Nutrition Assessment • Screen patient history for presence of other risk factors of cardiovascular disease and metabolic syndrome, such as blood glucose level, hypertension, smoking, hyperlipidaemia. • Complete the ABCDEF approach, by focusing especially on: • Assess body weight history and compare to current body weight and healthy weight references • Investigate possible causes of overeating i.e. stress, depression and anxiety • Review dietary intake, meal size and meal timing (1) • Assess the stage of change • Lifestyle behavior change such as exercise. Nutrition management • Emphasize the relationship between overweight/ obesity and other risk factors such as cardiovascular disease, diabetes and other metabolic complications • Gradually wt. loss 1-2 kg per month • Provide necessary follow-up based on presence of additional risk factors of cardiovascular disease and metabolic syndrome. • Encourage client to commence light aerobic and resistive exercise (2, 3) • Referral to medical for further investigation of physiological, medical and biochemical causes of overweight and obesity • Referral to other services such as counseling, psychology and social services for investigation and management of depression, stress and anxiety as required. Eating Behavior Strategies • Don’t skip meal but reduce the portion or amount of food, especially Dinner • Keep balance & variety in diet; Healthy eating guideline • Drink more water • Regular exercise at least 30 minutes, 3 times/week Lifestyle Modification Strategies Setting Easy-To-Achieve Short-term Goals - Increase number of minutes of walking on weekends - Include one fruit at Lunch Self-Monitoring - Food and activity records - Regular weigh in (i.e., daily or weekly) Stimulus Control - Shop when not hungry and with a grocery list - Make eating a singular activity (e.g., turn off the television) Confronting Barriers - Problem-solving steps - Planning ahead (e.g., healthful snacks on hand) Stress Management - Daily meditation or yoga - Progressive relaxation and visual imagery exercises Social support - Organized commercial support meetings or classes - Family, friends, co-workers as support systems Contracting - Realistic, simple, and achievable healthful goals - Useful for short-term change Modified from Foreyt JP: Need for lifestyle intervention: how to begin, Am J Cardiovasc 96:11E14E, 2005. TRCARC-SOP TRC.AI-EMR09-10-012 version 1.0 (Effective Date: February 19, 2010) Standard Operating Procedure for TRCARC Nutrition Service
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