NIH Public Access Author Manuscript Acad Today. Author manuscript; available in PMC 2014 January 10.

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Published in final edited form as: Acad Today. 2013 January ; 9(1): A9–A10.

Behavioral Approaches to Weight Loss and Control Michelle Cardel, PhD, RDE [Post-doctoral Fellow] University of Colorado Denver Individuals with lower-limb amputations are particularly affected by being overweight as the additional weight increases the risk for cardiovascular disease, skeletal problems, and a contralateral amputation. It is imperative that clinicians take the time to explain the risks associated with being overweight and provide education on lifestyle modifications to encourage weight loss. Behavioral approaches for long-term weight loss may attenuate the risk of further complications and have implications for more effective prosthetic treatment. The following behavior modifications may help your patients meet their weight-loss goals.

Keep a Food Journal NIH-PA Author Manuscript

Food journals can help patients monitor what they eat, reduce mindless snacking, and facilitate consumption of fewer calories. According to one of the largest and longest-running weight-loss maintenance trials ever conducted, dieters who diligently recorded what they ate each day using a food journal lost an average of 18 pounds over six months, while dieters who did not keep written records lost only nine pounds.1 Food journals can be maintained by scribbling what one eats on a piece of paper or using smartphone applications. Help your patients find an application that fits their specific needs to keep them accountable and on track with their weight loss.

For Your Next Meal, Grab a Smaller Plate

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As Americans, we generally believe bigger is better. Even though large portion sizes are increasingly available, recommend reducing portion sizes by using a nine-inch or ten-inch salad plate rather than larger dinner plates during meals. Research has shown that when people switch from a 12-inch plate to a ten-inch plate, they eat almost 22 percent fewer calories but they feel just as full2 Have a sample plate in your office to help patients visualize what to use at home. This method can lead to a slimmer waistline without your patient feeling deprived.

Fill Half of Your Plate with Fruits and Vegetables The U.S. Department of Agriculture (USDA) recommends five to nine servings of fruits and vegetables a day. Recommend that your patients use the USDA ChooseMyPlate.gov3 website to facilitate their understanding and food choices. Instruct your patients to fill half of their plate with fruits and vegetables at every meal. This manner of eating will allow them to meet dietary guidelines, provide lots of vitamins, minerals, and fiber, and fill them up without adding extra calories. Visit www.choosemyplate.gov for more great recommendations.

Get Plenty of Sleep When trying to get your patients to lose weight, getting more zzzs is the key! Sleep deprivation can lead to hormone imbalances and has been associated with weight gain.4 When one sleeps less, not only do changes in hormones increase appetite, causing one to eat

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more, but changes in glucose metabolism cause one to hoard calories and store them as fat.5 Recommend at least seven to eight hours of sleep a night.

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Drink Fluids Research suggests that adequate water intake or drinking water before and during a meal helps with weight reduction. Water can influence weight loss in a multitude of ways. First, many people do not drink enough water and may confuse hunger with thirst. Therefore, suggest to patients that if they still feel hungry after eating, they should drink eight to 12 ounces of water. If they are still hungry after that, then they should have something to eat. Filling up on water decreases the amount of food one eats, thereby decreasing total caloric intake and potentially influencing weight. Barbara Rolls, PhD, has done a significant amount of work on the study of volumetrics.6 She has shown that eating a broth -based soup or salad before a meal significantly decreases the calories consumed both at that meal and affects total calorie intake that day. Soup and salad are less calorie-dense than the majority of foods but fill you up quickly. Therefore, it is very important that individuals who are trying to lose weight drink at least eight to ten eight-ounce servings of water per day. One exception to this is individuals with cardiac or renal issues whose physicians put them on a fluidrestricted diet.

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Eat Slowly and Consciously Research has shown that people consume significantly more calories when they watch television while eating. This is often referred to as “mindless eating.” People do not register hunger or satiety cues as quickly when they are not fully engaged in the act of eating. Suggest that patients plate their meal, even if it is just a snack. Take the plate and a glass of water to sit down at the table. It is important to sit and enjoy each meal with no distractions. Studies have shown that children who eat family dinners without watching television are at significantly lower risk for the development of obesity than children who do not regularly sit down for family meals.

