advocate weight management · 2020-05-12 · advocate weight management program •physical...
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Tricia Ligon B.S.
Manager
Condell -- Libertyville
IMMC -- Ravenswood LGH – Parkside
Advocate Weight Management
Why do we have this problem? Calorie Confusion
• What percent of Americans can accurately estimate the number of calories they should consume in a day? – Only 9 percent!
• What percent of Americans are unable to estimate how many calories they burn in a day? – 50 percent
• Most Americans don’t track calories consumed or burned citing numerous barriers
– Extreme difficulty & lack of interest
– Lack of knowledge and focus
IFIC Foundation Releases 2011 Food &
Health Survey
The American Lifestyle
• What percent of the US food budget is spent eating outside the home ?
– 50 percent!
• Increased eating out coincides with the increasing overweight population & obesity in the US
• Physical activity has disappeared
– 40% of adults get no activity at all
Clauson & Leibtag, USDA 2011
The American Diet
• Too many carbohydrates & fat
– Many found in soft drinks, prepackaged food, fast food & eating out
• Carbohydrates & insulin leads to obesity
– CHO cause an insulin surge
– Insulin inhibits adipocyte lipolysis
– Causing fat storage, weight gain, and ultimately obesity
Variety, Balance, & Moderation of Food Groups
• You need more than 40 different nutrients for good health and no single food provides them all!
Typical Fast Food Meal
• Quarter pounder with cheese
• Large fries
• Large chocolate milkshake
26 g fat (12 g saturated);
520 cals
25 g fat (3.5 g saturated);
500 cals
23 g fat (15 g saturated);
850 cals
10 small changes that can make a
BIG Difference
1. NEVER skip meals…make sure especially to ALWAYS have breakfast!
2. Include a source of protein at EACH meal/snack
3. Eat a Rainbow of fruits and veggies
4. Take home 1/2 when eating at a restaurant
5. Eat a balanced lunch and dinner (remember the plate method)
6. Rethink your drink- always drink calorie-free beverages
7. Pack a healthy lunch
8. Record your food intake
9. DO NOT practice mindless eating in front of the T.V. or computer
10. Eat slowly, taste & ENJOY your food!
Weight loss of 10% will beneficially improve the following conditions affected by obesity:
Gout
Osteoarthritis Impaired Immunity
Rheumatoid Arthritis Impaired Respiratory Function
Neural Tube Defects Wound Infections
Breast, esophageal, stomach, colon, endometrial and kidney cancer
Infertility HTN
CAD Liver Disease
Carpal Tunnel Syndrome Low Back Pain
Daytime Somnolence OB/GYN Complaints
DVT risk Pain
DM2 and insulin resistance Pancreatitis
Kidney disease Sleep Apnea
Gallbladder disease Surgical complications
Gout Urinary Stress Incontinence
Knowler, WC. N Engl J Med 2002;346:393 American Obesity Association 2007
Exercise Daily
• 420 minutes of physical activity per week is recommended for long-term weight management
• 5 to 7 days a week at 30-60 minutes of exercise is recommended for long-term weight management
Strength Train Regularly
It is recommended that you perform strength
training each week to maintain adequate muscle
mass, healthy weight, increase bone density and
improve flexibility.
This combined effect will increase functional capacity
and improve your quality of life.
Drink half of your body weight in ounces of water per day
• A 150 pound person should consume 75 ounces per day
• You do not need to drink over 128 ounces per day.
• My goal is ____________________________________
Keep Accurate Food Records
• Sparkpeople.com or app
• MyFitnessPal.com or app
• Measure, Measure, Measure
Get Adequate Sleep
• 7 to 9 hours per night is recommended • Be sure your sleep is restful and uninterrupted
Advocate Health Care has identified the need to provide physicians & patients with tools to
help them treat weight issues.
Our mission is:
…..to provide a comprehensive weight management program that treats obesity through medical and behavioral intervention by teaching the tools needed to lose weight and maintain the weight loss for a lifetime.
The Multidisciplinary Team
• Our approach to your treatment involves caring for you as a whole person-not just your condition – Expert staff to give you support, knowledge and tools you need to
keep the weight off, regain self-confidence and properly nourish your body, mind, and spirit.
