P488 obesity


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  • One of Osci's early experiments divided rats into three groups. One group was a sedentary (Sed-Free) free eating group that was allowed to eat as much food as desired. The exercise group (Exercise) was also allowed to eat as much as they wanted. However, the third group was sedentary, but the food was restricted so that they would end-up weighing the same as the exercise group (Sed-Pair).
  • -top section is a rough estimate of caloric expenditure for weight… kcal per kg-lower section is a rough estimate of caloric expenditure for weight… kcal per Lb
  • 1. Top are formua for estimating resting caloric expenditure—need wt in KG and ht in Meters like 1.852. Once this value is determined then multiply it by PA values…this number (1-2) is determined by gender and PA classifaction
  • P488 obesity

    1. 1. OBESITY and OVERWEIGHT <br />PED 488<br />1<br />
    2. 2. OVERWEIGHT and OBESITY<br />An excess of body fat frequently resulting in a significant impairment of health<br />Having a very high amount of body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or higher.<br />Estimated to be the biggest health challenge in the future<br />Will exceed that of smoking as a cause of death<br />Exercise is most effective in preventing and controlling body weight and/or body fat<br />2<br />
    3. 3. CAUSE of DEATHS<br />
    4. 4. Diseases associated excess body fat <br />Coronary Heart Disease<br />Hypertension<br />Diabetes<br />Hyperlipidemia<br />Cancer<br />Gallbladder Disease<br />Menstrual Irregularities<br />Reproductive Hormone Dysfunction<br />4<br />
    5. 5. Associated Risk Factors<br />Predictive of CVD/CHD (especially central or visceral adiposity)<br />Metabolic Syndrome<br />Certain Cancers<br />Hypertension<br />Osteoarthritis<br />5<br />
    6. 6. Obesity Trends Among U.S. Adults between 1985 and 2006<br />Data shown in maps were collected through CDC’s Behavioral Risk Factor Surveillance System (BRFSS). <br />http://www.cdc.gov/NCCDPHP/dnpa/obesity/trend/maps/index.htm<br />6<br />
    7. 7. US Ranks Last in Preventable Deaths, Health Affairs, 2008<br />7<br />
    8. 8. Process of Excess Body Fat<br />Storage of extra energy <br />adipose cells<br />unlimited storage capacities. <br />No spot reduction<br />Useful for times when food is not available <br />Food available year-round food stores occur in excess<br />Obesity occurs when adipose cells increase excessively <br />size (hypertrophy) <br />number (hyperplasia)<br />Both size and number <br />8<br />
    9. 9. Theories for Fat Gain<br />Caloric Balance<br />you eat more calories than you expend, you gain fat<br />Biochemical Imbalance<br />Hormone and other substance alteration is associated with obesity<br />Set Point Theory<br />body desires to have a specific amount of body<br />always return to its own target percentage <br />Excess Fat Intake<br />9<br />
    10. 10. WEIGHT CYCLING<br /><ul><li>Twice as Long to Lose Weight
    11. 11. Third the time to Regain the Weight</li></li></ul><li>SomatotypePear versus the Apple<br />
    12. 12. Determining Obesity<br />Measure of “Body Build” or structure of the body<br />Muscularity<br />Linearity<br />Fatness<br />Body Mass Index (BMI) = weight (kg) / height (m2)<br />Body size is determined by height and weight<br />Body fat percentage<br />Skinfolds, underwater weighing, bioelectrical impedance, etc. <br />12<br />
    13. 13. Calculation of Ideal Body Weight Range<br />Women: 100 lbs for first 5 feet. <br />plus 5 lbs for each additional inch<br />Men: 106 lbs for first 5 ft. <br />6lbs for each additional inch<br />Assumes Medium Frame add/subtract 10%<br />110% overwt.<br />120% obese<br />Hamwi 1974<br />13<br />
    14. 14. BMI - Values<br />Disease Risk Relative to Normal Weight and Waist Circumference<br />BMI<br />(kg/m2)<br /><18.5<br />18.5 - 24.9<br />25.0 - 29.9<br />30.0 - 34.9<br />35.0 - 39.9<br />>40<br />Obesity<br />Class<br />I<br />II<br />III<br />Men (<102 cm) <40 in <br />Women (<88 cm) <35 in <br />--<br />--<br />Increased<br />High<br />Very High<br />Extremely High<br />Men (>102 cm) >40 in <br />Women (>88 cm) >35 in <br />--<br />--<br />High<br />Very High<br />Very High<br />Extremely High<br />Underweight<br />Normal<br />Overweight<br />Obesity<br />Extreme obesity<br />Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight <br />and Obesity in Adults—The Evidence Report. Obes Res 1998;6(suppl 2).<br />14<br />
    15. 15. OBESITY & MORTALITY<br />Mortality Ratio<br />High<br />Moderate<br />Low<br />Very<br />Low<br />Body Mass Index<br />15<br />
    16. 16. BMI Measurement Limitations<br />Doesn’t differentiate between body fat and body muscle<br />Fails to account for the location of body fat<br />Apple, pear, abdominal<br />As we age a slightly higher BMI may serve as a cushion against frailty<br /><ul><li>Low BMI may indicate poor nutrition or loss of muscle</li></ul>16<br />
    17. 17. Defining Obesity as % Body Fat<br />American Council on Exercise<br />17<br />
