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19.01.2015
It seems that almost everyone is seeking out information about the ketogenic diet guidelines these days. Bodybuilders tend to utilize this diet for its many benefits when it comes to managing weight.
Maybe you want to learn more about the ketogenic diet guidelines to figure out if this style of eating is ideal for what you want to achieve. Keep in mind that this diet is very low in carbohydrates and high in protein which places your body into a state of ketosis. When there are very little carbs available, the liver converts fat into fatty-acids and ketones. When there are elevated levels of ketones in the blood, the body has reached a state of ketosis which helps reduce the frequency of epileptic seizures. This is the reason that the diet has become popular with many people who want to know more about the ketogenic diet guidelines to manage their weight. While some of these possible side effects are not a huge concern for many, they make it even more important to consult with your physician prior to starting this diet. Some people do not like the possible risks involved with minimizing their carbs to such a low amount.
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Although keeping a properly balanced diet and eating healthy is often puzzling, you can gain success. We will give you some excellent tips to attain you in achieving success in your weight loss.
This means you don’t need to worry about lowering of metabolism as well as about any other health issues. Breakfast (Spinach and cheese omelette): one cup spinach, one ounce Swiss cheese, 2 large eggs, one muffin, one orange. Lunch(Honey mustard chicken pita with cucumber salad): 3 oz grilled sliced chicken, one whole grain pita, ? cup baby spinach, ? cups sliced cucumber, 2 tbsp. Dinner: South Pacific Shrimp, Warm beet and spinach salad, ? cup cooked couscous, one whole wheat roll, 1 medium peach.
Dinner: chicken breasts with mushroom sauce, one cup cooked brown rice, ? cup steamed asparagus, broiled mango.
1800 ADA (American Diabetic Association) diet menu plan recommends an effective and healthy diet that is balanced in calories, dense in nutrients and low in fat and sodium.
Due to ADA recommendations, carbohydrate servings should be evenly distributed throughout the day.
Lunch: Ham and veggie pita (? wheat pita, 3 ounce turkey ham, 5 sliced cherry tomatoes, 1 tbsp. If you are diabetic, you need to avoid such foods as: candies, cookie, cake, granola bars, ice creams, pastries, jelly and jam, sugar covered cereals, sodas, colas, sweet rolls, etc. Approximately one-third of the US population is obese, and that number has grown over the last 20 years [1]. The purpose of this paper is to guide providers on incorporating obesity treatment into their practice using the 5As model for obesity counseling. There are few studies that have examined the efficacy of using the 5As for weight management in patients.
We believe that the 5As is a useful model that highlights the skills needed to provide high-quality, behaviorally based obesity counseling. Before assessing current diet and exercise behavior, the provider should ask the patient about history of weight loss attempts, successes, and circumstances.
In the next part of the assessment, the health care professional elicits information from the patient regarding current dietary and exercise habits. The primary care physician advises specific behavior changes and timing based on the patient’s individual obesity risk factors, as described in the “advise” section of Table 1.
The primary care physician should then probe the patient for his or her goals and break down long-term weight loss goals into behaviorally specific short-term goals. Generally, dietary advice should be focused on making lower-calorie choices in the form of small changes that are sustainable. We recommend 2 strategies for providing dietary advice: the SERVE method and the plate method.
SERVE is a useful mnemonic developed at our institution to train resident physicians, but its effectiveness for obesity counseling has not been studied.
The plate method is an uncomplicated way to control portion sizes that was originally developed for nutritional counseling in diabetic patients. Meal replacement options have been found to be an effective management strategy as well, as noted in a 2003 meta-analysis [42]. It should be noted that intensive physical activity alone does not reliably lead to (or promote) weight loss. It is also important to establish that goals should be set as a commitment to long-term lifestyle changes that they will maintain.
There are many tools available to help guide this process including the plate method as mentioned above, portion control and monitoring, and dietary and exercise monitoring tools [43]. While this may be one of the most useful of the 5As, it is one of the least practiced parts of the 5As model [49,50].
For some patients, important barriers must be addressed prior to committing to intensive weight loss efforts.
While many patients would like to lose weight, they may be ambivalent about change or lack confidence. The primary care physician can probe the patient’s underlying ambivalence about weight loss or maintenance by then weighing the interest and confidence against one another, as was noted in the Assess section above. When a primary care physician assesses motivation and confidence, they can go one step further and actually develop discrepancy. The health care professional and patient must arrange for close follow-up to promote effective weight loss as well as referrals. Within the construct of CMS-reimbursed weekly and biweekly visit schedule, the first visit should focus on assessment, agreeing on a weight loss goal, and having the patient keep a food and activity diary.
One may advise and assist or even arrange depending on where the patient is on the stage-of-change continuum.
