Obesity: a person is considered obese when the percentage of body fat, according to age and sex, exceeds 5% of the average percentage for that age and sex classification. -BMI is a common measure expressing the relationship (or ratio) of weight-to-height. It is a mathematical formula in which a person's body weight in kilograms is divided by the square of his or her height in meters (i.e., wt/(ht)2. It is more highly correlated with body fat than any other indicator of height and weight. -Standard weight is based on sitting height and upper arm length.
vii) Psychological - psychogenic component in 90% of cases, however, it is NOT primary cause.
Obesity Is an Increasingly Common Childhood Condition Age 6 to 11: 4% 13% Age 12 to 19: 5% 14% Growth in Childhood Obesity Over Three Decades If obese at age 6 50% chance of life-long obesity If obese at age 13 75% chance of life-long obesity Blacks Mexican Americans Age 6–19 50% more likely to be obese than whites
A few statistics on childhood obesity: -4% overweight in 1982, and 16% overweight in 1994 -25% of all white children overweight in 2001 -33% African American and Hispanic children overweight 2001 -Hospital costs associated with childhood obesity rising from $35 Million (1979) to $127 Million (1999) Why this is a problem? -New study suggest one in four overweight children is already showing early signs of type 2 diabetes -60% already have one risk factor of heart disease
TV watching and Obesity People who watch T.V. weekly become more obese, the graph shows people who are underweight, and acceptable weight watch T.V. less then people who are overweight and obese. Therefore T.V. Watching has an effect on obesity!!
Obesity Related Diseases -80% of type 2 diabetes related to obesity -70% of Cardiovascular disease related to obesity -42% breast colon cancer diagnosed among obese individuals -30% of gall bladder surgery related to obesity -26% of obese people having high blood pressure Surge in childhood Diabetes -Between 8%-45% of newly diagnosed cases of childhood diabetes are type 2, associated with obesity -4% of childhood diabetes type 2 has risen 20% -Type 2 is most frequent in ages 10-19 -Of children diagnosed with type 2 diabetes, 85% are obese
Obesity Loves Inequity BMI >40: Morbidly Obese Male 60% 29% 4% Female 78% 50% 15% BMI >30: Obese BMI >25: Overweight Obese 27% 23% 21% 16% Diabetic 13% 8% 8% 6% Black Mex. Amer. Male 74% 29% 2% Female 72% 40% 6% White Male 68% 28% 3% Female 58% 31% 5% College Some College High School No High School
Obesity Virtually Guarantees Bad Health Diseases Tied to Obesity School
Type 2 diabetes
To Address Obesity, Target the Molecule, Cell, and Population; Not the Individual “ In the human body, as in the world, if you control fuel resources, you influence a lot of other things as well.” Molecular/Chemical Level Population
prosperity : calories
+ 335 cal/day for women
+ 168 cal/day for men
indoor entertainment: sedentary behavior
marketing of poor food: poorer nutrition
Not a by-product of individual greed and guilt
An active organ in its own right
– Dr. Gökhan Hotamisligil, Harvard School of Public Health
1996 2003 Obesity Trends* Among U.S. Adults BRFSS, 1991, 1996, 2003 (*BMI 30, or about 30 lbs overweight for 5’4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% 1991
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Benefits of Regular Physical Activity in Obese Persons
Decreases loss of fat-free mass associated with weight loss
Improves maintenance of weight loss
Improves cardiovascular and metabolic health, independent of weight loss
Physical Activity Helps Preserve Fat-Free Mass During Weight Loss Diet Only Loss of Fat-Free Mass (% Total Weight Loss) Ballor and Poehlman. Int J Obes Relat Metab Disord 1994;18:35. Diet Plus Physical Activity * P <0.05 Men Women
Energy Expenditure of Physical Activity Energy Expenditure (kcal/h) Adapted from: Alpers. Undergraduate Teaching Project. Nutrition: energy and protein. American Gastroenterological Association, 1978. All out competitive sports Running 10 mph Running 6 mph Climbing stairs Sexual intercourse Gardening Walking 4 mph Bicycling Walking 2 mph Chewing gum (11 kcal/h) 400 600 1000 200 800 1200
Relationship Between Physical Activity and Maintenance of Weight Loss Not Maintained Subjects Exercising (%) P <0.001 Kayman et al. Am J Clin Nutr 1990;52:800. Weight Loss Pattern Maintained
Start activity slowly and gradually increase planned aerobic activity to 200 min/wk
Programmed vs lifestyle activity
At-home vs onsite activity
Multiple short bouts vs single long bout of activity
Components of Behavioral Therapy for Obesity Wadden and Foster. Med Clin North Am 2000:84:441. Self Monitoring Problem Solving Contingency Management Cognitive Restructuring Social Support Stress Management Stimulus Control OBESITY
Diet: record food intake daily, limit certain foods or food quantity
Weight: check body weight > 1 x/wk
Low-calorie, low-fat diet:
Total energy intake: 1300-1400 kcal/d
Energy intake from fat: 20%-25%
Eat breakfast daily
Regular physical activity: 2500-3000 kcal/wk (eg, walk 4 miles/d)
Klem et al. Am J Clin Nutr 1997;66:239. McGuire et al. Int J Obes Relat Metab Disord 1998;22:572.
