- Email: [email protected]
Two Weight Loss Diets of Different Macronutrient Composition Combined with Exercise: Effects on Weight and Body Composition
SUNDAY, OCTOBER 7
Poster Session: Professional Skills; Nutrition Assessment; Medical Nutrition Therapy Exploring Parental Perception of the Childhood Overweight Paradigm
The Effects of Pre-Operative Nutrition Counseling Strategies on Bariatric Surgery Outcomes
Author(s): K. Horensky,1 J. Christaldi2; 1Morrison Healthcare Services, Hazleton, PA, 2Nutrition and Dietetics, Marywood Univ., Scranton, PA
Author(s): S. Lavertue,1 M. Salgueiro2; 1Graduate Program in Nutrition, Army Med. Dept. Ctr. & Sch., San Antonio, TX, 2Department of Nutritional Medicine, Brooke Army Med. Ctr., San Antonio, TX
Learning Outcome: Discuss the factors regarding parental perception of childhood overweight and interpret how the conclusions differ from prior research. Understand how conclusions could influence current practices. Childhood obesity has been the focus of many studies showing strong associations with psychosocial effects of lower self-esteem, social isolation, discrimination, and peer problems. Furthermore, studies have indicated that parents are not aware of their child’s body mass index (BMI). This current study was to investigate parental perception of BMI on a child’s self-esteem and to explore parental perception of childhood overweight. A qualitative study with a grounded theory approach was used, utilizing focus groups and interviewing techniques to gather and examine the data. Participants (N⫽13) included the parents of elementary school children in northeast Pennsylvania. Data were organized, classified and summarized in order to locate cohesive themes and patterns, summarize tentative answers to research questions and conceptualize hypotheses and theories. Four themes emerged: affects of BMI on child self-esteem and peer relationships, causes of overweight through parents eyes, coping mechanisms and compensatory strategies, and roles that parental dietary behavior plays on child overweight. Unlike previous research, parents perceived a positive relationship between increased BMI and negative self-esteem. Negative self-esteem was thought to be influenced by factors including self-perception, peer relationships, ridicule, and the BMI report card. The factors that play a prominent role in the development of the child’s overweight are learned or copied dietary behaviors, parental homemaking and cooking, food rewards and bribes, and genetics. Health professionals should be cognizant that while parents may be aware of their child’s overweight and factors needed to control weight, they are not knowledgeable about appropriate means for changing behavior.
Learning Outcome: Participants will be able to determine if the type of pre-operative nutrition counseling effects clinical outcomes for patients undergoing bariatric surgery. Background: Bariatric surgery for the treatment of obesity is a covered benefit for military family members and retirees. Determining the effectiveness of different nutrition education and counseling techniques prior to bariatric surgery is important to control healthcare costs. Objective: The objective of this study was to determine the effect of “group” versus “individual” pre-operative nutrition education and counseling on bariatric surgery outcomes. Methods: This retrospective database and medical records review was conducted at two military treatment facilities in San Antonio, Texas. Subjects included 40 patients who underwent bariatric surgery between 1 April 2009 and 31 July 2010. Type of counseling received, percent excess body weight (EBW) loss, hemoglobin A1C (HgbA1C),and lipid profile were recorded from the database or medical record at four timepoints: pre-surgery; and one month, three months, and six months post surgery. Results: All subjects lost significant EBW (p⬍0.001), and there were no differences in weight loss based on type of counseling. Significant improvements in HgbA1C, HDL cholesterol, and triglyceride levels were observed (p ⫽ 0.008, p ⫽ 0.002, p ⫽ 0.006, respectively), with no differences between groups. Total cholesterol and LDL cholesterol levels did not change significantly. Conclusion: Both individual and group nutrition counseling provided prior to bariatric surgery result in similar favorable improvements in clinical outcomes. The use of group counseling strategies may reduce healthcare costs by allowing Registered Dietitians to provide care to more patients in a shorter amount of time.
Funding Disclosure: None.
Funding Disclosure: None.
Two Weight Loss Diets of Different Macronutrient Composition Combined with Exercise: Effects on Weight and Body Composition
What Are the Knowledge, Representations and Declared Practices of Nurses and Physicians Regarding Obesity in a Swiss Hospital?
