Question #1 October 2014
The results of this meta-analysis concluded that combined programs involving both diet and physical activity led to greater long-term weight loss than diet-only or physical activity-only programs. As an RD, what tips for weight loss through diet would you give clients? Also, how would you address the physical activity component for weight loss?
posted by Caroline Moss @ 4:15 PM
15 comments
15 Comments:
This is an interesting topic, however I did expect these results. One semester I took a sports nutrition class that was mostly composed of FND and athletic training students. On the first night of class the professor asked for us all to vote if exercise was more important or diet. Oddly enough several of the athletic training students said diet and several of the FND students said exercise. I think it just goes to show that both sides can see how important the other is. As an RD I think I would make increasing fruit and vegetable consumption my main goal. I feel this aids in weight loss because people realize how good they feel when they eat fruits and vegetables so when they fall off the wagon, they crave that good feeling again. Fruits and vegetables also help to feel full and are low in calories. I would also encourage them to develop a healthy relationship w/ food. Not cutting out all the sweets, but focusing on moderation. I would put much emphasis on physical activity but I know enough about physical activity to know its not my expertise. I would hope to provide my clients with an interdisciplinary approach with a trainer or someone who can assist with the physical activity portion.
I had the same assumption as Jessica. Combining diet and exercise seems to always have a positive outcome for weight loss. I would recommend lean protein, fruits, vegetables and whole grains with the addition of exercising at least 30 minutes a day. It's important to consume quality protein after exercising especially to build and repair lean muscle mass. I would also tell my patient the importance of refueling with adequate calories. Just because you are now exercising doesn't mean you can eat an entire cake. However, nutrient needs will be increased and they should choose healthier food choices to sustain their body. Since we are not technically qualified to give exercise advice I would provide my patient with resources such as gym information, recommend walking and staying active throughout the day, and limiting tv/computer time.
In thinking about combining diet and exercise, and how obvious it seems the outcome would be it reminds me of what Dianne said in class this week. Knowledge does not equal behavior. I think this is why our job is so important. We have to be encouragers more than anything.
Jessica brought up a great point about the sports nutrition class, because I also remembered back to that class discussion while I was reading through this article. It reminded me of the saying, "You can't out-exercise a bad diet" that I've seen floating around the Internet. I think this saying makes sense with this study, because if you look at the results, participants lost more weight on the diet-only programs than the exercise-only programs. However, the combined BWMPs with diet and exercise had the most weight loss overall. So diet may play a larger role in weight loss than physical activity, but if you combine the two, then greater weight loss and long-term weight maintenance can occur.
Both Haley and Jessica made great points about how RDs are not really qualified to give clients recommendations for physical activity. I agree that providing the client with resources like gyms in the area or linking them up with a personal trainer can benefit the client without overstepping our areas of expertise.
My specific nutritional advice is going to differ depending on each person's situation and previous intake. But I think you just can't go wrong with helping someone move away from the processed carbohydrate and moving them toward more fruits and vegetables. I also think it's important to help every client understand that this is a slow and steady process, and healthy eating does not provide a quick fix. I want them to have a realistic understanding of the change process so they don't give up too quickly. I will always and forever push water as a necessary part of a weight-loss plan (and a healthy eating plan, in general). I would also want to help my clients establish healthy ways to enjoy their treat foods. Gotta keep those treat/cheat foods in their and help them not feel bad about it.
But even with all the diet advice, my message would still be that the diet changes are going to be most effective when combined with physical activity. I would encourage it, and help them set activity goals to get them started. Maybe help them figure out what kinds of activity can fit within their lifestyle.
Haley - good point about appropriate refueling. It goes both ways. You need to eat SOMETHING after exercise even if you're trying to lose, but you also can't go nutso on the post-exercise food either. I interned at a gym in town, and their post-workout drinks include options like 500 kcal Oreo shakes. How ridiculous is that for someone trying to lose weight? And I agree with Jess about the ability of fruits and vegetables to help someone feel full, and I would add whole grains to that list - quinoa, oatmeal, farro, millet and the like can stuff you for hours with minimal kcals.