In general, behavioral counseling for obese patients can produce modest, though still clinically significant, long-term weight loss. The USDA just announced the replacement of the Food pyramid we’ve all come to know and love for so many years. And here’s the original food pyramid introduced in 1992 by the USDA, and replaced last week. 1) find your daily basal calories requirement with the basal calories requirement calculator below.
2) If you do any exercises like walking or running during the day, use the activity calories calculator below to find out how many extra calories you have burned by walking one hour for example.
Add this to your daily basal calories requirement and you will get your total daily calories burned. The daily basal calories requirement calculator below shows your daily calories requirement in regards to your weight, age, gender and activity level. Calories burned during sleeping and watching TV and other low calories burning activities is part of our daily Basal calories burned.
If you purchase items through my links I will earn a commission that helps support this website. It is essential to consult with your health care provider before changing your nutrition plan. The ketogenic diet guidelines include foods high in fat, high in protein, and low in carbohydrates. Normally, the body converts carbs into glucose which is important for fueling brain function.
While all of the benefits seem to make the diet a no-brainer for some folks, the possible side effects cannot be ignored. In fact, many people sabotage their diets because they crave their favorite foods and no longer want to deny themselves.


My name is Eartha and I enjoy learning and writing about all things health and fitness related.
The main problem is that we often don’t know what portions and serving sizes of food are allowed. 1800 caloric range offers a wide variety of healthy food safe and easy to carry out on you own. Get yourself through the week with our healthy 1800 calorie meal plans without ruining your diet. Consistent eating throughout the day will help you to improve diabetes medications’ efficacy. However, whether you are aiming at losing your weight or controlling diabetes, correct meal planning is a solution. Several studies have suggested that physicians and other providers do not adequately counsel obese patients about their weight because of barriers such as poor reimbursement, lack of obesity-related counseling skills, and lack of time. Several large trials of lifestyle interventions have shown that sustained weight loss is achievable and that even modest weight loss (ie, 5% to 10% loss of body weight [2]) is clinically beneficial. Specifically, primary care physicians will be reimbursed for weekly visits for the first month and then every other week for months 2 through 6.
This model guides the provider to assess risk and readiness to change, advise specific behavior changes, agree on specific goals in a collaborative manner, assist via addressing barriers (motivational interviewing), and arrange to follow-up or refer the patient for further treatment. In a pilot study examining the use of 18 counseling practices related to the 5As, obese patients (n = 137) reported on the use of the 5As by primary care residents (n = 23).
Here we will outline the content of each of the 5As as adapted for obesity counseling skill development. As outlined in the “assess” section of Table 1, the health care professional’s initial task is to evaluate obesity risk, motivation to lose weight, history of weight loss efforts, current dietary and exercise behavior, and current expectations of medically supervised weight loss.
It should be recognized that certain major life events (recent move, new job, divorce, recent loss) might preclude commitment and attention to weight loss. A healthy weight loss goal is defined as on average no more than 1 to 2 pounds of weight loss per week or 5% to 10% weight loss in the first 6 months [2]. Low-fat, low-carbohydrate, and Mediterranean-type diets have been heavily promoted, but their effectiveness has yielded mixed results [22–24]. The first is based on the mnemonic “SERVE” that provides rapid assessment of habits that may be high-yield for change. There are several commercially available products (typically shakes or snack bars) that can be used as meal replacements though there are no high-quality comparative effective analyses to determine which types are best. However, exercise has been shown to be an effective weight maintenance measure and helps improve overall health.
For example, “I would like to walk more” is far less likely to be achieved than “I would like to walk 20 minutes, 5 days per week with my dog after work and I will record my progress in an exercise diary until our next visit.” It is most realistic to choose only 1 to 2 specific goals, and these may be small behavior changes rather than sweeping lifestyle changes.
We suggest that it is important that that providers document goals both in the electronic medical record and on a prescription for the patient to take home, with the expectation that they will be asked about these goals at the following visit.
Many of these tools can be used iteratively for assessing, advising, assisting and agreeing. As noted in Table 1, the primary care physician assists in addressing barriers with the patient and securing support. Motivational interviewing can address these barriers and has been shown to enhance the effectiveness of weight loss interventions [51,52]. For example, “I hear you that your interest in losing weight is a 10 and your confidence is a 6. In other words, change can be motivated when there is a discrepancy between a patient’s current behavior and his or her goals and values (eg, “I noticed that you say you want to lose 20 pounds but at the same time have been eating fast food because it is easier with your busy schedule”). Patients lose significantly more weight when they are part of an intensive lifestyle intervention as compared with standard of care; per recent CMS recommendations, primary care physicians who cannot perform intensive counseling should refer to more intensive programs. Much of the assessment can be done during a first visit as part of general history and physical exam.