Author(s): S. Hauck,1 K. Stewart2; 1Institute for Clinical and Translational Research, Johns Hopkins Univ., Sch. of Med., Baltimore, MD, 2Clinical and Research Exercise Physiology, Johns Hopkins Univ., Sch. of Med., Baltimore, MD
Author(s): S. Bucher Della Torre,1 D. S. Courvoisier,2 A. M. Patino Pineda,3 X. E. Martin,3 M. Kruseman,1 N. J. Farpour-Lambert3; 1Nutrition and Dietetics Department, Sch. of Hlth. Professions (HEdS-GE), Univ. of Applied Sci. Western Switzerland (HES-SO), Geneva, Switzerland, 2Division of Clinical Epidemiology, Univ. Hosp. of Geneva, Geneva, Switzerland, 3 Obesity Care Program, Service of pediatric Specialties, Dept. of Child and Adolescent, Univ. Hosp. of Geneva, Geneva, Switzerland
Learning Outcome: Participants will be able to explain the observed changes in body composition resulting from six months of a low-fat or low-carbohydrate diet with exercise. We examined two weight loss programs differing in macronutrient content for effects on body composition. Overweight or obese subjects, aged 30-65 years, were randomly assigned to a low-fat (LF) or low-carbohydrate (LC) diet for 6 months under the direction of registered dietitians. All subjects followed a supervised exercise program. We assessed weight, BMI, DXA-derived body composition, and dietary intake using 3-day diet records. Sixty subjects (LF, n⫽29; LC, n⫽31) completed the study. At baseline, the groups were similar in age, body composition, and dietary intake. Six-month caloric intake was similar in each group (overall 1638⫾478.5 kcals). Percent calories from carbohydrate, protein and fat were 51%, 20%, 28%, LF group, and 27%, 27%, 44%, LC group. All dietary components differed between groups by at least p⬍0.01. Compared to the LF group, the LC group lost more weight, ⫺13.1⫾5.0 versus ⫺8.2⫾4.7 kg; and total fat mass, ⫺11.1⫾4.5 versus ⫺6.5⫾4.5 kg, each p⬍0.01. Both groups had a similar loss of lean mass (overall ⫺1.5⫾2.7 kg, p⬍0.001). In multivariate analysis, the dietary components did not explain group differences in weight and fat loss, or the similar yet modest lean mass loss despite a markedly greater weight loss in the LC group. A LC diet produced greater weight loss through a greater reduction in fat mass and not at the expense of lean mass. These differences were not explained by the dietary components. Because both groups performed exercise training, it is possible that exercise provided a protective effect for preserving lean mass. Funding Disclosure: NIH Grants R01 HL092280 and UL1 RR 025005.
A-38
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
Learning Outcome: To improve training and health care quality by analyzing knowledge, representations and declared practices of health providers regarding obesity in a hospital. Obese individuals are commonly stigmatized in various settings such as education, media, employment, and also health care. This induces serious consequences at the psychological, medical and social levels. This study aimed to investigate the knowledge, representations and declared practices of nurses and physicians about obesity in a University hospital. A survey was developed based on existing questionnaires and exploratory interviews. An expert committee reviewed the survey, which was pre-tested with 15 physicians and nurses. All nurses and physicians of the hospital (n ⫽ 3452) received an email inviting them to participate in the electronic anonymous survey in August 2010. After 2 and 8 weeks, a reminder was sent. A total of 834 (24.2%) providers participated. Obesity was considered as a chronic condition by 71% of the respondents. Half of providers felt it was part of their role to take care of obese patients, even if 55% of them had the feeling that they didn’t have adequate training. Surprisingly, one third of providers did not know how to calculate body mass index. Between 60% and 80% of respondents correctly answered questions regarding dietary recommendations, but half did not know the magnitude of weight loss needed to reduce obesity co-morbidities in adults. This study confirmed that nurses and physicians are concerned about obesity. However, they admitted a lack of training, which was confirmed by the lack of knowledge of many respondents. Dietitians should be involved in educational programs for health professionals in order to ensure the dissemination of coherent messages. Funding Disclosure: Grant for Quality in Health Care, University Hospitals of Geneva, Switzerland.
