• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Via Christi 50+ Paths to a Healthy Weight
 

Via Christi 50+ Paths to a Healthy Weight

on

  • 1,178 views

Dr. Justin Moore discusses paths to a healthy weight at a Via Christi 50+ luncheon

Dr. Justin Moore discusses paths to a healthy weight at a Via Christi 50+ luncheon

Statistics

Views

Total Views
1,178
Views on SlideShare
262
Embed Views
916

Actions

Likes
0
Downloads
4
Comments
0

4 Embeds 916

http://www.via-christi.org 906
https://www.google.com 6
http://14sitemakweb.via-christi.org 3
http://www.via-christi.org. 1

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • 1) Heart disease 25.12) Cancer 22.13) Stroke 6.75) Alzheimer's disease 4.37) Diabetes 2.99) Kidney disease 2.0
  • Diabetes follows obesity by about 3 years
  • To understand why this is not the equivalent of weight loss surgery, we really need to understand the role of fat and bowel as endocrine organs.
  • Total weight loss (all procedures) at the time point for which data are available for 50% of the study patients was 38.5 kg (80.5 lbs; 55.9% excess weight loss)Total weight loss at 2 years was 41.6 kg (91.5 lbs; 59% excess body weight loss) Buchwald H et al, 2009
  • Doses lower than what’s available separately.
  • Echocardiographic data from > 5200 participants who got either lorcaserin or placebo for up to 1 year):Relative risk of FDA-defined valvulopathy 1.16 (95% CI, 0.81 to 1.67)
  • Berwick’s central law of design

Via Christi 50+ Paths to a Healthy Weight Via Christi 50+ Paths to a Healthy Weight Presentation Transcript