• Weekly Medical Monitoring with:
– Clinician
• Monthly Visits with: – Fitness Specialist – Registered Dietitian – Medical Doctor – Behaviorist
Weight Management Options
Low Calorie Diet (LCD) Very Low Calorie Diet (VLCD)
BMI Any BMI above 30
BMI > 35 with a co-morbid condition
or
BMI > 40
Intake
Consists of high protein meal
replacements and regular food as
prescribed by the dietitian.
Consists of High Protein Meal
Replacements ONLY
Average daily caloric intake is
1200 to1500.
600 of them are from High Protein
Meal Replacements
Average daily caloric intake is
800 to 840
Weekly Average
weight loss 2 to 4 pounds 4 to 6 pounds
3 Phase Model Specialized program designed to safely jump start your weight loss while
empowering you with the tools to maintain it. • Phase 1: Reducing
– Prescribed meal plan for quick weight loss – Medical monitoring – Weekly group sessions focused on nutrition, exercise and behavior changes.
• Phase 2: Adapting – A gradual transition through a guided, reduced calorie diet for continued
weight loss. – Continued weekly medical monitoring and group sessions – Learn additional behavior, nutrition and exercise skills needed for continuous
weight loss
• Phase 3: Sustaining (ideally 12 months in length) – An exciting time and a milestone in the weight loss journey. Weekly
monitoring available to help maintain focus. – Monthly motivational support group emphasizing the tools and knowledge
gained from the journey for continued weight management.
Advocate Weight Management
• Current Insurance Reimbursement Status
– Advocate Centered HMO
• Provide benefits for patients with a BMI of 40 or 35 to 40 with a co-morbid condition present.
– PPO Non union
• Provide benefits for patients with a BMI of 30 or higher
– Medicare
• Provide benefits for patients with a BMI of 30 or higher
The services are reimbursed are office visit and labs.
All other program required services and products are paid for by the patient at time of service.
1 Box = $25.00/Box
1 Meal=$3.21
1 Box = $22.50/box
1 Meal= $3.57
MEAL REPLACEMENTS
McDonald’s
Big Mac
$3.99
Advocate Weight Management Program
• Physical activity is critical for long-term weight management & strongly encouraged in our program.
– Best predictor of weight maintenance.
– Add resistance exercise to preserve lean body mass and improve resting metabolic rate
American College Sports medicine Position Standing 2009
Advocate Weight Management
• Behavior Modification & Lifestyle changes
– Patients are taught to modify their eating, exercise habits & lifestyle behavior
– Behavior Modification includes
• Self monitoring
• Stimulus control
• Reinforcement techniques
• Cognitive restructuring
2014 Advocate Weight Management Stats
Average 6.7 BMI point reduction
per patient attributing a medical
cost savings of $1701 per person
Program wide reduction of 1,585
BMI points for a medical cost
savings of $402,590
Clinics Combined 2014
Number of patient visits for 2014
4327
Average LOS in Reducing
21 weeks
Total pounds lost 8877
Average pounds lost per patient
38
Average pounds lost per patient per week
2
Impact on Diabetes
Ave percent of excess BW lost 58%
Ave Total wt loss 54.30
Ave wt lost in 12wks 35.00
Ave decrease HbA1c 1.62 points
Ave decrease in FBG 50.1 points
Average starting HbA1c 7.74
% of pts to get their HbA1c below 6.0 57%
% of pts to get their HbA1c below 7.0 85%
Average BMI
point decrease
of 10.2 per pt.
Medical spend
reduction:
Attributed to
BMI reduction
is $2591
Attributed to
Diabetes
Resolution
$7,900
total cost
reduction
$10,491
patient per year.
*Data 3/2013 American
Diabetic Association
Impact on Diabetes
• 100% of patients taking these medications have discontinued taking them. – Glyburide,
– Pioglitazone,
– Victoza
– Actos
– Actos Plus
– nateglinide
– Levemir
– Humolog
– bydureon
Impact on Diabetes
• 35% of patients taking metformin have discontinued or decreased their dose by 50% by week 12 (18% discontinued)
• 50% of patients taking metformin have discontinued or decreased their dose by 50% by week 18
• 100% of patients on Lantus have discontinued or decreased their dose by 50% by week 6 (33% discontinued)
Impact on Diabetes
• 100% of patients using novolog have discontinued or decreased their dose by 50% by week 16 (50% discontinued)
• 100% of patients using Janumet have discontinued or decreased their dose by 50% by week 18 (50% discontinued)
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