Weightloss

Can Mindful Eating Promote Behavior Change?

Can Mindful Eating Promote Behavior Change?

Mindful eating can help reduce automatic and emotional eating.

Inattentive eating, sometimes referred to as automatic eating, is a learned behavior. Automatic eating occurs when we eat around mealtime, even in the absence of hunger. We are also at risk of automatic eating when we see food or have it readily available at arm’s length, e.g., the tempting candy bowl on a colleague’s desk or your coffee table.

Automatic eating also manifests as emotional eating, wherein one uses food as a way to cope with depression, stress, or sadness.3 When food is used as a coping mechanism to manage elevated states of negative arousal, it is likely to become habitual and automatic. This begs the question, what can be done to mitigate one’s automatic impulse to eat driven by habituation to mealtimes and easy access to food, particularly since obesity has been identified as the second leading cause of preventable death is associated with increased risks for type 2 diabetes and cardiovascular disease?

While successful weight loss can be achieved through traditional approaches such as diet and exercise, integrative approaches, or complementary approaches, have also been shown to support successful weight loss. Recent research suggests that integrating mindfulness-based interventions, such as mindful eating, may help promote behavior change in the context of eating behaviors and mitigate automatic and emotional eating.

Integrating Mindfulness and Mindful Eating into a Weight Loss Program

Mindfulness is defined as purposeful and non-judgmental attention to the present moment. Mindful eating, a form of mindfulness is an approach to food that is characterized by paying purposeful attention to our food, and it can disrupt automatic responses to food and inattention to emotional triggers that precipitate a habituated response to satisfying food cravings. Mindful eating has been reported to increase one’s sensitivity to hunger and satiety cues as well as one’s food environment, eating pace, and characteristics of the food being consumed. Mindful eating purposely directs our attention to the activity of eating and helps bring conscious awareness to the task of eating, which can mitigate habituated responses to food.

A recent review of studies that included mindfulness-based interventions centered on mindful eating found strong support for integrating mindful eating into weight loss programs. Although the research in this area is still new, compared to the body of research on traditional diet and exercise approaches to weight loss, consideration of integrating mindful eating practices into a weight loss program is warranted.

— By Dawn M. Sweet, Ph.D


How Does Weight Affect Joint Health?

How Does Weight Affect Joint Health?

Losing weight can reduce knee pain and improve the kinematic function of the knee. It is estimated that nearly one-third of adults with obesity have arthritis. Patients with obesity are at an increased risk of developing knee osteoarthritis because of the increased load placed on their knee joints. For example, a common estimate is that for every one pound of body weight, your knees experience the force of three pounds of pressure each time you take a step. This means that losing just 10 pounds will yield a 30-pound decrease in pressure on your knees for each step taken. For patients with obesity, an elevated joint load can lead to knee osteoarthritis, which is accompanied by gait alterations and can further affect pain.

The discomfort associated with knee osteoarthritis can interfere with daily mobility, making it more challenging for patients with obesity to supplement weight loss efforts with physical activity such as walking. The Arthritis Foundation and the American College of Rheumatology consider walking to be a safe and effective form of exercise to promote weight loss for patients with obesity. To preserve quality of life and facilitate weight loss, it is important for patients with obesity to lose weight before knee pain caused by osteoarthritis restricts physical activity and gait alterations cause additional pain.

Knee Osteoarthritis, Weight and Gait

A 2019 study investigated weight loss on knee joint kinematics in a participants aged 25 – 60 with a BMI ≥ 35 and self-reported stiffness, knee pain, or aching in their knees for the previous 30 days. Those with diagnosed rheumatoid arthritis, previous or upcoming knee surgeries were excluded. Participants had either bariatric surgery or prescribed dietary medications such as phentermine, lorcaserin and a total daily energy intake of 1200 – 1500 k/cal and 1500 – 1800 k/cal for women and men respectively. They followed a high protein/low fat diet with meal replacements and were instructed to walk twice per week for at least 30 minutes.

Knee pain was evaluated using a self-report visual analog scale (VAS; 0 – 100) and a 3-Tesla MRI. The MRI images were segmented, and participant-specific 3D models were built. A fluoroscopic imaging system captured knee motion while participants walked on a treadmill at 1.5mph. Knee kinematics such as flexion-extension, adduction-abduction, internal-external rotation, anterior-posterior translation, medial-lateral translation, and superior-inferior translation were calculated.

Results suggest that knee pain was less at the one-year follow up and that the amount of weight loss was associated with an increase in the range of motion in flexion-extension and a decrease in adduction-abduction excursion. The authors note that the weight loss percentage was associated with reduced VAS self-report pain though the change in pain was not associated with kinematics. Overall, the results are promising and suggest that weight loss can modify knee kinematics, with greater weight loss being associated with greater kinematic change.

Losing Weight Reduces the Load on Knee Joints

For patients with obesity, losing weight reduces the load on their knee joints while improving their kinematic function. Because physical activity, especially walking, is a key component to maintaining a healthy weight and living an active lifestyle, health care providers should work with their patients to develop a weight loss strategy that meets their needs. To jumpstart weight, with the goal of helping patients become more active, a Low-Calorie Diet (LCD) or Very Low-Calorie Diet (VLCD) that is tailored to the specific needs of patients with obesity should be considered. When the pain and discomfort from knee osteoarthritis is reduced, patients can begin introducing new forms of low-impact activities into their weight loss program. Weight loss is effective in decreasing joint pain as well as improving kinematic function in patients with obesity and knee osteoarthritis.

— By Dawn M. Sweet, Ph.D


What Are the Common Side Effects of Semaglutide (GLP-1) Meds?

