Myths & Wt Mgmt 2014 FINAL - Exercise ETC1. Small changes yield big results 2. Ambitious goals are unlikely to be met 3. Slow weight loss is likely to be long‐term weight loss 4

(C) 2014 by Exercise ETC Inc. All rights reserved. 1

Myths, Motivation & Weight Management

20141990

Donna Kauchak, MS, CSCS

• Master’s Degrees in Exercise Physiology & Organic Chemistry

• Certified Strength & Conditioning Specialist

• Performance Enhancement Specialist (NASM)

• Personal Trainer in private practice in NYC

How to Get Your CE Certificates

• View the complete webinar • Make sure your printer is “on”• Log on to our website: www.exerciseetc.com• Click on “Administration” • Click on “Webinar on Demand Certificates”• Complete all required fields & click “submit”• Your CE certificate will appear on the screen; you

may either save or print your certificate; even if you do not have a working printer, make sure to complete this form

• Remember: The WebEx program records when you log on and off; logging off early or fast forwarding to the end of the meeting may result in denial of your CEs.


What Are People Talking About These Days?

1. What “Causes” Obesity

2. 10 Myths About Obesity

3. Extreme Weight Loss Methods

4. Diet to Control/Prevent Disease

5. New Motivational Techniques

6. Mindful Eating

1) What Causes Obesity?

• Obesity is a now defined as a chronic disease (American Medical Association, June, 2013)

• “People who are fat simply eat more than people who are lean.”

– The End of Overeating, 2009, David Kessler, MD

The always delicious “Krispy Kreme

Bacon Cheeseburger.”

Really.

What’s More Effective?Diet or Exercise?

• “People are not fat because they exercise too little. They are fat because they eat too much.”

– World Health Organization, 2012


Why Do We Overeat?

• We are hardwired to eat as much as we can

• We especially seek out salt, sugar, fat

• Traditionally, salt sugar & fat were hard to come by

• Welcome to the 21st Century!

2) 10 Obesity Myths(New England Journal of Medicine, February 2013)

1. Small changes yield big results

2. Ambitious goals are unlikely to be met

3. Slow weight loss is likely to be long‐term weight loss

4. The “stages of change model” effectively predicts outcomes

5. PE classes affect rates of childhood obesity

6. Breast fed babies are less obese than bottle fed babies

7. Eating breakfast protects against obesity

8. Eating more fruits & vegetables results in weight loss

9. Yo‐yo dieting is associated with higher mortality rates

10. Losing 3,500 calories will result in a weight loss of 1 pound

3) Extreme Weight Loss Plans:

• Fasting

• Bariatric Surgery

• Nutrient Restrictive Diets:

– Low fat diets

– Low carb diets

• Fecal Transplants

– (Yes, it’s exactly what you think it is.)


Meal Frequency Fact or Fiction?

• Limited evidence of improved body composition and increased meal frequency.

• However, the increased frequency improves appetite control and reduces overall calories consumed.

Intermittent Fasting

• Alternating days of fasting or fasting for extended periods of time during the day (14‐18hrs).

• Some promising research in rats but little on humans.

• Possible benefits includes:– Improved insulin response

– Fat oxidation improvements

– Increase glucose uptake into muscles

• Findings are interesting but further investigation is needed.

Is Fasting For Everyone?

• Research shows a correlation between hunger and severity in caloric deficit.

• There is a decrease in hunger during starvation or very low calorie diets (800kcal or less)


Should You Skip Breakfast?

• Children and adults who consumed breakfast meet daily micronutrient needs better.

• Skipping breakfast may impair cognitive function.

• An analysis of the National Weight Control Registry showed 78% eat breakfast everyday.

• Skipping breakfast decreases post‐meal insulin sensitivity and increases LDL.

• Protein synthesis rates are lowest after an overnight fast.

Fasting and Exercise

• Resistance training in a fasted state leads to suboptimal results.

• The following are associated with fasting before exercise:– Increase protein degradation

– Increase cortisol levels

– Reduced amino acid uptake

Bariatric Surgery• Most patients lose an average of 50% of Excess Body Weight with a weight regain of 15% over 14 years

• LAGB results in slower weight loss with weight loss continuing to occur 4 years post‐surgery


Laparoscopic Adjustable Gastric Banding (“Lap Band”)

• An adjustable band is placed around upper end of stomach creating a small pouch and narrow passage into the rest of the stomach.

