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Motivating Health Behavior Coaching Theory and Application

by: Dillon Quinn

Motivating Health Behavior Coaching Theory and Application NS 4000

Marketplace > Texas Tech University > Natural Sciences > NS 4000 > Motivating Health Behavior Coaching Theory and Application
Dillon Quinn

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About this Document

Obesity and Health Promotion Overview
Fundamentals of Human Health Behavior Change
Dr. Martin Binks
Class Notes
Obesity, childhood obesity, Changing Behavior, motivation and emotion
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This 24 page Class Notes was uploaded by Dillon Quinn on Monday May 16, 2016. The Class Notes belongs to NS 4000 at Texas Tech University taught by Dr. Martin Binks in Spring 2016. Since its upload, it has received 23 views. For similar materials see Fundamentals of Human Health Behavior Change in Natural Sciences at Texas Tech University.


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Date Created: 05/16/16
Motivating Health Behavior Coaching Theory and Application Dr. Martin Binks, Ph.D. FTOS. Text/Cell: 919-485-9215 E-mail: Office: Room HS301E Human Sciences Building Office Hours: Tue 5-7pm Obesity and Health Promotion Overview Obesity Epidemiological Facts: • A major public health problem - In the US, 65-70% of adults are overweight or obese as defined by a BMI of ≥25 or ≥30 kg/m ,2 respectively. • The second most frequent cause of preventable death in the US with over 400,000 deaths annually. • Related to increased chronic disease rates and healthcare costs. Relationship Between BMI and Percent Body Fat in Men and Women 70 60 Women Men 50 40 30 Body Fat (%) 10 0 0 10 20 30 40 50 60 Body Mass Index (kg/m ) Adapted from: Gallagher et al. Am J Clin Nutr 2000;72:694. BMI-Associated Disease Risk Classification BMI (kg/m ) 2 Risk Underweight <18.5 Increased Normal 18.5-24.9 Normal Overweight 25.0-29.9 Increased Obese I 30.0-34.9 High II 35.0-39.9 Very High III >40 Extremely high Additional risks: • 5 kg or more weight gain since age 18-20 yn >35 in) • Poor aerobic fitness • Specific races and ethnic groups and Obesity in Adults—The Evidence Report. Obes Res 1998;6(suppl 2). of Overweight Medical & Psychosocial Consequences of Obesity Depression, low self esteem, stigmatization, body image issues, reduced quality of life Pulmonary disease Idiopathic abnormal function intracranial obstructive sleep apnea Stroke hypertension hypoventilation syndrome Cataracts Nonalcoholic fatty liver Coronary heart disease disease steatosis Diabetes steatohepatitis Dyslipidemia cirrhosis Hypertension Metabolic Syndrome Gall bladder disease Severe pancreatitis Gynecologic abnormalities Cancer abnormal menses breast, uterus, cervix infertility colon, esophagus, pancreas polycystic ovarian syndrome kidney, prostate Osteoarthritis Phlebitis Skin venous stasis Gout Obesity Trends* Among U.S. Adults BRFSS, 1990, 1995, 2005 (*BMI ≥30, or about 30 lbs overweight for 5’4” person) 1990 1995 2005 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Contributors to Obesity Genetic, Biological & Physiological Predispositions and Maintaining Factors Obesity Promoting Environment Personal Lifestyle Choices & Habits Long-Term Positive Energy Balance Influenced by many factors Fat Stores BIOLOGICAL ENVIRONMENT Treatment of Obesity and Related Disorders Clinical trials & weight loss outcomes Review of Commercial Diets Source: Tsai, AG. & Wadden TA. Ann. Int. Med: 2005;142(1)56-66 • Weight Watchers : Efficacy demonstrated in mult-isite randomized controlled clinical trial (5% initial loss) – moderate price - still not affordable for many • TOPS, Overeaters Anonymous: No documented efficacy – affordable option - perhaps more accessible • Internet Commercial Programs: Growing evidence - clinical trial data very encouraging - potentially affordable & accessible intervention • Popular Diets 12 months: Atkins 5.4% (4.7 kg) Zone 1.9 % (1.6 kg) LEARN 2.6 % (2.2 kg) Ornish 3.0% (2.6 kg) HDL, Triglycerides and Blood pressure improved more in Gardner CD et al. JAMA 2007;297(9Atkins.7. LDL