Via Christi Women's Connection: Paths to a Healthier You

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Justin Moore, MD, Medical Director of Via Christi Weight Management presented a talk on how to achieve a healthy weight.

Justin Moore, MD, Medical Director of Via Christi Weight Management presented a talk on how to achieve a healthy weight.

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  • 1) Heart disease 25.12) Cancer 22.13) Stroke 6.74) Chronic lower respiratory diseases 5.55) Alzheimer's disease 4.36) Unintentional injuries 3.67) Diabetes 2.98) Influenza and pneumonia 2.39) Kidney disease 2.0
  • Quetelet Index
  • 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 36.6 kg (84.7 lbs; 53.8% 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
  • So this is the treatment model that is emphasized
  • Berwick’s central law of design
  • Diabetes follows obesity by about 3 years

Transcript

  • 1. Paths to a Healthy WeightJustin Moore, MDVia Christi Weight Management
  • 2. Hello My Name is Justin
  • 3. Body Mass Index (BMI)Heig h t (ftin ") 50" 52" 54" 56" 58" 510" 60" 62" 64" 66"Heig h t (in ) 60 62 64 66 68 70 72 74 76 78 BM I ( k g/m 2) 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 Overweight 250 48. 9 45. 8 43. 0 40. 4 38. 1 35. 9 34. 0 32. 2 30. 5 29. 0 Weight (lbs) 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 Obese 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 Morbidly 360 70. 5 66. 0 61. 9 58. 2 54. 9 51. 8 48. 9 46. 3 43. 9 41. 7 Obese 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
  • 4. 6 Type 2 diabetes 5 4 CholelithiasisRelative Risk 3 Hypertension 2 1 Coronary heart disease 0 Body-Mass Index N Engl J Med 1999; 341:427-434
  • 5. “Obesity can develop onlyfrom an excess of energy intake over expenditure.” Rosenbaum M, Leibel RL, Hirsch J. N Engl J Med 1997
  • 6. Today: Mocha Coffee20 Years Ago: Coffee (with steamed whole milk(with whole milk and sugar) and mocha syrup) 45 calories How many calories 8 ounces are in todays coffee? Portion Distortion, HHS, NIH, NHLBI
  • 7. Today: Mocha Coffee20 Years Ago: Coffee (with steamed whole milk(with whole milk and sugar) and mocha syrup) 45 calories 350 calories 8 ounces 16 ounces Calorie Difference: 305 calories Portion Distortion, HHS, NIH, NHLBI
  • 8. 20 Years Ago Today140 calories How many calories3-inch diameter are in this bagel? Portion Distortion, HHS, NIH, NHLBI
  • 9. 20 Years Ago Today140 calories 350 calories3-inch diameter 6-inch diameter Calorie Difference: 210 calories Portion Distortion, HHS, NIH, NHLBI
  • 10. 20 Years Ago Today500 calories How many calories1 cup spaghetti with do you think are insauce and 3 small todays portion ofmeatballs spaghetti and meatballs? Portion Distortion, HHS, NIH, NHLBI
  • 11. 20 Years Ago Today500 calories 1,025 calories1 cup spaghetti with 2 cups of pasta withsauce and 3 small sauce and 3 largemeatballs meatballs Calorie Difference: 525 calories Portion Distortion, HHS, NIH, NHLBI
  • 12. “…adding 1 oz of a sugar-sweetened beverage andwalking 1 minute less per day creates a temporaryenergy surplus of about 13 kcal/d, leading to aweight gain of 0.6 kg (1.4 lb). Repeating changesin diet and physical activity of this magnitude on anannual basis for 28 years would produce the 370kcal/d “energy gap” and 16-kg (35-lb) weight gain.”Journal of the American Medical Association, 2010
  • 13. Biology≠fate.
  • 14. http://www.pcrm.org/magazine/gm07autumn/health_pork.html
  • 15. J Hosp Med 2012, PMID 22086862
  • 16. 80 lbs.
  • 17. There’s no free lunch…  Bariatric surgery has not been shown to extend life  Postoperative care is somewhat complicated
  • 18. hCG does not work...
  • 19. 1992  34-week, double-blind clinical trial of 60 mg extended-release fenfluramine (Pondimin®) plus 15 mg phentermine vs. placebo (added to behavior modification, caloric restriction, and exercise):  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)  Weintraub M, Clin Pharmacol Ther, PMID 1587072
  • 20. 1995  Results of study are printed in Allure magazine and in Reader’s Digest  Cohen K, Fen-Phen Nation, pbs.org
  • 21. 1996  Redux® (dexfenfleuramine) is approved over the objections of several FDA reviewers concerned with pulmonary hypertension  Weight loss specialists cautioned 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
  • 22. 1997Connolly H, NEJM, PMID 9271479
  • 23. 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
  • 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)
  • 25. Qnexa  Combination phentermine/topiramate  Patients on Qnexa lost an average 11% of their starting weight at one year  Initial approval denied  Cognitive disorders  Metabolic acidosis  Tachycardia  Awaiting FDA approval (will decide by July 17)
  • 26. Lorcaserin  Originally turned down in 2010 over FDA scientists’ concerns that the drug carried heart-valve risks  Patients lost an average of 3.1% of their starting weight over a year versus placebo  Awaiting FDA approval (expected to announce its decision by June 27)
  • 27.  Orlistat (Xenical, Alli) Phentermine Diethylpropion Benzphetamine Phendimetrazine
  • 28. “Every system is perfectlydesigned to achieve the resultsthat it achieves.”  Don Berwick, MD
  • 29. “Handing out nutrition brochuresdoes not work.”  Eileen Kennedy, Dean of the Friedman School of Nutrition Science and Policy, Tufts University
  • 30. 12 pounds per year  Volunteers sleeping 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
  • 31. When we talk about diabetes, we’re really talking about obesitycdc.gov
  • 32. 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  Another 20 percent said they had lost 10 percent or more  Most of the successful weight losers used a “multipronged approach” of exercising more, eating fewer calories, and taking prescription diet medications  American Journal of Preventive Medicine
  • 33. It’s not like we’re not trying…  Those who lost the most weight also joined a formal weight-loss program  Programs may be more effective if they cost money, requiring people to “put some skin in the game”  People who tried to lose weight by eating diet foods and products were the most likely to gain weight  American Journal of Preventive Medicine
  • 34. Justin’s “To Do” list for weightreduction  Stop drinking calories  Move through space at least 30 additional minutes per day  Eat at least five servings (cups) of fruits and vegetables daily  Eat at least one “meal replacement” daily  Go to bed at night  Get tested for sleep apnea if you don’t sleep well  If you must work nights, get a new job  If you can’t lose weight, get help
  • 35. Conclusions  Blame obesity: It’s partially to blame for most chronic health problems affecting women in the modern era.  Multiple "paths"--exist for weight management, each with its own set of advantages and disadvantages.  The solution to the obesity epidemic involves all paths, but its foundation is behavioral and dietary intervention at both the personal and societal level.
  • 36. Photo credits  Jumprope, by Edward Boatman for the noun project, 2012  Pondera fm, the noun project, 2012  Likecool.com