As stated on the Nutrition Class post I created a few of days ago, I will be sharing my responses to nutrition topics. This post includes my initial response to a question posted by the professor and comments I made to others’ responses to that same question.
Class was presented with two cases. One was assigned to each student, depending on the first initial of their last name. This is the one I got:
“Mr. M recently went for his annual physical exam. He is a computer programmer and has a sedentary lifestyle. According to his physical he is 6’2” tall and weighs 260 pounds. As part of his health plan his doctor has referred him to you to discuss strategies to maintain a healthy weight. Describe one (1) important strategy you would offer to Mr. M to maintain a healthy weight.”
My Initial Response
[ME:] Being 6′ 2″ tall and weighing in at 260lbs, Mr. M has a BMI that puts him in the “obese” category.[1]
BMI = 260lbs/(5476) x 703 = 33.38
Unfortunately the given information isn’t enough to know if patient is obese or not. Nor do we know if there are any health complications. We are FORCED TO ASSUME that, because he has a sedentary lifestyle and spends most of his time in front a computer, most of his bodyweight is not muscle/bone/water (as would be the case with a bodybuilder) – rather excess fat.
I am one who believes that “it is impossible to out-train bad nutrition.” In other words, if you eat crap, it does not matter how much you work out, you will not lose excess body fat. It is much easier for someone who is already fit to stay fit than for someone who is obese to get down to a leaner state.
Having been in this same position a few years ago (I used to develop web applications before deciding to get a degree in health sciences), I am certain Mr. M needs a proper diet. It is likely that Mr. M makes three critical mistakes on a daily basis: 1) go on smoke breaks, 2) eat/drink unhealthy snacks between meals, 3) go out for lunch and pick up fast-food dinner on the way back home.
My #1 recommendation is for him to develop a diet based on glycemic index[2]/load[3]. With a proper/balanced diet, he is likely to feel better and MORE ENERGIZED. He is then more apt to start adding a little physical activity to his daily routine (maybe he’ll decide to take the stairs instead of the elevator).
Switching his diet will not take up any free time he has and should be easier to adopt than an exercise routine that requires him to make a time sacrifice. I’d say, “Pack a lunch and snacks”. Recommendations:
Assuming sensible/nutritious breakfast and dinner at home…
1 apple + 6-8 almonds mid-morning snack
All sorts of vegetables (salad – 2 cups), extra-virgin olive oil and balsamic vinegar for dressing + 1/4 breast of grilled chicken, poached egg-white, or 1/2 serving of cooked salmon for lunch.
1/2 cup cottage cheese and 4-6 strawberries mid-afternoon snack.
These are all things that can be very easily put into containers and taken into any office w/ a refrigerator (which almost every office has nowadays). They are small enough portions that it is unlikely that Mr. M would go over his Estimated Energy Requirement (again, assuming sensible breakfast – maybe 1 egg + 2 egg-white omelette w/ handful of spinach – and dinner).
References:
[1] BMI > 30 = obese
[2] Our textbook has mentioned that a diet based on low-glycemic foods has been successful in reducing excess body fat.
[3] Our textbook hasn’t yet mentioned glycemic load (GL). GL refers to a second variable that should be considered when looking at the glycemic index (GI) of foods. A GL above 10 results in an almost exact insulin response as when one eats food with a high GI. Example: 1 large, raw apple has a GI of 40 and a GL of 6[4]. Eating a second apple within the time it takes the first to pass through intestine (sugar absorption) shoots GL to 12, requiring a high insulin response from body (pancreas).
[4] Website: http://www.glycemicindex.com/ > GI Database Search
Discussion Based on my Initial Response
[STUDENT 1:] I really enjoy your thorough ideas for for this man to change his life. I also believe too that eating nutritious food as opposed to junk food is extremely important in living a healthy lifestyle. Similar to what you said, I also believe that physical activity and eating healthy will come hand in hand once someone starts to change their life. Small changes such as eating more fruit instead of chips will then increase the persons energy and want them to increase there physical activity.
I really enjoyed reading all of your tips for how he can make his lifestyle a better one.
[ME:] Thank you for the kind words, STUDENT 1.
