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1. STAFF TRAINING MANUAL ua ww korr co CONTENTS 1 Introduction to Target Caloric Zones 2 Who needs training 3 Promoting Metabolic Testing 4 Understanding your patient 5 Performing the test 6 Presenting the results 7 Answering the difficult questions 8 Counseling the Patients 9 Keys to Success Ch1 Introduction Congratulations You are about to implement the most exciting weight loss program ever The Target Caloric Zones program combines the science of metabolic testing with good teaching principles behavioral reinforcements and life style changing strategies Now you may be wondering What did my boss get me into Not to worry This manual will walk you step by step through the process Before you Know it you will be an expert in Target Zones First of all it is important to Know that KORR recognizes and respects the expertise of medical professionals We re not here to tell you how to do your job The goals of this program are simple 1 Motivate patients to begin a weight loss program by offering a new and exciting service 2 Measure their Resting Metabolic Rate revealing unique information about what it will take for them to reach their weight loss goal 3 Provide the framework to teach the basic principle of burn more than you eat After that your expertise takes over You can implement any philosophy of nutrition and weight management you may have or you c2. H EA metabolic rate Although their effects are minor reathing in air from the room but the gas that you breathe out will go into the metabolic analyzer to measure your metabolic rate we suggest you follow the guidelines to get the 1 Relax and close your eyes during the test You best results possible The closer you are to resting deserve a break enjoy it d bi IT See Ham nea nee the more this test represents your resting state mouthpiece It is important that all the air you breathe out is analyzed 3 In just 10 minutes your metabolic rate will be measured and those results will be used to z calculate your Target Caloric Zones These Zones If patients push to know how much these things will be printed out in an easy to understand n Aae E ee will affect their metabolic rate the answer is that your metabolism to help you lose weignt there is no way to know Everyone is different just as everyone s metabolic rate is unique That s it Before you know it you ll be on the road to comfortable permanent weight loss 4 Ch4 Understanding your patients The weight loss patient is someone who may be quite different from those coming to your office with traditional illnesses They may feel hesitant or ashamed of themselves But they have taken the first step by coming in to your office It is now up to you to show them that you are there to help them 1 Make them feel welcome Approach them immediate
3. burns calories in 3 different ways each represented by one of the colored boxes on the scale RMR The largest box at the bottom of the scale is the measurement of their rest ing metabolic rate Show them that number and explain that is how many Resti calories they would burn in a day if AO a lt they did nothing more than sit in a 2114 Cals chair all day long Metabolic Measurement RMR is what we just measured your a Resting Metabolic Rate It shows us how many calories your metabolism burns at rest This is how many calories your body has to burn just to stay alive RMR represents the majority about 70 of calories you burn in a day This measurement ts not affected by activ ity or anything you do during the day 11 Lifestyle The number in the middle box uses their RMR to estimate how many more calories they burn doing regular daily ac tivities like making the bed walking around the office etc Point out to them Lifestyle that this is an area where they can really 422 lt increase the number of calories they eee burn Even small changes like taking the stairs instead of the elevator or park Resting Metabolic Rate ing on the far side of the parking lot can 2114 Cals add up to a great deal in this category Metabolic Measurement As Look at the large number of calories you can burn through lifestyle This isn t becoming a marathon runne
4. lose weight 4 How can I have a fast metabolism if I am this overweight When an overweight patient sees test results that are higher than average they may be very confused They assume fast means thin But metabolic rate reflects the activity of fat free mass Even if someone is fat they may still have a great deal of fat free mass The back of the ReeVue printout teaches about fat and fat free mass Some studies suggest that carrying around excess weight can increase muscle mass and others indicate overeating may cause a temporary increase in RMR The most important thing is to focus the patient on the positive Your metabolic rate measurement shows that the active cells in your body your organs bones and muscles are burning more calories than average This can be true for both thin people and overweight people alike The good news is that now we know that if you eat within this Weight Loss Zone you will be burning more than you eat You will lose weight 20 Ch8 Counseling the patient Hitting the TARGET At this point it is time to introduce patients to their eating plan You may already have one in place at your office Familiarize yourself completely with the program you are implementing You may consider practicing by using family members or co workers as test patients first Because Metabolic Testing is based on sound scientific principles it will complement any diet philosophy you may adhere to I