• The small pouch results in a feeling of “fullness” with tiny portions

Criteria for Surgery

• A BMI of 40 or more (100 pounds overweight for men and 80 pounds for women)

• A BMI between 35 and 39.9 AND a serious health problem

• An understanding of the operation and lifestyle changes you will need to

make.

Exercise for the Bariatric Surgery Client

• Establish an Exercise Routine PRIOR to Surgery

• Special Population Guidelines Apply

• Work closely with doctor & dietitian

– The bariatric patient will be on lomg‐term dietary restrictions & supplements, often for life


What’s Old is New Again • 1990’s: Low fat diets

• 2000’s: Low fat diets

• Now: Low fat diets

• Tomorrow: Low carb diets?

• Sam Feltham:– Consumed a high fat, low carb diet of 5,000 calories per day with moderate exercise.

– Claims he lost weight & inches.

Understanding Ketosis• The body (especially the brain) needs glucose to live

• When the body is deprived of carbs it initially (48 hours) canibalizes muscle tissue for the glucogen stored there

• When the glucogen is gone, the body begins to break down fat to release the energy within the fat cells

• The breakdown of fat releases “ketones” which is what the body then uses for energy.

• An excess of ketones changes the body’s Ph balance, resulting in “ketoacidosis”

• In extreme cases, ketoacidosis can result in coma or liver failure

Fecal Transplants

• When obese mice received gut bacteria from lean people weight loss resulted.

• Worked optimally with a low fat diet.

• Lean mice who got gut bacteria from lean people stayed lean.


4) Diet & Disease Control/Prevention

Nutrition Misconception #1

• “Sea salt is better than table salt”

– 61% of CAD patients surveyed by AHA believed this

– Fact: Salt is salt, and sodium is sodium, be it sea salt, kosher salt or Morton’s

Nutrition Misconception #2“Alcohol is Good for the Heart”

• Drinking too much alcohol can: – Raise triglyceride level

– Increase blood pressure

– Contribute to obesity

– Increase the risk of diabetes

– Increase fall risk for seniors

– Increase stroke risk

• Moderation, defined: – an average of 1 – 2 drinks/ day for men and one drink/ day for women:

– One 12 oz. beer

– One 4 oz. glass of wine,

– 1 cocktail: 1.5 oz. pour

• The American Heart Association cautions people NOT to start drinking if they do not already drink alcohol.


What is Dyslipidemia?

• Hyperlipidemia

– Elevated triglyceride & cholesterol

• Hypertriglyceridemia

– Elevated triglycerides only

• Hypercholesterolemia

– Elevated cholesterol only

Controlling Cholesterol:Understanding Statin Drugs:

• Lipitor, Crestor, Luxor

• Reduces the amount of LDL (bad) cholesterol made by liver

• Reduces triglyceride level in blood

• Increases HDL (good) cholesterol

Statins:Possible Side Effects

• May cause muscle weakness, tenderness or pain, especially with exertion

• May affect liver function:

• May result in kidney failure: (rhabdomyolysis)

• May increase risk for Type II Diabetes

• May decrease size & number of mitochondria, decreasing or even negating exercise benefits


Does Oatmeal Help?

• Overwhelming evidence that oatmeal lowers cholesterol

• Soluble (“sticky”) fiber sticks to dietary cholesterol and prevents it from being absorbed

• In 1997 FDA allowed advertisers to promote oatmeal’s health claims

• 2005 study in “Journal of Clinical Nutrition” found that a diet high in oats and oat bran lowered cholesterol as much as cholesterol lowering drugs

Getting Oatmeal into the Diet• Aim for 5 – 10 grams of oatmeal (soluble fiber) per day

• Enjoy oatmeal or oat bran cereal for breakfast (1.5 cups of oatmeal = 3 grams soluble fiber)

• Add ground oatmeal to casseroles or soups, also mix with breadcrumbs

• ADA: For baking, replace 1/3 of the flour with oatmeal (quick or old fashioned)

Therapeutic Lifestyle Change Diet (TLC)

Sat fat < 7% of

Poly fat Up to 10%

Mono fat Up to 20%

Total fat 25%-35%

Carb 50% 60% (primarily complex)

Fiber 20-30 grams/day

Protein 15% (1 oz animal protein = 25 mg CH)

Cholesterol < 200 mg/day

Total Kcals Balance intake & expenditure to maintain desirable body weight


The Portfolio Diet

• Some studies have shown this diet to lower cholesterol as much as some statin drug therapies

• The diet focuses on daily inclusion of 4 specific types of foods:– Tofu instead of meat

– Sticky fiber on a daily basis: oats, barley, eggplant, okra, Metamucil (3 times per day)

– Plant‐sterol enriched margarine (“Benecol”) in lieu of butter or margarine

– Almonds and other tree‐nuts

Sodium & High Blood Pressure

• Traditional:– Limiting sodium intake lowers blood pressure

• 2013:– “There is no rationale that lowering sodium lowers blood pressure.”

