Bariatric Weight Loss

1. Bariatric Weight Loss Considerations for the Health Coach

2. Living With Obesity • Poor sleep • Waking up tired • Joint pain and stiffness • Easily short of breath • Embarrassment from sweating • Difficulty finding/buying clothing • Size of chairs, booths, desks, cars

3. Misunderstood Terms Medical: Social Understanding: 23-52% of overweight and obese women perceive themselves to be at a healthy weight Social push for “fat acceptance” can ignore medical risks • Obesity= BMI over 29.9

4. Obesity Trends* Among U.S. AdultsBRFSS,1990, 2000, 2010 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2000 1990 2010 No Data <10% 10%–14 15%–19% 20%–24% 25%–29% ≥30%

5. Causes of Obesity Behavior Environment Genetics Physical Activity Culture Ethnicity Nutrition School food Family hx Food “deserts” Health conditions Physical education Parents’ education Convenience Foods Lack of resources for exercise

6. Medical Outcomes for the Obese • Increased chances of death from cancer by up to 52% for men, up to 62% for women • Also increased risk for: gallbladder disease, COPD, heartburn, high cholesterol, heart disease, HTN, OA, clinical depression, sleep apnea, CVA • #2 medical cause for death, behind tobacco (2004)

7. Common Struggles and Consequences of Obesity • Depression • Anxiety • Low self-esteem • Poor body image • Social rejection by peers • Poor quality of interpersonal relationships • Potential negative impact on academic outcomes • Unhealthy weight control practices • Binge-eating • Avoidance of physical activity • Co-morbid health conditions related to obesity

8. Common Barriers to Weight Loss • History of failure with multiple “fad diets” or infomercial exercise programs • Mixed media information • Lack of energy • Pain • Difficulty moving • Embarrassment

9. Stigma of Obesity At the Workplace: less likely to be hired or promoted; more likely to be fired In Education: peers and teachers rate obese students are less intelligent, emotional and more likely to have problems at home Receiving HealthCare: Physicians are the second highest cited source of bias, MDs also recognize this

10. Healthcare for the Obese • Fewer preventive health services and exams • Fewer cancer screening tests, such as pelvic exams and mammograms • More frequent cancellation or delay of appointments • Less time spent with the physician, less intervention and less discussion with the physician

11. Weight Is Personal 2008 – 250.4 lbs 2009 – 147 lbs 250.4 weight 147 40.4 BMI 23.7 53% body fat 26% 160/88 BP 92/60 50” waist 28” fasting blood sugar 80 226 cholesterol 167

12. Each Phase of Weight Loss = New Social Challenges Everybody wants to give their opinion

13. Benchmarks and Challenges • New clothes • When people start to notice • Positive and negative comments • Adjusting to new lifestyle • Adjusting to not being perceived as obese • Adjusting to new social situations • Vacations? Birthdays? Celebrations? • Any stressor could potentially derail you

14. How would you feel if you lost 100 lbs? • “I didn’t even know how miserable I was!” • “I never want to go back” • “I am so grateful every day that I did this” • “It was the hardest thing I’ve ever done” • “I can’t believe how much energy I have!” • http://bmisurgery.org/_live/

15. Where do I start?Information Overload to Consumers • OTC Medications: Alli, Fat Burners, Raspberry Ketones, Green Coffee Bean, HCG • Prescribed Medications: Phentermine, HCG injections • Fad Diets: Atkins, South Beach, 500 calorie HCG diet, Cabbage Soup Diet • Dr. Oz, The Doctors • Infomercials: DVDs, exercise equipment, electronic toning devices • Spa Treatments • Cosmetic Procedures • CAM: chiropractic, massage, herbs, acupuncture • Gyms • Social media, blogs, apps • Hypnosis

16. Learning Curve of Weight Loss • Recognize unhealthy behaviors • Substitute unhealthy behaviors • Prioritize daily schedule (exercise, sleep) • Learning needs: stretch, exercise, heart rate, cooking, meal preparation, grocery shopping • Coping skills – stress, anxiety, boredom • What to do with extra time and energy? *These are great topics for coaching calls!*

17. Surgery is Effective…When Lifestyle is Addressed too! • Most insurance companies require patients to demonstrate physician-supervised weight loss before surgery • Most insurance companies require lifestyle evaluations with dieticians and therapists • Some surgeons require nutrition classes before and after surgery • Some surgeons/hospitals offer support groups for patients and family members

