Lower range of overweight BMI 25-26.9 Diet, PA, and behavior modification = with comorbidities Upper range of over weight BMI 27-29.9 Diet, PA, and behavior modification = with comorbidities Pharmacotherapy = with comorbidities Obesity class 1 BMI 30-34.5 Diet, PA, and behavior modification= Yes Pharmacotherapy = Yes Obesity class 2 BMI 35-39.9 Diet, PA, and behavior modification= Yes Pharmacotherapy = Yes Surgery = with comorbidities Obesity class 3 BMI >=40 Diet, PA, and behavior modification= Yes Pharmacotherapy = Yes 10 Tips to a great plate 1) Balance calories: be physically active 2) Enjoy your food but eat less: don't eat too fast 3) Use a smaller plate, bowl, and glass: choosing smaller options 4) foods to eat more often: vegetables, fruits, whole grains, and fat-free or 1% milk and dairy products 5) make half you plate fruits and vegetables: choose red, orange, and dark green vegetables 6) switch to fat-free or low-fat (1%) milk 7) to eat more whole grains, substitute a whole-grain for refined products 8) Foods to eat less often: cut back on foods high in solid fats, added sugars, and salt 9) compare sodium in foods: choose lower versions of foods. "low sodium", "reduced sodium", or "no salt added". 10) drink water instead of sugary drinks: a good way to cut calories Behavior modification ideas Think thin: Why you want to lose weight; set long term goals; avoid crash diets for certain occasions; give yourself nonfood rewards; learn to distinguish hunger for cravings Plan ahead: Only keep food in kitchen and not scattered around the house; stay out of kitchen unless cooking or cleaning; avoid tasting while cooking; low calorie foods in front in fridge and high calorie towards back; remove temptation; plan meals, snacks, and groceries Eat wisely: Never skip meals; wait 10 before eating if you have urge; eat before starving and stop when satisfied; serve food from stove to the plate to avoid large portion sizes; eat the low calorie foods first; drink water with meals; use a small plate; chew thoroughly and eat slowly; eat before attending a social function Shop smart: Never shop when hungry; shop from a list; buy foods in quantity that you need; stock up on fruits and vegetables Change your lifestyle: keep busy with hobbies or projects; brush teeth immediately after eating; trim recipes; keep food and activity and hunger records; give yourself permission for planned indulgences; exercise; get more sleep Phentermine FDA approved Short term weight loss Appetite suppressant Side effects: increased blood pressure and heart rate, sleeplessness, nervousness Diethylpropion FDA approved Short term weight loss Appetite suppressant Dizziness, headache, sleeplessness, nervousness Phendimetrazine FDA approved  short term weight loss appetite suppressant  Sleeplessness, nervousness Orlistat FDA approved Longer term weight loss (children 12 years and older can use) Lipase inhibitor Side effects: gastrointestinal issues (cramping, diarrhea, oily spotting), rare cases of severe liver injury reported Lorcaserin FDA approved Long term weight loss if tolerated and effective appetite suppressant Side effects: headache, dizziness, fatigue, nausea, dry mouth, and constipation Osymia FDA approved Long term weight loss appetite suppressant; seizure treatment Side effects: like SE for phentermine plus numbness of skin, change in taste, birth defects, suicidal thoughts Bariatric Diet recommendations 1-2 days after surgery Drink clear liquids that are sugar free, noncarbonated, and caffeine free. Sip liquids; avoid using a straw to avoid swallowing air Bariatric Diet recommendations 3-7 days after surgery Ingest a minimun of 48-64 oz/day of total fluids with 24-32 oz of clear liquids plus 24-32 oz of full liquids. Clear liquids should be sugar free or artificially sweetened and include salty fluids. Use full liquids with <= 15 g sugar per serving Examples:  Lactaid milk or soy milk with added soy or whey powder Plain or blended yogurt Greek yogurt Blended soup Bariatric Diet recommendations 2-3 weeks Increase clear liquids; total fluid intake/day should be 48-64 oz Replace full liquids with soft, moist, diced, ground, or pureed protein foods as tolerated, such as scrambled eggs; ground meats, poultry, or fish with gravvy, broth, or light mayonnaise (to moisten); bean soups; cottage cheese; low-fat cheese; yogurt; sugar-free liquid protein supplements (eg sugar-free instant breakfast) or milk fortified with sugar-free whey (protein powder may be used in place of a meal). Consume protein at the beginning of each of 4-6 meals/snacks per day with limited portion sizes Chew food thoroughly Avoid fluids with meals and until at least 30 minutes after eating Use small plates and utensils to help control portion sizes Bariatric Diet