National weight control registry

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Started in 1993 by Drs. Rena Wing and James Hill, the National Weight Control Registry (NWCR) is an on-going surveillance project to learn more about the healthy behaviors of those individuals who have successfully lost weight (>30 pounds) and maintained that loss

Table 9.5 IOM and USDA Sample Menus

IOM DIET SAMPLE MENU: BREAKFAST

1 cup complete bran flakes 1 mini box of raisins (.5 oz) 1 cup of skim milk

SNACK

1 medium tart apple

2 oz (28 halves) walnuts

LUNCH

McDonald's grilled chicken caesar salad

One packet of low fat balsamic vinagrette dressing 1 Orange Bottle Water

SNACK

6 oz of low-fat fruited yogurt 1/2 cup blueberries

DINNER

3 oz lean, Grilled Flank Steak 1 cup steamed asparagus tips 1 small ear of corn

1 tsp of low-fat tub margarine 1 wedges of watermelon

(approximately 1/16 of melon) Nutrient Information: Calories: 1500 Fat: 49 gm fat (30%), 7% saturated, 11% polyunsaturated, 6% monounsaturated Carbohydrates: 201 gm (47%) Fiber: 28gm Protein: 82 gm (22%)

USDA DIET SAMPLE MENU: BREAKFAST

1 cup bran flakes 1 cup fat-free milk 1 small banana

SNACK

1 orange

1 oz part-skim mozzarella cheese LUNCH

Open-face tuna fish sandwich

1 slice rye bread

3 oz tuna (water packed, drained)

2 tsp mayonnaise

1 tbsp diced celery

1 cup shredded romaine lettuce

2 slices tomato 1 medium pear

SNACK

Vi cup dried apricots 1 cup low-fat fruited yogurt

DINNER

3 oz boneless, skinless chicken breast 1 small (2' diameter, 5" long) baked sweet potato 1/2 cup peas and onions 1 cup leafy greens salad 3 tsp sunflower oil and vinegar dressing 1/2 cup red grapes Nutrient Information: Calories: 1500

Fat: 46gmfat (29%), 6% saturated, 12% polyunsaturated, 7% monounsaturated Carbohydrates: 217gm (52%) Fiber: 29 gm Protein: 68gm (19%)

Final recommendations

• Measure patient's height, weight and waist circumference

• Calculate patient's BMI

• Assess patient's risk factors (diabetes mellitus, hypertension, coronary artery disease, hypercholesterolemia)

• Lifestyle changes o Aim for 5-10% weight loss over 6 months o Consume a variety of foods within and among the basic food groups while staying within energy needs o Caloric deficit: 500 to 1,000 calorie deficit/day o Increase physical activity: 30 min on most, preferably all, days of the week

• Consider pharmacotherapy if patient's BMI >30kg/m2 or >27kg/m2 with comorbidities o Unsuccessful weight loss or weight maintenance with lifestyle changes

• If pharmacotherapy used, monitor side effects o Daily multivitamin with orlistat o Blood pressure and heart rate with sibutramine

• Consider surgical therapy if patient's BMI >40kg/m2 or >35kg/m2 with comorbidities o Patient with low probability of success with non-surgical measures, as demonstrated by failure in established weight control programs o Informed, well-motivated patient with acceptable operative risks for at least 1 year [27]. All of the data collected are self-reported by registry members who volunteer information.

There was no single, common approach that members reported for weight loss; however, the majority of members reported calorie reduced diets as well as regular exercise. Members reported several common themes for weight maintenance such as eating a low calorie, low fat diet, consuming breakfast daily, engaging in self-monitoring techniques such as food logs or self-weighing or both and regular physical exercise for approximately 1h daily (www.nwcr.ws). In a recent paper by Wyatt et al. [27], the key lessons of the NWCR were reported and are listed as follows:

• There is an important difference between weight loss and weight maintenance.

• Individuals who have successfully maintained weight loss have similarities in how they keep weight off.

• Many people wishing to lose weight experience an important "trigger" event in their lives that becomes self-motivating.

• Maintenance of weight loss becomes easier over time.

• Weight loss is reported to improve the overall quality of a person's life.

• Maintaining weight loss does not increase eating disorders.

• Successful weight loss maintenance is achievable.

While the lessons of the NWCR may not be applicable to all individuals seeking weight loss, they do clarify healthful diet and lifestyle approaches that reach beyond popular diets and speak to comprehensive lifestyle change. The behaviors of the NWCR members also mirror the recommendations of the IOM and the USDA with regard to energy intake, lifestyle change and regular physical activity.

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