similar across all. Similar improvement in insulin & glucose for all diets. Obesity: 2006;14(8)1283-1293. • Very Low Calorie Diets (VLCD; i.e. Optifast , HMR ): multiple outcome studies: 6 RCT’s. • Short-term weight losses: - VLCD 16.1 % vs. LCD 9.7 %. • Long-term weight loss: - VLCD 6.3 % vs. LCD 5.0 %. • NHLBI expert panel did not recommend these over LCD’s due to relative cost/benefit and non-maintenance of larger initial losses. Diabetes Care 2002;25(12):21652171.; Ratner RE et al. Endocrine practice, 2006 12 supp1:20-4 • 3 year - 27-center RCT (N=3800) comparing lifestyle intervention with metformin to prevent/delay onset of diabetes in persons with impaired glucose tolerance. • Goals: Min. 7% weight loss (maintained) & 150 minutes of activity (brisk walking). • Goal-based, health coaches, frequent contact, tailored to individual, “toolbox” behavioral curriculum, individualized maintenance strategies, culturally specific. • Both lifestyle intervention & metformin effective in decreasing incidence of type 2 diabetes. – Lifestyle = 58% – Metformin = 31% Multidisciplinary Behavioral Lifestyle Intervention Programs • Physicians (physician extenders), registered dietitians, exercise physiologists, psychologists / behavioral specialists. • Typically group-delivered, protocol-based, behavioral lifestyle change intervention. • Balanced nutrition reduced kcal (ADA) diet (some offer VLCDs). • ACSM-based individual exercise plan. • Outpatient typically 24 + weeks in duration (Mean weight losses 10%). Pharmacotherapy Medical Devices Bariatric Surgery • BMI ≥35 with comorbidities, or BMI ≥40 • Consider after other weight loss attempts Vertical Banded have failed Gastroplasty • Requires long-term medical monitoring • Laprascopic techniques increasingly available • Mean % excess weight loss at 5 years ranged from 48% to 74% Roux-en-Y Gastric Bypass • Excellent diabetic control • 600 patients following gastric bypass, 96% follow-up, mean percent excess weight loss still > 50% at 14 years. • Most effective intervention for weight loss Gastric • Use only when medically appropriate Banding Adapted from NIH/NHLBI – The Practical Guide Identification, Evaluation, and Treatment of overweight Overview of Behavioral Lifestyle Intervention Adult Nutritional Planning • Various nutrition regimens are appropriate and safe. • For non-medically monitored – ADA, AHA, food guide pyramid, with moderate caloric restriction (1200-1500 kcals) - Diet rich in fruits/vegetables. • weight loss and weight maintenance.ment enhances – Shakes – Meal bars – Frozen entrees • Under appropriate circumstances – more aggressive approaches (low carbohydrate, meal replacements, VLCD) may be appropriate. Guiding healthy , weight conscious eating • Avoid skipping meals/deprivation – Leads to overeating. • Reduce current calories ~ 500 - 1000 / day. • Structure meals & snacks – max 3-5 hours between. • Reduce portions. • Select “high volume” foods. • Reduce restaurant eating. • Monitor hunger and satiety – Scale 1-7. • Monitor food and activity. • Eat more slowly and mindfully. Physical Activity •ANY increase in activity is better than none. •Encourage seeking enjoyable (or at least tolerable) activities. •Attend to the three components listed below. LIFESTYLE ACTIVITY 10,000 to 15,000 steps AEROBIC & STRENGTH EXERCISE Variety in type and intensity ACTIVE LEISURE Explore alternatives for recreation They know what to do… Why don’t they just do it ? People need more than education in diet and exercise. We need to assist them in identifying and changing long-standing psychosocial, behavioral, and emotional patterns that interfere with their health and wellness goals. Consider the following: • Psychosocial context: Environmental influences, availability of resources, support systems. • Personal context: Personal history and current life situations, relationship with food and activity, psychological contributors, readiness for change. • Coping: Evaluate existing coping resources (e.g. problem solving, emotion regulation, stress management skills) and the degree of utilization of these.


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