recommendations 4 weeks after surgery Add well cooked, soft vegetables and soft and/or peeled or canned fruit, such as Whipped winter squash Soft cooked carrots Banana Water-packed canned peaches Adequate hydration is vital during rapid weight loss phase Bariatric Diet recommendations 5 weeks after surgery Continue to eat protein with some fruit or vegetable at each meal Consider consuming salads at 1 month postoperatively if tolerated Avoid rice, bread, and pasta until the 60 g of protein plus fruits and vegetables can be consumed comfortably daily Bariatric Diet recommendations As hunger increases and tolerance improves Remember that a healthy solid food diet consists of adequate protein, fruits, vegetables, and whole grains Keep in mind that calorie needs are individualized according to height, weight, and age Avoid raw fruits and vegetables that are highly fibrous, such as celery, corn, tomatoes, and oranges; they may be eaten if well cooked or pureed Consume 3 meals and 2 snacks per day of limited portion size Continue with 48-64 oz of clear liquids that are noncarbonated, calorie free, and caffeine free Chew foods thoroughly Avoid liquids for at least 30 minutes before and after eating Comparison of Anorexia and Bulimia Nervosa Major characteristics A: Complusive pursuit of thinness Intense fear of becoming fat; intense preoccupation with food Self-worth based on size and shape B: Lack of sense of control regarding eating Fear of being overweight Comparison of Anorexia and Bulimia Nervosa Onset and population A: Usually develops during adolescence or young adulthood; 90%-95% are female B: Usually develops during adolescence or young adulthood; is more likely to occur in men than anorexia Comparison of Anorexia and Bulimia Nervosa Typical eating and exercise behaviors A: Semistarvation with compulsive exercise; onset of disorder is usually preceded by dieting behavior B:  Gorging (1200-11,500 calories in a short amount of time) followed by purging, such as self-induced vomiting, excessive exercise, abuse of laxatives, emetics, diuretics, or fasting; "dieting" is a way of life but bingeing may occur several times per day and may be planned Comparison of Anorexia and Bulimia Nervosa Weight A: Less than 85% of expected weight, which is a BMI of 17.5 or less for adults B: Flunctuations are normal; weight may be normal or slightly above normal Comparison of Anorexia and Bulimia Nervosa Emotional Symptoms A: Vicarious enjoyment of food; denial of the condition can be extreme; body image disturbance; pronounced emotional changes; low self-esteem B: Displays mood swings; full recognition of the behavior as abnormal; ongoing feelings of isolation, self-deprecating thoughts, depression, and low self-esteem Comparison of Anorexia and Bulimia Nervosa Physical symptoms A: Lanugo hair on the face and trunk; brittle listless hair; dry skin, brittle nails, intolerance of cold B: May appear normal Swollen salivary glands in cheeks Sores, scars, or calluses on knuckles or hands Comparison of Anorexia and Bulimia Nervosa Cardiovascular effects A: Bradycardia, hypotension, orthostatic hypotension B: Arrhythmias; palpitations; weakness Comparison of Anorexia and Bulimia Nervosa GI effects A: Delayed gastric emptying, decreased motility, severe constipation B:  Bloating, constipation, flatulence; gastric dilation with rupture is a risk Comparison of Anorexia and Bulimia Nervosa Endocrine/metabolic imbalances A: Cold sensitivity; fatigue; hypercholesterolemia, hypoglycemia; amernorrhea or menstrual irregularities B: Menstrual irregularities, dehydration, and electrolyte imbalances may occur secondary to vomiting and laxative abuse; rebound fluid retention with edema Comparison of Anorexia and Bulimia Nervosa Musculoskeletal A: Osteopenia, osteoporosis, muscle wasting and weakness B: Dental erosion; muscular weakness Comparison of Anorexia and Bulimia Nervosa Growth status A: Arrested growth and maturation B: Usually not affected Comparison of Anorexia and Bulimia Nervosa Nutrient deficiencies A: Protein-calorie malnutrition; various micronutrient deficiencies B: Varies Nutrition therapy for anorexia nervosa Gassy foods: Cruciferous vegetables (broccoli, cauliflower, cabbage), dried peas and beans, dried prunes and raisins, carbonated beverages, garlic, onions, melon, and products containing sorbitol Limit fatty or fried foods Avoid caffeine because it is a stimulant and mild diuretic _________________ Help control symptoms of constipation and fluid retention with a high-fiber or low-sodium diet Nutrition therapy for bulimia nervosa A high-protein and/or high-fiber snack slightly before the times of the day when the binge is more likely to occur may help promote satiety and keep blood glucose levels within normal range