Game Plan modification? Lifestyle and behavioral modification - - PDF document

Lifestyle and Behavioral Modification: I nitial Approaches to Managing Obesity ( and stopping the “Yo-Yo”

• nce and for all)

Holly Wyatt, M.D. Associate Professor of Medicine Division of Endocrinology, Metabolism and Diabetes Anschutz Health and Wellness Center Like me on FB: Dr. Holly Follow me on Twitter at: @DrHollyWyatt Instagram: DrHollyWyatt

Disclosure Slide for Holly Wyatt, M.D.

• Book Author, Rodale/ State of Slim
• Ownership, Shakabuku LLC
• Patent, Energy Gap
• Consultant, The Beef Checkoff
• Advisory Board, Retrofit
• Research Support, Novo Nordisk
• Research Support, Gelesis
• Research Support, National Cattleman's Association
• Research Support, DuPont

Game Plan

• Lifestyle and Behavioral Modification
• What is it?
• Why is it important? Why should we care?
• Key Concepts and Initial Approach
• What is missing?

What is lifestyle and behavioral modification?

Lifestyle and behavioral modification involves altering long- term habits, typically of eating or physical activity, and maintaining the new behavior for months or years. Lifestyle modification can be used to treat a range of diseases, including

• besity.

Why is it important?

• The cornerstone for long term success
• Your lifestyle and behaviors produces your health AND happiness
• Impacts your quality of life
• 1. We need an enemy.
• 2. Weight loss ≠ Weight Loss Maintenance

Weight loss ≠ Weight Loss Maintenance

Acute Weight Loss Chronic Weight Loss Weight Loss Weight Maintenance 4-6 months Years/Forever? Strategy Strategy Strategy 1 Strategy 2 Weight Maintenance

How to think about weight loss versus weight loss maintenance

• Weight Loss
• Finite period of time
• 4-6 months
• Negative energy balance
• Fat burning needed
• A reduction in calories is usually

required

• More Success
• Weight Loss Maintenance
• Long period of time
• Forever
• Energy balance, matching intake to

expenditure

• Metabolic flexibility needed
• High levels of activity is usually

required

• Less Success
• When adherence to a “diet” fades

understanding physiology becomes more important

• Find a long-term strategy that

fights back against “biology” and “the environment”

Comparison of weight loss diets with different compositions of fat, protein and carbohydrates (n=811)

• 7
• 6
• 5
• 4
• 3
• 2
• 1

6 12 18 24 weight loss (kg) months 65/15/20% 55/25/20% 45/15/40% 35/25/40%

Sacks FS. et al. NEJM 2009;360(9) 859-873

WEIGHT LOSS WEIGHT Re-GAIN

What works for Weight Loss Maintenance In the REAL World?

• National Weight Control Registry (NWCR)
• Founded in 1993- Hill and Wing
• Identified lifestyle modification practices for achieving and maintaining

weight loss

• Weight loss of at least 13.6 kg, sustained for a minimum of 1 year
• COMMON CHARCTERISTICS
• Eating breakfast every day- 78%
• High levels of volitional physical activity- 90%, 1 hour a day
• Reduced fat intake- 24% of calories from fat
• Self monitoring of dietary intake and activity
• Consumption of low or no calorie sweeteners
• Regular self monitoring of weight- 75% weigh at least once a week
• Limiting TV viewing – 62% watched <10hrs/week

National Weight Control Registry Website http://www.nwcr.ws/Research/default.htm

• 3. We Know WHAT to Do

But We Just Do NOT Do It

Body Weight Time

energy gap Pre-Weight Loss Metabolic Rate Post-Weight Loss Metabolic Rate

• 4. The Energy Gap

aka the Behavioral Gap

Weight loss maintenance at high vs low energy expenditure (EE)

Drop in EE with weight loss

kcal/ 24 hr

Restriction of energy intake Physical activity After Increased physical activity Food Restriction Before After Before After Before

Maintenance

• Only 2.7% of adults met criteria of
• 1) healthy diet
• 2) adequate physical activity
• 3) healthy weight
• 4) non smoking

Behavior Change is Hard

What is Missing?

What is Transformative Weight Loss?

The process of creating and aligning a new reduced body weight, a positive and emotionally resilient mindset and your bigger purpose/spirit with a new lifestyle and way of being.

Begin With The End in Mind

Image By Abraham Sanogo CC BY-NC-SA 3.0

Weight Mindset Metabolism Activity Level Nutrition Environment Routines and Rituals Link to Purpose BIG Why? Your Identity

LIFE TRANSFORMATION Mindset Choices and Skills

• What I get to do versus what I am giving up
• Believing I have the power to change versus believing I am

a victim to my life/circumstances

• Expecting success versus failure
• Finding and aligning your new life with your purpose and

values/your BIG WHY?

• Developing Emotional Resiliency Skills- bending versus

breaking in rougher times

• Feeling Fear and Living in the Arena

Create a Powerful Autopilot.

• In todays world healthy behaviors takes planning

and choices

• It’s not the “default”
• Sticking to your intentions requires willpower
• It is important for long-term success to make it as

easy as possible, to use the least amount of willpower

Aligning Your New Life with Your Purpose –Your BIGGEST WHY?

• Looking for connections between your weight

loss goals/behaviors and your life goals/purpose/Biggest Why?

• Listening to and behaving more in sync with

your inner self, who you want to be, how you want to live your best life.

• Identity shift