5. an use the program developed by KORR Eating To Your Metabolism the Target Zones Program The point is metabolic testing has drawn your patient through the first step of the weight loss process You now have their attention and you can truly help them change their lives Ch2 Who needs training ALL STAFF WEIGHT LOSS COUNSELORS PHYSICIANS Metabolic testing will generate a great deal of interest from current patients and new patients Anyone in your office may be called upon to answer basic inquiries Consequently we recommend that everyone in your office be able to explain the basics of how the test is done what information it reveals and why they should have it done Certain members of your staff will most likely be identified as those administering the test and counseling patients They should read this manual thoroughly as well as the Eating To Your Metabolism guide and the REEVUE user manual Physicians within your practice will want to read this manual to help them explain the results in the most time efficient manner The User Manual provides more details related to the technology and physiology of metabolism Ch3 Promoting the Test Korr has provided you with banners posters and brochures that will catch the interest of patients But remember this is a whole new thing for them Despite what they read most will still want to ask questions and talk to a real person It is important to be enthu
6. approximately 10 minutes the display will read test complete and the device will beep indicating that the test is finished Be sure to discard the breathing tube and mouthpiece after each use Patient data When the test is complete the device will ask if you would like to enter patient data If you would like to compare your patient s measurement to normal values and calculate their BMI press the button under the answer yes ee up Next enter their age height weight and gender Those A numbers are adjusted using the up and down arrows on the keypad To enter press the check mark in the center back menu Other menu options are available allowing physicians to view values such as VO2Q tidal volume check calibration etc But you can read more about those in the REEVUE all user manual Its Ch6 Presenting the Resu a t ing the patien i teaching l ted in a manner to Papara extra attention to inte i The test results are it the printout beforehand p fe ourself wi Familiarize y burn What you What you should eat 3 How do you compare r patient ining the test results to is anaes In e i a divided into 3 separa can fs f f Very low Calorie diets Should only be done f under Medical Supervision Supervision is N Medically required to ensure adequate Nutrition ang to UPerviseg Zone monitor and tre
7. at the 0 to 2225 Potential Slowing of metabolic rate Medically Superviseg Only Calories 7 Day 3539 Cals Total Energy Output Calories ri Day Energy Input ant to repeat the test ask ab St pr a lorie Te e Wilp the Cal oper eae to help you body Pr with aaa even help your body ht and wil eig lose wW appe control your ap What you BURN tite Mouthpiece Or i e Total REE Lifestyle Exercise Caregiver s Interpretation How d S your me abolism c Pare OMpared to a typical Person fae Of similar age height and Weight ur Metabolic te is Target daily calories r Nerana SLow FAST Next Test Date CAUTION you think You may not have Sealed your Nose or m ate a large me beforehand yo ay wi if you Xerciseq or Paration 10 the Predicteg value Og Z 3 2 8 Age 29 years E 2 o Gender Male o Height 183 cm 6 fto in Weight 103 kg 227 Ibs BMI 30 8 CAUTION Consult your Physician before Starting any weight loss or fitness Program ps of your s you lose increase walking ad ses that bui caregiver way Ingth es Inc logi echno f 1 conte Pending 10 1 What you burn Focus the patient on the left side of the scale Explain that their body
