HOSPITAL SELAYANG

MDA Free Paper Non-Invasive Dietary Intervention for Biochemical

Improvement through Weight Management

L Mageswary Lapchmanan

Chong Sin Tzun

Teong Lee Fang

Harizah Mohd Yaccob

Hamidah Osman

Fathiyah Noor Osman

Ilman Hadree Idris

Khor Ban Hock

Nurul Asyikin Adnan

Department of Dietetics & Food Service, Selayang Hospital

Introduction

• Obesity is a complex, multi-factorial condition characterized by excess body fat. • Obesity is defined as BMI ≥ 27.5kgm-2 (CPG 2004). •The co-morbidities of obesity impose greater socio-economic burden and increase liability in human resource (Ismail MN, 2002). •Moderate weight loss (10%) has been shown to improve fasting plasma glucose, HbA1c, fasting serum lipid and blood pressure (CPG 2004). •For successful weight loss, we need strategies for calorie restriction, behavioral changes and increase energy expenditure (Edward PW et al. 2006).

4.4

14 15.1

0

5

10

15

20

1996 2006 2011

Pe

rce

nta

ge (

%)

National Health and Morbidity Survey (NHMS)

Obesity

8.3

14.9

31.2

0

10

20

30

40

1996 2006 2011

Pe

rce

nta

ge (

%)

National Health and Morbidity Survey (NHMS)

Diabetes Mellitus

20.7

32.2 32.73

0

10

20

30

40

1996 2006 2011

Pe

rce

nta

ge (

%)

National Health and Morbidity Survey (NHMS)

Hypertension

11.5

20.7

38.84

0

10

20

30

40

50

1996 2006 2011

Pe

rce

nta

ge (

%)

National Health and Morbidity Survey (NHMS)

Hypercholesterolemia

Background

Total Selayang Hospital number of staffs: 2985 Projections: 448 staffs are obese

Objective:

1. To reduce weight among Selayang Hospital Staffs.

2. To determine biochemical changes among participants in I am The Biggest Loser

program.

Methodology Criteria Details

Sampling

• On voluntarily basis, convenience sampling

• 51 subjects enrolled, 35 subjects completed and 16 subjects withdrew due transfer of duty to other places, Became pregnant, Poor commitment

Inclusion criteria

• BMI ≥27kgm-2

• Hospital Selayang staffs

Exclusion criteria

• Pregnancy

• Under commercial weight loss program or taking slimming product/supplementation

• DM on insulin, renal insufficiency

Methodology Criteria Details

Data Collection

• Social Demographic

• Anthropometric (Weight, Height, Fat Percentage) Baseline & Every 2 weeks

• Biochemical (FBS, FSL) Baseline & 3 months (Post Event)

• Food diary and physical activity level diary Submit every 2 weeks

• Questionnaire for compliance and feedback

Data Analysis

• SPSS Version 14

Duration

• 3 months

51 “Biggest Loser”

participants

16 people drop out

(31.4%)

35 “Biggest Loser”

participants (68.6%)

16/5/2012

8/8/2012

After 3 months

“I Give Up”

Methodology Strategies of Intervention

Mentoring System -Divided into 7 groups, each group is being mentored by a clinical dietitian -Follow up once every 2 weeks

Grand Meeting -Every month to conduct activity as a whole group

Motivation

Methodology Strategies of Intervention

Awareness of Obesity Complications

Energy Balance & Weight Reduction

Food Calorie Counting

Motivation

Education

Methodology Strategies of Intervention

Motivation

Education

Calorie Restriction

Meal Planning -Male; 1800 kcal/d, Female; 1500kcal/d

Meal Replacement Program (MRP) -Allow to add 50 kcal solid foods like oat & cereals

High Protein Diet -Male; 1800 kcal/d, Female; 1500kcal/d (Protein contribution: 15-20%) -1 meal (Lunch or Dinner) with only protein and fruits and vegetable -Replace 2 exchanges of carbohydrate (cereal) with 1 exchange protein every meal -Encourage vegetable intake

Flushing Diet -Calorie is provided around 800kcal/d -Replace all cereals with fruits and vegetables. -Encourage to drink a lot of water -Subjects are discouraged from performing strenuous exercise as precaution.

