Nutrition Counseling and Physical Activity How Wellness Fits Into the Puzzle Learning Objectives Identify three changes you can implement to improve students nutrition and exerciserelated behaviors ID: 725420
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Slide1
1Slide2
Live Healthy!
Weight Management
, Nutrition
Counseling, and Physical Activity: How Wellness Fits Into the PuzzleSlide3
Learning Objectives
Identify three changes you can implement to improve students’ nutrition- and exercise-related behaviors
List three staff members to recruit for collaborationDescribe results from various research studies on nutrition, exercise, and health behavior changeDescribe components of the Behavioral Ecological Model
3Slide4
What’s Coming?
Healthy Eating and Active Lifestyles
Policy changesLive Healthy! campaignGuidance for each staff member on centerCurriculum to educate studentsGuidance to change the center’s culture
Webinars
Launch, competitions, quarterly campaigns
4Slide5
It takes a “village” to promote student health.
5Slide6
The Triumvirate
Three powerful individuals, each a
triumvir
The core: health and wellness, recreation, and food service
6Slide7
Who Else?
Social Development
InstructorsCD/AdministrationFinanceSGACommunity ConnectionsOthers
7Slide8
But…
…Today, it’s not about them.
“[Insert higher power of choice] grant me the serenity to accept the things I
cannot
change; courage to change the things I can; and wisdom to know the difference.”
-Reinhold Niebuhr
8Slide9
Today, we are talking about how
you can help students be the best they can be.
(Whether you are a nurse, psychologist, social worker, substance abuse provider, physician, or counselor)
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…And We Are Moving
Those who sit most of the day have larger waists than those who sit less.
Jogging does not offset an otherwise sedentary lifestyle.
Lack of muscle contraction for long periods of time may short-circuit unhealthy molecular signals causing metabolic diseases.
Source: Judson O. (2010). Stand up while you read this!
The New York Times. Retrieved online from
http://opinionator.blogs.nytimes.com/2010/02/23/stand-up-while-you-read-this/
.
Hamilton, M.T., Hamilton, D.G., &
Zderic
, T.W. (2007). Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease.
Diabetes.
56(11), 2655-2667.
Chronic sitting results in tight hamstrings, flat back,
kyphosis
, and weakened
iliopsoas
muscles.
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What Does Underwear
Have to Do With It?
NEAT - Nonexercise Activity Thermogenesis – physical activity other than volitional exercise (ADL, fidgeting…)
Interindividual
differences
Lean individuals have higher NEAT and increase NEAT if overeat
11Slide12
From: Hamilton, M.T., Hamilton, D.G., &
Zderic
, T.W. (2007). Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease.
Diabetes.
56(11), 2655-2667.
Nonexercise Activity
Thermogenesis
(NEAT) and Exercise Comparison
12Slide13
Game Break!
True or False?
Educating students 1:1 about making healthy choices is more effective than changing cafeteria policies to promote healthy choices.
13Slide14
False
Interventions that target the culture and policy are more effective than interventions that try to change individual behaviors.Slide15
Behavioral Ecological Model
15Slide16
Assess
, counsel, Advocate
Live Healthy! 16Slide17
Assessment
BMI – ratio of weight to height
Waist circumferenceIntake formFood journalingExercise journaling
17Slide18
Discuss Food Journals
What made it easier to eat well?
What made it more challenging?How might you use this information on center?
18Slide19
Game Break!
True or False?
A
healthy BMI range is
different
for different ethnic groups.
19Slide20
TRUE
People of Asian decent experience obesity-related diseases at a lower BMI than those of European heritage. An optimum BMI for those of African decent is under debate.
Source:
Rakugi
, H. &
Ogihara
, T. (2005). The metabolic syndrome in the Asian population.
Current Hypertensive Reports.
7(2), 103-109.
Van
Houten
, B. (2004). Optimal BMI for black women
undertermined
.
OB/GYN News.
Retrieved online from: http://findarticles.com/p/articles/mi_m0CYD/is_20_39/ai_n6346067/.Slide21
Assess,
counsel, Advocate
Live Healthy! 21Slide22
Game Break!
True or False?
Health
care providers should deliver a
directive
message to their overweight patients to help them lose weight.
22Slide23
FALSE
A directive style often backfires.Slide24
Framing Messages
24Slide25
AOL Search—signs of obesity
“Due
to the sensitive topic and the team not wanting to hurt anyone's feelings, no pictures were taken to show signs of obesity...”
25Slide26
Why Motivational Interviewing Style?
Respectful
AcceptingEncouraging
Mobilizing
26Slide27
“Just because students know how to eat healthy, does not mean they will. Food preference is linked to culture, feelings, and although teaching nutrition is important, changing behavior and attitudes is often more important.”