What Are the Common Side Effects of Semaglutide (GLP-1) Meds?

Although GI issues are commonly reported side effects of semaglutide (GLP-1) medications, there things you can do to help patients reduce and manage them.

Although semaglutide medications such as Ozempic and Wegovy are helping patients with obesity and type 2 diabetes to lose weight, there are some side effects of semaglutide medications that can have an impact on a patient’s nutritional needs. For example, side effects include gastrointestinal issues such as nausea, diarrhea, vomiting, boating, and stomach paralysis. Because proper nutrition is crucial during active weight loss, the quality and type of calories consumed should be a key focus.

Side Effects of Semaglutide

Semaglutide is a GLP-1RA and can be taken subcutaneously or orally, which is unlike other drugs in this class. Side effects are of course common with many medications and semaglutide medications are no different. Subcutaneous and oral semaglutide were compared in one part of phase 2 trials with patients being randomized into 5, 10, 20, or 40 mg once daily oral semaglutide doses and 1mg once weekly subcutaneous semaglutide doses. GI events were similarly observed in both the 20mg oral and 1mg subcutaneous doses, with GI side effects observed in 56 percent and 54 percent, receptively. Nausea (34 percent and 32 percent), vomiting (16 percent and 9 percent), and diarrhea (20 percent and 14 percent) were observed in oral and subcutaneous doses. Patients in the 20mg oral semaglutide treatment group in this part of the phase 2 trial had a higher dropout rate (27 percent) compared to the 1mg subcutaneous treatment group (14 percent). Adverse GI events when doses for both the oral and subcutaneous doses were increased, though when the dose was increased to 40 mg in two weeks 77 percent of patients experienced adverse GI events compared to only 54 percent of patients in the eight-week dose escalation group.

Helping Patients Mitigate the Side Effects of Semaglutide

Semaglutide medications such as Wegovy and Ozempic suppress one’s appetite, contributing to as much as a 45 percent decrease in caloric intake. Because the GI events noted above can put patients at risk for nutritional deficits, it is important to consider the role of nutrition while patients are on an anti-obesity medication, so working your patients to develop a healthy eating plan will play a crucial role in their weight loss success and overall well-being.

Educating patients on the importance of consuming nutrient-dense foods like lean proteins for lean muscle mass preservation and non-starchy vegetables and fruits to help meet recommended dietary allowances can help them make informed food choices. Nutritionally designed shakes/beverages help patients maintain a healthy caloric intake, stable blood sugar levels throughout the day, and a balanced and nutritious diet. Nutritionally designed shakes/beverages have the added benefit of reducing GI side effects and should be considered as part of patients eating healthy plan while on anti-obesity medications. To ensure nutritional needs are being met, pre-packaged, nutritionally designed shakes/beverages offer convenience and satisfy daily recommendations for vitamins and minerals.


Semaglutide, Tirzepatide, & Dulaglutide: How do They Stack Up?

Semaglutide, Tirzepatide, & Dulaglutide: How do They Stack Up?

Semaglutide, tirzepatide, and dulaglutide achieve similar results and have similar mechanisms of action, so the choice often comes down to preference and tolerability.
Glucagon-like peptide-1 receptor agonists (GLP-1) medications are used to treat patients with type 2 diabetes and obesity. GLP-1 medications such as semaglutide, tirzepatide, and dulaglutide help control blood glucose and appetite. The newest of the three is tirzepatide, approved by the FDA in 2023. Its notable difference is that it works on both GLP-1 and glucose dependent insulinotropic polypeptide receptors (GIP).

Research shows that semaglutide, tirzepatide, and dulaglutide are each efficacious in lowering HbA1c and body weight, and the newer once-weekly injectable tirzepatide has shown similar weight loss results as semaglutide. The SOURMOUNT-1 trial, however, found that reduction in baseline weight of 15 percent, 19.5 percent, and 20 percent at 72 weeks with the 5mg, 10mg, and 15mg doses of tirzepatide surpassed the performance of semaglutide; it’s also reported that tirzepatide resulted in greater weight loss than dulaglutide, which is good news for patients because of its recent FDA approval for weight loss.

Because semaglutide, tirzepatide, and dulaglutide produce similar results in the context of type 2 diabetes and weight loss, the choice regarding which medication to prescribe comes down to preference, patient tolerance, cost, administration (oral or injectable), and patient responsiveness. For a general overview of each medication contact the BioDezyne Center of Victoria, LLC.

Implications for Clinical Practice: GLP-1s as Adjuncts to Diet and Exercise

Commonly reported side effects of GLP-1 medications include gastrointestinal events such as bloating, nausea, vomiting, and diarrhea. To offset the side effects and to ensure nutritional needs are being met, supplementing patients’ diets with nutritionally designed meal replacements for patients prescribed GLP-1 medications warrants consideration. Supplementing patients’ diets with nutritionally designed meal replacements can help patients ensure they are consuming the RDA for vitamins, minerals, protein, and fiber while also helping them manage the GI side effects of GLP-1 medications.

In addition to the GI side effects, patients can lose muscle mass quickly when food consumption is reduced. Loss of lean muscle mass can adversely affect major organs of the body; most importantly, muscle is metabolically active, requiring energy to sustain itself. When one has more lean mass, their resting metabolic rate is increased, which translates into an increase in the number of calories being burned. In short, more lean mass results in higher energy expenditure because of the increased metabolic rate.

To ensure nutritional needs are being met, pre-packaged, nutritionally designed shakes/beverages offer convenience and satisfy daily recommendations for vitamins and minerals. Nutritionally designed shakes/beverages have the added benefit of reducing GI side effects and should be considered as part of patients eating healthy plan while on weight loss medications.