Sample Menu

Methodology Strategies of Intervention

Motivation

Education

Calorie Restriction

Exercise

Daily routine 30-45min/session, 3-5 times/week

Aerobic Exercise -On 1st and 6th Week of Intervention

10 000 Steps Running Competition -On 6th Week of Intervention

Methodology Strategies of Intervention

Motivation

Education

Calorie Restriction

Exercise

Maintenance

Food Calorie Counting

Weight Maintenance

Methodology Regular Menu: 4 days Menu +MRP: 3 days

Regular Menu: 2 days Menu +MRP: 5 days

Regular Menu: 2 days Menu +MRP: 3 days High Protein + MRP: 1 day Flushing Diet + MRP: 1 day

Regular Menu: 7 days

30-45min/session, 3-5 times/week Exercise

Education

Maintenance

10000 Steps & Education

•Awareness of Obesity Complications •Energy Balance & Weight Reduction Education

1st 2nd 3rd 4th

5th 6th 7th 8th

9th 10th 11th 12th

M

M Mentorship Grand Meeting

M

M

M

M

M

Result All

(n=35)

<5%

(n=13)

≥5%

(n=22) p value

Social:

Age 24-58

(35.63±8.22)

25-58

(35.38±9.63)

24-50

(35.77±7.51)

*0.895

Gender: **0.474

Male 6 3 3

Female 29 10 19

Anthropometric:

Pre-Weight (kg) 84.51±14.58 91.94±16.41 80.12±11.67 *0.018

Weight Change (kg) -5.91±4.05 -2.26±1.93 -8.05±3.38 *0.000

Pre-BMI (kgm-2) 34.09±4.35 36.27±4.31 32.79±3.91 *0.020

BMI Change (kgm-2) -2.39±1.50 -0.94±0.80 -3.24±1.11 *0.000

Fat Loss Change (%) -2.89±1.97 -1.32±1.63 -3.81±1.53 *0.000 *Independent Samples t-test Sig. (2 tailed) **Chi-Square Test

Result All

(n=35)

<5%

(n=13)

≥5%

(n=22) p value

Dietary:

Compliance

Breakfast with Big Loser Drinks (%) 74.3 76.9 72.7 **0.784

Breakfast without Big Loser Drinks (%) 37.1 30.8 40.9 **0.549

Lunch (%) 77.1 76.9 77.3 **0.981

Dinner (%) 60.0 46.2 68.2 **0.353

High Protein (%) 80.0 61.5 90.9 **0.097

Flushing Diet (%) 40.0 46.2 36.4 **0.830

Follow menu (day/week) 4.66±1.28 4.15±1.52 4.95±1.05 *0.074

No. Big Loser Drink (packet/week) 3.86±1.61 3.46±1.85 4.09±1.44 *0.271

Behavior:

Exercise; Light-moderate (min/week) 95.86±75.02 62.31±32.76 115.70±85.97 *0.014

Increase Walking Tendency: **0.100 Increase (%) 82.9 69.2 90.9 No change (%) 17.1 30.8 9.1 Food Selection & Read Food Labeling: **0.265 Yes (%) 88.6 76.9 86.4 No (%) 11.4 23.1 13.6

*Independent Samples t-test Sig. (2 tailed) **Chi-Square Test

Result

0

1

2

3

4

5

6

<5% ≥5% <5% ≥5% <5% ≥5% <5% ≥5% <5% ≥5%

FBS TC TG HDL -Chol LDL-Chol

5.54 4.84

5.57 5.76

1.61 1.33 1.14 1.33

3.68 3.82

4.97 4.62 4.9

4.9

1.29 1.18 1.16 1.25

3.18 3.12

mm

ol/

l

Weight Loss Group

Comparison of Biochemical Outcome Between Groups

Pre

Post

*Paired samples t-test Sig. (2 tailed) TC Total Cholesterol HDL-Chol High Density Lipoprotein Cholesterol FBS Fasting Blood Serum TG Triglyceride LDL-Chol Low Density Lipoprotein Cholesterol

Parameter All (n=35) <5% (n=13) ≥5% (n=22)

Pre Post * p value Pre Post * p value Pre Post * p value

FBS 5.10±0.66 4.75±0.51 0.003 5.54±0.77 4.97±0.56 0.027 4.84±0.43 4.62±0.45 0.061

TC 5.69±1.06 4.90±0.95 0.000 5.57±0.98 4.90±1.05 0.000 5.76±1.12 4.90±0.92 0.000

TG 1.44±0.48 1.22±0.35 0.005 1.61±0.35 1.29±0.35 0.046 1.34±0.52 1.18±0.41 0.055

HDL-Chol 1.26±0.22 1.21±0.19 0.057 1.14±0.10 1.16±0.11 0.504 1.33±0.25 1.25±0.21 0.018

