Welcome to the NP from Home, LLC and NP Obesity Treatment Clinic. At this site we will explore the disease of obesity and the current and best evidence for treatment.
Are you a healthcare provider looking for more information related to treating obesity? I have written a book just for you. Springer is the publisher and the book can be found on their website or Amazon.
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With 70% of Americans having preobesity (overweight) or obesity treatment of this endocrine disease must occur in primary care settings.This course provides the information about obesity, the pathophysiology, complications and most importantly today’s best evidence for treatment. The course is designed for self progress and has three hours of mentoring with me via zoom. A steal for $129.
The DASH (Dietary Approaches to Stop Hypertension) is another eating plan with limited need for calorie counting and instead doing serving counting’s. This eating plan has been around for many years and is recommended by the American Heart Association for anyone with cardiovascular disease. It is considered a heart healthy eating style.
What food is
recommended
Let’s first explain what the eating plan is. It has a lot of things in common with some of the other eating plans that you’ve looked at including the Mediterranean and Whole Food Plant Based; for instance it recommends limiting the foods that are highly processed, limiting all sugar sweetened beverages and sweets. It recommends eating vegetables, fruits and whole grains while limiting foods are high in saturated fats such as that he needs, full fat dairy products and tropical oils such as coconut, palm kernel, palm oil. It recommends fish, poultry, beans, nuts, vegetable oil. And recommends that fat-free or low fat dairy products be the only ones consumed.
It has both weekly recommendations and daily recommendations. For instance, daily recommends include 6 to 8 daily servings of grains, 4 to 5 servings of vegetables and four to five servings of fruits. Weekly recommendations include 4 to 5 servings of nuts, seeds, dried beans, and peas and five or less of sweets.
Evidence for this
eating plan
The science behind the dash diet was the Dietary Approaches
to Stop Hypertension trial from 1995. The study was designed with 456 adults eating
one of three eating diets. The three diets were the typical American diet at
the time, the typical American diet plus more fruits and vegetables and the DASH
diet. The dash diet lowered LDL-cholesterol and blood pressure that did not
occur in the other two eating plans. The
majority of the original studies had only Blood Pressure and elevated LDL for
outcomes. Some studies in the past few
years have shown a modest decrease in body weight. But the greatest advantage continues to be in
lowering blood pressure.
This is an eating plan that is low carbohydrate approach to
eating. The premise and evidence behind
this plan is to remove the majority of carbohydrates to have the body use
ketones as fuel. Ketones are formed from
the burning of fat in the liver. Lower
amounts of carbohydrates consumed also lower the levels of insulin. The research has shown in some people that
insulin resistance and levels drop greatly.
Over 20 studies have shown effective weight loss initially and some have
demonstrated long term weight loss. In
many studies people report improved focus and concentration and decreased
hunger. Additionally, lowered
triglycerides and elevated HDL levels are demonstrated.
The eating plan can
range from less than 20 grams a day of net carbohydrates up to 50 grams for some
people, but the majority of the plans are below 30 grams per day. Fiber is unlimited, The goal is to be in ketosis to allow the body
to burn fat as a fuel. Examples of items
that are avoided in this eating plan are bread, pasta, rice and potatoes. Fruits are not off limits, but very restricted
as are some vegetables. These are also
moderate protein approximately 1 gm/kg/day while the rest of the eating is made
up of fat. The body is using fat for fuel, but you want the fats to be healthy;
look primarily for fats that are unsaturated like polyunsaturated and monounsaturated,
eat sparingly saturated and trans fats. For
great pictures and reliable information on foods to eat on this eating plan see:
https://www.dietdoctor.com/low-carb/keto/visual-guides.
For more information on fats: https://www.health.harvard.edu/staying-healthy/the-truth-about-fats-bad-and-good
Ways to reach ketosis include restricting net carbohydrates
to a level that allows for ketosis to occur.
