ࡱ> 8;9c NjbjbSS %411N ] ,BFFFFFFF,`FFFFFFFBF:FF"^^F,"łFHandout 4 Pharmacologic Weight Loss Treatment Appetite Suppressants Nutrient absorption inhibitors Energy expenditure stimulants Appetite suppressants Affect neurotransmitter activity Serotonin Norepinephrine Require chronic intake Side effects Primary Pulmonary Hypertension Valvular Heart Disease Average patient loses 8-10% of initial body weight Inhibitors of nutrient absorption Lipase inhibitor - Orlistat Up to 30% of the fat in a meal is not absorbed Average patient loses 10% of initial body weight Energy expenditure stimulants Amphetamines Ephedrine act on (3 adrenergic receptors to increase catabolic reactions Weight loss Maintenance Factors affecting energy requirements Decreased body weight Decreased lean body mass Reduced ability to oxide fat? Weight maintenance requires permanent changes in lifestyle Diet Exercise The Cold Foods Diet Case 993: Ruth overweight all her life Failure to regain prepregnancy weight Family History Diabetes- mother Obesity -Mother and Father Hypertension- Father Social History Occupation at home caring for child Exercise-sedentary married Education - high school recent move to new home isolated from family and friends Beer 3-4/week Caffeine-coffee, soda - 2/day Diet History- 24 Hour recall 2717 Kcal Anthropometrics Weight -170 pounds Height- 54 BMR ~30 Weight History Calculation of Ideal Body Weight BMI: 19-24 is acceptable, 19-22 is better 106-139 pounds, 106-128 is better Quick formula for Women : 100 lbs. for the first 5 feet of height and then 5 lbs. for each additional inch, + or - 10%, so... for Ruth: 100 + (5 x 4) = 120 +/- 12 108-132 pounds Calculation of Energy Needs Adjusted Body Weight: [(170-120) X 25%] + 120 = 132.5 pounds 132.5 pounds = 60.2 kg REE: 655+[9.7 x 60.2]+[5.0 x 162]-[4.7 x 22] = kcal/day 1428 kcal/day Energy expenditure= REE x activity factor Comparison to Food Pyramid Treatment Diet and Exercise Is Ruth motivated to make changes? Recognize and discuss barriers to change Develop a treatment plan with appropriate goals Food Pyramid Servings Slimfast Infants and Children Growth Periods of rapid growth Infancy Adolescence Brain Growth 70% in the first three years of life 90% by age 7 Assessing dietary adequacy in children Accurate anthropometric measurements Longitudinal charting Weight History Infants: Birth to 4-6 months Milk based food is primary nutritional source Breast Milk Composition ideally suited to infants needs Immunological factors are present Adjustable volume Hypoallergenic Lower incidence of GI infections and otitis media? Fortification may be necessary for premature infants Formula Composition mimics breast milk Cows milk or soy based Proteins are heat treated for digestion Parental education to avoid overfeeding and nursing bottle syndrome In some cases, may be the best feeding option Cows milk Never appropriate for infants under 6 months of age Not recommended for infants under 1 year Untreated casein difficult to digest High renal solute load GI blood loss How much? 4-6 wet diapers a day Appropriate growth rate Let infant indicate satiety ;<>NH* jb .Dc+^)3sd & Fd & Fd$d$d .Dc+^)3sȽ{pe_TI>       W      L                     9>G[j 0CKc{peZOD  (  '  &  %  $   #/  "   /    !/            9>G[j 0CKcdd$d & Fd  " * 9 Z 7 G f u v / 0 j ľ도ync]R4  1 =  09  /  .(  -"  ,   . @      +  *.  )   !  " * 9 Z 7 G f u v / 0 j  & Fdd & Fd$dd   4 = ? T [ s {  ( ) * 9 : ; < Y  & Fd$dd & Fd   4 = ? 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DialAssist will add the appropriate code to the phone number.lThis is the exact phone number that DialAssist will use to make the call, when you click the Connect button.vClick the Options button to see or change options for protocol settings, connection reminders, redialing options, etc.ZETo hide or show Remote Access setup information, click this triangle.\HThis is the name or IP address of the server to which you are connected.TThis display indicates the rate at which information is being received. More icons mean more activity, in comparison with the maximum speed of this connection.This display indicates the rate at which information is being received. More icons mean more activity, in comparison with the maximum speed of this connection.TThis display indicates the rate at which information is being received. More icons mean more activity, in comparison with the maximum speed of this connection.This display indicates the rate at which information is being received. 