Weight Management - The SUSTAIN Clinic

What is Obesity?

• Obesity is a complex medical condition.
• Obesity is a genetically conferred, neurological and hormonal disease that is
  heavily influenced by our environment.
• Obesity is a disease that needs and deserves treatment.
• Obesity Quickdraw Video here.

Obesity myths:

• Obesity is not a lack of willpower or lifestyle issue.
• Obesity is not your fault.
• Obesity is not as simple as “eat less and move more”.
• Diets are not a treatment for obesity.
• Health is not just about weight, look past the scales to gain health.
• Population based interventions focus on prevention and not treatment.
• Body Mass Index (BMI) is a measure of size and not necessarily health.

What is Weight Bias?

• Weight Bias: beliefs about a person’s values, skills, abilities, or personality based
  on their body weight and shape.
• 88% of people living with obesity report having been stigmatized, criticized or
  abused as a direct result of their weight.
• People living with obesity experience weight bias and discrimination from
  strangers, educators, employers, health professionals, media and even friends and
  family.
• What are examples of weight bias in healthcare? Being denied medical treatment
  based on weight or all health problems blamed on weight
• Bias can cause shame or blame, anxiety, depression, poor self-esteem and body
  dissatisfaction that can lead to unhealthy weight-control practices.
• Weight Bias Video here.

What is “person first” language?

• Putting a person before a diagnosis, it describes what a person "has" rather than
  asserting what a person “is."
  People are not defined by Obesity. We do not say someone “is cancer”, we say
  that they “have cancer”.
• We should talk about a “person with obesity” and not an “obese person”.

What is “Best Weight”?

• Best Weight: the weight you achieve while living the healthiest lifestyle you can
  truly enjoy and sustain.
• We have less control over our weight than we think we have.
• Factors we cannot change; genetics, ethnicity, sex, age, metabolism. We need to
  focus on things we can modify; food choices, portion size, sleep, exercise, screen
  time, stress, time management.

Why is it so hard to lose weight and keep it off?

• Sometimes the “diets” we follow are neither enjoyable nor sustainable, once we
  break the “rule” it loses power over us psychologically.
• As humans, our bodies were designed to resist weight loss and survive in times
  when food was scarce.
• When we lose weight our biology and metabolism adapt to encourage weight
  regain.
• The environment we live in is considered “Obesogenic” - it encourages cheap,
  convenient, tasty, calorie laden processed foods and a sedentary lifestyle.

Treatment Options (evidence based):

• Lifestyle/behavioural:
• Mindful eating, exercising and building powers of restraint and resilience.
• Identifying triggers and high risk times for overeating.
• Dietary modification, portion size and healthy eating.
• Support & accountability.
• Pharmacotherapy/Medication:
  - Liraglutide (Saxenda): once/day injectable medication
  - Naltrexone/Bupropione (Mysimba in EU, Contrave in US) - twice per day oral
  medication.
  - Orlistat (Xenical): three times per day oral medication.
• Bariatric Surgery: Gastric Sleeze, Roux-en-Y Gastric Bypass, Duodenal Switch
  Procedure.

What is the Best Diet?

• The “Best Diet” is one you enjoy and can sustain in the long term.
• It should focus on healthy eating, balanced nutrition, portion sizes and real foods.
• Studies have shown that, when it comes to weight, no one diet/pattern of eating is
  better than another. We must end the fad diet wars that may promote disordered
  eating and promote unsustainable eating.

What drives us to eat?

• Body Hunger: feeling physically hungry - regulated by your gut, blood sugars and
  fatty tissue. Can be helped by eating regularly (appropriate amounts), balanced
  meals and limiting high sugar and high fat foods
• Reward Hunger: This is controlled by the brain - emotional, stress-related and
  “mindless” or unconscious eating. This can cause us to eat even if we are not
  physically hungry and often foods that are pleasurable and calorie dense. This
  pattern of eating may have developed as a coping mechanism.

 

The Sustain Comprehensive Program Visit Outline - What we do for You

Session 1
- Intro to program
- Weight/Medical/Social History
- Obesity as a chronic disease & Bias/Stigma
- Overview of treatment options: Lifestyle & Behavioural/Pharmacological/Surgical
- Handout: Obesity Facts & Expectations, Why are more people struggling with weight?
- Homework: Food tracker form

Session 2 Topics
- Value Clarification
- Calorie & Activity Tracking
- Handout: Values and Reflection

Session 3 Topics
- Expectations and Best Weight
- Weight Set Point
- Wanting/Reward learning

Session 4 Topics
- High risk times and triggers
- Planning & Mindful Eating (portion sizes and decision making)

Session 5 Topics
- Calorie deficit
- Acceptance
- Handout: Working towards best Weight and Calorie Deficit

Session 6 Topics
- Permission Thoughts & Barriers
- Restraint/Resilience
- Handout: Permission thoughts

Session 7 Topics
- Restaurant eating/Weekends/Special Occasions
- Diffusion and Urger surfing

Session 8 Topics
- Pharmacotherapy & Bariatric Surgery

Session 9 Topics
- Maintaining losses and motivation long term
- Lapse versus Relapse and reversing small weight gain

Session 10 Topics
- Overeating and Emotional Eating
- Physical Activity
- Handout: Exercise and Weight
- Restaurant eating/Weekends/Special Occasions
- Diffusion and Urger surfing

 

Programme Options and Costs:

 

 

Useful Books and Leaflets

• Lets Talk about Weight
• Gene Eating - Giles Yeo PhD (ISBN-13: 978-1643131276 , ISBN-10: 1643131273)
• Why we eat (too much) - Dr Andrew Jenkinson (ISBN-10 : 024140052X, ISBN-13 : 978-0241400524)

Useful Links:

• https://asoi.info/public/
• https://eurobesity.org
• https://obesitycanada.ca/public-resources/
• Irish Coalition for People living with Obesity (ICPO)

Useful Videos

• Dr David Macklin Video 
• What Causes Obesity  
• Time to Act on Obesity 
• EASO Obesity video 
• Sharma TEDx Talk
• Zentner TEDx Talk
• Lets Make our Day Harder!
• Is Obesity a Choice?

Links for Healthcare Professionals

• https://www.worldobesity.org/training-and-events/training/scope/e-learning
• https://obesitycanada.ca/resources/
• https://obesitycanada.ca/guidelines/chapters/
• http://www.mdbriefcase.net/phm/LandingPage.aspx?
  phm=OPTiMO&regionID=16&utm_campaign=445043_mdBriefCase%20volunteer
  %20programme&utm_medium=email&utm_source=Dotmailer&dm_t=0,0,0,0,0
• https://obesitymedicine.org/category/podcasts/