– Institute of Medicine, for the Centers for Disease Control and Prevention

• And furthermore….– Limiting sodium increases triglyceride levels

– Insulin resistance increases

– Sympathetic nervous system activity increases

– Each of these factors can increase the risk of heart disease, including CHF

The DASH Diet“Dietary Approaches to Stop Hypertension”

• Promoted by National Heart, Lung & Blood Institute

– (An agency of the US Dept of Health & Human Services)

• Endorsed by the US Department of Agriculture:

– “An ideal eating plan for all Americans”

• Has been shown to lower blood pressure without having to lose weight

• Now also used to combat diabetes & pre‐diabetes

• Focuses on fruits & vegetables, low fat dairy, lots of fiber, minimal sweets & sugary drinks

• Considered to be highly sustainable for long duration lifestyle change.


DASH Diet Daily Composition

• Fat: 27%– Saturated: 6%

• Protein: 18%

• Carb: 55%

• Cholesterol: 150 mg

• Potassium: 4700 mg

• Sodium: 2300

• Calcium: 1250

• Magnesium: 500

• Fiber: 30 grams

5) New Motivational Techniques

• There is a growing societal acceptance of overweight, obese people

– Especially among young people

• There is growing consensus people are not motivated by “better health” or “disease prevention.”

– Too abstract, especially if they are not currently ill

– Results & benefits are too far in the future

– Exercise is perceived as “punishing”

• Focus on short‐term, immediate benefits instead

A New Model for Motivation

• OLD School

– Eat healthy & lose weight or you will die young from some horrible disease

• Example:

– You must work out for 60 minutes per day six days a week for the rest of your life & NEVER eat anything you enjoy ever again.

• NEW School

– Exercise and a healthy diet will make you feel better, reduce stress, give you more energy and a give you a better quality of life starting today!

• Example:

– Take a walk with your kids every day. You’ll enjoy the quality time & you will all benefit by feeling better,


Psychological & Other Factors that Influence Motivation

• Body image

• Body size

• Self esteem

• Comfort level with the trainer

• Eating disorders

• Age, gender &

other factors

2011: The first boomersturned 65!

Barriers to Adherence• Too little time

– Schedule appropriately

• Too little energy– Encourage proper rest, nutrition, hydration

– Do not have them over exert at first

• Too little money– Be upfront about fees & costes– Make your services affordable– “Training is not an expense, it is an investment.”

Should Your Client “Weigh In”?

• ABSOLUTELY!

• The scale can be a powerful motivational tool.

• Weighing in establishes a baseline for weight loss

• If your client is gaining weight after starting to exercise, schedule a conversation to review their eating habits.

“A woman on a scale is weighing her self-esteem.”


6) Mindful Eating

• People gain weight due to mindless eating:

– Eating while not paying attention or distracted

– Eating out of habit

– Eating out of boredom

– Too large portions

What’s Your Danger Time?

• Mid‐afternoon?

• Right after work?

• Immediately after exercise?

• While cooking dinner?

• While watching TV at night?

• Right before bed?

Portion Control:The average person eats 80% of what is on their plate,

regardless of plate size.

SOLUTION: Use smaller plates


TeachingIdeal Portion Sizes

Cheese

Fruit

Meat

PastaSandwich

How to Get Your CE Certificates

• View the complete webinar • Make sure your printer is “on”• Log on to our website: www.exerciseetc.com• Click on “Administration” • Click on “Webinar on Demand Certificates”• Complete all required fields & click “submit”• Your CE certificate will appear on the screen; you

may either save or print your certificate; even if you do not have a working printer, make sure to complete this form

• Remember: The WebEx program records when you log on and off; logging off early or fast forwarding to the end of the meeting may result in denial of your CEs.

Documents

Myths & Wt Mgmt 2014 FINAL - Exercise ETC1. Small changes yield big results 2. Ambitious goals are unlikely to be met 3. Slow weight loss is likely to be long‐term weight loss 4