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FCSN 245 – Basic Nutrition Summer 2005 Episode III – Dr. David Gee. Starting tomorrow, all lectures will be held in PE 201 Clicker points: attendance sheets Course web page www.cwu.edu/~geed Grades so far posted on bulletin board outside 136 Michaelsen. - PowerPoint PPT Presentation
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FCSN 245 – Basic NutritionSummer 2005
Episode III – Dr. David Gee Starting tomorrow, all lectures will be held
in PE 201 Clicker points: attendance sheets
Course web page www.cwu.edu/~geed
Grades so far posted on bulletin board outside 136 Michaelsen
Healthy Weight and the Non-Diet Approach
David L. Gee, PhDProfessor of Food Science and Nutrition
Central Washington University
Prevalence of Overweight in the US 1990: 56% of Americans were overweight
23% were obese 2000: 64% of Americans were overweight
30% were obese At this rate
In 2010: 73% overweight In 2020: 84% overweight In 2030: 96% overweight
Increases in overweight/obesity were seen in: Both males and females All age groups All ethnic groups
Ethnicity and Overweight (BMI>27.5) Prevalence
White Black Hispanic Native Am Hawaiian
24 27 26
45
31
4234
40
66 63
0
10
20
30
40
50
60
70
%
White Black Hispanic Native Am Hawaiian
MaleFemale
Prevalence of overweight in children. CDC (2004)
Overweight = above the 95th percentile for BMI based on NHANES II data from 1970’s
For adolescents 12-19 yrs: 1974 = 7.4% 2002 = 15.6%
Prevalence of Overweight Children in the US
Epidemic Increase in Childhood Overweight, 1986-1998JAMA 286:2845-2848 (2001)
Epidemic Increase in Childhood Overweight, 1986-1998JAMA 286:2845-2848 (2001)
National Longitudinal Survey of Youth 1986-1998 8,270 children, aged 4-12 yrs
Prior studies show it took 30 years for overweight prevalence to double. Current study show doubling time to be less than 12 years. Rate of increase particularly high in African
American and Hispanic children
Why lose weight? Obesity is associated with greater risk of:
Diabetes Hypertension & stroke Coronary heart disease Most cancers (except lung cancer) Sleep apnea, arthritis, gall stones, ….
Overfat vs Underfit ???? Good question Vast majority of overfat are underfit
Obesity and Causes of Death in the US
Epilog: Supersize MeThe Food Industry Strikes Back
NY Times (July 7, 2005) 20 states have passed ‘Common sense
consumption laws’ preventing personal injury lawsuits related obesity (11 states pending)
During elections of 2002 & 2004, the food and restaurant industry gave $5.5 million to politicians in the 20 states. Institute on Money in State Politics.
Epilog: Supersize MeThe Food Industry Strikes Back
NY Times (July 7, 2005)
83% of public opposed to obesity lawsuits against restaurants and fast food companies
Pelman & Bradley vs McDonald’s Initial personal injury lawsuit dismissed Jan 2005, panel of 3 Federal Judges reinstated
‘deceptive practices claim’ (McDonald’s falsely presented their food as nutritionally beneficial to consumers)
Is being overweight really that dangerous?
Excess Deaths Associated with Underweight, Overweight, and Obesity
JAMA 2005:293:1861-1867 “Underweight and obesity… were associated
with increased mortality…” “Overweight was not associated with excess
mortality.” “Study finds government overstated danger
of obesity” – USA Today – 4/19/05 http://www.usatoday
.com/news/health/2005-04-19-obesity-danger_x.htm
For adults ages 25-59, increased mortality in underweight and obese categories, but not overweight category.
Is Obesity a Public Health Problem?
Obesity and Overweight prevalence is rising rapidly
Obesity is associated with increased risk of mortality (overweight?)
Overweight is a temporary period of transition (many/most overweight people become obese)
Is Obesity a Public Health Problem?
Obesity and Overweight are associated with increased risk of diabetes, hypertension, dyslipidemia
While treatment of these diseases has improved Health care costs are rising Quality of life impacted
The Obesity Epidemic in America:Who’s responsible?
Personal responsibility Environmental influences
Do we need a “Food Police”? http://www.nytimes.com/2005/06/12/business/
yourmoney/12food.html?pagewanted=1
Discussion: What role should American society play
in addressing the Obesity Crisis? Name 1: Weight problems are a matter of personal responsibility.
No significant changes need to be made. 2: Weight problems are significantly influenced by
environmental factors. Society needs to implement changes.
3: Weight problems are highly influenced by environmental factors and will lead to catastrophic health problems. Society needs to implement sweeping changes.
Why we gain weightGenes/Biology vs Environment Overweight is a result of both Adoption studies (biology)
Adopted adults have BMI that are more similar to biological parents than to adoptive parents.
Animal studies (biology) genetically obese rats and mice
Genes/Biology vs Environment (cont.)