  • Paths to a Healthy Weight Justin Moore, MD Via Christi Weight Management
  • Body Mass Index (BMI) Height (ft'in") 5'0" 5'2" 5'4" 5'6" 5'8" 5'10" 6'0" 6'2" 6'4" 6'6" Height (in) 60 62 64 66 68 70 72 74 76 78 BMI (kg/m2) 150 29.4 27.5 25.8 24.3 22.9 21.6 20.4 19.3 18.3 17.4 160 31.3 29.3 27.5 25.9 24.4 23.0 21.7 20.6 19.5 18.5 170 33.3 31.2 29.2 27.5 25.9 24.4 23.1 21.9 20.7 19.7 180 35.2 33.0 31.0 29.1 27.4 25.9 24.5 23.2 22.0 20.8 190 37.2 34.8 32.7 30.7 28.9 27.3 25.8 24.4 23.2 22.0 200 39.1 36.7 34.4 32.3 30.5 28.8 27.2 25.7 24.4 23.2 210 41.1 38.5 36.1 34.0 32.0 30.2 28.5 27.0 25.6 24.3 220 43.1 40.3 37.8 35.6 33.5 31.6 29.9 28.3 26.8 25.5 230 45.0 42.2 39.6 37.2 35.0 33.1 31.3 29.6 28.1 26.6 240 47.0 44.0 41.3 38.8 36.6 34.5 32.6 30.9 29.3 27.8 250 48.9 45.8 43.0 40.4 38.1 35.9 34.0 32.2 30.5 29.0 260 50.9 47.7 44.7 42.1 39.6 37.4 35.3 33.5 31.7 30.1 270 52.8 49.5 46.4 43.7 41.1 38.8 36.7 34.7 32.9 31.3 280 54.8 51.3 48.2 45.3 42.7 40.3 38.1 36.0 34.2 32.4 290 56.8 53.2 49.9 46.9 44.2 41.7 39.4 37.3 35.4 33.6 300 58.7 55.0 51.6 48.5 45.7 43.1 40.8 38.6 36.6 34.7 310 60.7 56.8 53.3 50.1 47.2 44.6 42.1 39.9 37.8 35.9 320 62.6 58.7 55.0 51.8 48.8 46.0 43.5 41.2 39.0 37.1 330 64.6 60.5 56.8 53.4 50.3 47.4 44.8 42.5 40.3 38.2 340 66.5 62.3 58.5 55.0 51.8 48.9 46.2 43.7 41.5 39.4 350 68.5 64.1 60.2 56.6 53.3 50.3 47.6 45.0 42.7 40.5 360 70.5 66.0 61.9 58.2 54.9 51.8 48.9 46.3 43.9 41.7 370 72.4 67.8 63.6 59.8 56.4 53.2 50.3 47.6 45.1 42.8 380 74.4 69.6 65.4 61.5 57.9 54.6 51.6 48.9 46.4 44.0 390 76.3 71.5 67.1 63.1 59.4 56.1 53.0 50.2 47.6 45.2 400 78.3 73.3 68.8 64.7 60.9 57.5 54.4 51.5 48.8 46.3 410 80.2 75.1 70.5 66.3 62.5 59.0 55.7 52.8 50.0 47.5 Morbidly Obese Overweight Obese Weight(lbs)
  • N Engl J Med 1999; 341:427-434 0 1 2 3 4 5 6 Type 2 diabetes Gallstones High Blood Pressure Coronary artery disease Body-Mass Index RelativeRisk
  • cdc.gov
  • “Obesity can develop only from an excess of energy intake over expenditure.” Rosenbaum M, Leibel RL, Hirsch J. N Engl J Med 1997
  • 20 Years Ago: Coffee (with whole milk and sugar) Today: Mocha Coffee (with steamed whole milk and mocha syrup) How many calories are in today's coffee? Portion Distortion, HHS, NIH, NHLBI 45 calories 8 ounces
  • 20 Years Ago: Coffee (with whole milk and sugar) Today: Mocha Coffee (with steamed whole milk and mocha syrup) 45 calories 8 ounces Portion Distortion, HHS, NIH, NHLBI Calorie Difference: 305 calories 350 calories 16 ounces
  • 20 Years Ago Today 140 calories 3-inch diameter How many calories are in this bagel? Portion Distortion, HHS, NIH, NHLBI
  • 20 Years Ago Today 140 calories 3-inch diameter Portion Distortion, HHS, NIH, NHLBI 350 calories 6-inch diameter Calorie Difference: 210 calories
  • 20 Years Ago Today 500 calories 1 cup spaghetti with sauce and 3 small meatballs How many calories do you think are in today's portion of spaghetti and meatballs? Portion Distortion, HHS, NIH, NHLBI
  • 20 Years Ago Today 500 calories 1 cup spaghetti with sauce and 3 small meatballs Portion Distortion, HHS, NIH, NHLBI 1,025 calories 2 cups of pasta with sauce and 3 large meatballs Calorie Difference: 525 calories
  • “…adding 1 oz of a sugar-sweetened beverage and walking 1 minute less per day creates a temporary energy surplus of about 13 kcal/d, leading to a weight gain of 0.6 kg (1.4 lb). Repeating changes in diet and physical activity of this magnitude on an annual basis for 28 years would produce the 370 kcal/d “energy gap” and 16-kg (35-lb) weight gain.” Journal of the American Medical Association, 2010
  • Biology≠fate.
  • J Hosp Med 2012
  • 80 lbs.
  • Bariatric surgery makes people live longer • 24% reduction in mortality (N Engl J Med 2007) • 53% reduction in fatal heart attacks (JAMA 2012)
  • But… • Increased suicidality (Am J Med 2010) • Possibly increased alcohol abuse (JAMA 2012) • Decreased bone mineral density (BMJ 2012) • Postoperative care is complicated  Hospitalizations roughly doubled (7.9% vs 3.9%) over six years (JAMA 2012)
  • hCG does not work...
  • 1992  34-week trial of extended-release fenfluramine (Pondimin®) plus 15 mg phentermine (Clin Pharmacol Ther 1992) versus placebo  Drug group lost 14.2 +/- 0.9 kg, or 15.9% +/- 0.9% of initial weight (n = 58)  Control group lost 4.6 +/- 0.8 kg or 4.9% +/- 0.9% of initial weight (n = 54; p<0.001)
  • 1995