Net carbohydrates equals the grams of carbohydrates subtracting grams of
fiber. Fiber is often very
beneficial. Moderate protein and
primarily healthy fats. Snacks should
only be eaten if hungry. Any activity
can improve levels of ketosis.
Measuring or recognizing ketosis can be done in several
ways. The first is just to recognize the
symptoms: dry mouth, increased thirst, increased urination, reduced hunger, and
“keto breath”. Keto breath is a fruity
smell to the breath. Three other simple
ways to measure this is through urine strips and blood measurement. Urine strips can be found at most drug stores. Measuring the ketones in the first urine of
the morning showing moderate to large ketones.
Blood monitors, similar to glucometers can be used with optimal levels
between 1.5 – 3.0 mmol/L. Finally, is a breath ketone analyzer, but the blood
meter and breath analyzer can be found from many online stores.
There are some people who should not use this eating plan including
people on insulin, women thinking of becoming pregnant or those who are pregnant
or breastfeeding. And anyone on
medication for a chronic disease should check with their healthcare provider
prior to starting this plan.
There are also some side effects of ketosis for people. Knowing that the average American eats 300 grams of carbohydrates a day lowering to less than 30 a day may cause symptoms that are often called “keto flu” such as headache, fatigue, dizziness, nausea, muscle cramps, and irritability. To overcome this, carbohydrates can be lowered over several days instead of drinking lots of water and increasing salt intake the first few days. Also, during the first few days it is wise to not exercise. Beyond the first few days are constipation, reduced physical performance if exercising a lot, and slightly increased heart rate and for occasionally feel heart beating harder. For more information: https://www.dietdoctor.com/low-carb/keto/flu-side-effects
Processed foods have come about to allow our food supply to have more safety for perishable items and convenience for obtaining food. However, they are now the majority of the calories consumed in America.
How to identify a processed food
The easiest way is to look at the label. When the label has a laundry list of ingredients,
especially if the ingredients are complicated names or unrecognized as food, it
is very likely processed.
But are processed foods bad?
First many of the processed foods are high in salt, sugar
and/or fat – all of which when in high amounts are known to be a problem for
health. Beyond those issues, many
processed foods have a lot of additives through chemicals to do three things –
improve taste, texture and extend the shelf-life.
The health (actually illness) issues that have been
connected to processed foods include: Obesity, Metabolic Syndrome,
Cardiovascular disease, Type 2 Diabetes, Inflammatory Bowel Disease, Autoimmune
diseases, Colorectal Cancer, and even Anxiety and Depression.
How does processed
food cause these illnesses?
Anxiety and Depression – the theory is that added
sugars impacts the gut and the majority of the neurotransmitter serotonin is
produced in the gut. The chemicals in
processed foods are thought to impact the ability of the body to keep normal
levels of serotonin.
Colorectal Cancer has been linked to processed
meats (hot dogs, sausage, bacon), with an increase risk with red meat.
Autoimmune disease has over 100 different
autoimmune diseases. Again the gut is
the key as approximately 70% of the immune system is found in the gut. There are common additives found in processed
foods that damage the lining of the intestine and is thought to allow toxins
that can harm the immune system.
Metabolic Syndrome (including CV disease and
Diabetes) rates are increased with high consumption of processed foods possibly
due to high levels of sugar in processed foods. Insulin resistance occurs due
to the sugar exposure and then an increase in triglycerides occur. This then raises the development of heart
disease and diabetes.
Obesity has the same issues with sugar and
metabolic syndrome. There is clear
association in the literature about processed food and obesity. It is less clear if this is due to the processing
of the food or the nutrient content (or lack there of) of the processed
foods.
One more item
All thetalk about sugar may have you think you only need to look for that word. But there are 50 different words that areactually a form of sugar. Examples ofsome of those words are syrup, fructose, glucose, sucrose, caramel, fruit juiceconcentrate, honey, molasses, and maltose.
This eating planhas no calorie counting, but there is tracking –
some things by the day and some by the week. Its premise is one of primarily
whole foods and approximately 40% of the total food eaten to be from monounsaturated
fat sources. These are fats found in
olive oil, fatty fish, nuts and seeds.
