Obesity, Overweight and Weight Control

1. Obesity, Overweight and Weight Control Healthy Weight Network

3. Prevalence of Overweight Among Children & Adolescents 6-19 Years Source: National Center for Health Statistics

4. 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

5. Overweight and Obesity Definitions • BMI = weight (kg) height squared (m²) • Significantly correlated with total body fat content

6. Classification of Overweight and Obesity by BMI

7. 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 >102 cm (>40 in.); • Women > 88 cm (>35 in.)

9. Waist-to-Hip Ratio • Waist-to-hip ration measures waist at its narrowest point and hip at widest point. • Women with 35” waist and 46”hip = • 35/46 = 0.76 • Risk: • Women with waist-to-hip ratio >0.8 • Men with waist-to-hip ratio > 1.0

10. Assessment of Obesity • Anthropometrics • Medical • Psychological • Nutritional

11. 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

12. 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).

13. NHANES III Age-Adjusted Prevalence of High Blood Cholesterol* According to BMI Percent *Defined as > 240 mg/dL. Brown C et al. Body Mass Index and the Prevalence of Risk Factors for Cardiovascular Disease (in preparation).

14. NHANES III Age-Adjusted Prevalence of Low HDL-Cholesterol* According to BMI Percent *Defined as <35 mg/dL in men and <45 mg/dL in women. Brown C et al. Body Mass Index and the Prevalence of Risk Factors for Cardiovascular Disease (in preparation).

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

16. Nutritional Assessment • Environmental Factors • Exercise history • Motivation and readiness to change

17. Treatment for Obesity

18. 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

19. 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

20. 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 individual’s motivation and readiness to enter weight loss therapy.

21. 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.

22. 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

23. How To Achieve Weight Loss • Behavior Therapy • Pharmacotherapy - weight loss drugs • Weight loss drugs may be used in combination with a comprehensive weightloss program, for patients with BMI>=30 with no risk factors & BMI >=27 with risk factors. • Weight loss drugs should never be used without concomitant lifestyle changes.

24. 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

25. 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?

26. 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 • Decreaseconsumption of energy dense foods • High fat foods • Foods with low moisture content

27. Mayo Clinic Food Guide

28. 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 >2

29. 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

30. Shopping Tips • Use a shopping list • Read labels • serving size and servings per container

31. 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’

32. Tips for Weight Loss • Use of Meal Replacements?

34. Fad Diets • Americans spend >30 billion in the weight loss industry • Single food diets - grapefruit, rice etc. • High-protein, high fat diets • VLCD • Fasting • High fiber, low-calorie diets

35. Weight Loss Surgery