  • 1996  Redux® (dexfenfleuramine) is approved over the objections of several FDA reviewers concerned with pulmonary hypertension  Weight loss specialists caution that only those “moderately to severely” obese should take Fen- Phen  $52 million marketing campaign results in $300 million in sales of Pondimin® and Redux® for American Home Products (now Wyeth) • Cohen K, Fen-Phen Nation, pbs.org
  • NEJM 1997 1997
  • 1997  Both Pondimin® and Redux® voluntarily withdrawn from the market on September 15 (Cohen K, Fen-Phen Nation, pbs.org)  Sibutramine (Meridia®) approved November 24
  • 2010  Sibutramine (Meridia®) voluntarily withdrawn from the marked on October 9  16% increase in risk for major adverse cardiovascular events  2.5% weight loss at 60 months  (Pollock A, NYTimes.com)
  • 2010: Qnexa®  Combination phentermine/topiramate ER  Patients on Qnexa® lost an average 11% of their starting weight at one year  Initial approval denied  Cognitive disorders  Metabolic acidosis  Tachycardia
  • Phentermine/topiramate ER (Qsymia®) • Approved in adults if: • BMI ≥30 kg/m2 or BMI ≥27 kg/m2 with at least one “weight-related condition” (HTN, dyslipidemia, DM or pre- DM, abdominal obesity) Package insert: http://www.vivus.com/docs/QsymiaPI.pdf, accessed 10/10/12
  • 2010: Lorcaserin (Belviq®)  Approval originally denied over FDA scientists’ concerns about heart-valve risks  Patients lost an average of 3.1% of their starting weight over a year versus placebo  Approved by FDA June 2012
  • Lorcaserin (Belviq®) • 10 mg twice daily in addition to diet and exercise if:  BMI >30 kg/m2 or  BMI >27 kg/m2 with “weight-related comorbidities” • “Cautious use” if heart failure or depression • Headache, nausea, and dizziness most common adverse events • Label recommends discontinuation if <5% of body weight lost in 12 weeks  Does allow for use for “weight maintenance” Package insert: http://us.eisai.com/package_inserts/BelviqPI.pdf, accessed 10/10/12
  • Orlistat (Xenical®, Alli®) • -2.9% weight loss vs. Placebo • Use limited by stomach discomfort and greasy stools BMJ 2007
  • “Every system is perfectly designed to achieve the results that it achieves.”  Don Berwick, MD
  • http://www.pcrm.org/magazine/gm07autumn/health_pork.html
  • “Handing out nutrition brochures does not work.”  Eileen Kennedy, Dean of the Friedman School of Nutrition Science and Policy, Tufts University
  • It’s not like we’re not trying…  40 percent of obese Americans say they’ve lost >5% of their weight in the last year  Most successful weight losers 1) exercised more, 2) intentionally ate fewer calories, and 3) used prescription diet medications  Those who lost the most joined a formal weight-loss program  People who tried to lose weight by eating diet foods and products were the most likely to gain weight  American Journal of Preventive Medicine 2012
  • Children are less active today than at any other time in American history, spending 7.5 hours a day watching TV, playing video games or simply involved in efforts that don't require movement (Xanthakos S, 2010)
  • How much exercise is enough? (Obesity 2008) • National Weight Control Registry • Persons maintaining ≥ 30 lb weight loss at one year: • Average 2,621 calories per week in intentional physical activity
  • “…27% to 30% of the daily caloric intake of American children and adults is comprised of low nutrient density food “…with sweeteners and desserts contributing 18% to 24% of the total” (Xanthakos S, 2010)
  • What predicts weight loss in postmenopausal women? (J Acad Nutr Diet 2012) 6 month weight loss:  Decreased intake of desserts (P<0.001)  Decreased restaurant eating (P=0.042)  Decreased sugar-sweetened beverage intake (P=0.009)  Decreased fried foods (P<0.001)  Increased fish consumption (P=0.003) 48 month weight loss associated with:  Decreased intake of desserts (P=0.003)  Decreased intake of sugar-sweetened beverages (P=0.011)  Decreased intake of meats/cheeses (P=0.024  Increased fruit/vegetable intake (P<0.001)
  • Sleep may be worth 12 pounds per year  Volunteers sleeping only 5.6 hours per night for three weeks experienced an average 8 percent decrease in resting metabolic rate  Theoretical weight gain: one bowling ball per year  Science Translational Medicine 2012
  • Justin’s “To Do” list for weight reduction  Stop drinking calories  Move through space at least 30 additional minutes per day  Eat at least five servings (cups) of fruits and vegetables daily  Modify your environment  Go to bed at night  If you don’t sleep well, get tested  If you must work nights, get a new job  If you can’t lose weight, get help