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Live Healthy!

Weight Management, Nutrition Counseling, and Physical Activity: How Wellness Fits Into the Puzzle

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Learning Objectives

• Identify three changes you can implement to improve students’ nutrition- and exercise-related behaviors

• List three staff members to recruit for collaboration

• Describe results from various research studies on nutrition, exercise, and health behavior change

• Describe components of the Behavioral Ecological Model

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What’s Coming?

• Healthy Eating and Active Lifestyles• Policy changes• Live Healthy! campaign• Guidance for each staff member on center• Curriculum to educate students• Guidance to change the center’s culture• Webinars• Launch, competitions, quarterly campaigns

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It takes a “village” to promote student health.

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The Triumvirate• Three powerful

individuals, each a triumvir

• The core: health and wellness, recreation, and food service

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Who Else?

• Social Development• Instructors• CD/Administration• Finance• SGA• Community

Connections• Others

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But…

…Today, it’s not about them.

“[Insert higher power of choice] grant me the serenity to accept the things I cannot change; courage to

change the things I can; and wisdom to know the difference.”

-Reinhold Niebuhr

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Today, we are talking about how you can help students be the best they can be.(Whether you are a nurse, psychologist, social worker, substance abuse provider, physician, or counselor)

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…And We Are Moving

Those who sit most of the day have larger waists than those who sit less.

Jogging does not offset an otherwise sedentary lifestyle.

Lack of muscle contraction for long periods of time may short-circuit unhealthy molecular signals causing metabolic diseases.

Source: Judson O. (2010). Stand up while you read this! The New York Times. Retrieved online from http://opinionator.blogs.nytimes.com/2010/02/23/stand-up-while-you-read-this/. Hamilton, M.T., Hamilton, D.G., & Zderic, T.W. (2007). Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes. 56(11), 2655-2667.

Chronic sitting results in tight hamstrings, flat back, kyphosis, and weakened iliopsoas muscles.

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What Does Underwear Have to Do With It?

• NEAT - Nonexercise Activity Thermogenesis – physical activity other than volitional exercise (ADL, fidgeting…)

• Interindividual differences

• Lean individuals have higher NEAT and increase NEAT if overeat

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From: Hamilton, M.T., Hamilton, D.G., & Zderic, T.W. (2007). Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes. 56(11), 2655-2667.

Nonexercise Activity Thermogenesis (NEAT) and Exercise Comparison

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Game Break!

True or False?Educating students 1:1 about making healthy choices is more effective than changing cafeteria policies to promote healthy choices.

False

Interventions that target the culture and policy are more effective than

interventions that try to change individual behaviors.

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Behavioral Ecological Model

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ASSESS, COUNSEL, ADVOCATELive Healthy!

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Assessment

• BMI – ratio of weight to height

• Waist circumference

• Intake form– Food journaling– Exercise journaling

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Discuss Food Journals

• What made it easier to eat well?

• What made it more challenging?

• How might you use this information on center?

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Game Break!

True or False?

A healthy BMI range is different for different ethnic groups.

TRUE

People of Asian decent experience obesity-related diseases at a lower BMI than those of European heritage. An optimum BMI for

those of African decent is under debate.

Source: Rakugi, H. & Ogihara, T. (2005). The metabolic syndrome in the Asian population. Current Hypertensive Reports. 7(2), 103-109.Van Houten, B. (2004). Optimal BMI for black women undertermined. OB/GYN News. Retrieved online from: http://findarticles.com/p/articles/mi_m0CYD/is_20_39/ai_n6346067/.

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ASSESS, COUNSEL, ADVOCATE Live Healthy!

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Game Break!

True or False?

Health care providers should deliver a directive message to their overweight patients to help them lose weight.

FALSE

A directive style often backfires.

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FRAMING MESSAGES

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AOL SEARCH—SIGNS OF OBESITY

“Due to the sensitive topic and the team not wanting to hurt anyone's feelings, no pictures were taken to show signs of obesity...”

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Why Motivational Interviewing Style?

• Respectful

• Accepting

• Encouraging

• Mobilizing

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“Just because students know how to eat healthy, does not mean they will. Food preference is linked to

culture, feelings, and although teaching nutrition is important,

changing behavior and attitudes is often more important.”

Nutrition Education, Food and Nutrition, Job Corps Community Website, 2010

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Communication Styles

• Aggressive — “I’m superior and right.”

• Passive — “I’m weak or ‘shaky.’”

• Assertive — “Although you and I have our differences, you are equally right to express yourself.”