September 2012 Suppl 3—Abstracts Volume 112 Number 9
Poster Session: Professional Skills; Nutrition Assessment; Medical Nutrition Therapy Exploring Parental Perception of the Childhood Overweight Paradigm
The Effects of Pre-Operative Nutrition Counseling Strategies on Bariatric Surgery Outcomes
Author(s): K. Horensky,1 J. Christaldi2; 1Morrison Healthcare Services, Hazleton, PA, 2Nutrition and Dietetics, Marywood Univ., Scranton, PA
Author(s): S. Lavertue,1 M. Salgueiro2; 1Graduate Program in Nutrition, Army Med. Dept. Ctr. & Sch., San Antonio, TX, 2Department of Nutritional Medicine, Brooke Army Med. Ctr., San Antonio, TX
Learning Outcome: Discuss the factors regarding parental perception of childhood overweight and interpret how the conclusions differ from prior research. Understand how conclusions could influence current practices. Childhood obesity has been the focus of many studies showing strong associations with psychosocial effects of lower self-esteem, social isolation, discrimination, and peer problems. Furthermore, studies have indicated that parents are not aware of their child’s body mass index (BMI). This current study was to investigate parental perception of BMI on a child’s self-esteem and to explore parental perception of childhood overweight. A qualitative study with a grounded theory approach was used, utilizing focus groups and interviewing techniques to gather and examine the data. Participants (N⫽13) included the parents of elementary school children in northeast Pennsylvania. Data were organized, classified and summarized in order to locate cohesive themes and patterns, summarize tentative answers to research questions and conceptualize hypotheses and theories. Four themes emerged: affects of BMI on child self-esteem and peer relationships, causes of overweight through parents eyes, coping mechanisms and compensatory strategies, and roles that parental dietary behavior plays on child overweight. Unlike previous research, parents perceived a positive relationship between increased BMI and negative self-esteem. Negative self-esteem was thought to be influenced by factors including self-perception, peer relationships, ridicule, and the BMI report card. The factors that play a prominent role in the development of the child’s overweight are learned or copied dietary behaviors, parental homemaking and cooking, food rewards and bribes, and genetics. Health professionals should be cognizant that while parents may be aware of their child’s overweight and factors needed to control weight, they are not knowledgeable about appropriate means for changing behavior.
Learning Outcome: Participants will be able to determine if the type of pre-operative nutrition counseling effects clinical outcomes for patients undergoing bariatric surgery. Background: Bariatric surgery for the treatment of obesity is a covered benefit for military family members and retirees. Determining the effectiveness of different nutrition education and counseling techniques prior to bariatric surgery is important to control healthcare costs. Objective: The objective of this study was to determine the effect of “group” versus “individual” pre-operative nutrition education and counseling on bariatric surgery outcomes. Methods: This retrospective database and medical records review was conducted at two military treatment facilities in San Antonio, Texas. Subjects included 40 patients who underwent bariatric surgery between 1 April 2009 and 31 July 2010. Type of counseling received, percent excess body weight (EBW) loss, hemoglobin A1C (HgbA1C),and lipid profile were recorded from the database or medical record at four timepoints: pre-surgery; and one month, three months, and six months post surgery. Results: All subjects lost significant EBW (p⬍0.001), and there were no differences in weight loss based on type of counseling. Significant improvements in HgbA1C, HDL cholesterol, and triglyceride levels were observed (p ⫽ 0.008, p ⫽ 0.002, p ⫽ 0.006, respectively), with no differences between groups. Total cholesterol and LDL cholesterol levels did not change significantly. Conclusion: Both individual and group nutrition counseling provided prior to bariatric surgery result in similar favorable improvements in clinical outcomes. The use of group counseling strategies may reduce healthcare costs by allowing Registered Dietitians to provide care to more patients in a shorter amount of time.
Funding Disclosure: None.
Funding Disclosure: None.
Two Weight Loss Diets of Different Macronutrient Composition Combined with Exercise: Effects on Weight and Body Composition
What Are the Knowledge, Representations and Declared Practices of Nurses and Physicians Regarding Obesity in a Swiss Hospital?
