Prevention of obesity in U.S. children and youth

SUNDAY, OCTOBER 3

POSTER SESSION: NUTRITION ASSESSMENT/MEDICAL NUTRITION THERAPY TITLE: PREVENTION OF OBESITY IN U.S. CHILDREN AND YOUTH

TITLE: INTRODUCING TECHNOLOGY INTO MEDICAL NUTRITION SERVICES FOR WEIGHT MANAGEMENT

AUTHOR(S): V.I. Kraak, MS, RD; C.T. Liverman, MLS; J.R. Okita, PhD, RD; Institute of Medicine

AUTHOR(S): V.H. Bovee, MS, RD; S.T. St. Jeor, PhD, RD; J.K. Wirshing, RD; R.A. Plodkowski, MD; J.A. Krenkel, MS, RD, CNSD; Center for Nutrition and Metabolic Disorders, Division of Medical Nutrition, Department of Internal Medicine, University of Nevada School of Medicine, Reno, NV

LEARNING OUTCOME: Discuss the concept of energy balance, identify factors that contribute to obesogenic environments, and promising public health approaches that support obesity prevention in children and youth. TEXT: The Institute of Medicine (IOM) Committee on Prevention of Obesity in Children and Youth is charged with assessing the nature of obesity in children and youth in the United States and developing a prevention-oriented action plan to reduce its prevalence. The committee is assessing the array of interrelated factors that contribute to childhood obesity and that may play a role in obesity prevention in the short and long term. A primary emphasis is placed on behavioral and cultural factors, families and the home environment, social constructs that encourage appropriate eating patterns and activity levels, and other broader environmental factors (e.g., schools; advertising and the media; public health infrastructure in communities; community design; physical activity; and community safety). A summary of the report’s findings and recommendations will be presented with a focus on public health approaches that promote energy balance by integrating diet and physical activity interventions at home, schools and in communities. FUNDING DISCLOSURE: Government: NIH (NHLBI, NIDDK, NICHD), DHHS (CDC, ODPHP), Foundation: RWJF

LEARNING OUTCOME: To increase awareness regarding how dietitian services can be enhanced with new technology for resting metabolic rate, body composition, and self-monitoring. TEXT: The Center for Nutrition and Metabolic Disorders (CNMD) was created in January 2003 primarily as a weight management program. Patients are physician or self-referred and undergo a four visit comprehensive assessment that includes a medical work-up, complete nutrition assessment, and behavioral assessment. The nutrition assessment includes indirect calorimetry to measure resting metabolic rate (RMR) with new technology using a portable, easy to use, and affordable medical device (MedGem, HealtheTech, Inc., Golden CO) and a bioimpedance scale to measure % body fat (Tanita Body Composition Scale, Tanita Corp., Arlington Heights, IL). These assessment parameters obtained by dietitians utilizing new technology are then used to create an individual profile for the patient in formulating treatment goals and plans. The four initial visits are followed by enrollment into a 6 month individualized program where patients select from a variety of treatment options. Patients are encouraged to selfmonitor and approximately one third are using a computerized selfmonitoring program (Balance Log, HealtheTech, Golden, CO). Dietitians have introduced technological tools into routine assessment and management of CNMD patients. Patients have reported a high degree of satisfaction with CNMD operations and innovations. In the first year of operation 85 patients enrolled and 76 completed at least one full phase of the program for an attrition rate of 11%; 39 have lost at least 5% of initial body weight and 19 have lost at least 10%. Ten patients have lost greater than 30 lbs. Five patients are currently enrolled in a maintenance plan. FUNDING DISCLOSURE: Equipment for CNMD start up furnished by HealtheTech, Inc, Golden, CO and Tanita Corp., Arlington Heights, IL.

TITLE: PATIENTS AT RISK FOR TYPE 2 DIABETES SUBSTANTIALLY IMPROVE RISK FACTORS IN AN INTENSIVE WEIGHT MANAGEMENT TREATMENT PROGRAM AUTHOR(S): C. Weithman, MBA, RD, LDN; L. Gotthelf, PhD; L. Grant, BS; B. O’Brien, MA; Health Management Resources, Boston, MA LEARNING OUTCOME: To increase awareness of the effect of an intensive weight management treatment program on people at risk for type 2 diabetes. TEXT: Large-scale studies, such as the DPP, have clearly defined the lifestyle changes, including weight management and physical activity, which can impact the progression from pre-diabetes to diabetes. Data were analyzed on 150 patients in the HMR威 Program for Weight Management™. Patients lost weight in an intensive behavioral program with a very-low-calorie, low-calorie, or moderately restricted diet. The maintenance program utilizes the same behaviors: recordkeeping, weekly attendance, meal replacements, physical activity (minimum of 2,000 calories/week), and vegetables and fruits (minimum of 35 full-cup servings/week). The sample consisted of all maintenance patients who had completed a follow-up health risk appraisal (HRA) during 2002-2003 and had a pre-treatment fasting blood glucose ⱕ100 mg/dl but no diagnosis of diabetes. The average length of time between the initial and follow-up HRA was 3 years. At follow-up, patients were maintaining an average weight loss of 38 lbs or 15% of initial body weight. The average BMI dropped from 39.6 to 33.7 kg/m2. In terms of medical parameters, there were declines in average total cholesterol/HDL ratio (12.4%), triglycerides (14.2%), systolic blood pressure (8 mm/Hg), diastolic blood pressure (8 mm/Hg) and fasting blood glucose (14.3%, a drop from 112-96). Only 3.4% (5 of 150 patients) were taking oral diabetes medications at follow-up. In addition, the number of elevated risk factors dropped from 7 to 3. Overweight patients who are at risk for Type 2 diabetes can make critical lifestyle changes as part of an ongoing intensive treatment program and positively impact their health. FUNDING DISCLOSURE: All authors are employees of Health Management Resources

A-24 / August 2004 Suppl 2—Abstracts Volume 104 Number 8

TITLE: NUTRITIONAL AND LIFESTYLE ISSUES OF POSTOPERATIVE GASTRIC BYPASS PATIENTS AUTHOR(S): M.K. Kyzer, PhD, RD, LDN; C. Ashton-Shaeffer, PhD; D.E. Johnson, PhD LEARNING OUTCOME: Participants will be able to identify perceived nutritional, leisure and psychosocial needs associated with gastric bypass patients. TEXT: Obesity has now become on the biggest public health problems in the United States. The Centers for Disease Control estimates that 64% of all Americans are overweight or obese. Gastric bypass surgery has become an increasingly popular treatment for the morbidly obese. What is remarkable and surprising is that there have been no follow-up protocols established to support post-operative bypass patients. While the surgery results in rapid weight loss and reduced complications in the short term, appropriate health and behavior management is necessary for optimal health as well as weight maintenance. This project involved a series of five focus groups to explore the nutritional and lifestyle issues which arise post-operatively in gastric bypass patients. These focus groups consisted of fifty post-operative gastric bypass patients referred from various practicing bariatric surgeons in southeastern North Carolina. Participants ranged in age from 28 to 62 and came from various socioeconomic and educational backgrounds. They were all within one year post surgery. Issues identified from this process include lack of nutrition information and post-operative support, changes in body image, changes in personal and work relationships, adjustment in leisure and social activities, and finally, assertiveness and anger management issues. Themes from the focus groups will be presented as well as their implications for interventions and practice. FUNDING DISCLOSURE: University of North Carolina at Wilmington Internal Grant Funding