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The Art of Nondefensive Communication

• Eliminates defensiveness

• Liberates honesty

• Builds integrity

• Inspires compassion

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The Art of Nondefensive Communication

• Drops defenses and opens up

• Direct feedback without being judgmental

• Express our own beliefs without being adversarial

• Set firm boundaries that create expectations

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Nondefensive Questions

• Function is to gather information• No need to control how the student answers• Your demeanor is sincere, calm, relaxed• Asked in a neutral tone• Nonopinionated • Effect is disarming• Leaves student accountable for the response

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Nondefensive Statement Format

• Overt message: reporting what you hear

• Covert message: reporting what you see

• Interpreting cause or motive

• Your own reaction to the student

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Preparation for Nondefensive Statements

• Acknowledge viewpoints don’t apply to all

• Don’t try to convince everyone to agree

• Recognize value of student’s experience

• Prepare open statements

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Nondefensive Predictions

• How we will respond to the student’s choice?

• Neutral in voice and body language

• Creates security for the student and yourself

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Effective Predictions

• The consequences are as small as possible

• The student has max. opportunity for control

• The consequences are self-contained

• No foreseeable ramifications we can’t tolerate

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Rolling with Resistance

“My whole family is overweight. I’ll never be thin.”

“I really like good food. More meat, please!”

“You’re crazy if you think I’m

getting off this couch.”

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Game Break!

True or False?

Genetics plays a large role in a person’s metabolism (i.e., how many calories a person burns in a day at rest).

FALSE

Our genetics affect our weight, but they do not usually affect our

metabolism.

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Genes and Weight• FTO (~55% carry A allele),

leptin (mutation prevalence unknown) and MC4R (~6% mutation) are important genes• Increase the attractiveness of

highly-palatable foods• Loss of control (LOC) of eating• Never feel full

Sources: Cecil, J.E., Tavendale ,R., Watt, P., Hetherington, M.M., Palmer, C.N. (2008). An obesity-associated FTO gene variant and increased energy intake in children. New England Journal of Medicine. 359(24), 2558-2566.den Hoed M, et al.(2009). Postprandial responses in hunger and satiety are associated with the rs9939609 single nucleotide polymorphism in FTO. American Journal of Clinical Nutrition. 90(5),1426-32.Farooqi IS, Keogh JM, Yeo GS, Lank EJ, Cheetham T, O’Rahilly S. Clinical spectrum of obesity and mutations in the melanocortin 4 receptor gene. New England Journal of Medicine. 2003;348:1085-95.Tanofsky-Kraff, M., Han, J.C., Anandalingam, K., Shomaker, L.B., Columbo, K.M., Wolkoff, L.E., Kozlosky, M., Elliott, C., Ranzenhofer, L.M., Roza, C.A., Yanovski, S.Z., Yanovski, J.A. (2009). The FTO gene rs9939609 obesity-risk allele and loss of control over eating . American Journal of Clinical Nutrition. 90(6), 1483-8.

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Why Are We Talking About This?

• Be ready to help change the thinking “I can’t lose weight because I have a slow metabolism”

• A lot of people are normal weight regardless of FTO, MC4R, leptin or any of the other 400+ genes that control obesity

• Help students learn their triggers

I’m built just like my mom.

Overeating as an Addiction

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Game Break!

True or False?

The same parts of the brain are responsible for both food and cocaine addiction.

TRUE

Functional neuroimaging studies revealed that good smelling, looking, tasting, and

reinforcing food has characteristics similar to that of drugs of abuse.

Source: Liu, Y. et al. (2010). Food addiction and obesity: evidence from bench to bedside. Journal of Psychoactive Drugs. 42(2); 133-145.

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How It Works

• Craving, wanting, and liking occur after early and repeated exposures

• Decreased sensitivity in dopamine reward system/D2 receptor density

• MRI studies ID changes in the hippocamupus, insula, and caudate

Sources:Liu, Y. et al. (2010). Food addiction and obesity: evidence from bench to bedside. Journal of Psychoactive Drugs. 42(2); 133-145.Pelchat. (2009). Food addiction in humans. Journal of Nutrition. 139, 620-622.

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Specifically Sugar

• Sugar-rich foods release euphoric endorphins and dopamine w/in nucleus accumbens as do narcotics

• Craving, tolerance, withdrawal, and sensitization seen in both

• Large number of AODA-dependent people, and the children of alcoholic fathers, have a sweet preference

• Common genetic markers

Source: Fortuna,, J.L. (2010). Sweet preference, sugar addiction and the familial history of alcohol dependence: shared neural pathways and genes. Journal of Psychoactive Drugs. 42(2), 147-151.

