Obesity, Overweight and Weight Control

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Obesity, Overweight and Weight Control

• Healthy Weight Network

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Overweight and Obesity

• An estimated 97 million adults in US are
  overweight or obese.
• 1 in 5 children in the US is overweight (gt95
  weight for height)
• USATODAY.com - Obesity alone puts heart in
  jeopardy

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Prevalence of Overweight Among Children
Adolescents 6-19 Years
Source National Center for Health Statistics
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Overweight and Obesity Definitions

• Height/Weight Tables
• Metropolitan Life Insurance, revised 1983
• Based on weight-height mortality study
• Weights are ages 25 to 59 based on lowest
  mortality
• Height and Weight Chart - height weight chart,
  weight height chart

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Overweight and Obesity Definitions

• BMI weight (kg)
• height squared (m²)
• Significantly correlated with total body fat
  content

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Classification of Overweight and Obesity by BMI
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Overweight and Obesity - Definitions

• Waist Circumference
• Presence of excess fat in abdomen out of
  proportion to total body fat is a independent
  predictor of risk and mortality.
• Waist circumference is positively correlated with
  abdominal fat content.
• High Risk
• Men gt102 cm (gt40 in.)
• Women gt 88 cm (gt35 in.)

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Waist-to-Hip Ratio

• Waist-to-hip ration measures waist at its
  narrowest point and hip at widest point.
• Women with 35 waist and 46hip
• 35/46 0.76
• Risk
• Women with waist-to-hip ratio gt0.8
• Men with waist-to-hip ratio gt 1.0

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Assessment of Obesity

• Anthropometrics
• Medical
• Psychological
• Nutritional

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Weight Control

• Advantages of Weight Loss
• Blood Pressure
• Serum/Plasma Lipids
• Reductions in serum triglycerides and increases
  in HDL
• Reductions in total cholesterol and LDL
• Blood Glucose

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NHANES III Age-Adjusted Prevalence of
Hypertension According to BMI
Percent
Defined as mean systolic blood pressure ? 140 mm
Hg, as mean diastolic ? 90 mm Hg, or currently
taking antihypertensive medication.
Brown C et al. Body Mass Index and the
prevalence of Risk Factors for Cardiovascular
Disease (in preparation).
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NHANES III Age-Adjusted Prevalence of High Blood
Cholesterol According to BMI
Percent
Defined as gt 240 mg/dL.
Brown C et al. Body Mass Index and the Prevalence
of Risk Factors for Cardiovascular Disease (in
preparation).
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NHANES III Age-Adjusted Prevalence of Low
HDL-Cholesterol According to BMI
Percent
Defined as lt35 mg/dL in men and lt45 mg/dL in
women.
Brown C et al. Body Mass Index and the
Prevalence of Risk Factors for Cardiovascular
Disease (in preparation).
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Nutritional Assessment

• Weight History
• Age of onset
• Highest/lowest adult weights
• Patterns of weight gain and loss
• Environmental triggers
• Current eating patterns
• Nutritional Intake

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Nutritional Assessment

• Environmental Factors
• Exercise history
• Motivation and readiness to change

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Treatment for Obesity
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Position of ADA

• Successful weight management requires a livelong
  commitment to healthful lifestyle behaviors
  emphasizing sustainable and enjoyable eating
  practices and daily physical activity
• Position Paper

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Goals for Weight Loss

• Prevent weight gain or stop weight gain
• Improvement in physical and emotional health
• Small maintainable weight losses or more
  extensive weight loss through sensible eating and
  exercise patterns
• Improvement in eating, exercise and other
  behaviors apart from any weight loss

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Goals for Weight Loss

• Initial goal to reduce body weight by
  approximately 10 from baseline.
• 1-2/week for period of 6 months
• 1 body fat 3500 calories
• 3500/7days - 500 calories/day
• Need to assess individuals motivation and
  readiness to enter weight loss therapy.

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How To Achieve Weight Loss

• 1,000 1,200 kcal/day for women and 1,200
  1,600 kcal/day for men
• Reducing dietary fat along with carbohydrates can
  facilitate calorie reduction.
• Reducing dietary fat alone without reducing
  calories is not sufficient for weight loss.

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How To Achieve Weight Loss

• Physical activity is recommended as part of a
  comprehensive weight loss program because
• contributes to weight loss
• may decrease abdominal fat
• increase cardio-respiratory fitness
• may help with maintenance of weight loss

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How To Achieve Weight Loss

• Behavior Therapy
• Pharmacotherapy - weight loss drugs
• Weight loss drugs may be used in combination with
  a comprehensive weight loss program, for
  patients with BMIgt30 with no risk factors BMI
  gt27 with risk factors.
• Weight loss drugs should never be used without
  concomitant lifestyle changes.

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How To Achieve Weight Loss

• Better weight loss results are achieved with diet
  therapy when
• the duration of the intervention is at least 6
  months.
• Long term weight loss is enhanced by a program of
  dietary therapy, physical therapy and behavioral
  therapy continued indefinitely.
• Habit is habit and not to be flung out of the
  window by any man, but coaxed downstairs a step
  at a time.
• Mark Twain

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How To Achieve Weight Loss

• Outcome data on behavior therapy, Very Low
  Calorie Diets (VLCD) and Pharmacotherapy show
• weight regain in 3-5 years
• Frequent contacts between professional counselors
  and patients promote weight loss and weight
  maintenance
• Chicago Tribune Biggest 'Lost' mystery Why is
  Hurley still fat?

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Tips for Weight Loss

• Eat a variety of foods from the Food Guide
  Pyramid, including favorite foods
• Increase intake of high-water/high-fiber foods
• Vegetables and fruits
• Whole grains and legumes
• Soups
• Decrease consumption of energy dense foods
• High fat foods
• Foods with low moisture content

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Mayo Clinic Food Guide
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How to Calculate Energy Density

• Energy Density Calories/Grams
• E.G. 150 Calories/100 grams 1.5 Kcal/g
• Energy density of 1 Eat any quantity
• Limit foods with energy density gt2
  

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Tips for Weight Loss

• Limit consumption of beverages containing alcohol
  and sugars
• Control Portion Sizes
• Plan meals and snacks ahead
• Establish regular eating habits
• Shop on a full stomach

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Shopping Tips

• Use a shopping list
• Read labels
• serving size and servings per container

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Tips for Weight Loss

• Eat from plates, not food packages
• Portion foods before bringing them to the table
• Eat slowly
• Sit down to eat
• Stop eating when you leave the table
• Watch for food triggers

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Tips for Weight Loss

• Use of Meal Replacements?

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Fad Diets

• Americans spend gt30 billion in the weight loss
  industry
• Single food diets - grapefruit, rice etc.
• High-protein, high fat diets
• VLCD
• Fasting
• High fiber, low-calorie diets

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Weight Loss Surgery
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