Obesity Diet and Physical Activity

1. Obesity Diet and Physical Activity Pennington Biomedical Research Center Division of Education

2. Obesity in the United States • Approximately 66% (or two thirds) of U.S. adults are overweight or obese. • Healthy People 2010: reduce the prevalence of obesity among adults to less than 15%. • The obesity rate increased from the late 1970’s to 2003 from 15 to nearly 33 percent. CDC

3. Obesity in the U.S. • Body mass index (BMI) weight (kg)/ height squared (m2). • BMI is significantly correlated with total body fat content. • BMI tables: • http://www.nhlbisupport.com/bmi NIDDK

4. Obesity in the U.S. • Obesity is further divided into three separate classes, with Class III obesity being the most extreme of the three. CDC, NHLBI

5. Obesity in the United States • In the United States, some minority groups are more affected than others. Income and education are also related to obesity prevalence. • Some states have significantly higher rates of obesity than others. http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/ NIDDK, Women’s Health

6. Hypertension Dyslipidemia Type 2 Diabetes Coronary Heart Disease Stroke Gallbladder Disease Osteoarthritis Sleep apnea Certain cancers (endometrial, breast, prostate, colon) Obesity in the U.S. Being overweight/obese substantially raises one’s risk of morbidity from: Higher body weights are also associated with increases in all-cause mortality. J La State Med Soc. 2005; 156: S42-S49.

7. High blood cholesterol Complications of pregnancy Menstrual irregularities Hirsutism (presence of excess body and facial hair) Stress incontinence ( urine leakage caused by weak pelvic-floor muscles) Psychological disorders such as depression Increased surgical risk Obesity in the U.S. Obesity is also associated with: NIDDK

8. What Causes Obesity? • Energy imbalance over a long period of time. • Energy in > Energy out. • Excess calories and lack of physical activity. Energy balance is like a scale. When calories consumed are greater than calories used, weight gain is the result. CDC

9. Calories Used • Eating, digestion, sleeping, breathing, and movement. • Excess calories. • Physical activity. Energy Balance Necessary physiological functions Calories in Calories used (consumed) (expended) Physical activity Food/beverages consumed CDC

10. OverweightThe Right Approach • If your BMI is between 25 and 30 and you are otherwise healthy • Try to avoid gaining any additional weight • Look into healthy ways of losing weight and increasing physical activity NIDDK

11. OverweightThe Right Approach • BMI is 30 or above, or • BMI is between 25 and 30 and: • You have other health conditions • Waist measures > 35 inches (women) or > 40 inches (men) and: • You have other health conditions Talk to your doctor about losing weight if you fall into any one of the three scenarios: NIDDK

12. Weight Loss & MaintenanceStrategies to Consider Physical Activity & Diet Therapy

13. Why Treat Overweight and Obesity? blood pressure serum triglycerides total serum cholesterol low-density lipoprotein cholesterol blood glucose levels Because there is strong evidence that weight loss reduces risk factors for diabetes and cardiovascular disease, such as: NHLBI

14. Weight Loss Programs Any safe and effective weight-loss program should include these components: • Healthy eating plans that reduces caloric intake • Regular physical activity and/or exercise instruction • Tips on healthy behavior • Slow and steady weight loss of about ¾ to 2 pounds a week • Medical care if needed • A plan to keep the weight off after you have lost it NIDDK

15. Weight Loss The key to any successful weight loss is making changes in your eating and physical activity habits that you can keep for the rest of your life. NIDDK

16. Physical Activity

17. Physical InactivityIn the U.S. • Many studies show that Americans are too sedentary. • Due to • Increased use of technology. • Increased use of automobiles. According to the Behavioral Risk Factor Surveillance System, in 2000 more than 26 percent of adults reported no leisure time physical activity. CDC

18. Physical InactivityIn the U.S. • Physical inactivity contributes to premature deaths. • Rates differ by race and ethnicity. • Hispanic women - most inactive • Hon-Hispanic women – second • Asian and Pacific islander women – third and, lastly, • White non-Hispanic women - fourth. Women’s Health

19. Physical Activity • Contributes to weight loss. • Helpful for the prevention of overweight and obesity. • Helps maintain weight loss. CDC

20. Physical Activity • Occupational work • Carpentry, construction, waiting tables, farming • Household chores • Washing floors or windows, gardening, or yard work • Leisure time activities • Walking, skating, biking, swimming, playing Frisbee, dancing, softball, tennis, football, aerobics CDC

21. Physical Activity Regular physical activity is good for overall health. • Physical activity decreases the risk for: • Colon cancer • Diabetes • High blood pressure • Physical activity also helps to: • Control weight • Contribute to healthy bones, muscles, and joints • Reduce falls among the elderly • Relieve the pain of arthritis. CDC

22. How Much Physical Activity a Day? The 2005 Dietary Guidelines for Americans recommend the following for adults: • To reduce the risk of chronic diseases in adulthood: Engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week. • To help manage weight and prevent gradual, unhealthy weight gain inadulthood: Engage in approximately 60 minutes of moderate- to vigorous-intensity activity on most days of the week while not exceeding caloric intake requirements. • To sustain weight loss in adulthood: • Participate in at least 60 to 90 minutes of daily moderate- to vigorous-intensity physical activity while not exceeding caloric intake requirements. (Some may need to contact their healthcare provider before participating in this level of activity.) Dietary Guidelines for Americans

23. How Much Physical Activity a Day? • Any activity helps. • Moderate physical activity brings health benefits. • Make it personal. • Start slowly (10 minute walk/day).