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TEAP Specialist/Team Role

• Work with students who are struggling with both addictions/cravings

• Be cognizant of replacing one addiction with another

• Another good reason to work closely with recreation

The Mind and the Body

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BED DSM-V Proposed Diagnostic Criteria

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that

is definitely larger than most people would eat in a similar period of time under similar circumstances

2. Sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating

B. The binge-eating episodes are associated with three (or more) of the following:1. Eating much more rapidly than normal2. Eating until feeling uncomfortably full3. Eating large amounts of food when not feeling physically hungry4. Eating alone because of being embarrassed by how much one is eating5. Feeling disgusted with oneself, depressed, or very guilty after overeating

C. Marked distress regarding binge eating is presentD. The binge eating occurs, on average, at least once a week for three monthsE. The binge eating is not associated with the recurrent use of inappropriate

compensatorySource: American Psychiatric Association. (2010). Binge Eating Disorder. Retrieved online September 17, 2010 from http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=372.

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Prevalence of BED

National Institute of Diabetes and Digestive Kidney Diseases: Weight-Control Information Network. (2010). Binge Eating Disorder. Retrieved online September 17, 2010 from http://www.win.niddk.nih.gov/publications/binge.htm.

2% of the general population

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Prevalence of BED

National Institute of Diabetes and Digestive Kidney Diseases: Weight-Control Information Network. (2010). Binge Eating Disorder. Retrieved online September 17, 2010 from http://www.win.niddk.nih.gov/publications/binge.htm.

10-15% of the mildly overweight people

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Prevalence of BED

National Institute of Diabetes and Digestive Kidney Diseases: Weight-Control Information Network. (2010). Binge Eating Disorder. Retrieved online September 17, 2010 from http://www.win.niddk.nih.gov/publications/binge.htm.

Prevalence is “much higher” in morbidly obese people.

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Disordered Eating

75% of women between ages 25-45 eat, think, and behave abnormally around food some of the time.

Source: University of North Carolina at Chapel Hill, news release, April 22, 2008

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Obesity and Depression

• What came first?– Obesity causes depression?– Depression causes obesity?

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Obesity Causes Depression

• Mechanism 1 – Body image and lack of

exercise lead to depressive symptoms

• Mechanism 2– Hormones produced by

fat cells cause depression

Source:Emersson, A., et al. (2010). An obesity provoking behaviour negatively influences young normal weight subjects' health related quality of life and causes depressive symptoms. Eating Behavior. 11(4), 247-252.Taylor, V.H. & MacQueen, G.M. (2010). The role of adipokines in understanding the associations between obesity and depression. Jounal of Obesity.. 2010, (1-6).

Ugh… I wish I hadn’t signed up for this

stupid research study.

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Depression Causes Obesity

• Emotional eating in overweight populations– High negative affect

(worry more about their bodies)

– Low negative affect– No effect in normal

weight people

Source: Jansen, A., Vanreyten, A., van Balvern, T., Roefs, A., Nederkoorn, C., & Havermans, R. (2008). Negative affect and cue-induced overeating in non-eating disordered obesity. Appetite. 51(3); 556-562.

Someone who feels bad about their body is more likely to overeat when sad than someone who feels okay

about the way they look.

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Risk and Protective Factors

Protective Factors• Body satisfaction• Servings of fruits and

vegetables• Eating breakfast• Regular moderate to vigorous

physical activity• Milk intake (boys only) • Family meals eaten together

Risk Factors• Weight concern• Teasing/pressure (peer and

parental)• Poor body image• Use of unhealthy weight

control methods• Peer dieting• Overweight friends and family

members• Sugar-sweetened/diet

beverage consumptionSources: Haines, J., Kleinman, K.P., Rifas-Shiman, S.L., Field, A.E, & Austin, S.B. (2010). Examination of shared risk and protective factors for overweight and disordered eating among adolescents. Archives of Pediatric and Adolescent Medicine. 164(4), 336-343.Haines, J. Neumark-Sztainer, D., Wall, M., & Story, M. (2007). Personal, behavioral, and environmental risk and protective factors for adolescent overweight. Obesity. 15(11), 2007.

Strategy 1: Exercise

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National Weight Control Registry (NWCR)

• There is variety in how NWCR members keep the weight off. Most report continuing to maintain a low calorie, low fat diet and doing high levels of activity. – 78% eat breakfast every day. – 75% weigh themselves at least once a week. – 62% watch less than 10 hours of TV per week. – 90% exercise, on average, about 1 hour per day.

