Tricia Ligon B.S.

Manager

Condell -- Libertyville

IMMC -- Ravenswood LGH – Parkside

Advocate Weight Management

Why do we have this problem? Calorie Confusion

• What percent of Americans can accurately estimate the number of calories they should consume in a day? – Only 9 percent!

• What percent of Americans are unable to estimate how many calories they burn in a day? – 50 percent

• Most Americans don’t track calories consumed or burned citing numerous barriers

– Extreme difficulty & lack of interest

– Lack of knowledge and focus

IFIC Foundation Releases 2011 Food &

Health Survey

The American Lifestyle

• What percent of the US food budget is spent eating outside the home ?

– 50 percent!

• Increased eating out coincides with the increasing overweight population & obesity in the US

• Physical activity has disappeared

– 40% of adults get no activity at all

Clauson & Leibtag, USDA 2011

The American Diet

• Too many carbohydrates & fat

– Many found in soft drinks, prepackaged food, fast food & eating out

• Carbohydrates & insulin leads to obesity

– CHO cause an insulin surge

– Insulin inhibits adipocyte lipolysis

– Causing fat storage, weight gain, and ultimately obesity

Insulin Resistance

Prediabetescenters.com, 2013

Variety, Balance, & Moderation of Food Groups

• You need more than 40 different nutrients for good health and no single food provides them all!

Plate Challenge

V e g g i e s

Starches Meats

Example Plate

Typical Fast Food Meal

• Quarter pounder with cheese

• Large fries

• Large chocolate milkshake

26 g fat (12 g saturated);

520 cals

25 g fat (3.5 g saturated);

500 cals

23 g fat (15 g saturated);

850 cals

10 small changes that can make a

BIG Difference

1. NEVER skip meals…make sure especially to ALWAYS have breakfast!

2. Include a source of protein at EACH meal/snack

3. Eat a Rainbow of fruits and veggies

4. Take home 1/2 when eating at a restaurant

5. Eat a balanced lunch and dinner (remember the plate method)

6. Rethink your drink- always drink calorie-free beverages

7. Pack a healthy lunch

8. Record your food intake

9. DO NOT practice mindless eating in front of the T.V. or computer

10. Eat slowly, taste & ENJOY your food!

Weight loss of 10% will beneficially improve the following conditions affected by obesity:

Gout

Osteoarthritis Impaired Immunity

Rheumatoid Arthritis Impaired Respiratory Function

Neural Tube Defects Wound Infections

Breast, esophageal, stomach, colon, endometrial and kidney cancer

Infertility HTN

CAD Liver Disease

Carpal Tunnel Syndrome Low Back Pain

Daytime Somnolence OB/GYN Complaints

DVT risk Pain

DM2 and insulin resistance Pancreatitis

Kidney disease Sleep Apnea

Gallbladder disease Surgical complications

Gout Urinary Stress Incontinence

Knowler, WC. N Engl J Med 2002;346:393 American Obesity Association 2007

The 6 Imperatives

Cornerstones of Your Long-term Success in Weight Management

Exercise Daily

Exercise Daily

• START with at least 10 minutes of activity each day • Activity grows into exercise

Exercise Daily

• 420 minutes of physical activity per week is recommended for long-term weight management

• 5 to 7 days a week at 30-60 minutes of exercise is recommended for long-term weight management

Strength Train Regularly

It is recommended that you perform strength

training each week to maintain adequate muscle

mass, healthy weight, increase bone density and

improve flexibility.

This combined effect will increase functional capacity

and improve your quality of life.

Strength Train Regularly

Drink half of your body weight in ounces of water per day

Drink half of your body weight in ounces of water per day

• A 150 pound person should consume 75 ounces per day

• You do not need to drink over 128 ounces per day.

• My goal is ____________________________________

FOLLOW YOUR MEAL PLAN

Keep Accurate Food Records

Keep Accurate Food Records

• Sparkpeople.com or app

• MyFitnessPal.com or app

• Measure, Measure, Measure

Get Adequate Sleep

Get Adequate Sleep

• 7 to 9 hours per night is recommended • Be sure your sleep is restful and uninterrupted

Stay Accountable

Stay Accountable

• Many online and in person tools

• Try to choose groups lead by professionals

Advocate Health Care has identified the need to provide physicians & patients with tools to

help them treat weight issues.

Our mission is:

…..to provide a comprehensive weight management program that treats obesity through medical and behavioral intervention by teaching the tools needed to lose weight and maintain the weight loss for a lifetime.

The Multidisciplinary Team

• Our approach to your treatment involves caring for you as a whole person-not just your condition – Expert staff to give you support, knowledge and tools you need to

keep the weight off, regain self-confidence and properly nourish your body, mind, and spirit.

