases intake.
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Nuts and artificial sweeteners, there is a place for both:
10-20% of the energy from nuts is not bio-accessible and very few of their calories are stored as fat. Both observational studies and randomized controlled trials indicate that substituting low-calorie sweeteners for regular-calorie versions can result in modest weight loss and does not trigger a craving for sweets.
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Does anyone succeed with weight maintenance? :
The statistics are staggeringly discouraging with 80-90% regaining their lost weight. Here is where lifestyle changes really come into play. For weight loss, calorie restriction is vital. For weight maintenance, diet and exercise are critical. Because metabolism decreases with weight loss, increased exercise is necessary and >250 minutes per week is recommended. Other proven methods include using portion controlled foods, keeping a food diary, and daily self-weighing and graphing of weight to watch weight trends over time. The same tools that help with weight loss help with weight maintenance.
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The bottom line…
Today’s RDNs have many more tools in their toolboxes that we should embrace to help our patients achieve a healthier lifestyle. Reimbursement for services is more readily available and the Academy has resources for their members to help navigate the path to reimbursement at www.eatrightpro.org/resources/getting-paid. However, with regard to weight loss and weight maintenance, it’s still all about eating less and moving more.
Submitted by: Leslie Coates, MS, RD, CDE, Certified Wellness Coach