18. Bariatric Surgery Statistics Source: BMIsurgery.org

19. Co-Morbidity Improvement Darker color indicates 100% resolution; lighter color indicates improvement Source: BMIsurgery.org

20. Post-Operative Bariatric Lifestyle • Prescription for nutrition for the rest of their lives • High protein • Vegetables and some fruits only for carbs; generally 10g carbs daily • Exercise prescription to walk every day! • Complications • Weight gain occurs when members “cheat” their diets, resulting in diarrhea or vomiting, and eventual stretching of their stomach back to the original size • Patients often cheat with shakes, soda, ice cream

21. Coaching Obese Members Remember: • They already know they are obese • They have probably tried dozens of diets in the past • They are already being criticized or judged for it • Exercise probably has a negative connation from their past • Diet really is a 4 letter word!

22. Coaching the Pre-Contemplative Obese Member “I Won’t” “I Can’t” These people want to change but feel overwhelmed by barriers Help bolster their confidence for overcoming their barriers Help sort out real barriers from perceived barriers Goal is to impart hope for the prospect of change • These people don’t see a need for change • Accept them right where they are • No lecturing! • Build trust • Goal for the call is to be a catalyst for change

23. Coaching Considerations for Pre-Contemplators • Listen • Express non-judgmental empathy • Praise them for knowing their barriers • Help them sort out their barriers • Goal: decrease the emotional response and increase the rational response to enable a catalyst for change

24. Contemplative = “I Might” These members need: Coaching Considerations Empathy! Empathy! Help clarify their vision Brainstorm ways to overcome barriers Share information, relate to the member Goals will be thinking, feeling tasks to resolve ambivalence • To get in touch and stay connected with their strengths, core values, and intrinsic motivation to change • Need to find strong motivators • Need to understand their barriers

25. Preparation: “I Will” These members need Examples What are you willing to do? Why is this important to you? Review core values Let’s brainstorm some possibilities… Who is supporting you? Ask member to formalize commitments • Powerful questions to explore their strengths • Help to discover, design and experiment with their own ideas • Strategies for barriers • Goals that will yield “quick wins” to bolster self-efficacy • Identification of resources

26. Action: “I Am” Specific Client Needs Coaching Considerations “Cheerleader” Support but challenge them Achievable short term goals Social support Plan environmental cues and support Gradual change leads to lifestyle change! Do you need to plan for any stressful events coming up? • Confidence, energy, commitment to help them stay on the path • Explore new solutions to new challenges • It is easy to slide out of the action stage and back into contemplative during times of stress

27. Maintenance “I Still Am” Specific Tasks Coaching Considerations Help them find new role models, new goals Encourage them to find ways to help others Finding new ways to reward themselves Early recognition of lapses Establish social support • Self-image as a normal weight person • Social/Cultural-identity • New challenges and setbacks • Potential boredom and discouragement

28. Common Struggles in the Maintenance Phase • How do I transition my workouts from weight loss to maintenance? • How do I plan new goals? • How in the world do I go to social events now? • “Oh, you’re so skinny, you can eat that!” • Adjusting to needing more/less exercise • “It was just so easier when I was heavy…” • Maintaining motivation – its not fun anymore. • New social challenges – where do I fit in? • Extra skin issues….

29. Coaching Surgical Members • What motivated them to have the surgery? • What’s going well with their nutrition plan? • Are they taking advantage of support groups and classes? • Are they aware of resources in their area? • How are they doing with exercise? • Are they taking advantage of discounted restaurants and fitness centers? • What do they enjoy most about their new lifestyle and health?

30. Summary • Obesity is a multifactorial epidemic affecting all ages and can be enabled by our culture, societal standards and busy lifestyles • Many obese individuals do not recognize they are obese or their risk levels • As health coaches, we need to be ready to meet them and support them at their stage of change and hopefully help prepare them for what’s ahead

31. Sources: BMI Surgery (2014). BMI’s Surgery Results. Retrieved from http://bmisurgery.org/_live/includes/bmisurgerysresults.php Centers for Disease Control and Prevention. (2013). Adult Obesity Facts. Retrieved from http://www.cdc.gov/obesity/data/adult.html Moore, M. and Tschannen-Moran, B. (2010). Coaching Psychology Manual. Baltimore, MD: Lippincott Williams and Wilkins. Obesity Action Coalition. (2014). Understanding Weight Bias and Stigma. Retrieved from http://www.obesityaction.org/weight-bias-and-stigma