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Obesity, Nutrition, and Excercise
Mohammed Alo
Copyright Mohammed Alo 2006. All Rights Reserved. May be used for educational purposes without alteration including the first slide.
Questions?
• Is being overweight bad?• Is it a serious problem in America?• How many think they are overweight?• How many want to lose weight?• What have you tried?• Did you gain your weight back?• How many of you had overweight parents?• Is obesity genetic?
Questions?
• What percentage of United States population is overweight?
• What percentage of population is obese?
• What percentage of children overweight?
Answers
• 67% of adults overweight
• 30% of adults obese
• 16% of children 6-19 years of age overweight
Costs of obesity?Q: What is the cost of overweight and obesity?A: Total cost: $117 billion , Direct cost: $61 billion,* Indirect cost: $56 billion
(comparable to the economic costs of cigarette smoking)
Q: What is the cost of heart disease related to overweight and obesity?A: Direct cost: $8.8 billion (17 percent of the total direct cost of heart disease,
independent of stroke)
Q: What is the cost of type 2 diabetes related to overweight and obesity?A: Total cost: $98 billion (in 2001)[15]
Q: What is the cost of osteoarthritis related to overweight and obesity?A: Total cost: $21.2 billion, Direct cost: $5.3 billion, Indirect cost: $15.9 billion
Q: What is the cost of hypertension (high blood pressure) related to overweight and obesity?
A: Direct cost: $4.1 billion (17 percent of the total cost of hypertension)
Q: What is the cost of gallbladder disease related to overweight and obesity?A: Total cost: $3.4 billion, Direct cost: $3.2 billion, Indirect cost: $187 million
More costs…Q: What is the cost of cancer related to overweight and obesity?• Breast cancer: Total cost: $2.9 billion, Direct cost: $1.1 billion, Indirect cost: $1.8
billion
• Endometrial cancer: Total cost: $933 million, Direct cost: $310 million, Indirect cost: $623 million
• Colon cancer: Total cost: $3.5 billion, Direct cost: $1.3 billion, Indirect cost: $2.2 billion
Q: What is the cost of lost productivity related to obesity?• The cost of lost productivity related to obesity (BMI > 30) among Americans
ages 17–64 is $3.9 billion. This value considers the following annual numbers (for 1994):
• Workdays lost related to obesity: 39.3 million
• Physician office visits related to obesity: 62.7 million
• Restricted activity days related to obesity: 239.0 million
• Bed-days related to obesity: 89.5 million
Obesity?
Once all of the Lung Cancer generation has died off, the number one killer will be Obesity and it’s complications.
No 1 KILLER!
What is obesity?
We know it when we see it
Morbid Obesity
Morbid Obesity?
Fat Kids
The opposite of obese
The wise guy
Why fat kids?
Weight is not genetic!
Definition?
Obesity = Body Mass Index over 30
BMI = Weight in Pounds x 703 (Height in inches) x (Height in inches)
Mohammed Alo
Wt: 175Ht: 68 inches
(175/(68x68)) x 703 175/4624 x 703 = 26.6
More BMI Definitions
< 18.5 Underweight
19 – 25 Normal
25 – 30 Overweight
30 – 40 Obese
40 + Extremely Obese
More on BMI
BMI is a good overall average. It does work for all, but there are some modifications.
1. Women should try to be at lower end of normal (18-23), men at higher end (23-25)
2. Athletes, body builders, etc will have “overweight” BMI.
3. BMI is one factor among many. Try to improve all factors.
BMI-Associated Disease RiskClassification BMI (kg/m2) Risk
Underweight <18.5 Increased
Normal 18.5-24.9 Normal
Overweight 25.0-29.9 Increased
Obese I 30.0-34.9 High
II 35.0-39.9 Very High
III >40 Extremely high
Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. Obes Res 1998;6(suppl 2).
Additional risks:• Large waist circumference (men>40 in; women >35 in)• 5 kg or more weight gain since age 18-20 y• Poor aerobic fitness• Specific races and ethnic groups
Source: Behavioral Risk Factor Surveillance System, CDC.
