2What’s Your Wellness Score? Get a Good Grade In Your Health
3Body Mass Index (BMI) BMI = Weight (in kg) Height2 (in meters) Lbs/ inches2 x 703A BMI of<25 = desirable25 – = overweight>30 = obeseTells us if you are over weight
4Relationship of BMI to Excess Mortality 300Age at Issue20-2925030-39200150Mortality Ratio100LowModerateHighDr. George Bray is a well-known obesity researcher. He’s looked at our likelihood of living a long life relative to our BMI and found the risk of dying is low with a BMI of 25 to 30 and increases as BMI increases. The greatest risk is seen with BMIs above 40.50RiskRiskRisk152025303540Body Mass Index (kg/[m2])Bray GA. Overweight is risking fate. Definition, classification,prevalence and risks. Ann NY Acad Sci 1987;499:14-28.
5Waist/Hip Ratio Waist/Hip Ratio Ideal: <.80 Woman and <.95 Man Tells us if you are Over-Fat. Skinny fat person can have normal BMI and high body fat.Adipose Tissue is the largest endocrine gland in the body and produce:Inflammatory chemicalsEstrogenCortisol
6Blood Pressure & Resting Pulse Systolic less than or equal to 110mm-GoodDiastolic equal to or less than 70mm-GoodGreater than 130/85mm is Mildly HypertensiveIn Blood Pressure above 11/5/75, a 10 point jump in Diastolic BP (bottom number), causes a 2-fold increase in death from heart diseaseMedications??
7Sugar Biomarkers Fasting Glucose 80-100 mg/dl If Fasting Glucose is above 100 mg/dl then consider HbA1C- Glycosylated HemoglobinNormal range is %. In poorly controlled diabetes, its 8.0% or above, and in well controlled patients it's less than 7.0%The predictive value of HbA1C for total mortality was stronger than that documented for cholesterol concentration, body mass index and blood pressure.”Khaw, K-T, et al, BMJ, 2001, Vol 322: 1-6Also consider Fasting InsulinIncreased insulin production causes insulin resistanceSign of Insulin Resistance with levels over 15 uU/ml
8Lipid Biomarkers Lipids, fractionated lipids Total Cholesterol-under 200Triglycerides-under 150, preferably under 100HDL-over 50 (male) and over 60 (female)LDL-under 130Trig/HDL ratio- under 2.0Chol/HDL ratio- under 3.0Triglyceride/HDL ratio predicts a heart attack 17 times more accurately than just Cholesterol numbers.
9Consider an MSQ- Systems Evaluation Medical Symptoms Questionnaire (MSQ)Identifies symptoms in most body systemsQuantifies patient’s level of symptomsProvides a simple metric to track patient improvement
10EPIC HEALTHY LIVING STUDY 1. BMI Under Hours of Physical Activity Per Week 3. Following a Healthy Diet (fruits, vegetables, beans, whole grains, nuts, seeds, and limited amounts of meat) 4. Never SmokingParticipants with all 4 factors to the right had a 78% lower risk of developing a chronic disease (diabetes 93%; myocardial infarction 81%; stroke 50% and cancer 36% than participants without engaging in healthy factors.Arch Intern Med. 2009;169(15):
11How to Identify Patients with Metabolic Syndrome National Cholesterol Education Program (NCEP) definition is the presence of 3 or more of the following:Waist CircumferenceMen >40 in, Women >35 inTriglycerides≥150 mg/dLHDL CholesterolTG/HDL Ratio ≥3Men <40 mg/dL;Women <50mg/dLBlood Pressure≥130/≥85 mmHgBlood Glucose≥100 mg/dLAccording to the CDC if you have any two of these symptoms you have double the risk of death from coronary heart disease and if you have 4 of the above you have 3.5 times the risk.
12General Features of Metabolic Syndrome Abdominal obesityMen – waist > 40 inches, or waist is larger than hipsWomen – waist > 35 inches, or waist is greater than 80% the size of hipsAltered blood lipids (fats)High triglycerides, trig/HDL ratioSmall LDL cholesterol particlesLow HDL cholesterolRaised blood pressureInsulin resistance ( glucose intolerance)Pro-thrombotic state (blood clotting tendency)Increased Fibrinogen and PAI-1Pro-inflammatory stateIncreased IL-6 and hs-CRPfirstlinetherapy
14Food is a Mixture 30-20-10 Protein Fat 20 g 10 g Carbohydrate 30 g We don’t tend to think of what we eat as protein, carbohydrate and fat. We think in terms of food, but the body sees food in these terms. Most foods are a mixture of these macronutrients.Knowledge is power. You must know what you are eating.Yes there’s lots of info out there, high fat, low fat, low salt, Atkins, South Beach, Weight Watchers. Etc etc.Go through example of PBnJ sandwich, what is carb, what is fat, what is protein, and are they healthy.Carbohydrate30 g
15What Hormone is secreted when your eat sugar What Hormone is secreted when your eat sugar? Understanding Glycemic Index
18Use your hand as your guide Carbohydrate- FistProtein- PalmFat- Thumb
19Question? How many teaspoons of sugar in a 20 ounce soda? Bonus question – what is the average pH of a soda (diet or regular)?
20Are you eating like a BEAR or a DEER? Eats Big Meals 2-3 times a day!Eats Small Meals 5-7 times a day!
21Eating Out Don’t look at the menu The average restaurant portion size is 4-5 X a normal sizeThe calories add up quicklyNo Starch-Double VegetableSplit meals and ask for the “to go” container ahead of timeNo bread before dinner!
22Good Fat vs. Bad Fat70 Trillion Cells in the Human Body!!