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More icons mean more activity, in comparison with the maximum speed of this connection.TThis display indicates the rate at which information is being sent out. More icons mean more activity, in comparison with the maximum speed of this connection.This display indicates the rate at which information is being sent out. More icons mean more activity, in comparison with the maximum speed of this connection.TThis display indicates the rate at which information is being sent out. More icons mean more activity, in comparison with the maximum speed of this connection.This display indicates the rate at which information is being sent out. More icons mean more activity, in comparison with the maximum speed of this connection.TThis display indicates the rate at which information is being sent out. More icons mean more activity, in comparison with the maximum speed of this connection.This display indicates the rate at which information is being sent out. More icons mean more activity, in comparison with the maximum speed of this connection.TThis display indicates the rate at which information is being sent out. More icons mean more activity, in comparison with the maximum speed of this connection.This display indicates the rate at which information is being sent out. More icons mean more activity, in comparison with the maximum speed of this connection.\HThe time connected shows how long you have been connected to the server.uTime remaining shows how long you have before the server disconnects you. The server determines this amount of time.Remote Access This control panel allows you to set up your Remote Access configurations. It also lets you establish and monitor dialup connections. kRemote Access menu Use these commands to help configure, establish, and monitor Remote Access connections.aThis menu is not available when a dialog box is open. To activate the menu, close the dialog box.TKOpens the AppleTalk control panel. Use to change your AppleTalk connection.zOpens the DialAssist control panel. Use to enter phone number information required by Remote Access for automated dialing.NFOpens the Modem control panel. Use to change your modem configuration.NEOpens the TCP/IP control panel. Use to change your TCP/IP connection.zqOpens the Users & Groups control panel. Use to specify which users on a network can share files on your computer.LCOpens an activity log of your most recent remote-access activities.TLOpens the answering setup dialog. Use to specify answering (server) options.ZOpens the Change Password dialog. Use to change the password for your ARAP server account.This menu is available only when ARAP protocol is selected and you are connected to a ARAP server on which your password is registered ՜.+,D՜.+,4 hp|  'UNEu :  Handout 4 Title 6> _PID_GUID'AN{976A4D80-E73B-11D4-A320-000502A708D0}OK IR{^015!UU0 wSorry, there is not enough memory to open this control panel. 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Weight maintenance requires permanent changes in lifestyle Diet Exercise The Cold Foods Diet Case 993: Ruth overweight all her life Failure to regain prepregnancy weight Family History Diabetes- mother Obesity -Mother and Father Hypertension- Father Social History Occupation at home caring for child Exercise-sedentary married Education - high school recent move to new home isolated from family and friends Beer 3-4/week Caffeine-coffee, soda - 2/day Diet History- 24 Hour recall 2717 Kcal Anthropometrics Weight -170 pounds Height- 54 BMR ~30 Weight History Calculation of Ideal Body Weight BMI: 19-24 is acceptable, 19-22 is better 106-139 pounds, 106-128 is better Quick formula for Women : 100 lbs. for the first 5 feet of height and then 5 lbs. for each additional inch, + or - 10%, so... for Ruth: 100 + (5 x 4) = 120 +/- 12 108-132 pounds Calculation of Energy Needs Adjusted Body Weight: [(170-120) X 25%] + 120 = 132.5 pounds 132.5 pounds = 60.2 kg REE: 655+[9.7 x 60.2]+[5.0 x 162]-[4.7 x 22] = kcal/day 1428 kcal/day Energy expenditure= REE x activity factor Comparison to Food Pyramid Treatment Diet and Exercise Is Ruth motivated to make changes? Recognize and discuss barriers to change Develop a treatment plan with appropriate goals Food Pyramid Servings Slimfast Infants and Children Growth Periods of rapid growth Infancy Adolescence Brain Growth 70% in the first three years of life 90% by age 7 Assessing dietary adequacy in children Accurate anthropometric measurements Longitudinal charting Weight History Infants: Birth to 4-6 months Milk based food is primary nutritional source Breast Milk Composition ideally suited to infants needs Immunological factors are present Adjustable volume Hypoallergenic Lower incidence of GI infections and otitis media? Fortification may be necessary for premature infants Formula Composition mimics breast milk Cows milk or soy based Proteins are heat treated for digestion Parental education to avoid overfeeding and nursing bottle syndrome In some cases, may be the best feeding option Cows milk Never appropriate for infants under 6 months of age Not recommended for infants under 1 year Untreated casein difficult to digest High renal solute load GI blood loss How much? 4-6 wet diapers a day Appropriate growth rate Let infant indicate satiety ;<>Nd4CJH* jbY 6ksEP2N & Fd$dd6ksEP2Nƻ祚yncX  N  M2  L  K  J  I  H1  G  F  E  D  C4  B  A  @#0P/ =!"#$%e to regain prepregnancy weight