19961991
Obesity Trends* Among U.S. AdultsBRFSS, 1991, 1996, 2004
(*BMI 30, or about 30 lbs overweight for 5’4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
2004
Pulmonary diseasePulmonary diseaseabnormal functionobstructive sleep apneahypoventilation syndrome
Nonalcoholic fatty liver Nonalcoholic fatty liver diseasediseasesteatosissteatohepatitiscirrhosis
Coronary heart diseaseCoronary heart disease
DiabetesDiabetes
DyslipidemiaDyslipidemia
HypertensionHypertension
Gynecologic abnormalitiesGynecologic abnormalitiesabnormal mensesinfertilitypolycystic ovarian syndrome
OsteoarthritisOsteoarthritis
SkinSkin
Gall bladder diseaseGall bladder disease
CancerCancerbreast, uterus, cervixcolon, esophagus, pancreaskidney, prostate
PhlebitisPhlebitisvenous stasis
GoutGout
Medical Complications of ObesityIdiopathic intracranial Idiopathic intracranial hypertensionhypertension
StrokeStroke
CataractsCataracts
Severe pancreatitisSevere pancreatitis
Complications no one talks about
• Not fitting in CT scanner
• Abdominal surgery and healing
• Medical emergencies-can they carry you?
• Difficulty dosing medications
• Operating tables not capable
• Not fitting in airplane
Slide Source:www.obesityonline.org
0.6
1.0
1.4
1.8
2.2
2.6
3.0
Relationship Between BMI and Relationship Between BMI and Cardiovascular Disease MortalityCardiovascular Disease Mortality
Rel
ativ
e R
isk
of D
eath
Body Mass index
<18.5
MenMen
WomenWomen
Calle et al. N Engl J Med 1999;341:1097.
18.5–
20.4
20.5–
21.9
22.0–
23.4
23.5–
24.9
25.0–
26.4
26.5–
27.9
28.0–
29.9
30.0–
31.9
32.0–
34.9
35.0–
39.9
>40.0
Lean Overweight Obese
Obesity Is Caused by Long-Term Positive Energy Balance
FatFatStoresStores
Diet or Exercise?
What is more important in determining your body
composition?
85% Diet 15% Exercise
Diet or Exercise Study
• JAMA March 22/29 2006• 27,000 women since 1992• BMI or Activity level?
High BMI was more strongly related to adverse cardiovascular biomarker levels than physical inactivity. However, within BMI categories, physical activity was generally associated with more favorable cardiovascular biomarker levels than inactivity.
You are what you eat!
How many Calories do I need?
Determine Calorie NeedsEstimated Energy Requirements* for males
1000
1200
1400
1600
1800
2000
2200
2400
2600
2800
3000
3200
3400
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 20 25 30 35 40 45 50 55 60 65 70 75 80
Age
Cal
orie
s
ACTIVE
SEDENTARY
*From the National Academy of Sciences, Institute of Medicine Dietary Reference Intakes Macronutrient Report
0
500
1000
1500
2000
2500
3000
Discrepancy Between Reported and Actual Energy Intake and Expenditure
Kca
l/d
Reported*P<0.05 vs reported.Lichtman et al. N Engl J Med 1992;327:1893.
Energy Intake
Actual Reported Actual
Energy Expenditure
**
**
Calories to lose weight?
Total 1800 calories per day
500 less calories per day than what you need (3500/week)
Results in stable weight loss of 1-2 pounds per week.
Lifetime Food Intake
*kcal in millions
Water
45,300 kg
Fat
2300 kg
21 kcal*
Carbs
8000 kg
31 kcal*
Protein
1900 kg
7 kcal*
-20
-15
-10
-5
0
5
Short-term Obesity Therapy Does Not Result in Long-term Weight Loss
Cha
nge
in W
eigh
t (kg
)
Wadden et al. Int J Obes 1989;13 (Suppl 2):39.
5-yearFollow-up
1-yearFollow-up
End ofTreatment
Baseline
Diet alone
Behavior therapy
Combined therapy
-18-16-14-12-10
-8-6-4-20
Long-term Weight Loss is Improved with Long-term Maintenance Therapy
Wei
ght L
oss
(%)
Perri et al. J Consult Clin Psychol 1988;56:529.