8. ate the excuse of a slow metabolism If they read normal or above you can approach it like this Wow Look at this Your metabolism is normal That s great Now all we need to do is focus on what you eat how much you are eating and start burning a few more calories lf they measure slower than normal consider saying This may explain some of your troubles in the past But now that we know what we re dealing with it we can really focus on getting your metabolism reved up and going again In either case repeated testing is recommended to monitor the affect your interventions are having on their metabolic rates Keep in mind that for the first month or two their metabolic rate may be pretty unpredictable as their bodies adjust to the changes 18 Ch7 Answering the tough questions 1 I can t lose weight eating this many calories Patients sometimes claim that they have been unsuccessful in the past eating at or below the same caloric intake recommended after their ReeVue test They can stubbornly stand by the belief that cutting calories won t work for them It is rarely successful to try to analyze whether or not they ve been truly compliant cutting calories in the past Your best approach may be to focus the patient on the present Im sure you ve worked hard at losing weight and you must be frustrated I m not sure exactly what was going on in the past But what we ve done today is test where you are tod
9. ay Simply put these results are your own body telling us how many calories it is burning right now If we listen to your body and structure your eating around what it is telling us you will lose weight 2 This machine must be wrong I know my metabolism is slow It is important to keep in mind that an RMR test may take away a patient s primary excuse for being overweight This may be a very difficult reality to face So gently but firmly reassure them of the medical accuracy of indirect calorimetry This is the same kind of testing used in the ICU on critically ill patients It is very accurate So while your metabolism may be slower than it used to be it is within a normal range for your age What is most important is that now we know you have a healthy metabolism and what it will take for you to lose weight 19 3 Upon re testing I did everything I was supposed to and my RMR went down What happened An individual s RMR is affected by many factors including lifestyle and dietary changes Some of those changes even healthy ones will decrease a metabolic rate at the same time that other behaviors are increasing it Consequently changes in RMR are impossible to predict and are not a measure of success or failure A measure of your resting metabolic rate simply indicates where you are not how good you ve been What it tells us is how we need to adjust your caloric intake to adjust for changes that occur as you
10. ay to burn extra calories and increase your rate of weight loss Total Energy Expenditure All 3 of these categories are added up at the bottom of the scale as a total energy expenditure TEE That is the total number of calories your client burns in a day Metabolic Measurement E ER Calories Day Energy Output 2693 Cals 13 2 What you should eat This side of the scale uses the RMR measurement to calculate 3 different zones The effect of eating within these caloric zones can be explained the following ways Medically Supervised Zone This zone shows the calorie range that is too low for most patients Not only is it hard to get the nutrients their bodies need but if their calorie intake drops this low their metabolic rate will proba bly slow down If their body perceives that they must be starving it will hang onto every last calorie instead of burn ing it Their bodies become very energy efficient making it hard to lose weight And with a slowed metabolic rate it is very easy to regain any weight lost even with normal eating Under the direct supervision of a physi cian individuals sometimes can diet successfully in this zone But it requires strict monitoring of nutritional status and metabolic rate 14 Medically Supervised Zone O to 1692 Medically Supervised Only gt Drastically cutting calories can trigger a stress response Wh
11. check on their progress take a repeat RMR test and give them encouragement According to the CDC people are 3 times more likely to lose weight when their physician is involved in the process Eating To Your Metabolism Plan Korr Medical has developed a simple plan to teach patients to plan their meals track their caloric intake and identify and eliminate destructive Zan eating behaviors The plan requires that patients keep a food journal which is shared with their physician or counselor each week Patients identify emotional eating patterns and develop alternative coping mechanisms They are encouraged to discuss their progress with a Support group It depends heavily on the expertise of the physician or counselors to evaluate and advise patients It requires no cost to the facility and is an inexpensive investment for the patient TARGET TRACKER DietMaster Pro Software Korr also offers DietMaster Pro a software based diet program Physicians and counselors utilize this software to assign meal plans to patients based on their Metabolic Rate Test The client software helps to create meal plans grocery lists and to track eating through food journals Each week their journals are e mailed to the physician s office for evaluation This program is a bigger investment for the facility but does not require experienced staff to manage it lt P Don t stress that you have to implement a complete weight loss program or become a w