Nutrition Education, Food and Nutrition, Job Corps Community Website, 2010
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Communication Styles
Aggressive — “I’m superior and right.”
Passive — “I’m weak or ‘shaky.’”Assertive — “Although you and I have our differences, you are equally right to express yourself.”
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The Art of Nondefensive Communication
Eliminates defensiveness
Liberates honestyBuilds integrityInspires compassion
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The Art of Nondefensive Communication
Drops defenses and opens up
Direct feedback without being judgmentalExpress our own beliefs without being adversarialSet firm boundaries that create expectations
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Nondefensive Questions
Function is to gather information
No need to control how the student answersYour demeanor is sincere, calm, relaxedAsked in a neutral toneNonopinionated Effect is disarming
Leaves student accountable for the response
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Nondefensive Statement Format
Overt message: reporting what you hear
Covert message: reporting what you seeInterpreting cause or motiveYour own reaction to the student
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Preparation for
Nondefensive Statements
Acknowledge viewpoints don’t apply to allDon’t try to convince everyone to agreeRecognize value of student’s experience
Prepare open statements
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Nondefensive Predictions
How we will respond to the student’s choice?
Neutral in voice and body languageCreates security for the student and yourself
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Effective Predictions
The consequences are as small as possible
The student has max. opportunity for controlThe consequences are self-containedNo foreseeable ramifications we can’t tolerate
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Rolling with Resistance
“My whole family is overweight. I’ll never be thin.”
“I really like good food. More meat, please!”
“You’re crazy if you think I’m getting off this couch.”
40Slide41
Game Break!
True or False?
Genetics plays a large role in a person’s metabolism (i.e., how many calories a person burns in a day at rest).
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FALSE
Our genetics affect our weight, but they do not usually affect our metabolism.Slide43
Genes and Weight
FTO (~55% carry A allele), leptin (mutation prevalence unknown) and MC4R (~6% mutation) are important genes
Increase the attractiveness of highly-palatable foods
Loss of control (LOC) of eating
Never feel full
Sources:
Cecil, J.E.,
Tavendale
,R., Watt, P., Hetherington, M.M., Palmer, C.N. (2008). An obesity-associated FTO gene variant and increased energy intake in children.
New England Journal of Medicine.
359(24), 2558-2566.
den Hoed M, et al.(2009). Postprandial responses in hunger and satiety are associated with the rs9939609 single nucleotide polymorphism in FTO.
American Journal of Clinical Nutrition
. 90(5),1426-32.
Farooqi
IS, Keogh JM,
Yeo
GS, Lank EJ,
Cheetham
T,
O’Rahilly
S. Clinical spectrum of obesity and mutations in the
melanocortin
4 receptor gene.
New England Journal of Medicine.
2003;348:1085-95.
Tanofsky-Kraff
, M., Han, J.C.,
Anandalingam
, K.,
Shomaker
, L.B.,
Columbo
, K.M.,
Wolkoff
, L.E., Kozlosky, M., Elliott, C.,
Ranzenhofer
, L.M., Roza, C.A.,
Yanovski
, S.Z.,
Yanovski
, J.A.
(2009)
.
The FTO gene rs9939609 obesity-risk allele and loss of control over eating
.
American Journal of Clinical Nutrition.
90(6),
1483-8.
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Why Are We Talking About This?
Be ready to help change the thinking “I can’t lose weight because I have a slow metabolism”
A lot of people are normal weight regardless of FTO, MC4R, leptin or any of the other 400+ genes that control obesity
Help students learn their triggers
I’m built just like my mom.
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Overeating as an AddictionSlide46
Game Break!
True or False?
The same parts of the brain are responsible for both food and cocaine addiction.
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TRUE
Functional neuroimaging studies revealed that good smelling, looking, tasting, and reinforcing food has characteristics similar to that of drugs of abuse.
Source: Liu, Y. et al. (2010). Food addiction and obesity: evidence from bench to bedside.
Journal of Psychoactive Drugs.
42(2); 133-145.Slide48
How It Works
Craving, wanting, and liking occur after early and repeated exposures
Decreased sensitivity in dopamine reward system/D2 receptor densityMRI studies ID changes in the hippocamupus,
insula
, and caudate
Sources:
Liu, Y. et al. (2010). Food addiction and obesity: evidence from bench to bedside.
Journal of Psychoactive Drugs.
42(2); 133-145.
Pelchat
. (2009). Food addiction in humans.
Journal of Nutrition.
139, 620-622.
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Specifically Sugar
Sugar-rich foods release euphoric endorphins and dopamine w/in nucleus accumbens as do narcotics
Craving, tolerance, withdrawal, and sensitization seen in both
Large number of AODA-dependent people, and the children of alcoholic fathers, have a sweet preference
Common genetic markers
Source: Fortuna,, J.L. (2010). Sweet preference, sugar addiction and the familial history of alcohol dependence: shared neural pathways and genes.