LDL-Chol 3.78±0.94 3.13±0.88 0.000 3.68±1.04 3.16±0.99 0.000 3.82±0.91 3.12±0.84 0.000

*Paired samples t-test Sig. (2 tailed)

Result

*Paired samples t-test Sig. (2 tailed) TC Total Cholesterol HDL-Chol High Density Lipoprotein Cholesterol FBS Fasting Blood Serum TG Triglyceride LDL-Chol Low Density Lipoprotein Cholesterol

Gender

We

igh

t_c

BM

I_c

%F

at_

c

Exe

rcis

e

(Min

)

BM

I_1

FBS Total

Cholesterol Triglyceride HDL-C LDL_C

1 2 C 1 2 C 1 2 C 1 2 C 1 2 C

♀ -3.7 -1.5 -0.9 90 31.2 4.6 4.7 0.1 6.0 4.4 -1.6 1.9 0.9 -1.0 1.3 1.3 0.0 3.8 2.7 -1.1

♀ -0.9 -0.4 -0.4 30 31.7 5.0 5.6 0.6 4.1 3.6 -0.5 2.1 1.1 -1.0 1.1 1.1 0.0 2.0 2.0 0.0

♀ -3.1 -1.4 -1.9 90 32.4 6.2 4.7 -1.5 7.5 6.5 -1.0 1.7 1.4 -0.3 1.2 1.3 0.1 5.5 4.6 -0.9

♀ -0.9 -0.4 -0.4 30 35.2 4.2 4.3 0.1 6.6 6.9 0.3 1.3 1.3 0.0 1.1 1.3 0.2 4.9 5.0 0.1

♀ -3.7 -1.7 -1.7 75 36.2 5.7 4.3 -1.4 5.2 4.8 -0.4 1.2 1.5 0.3 1.3 1.2 -0.1 3.4 2.9 -0.5

♀ -4.2 -1.8 -5.1 50 41.2 7.1 5.6 -1.5 4.6 3.9 -0.7 1.3 1.6 0.3 1.2 1.2 0.0 2.8 2.0 -0.8

♀ -5.3 -2.1 -4.1 120 42.9 6.0 5.7 -0.3 4.5 3.7 -0.8 2.0 1.3 -0.7 1.1 1.1 0.0 2.5 2.0 -0.5

Biochemical Parameters in <5% Weight Loss Group

Discussion

A combination of physical activity, behavioral therapy and diet is more effective for weight loss compared with diet alone. (NHS, 2010) Overweight and obese individuals should be prescribed a volume of physical activity of five session of 45-60 minutes per week. (NHS, 2012) A diet using portion-controlled meal replacements yielded significantly greater initial weight loss and less regain after one year of maintenance. (AADE, 2008) Limitation: -Number of subjects -Quality & type of fat consumed -Need a more user-friendly tool for tracking diet intake

Conclusion Overall, weight loss with appropriate dietary regime (MECEM) is a non invasive intervention that can contribute to biochemical improvement for long term prevention and management of non-communicable disease. Proper and consistent follow up (Mentorship) will help individuals undergoing weight loss regime to continue with the momentum. Weight loss <5% in 3 months may also contribute to improvement of biochemical markers. Changes start from inside!! As a starter, encourage overweight individuals to increase tendency of walking, read food label and do at least 60minutes/week of light-moderate exercise. By doing blood test, it will provide additional reason of change to fuel the motivation level.

Reference

Clinical Practical Guidelines on Management of Obesity. 2004. Ministry of Health, Malaysia. Edward PW et al. 2006. Improvements in glucose tolerance and insulin action induced by increasing energy expenditure or decreasing energy intake: a randomized controlled trial. American Journal of Clinical Nutrition. 85(5):1033-1042 Ismail MN. 2002. The Nutrition and Health Transition in Malaysia. Public Health Nutrition. 5(1A):191-195. Institute for Public Health (IPH). 2008. The Third National Health and Morbidity Survey (NHMS III) 2006, Nutritional Status. Ministry of Health, Malaysia. Institute of Public Health (IPH). 2011. National Health and Morbidity Survey 2011. Ministry of Health, Malaysia. Institute for Public Health, Kuala Lumpur. 1996. National Health and Morbidity Survey 1996. Ministry of Health, Malaysia.

Acknowledgement

Thank you!