0 1 2 3 4 5 6 7 8 9 10 11 12
Time (mo)
13 14 15 16 17
PP <0.05 <0.05
No maintenance tx
Maintenance tx
Diet andbehaviormodificationtherapy
Diet everyday for the rest of your life
• A diet is a long term commitment.
• Just like you have to sleep every night, you have to diet every day.
• Any time you eat, you are dieting.
• You have to diet everyday for the rest of your life!
• 95% of people gain all their weight back, is not true!
Total Garbage!
95% of people that lose weight will gain it back!
Why?
• Body is very smart• Human Body has set point for weight• Takes 8-12 months to reset• Inmate experiments with
over/underfeeding• Body detects less food as starvation and
lowers metabolism• Eating once a day and skipping meals
reinforces starvation signal.
Pattern of Changes In Energy Intake, Body Fat, and Fat-
free Weight100% + 78% of Control
100% ControlValue
Hyp
erp
hag
ia
Restricted Ad libtium
C12 S12 S24 R12 R20C12 S12 S24 R12 R20
Semistarvation Refeeding
Fat-free Wt
Fat Wt
100% Control
Value
Feeding 40% of Control
Keys, 1950; Dulloo, AJCN - 1997Keys, 1950; Dulloo, AJCN - 1997
Obesity Treatment Pyramid
DietDiet Physical ActivityPhysical Activity
Lifestyle ModificationLifestyle Modification
PharmacotherapyPharmacotherapy
SurgerySurgery
History of USDA’s Food Guidance
1940s
1950s-1960s
1970s
1992
2005
Food for Young
Children
1916
--1992--Food Guide Pyramid
Reasons for Revising—Updating the Science
• To ensure that the guidance reflects the latest nutrition science – New nutrient standards—DRI – New Dietary Guidelines – Food consumption and composition data– Americans still gaining weight with old
pyramid
--2005--MyPyramid
Print materials: Mini Poster
Focus on fruits.Focus on fruits.
Vary your veggies.Vary your veggies.
Get your calcium-rich foods.Get your calcium-rich foods.
Make half your grains whole.Make half your grains whole.
Go lean with protein.Go lean with protein.
Know the limits on fats, salt, and sugars.Know the limits on fats, salt, and sugars.
Key food group messages from the Dietary Guidelines and MyPyramid:
Daily Amountsin cups or ounces
Print materials: Mini Poster
Implementation
• Implementation is the challenge ahead.
• Health/education professionals are vital for success.
• It will be an ongoing process.
• Working together, we can help Americans to be healthier.
What types of calories?
• Carbohydrates- sugar, bread, rice, pasta
• Protein- meat, beans
• Fat- butter, oil, margarine, fat on meat
Also…
• Fiber- fruits, veggies, bran
Carbohydrates?• Sugars, flour, oat, grain, bread, rice, pasta
Protein?• Meat and beans
Fats?
• Oil, butter, parts of meat, skin
Saturated Fat
• Fat that is Solid at room temperature
-Butter, cheese, margarine, ice cream, meat fat, skin, peanut oil, palm oil
Fiber?
• Fruits, veggies, whole everything
Indigestible, fills you up, lowers cholesterol
What diets?
• All diets work• You have to do them and be dedicated• Human Body has set point for weight• Takes 8-12 months to reset• Inmate experiments with over/underfeeding• Women can’t lose weight as easily• Skipping meals send wrong signal (starvation,
body lowers metabolism)• Eat smaller spread out meals
All Diets
Low Calorie/Low Fat
High Protein/Low Carb
21
Low Calorie/Low Fat Diets
• Eat less of everything• Eat less fat• Monitor caloric intake closely• Count calories• Many choices: Zone Diet, Jenny Craig, Weight
Watchers• Many physicians endorse these, Dr. Koop, Dr.