12. eight loss doc in order to effectively help your patients who need to lose weight Studies show that patients are more likely to lose weight when their physician is involved Use Metabolic Testing as a baby step to get you patients involved in what is really going on in their body and to confront the changes they need to make to become healthier 22 Ch9 Keys to Success e Educate the patient People can t live principles they don t know Don t be judgmental Everyone feels that they ve fallen short sometimes The key is that your client needs to feel safe coming back to you even when they ve gotten off track Really listen You can learn a great deal about WHY your patient makes unhealthy choices if you really listen to what they are saying Help them become aware of their motivations o Have frequent contact Accountability increases the chance for success e Provide support Patients learn a great deal when they don t feel alone Weekly group classes are a great way to both educate and provide support e Include daily exercise with your program Encourage your patients Get them excited about the knowledge they have just gained Show them how long it will take them to reach their goal if they stick to their Zone Let them know you believe in their power to change their lives and will be there every step of the way They are truly on the threshold of a happier healthier life
13. en this happens your body releases chemicals and hormones that make it hard J to lose weight Don t think that starving yourself will get you to your goal faster It won t Tf your body thinks it is starving it tries to store fat LA not burn it Weight Loss Zone This is the magic number each client s own metabolic sweet spot Notice that the weight loss zone corresponds close ly to the RMR measurement Remember RMR is the number of calories a person needs to keep their body alive If patients consume the number of calo ries in this zone each day they will be satisfying their body s most basic needs With those needs met their body will be relaxed and satisfied We call eating to their metabolism But note that there are still calories be ing burned through lifestyle and exercise Those calories will tip the scale to the burn side allowing your patient to lose weight at a rate of about 2 Ibs a week this 15 Weight Loss Zone 1692 to 2114 Starvation Zone O to 1692 Medically Supervised Only a This range of calories is where you should eat in order to lose weight It is unique to you based 77 on your RMR measurement Your goal is to eat the most calories possible within your Weight Loss Zone Do this and you will lose weight By making good food choices you will find that you will have plenty to eat in your weight loss zone Y
14. f you have a diet program you believe in your initial obstacle may be getting the attention of your patients But after viewing their metabolic test results they have no more excuses and you have a captive audience You can show them that their metabolism is fine and that it is possible for them to lose weight Get them excited about the prospect then present to them your diet plan They ll be excited and ready to go If you don t have a weight loss program in place you may consider the following options available through Korr Simple Consult Some facilities want to offer something to their overweight patients but are not ready to add a complete weight loss program Korr produces a simple weight loss guide for this purpose called Hitting the Target This pamphlet reinforces the concepts of energy balance as shown through Metabolic Testing It also teaches how to track caloric intake reduce portion sizes attack emotional eating and change unhealthy behavior A sample of this brochure is provided with your ReeVue The concept of the 5 minute consult can also be incorporated with other weight loss programs or support groups that you may want to refer patients to For instance if your community offers American Heart Association s Fit for Life Overeaters Anonymous Weight Watchers or similar programs you can refer your patients to them But it is best if you can stay a part of the process by having them meet with you regularly to
15. feel kind of restrictive at first It s kind of like breathing through a snorkel or scuba diving All the fresh air you need will come in through this valve And if at any time during the test you need to take the mouthpiece out to swallow wet your lips or use a tissue that s OK It won t mess up your results Just make sure all your exhaled air goes right in here Hey relax It will get easier as you get used to it and before you know it your 10 minutes will be up Have the patient put the mouthpiece in first to get it comfortable It doesn t matter which way the valve is facing Then bend or adjust the hose to get it ina comfortable position before plugging it into the device Have her place the nose clip on to insure that all the expired air goes into the device Once she s comfortable just connect the hose to the box Testing The analyzer goes to work automatically as soon as the first breath is detected Just have your patient relax as much as possible with even breaths in and out that s all there is to it lt P e If the patient seems tense you can encourage them by saying Just close your eyes and relax e f noise seems to be an issue in your testing location you may consider headphones with quiet music e Watch them throughout the test to make sure they keep their lips sealed completely around the mouthpiece and that the display shows even breaths Don t talk to the patient during this time In