Source: National Weight Control Registry (2010). Retrieved online: http://www.nwcr.ws/Research/default.htm

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How Exercise Really Works

• Strongest predictor of sustaining weight loss

• Doesn’t really burn that many calories

• Weight reduction due to improvements in psychological factors—mood, self-efficacy, self-concept

• Study=significant weight loss in exercise intervention, but only 19% could be directly attributed to kcal expenditure

• Direct correlation between weight loss and mood score

Sources: Aneesi, J.J. (2008). Relations of mood with body mass index changes in severely obese women enrolled in a supported physical activity treatment. 1(2)88-92.Annesi, J.J., Gorjala, S. (2010). Changes in theory-based psychological factors predict weight loss in women with class III obesity initiating supported exercise. Journal of Obesity. 2010;1-4. doi:10.1155/2010/171957

Strategy 2: Counseling

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Other Successful Treatments

• Cognitive therapy more successful than standard of care in preventing weight regain

• Foods and moods—decrease body-related worrying/increase self esteem

• Note: Antidepressants only effective in BED

Source:Werrij, M.Q., Jansen, A., Elgersma, H.J., Ament, A.J., & Hospers, H.J. (2009). Adding cognitive therapy to dietetic treatment is associated with less relapse in obesity. Journal of Psychosomatic Research. 67(4); 315-324.

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Practical Solutions

• Have a recreation schedule on your desk

• Incorporate exercise into groups

• Foods and Moods curriculum

• Screen for disordered eating– Partnership with outside treatment facility

• Brief cognitive behavioral therapy

• Collaborate with recreation staff

• Food addictions group

Diet and the Dentist

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Cass Job Corps Center

Jamie Sjo, RN, HWM

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Obesity is a risk factor for periodontal disease* and dental caries lesions.

Gregg Hiatt, DDS, Center Dentist*Journal of Periodontology, Aug 2010

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E

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Toothpaste “A” Toothpaste “B”

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Beware of…

Sugar and Acid Cooked starches too!

Duration and frequency matter!

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Protective Factors

• Saliva• Fluoride, Ca, P• Antibacterials

No Caries

Caries Progression

Risk Factors•Acidogenic Bacteria•Frequent carbohydrates •Sub-normal saliva

Disease Indicators•Cavities/dentin•Enamel lesions•Restorations < 3 yr•White spots

John Featherstone, Young, Wolff, 2007

The Caries Imbalance

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“Small changes can lead to enormous results over time.”

According to Oprah Magazine:*

Willpower is like a muscle that gets stronger with use

Focus on a small task

Practice *February ‘10

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Hmmm…it is any wonder I

caught cavities from fast food

too?

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ASSESS, COUNSEL, ADVOCATELive Healthy!

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Being a Consultant

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Game Break!

True or False?

Labeling a healthy food with a heart or other icon is the most effective way to get students to choose healthy foods.

False

Labeling with an icon is a mixed bag; although there is some evidence that

providing calorie information on menus reduces the number of calories people eat.

Source: Albright, C.L. et al. (1990). Restaurant menu labeling: impact of nutrition information on entrée sales and patron attitudes. Health Education Quarterly. 17(2), 157167.Harnack, L.J. & French, S.A. (2008). Effect of point-of-purchase calorie labeling on restaurant and cafeteria food choices. International Journal of Behavioral Nutrition and Physical Activity. 26(5); 51.

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Game Break!

True or False?

Slightly reducing the cost of healthy foods in comparison to unhealthy foods will encourage healthier eating.

$0.10

True

As little as a 10% reduction in cost of healthy foods will encourage an increase in consumption of

healthy foods. Larger reductions encourage people to buy more snacks and consume more calories.

Source: French, S.A. (2003). Pricing effects on food choices. Journal of Nutrition. 133(3), 841S-843S.

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Game Break!

True or False?

Watching and discussing a health-related documentary, like Food, Inc., is more effective in eliciting behavior change than imparting basic nutrition knowledge during a health class.

True

Students in a Food and Society course ate more vegetables and decreased high-fat dairy compared to students in a standard

nutrition course.

Source: Heckler, E.B., Gardner, C.D., & Robinson, T.N. (2010). Effects of a college course about food and society on students’ eating behaviors. American Journal of Preventative Medicine. 38(5), 543-547.

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Game Break!

True or False?

Tangible prizes (e.g., t-shirts, gift cards) are the most effective way of motivating adolescents to change a health behavior.

False

Fun activities, support, competence, and autonomy are effective ways of

motivating students.

Source: Ryan R.M. & Deci, E.L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist. 55(1), 68-78. doi:10.1039/0003-066x.55.1.68

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Any questions about your piece of the puzzle?