I opted for a change in diet over an increase of physical activity because, at least to me, it is easier (timewise) to do. No changes in daily activity, just substitute what and when you eat.
Again, thank you for the feedback, STUDENT 1. :)
[STUDENT 2:] I think it’s great how in depth you went with your discussion but I personally am not a fan of bmi. If this were the case than nearly half of the NBA and NFL players are considered obese. Muscle to fat ratio cannot be measured with numbers or with simple “average” calculations. People vary and so does their diet and bmi. I know it doesn’t really say what condition Mr. M’s body is in so I understand that we are all assuming but at the same time we need to realize he might be walking in with a 3-4 percent body fat and could be completely fit.
[ME:] Yes, STUDENT 2.. that was precisely the point i was trying to make about this case when I enclosed the word ‘obese’ in quotes and stated that the “given information isn’t enough to know if patient is obese or not” and “We are FORCED TO ASSUME” that he was obese.
I also do not believe in BMI. A recent study determined it of little use as it missed many obese cases.[1] I am confident the test also fails in the other direction and improperly diagnoses many as obese.
I personally believe the waist-to-hip proportion is a better marker. Recently, researchers found that neck circumference served as a single measurement point for identifying overweight/obese patients.[2] In the past few years, I have also read that upper-arm (around bicep/triceps) circumference is just as precise as neck circumference when screening teens.
References:
[1] MedicalNewsToday.com :: New Research Indicates A Massive Underdiagnosis Of Obesity When Using Body Mass Index (BMI) :: http://www.medicalnewstoday.com/articles/183679.php
[2] Nature.com :: Neck Circumference as a Simple Screening Measure for Identifying Overweight and Obese Patients :: http://www.nature.com/oby/journal/v9/n8/full/oby200161a.html
[STUDENT 3:]I Agree!
It is true what you said about the BMI index and body building. The BMI index does not give a specific body fat ratio; it gives a general area where a person belongs based on only a few factors.
A man who is a body builder could be 9% body fat at 250 pounds and that would be extremely lean! However, on the BMI index he would be considered overweight.
I also see people overtraining all the time instead of making healthier eating choices and they do lose weight much slower than people who eat balanced and exercise.
It’s all about balance! As he eats healthier foods he will have more energy and be able to make healthier choices all day long!
My Comments on Other Students’ Initial Responses
(First Conversation)
[STUDENT 1:]I would put Mr. M on a high fiber diet that includes the adequate amount of water per day and low fat intake as well as a more active lifestyle.
Eating more vegetables would be a priority because he could eat more broccoli and receive less calories than he would from eating a smaller amount of chips or some fruit. Having him eat more vegetables in a fiber rich diet would increase his planning ahead and bringing healthy meals with him to work instead of going out and getting a meal full of empty calories. Drinking the right amount of water also helps your body feel more full. Many times when your body is dehydrated it thinks you are hungry, but in reality it is water that your body is asking for. Mr. M will find himself more full and making healthier choices simply from drinking the right amount of water.
A diet low in fat is also very important for Mr. M while he is trying to lose weight. Eating a diet that is low in fat will help his body to shed unhealthy pounds as he begins to eat healthy.
A more active lifestyle is also vital. The kcalorie intake must be less than the kcalorie expended if he wants to lose weight. Aside from eating a more “natural” diet of vegetables, lean meats, low fats, and fruits getting a good amount of exercise will be extremely beneficial. Walking more often is a good place to begin. Taking a walk at a brisk pace for a few miles a day will begin to strengthen his muscles and burn calories. For each pound of muscle he creates his body will burn about sixty more calories a day than it would burn as fat. This will help him reach his weight loss goals quickly. After he can do the walking I would recommend doing some moderate weight lifting as well as amping up the “cardio” to a light jog and walk routine about 3 minutes walk to one minute jog. As Mr. M continues to lose weight he will decrease the ratio until he is able to jog more than walk and eventually not need the walk aspect of the plan at all (just jog for the few miles).
This plan would be extremely beneficial for Mr. M. This is a two pronged plan that would increase his weight loss by teaching him how to eat foods that supply him the nutrients his body needs without an excess of fat or sugar as well as creating an active lifestyle that will help Mr. M maintain a healthy weight for all his life.