    18. 18. Children<br />Based on BMI for age and gender<br />Overweight <br />at or above 95th percentile<br />At risk for Overweight <br />85th to 95th percentile<br />Source: Expert Committee on Clinical Guidelines for Overweight Adolescent Preventative Services.(Pediatrics 1998;102(3). pediatrics.aappublications.org/cgi/content/full/102/3/e29<br />18<br />
    19. 19. Overweight<br />Overweight<br />At risk<br />At risk<br />19<br />
    20. 20. Source: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overwght99.htm<br />20<br />
    21. 21. 21<br />Clinical Management<br />Assess other Risk Factors<br />Determine Body Mass Index<br />Clinical Judgment<br /><ul><li> Hypertension
    22. 22. Cardiovascular Diseaes
    23. 23. Dyslipidemia
    24. 24. Type 2 Diabetes
    25. 25. Sleep Apnea
    26. 26. Osteoarthritis
    27. 27. Infertility
    28. 28. Other
    29. 29. Progressive gain since adolescence
    30. 30. Hx of Obesity
    31. 31. Bulimia Nervosa
    32. 32. Binge Eating Disorder
    33. 33. Depression/Anxiety/Stress
    34. 34. Relevant medical conditions
    35. 35. Overall Disease Burden
    36. 36. Quality of Life
    37. 37. Physical Inactivity
    38. 38. Waist-Hip
    39. 39. > 1.0 in
    40. 40. >0.8 in
    41. 41. Waist Circumference
    42. 42. >40 in
    43. 43. >35 in </li></li></ul><li>22<br />BMI 40<br /> 35<br /> 30<br /> 25<br />Surgery<br />Pharmacotherapy<br />Lifestyle Modification<br />Diet<br />Physical Activity<br />Obesity Treatment Pyramid<br />Slide source: R.Kushner, Obesity: Current Research and Future Directions, Certificate of Training in Adult Weight Management, March 2004. <br />
    44. 44. The etiology of overweight and obesity is a combination of genetic and life-style factors. The life-style factors will contribute to overweight and obesity provided the genetic predisposition exists.<br />Genetics<br />Exercise<br />Eating Habits<br />23<br />
    45. 45. Trends in Health Education…what is missing<br />
    46. 46. Physical Activity and Obesity<br />Minimal weight loss in the absence of caloric restriction<br />Best predictor of weight loss maintenance<br />Include both programmed and lifestyle <br />Utilize self monitoring tools – for example pedometers<br />Is recommended for health benefits whether or not it directly results in wt. loss<br />Decreases visceral inflammation<br />Increases Insulin Sensitivity<br />Reduces Mortality regardless of BMI<br />25<br />
    47. 47. Exercise in OBESITY<br />Sedentary Free Eaters<br />Sedentary Pair Weighted<br />Exercise<br />Calories per Day<br />Oscai et al J Lipid Research 13:588-592, 1972.<br />
    48. 48. Exercise in OBESITY<br />Body Weight (g)<br />Percent Fat (%)<br />
    49. 49. Exercise in OBESITY<br />Fat Cell Number<br />Fat Cell Size<br />
    50. 50. Lifestyle Management<br />Most effective treatments require a gradual long-term approach<br />Sensible diet, moderate physical activity, behavioral counseling<br />In isolation these approaches do not lead to significant weight loss<br />10% wt. loss is associated with a decrease in obesity related health consequences<br />29<br />
    51. 51. A Multilevel, Transdisciplinary,<br /> Ecological Model of Factors<br /> that Influence What <br />Children Eat<br />. L Kolbe & M Story,<br /> 2007<br />Push—Pull <br />Factors<br />30<br />
    52. 52. Estimating Energy Needs<br />Level of Activity and Cal/kg<br />Goal: Low Moderate High<br />Lose Wt. 15kcal/kg 20kcal/kg 25kcal/kg<br />Maintain Wt. 20kcal/kg 25kcal/kg 30kcal/kg<br />GROUPCALORIES/lb.<br />Men/Active Women 15<br />Women/Sedentary Men/>55 13<br />Sedentary women/obese adults 10<br />31<br />
    53. 53. M: 662 – (9.53 X Age) + PA{(15.91 X W in kg) + (539.6 X Ht in m)}<br />F: 354 – (6.91 X Age) + PA {(9.36 X Wt in kg) + 726 X Ht in m)}<br />PA Values for Different Activity Levels<br />SedLow ActiveActiveVery Active<br />M 1.00 1.11 1.25 1.48<br />F 1.00 1.12 1.27 1.45<br />32<br />Energy Expenditure Rate <br />(Formula based on Physical Activity)<br />
    54. 54. Pharmacological Approaches<br />Should only be considered with high BMI and/or comorbidities<br />Need to consider cost, side effects, and rebound weight gain<br />Noradrenergic Agents<br />Appetite Suppression<br />Serotonergic Agents<br />Appetite Suppression<br /> Mixed Noradrenergic/Serotonergic<br />LIPASE INHIBITORS<br />Reduction of Nutrient Absorption<br />33<br />
    55. 55. 34<br /><ul><li> Roux en-Y
    56. 56. Laparoscopic
    57. 57. Adjustable Gastric Binding
    58. 58. Bilio Pancreatic Diversion
    59. 59. Distal Bypass</li></ul>GASTRIC BYPASS<br />34<br />
    60. 60. GASTRIC BYPASS<br /><ul><li> Roux en-Y
    61. 61. Laparoscopic
    62. 62. Adjustable Gastric Binding
    63. 63. Bilio Pancreatic Diversion
    64. 64. Distal Bypass</li></ul>35<br />
    65. 65. Obesity Resources for Practitioners<br />Partnership for healthy Weight Management<br />http://www.consumer.gov/weightloss<br />Weight Information Network<br />http://win.niddk.nih.gov/publications/choosing.htmThe<br />Practical Guide: Identification, Evaluation, and treatment of Overweight and Obesity in Adults<br />http://www.nhlbi.nih.gov/about/oei/index.htm<br />North American Association for the Study of Obesity<br />http://www/nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf<br />North American Obesity Association<br />http://www.naaso.orghttp://www.obesity.org<br />36<br />