The Nutrition Prescription

1. The Nutrition Prescription Easy and Practical Approaches to Improve the Nutrition Care of your Patients Jim White RD, ACSM HFS, ADA Spokesman

3. ! Face the Facts ! Fifty million people in the US are dependent on fast food American adults eat 22 teaspoons of sugar a day; teens eat 34 teaspoons The average American adult drinks the equivalent of 38 6-packs of beer, 12 wine bottles, and 2 quarts of distilled spirits in a year Morbid obesity in the US is the second largest cause of death affecting over 9 million adults

4. How do I assess my patient in so little time?

5. PATIENT EVALUATION: Identifying Risk Factors • BMI – measures height and weight • Underweight: below 18.5 • Normal: 25-29.9 • Obese: 30-39 • Morbidly obese: 40-49 • Super-morbidly obese: > or = to 50

7. PATIENT EVALUATION: Identifying Risk Factors • Waist Circumference – measure smallest part of waist • Men > or = to 40” • Women > or = to 35”

8. PATIENT EVALUATION: Identifying Risk Factors • Percentage of Body Fat- bioelectrical impedance body fat calculator (will also give BMI)

9. How do I motivate my patient to gain better health with limited time?

10. Motivating clients to gain better health • Assess patient readiness • Do they want to lose weight? • Have a heart to heart (empathy, compassion, positive encouragement) • Assess barriers/motivators • Explain the benefits of better health and dangers of poor health • Establish attainable short-term goals • S.M.A.R.T. Principle • Initial weight loss of 10% of body weight over 6 months is a recommended target. A 10% reduction in body weight reduces disease risk factors. • The rate of weight loss should be 1-2lbs a week.

11. MOTIVATIONAL FACTORS FOR WEIGHT LOSS • Explaining the dangers of poor diet and inactivity • Overweight and obesity in a patient increases the risk for several diseases: • Coronary heart disease • Stroke • Some cancers (endometrial, breast, and colon) • Hypertension • Dyslipidemia (for example, high total cholesterol or high levels of triglycerides) • Type 2 diabetes • Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint) • Gallbladder disease • Sleep apnea and respiratory problems

12. MOTIVATIONAL FACTORS FOR WEIGHT LOSS • Benefits of healthy eating • Decrease in medication • Increased energy and strength • Better sleep • Increased confidence • Increased mood • Live longer • Healthy appearance (Skin, Hair and Nails)

13. HEALTHY EATING AND LIFESTYLE CHANGESTip sheets available on jimwhitefit.com website • Interpreting food labels • Getting to know portion sizes • Dining out • Alcohol consumption • Establish vices • Incorporating daily exercise

14. How can I implement nutrition education with limited time?

15. 2010 DIETARY GUIDELINES Key Recommendations • Reduce daily sodium intake to less than 2,300 mg and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. • Recommended daily fiber: • Women: 25 grams • Men: 30 grams

16. 2010 DIETARY GUIDELINES Key Recommendations • Consume less than 10% of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids. • Consume less than 300 mg per day of dietary cholesterol. • Keep trans fatty acid consumption as low as possible, especially by limiting foods that contain trans fats, such as partially hydrogenated oils, and by limiting other solid fats.

17. 2010 DIETARY GUIDELINESKey Recommendations • Eat a variety of fruits and vegetables, especially dark-green,red and orange vegetables and beans and peas. • Consume at least half of all grains as whole grains. Increase whole- grain intake by replacing refined grains with whole grains. • Choose a variety of protein foods, which include seafood, lean meat and poultry, eggs, beans, and peas, soy products, and unsalted nuts and seeds.

18. INCREASE PHYSICAL ACTIVITY • Exercise DVD’s • Elliptical, treadmill, dumbbells • Lifestyle activities: yard work, walking dog, biking • Personal trainer • Walking program – pedometer • Gym membership

19. Once my patient loses weight how do I monitor their progress?

20. TOOLS FOR SUCCESS • Food journals • Activity/exercise logs • Support system: family & friends • User friendly websites: eatright.org, myplate.gov • Tip sheets, food journals, activity/exercise logs can be downloaded fromjimwhitefit.comwebsite

21. WHEN TO REFER TO A REGISTERED DIETITIAN • After 6 months or 1 year if patient does not meet 10% weight loss goal • Patients needing more in-depth meal planning: • Diabetes, chronic kidney disease

22. RE-EVALUATION • Monitor progress with simple charts or graphs • Re-evaluate goals • Follow-up appointment 2-4 weeks with staff or provider for progress • 6 month re-evaluation for weight loss • Every year follow-up for weight maintenance • Regular clinic visits, group meetings, email or via telephone

23. THE POWER OF NUTRITIONCase Study #1 • Lost 102 lbs • Lost over 20 inches • Went off all of her medications

24. THE POWER OF NUTRITIONCase Study #2 • Lost 50lbs • Increased athletic ability • Is running under a 7 minute mile

25. THE POWER OF NUTRITIONCase Study #3 • Lost 93lbs • Went off blood pressure medication • Doesn’t suffer from sleep apnea anymore