24. Increasing Physical Activity You can increase your physical activity by taking small steps to change what you do everyday. Women’s Health

25. How Many Calorie Am I Burning? Calories burned/hour of activity American Heart Association

26. How Many Calories Do I Need? • To maintain - use your current weight. • To lose - use the average healthy weight recommended for your height. ACS

27. Calculating Ideal Body Weight For men: Use 106 pounds of body weight for the first 5 feet of their height. Add 6 pounds for each additional inch. For women: Use 100 pounds of body weight for the first 5 feet of their height. Add 5 pounds for each additional inch. A 5’9 man’s ideal body weight would be: First 5’0 = 106 lb standard weight for men Plus 9 additional inches 9 (6 lbs)= 54 lbs 106 + 54= 160 pounds (± 10%)= 144 to 176 144 to 176 pounds is this man’s idea weight A 5’4 woman’s ideal body weight would be: First 5’0= 100 lb standard weight for women Plus 4 additional inches  4(5 lbs)= 20 100 + 20= 120 pounds (± 10%)= 108 to 132 108 to 132 pounds is this woman’s ideal weight

28. How Many Calories Do I Need? • USDA’s MyPyramid site: http://www.mypyramid.gov/ • Determines calorie needs and calculates the servings needed from food groups. • The American Cancer Society (ACS) site: http://www.cancer.org/docroot/PED/content/PED_6_1x_Calorie_Calculator.asp • The ACS site indicates the number of calories that are needed per day to maintain your current weight.

29. On the Path to Increased Physical Activity

30. Are a man older than age 40 or a woman older than age 50 Have had a heart attack Have a family history of heart-related problems before age 55 Have heart, lung, liver or kidney disease Feel pain in your chest, joints, or muscles during physical activity Have high blood pressure, high cholesterol, diabetes, arthritis, osteoporosis, or asthma Have had joint replacement surgery Smoke Are overweight or obese Tale medication to manage a chronic condition Have an untreated joint or muscle injury, or persistent symptoms after a joint or muscle injury Are pregnant Unsure of your health status. Before Beginning an Exercise Program You should check with your doctor before beginning an exercise program if you: Mayo Clinic

31. Health Benefits of Physical Activity Health benefits of physical activity. CMAJ. 2006; 174(6): 801-809.

32. Physical ActivityPrimary Effects on Diabetes Mellitus • Aerobic and resistance types of exercise decrease the incidence of type 2 diabetes. • A modest weight loss through diet and exercise reduces the incidence of diabetes. CMAJ. 2006;174(6): 801-809.

33. Physical ActivitySecondary Effects on Diabetes Mellitus • Exercise helps in the management of diabetes. • Aerobic and resistance training help in the control of diabetes CMAJ. 2006;174(6): 801-809.

34. Physical ActivityPrimary Effects on Cancer • Routine activity reduces the incidence cancers. • Activity results in a 30-40% reduction in the relative risk of colon cancer and breast cancer. Moderate physical activity is believed to exhibit a greater protective effect than activities of less intensity. CMAJ. 2006;174(6): 801-809.

35. Physical ActivitySecondary Effects on Cancer • Regular physical activity - important. • Increased self-reported physical activity = decreased reoccurrence of cancer and a decreased risk of death from cancer. • Reduced cancer-related death. CMAJ. 2006;174(6): 801-809.

36. Physical ActivityPrimary Effects on Osteoporosis • Many studies have been conducted. • According to findings, routine physical activity, especially weight-bearing and impact exercise, prevents bone loss associated with aging. CMAJ. 2006;174(6): 801-809.

37. Physical ActivitySecondary Effects on Osteoporosis • Regular physical activity can lead to stronger bones. • Bone responds to physical stress at any age; even in the elderly. Osteoporosis CMAJ. 2006;174(6): 801-809.