I would preach moderation and making small, progressive, changes to diet over a period of time as opposed to becoming severely restrictive. As we know from what we've learned in classes, highly restrictive diets are rarely (if ever) successful in the long term. While much of my education would be contingent on a dietary recall (if the patient is consuming 7 cans of Pepsi a day, that's obviously going to be the first thing to limit or stop outright) I like to try to make things like this fun for clients.
For instance, step one could be learning to read labels and using the nutrition facts label as your guide by looking at total calories per serving, if it has (say) more than 200-300 calories per serving, it maybe isn't something you want to be eating, and should consider an alternative. Step two could involve trying to consume foods with less than five ingredients on the label, as we know, the more ingredients something has, the chances are it's more highly processed with things that we don't want our weight loss clients (or really any of our clients for that matter) to be consuming. Foods with less than 5 ingredients are typically the foods we want them eating like the fruits and vegetables. With these two tactics, in combination with simplistic education and meal planning focusing on healthy balanced meals emphasizing colorful fruits/vegetables, whole grain products, lean meats and dairy, I think we could make a ton of progress and it wouldn't be too much of an overload on the patient.
I really like patients to understand the resources that are available to them as a consumer in addition to the services that I can provide in our one on one time. I may see a patient once, or maybe more than that, but an RD is not always going to be there to help to guide them with each and every meal choice or grocery purchase so giving them simple tips and skills (label reading, the 5 ingredient rule, whole vs. refined etc.) can go a long way. Additionally, and this would be something that would be contingent on getting to know the patient's eating habits through the recall, I'd place a firm emphasis on how to eat out healthfully including being aware of the nutritional content of the food you're ordering by asking for the facts and/or doing research ahead of time. A few of the patients I've met with at BroMenn explicitly stated that going out to eat really isn't their thing, so I wouldn't waste a lot of time talking about eating at restaurants if they don't hardly eat at restaurants. It's all about finding what works for that individual patient based on their lifestyle.
In terms of physical activity, I would stay away from any specific recommendations, but would provide them with contact information for an exercise specialist or perhaps to a gym (depending on hospital or facility policy on that type of thing) and would also just generally state that (with doctor approval) physical activity can go a long way in helping them to achieve their goals and can be a great partner with a healthy diet! Like Haley said, we really aren't qualified for exercise prescription or specific advice, so I like to leave that to the professionals who are (just like I don't really want exercise physiologists or personal trainers giving nutrition advice...).
Brady, I also really appreciate what you said about those "treat/cheat" meals. I'm a firm believer in those, just as long as it doesn't become an every day thing but an every week or so kind of thing. Food brings us pleasure, and we all enjoy different types of foods that aren't particularly good for us (Nachos for this ol' boy), so it's a balancing act. I think the 90/10 rule is a good principle to teach. Be good 90% of the time, but give yourself some slack to be uh...human. Being too rigid can quickly turn into obsessive behavior (orthorexia anyone?) and is depriving. If it's a family get together and you want a piece of Aunt Martha's world famous cheese cake, who am I to tell you no as your dietitian? Life happens and I think we all need to understand that.
I also like what Haley said regarding the patient not going too low in calories either, especially if they begin to exercise more frequently. Increased physical activity requires calories, and it's not wise to both drastically increase physical activity and slash calories at the same time. A healthy, balanced, diet with regular physical activity is key. It's just our job to prescribe the healthy diet part, which is 95% of the fun anyways :)
I think the results of this article, while not surprising, emphasize the importance of a multidisciplinary approach to weight loss. I think the issue of weight and people's relationship with food can be incredibly complex, and like Jess reminded us, knowledge does not dictate behavior. So while I can educate on proper nutrition, I can't force you to make healthier decisions. I think it can be really helpful to have a team approach to weight loss with multiple experts, especially for people with a lot of weight to lose. I can honestly say I am not qualified to give out exercise recommendations, besides "move more" because what I enjoy doing for exercise doesn't work for everyone. My method for approaching weight loss would be highly dependent upon the client but my focus would be on moderation, increasing fruits and vegetables, and celebrating small successes.