Despite the paucity of studies examining the efficacy of the 5As in promoting weight loss, we believe that the 5As is a practical model for approaching obesity counseling. Goldstein MG, Whitlock EP, DePue J; Planning Committee of the Addressing Multiple Behavioral Risk Factors in Primary Care Project.
The practical guide: Identification, evaluation and treatment of overweight and obesity in adults.
Michelle Obama is a huge supporter for healthier eating habits for Americans and was there to push the new FOOD PLATE (MyPlate) on America this week. Studies shows that uncontrolled diabetes may leads you to organ damage, sometimes heart disease, stroke, vision loss, kidney failure at last death. It is a diet often prescribed by doctors to help treat difficult to control epilepsy in children. However, she did say she ended up with gall stones as an effect of high ketones in her system. Carbs, proteins, fats and calories are balanced providing optimum nutrition to the patients with diabetes. With correct diet meal plans controlling blood glucose levels and losing your weight can be easy and enjoyable.
The 5As (Assess, Advise, Agree, Assist, Arrange) is an evidence-based, behavior-change counseling framework endorsed by the Centers for Medicare and Medicaid Services and the United States Preventive Services Task Force. Primary care physicians are ideally situated to promote weight loss via effective obesity counseling. Given the efficacy of weight loss interventions and the potential remuneration for frequent visits, primary care physicians should be comfortable providing basic weight management counseling for their patients. Furthermore, we will discuss how to complete the 5As in a time-efficient manner while recognizing that in a busy primary care practice addressing all the “As” can be done over several visits.
For a continuity visit, the past medical history and active comorbidities are usually known; the body mass index (BMI) can be calculated at triage.
Overweight status is defined as a BMI in the 25–29.9 range and obese status is 30 or greater [19]. Anecdotally, many patients who have attempted to lose weight using fad diets or extreme calorie restriction may initially be successful but then often regain the weight several months later. One option may be to ask the patient to recall everything he or she ate in the last 24 hours, including drinks and condiments. Therefore, a specific diet should be guided by patient individual preferences and comorbidities with an emphasis on lifestyle changes. The other half is subdivided, with starchy foods (bread, rolls, cereals, potatoes, beans) taking up ? of the plate and protein (meat, fish, soy, cheese) the other ? of the plate. Consideration such as price, taste, and clinician and patient preference may guide selection. The health care professional and patient agree and set specific behavioral goals for weight loss. Assist may also involve prescribing weight loss medications, using meal replacements, or referring for bariatric surgery evaluation.
A focus on stress management techniques and stimulus control may improve compliance with dietary and physical activity changes. It is a patient-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence [53].
The physician emphasizes small steps as successes such as taking the stairs or coming to appointments even if the patient has failed to lose weight.
The second visit could incorporate reviewing the food diary, agreeing on goals using the SERVE or plate method, and assisting in addressing barriers.
All in all, obesity counseling using the 5As is an iterative process in which the physician uses the 5As repeatedly over time with the patient (Table 2 and Table 3). In this paper we reviewed the evidence for and concrete day-to-day use of the basic components of the model. A randomized trial of a brief multimedia intervention to improve comprehension of food labels. Physicians’ attitudes about obesity and their associations with competency and specialty: a cross-sectional study. Weight loss through living well: translating an effective lifestyle intervention into clinical practice.


Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. Provider feedback to improve 5A’s tobacco cessation in primary care: a cluster randomized clinical trial. From the patient’s perspective: the impact of training on resident physician’s obesity counseling.
Physicians’ use of the 5As in counseling obese patients: is the quality of counseling associated with patients’ motivation and intention to lose weight? An electronic linkage system for health behavior counseling effect on delivery of the 5A’s. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial.
Meta-analysis: effect of exercise, with or without dieting, on the body composition of overweight subjects.
Implementation and assessment of a spiritual history taking curriculum in the first year of medical school. Changes in intake of fruits and vegetables in relation to risk of obesity and weight gain among middle-aged women. A prospective study of fruit and vegetable intake and the risk of type 2 diabetes in women. Goal setting as a strategy for dietary and physical activity behavior change: a review of the literature.
Weight management using a meal replacement strategy: meta and pooling analysis from six studies. Goal setting frequency and the use of behavioral strategies related to diet and physical activity.
Use of the Patient Assessment of Chronic Illness Care (PACIC) with diabetic patients: relationship to patient characteristics, receipt of care, and self-management. Effects of counseling techniques on patients’ weight-related attitudes and behaviors in a primary care clinic.
Four-year weight losses in the Look AHEAD study: factors associated with long-term success.