Let’s look at what this means for your eating. First
some fats are not bad for you – in fact olive oil is antioxidant rich and in
this eating plan is recommended for use when
cooking or on salads. Eat fish several
times a week, it is a great source Almonds and walnuts, are great snacks and
have heart-healthy monounsaturated fat. BUT remember a serving size is a snack
so a small number. Anything in too large
amounts can go against your goals of decreasing weight and treating obesity.
The Mediterranean Eating Plan: Eat poultry and fish
several times a week, keep eggs less than 5 x week. Eat red meat once or twice
per month.
What this means for
your eating:
Replace red meat with protein sources that are lower in saturated fat. Replace
a meat-based meal twice a week with a vegetarian protein source such as beans
and lentils. Use two egg whites in place of whole eggs whenever possible.
The Mediterranean Eating Plan: Keep dairy to small
amount each day.
What this means for
your eating:
Avoid yogurts with higher sugar contents – replace with Greek-style yogurt (low
in sugar and high in protein). Consider using only organic dairy, which is free
of the hormones found in most US dairy products. If consuming dairy be sure it
is low fat.
The Mediterranean Eating Plan: Eat as many fruits
and vegetables as possible.
What this means for
your eating:
Aim for 7-9 servings of various colored high-fiber fruits and vegetables per
day. Be sure to wash produce or buy only organic to avoid the pesticides so
common in produce grown within our borders or shipped from neighboring
countries. Try preparing vegetables with a bit of olive oil as recent studies
show that a small amount of fat is necessary for the body to absorb the maximum
amount of nutrients found in vegetables.
The Mediterranean Eating Plan: Incorporate a
moderate amount of whole grain breads and high-fiber cereals into the eating. A
great tip – seek out fresh, artisan bread and serve with high quality olive oil
(preferably cold pressed).
What this means for
your eating:
Avoid processed, low-fiber bread. You’ll be satisfied sooner and eat less.
The Mediterranean Eating Plan: Eat fruit, one ounce
of high-quality dark chocolate, or a small piece of fresh cheese along with a
small glass of red wine for dessert. And then, go for a walk.
What this means for
your eating:
Do what the Spaniards do and indulge in a serving-controlled dessert a few
hours before dinner in the early
evening and then take a walk. The ritual is called la merienda. Savor it-and
don’t feel guilty.
The Mediterranean Eating Plan: Walk everywhere.
What this means for
your eating:
Okay so it really doesn’t have anything to do with what you eat, but activity
is good for your heart and pancreas and mood and (well you get the idea – it is
good for you). Aim for 10,000 steps a day in addition to bi-weekly strength
workouts.
The Mediterranean Eating Plan: Eat the biggest meal
of the day midday.
What this means for
your eating:
If you don’t have the luxury of an hour-long lunch, divide up a larger meal
over the course of the late morning and afternoon. Some research shows, when
you eat more of your calories earlier in the day the less you’ll eat overall.
The Mediterranean Eating Plan: Eat seasonally fresh
and locally sourced food.
What this means for
your eating:
This really helps in keeping your processed foods to a minimum. Shop the parameter of the grocery store and
shop farmer markets. Eat food as close to its whole natural state as possible.
Recent studies show that chemically altered foods and preservatives confuse the
body’s register of calorie consumption.
The
Mediterranean Eating Plan: There are two things
to think about with this plan, first it has great research showing improvements
for heart disease and diabetes but not a lot of weight loss for the treatment
of obesity. And two this plan does have “counts”
and keeping track of them is at times a bit cumbersome.