I also agree with Brady that pushing water is important not only for overall health, but it is especially important when you're increasing your physical activity!
Everyone has made some great points! I think everyone so far has mentioned that they would suggest eating more fruits and vegetables to clients that want to lose weight.
I also like that some of you discussed the importance of not being too restrictive on a diet. It's alright if clients have a treat every once in a while. I think too many people view dieting as "all or nothing," so if they eat a treat at lunch, they think that ruins their diet for the rest of the day, and then they eat poorly at dinner. Then this starts a downward spiral of less healthy food choices.
I think everyone so far also agrees that they would not give recommendations for physical activity themselves, but that they would provide the client with resources pertaining to physical activity. I like what Arthur said about how we aren't qualified to give exercise advice, so we should leave that to the professionals who are, since RDs don't want other professionals giving nutrition advice. It's a two-way street.
While I absolutely agree with everything that everyone has brought up, I think I would focus on how my clients could make their favorite meals a bit healthier by making simple substitutions. Also, teaching them how to cook their meals at home instead of eating them out would definitely be one of the first items that I would address. I think it might be shocking to most people to realize that by cooking their own meals, they will not only save calories, but also money. Also, teaching clients to cook will encourage them to rethink about what and how they eat, ensuring long term success in making dietary changes. As this study points out, exercise is essential to weight loss, so I would heavily stress that my clients get involved in some type of physical activity routine. However, since it is not our area of expertise, as Jessica mentioned, I would refer them to meet with a personal trainer or educate themselves on exercise routines after getting approval from their doctor to begin exercising.
I really like how Sammy pointed out that our approach to clients needs to be individualized to each person. We really have no idea what stage our client will be in, or what knowledge they already have, so we will have to assess what to focus on after we initially meet with our client. Also, each person has a different motivator for losing weight, so we need to understand this before we can be effective in helping them to see some pounds come off.
I really do believe that eating right and exercising are both important for weight loss but now a days you find a lot of people that feel like they don't have time for even one of those activities, let alone both. I think I would definitely highlight drinking lots of water to stay hydrated and full, filling up with fruits and veggies, and portion control. I think some people also have that all or nothing mindset. If they're healthy for a day or two they're eating healthy and working out but if they eat 1 cookie then they'll want to eat 5 or if they miss a workout, they'll skip the rest of the week. I think that we have to emphasize that one mistake doesn't mean you should give up the rest of the time. It's about what you do most often that will make a difference. Also, like a couple people mentioned you have to consider people's stages of change. If they're not ready, there's nothing you can do to change their mind.
I like Susan's idea of teaching them how to cook their own foods. We can tell people to eat their vegetables but if they don't know how to turn it into something they like then it really isn't helpful advice.
As several of you have said, I think it's very important to tailor your advice to the client. What each client needs to change can vary based on what they are doing. So we need to find out what they are eating and point out the good things they are doing and the opportunities for improvement. I would like to focus on 2-3 changes at a time that the client feels like they could make and continue. Then I'd like to help them determine what they could do to make those changes that would be comfortable for them. If the client doesn't eat vegetables because they think vegetables are too much work, I might try to find strategies for vegetables that appeal to them and are easy to fix. If the client doesn't eat vegetables because they hate them, I would try to start with something else that could show value and success more quickly. I think it's really important to find changes that might work for the client. Success helps encourage them to make more changes and believe they can get where they want to be.
I like what Susan said about teaching people how to cook at home instead of eating out. It's so easy for people to consume a lot more calories than they think they are consuming. If they cook at home, they can make small changes that may have a big impact on the calories in the food. They can gradually add more changes until the food they eat is much healthier.
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