15. 20 Years Ago Today
500 calories How many calories
1 cup spaghetti with do you think are in
sauce and 3 small today's portion of
meatballs spaghetti and
meatballs?
Portion Distortion, HHS, NIH, NHLBI
16. 20 Years Ago Today
500 calories 1,025 calories
1 cup spaghetti with 2 cups of pasta with
sauce and 3 small sauce and 3 large
meatballs meatballs
Calorie Difference: 525 calories
Portion Distortion, HHS, NIH, NHLBI
17.
18. “…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
31. 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
32. 1995
Results of study are
printed in Allure
magazine and in
Reader’s Digest
Cohen K, Fen-Phen
Nation, pbs.org
33. 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
35. 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withdrawn from the market on September 15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
36. 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Sibutramine (Meridia®) voluntarily withdrawn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)
37. 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)
38. 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)
41. “Every system is perfectly
designed to achieve the results
that it achieves.”
Don Berwick, MD
42. “Handing out nutrition brochures
does not work.”
Eileen Kennedy, Dean of the Friedman
School of Nutrition Science and Policy, Tufts
University
43.
44.
45.
46.
47.
48.
49. 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
50. When we talk about
diabetes, we’re really
talking about obesity
cdc.gov
51.
52.
53. 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
54. 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
55. 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
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
56. 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.
57. Photo credits
Jumprope, by Edward Boatman for the noun
project, 2012
Pondera fm, the noun project, 2012
Likecool.com
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