What this means for your eating:
Oils/Fats – choose plant
based fats
Vegetables: 2-3 cups per
day
Fruit: 1-1/2 cups per
day
Cereals and whole grains:
1 ½ cups per day
Dairy less than one cup
per day
Meats 3-4 ounces per
day (remember red meat sparingly in a moth)
Alcohol – if consumed 1
drink per day for women and 2 for men
Legumes – 2 cups WEEKLY
Fish 2-4 ounces per WEEK
Adapted from Mayo Clinic, WebMD, Goldring Center for Culinary Medicine, and Shapefit.com for NP Obesity Treatment Clinic 1016 W. University AveSte206 Flagstaff, AZ 928-814-8011 Fax 1-888-877-4669 npfromhomepts@gmail.com
There is research out of Tulane University indicating
that following the guidelines of the Mediterranean Plan provides very good
health benefits, while the research on whole foods, plant based is also
encouraging, especially for those with any metabolic component (like diabetes –
either yourself or a history in the family)
The ketogenic eating plan (or low carbohydrate) has research
for some patient populations.
Both of these plans have one thing in common and that
is “clean” food – meaning not processed.
Another option includes full or partial meal
replacement – this means purchased food that replaces regular food decisions.
And finally, all the guidelines have the indication
for the use of reduced calorie of 500 kCal a day (this is only my
recommendation IF you were eating more than 2000 calories prior to starting an obesity
management program).
While thinking over these options as you start an obesity
management program here are small steps I recommend.
Start to reduce processed foods – just one at each meal – read the labels and find out if there is “non-food” items there)
If the food comes packaged it has very few ingredients listed. An example is bread – look at your package of bread – is there four ingredients – flour, water, salt and levain or a list like this with highlighted items that are not “whole foods or “clean” items that your body many know what to do with: (Whole Wheat Flour, Water, Sugar, Wheat Gluten, Sunflower Seeds, Cracked Wheat, Rye, Cellulose Fiber, Oats, Soybean Oil, Yeast, Ground Corn, Salt, Molasses, Buckwheat, Brown Rice, Preservatives (Calcium Propionate, Sorbic Acid), Monoglycerides, Triticale, Calcium Sulfate, Barley, Flaxseed, Millet, Datem, Grain Vinegar, Soy Lecithin, Nuts [Walnuts and/or Hazelnuts and/or Almonds], Monocalcium Phosphate.)
Start using a mindful approach to eating (see the blogs on mindfulness)
Reduce all food consumption after dinnertime – or limit to a 200-calorie snack
Mindfulness simply is a way of being fully aware of what is going on in a moment. This practice can be applied to any part of your life, but when applied to eating it often can help you meet your goals for weight loss in your obesity treatment plan. This practice is being aware of yourself emotionally, mentally and physically. Let’s look at how that happens when eating.
What is Mindful Eating?
Many of us will eat without being mindful or what we are eating. Have you ever sat down with a bag of popcorn and suddenly realized you were at the bottom of the bag and don’t remember a single bite? Mindful eating takes the concept of mindfulness and applies it to why, when, where, what, and how you eat. Following are some tips of how to recognized the who – what – why of eating.
• Observe your body. Notice hunger and fullness signals that guide you to start and stop eating. When you are getting ready to reach for food be sure you are physically hungry and not “feeding” an emotion.
• Do not judge yourself or your reaction to food.
• Notice your reaction to food. What do you like, what don’t you like? Stop and really notice if you are eating something you like.
• Savor your food. While eating, notice all of the colors, smells, flavors, and textures of the food. Ask yourself – Is it a flavor you enjoy?
Mindfulness may help you
to avoid overeating. First bites may be the most satisfying, and additional
bites may not be as pleasurable. This can help with portion control.
BE AWARE Ask yourself,
“Am I…..”
•Physically hungry? (on a
scale from “1” to “10”)
•Eating quickly or slowly?
•Dining in-the-moment. Am I mindlessly munching or noticing each bite?