Journal of Psychoactive Drugs.
42(2), 147-151.
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TEAP Specialist/Team Role
Work with students who are struggling with both addictions/cravings
Be cognizant of replacing one addiction with anotherAnother good reason to work closely with recreation
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The Mind and the BodySlide52
BED DSM-V Proposed
Diagnostic Criteria
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
Sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating
The binge-eating episodes are associated with three (or more) of the following:
Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone because of being embarrassed by how much one is eating
Feeling disgusted with oneself, depressed, or very guilty after overeating
Marked distress regarding binge eating is present
The binge eating occurs, on average, at least once a week for three months
The binge eating is not associated with the recurrent use of inappropriate compensatory
Source: American Psychiatric Association. (2010). Binge Eating Disorder. Retrieved online September 17, 2010 from
http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=372
.
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Prevalence of BED
National Institute of Diabetes and Digestive Kidney Diseases: Weight-Control Information Network. (2010). Binge Eating Disorder. Retrieved online September 17, 2010 from
http://www.win.niddk.nih.gov/publications/binge.htm.
2% of the general population
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Prevalence of BED
National Institute of Diabetes and Digestive Kidney Diseases: Weight-Control Information Network. (2010). Binge Eating Disorder. Retrieved online September 17, 2010 from
http://www.win.niddk.nih.gov/publications/binge.htm.
10-15% of the mildly overweight people
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Prevalence of BED
National Institute of Diabetes and Digestive Kidney Diseases: Weight-Control Information Network. (2010). Binge Eating Disorder. Retrieved online September 17, 2010 from
http://www.win.niddk.nih.gov/publications/binge.htm.
Prevalence is “much higher” in morbidly obese people.
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Disordered Eating
75% of women between ages 25-45 eat, think, and behave abnormally around food some of the time.
56
Source: University of North Carolina at Chapel Hill, news release, April 22, 2008 Slide57
Obesity and Depression
What came first?
Obesity causes depression?Depression causes obesity?
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Obesity Causes Depression
Mechanism 1
Body image and lack of exercise lead to depressive symptomsMechanism 2
Hormones produced by fat cells cause depression
Source:
Emersson, A., et al. (2010). An obesity provoking
behaviour
negatively influences young normal weight subjects' health related quality of life and causes depressive symptoms. Eating Behavior. 11(4), 247-252.
Taylor, V.H. &
MacQueen
, G.M. (2010). The role of
adipokines
in understanding the associations between obesity and depression.
Jounal
of Obesity..
2010, (1-6).
Ugh… I wish I hadn’t signed up for this stupid research study.
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Depression Causes Obesity
Emotional eating in overweight populations
High negative affect (worry more about their bodies)Low negative affectNo effect in normal weight people
Source: Jansen, A.,
Vanreyten
, A., van
Balvern
, T.,
Roefs
, A.,
Nederkoorn
, C., &
Havermans
, R. (2008). Negative affect and cue-induced overeating in non-eating disordered obesity.
Appetite.
51(3); 556-562.
Someone who feels bad about their body is more likely to overeat when sad than someone who feels okay about the way they look.
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Risk and Protective Factors
Protective Factors
Body satisfactionServings of fruits and vegetablesEating breakfast
Regular moderate to vigorous physical activity
Milk intake (boys only)
Family meals eaten together
Risk Factors
Weight concern
Teasing/pressure (peer and parental)
Poor body image
Use of unhealthy weight control methods
Peer dieting
Overweight friends and family members
Sugar-sweetened/diet beverage consumption
Sources: Haines, J.,
Kleinman
, K.P.,
Rifas-Shiman
, S.L., Field, A.E, & Austin, S.B. (2010). Examination of shared risk and protective factors for overweight and disordered eating among adolescents. Archives of Pediatric and Adolescent Medicine. 164(4), 336-343.
Haines, J.
Neumark-Sztainer
, D., Wall, M., & Story, M. (2007). Personal, behavioral, and environmental risk and protective factors for adolescent overweight. Obesity. 15(11), 2007.
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Strategy 1: ExerciseSlide62
62Slide63
National Weight Control Registry (NWCR)
There is variety in how NWCR members keep the weight off. Most report continuing to maintain a low calorie, low fat diet and doing high levels of activity.
78% eat breakfast every day. 75% weigh themselves at least once a week. 62% watch less than 10 hours of TV per week.
90% exercise, on average, about 1 hour per day.