Achieving weight and activity goals among diabetes prevention program lifestyle participants. Comparison of methods for delivering a lifestyle modification program for obese patients: a randomized trial.
Above is my cartoon version of the cartoon Myplate , and below is the real new myplate food pyramid replacement.
To lose weight you can also choose to BURN more calories either by doing more exercise OR by choosing a fatburning diet, look below.
They have longitudinal relationships that enable rapport building and behavioral change management with a large percentage of the population, and are experts in managing chronic diseases and health conditions.
The 5As model, initially found to be effective when used by primary care physicians to promote smoking cessation [11], has since been adapted for use in obesity counseling training for primary care physicians and has been found to promote physician obesity counseling competence [5,12–14]. In general, weight loss should be recommended to all patients with a BMI greater than 30 and those with a BMI 25–29.9 who have 2 or more risk factors for cardiovascular disease.
This observation can be pointed out to the patient later on as a way of supporting the idea of sustainable, gradual weight loss. While this might not reflect what the patient typically eats, it does provide a detailed starting point for further discussion.
Rather than focusing on diets, which many patients cannot sustain, the approach should be to promote goal setting around changes that patients can maintain for the rest of their lives.
Meal replacements can be used to substitute for one or more meals but we do not recommend that clinicians advise patients to use meal replacements exclusively (ie, a liquid diet) without further training in how to monitor such patients safely. Physical activity should be increased slowly from the patient’s baseline level in order to avoid injuries. Current goal setting theory, much of which is derived from the occupational psychology literature, states that to maximize goal attainment, behavior change goals should be specific, proximal, and set collaboratively with the provider [45–47].
While nonbehavioral obesity treatments are beyond the scope of this review, they should be offered in conjunction with high-quality counseling. Patients should develop a habit of self-monitoring, which has been shown to be one of the most commonly reported strategies for long-term weight maintenance [43]. Evocation, one of the core principles of motivational interviewing, involves eliciting the patient’s rationale for change rather than stating the physician’s rationale.
For many patients struggling with weight loss, their ambivalence may relate to the burden of constant vigilance rather than whether weight loss is necessary.
For patients who do not achieve a weight loss of at least 3 kg during the first 6 months of intensive therapy, it is appropriate to reassess BMI and readiness to change after an additional 6-month period. Subsequent visits should involve monitoring goals and assisting and arranging for more intensive services, if necessary. Behavioral counseling in primary care to promote physical activity: recommendation and rationale. The United States Preventive Services Task Force (USPSTF) recommends that primary care providers screen patients for obesity and offer intensive behavioral treatment [3]. The model is also useful as a clinical reminder in an electronic medical record [15]  and may impact patient outcomes in physician training in graduate and continuing medical education [13,16,17].
For overweight patients without risk factors or those who cannot undergo weight loss, efforts should be focused on weight maintenance or prevention of further weight gain [20]. Another approach might be to have the patient describe a typical day, with attention to typical foods chosen for each meal as well as daily activities and routines. It may be helpful to start by asking patients how they think they could improve their diet and allow the response to guide the discussion.
Drawing the plate or providing a picture offers a meaningful visual reference for the patient on portion size. A long-term goal of at least 30 minutes of moderate intensity activity on most, preferably all, days of the week is appropriate for all adults. This includes keeping food diaries, logging exercise time, and frequently monitoring weight. The underlying philosophy is that human beings are generally ambivalent about behavior change. Successful models include a combination of weekly group visits, monthly individual sessions, and frequent use of self-monitoring tools like food diaries [54,55]. This model guides the physician to use a collaborative, patient-centered approach to behavior change while respecting patient autonomy.
However, the literature reveals that primary care physicians may lack confidence and competence in managing obesity [4], largely due to lack of systematic counseling skills [5], negative attitudes [6], and lack of time [7,8].
Finally, patients can be asked to keep a more prolonged daily dietary and exercise log [20] that can be reviewed at the next visit. The plateau is an expected part of medical weight loss that patients should be anticipating. Individual follow-up appointments consist of a reiteration of 5As, specifically focusing on barriers to meeting goals and setting new goals. With any of these approaches, attention should be paid to eating patterns (regular meals including breakfast), methods of food preparation (home-cooked vs. The data regarding the efficacy of the plate method for weight loss counseling in a primary care setting is limited. Activity logs should include information about activity performed, time spent doing activity, and intensity.
In brief, there are several key skills that may help in exploring and managing the patient’s ambivalence to change. Once patients reach their weight loss goals, the focus shifts to weight maintenance using the 5As. A small pilot study that included 65 primary care patients randomized to a portion control plate versus standard patient education handouts showed improve weight loss at 3 months in those patients using the plate [41].



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