Five Steps to Facilitate Behavior Change Review when, where, and how behaviors will be performed Identify behavior change goal Have patient keep record of behavior change Review progress at next treatment visit Wadden and Foster. Med Clin North Am 2000;84:441. 1 2 5 3 4 Congratulate patient on successes (do not criticize shortcomings)
In the last few years portions sizes have increased dramatically
We have become so used to the larger portions that normal portions sizes look too small
Some researchers have found that patients responded better to reducing portion size vs. counting calories
BAGEL 140 calories 3-inch diameter Calorie Difference: 210 calories 350 calories 6-inch diameter 20 Years Ago Today
COFFEE 20 Years Ago Coffee (with whole milk and sugar) Today Mocha Coffee (with steamed whole milk and mocha syrup) 45 calories 8 ounces 350 calories 16 ounces Calorie Difference: 305 calories
20 Years Ago Today Calorie Difference: 290 calories 500 calories 4 ounces MUFFIN 210 calories 1.5 ounces
PEPPERONI PIZZA 20 Years Ago Today 500 calories 850 calories Calorie Difference: 350 calories
CHICKEN CAESAR SALAD 20 Years Ago Today 390 calories 1 ½ cups 790 calories 3 ½ cups Calorie Difference: 400 calories
POPCORN 20 Years Ago Today 270 calories 5 cups 630 calories 11 cups Calorie Difference: 360 calories
Recommended Nutrient Content of a Weight-Reducing Diet < 15% Saturated fatty acids Polyunsaturated fatty acids Monounsaturated fatty acids 8%-10% < 10% Carbohydrate > 55% Protein 15% Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults– The Evidence Report. Obes Res. 1998;6 (suppl 2). Fat < 30% Calories: 500-1000 kcal/d reduction Cholesterol: <300 mg/d Fiber: 20-30 g/d
Suggested Energy Intake Based on Initial Body Weight Klein et al. Gastroenterology. 2002 Sep;123(3):882-932. 1000 1500 250-299 1250 1800 300-349 750 1200 200-249 > 1500 2000 > 350 500 1000 150-199 Approximate Initial Energy Deficit (kcal/d) Suggested Energy Intake (kcal/d) Body Weight (lb)
Over time the rate averages 4.5% for those obese patients who did not have the surgery and about 1% for those undergoing gastric bypass.
Gastric bypass is becoming a successful current treatment method of obesity.
Short-term Obesity Therapy Does Not Result in Long-term Weight Loss Change in Weight (kg) Wadden et al. Int J Obes 1989;13 (Suppl 2):39. 5-year Follow-up 1-year Follow-up End of Treatment Baseline Diet alone Behavior therapy Combined therapy
Long-term Weight Loss is Improved with Long-term Maintenance Therapy Weight Loss (%) Perri et al. J Consult Clin Psychol 1988;56:529. P <0.05 No maintenance tx Maintenance tx Diet and behavior modification therapy 0 1 2 3 4 5 6 7 8 9 10 11 12 Time (mo) 13 14 15 16 17
Physiologic problems associated with ketogenic diets:
Ketosis occurs from incomplete breakdown of fatty acids and are excreted in the urine. Thus, much of the weight loss results from water loss due to body's attempt to excrete accumulating ketone bodies.
Initial dramatic weight loss - results from consumption of lean body mass. During low CHO diet (ie starvation) body burns protein preferentially. Requires only 480 calories to burn one lb of protein vs 3500 for a lb of fat.