Source: National Weight Control Registry (2010). Retrieved online:
http://www.nwcr.ws/Research/default.htm
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How Exercise Really Works
Strongest predictor of sustaining weight loss
Doesn’t really burn that many caloriesWeight reduction due to improvements in psychological factors—mood, self-efficacy, self-concept
Study=significant weight loss in exercise intervention, but only 19% could be directly attributed to kcal expenditure
Direct correlation between weight loss and mood score
Sources:
Aneesi
, J.J. (2008). Relations of mood with body mass index changes in severely obese women enrolled in a supported physical activity treatment. 1(2)88-92.
Annesi
, J.J.,
Gorjala
, S. (2010). Changes in theory-based psychological factors predict weight loss in women with class III obesity initiating supported exercise. Journal of Obesity. 2010;1-4. doi:10.1155/2010/171957
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Strategy 2: CounselingSlide66
Other Successful Treatments
Cognitive therapy more successful than standard of care in preventing weight regain
Foods and moods—decrease body-related worrying/increase self esteemNote: Antidepressants only effective in BED
Source:
Werrij
, M.Q., Jansen, A.,
Elgersma
, H.J.,
Ament
, A.J., & Hospers, H.J. (2009). Adding cognitive therapy to dietetic treatment is associated with less relapse in obesity. Journal of Psychosomatic Research. 67(4); 315-324.
66Slide67
Practical Solutions
Have a recreation schedule on your desk
Incorporate exercise into groupsFoods and Moods curriculum Screen for disordered eating
Partnership with outside treatment facility
Brief cognitive behavioral therapy
Collaborate with recreation staff
Food addictions group
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Diet and the DentistSlide69
69Slide70
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71Slide72
Cass Job Corps Center
Jamie
Sjo
, RN, HWM
72Slide73
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Obesity is a risk factor for periodontal disease* and dental caries lesions.
Gregg Hiatt, DDS, Center Dentist
*Journal of
Periodontology
, Aug 2010
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E
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Toothpaste “A”
Toothpaste “B”
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Beware of…
Sugar and Acid
Cooked starches too!
Duration and frequency matter!
79Slide80
Protective
Factors
Saliva
Fluoride, Ca, P
Antibacterials
No Caries
Caries Progression
Risk Factors
Acidogenic
Bacteria
Frequent
carbohydrates
Sub-normal saliva
Disease Indicators
Cavities/dentin
Enamel lesions
Restorations < 3 yr
White spots
John Featherstone
, Young, Wolff, 2007
The Caries Imbalance
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“Small changes can lead to enormous results over time.”
According to Oprah Magazine:*
Willpower is like a muscle that gets stronger with use
Focus on a small task
Practice
*February ‘10
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Hmmm…it is any wonder I caught cavities from fast food too?
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Assess, counsel,
Advocate
Live Healthy! 83Slide84
Being a Consultant
84Slide85
Game Break!
True or False?
Labeling a healthy food with a heart or other icon is the most effective way to get students to choose healthy foods.
85Slide86
False
Labeling with an icon is a mixed bag; although there is some evidence that providing calorie information on menus reduces the number of calories people eat.
Source:
Albright, C.L. et al. (1990). Restaurant menu labeling: impact of nutrition information on entrée sales and patron attitudes. Health Education Quarterly. 17(2), 157167.
Harnack
, L.J. & French, S.A. (2008). Effect of point-of-purchase calorie labeling on restaurant and cafeteria food choices. International Journal of Behavioral Nutrition and Physical Activity. 26(5); 51.Slide87
Game Break!
True or False?
Slightly reducing the cost of healthy foods in comparison to unhealthy foods will encourage healthier eating.
$0.10
87Slide88
True
As little as a 10% reduction in cost of healthy foods will encourage an increase in consumption of healthy foods. Larger reductions encourage people to buy more snacks and consume more calories.
Source: French, S.A. (2003). Pricing effects on food choices. Journal of Nutrition. 133(3), 841S-843S.Slide89
Game Break!
True or False?
Watching
and discussing a health-related documentary, like Food, Inc
.,
is more effective in eliciting behavior change than imparting basic nutrition knowledge during a health class.
89Slide90
True
Students in a
Food and Society course ate more vegetables and decreased high-fat dairy compared to students in a standard nutrition course.
Source: Heckler, E.B., Gardner, C.D., & Robinson, T.N. (2010). Effects of a college course about food and society on students’ eating behaviors.
American Journal of Preventative Medicine.
38(5), 543-547.Slide91
Game Break!
True or False?
Tangible prizes (e.g., t-shirts, gift cards) are the most effective way of motivating adolescents to change a health behavior
.
91Slide92
False
Fun activities, support, competence, and autonomy are effective ways of motivating students.
Source: Ryan R.M. &
Deci
, E.L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being.
American Psychologist.
55(1), 68-78. doi:10.1039/0003-066x.55.1.68Slide93
Any questions about your
piece of the puzzle?
93