Author(s): S. Hauck,1 K. Stewart2; 1Institute for Clinical and Translational Research, Johns Hopkins Univ., Sch. of Med., Baltimore, MD, 2Clinical and Research Exercise Physiology, Johns Hopkins Univ., Sch. of Med., Baltimore, MD
Author(s): S. Bucher Della Torre,1 D. S. Courvoisier,2 A. M. Patino Pineda,3 X. E. Martin,3 M. Kruseman,1 N. J. Farpour-Lambert3; 1Nutrition and Dietetics Department, Sch. of Hlth. Professions (HEdS-GE), Univ. of Applied Sci. Western Switzerland (HES-SO), Geneva, Switzerland, 2Division of Clinical Epidemiology, Univ. Hosp. of Geneva, Geneva, Switzerland, 3 Obesity Care Program, Service of pediatric Specialties, Dept. of Child and Adolescent, Univ. Hosp. of Geneva, Geneva, Switzerland
Learning Outcome: Participants will be able to explain the observed changes in body composition resulting from six months of a low-fat or low-carbohydrate diet with exercise. We examined two weight loss programs differing in macronutrient content for effects on body composition. Overweight or obese subjects, aged 30-65 years, were randomly assigned to a low-fat (LF) or low-carbohydrate (LC) diet for 6 months under the direction of registered dietitians. All subjects followed a supervised exercise program. We assessed weight, BMI, DXA-derived body composition, and dietary intake using 3-day diet records. Sixty subjects (LF, n⫽29; LC, n⫽31) completed the study. At baseline, the groups were similar in age, body composition, and dietary intake. Six-month caloric intake was similar in each group (overall 1638⫾478.5 kcals). Percent calories from carbohydrate, protein and fat were 51%, 20%, 28%, LF group, and 27%, 27%, 44%, LC group. All dietary components differed between groups by at least p⬍0.01. Compared to the LF group, the LC group lost more weight, ⫺13.1⫾5.0 versus ⫺8.2⫾4.7 kg; and total fat mass, ⫺11.1⫾4.5 versus ⫺6.5⫾4.5 kg, each p⬍0.01. Both groups had a similar loss of lean mass (overall ⫺1.5⫾2.7 kg, p⬍0.001). In multivariate analysis, the dietary components did not explain group differences in weight and fat loss, or the similar yet modest lean mass loss despite a markedly greater weight loss in the LC group. A LC diet produced greater weight loss through a greater reduction in fat mass and not at the expense of lean mass. These differences were not explained by the dietary components. Because both groups performed exercise training, it is possible that exercise provided a protective effect for preserving lean mass. Funding Disclosure: NIH Grants R01 HL092280 and UL1 RR 025005.
A-38
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
Learning Outcome: To improve training and health care quality by analyzing knowledge, representations and declared practices of health providers regarding obesity in a hospital. Obese individuals are commonly stigmatized in various settings such as education, media, employment, and also health care. This induces serious consequences at the psychological, medical and social levels. This study aimed to investigate the knowledge, representations and declared practices of nurses and physicians about obesity in a University hospital. A survey was developed based on existing questionnaires and exploratory interviews. An expert committee reviewed the survey, which was pre-tested with 15 physicians and nurses. All nurses and physicians of the hospital (n ⫽ 3452) received an email inviting them to participate in the electronic anonymous survey in August 2010. After 2 and 8 weeks, a reminder was sent. A total of 834 (24.2%) providers participated. Obesity was considered as a chronic condition by 71% of the respondents. Half of providers felt it was part of their role to take care of obese patients, even if 55% of them had the feeling that they didn’t have adequate training. Surprisingly, one third of providers did not know how to calculate body mass index. Between 60% and 80% of respondents correctly answered questions regarding dietary recommendations, but half did not know the magnitude of weight loss needed to reduce obesity co-morbidities in adults. This study confirmed that nurses and physicians are concerned about obesity. However, they admitted a lack of training, which was confirmed by the lack of knowledge of many respondents. Dietitians should be involved in educational programs for health professionals in order to ensure the dissemination of coherent messages. Funding Disclosure: Grant for Quality in Health Care, University Hospitals of Geneva, Switzerland.
September 2012 Suppl 3—Abstracts Volume 112 Number 9