Migration studies (environment) Japanese Hawaiian Japanese Californian Japanese
Dietary Change Studies (biology and environment) SW Native Americans
Pima IndiansMexican Pima Indians
subsistence farming & ranching 20% fat diet, 40 hrs/wk physical work
Arizona Pima Indians mechanized agriculture, sedentary lifestyle 40% fat diet
Pima IndiansArizona Pima Indians are:
1 inch taller 57 pounds heavier 70% obese 50% with diabetes by age 35
Genes vs Environment: Conclusions
Genes for weight gain predisposes some individuals towards weight gain.
Environment determines which of those individuals actually gain weight.
The rapid change in obesity prevalence is likely to be more due to changes in the environment than changes in our genetic pool.
What is a “Healthy Weight”?
A broad range of weight which allows for minimal risks for chronic diseases.
Goes beyond using only body weight as a criteria for good health.
Determination of your "healthy weight". Step 1. Body Mass Index
BMI = BW(kg)/Ht2(m2) Dr. Phil
from Nutrition Action Health Letter, Jan. 2004 6‘4" = 78" x 0.0254(m/in)= 1.93m 240lbs / 2.2(lb/kg) = 109kg
BMI = 109/(1.932)=109/3.72 = 29.3
BMI Classifications
BMI = 19 - 25 => Desirable BMI = 25 - 30 => Overweight BMI = 30 - 35 => Obese, category 1 BMI = 35 - 40 => Obese, category 2 BMI > 40 => Severe obesity
BMI and Mortality Risk
Healthy Weight (cont.)
If your BMI > 25, then consider presence of other health risk factors.
Healthy Weight (cont.) Body Fat Distribution upper body fatness associated with
higher health risks Waist Circumference (1998 NIH)
> 35” for females, > 40” for males
Healthy Weight (cont.):Know your blood lipids! Hyperlipidemia/dyslipidemia
TC > 240 mg/dl LDL-C > 160 mg/dl HDL-C < 40 mg/dl TG > 200 mg/dl
Healthy Weight (cont.):Know your blood pressure! High Blood Pressure
Systolic BP > 140 mm Hg or Diastolic BP > 90 mm Hg or Borderline hypertensive
Pre-hypertensive>130/85
Healthy Weight (cont.):Know your blood sugar and history Hyperglycemia (Diabetes)
Fasting Blood Glucose > 126 mg/dl
Impaired Glucose TolerancePre-diabetic >110 mg/dl
Gestational Diabetes Family History of Diabetes
Healthy Weight Summary If your BMI is 19-25, you are at a Healthy
Weight. Health problems are not weight related
If your BMI is > 25 and you have no other risk factors, you are at a Healthy Weight.
If your BMI is > 25 and you have one or more risk factors, you are NOT at a Healthy Weight. Weight loss is likely to improve your health
Should everybody who is overweight try to lose weight?
Will weight loss improve your quality of life?A Prospective Study of Weight Change and Health-Related
Quality of Life in Women
JAMA Dec. 1999 Nurse’s Health Study
40,098 women, 4 yr longitudinal study Weight changes Quality of life questionnaire
Physical function Vitality Freedom from bodily pain Mental health
The effect of weight gain/loss on:Vitality Score Weight gain:
associated with declines in vitality scores in all BMI categories
Weight loss associated with
improved vitality scores only in women with BMI>25
The effect of weight gain/loss on:Mental Health Score Weight gain
associated with a decline in mental health scores in all weight categories
Weight loss associated with
improved mental health scores only in obese class I women and declined in normal weight women.
A Prospective Study of Weight Change and Health-Related Quality of Life in Women.
Conclusions: For women at all BMI categories:
Don’t gain weight Reduced quality of life
For overweight and obese women: Weight loss is generally associated with improved
quality of life For normal weight women
Weight loss does not improve quality of life May actually reduce quality of life
Do media images affect your idea of
what you should look like?
2000 Grammy Awards
Do media images actually Contribute to weight problems?
Bottom Line on Weight Loss
Lose weight for the right reasons Improve health and your quality of life
Losing weight to attain the ‘perfect body’ May lead to frustration
And, ironically, weight gain May lead to eating disorders
Dietary Means to a Healthy Weight
Weight loss occurs when in negative energy balance
Weight loss is only half the battle Maintenance of weight loss is the critical
problem
Dietary Means to a Healthy WeightBalanced Reduced Calorie Diet
Characteristics Calories reduced by 500-1000 Cal/day CHO:PRO:FAT = 50-60%: 10-15%: 20-
30% Examples
Weight Watchers, Jenny Craig, Slim Fast What the research shows:
Short-term outcomes Modest weight loss, improved health
Long-term outcomes Success rate not great
Dietary Means to a Healthy WeightLow Carbohydrate Diets
Characteristics Very low in CHO Restricted intakes of fruit, cereals, pasta, bread, potatoes, rice Caloric intake not specified
Examples Atkins diet
What the research shows: Short-term outcomes
6 month studies, good weight loss, no substantial change in heart disease risk factor, drop-out rate significant
Long-term outcomes No long term studies, health risks?