[ME:] NICE, STUDENT 1!
Great point about hunger sensation and need for water. I put this to practice a lot, actually! If I get really hungry between meals and notice that i haven’t drank water in the past few hrs I will down an 8-10oz glass and wait 15 mins. If the hunger goes away, I know I just needed water and I continue to sip throughout the day. If the hunger comes back though, I reach for a light snack.
I noticed you included both, an improved diet and an increase in physical activity. Which do you think is the most important?
[STUDENT 1:]That is hard to choose! I am going to say diet because you can exercise a lot and if you eat unhealthy foods you may be thin but you will not be healthy. You may have unhealthy amounts of fats, sugars, cholesterol and may develop risks for many diseases because you are not getting adequate and balanced nutrients. I do believe they go hand in hand though and that merely eating healthy is only half the battle if you are truly trying to attain overall health and a healthy lifestyle!
[ME:] So true.. Even our book points out that an overweight but physically active person is a healthier individual than a thin, someone who is thin but lacks physical activity.[1]
References:
[1] Textbook
(Second Conversation)
[STUDENT 1:] I would probably tell Mr. M that his best bet would be a fiber and strict protein based diet. The reason I say strict is his lifestyle isn’t an active one, yet. He needs to stay away from fatty foods and find ways to convert that energy. Those carbs and protein have to somewhere and better used than stored. I wouldn’t recommend anything too drastic that will change his life that might be too demanding with work. I would recommend small and healthy snacks during his long hours at the office. If he takes his work home, I recommend activities while he works. There are many great things like Exercise Balls
or small at the desk workout routines he can work with. I completely understand how easy it is to fall into the routine of being at a desk for 8-9 hours a day and that doesn’t include the 8-9 hours of sleeping or sitting around at home. The key or important strategy I would recommend would be to take the lifestyle he has now and instead of not being able to FIND time to work out, MAKE and weave time into your daily lifestyle. Also, find very healthy and nutrient rich foods that fill him up. Oats and berries to simple ants on a log.
[ME:]STUDENT 1:
Great point about doing small exercises at his desk. There are grip strengtheners like this http://www.smartgym.eu/images/gripmaster2.jpg that I used to take into the office when I developed software. :)
Getting up once an hr would also help. Just getting up and walking to the restroom. The simple act of sitting has recently been dubbed the new smoking.[1]
Apparently, prolonged sitting will kill you prematurely REGARDLESS of your diet or the amount/intensity of physical activity you engage in.
References:
[1] The Washington Post :: Those with a desk job, please stand up :: http://www.washingtonpost.com/wp-dyn/content/article/2010/10/16/AR2010101602903.html
[STUDENT 2:]Kevin,
I read the article you referenced about sitting all day. It was very interesting. I agree with some of points that were made about cramped necks and headaches occurring from sitting all day. I also learned something new about the digestive enzyme they mentioned that burns fat, doesn’t work properly while sitting. I had no idea, however, it makes sense, since you are not really using much energy. It is unfortunate that our jobs or school usually push us so hard that it is hard to not be stuck sitting for a long time. I have fibromyalgia that developed after a car accident so like one of the girls in the article, it also hurts for me to sit (or stand still) for a long time. I am lucky, however, that my job requires that I remain standing and moving most of the time which for me reduces the pain. I think a healthy balance of both is key. If you have a desk job, don’t let it rule your health! Even a raise can’t make up for the cost of having a chronic disease! Spare a few minutes to stretch and walk around and the desk exercises and grip strengtheners you mentioned are handy tools too to burn kcalories and deter muscle cramps. There are also certain stretches you can do at your desk so you won’t necessarily have to walk away and some, you may not need to get up either (although, you probably should). Stretching will help you feel better, prevent cramps and increase blood flow.
[STUDENT 3:]Ali, I agree that Mr M has to exercise more but the changes he has to make have to be drastic. Exercising at his desk is great but he will need to be doing alot more to lose enough weight to be in the healthy bracket. Mr M has to combine a healthy balanced diet with regular exercise. I would suggest a personal trainer or at least a gym membership.
Please Join In
Please continue these discussions by adding your comment below.