Each of these questions and techniques will guide you towards a relationship with food that is about fueling your body and being sure that it isn’t about “feeding” an emotion – be that anger, sadness, happiness. We need to change this relationship and learn to eat when we are physically hungry 🙂
This weeks blog is about the pillars of treatment for obesity. There are five pillars for the treatment of obesity the first three are the basis of this treatment. And those three include
1. The pillar of nutrition or finding an eating plan that works to treat your disease
2. The second pillar is activity, although some people prefer to call it exercise, I prefer to call it moving more or activity
3. The third pillar that finishes up the underlying premise of all treatment is the behavioral intervention. Behavioral Intervention really means how to find our roadblocks and how to work around. What’s worked for you in the past and what hasn’t worked – and then use those successes to create the perfect treatment plan.
The fourth and fifth pillar support the first three. And obesity medications can be very beneficial in helping with making good food choices for your eating plan. We’ll talk more about medications in future blog post. And the fifth pillar is Referral to a bariatric surgery program think this will be another topic for another day.
Hope this helps set up your understanding a bit of the overall treatment plan that are created for the chronic disease obesity.
Obesity is due to the storage of excess adipose tissue. This disease has multiple causes – the video above clearly demonstrates how mutlifactorial the disease is – the diagram above from the Foresight Report for the United Kingdom (http://webarchive.nationalarchives.gov.uk/20170110170031/https://www.noo.org.uk/NOO_about_obesity/causes)
Below are some of the pieces we can change to treat the disease of obesity
Behavior Behavior, in the case of obesity, relates to food choices, amount of physical activity you get and the moving through roadblocks to maintaining your health. Looking at food choices, many people now select foods that are calorie-rich, but nutrient-poor. This behavioral problem also relates to the increase in portion sizes at home and when dining out. NOW THIS ISN’T to say it is your fault. It is just a portion of what the cause is – keep reading…
Environment Environment can impact much about our eating. There are endocrine disrupting chemicals that may be impacting our genetics. The environment we live in can shape our habits and out lifestyle (you can see how this interacts with behavior then) There are many environmental influences that can impact your health decisions. Today’s society has developed a more sedentary lifestyle. Our foods have also changed in how they are grown and processed that can have an impact.
Medications There are medications that are called “obesigenic” meaning they add weight to a person. Sometimes something else can be substituted and sometimes it can’t – so consulting with your healthcare provider (like a nurse practitioner, physician assistant, or physician) on any of your chronic medications to see if they are contributing is a great idea.
Physiologic The regulation of hunger and fullness may be imbalanced. Newer research is also looking at the gut microbiome and how it is affected by sugar and highly processed food.
Genetics Science shows that genetics play a role in obesity. Genes can cause certain disorders which result in obesity. However, not all individuals who are predisposed to obesity will become affected by obesity. Research is currently underway to determine which genes contribute most to obesity. But you may notice that others in your family are having the same issues with the disease of obesity. And you may be wondering how you could impact your genetics [and no I don’t mean select new parents 🙂 ]. As we learn more about this we are finding out that perhaps how we move and what we eat could be affecting our genome and how it presents in each one person.
I look forward to hearing form you – please comment
Mindful eating can be quite powerful. Many of us really don’t know what we spend our money on or what we actually eat in a day. So learning to be aware and in the moment when we are eating or drinking something can be a very powerful tool.
What is mindful eating? There are several different definitions. From the Center for Mindful Eating “As a practice, mindful eating can bring us awareness of our own actions, thoughts, feelings and motivations, and insight into the roots of health and contentment” https://thecenterformindfuleating.org/about-us
Here are my tips for mindfulness around eating:
first observe when you are starting to eat – are you hungry – if not what is it about the situation that has you eating – are you out with friends and it is a social event? are you angry or sad and eating to “deal” with the emotion? or is it just habit – it is “time to eat”? -The goal here is to recognize if we are hungry we should eat – if it is something else then food isn’t the “best” answer if we have the disease of obesity.
the next step of mindful eating is to “just eat” – don’t mutlitask when you are eating – don’t read a book, or watch TV – and if you are in a social situation be sure you are mindful of what is on your plate and keep the portion small
now that you are only eating – pay attention to the food selected – what does it taste like, what did you choose.
All of these techniques begin to make us be in touch with our relationship with food and the next blog we will talk about how values affect our food choices.
