Dr Martin Fried Nutrition Talk

Healthy Nutrition Martin D. Fried, MD Pediatric Gastroenterology and Nutrition 41 State Route 34 – Charms Bldg- Suite 104 (Opposite delicious orchards) Colts Neck, New Jersey 07722 www.healthydays.info Phone 732-682-3425

BODY MASS INDEX (BMI)
Weight (kg) /Height x Height(m)
A Measure of Health .

Assessing Weight What Is BMI?
BMI
Evaluates weight relative to height
Replaced % ideal body weight as the primary criterion for assessing obesity
Correlates significantly with body fat, morbidity, and mortality
NIH Natl Heart, Lung, and Blood Inst. Obes Res . 1998;6(suppl 2):51S. Willett WC et al. N Engl J Med . 1999;341:427. Category BMI Underweight < 18.5 Normal* 18.5 – 24.9 Overweight 25.0 – 29.9 Obesity ≥ 30.0 Class I 30.0 – 34.9 Class II 35.0 – 39.9 Class III ≥ 40.0

Relationship Between BMI and Comorbidities Is Positive, Willett WC, et al. N Engl J Med. 1999;341:427-434. Body Mass Index (kg/m 2 ) Relative Risk Women Men Body Mass Index (kg/m 2 ) Relative Risk 4 6 5 3 2 1 0 < 21 22 23 24 25 26 27 28 29 30 4 6 5 3 2 1 0 < 21 22 23 24 25 26 27 28 29 30 T2 diabetes Cholelithiasis Hypertension Coronary heart disease

Causes of BMI >30
What you eat
How much you eat
Activity level
Family History
Genetics- Praeder Willi,
Medical- Steroids, hypothyroid
Stressors- divorce, death, recent move
Depression

Environment - Overfeeding

PRADER WILLI

Gene-Environment Interaction in the Pathogenesis of BMI >30 Ravussin E et. al. Diabetes Care 17:1067, 1994. Body Mass Index (kg/m 2) Pima Indians in Maycoba, Mexico Pima Indians in Arizona 0 10 20 30 40 50 p < 0.0001

Overweight is Caused by:
Fat
stores
Energy intake Energy expenditure

16 oz 32 oz 44 oz 52 oz 64 oz 1 oz ≈ 12 calories

Treatment Pyramid Surgery Pharmacotherapy Lifestyle Modification Diet Physical Activity BMI  40 35 30 25

20 Years Ago Today 270 calories 630 calories

What WE Should Eat
5 servings fruits and vegetables a day
Lean cuts of meat and poultry
Not to exceed 30% of calories from fat
Grilled, baked, steamed not FRIED
Don’t supersize
Catsup, mustard not mayo, dressings
Avoid sugar drinks

610 Calories 6.9 ounces Calorie Difference: 400 Calories 20 Years Ago Today 210 Calories 2.4 ounces

How long will you have to walk in order to burn those extra 400 calories?* Healthy Weight is a Balancing Act Calories In = Calories Out

Walk for 1 hour and 10 min you will burn 400 calories.*

Shopping Hint
Don’t buy high calorie snacks
Don’t buy Potato chips or soft drinks
Don’t keep junk food in the house

45 calories 8 ounces 350 calories 16 ounces

Regulation of Body Weight
Genes confer the potential for obesity
Environment determines whether and to what extent the potential is realized

American Academy of Pediatrics. Percent of Children with Daily Physical Education

ACTIVITY
increases your strength
lowers your stress and boosts your mood
helps control blood pressure and blood sugar
helps build healthy bones, muscles, joints
helps your heart and lungs work better
improves your self-esteem.

BE ACTIVE Find an activity you enjoy and do it regularly Regular daily activity makes you feel good Walk around the house while on the phone a good way to start, even in winter

Be Active
Walk instead of ride in car
Use stairs instead of elevators
Aerobic class
Take dog for long walk
Dance to music – 30 minutes

Prevalence of Obesity by Hours of TV per Day NHES Youth Aged 12 to 17 in 1967-1970 and NLSY Youth Aged 10 to 15 in 1990 0 5 10 15 20 25 30 35 40 TV hours per day (youth report) Prevalence (%) NHES 1967-1970 NLSY 1990 0 - 1 1 - 2 2 - 3 3 - 4 4 - 5 > 5

Medical Complications of BMI > 95%ile

Visceral Adiposity: The Critical Adipose Depot Subcutaneous Fat Abdominal Muscle Layer Intra-abdominal Fat

Question
Which disease has the highest risk in association with BMI >95 th percentile?
Breast cancer
Diabetes
Cardiovascular disease
Osteoarthritis
Kidney stones
Hypertension
Abnormal Cholesterol

Medical Complications BMI>30 Pulmonary disease obstructive sleep apnea hypoventilation Fatty liver Steatosis, hepatitis Coronary disease Diabetes Dyslipidemia Hypertension GYN problems abnormal menses infertility polycystic ovarian syndrome Hip dislocation Skin - Acanthosis Nigrans Gallstones Cancer breast, uterus, cervix colon, kidney, prostate Gout Pancreatitis high triglycerides

Increasing Prevalence of Type 2 Diabetes Mellitus in the US
15 years ago,
Type 2 diabetes mellitus accounted for less than 3% of all new cases of diabetes in US children and adolescents
The figure now stands at 45%
* Report of American Academy of Pediatrics. 2003.112.