38. Eating for Weight Loss

39. The Critical Role of Healthy Eating • Good nutrition leads to a healthier life. • Many do not eat based on MyPyramid recommendations. CDC

40. U.S. Eating Habits In 2000, the larger majority of U.S. adults reported that they did not consume 5 or more servings of fruits and vegetables/day. 81% 77% 73% CDC. Behavioral Risk Factor Surveillance System

41. Dietary Guidelines for Americans, 2005Tips for Healthy Eating • Make half your grains whole • Vary your veggies • Focus on fruit • Get your calcium rich foods • Go lean with protein • Find your balance between food and physical activity MyPyramid, which is the newest Food Guide Pyramid, recommends the following for a healthy lifestyle: MyPyramid: http://mypyramid.gov/

42. A Healthy Diet • Emphasizes fruits, vegetables, whole grains, fat-free or low-fat milk, & milk products; • Includes lean meats, poultry, fish, beans, eggs, and nuts • Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars. The 2005 Dietary Guidelines for Americans defines a healthy diet as one that: MyPyramid: http://mypyramid.gov/

43. Dietary Guidelines for Americans, 2005Key Recommendations for the General Population • 1. Adequate Nutrients Within Calorie Needs • Consume a variety of nutrient-dense foods (whole grains, fruits and vegetables, lean meats, low-fat dairy) and beverages within and among the basic food groups while choosing foods that limit the intake of saturated fats and trans fats, cholesterol, added sugars, salt, and alcohol. • Meet recommended intakes within energy needs by adopting a balanced eating pattern, such as the USDA Food Guide or the Dietary Approaches to Stop Hypertension (DASH) Eating Plan. MyPyramid: http://mypyramid.gov/

44. Dietary Guidelines for Americans, 2005Key Recommendations for the General Population • 2. Weight Management • To maintain body weight in a healthy range, balance calories from foods and beverages with calories expended. • To prevent gradual weight gain over time, make small decreases in food and beverage calories and increase physical activity. MyPyramid: http://mypyramid.gov/

45. Dietary Guidelines for Americans, 2005Key Recommendations for the General Population • 3. Physical activity • Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a healthy body weight. • Achieve physical fitness by including cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises for muscle strength and endurance. MyPyramid: http://mypyramid.gov/

46. Dietary Guidelines for Americans, 2005Key Recommendations for the General Population • 4. Food Groups to Encourage • Consume a sufficient amount of fruits and vegetables while staying within energy needs. • Choose a variety of fruits and vegetables each day. Select from all five vegetable subgroups (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week. • Consume 3 or more ounce-equivalents of whole-grain products per day, with the rest of the recommended grains coming from enriched or whole-grain products. At least half the grains should come from whole grains. • Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products. MyPyramid: http://mypyramid.gov/

47. Dietary Guidelines for Americans, 2005Key Recommendations for the General Population • 5. Fats • Keep total fat intake between 20 - 35 percent of calories (With most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils). • Limit intake of fats and oils high in saturated and/or trans fatty acids, and choose products low in such fats and oils. • Consume less than 10 percent of calories from saturated fatty acids • Consume less than 300 mg/day of cholesterol • Keep trans fatty acid consumption as low as possible • When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low-fat, or fat-free. MyPyramid: http://mypyramid.gov/

48. Dietary Guidelines for Americans, 2005Key Recommendations for the General Population • 6. Carbohydrates • Choose fiber-rich fruits, vegetables, and whole grains often. • Choose and prepare foods and beverages with little added sugars or caloric sweeteners. • Reduce the incidence of dental caries by practicing good oral hygiene and consuming sugar- and starch-containing foods and beverages less frequently. • 7. Sodium and Potassium • Consume less than 2,300 mg (approximately 1 teaspoon of salt) of sodium per day. • Choose and prepare foods with little salt. At the same time, consume potassium-rich foods, such as fruits and vegetables. MyPyramid: http://mypyramid.gov/

49. Dietary Guidelines for Americans, 2005Key Recommendations for the General Population • 8. Alcoholic Beverages • Those who choose to drink alcoholic beverages should do so sensibly and in moderation (≤ 1 drink for women/day and ≤ 2 drinks for men/day). • Alcoholic beverages should be avoided by individuals engaging in activities that require attention, skill, or coordination, such as driving or operating machinery. • Alcoholic beverages should not be consumed by some individuals, including: those who cannot restrict their alcohol intake, women of childbearing age who may become pregnant, pregnant and lactating women, children and adolescents, individuals taking medications that can interact with alcohol, and those with specific medical conditions. MyPyramid: http://mypyramid.gov/

50. Dietary Guidelines for Americans, 2005Key Recommendations for the General Population • 9. Food Safety • To avoid microbial food borne illness: • Clean hands, food contact surfaces, fruits, and vegetables. Meat and poultry should not be washed or rinsed. • Separate raw, cooked, and ready-to-eat foods while shopping, preparing, or storing foods. • Cook foods to a safe temperature to kill microorganisms. • Chill (refrigerate) perishable food promptly and defrost foods properly. • Avoid raw (unpasteurized) milk or any products made from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, unpasteurized juices, and raw sprouts. MyPyramid: http://mypyramid.gov/