16. ly upon entering the facility They may feel very lost and uncomfortable in this environment Don t wait around for them to ask you for help 2 Offer to explain metabolic testing in more detail Most people seeking help losing weight have dieted before They are very skeptical of empty promises or gimmicks Give examples of patients you have seen who have done the test and are seeing results You might say This program works because it allows you to eat the most food possible and still lose weight Tf you ve had trouble losing weight in the past you actually may have deprived yourself too much Our success is based on knowing what your body needs to maintain a healthy metabolism 3 Accept these potential clients for where they are at not where you think they should be Set reasonable goals especially when it comes to exercise Spend time to discuss activity and discover a form of exercise that your patient will not only enjoy but succeed at Increase their activity level gradually focusing on what they can do not what they can t Ch5 Doing the Test When a patient comes in for their Metabolic Test you want to start by weighing them Spend some time talking with them and determine what their goals are Help them settle on a reasonable goal Most overweight patients have an unrealistic expectation of what they should weigh often going back to some ideal size they were as a teenager or on their weddi
17. ng day Most experts agree that a 10 reduction in weight is the best initial goal Reassure your patient that once that goal is met you can re evaluate their status A 10 reduction is calculated by taking their current weight then E moving the decimal point one place to the left For example if your client weighs in at 160 Ibs a 10 reduction would be 16 pounds at CHNiCy 7 Begin testing Conducting the test is simple Anybody can learn to do it in about 5 minutes More important than pushing the right buttons is what you are going to say to the patient as you prepare and administer the test Patients appreciate when wf you take the time to carefully explain each step as it happens Its best to do testing in a quiet area away from noise or distractions It s also optimal that those being tested be in a reclining position BREMEN omy Turning on the device To begin testing simply press the on off button The on off device will begin to warm up then automatically start calibrating This usually takes 2 to 3 minutes The breathing tube should NOT be attached to the device The breathing circuit Remove a clean mouthpiece from the packaging and hand it to your patient You may want to prepare them for the sensation of breathing through the mouthpiece It is helpful if you have previously performed the test on yourself Your explanation may sound something like this Breathing through this mouthpiece might
18. our goal is to satisfy your body not deprive it Maintenance Zone This zone is where your patient will want Maintenance Zone 2114 to 2536 to eat to maintain their weight It balan ces what they eat with what they burn wegh LossZone so that weight stays stable It is just above the weight loss zone making the Starvation Zone transition to maintenance very easy 0 to 1692 Medically Supervised Only The reason most weight loss programs fail is because the transition from dieting to real life is too abrupt By learning to eat to your metabolism you will actually be learning to stay slim and healthy for the rest of your life Just see how close your Maintenance Zone is to your Weight Loss Zone It is vital that we continue to measure your RMR throughout the weight loss process Once you reach your goal we ll be able to pinpoint the precise caloric intake it will take to keep you there for the rest of your life 3 Comparison scale Most people want to know if their metabolism is fast or slow This scale takes their metabolic rate measurement and compares it to the averages of other people of the same age height weight and sex Then it calculates whether they are faster slower or the same as those averages Medically Supervised Only Calories Day 2305 Cals Total Energy Output Total REE Lifestyle Exercise How does your metabolism compare compared