Diabetes
Fasting insulin
C peptide level
Hemoglobin A1c
Acanthosis nigrans = insulin resistance
Glucose tolerance test

Sleep Apnea
Elevated serum bicarbonate
Retained CO2 from hypoventillation
Right ventricular hypertrophy
Cor Pulmonale – hypertension in lungs

High Cholesterol, Triglycerides
Coronary artery disease prematurely
Gallstones
Pancreatitis

Coronary Heart Disease Hypertension Diabetes Dyslipidemia OBESITY

Liver and Increased Weight
Nonalcoholic fatty infiltration of the liver
Hepatitis with elevated liver enzymes
Hepatitis is reversible with weight loss
Higher incidence in Mexicans.

Question
Which of the following is not part of the Metabolic Syndrome?
High HDL-cholesterol (> 50 mg/dL)
High blood pressure (> 130/85)
High Triglyceride (> 150 mg/dL)
fasting glucose (100-126 mg/dL)
waist circumference [> 35in (F) 40in (M)]

Metabolic Syndrome
Glucose intolerance
High triglycerides
Low HDL-cholesterol
High blood pressure
Insulin resistance
Abdominal Obesity

Metabolic Syndrome JAMA 2001;285:2486-2497. Risk Factor Cut-off M (waist) > 40 in F > 35 in Triglycerides ≥ 150 mg/dL HDL cholesterol M < 40 mg/dL F < 50 mg/dL Blood Pressure ≥ 130/ ≥ 85 mmHg Fasting Glucose ≥ 110 (100)mg/dL

Proportion of Disease Prevalence Due to Obesity Type 2 Diabetes 57% Gall bladder disease 30% Hypertension 17% Cardiovascular disease 17% Osteoarthritis 14% Breast Cancer 11% Uterine Cancer 11% Colon Cancer 11%

Relationship Between BMI and Risk of Type 2 Diabetes Mellitus Chan J et al. Diabetes Care 1994;17:961. Colditz G et al. Ann Intern Med 1995;122:481. Age-Adjusted Relative Risk Body Mass Index (kg/m 2 ) < 23 24 - 24.9 25 - 26.9 27 - 28.9 33 - 34.9 0 25 50 75 100 < 22 23 - 23.9 29 - 30.9 31 - 32.9 35 + 1.0 2.9 4.3 5.0 8.1 15.8 27.6 40.3 54.0 93.2 1.0 1.5 2.2 4.4 6.7 11.6 21.3 42.1 1.0 Men Women

Summary
The metabolic syndrome defined as central adiposity, hypertension, impaired fasting glucose and dyslipidemia is a major risk factor for heart disease and diabetes
Diabetes, heart disease, osteoarthritis, cancer, kidney stones, sleep apnea and impaired physical functioning are all associated with obesity
Good eating habits, maintaining weight and daily physical activity can prevent these complications

Suggestions
1) Don’t skip breakfast
People who eat breakfast lose more weight than those who skip it
2) Don’t keep junk food in the house
When you feel stressed it wont be around

General Points
Portion control
Activity 1 hr a day, 6-7 days a week
Motivation
positive reinforcement- not food
Eating habits
Water not high calorie drinks

Healthy Eating Habits is an ongoing process set realistic, practical goals short term and long term goals http://win.niddk.nih.gov/publications/active.htm

Realistic Goals
Increase fruits and vegetables daily (5)
Limit processed/refined foods and saturated fats
Increase fiber in your diet
Portion Control
Daily activity, starting slow and advancing
Progress not perfection

320 calories TURKEY SANDWICH 20 Years Ago Today

Calorie Difference: 500 820 calories 320 calories TURKEY SANDWICH 20 Years Ago Today

How long will you have to ride a bike in order to burn those extra calories?* Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out

If you ride a bike for 1 hour and 25 min, you will burn approximately 500 calories.* Calories In = Calories Out

One in nutrition One in activity Small Changes

Eating habits
Eat at table, not in front of TV, computer
Try not to eat if you aren’t hungry
Don’t offer desserts as a reward
Try to keep healthy choices in the house
Dispose of poor food choices
Try not to eat within three hours of bed

Suggestions
Whole milk to two percent milk
Replace boredom with activity
Replace sedentary with activity
Limit TV to a hour a day
get up during commercials

PEPPERONI PIZZA 20 Years Ago Today 500 calories 850 calories Calorie Difference: 350

How long will you have to play golf in order to burn those extra 350 calories ? Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out

If you play golf (walking, carrying your clubs) for 1 hour, you will burn 350 calories.* Calories In = Calories Out

Whats Next?
After some lifestyle alterations are in place, start on a structured exercise plan
Start slow - perhaps as little as 5 - 10 min of activity per day (whatever they enjoy and will continue to do)
Total amount of activity is what counts

Conclusions
Physical activity 30 minutes most days of the week improves CV health
60 - 80 minutes of physical activity to prevent regain following weight loss
Muscle mass decreases as you age Activity helps maintain your weight

Decrease with age REE /kg of muscle and Muscle Mass

For many individuals, starting a structured exercise program is not possible
Implement small lifestyle changes to increase daily physical activity
Park at end of lot when driving to store
Find the stairs and use them!
Decrease sedentary activity
How to Be More Active

Lifestyle Activity Program
Increase activity by 5-10 minutes a week
Goal is 1 hour walking 5-6 times a week for weight maintenance
1 hour 20 minutes for weight loss

Final Conclusion Risk factors associated with Metabolic Syndrome improve with physical activity Lifestyle changes and short bouts of activity in sedentary individuals may be the place to start Gradual increase over 1 - 2 years may be necessary Long-term adherence is an important goal Healthy Food choices, including variety, moderation (portion control) coupled with daily activity is the goal for all of us.

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Dr Martin Fried Nutrition Talk

by healthy days LLC on Mar 17, 2009

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