Sears (Zone)
Low Calorie/Low Fat Diet
Advantages:• Easy to tolerate• Lots of low fat
foods• Can still be doing
this in 2010• Weight Watchers is
best choice• Slow weight loss
Disadvantages:• Becomes boring,
people lose interest• Has lead to more
weight gain• Very tight caloric
control• Slow weight loss
High Protein/Low Carb Diet
Eat protein and fat: eggs, chicken, beef, bacon, cheese
Avoid: bread, rice, sugar, pasta, potatoesEat as much as you wantNo need to count caloriesSeparated into 3 or 4 stagesFast initial resultsAvoid fruits and veggies in initial stageMany to chose from: Atkins Diet, South Beach DietEndorsed by many physicians and cardiologists:
Dr. Agatston (invented heart scan)
High Protein/Low Carb Diet
Advantages:• Easy to follow• Quick weight loss
initially• No calorie counting• Reduces many
cardiovascular risk factors (diabetes, weight, LDL, HDL, CRP, etc)
• Atkins and South Beach both work great
Disadvantages:• If you don’t like
meat you are in trouble (use protein shakes)
• May be costly• Maybe difficult to
still be doing this in 2010
Other Tips
• Drink plenty of water
• Eat slowly
• Eat half your plate
• Sugar alternatives
• Low fat usually = More Sugar (better to find lower calorie)
• Stop telling kids to eat whole plate
• Substitute good for bad
Substitution?
• Splenda instead of Sugar• Oil instead of butter, margarine, lard, fat• Ground turkey instead of beef (or low fat beef)• Chicken or fish instead of beef• Whole grain instead of plain• Low carb pasta instead of pasta (even whole
grain pasta is available)• Fruit instead of cake, desert• Lettuce wrap instead of sandwich• Oil spread instead of cheese
Sugar Alternatives?
• Splenda• Nutrasweet• Equal
• Splenda seems to be the best, tastes best, not artificial, can cook with it at high temperatures.
Exercise?
Physical activity that keeps your heart rate above 65% of predicted maximum
(220 – Age) x 65%
Mohammed:
220 – 29 = 191 x 0.65 = 124
At least 30 minutes of 65% or higher for 3-4 days a week!
Does not include time it takes to reach 65%.
Exercise?
For most people, your diet is the problem.
Changing your diet will change 85% of your life.
For some people, you have to exercise to shed the weight. When you lose weight your body knows and slows down your metabolism, so you need to exercise in order to increase it.
This is especially true for women. Women have a much harder time losing weight, and must exercise to get to healthy weight.
Making Physical Activity a Part of Your Life • Do housework yourself instead of hiring someone else to do it. • Work in the garden or mow the grass. Using a riding mower doesn't
count! Rake leaves, prune, dig and pick up trash. • Go out for a short walk before breakfast or after dinner or both! Start with
5-10 minutes and work up to a minimum of 30 minutes. • Walk or bike to the corner store instead of driving.• When walking, pick up the pace from leisurely to brisk. Choose a hilly
route.• When watching TV, sit up instead of lying on the sofa. Better yet, spend a
few minutes pedaling on your stationary bicycle while watching TV. Throw away your video remote control. Instead of asking someone to bring you a drink, get up off the couch and get it yourself.
• Do leg lifts talking on the telephone. • Walk the dog.• Park farther away at the shopping mall and walk the extra distance. Wear
your walking shoes and sneak in an extra lap or two around the mall. • Stretch to reach items in high places and squat or bend to look at items at
floor level. • Keep exercise equipment repaired and use it!
At Work?• Brainstorm project ideas with a co-worker while taking a walk. • Stand while talking on the telephone. • Walk down the hall to speak with someone rather than using the telephone.• Take the stairs instead of the elevator. Or get off a few floors early and take
the stairs the rest of the way. • Walk while waiting for the plane at the airport. • Stay at hotels with fitness centers or swimming pools while on business
trips. • Take along a jump rope in your suitcase when you travel. Jump and do
calisthenics in your hotel room. • Participate in or start a recreation league at your company. • Form a sports team to raise money for charity events. • Join a fitness center or Y near your work. Work out before or after work to
avoid rush hour traffic, or drop by for a noon workout. • Schedule your exercise time on your business calendar and treat it as any
other important appointment. • Get off the bus a few blocks early and walk the rest of the way to work or
home.• Walk around your building for a break during the work day or during lunch.
Goals and Results?
• Not cosmetic • Goal is to improve health• Life style changes• Slow and steady change• Long term goals• Change family habits• Change friends and society• Live longer and healthier• Less miserable life at the end• Save future generations (kids)
Solution?