19. r it is simply moving more as you go through your day As you can see the greatest power to con trol or affect caloric burn lies in lifestyle changes Try just making small changes like get ting up from your desk once an hour to walk around the office or walking around the house while chatting on the phone This is where burning calories can really add up 12 Exercise 157 lt Exercise Estimated from Measurement The top box uses the RMR to estimate Lifestyle how many calories they burn with 30 422 Estimated from Measurement minutes of moderate exercise like walking Be sure to explain that although this number seems relatively Resting small the benefits of exercise go way ea Sal beyond just calories burned Exercise releases hormones that facilitate weight Metabolic Measurement loss increase fat burning muscle and stabilize food cravings The ReeVue defines moderate exercise as 6 METS A MET is a measure of intensity typically used by exercise physiologists and is v ia based on RMR This is an estimate of how many calories you burn every time you exercise for 30 minutes at a moderate level Even though this is an estimate it is based on your RMR measurement making it unique to you Don t be discouraged by this relatively small number Exercise has many benefits besides just burning calories that are vital to weight loss Exercise is a w
20. s not include drinking although very cold water can affect results is ingested just prior to testing e Avoid exercising before testing This does not include normal activities It is referring to a workout that sustains the patient s heart rate for a sustained period of time e f possible avoid the use of stimulants such as caffeine on the day of the test Patients may ask about what are stimulants Never advise they stop taking prescription medication without the express instruction of the physician Over the counter antihistamines caffeine and some herbal remedies should be avoided The handout looks like this Your next Metabolic Test is scheduled for The most common question regarding preparation sounds something like this Preparing for the Test It is desirable to measure your metabolic rate ata Q e 4 true resting level To ensure you are at rest we What will happen if al eat or I exercise or I have recommend the following preparation j a cup of coffee etc 1 You should avoid eating a meal 1 hour before the test 2 Avoid exercising on the day of your test 3 If possible avoid the use of stimulants such as caffeine on the day of the test The answer to that question is simple During The Breath Test During the test you will be invited to recline in a A These are all things that slightly increase your comfortable position You will be given a mouth iece or a mask to breathe into You will be A H
21. siastic and promote this new service You might consider the following comments Have you heard about our new service We can actually test your metabolism by measuring your breathing for just 10 minutes How does it work Well since it takes oxygen to make energy we just measure how much oxygen your body uses in 10 minutes and that tells us how much energy or calories you are burning Metabolic testing begins as the REEVUE measures the amount of oxygen in the room It then measure how much oxygen was in the air you breathed out during the test By subtracting those 2 numbers REEVUE is able to calculate how much oxygen your body used Is it accurate Actually it is the same technology they use in the hospital so itis VERY accurate Ts it hard No You just sit in a chair relax and breathe through a breathing tube That s it What does it tell you It tells you how to eat the most calories possible and still lose weight WARN Be careful that you don t get too off track with complicated discus sions about metabolism It is important for the patient to Know that a metabolic test provides information they can understand and use Test Preparation If someone schedules a test you need to give them the test preparation handout that instructs them how to be best prepared for their test You may want to go over those points with them e Avoid eating for 4 hours prior to testing This doe
22. to a typical person of similar sex age height and weight your metabolic rate is SLOW NORMAL FAST uP Fast 5 CAUTION If you think you may not have sealed your nose or mouth around the mouthpiece or if you exercised or ate a large meal beforehand you may want to repeat the test ask about correct test preparation note NORMAL is considered to be 10 the predicted value 6 87 kJoule day 1642 kcal day 6 56 kJoule day 1568 kcal day 8 93 kJoule day 2134 kcal day 239 ml min 2 92 ml kg min 15 21 expired oxygen 5 07 Liters min 937 ml 5 8 breaths min 10 1 minutes MeastreciRE Ean tat Rredictedi REE eter Estimated TEE a aa Minute Volume TEEVEE sonnneermnenennee Respiratory Rate MeSH Ukation a Calories Day Energy Input Caregiver s Interpr i 41 years Gender Female Height Weight BMI Test ID Most overweight people who have struggled with losing weight assume that their metabolism must be slow Actually if they are currently overeating their metabolism may be higher than the averages because their bodies are trying to compensate for the extra calories Or if they are significantly obese it may also be high as their bodies exert more energy moving a large heavy body 17 Knowing your patient s metabolic rate is invaluable regardless of how it compares to the averages But the teaching power of this comparison is to elimin
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