Now that they’ve lost the weight, how do I help them keep it off? The National Weight Control Registry Many patients believe that losing weight and keeping it off is nearly impossible. However, there are people who have not only successfully lost weight but have kept it off. What can we learn from those individuals? The goal of the National Weight Control Registry (NWCR) is to collect and share successful strategies.

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The NWCR was established in 1994 by James O. Hill, PhD, and Rena Wing, PhD, to identify individuals who had lost more than 30 pounds and maintained that weight loss for more than a year. However, on average, the 4,200 participants enrolled in the registry have lost 66 pounds and kept it off for more than five years.7 Not only are these individuals inspiring, but their data has identified a number of behaviors that are associated with weight loss and, even more importantly, maintaining weight loss.

Eat Breakfast Every Day Many people skip breakfast as a weight-loss strategy believing they are cutting calories, but research has shown that people who skip breakfast are actually more likely to become overweight.8 This may be because skipping breakfast causes hunger that can lead to nibbling and overeating throughout the day. Daily breakfast is a habit for participants in the NWCR. Most (78 percent) in the NWCR report eating breakfast every day, and almost 90 percent eat

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breakfast at least five days a week.9 This suggests that starting your day off with breakfast is an important strategy for losing weight and maintaining that weight loss. It seems like your mother was right when she told you breakfast was the most important meal of the day!

Exercise Physical activity combined with a healthy diet is a great way to lose weight and keep it off. More than 90 percent of NWCR participants increased their physical activity to an hour per day.10 The most popular form of exercise was walking, but others lift weights, ride bikes, or do aerobic training. Initially, patients may feel an hour of exercise a day is an impossible goal, but assure them they do not need to overhaul their life overnight to make physical activity a reality. An easy way to introduce exercise is the use of a pedometer. Pedometers provide an objective way to track movement and many find it to be a fun way to be accountable for daily exercise. Instruct patients to work up slowly to a goal of 10,000 steps a day.

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When the exercise is done does not matter. Studies have shown three ten-minute walks are equally as effective as one 30-minute walk. Depending on the type of exercise, the body’s metabolism can stay elevated for up to 24 hours. Combining both resistance and aerobic training will provide the highest increase in energy expenditure during and after exercise. Walking after dinner is great because the physical activity stimulates peristalsis and can decrease that bloated feeling that often occurs after a meal.

Weigh Yourself Often Consistent self-weighing appears to help individuals maintain their weight loss.9 This may serve as a warning system allowing individuals to make necessary behavior changes to prevent further weight gain before it gets out of control.

Conclusion Providing behavioral strategies that allow patients to both lose weight and keep the weight off will improve their overall health and decrease risk for complications associated with their amputations.

References

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1. Hollis JF, Gullion CM, et al. Weight loss during the intensive intervention phase of the weight-loss maintenance trial. Am J Prev Med. 2008 Aug; 35(2):118–26. [PubMed: 18617080] 2. Wansink B. Environmental factors that increase the food intake and consumption volume of unknowing consumers. Annu Rev Nutr. 2004; 24:455–79. [PubMed: 15189128] 3. USDA. www.choosemvplate.gov 4. Mozaffarian D, Hao T, Rimm EB, et al. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011 Jun 23; 364(25):2392–404. [PubMed: 21696306] 5. Cizza G, Reguena M, et al. Chronic sleep deprivation and seasonality: implications for the obesity epdiemic. J Endocrinol Invest. 2011 Nov; 34(10):793–800. [PubMed: 21720205] 6. Rolls, B.; Hermann, M. Smart, Simple, Science-Based Strategies for Losing Weight and Keeping It Off. New York: William Morrow; 2012. The Ultimate Volumetrics Diet. 7. The National Weight Control Registry. www.nwcr.ws/Research/default.htm 8. Niemeier HM, Raynor HA, et al. Fast food consumption and breakfast skipping: predictors of weight gain from adolescence to adulthood in a nationally representative sample. J Adolesc Health. 2006 Dec; 39(6):842–9. [PubMed: 17116514] 9. Wyatt HR, Grunwald OK, et al. Long-term weight loss and breakfast in subjects in the National Weight Control Registry. Obes Res. 2002 Feb; 10(2):78–82. [PubMed: 11836452]

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10. Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005 Jul; 82(1 Suppl): 222S–5S. [PubMed: 16002825]

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