Nutrition Ch 14

BMI 25-26.9

Diet, PA, and behavior modification = with comorbidities

BMI 27-29.9

Diet, PA, and behavior modification = with comorbidities

Pharmacotherapy = with comorbidities

BMI 30-34.5

Diet, PA, and behavior modification= Yes

Pharmacotherapy = Yes

BMI 35-39.9

Diet, PA, and behavior modification= Yes

Pharmacotherapy = Yes

Surgery = with comorbidities

BMI >=40

Diet, PA, and behavior modification= Yes

Pharmacotherapy = Yes

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}

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

FDA approved

Short term weight loss

Appetite suppressant

Side effects: increased blood pressure and heart rate, sleeplessness, nervousness

FDA approved

Short term weight loss

Appetite suppressant

Dizziness, headache, sleeplessness, nervousness

FDA approved 

short term weight loss

appetite suppressant 

Sleeplessness, nervousness

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

FDA approved

Long term weight loss if tolerated and effective

appetite suppressant

Side effects: headache, dizziness, fatigue, nausea, dry mouth, and constipation

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

Drink clear liquids that are sugar free, noncarbonated, and caffeine free.

Sip liquids; avoid using a straw to avoid swallowing air

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

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

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

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

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

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

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

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

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

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

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

A:

Bradycardia, hypotension, orthostatic hypotension

B:

Arrhythmias; palpitations; weakness

A:

Delayed gastric emptying, decreased motility, severe constipation

B: 

Bloating, constipation, flatulence; gastric dilation with rupture is a risk

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

A:

Osteopenia, osteoporosis, muscle wasting and weakness

B:

Dental erosion; muscular weakness

A:

Arrested growth and maturation

B:

Usually not affected

A:

Protein-calorie malnutrition; various micronutrient deficiencies

B:

Varies

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

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