Last updated 10/14/23

Contents

• Background
• Diet
• General principles
• Calculating a Calorie Deficit
• Physical activity
• General principles
• Misc. Block Types
• References

Background

The management of obesity has (at least) four key pillars:

1. Diet
2. Physical activity
3. Medications
4. Surgery/ Procedures.

There are multiple contributing factors that intersect with these pillars, including stress, sleep, and mood. Of the four core pillars, Miga clinicians are currently focused diet, physical activity, and medications, though supporting consumers in preparing for procedural management is something that we will likely explore in the future. Clinicians should be familiar with the procedural management of weight loss and understand when to refer.

This document covers some basic information on diet and physical activity, as it will be important for clinicians to address these topics with consumers. We plan to further develop our resources in these areas in the future as well as to build out our approach to lifestyle programming that will be led by Miga dietitians.

Diet

General principles

Some general principles on diet include:

• It is important to create a caloric deficit
• Adherence, not type of diet, is the best predictor of weight loss in studies
• Encourage patients to try a low-calorie diet they can stick with - some may prefer “low-carb”, others “low-fat”, and others “high-protein”
• There is no convincing evidence that a low-carb vs low-fat diet is better
• Adequate protein intake (along with resistance training) is important in order to preserve lean muscle tissue during caloric deficit
• No less than 1g protein per kg body weight (unless kidney disease present)
• Co-morbidities can also guide dietary plans:
• The DASH diet and Mediterranean diet have the best data for CV risk reduction
• A low glycemic index diet can be helpful in diabetes and prediabetes
• Ultra-processed food consumption leads to higher caloric intake, so consumers should be encouraged to eat as many “whole foods” as possible

Calculating a Calorie Deficit

• 1 lb = 3500 kcals
• In order to lose 1 lb per week, it is necessary to have a 500-750 kcal/day deficit below total energy expenditure (TEE)
• The Mifflin-St. Jeor equation is the most accurate TEE estimate in patients with obesity
• Subtract -250 to -500 calories from Mifflin calculation to achieve weight loss of 0.5 - 1 lb/wk
• Meagan’s Mifflin-St. Jeor calculator here

To calculate Mifflin REE free hand:

• Calculate REE
• Adult female: (10 x wt in kg) + (6.25 x ht in cm) - (5 x age in years) - 161
• Adult male: (10 x wt in kg) + (6.25 x ht in cm) - (5 x age in years) + 5
• Multiply REE values from above x AF to get TEE

	BMI >25
Sedentary	1.0-1.1
Lightly Active	1.1-1.2
Moderately Active	1.2-1.3
Highly Active	1.3-1.4

• Subtract -250 to -500 kcals from TEE to achieve weight loss of 0.5 - 1 lb/wk

Physical activity

General principles

• Decrease sedentary behavior - move more and sit less throughout the day
• Some physical activity is better than none
• The 2018 Physical Activity Guidelines for Americans from the US Department of Health and Human Services recommend:
• 150 to 300 minutes of moderate-intensity physical activity per week; or
• 75 to 150 minutes of vigorous-intensity aerobic physical activity per week; and
• ≥ 2 days a week of muscle-strengthening activities (resistance training) involving all major muscle groups
• Importantly, mortality benefits of cardiovascular/aerobic fitness occur across BMI levels:
• This is important to convey, as some people may be discouraged that cardiovascular health is out of reach if they are obese, but this is not true

Misc. Block Types

References

1. Mozaffarian D, et al. "Heart Disease and Stroke Statistics-2015 Update: a report from the American Heart Association." Circulation, 2015.
2. Estruch R, et al. "Primary Prevention of Cardiovascular Disease with a Mediterranean Diet." New England Journal of Medicine, 2013.
3. Myers J, et al. "Exercise and Cardiovascular Health." Circulation, 2003.
4. Shiroma EJ, Lee IM. "Physical Activity and Cardiovascular Health: Lessons Learned From Epidemiological Studies Across Age, Gender, and Race/Ethnicity." Circulation, 2010.
5. Mozaffarian D, et al. "Heart Disease and Stroke Statistics-2015 Update: a report from the American Heart Association." Circulation, 2015.
6. Estruch R, et al. "Primary Prevention of Cardiovascular Disease with a Mediterranean Diet." New England Journal of Medicine, 2013.