Dietary Means to a Healthy WeightThe Carbohydrate ‘Restrained’ Diets
Characteristics Lower in CHO than Dietary Guidelines but
higher than Low Carb diets (~40% CHO, 30%FAT, 30%PRO)
Low glycemic index foods encouraged Monounsaturated fats encouraged
Examples Zone Diet, South Beach Diet
What the research shows: Little research available on these diets
Dietary Means to a Healthy WeightHealthy Diet/Non-Diet Approach
Characteristics Focus on quality of the diet, not quantity Attaining good health is primary goal, not weight loss
Examples DASH diet, Dietary Guidelines, Food Guide Pyramid
What the research shows: Short-term outcomes
Slow, limited weight loss, health benefits Long-term outcomes
U. Colorado’s Weight Loss Registry Diet most adopt in order to maintain weight loss
Summer 2005 – Final Exam Thursday, July 28, 12:50PM, 201 PE Gee
Lecture materials Chapter 11-Achieving and Maintaining a Healthful Body
Weight Chapter 9 – Nutrients Involved in Bone Health 20 MC/TF questions See www.cwu.edu/~geed tomorrow for study guide Take Home essay question (turn in with final)
What is the role of American Society in Addressing the US Obesity Crisis?
1 page, double space, 12 pt font, 1” margins 10 pts: grammatically perfect, well thought out, clearly states and
defends position.
Bergman & Bennett Study old exams and example question on their
web pages 40 MC/TF questions
Key Points: Diet and Weight Loss Prevention is far easier than the cure People lose weight using many types of
dietary programs Always energy balance
People are far more likely to maintain weight loss eating a balanced healthy diet
Exercise and Weight Loss U. Colorado’s Weight Loss Registry
Exercised used by nearly 100% Walking the most common form of exercise
Benefits of Exercise Rate of weight loss greater Caloric restriction not as great Quality of weight loss better Proactive choice vs dieting Health benefits independent of weight loss
Rates of physical inactivity in the US
Exercise and Weight LossStructured Exercise
Aerobic Exercise Burns more calories, more fat Stress duration initially
Strength Training Builds more lean tissue Increases basal metabolic rate
Exercise for Weight Loss:Walking vs Running
Going 4 miles
Walking @ 15min/mile
Jogging @ 8 min/mile
Calories burned 400 Cal 400 Cal
Fuels burned:CHO:FAT
50:50 75:25
Calories CHO 200 Cal 300 Cal
Calories FAT 200 Cal 100 Cal
Exercise for Weight Loss:Walking vs Running
Going 1 hour
Walking @ 15min/mile
Jogging @ 8 min/mile
Distance covered 4 miles 7.5 miles
Calories burned 400 Calories 750 Calories
Fuels burned:CHO:FAT
50:50 75:25
Calories CHO 200 Calories 560 Calories
Calories FAT 200 Calories 190 Calories
Exercise and Weight LossStructured Exercise
Successful Programs: Convenient Enjoyable Safe affordable Subject realizes net benefit over costs
Exercise and Weight LossLifestyle Activity
24 hr day Sleep/rest = 10 hrs Structured exercise = 1 hr What you do the remaining 13 hrs of the day?
Burn extra 25 Cal/hr = 325 Cal/day = 33 pounds of fat loss per year
Develop a new attitude about being active Pedometers and 10,000 step programs Health benefits significant
Weight Loss/Weight MaintenanceBehavior/Attitude Changes
Pay attention to what you eat Success of weight loss programs
Examine: Triggers for eating
Emotional eating It’s not just what your eating, it’s what’s eating you!
Risky situations Behavior Modification Programs
Track/record eating behaviors Identifies problems Sets goals and establishes rewards Continual reassessment/problem solving
For more severe weight loss: Prescription Drugs
For those with BMI > 30 or For those with BMI >27 and risk factors
Meridia (Sibutramine, Abbott Lab) Suppresses appetite
Xenical (Orlistat, Roche) Inhibits fat absorption
Long term success and risks
For those with Severe Obesity Surgical Methods
For those with BMI >40
For those with Severe Obesity
Gastroplasty Reduces size of stomach by
banding or stapling Gastric Bypass Surgery
Reduces size of stomach Bypasses much of the small
intestine Outcomes
Rapid and substantial weight loss
Side effects Dangers
Tips from the National Weight Control Registry (est. 1994) Focus on successful weight loss >3000 people kept >30 lbs off > 1year
Average: 60 lbs for 5 yrs 80% female
many had “bad” genes 2/3rds were overweight as children 46% w/one or both parents overweight 60% had family history of obesity
any age average age 45 yrs
Tips from the National Weight Control Registry Failed to lose weight in the past
Don’t view past failures as signs you can’t succeed
Found process difficult No pain, no loss
Made smaller lifestyle goals Planned indulgences
How they lost weight
10% lost weight with diet only 1% w/ exercise only 89% w/ diet + exercise used many types of diets to lose
weight 50% did it on their own
How they maintained their weight loss Low fat diets Watched calories Daily exercise
averaged + 2600 Cal/week, ~ 1 hr/day 70% walked or walked + other exercise 20% weight training 20% bicycling 18% aerobic dance avg 3 hrs/week of TV
Tips from the National Weight Control Registry
Do what you want, not what you should