• Weekly Medical Monitoring with:

– Clinician

• Monthly Visits with: – Fitness Specialist – Registered Dietitian – Medical Doctor – Behaviorist

Weight Management Options

Low Calorie Diet (LCD) Very Low Calorie Diet (VLCD)

BMI Any BMI above 30

BMI > 35 with a co-morbid condition

or

BMI > 40

Intake

Consists of high protein meal

replacements and regular food as

prescribed by the dietitian.

Consists of High Protein Meal

Replacements ONLY

Average daily caloric intake is

1200 to1500.

600 of them are from High Protein

Meal Replacements

Average daily caloric intake is

800 to 840

Weekly Average

weight loss 2 to 4 pounds 4 to 6 pounds

3 Phase Model Specialized program designed to safely jump start your weight loss while

empowering you with the tools to maintain it. • Phase 1: Reducing

– Prescribed meal plan for quick weight loss – Medical monitoring – Weekly group sessions focused on nutrition, exercise and behavior changes.

• Phase 2: Adapting – A gradual transition through a guided, reduced calorie diet for continued

weight loss. – Continued weekly medical monitoring and group sessions – Learn additional behavior, nutrition and exercise skills needed for continuous

weight loss

• Phase 3: Sustaining (ideally 12 months in length) – An exciting time and a milestone in the weight loss journey. Weekly

monitoring available to help maintain focus. – Monthly motivational support group emphasizing the tools and knowledge

gained from the journey for continued weight management.

Advocate Weight Management

• Current Insurance Reimbursement Status

– Advocate Centered HMO

• Provide benefits for patients with a BMI of 40 or 35 to 40 with a co-morbid condition present.

– PPO Non union

• Provide benefits for patients with a BMI of 30 or higher

– Medicare

• Provide benefits for patients with a BMI of 30 or higher

The services are reimbursed are office visit and labs.

All other program required services and products are paid for by the patient at time of service.

1 Box = $25.00/Box

1 Meal=$3.21

1 Box = $22.50/box

1 Meal= $3.57

MEAL REPLACEMENTS

McDonald’s

Big Mac

$3.99

Advocate Weight Management Program

• Physical activity is critical for long-term weight management & strongly encouraged in our program.

– Best predictor of weight maintenance.

– Add resistance exercise to preserve lean body mass and improve resting metabolic rate

American College Sports medicine Position Standing 2009

Advocate Weight Management

• Behavior Modification & Lifestyle changes

– Patients are taught to modify their eating, exercise habits & lifestyle behavior

– Behavior Modification includes

• Self monitoring

• Stimulus control

• Reinforcement techniques

• Cognitive restructuring

2014 Advocate Weight Management Stats

Average 6.7 BMI point reduction

per patient attributing a medical

cost savings of $1701 per person

Program wide reduction of 1,585

BMI points for a medical cost

savings of $402,590

Clinics Combined 2014

Number of patient visits for 2014

4327

Average LOS in Reducing

21 weeks

Total pounds lost 8877

Average pounds lost per patient

38

Average pounds lost per patient per week

2

Impact on Diabetes

Ave percent of excess BW lost 58%

Ave Total wt loss 54.30

Ave wt lost in 12wks 35.00

Ave decrease HbA1c 1.62 points

Ave decrease in FBG 50.1 points

Average starting HbA1c 7.74

% of pts to get their HbA1c below 6.0 57%

% of pts to get their HbA1c below 7.0 85%

Average BMI

point decrease

of 10.2 per pt.

Medical spend

reduction:

Attributed to

BMI reduction

is $2591

Attributed to

Diabetes

Resolution

$7,900

total cost

reduction

$10,491

patient per year.

*Data 3/2013 American

Diabetic Association

Impact on Diabetes

• 100% of patients taking these medications have discontinued taking them. – Glyburide,

– Pioglitazone,

– Victoza

– Actos

– Actos Plus

– nateglinide

– Levemir

– Humolog

– bydureon

Impact on Diabetes

• 35% of patients taking metformin have discontinued or decreased their dose by 50% by week 12 (18% discontinued)

• 50% of patients taking metformin have discontinued or decreased their dose by 50% by week 18

• 100% of patients on Lantus have discontinued or decreased their dose by 50% by week 6 (33% discontinued)

Impact on Diabetes

• 100% of patients using novolog have discontinued or decreased their dose by 50% by week 16 (50% discontinued)

• 100% of patients using Janumet have discontinued or decreased their dose by 50% by week 18 (50% discontinued)

Thank you!