1. Obesity Training Jacques Courseault, M.D. www.exercisemenu.com

2. Fitness and Wellness Weight Management Weight Management –Who is overweight? –What is obesity? –Why are we overweight? –Negative effects of obesity –Nutrition and Weight –Adapt eating habits to New Orleans culture –Exercise and Weight Management

3. American Obesity Association Who is overweight? Facts: Facts: –120 million U.S adults are overweight –60 million U.S adults are obese –9 million U.S adults are severely obese –64.5% are overweight –30.5% are obese –Overweight and obesity increases steadily with age –New Orleans is the 7 th ranked city with the highest overweight rates (2005) –Many college students gain 10-15 lbs. freshman year

4. American Obesity Association Health and Social Impact Too much fat increases the risk of illness from about 30 serious medical conditions. Too much fat increases the risk of illness from about 30 serious medical conditions. Obesity is associated with increases in deaths from all- causes. Obesity is associated with increases in deaths from all- causes. Earlier onset of obesity-related diseases, such as type 2 diabetes, are being reported in children and adolescents with obesity. Earlier onset of obesity-related diseases, such as type 2 diabetes, are being reported in children and adolescents with obesity. Individuals with obesity are at higher risk for impaired mobility. Individuals with obesity are at higher risk for impaired mobility. Overweight or obese individuals experience social stigmatization and discrimination in employment and academic situations. Overweight or obese individuals experience social stigmatization and discrimination in employment and academic situations. Billions in healthcare expenditures Billions in healthcare expenditures

5. American Obesity Association Is Obesity Considered a Disease ? Disease - an interruption, cessation or disorder of a bodily function, organ or system. Disease - an interruption, cessation or disorder of a bodily function, organ or system. 3 Criteria of Disease: 3 Criteria of Disease: Recognized causes Recognized causes Identifiable signs and symptoms Identifiable signs and symptoms Consistent Anatomic Alteration Consistent Anatomic Alteration Does obesity meet these criteria?

6. American Obesity Association Is Obesity Considered a Disease? Recognized Causes include: Recognized Causes include: –Social- influence from friends, family, work, etc. –Cultural- some favor certain unhealthy foods more than others. –Psychological- stress can have an effect on habits –Behavioral- Behavior can be learned to eat when angry or bored –Metabolic – sugar is not cleared from the bloodstream –Genetic factors – mutations in certain genes have been shown to cause obesity

7. American Obesity Association Is Obesity Considered a Disease? Signs and Symptoms include: Signs and Symptoms include: –Excess accumulation of fat –Increased size of fat cells –Insulin resistance –Increased blood sugar –Increased blood pressure –Elevated cholesterol and triglyceride levels –Shortness of breath –Back pain

8. American Obesity Association Is Obesity Considered a Disease? Consistent Anatomic Alterations include: Consistent Anatomic Alterations include: –Increase in body mass

9. American Obesity Association Why are we Overweight? Simply put: too much food, too little activity Simply put: too much food, too little activity Today people are eating more food and exercising less Today people are eating more food and exercising less Fatty convenience foods are more prevalent Fatty convenience foods are more prevalent –McDonald’s, Burger King, Taco Bell, etc. Many are working more sedentary jobs Many are working more sedentary jobs

10. Forbes.com Why are we Overweight? We drink anything but water We drink anything but water –Most soft drinks and “juices” have High Fructose Corn Syrup which cause blood sugar levels to spike. –The body then produces high levels of insulin which causes the body to store excess sugar as fat.

11. Forbes.com Why are we Overweight? We don’t walk We don’t walk –We should: Walk to our destination Walk to our destination Take the stairs Take the stairs Deliver messages by hand at work instead of email or instant message Deliver messages by hand at work instead of email or instant message Park in the back of the parking lot Park in the back of the parking lot Walk the dog Walk the dog Play with kids Play with kids

12. American Obesity Association Why are we Overweight? Genetics Genetics –If our parents are overweight, chances are we will be. –However: Genes can be beat! Genes can be beat! –Regular exercise –Healthy Diet –Plenty of Water –Ample Sleep

13. Forbes.com Why are we Overweight? We Grow Older We Grow Older –Metabolism slows down as we age because of loss of muscle mass We Eat Junk Food We Eat Junk Food –Potato Chips, Candy, Cookies, etc. These foods have little to no nutritional value!! These foods have little to no nutritional value!! Contains refined carbohydrates Contains refined carbohydrates Is calorie dense Is calorie dense Full of Fat!!! Full of Fat!!!

14. American Obesity Association Why are we Overweight? We love Fried Food We love Fried Food –Fried Chicken, Shrimp, Beef, Crawfish, Fries, etc. –Fried Foods contain: High carbohydrates and calories High carbohydrates and calories Easy way to pack on pounds! Easy way to pack on pounds!

15. American Obesity Association Why are we Overweight? Excessive Alcohol Excessive Alcohol –Alcoholic drinks have tons of calories Alcohol slows the body’s fat-burning power Alcohol slows the body’s fat-burning power Produces acetate which is used as fuel instead of fat Produces acetate which is used as fuel instead of fat Alcohol is an appetite stimulant Alcohol is an appetite stimulant Reduces testosterone levels, which slow fat burn Reduces testosterone levels, which slow fat burn But wine is good! But wine is good!

16. Forbes.com Why are we Overweight? Never read food labels Never read food labels –Check labels for: Calories Calories Refined Carbohydrates Refined Carbohydrates Total Fat Total Fat Sugar Sugar

17. American Obesity Association Why are we Overweight? We don’t exercise!! We don’t exercise!! –Sedentary lifestyles cause us to gain weight! –Metabolism slows down –Body stores extra weight because it isn’t burning any –Reduction of muscle slows metabolism

18. Forbes.com Why are we Overweight? Stress Stress –Heightened stress increases amount of cortisol in the body –Cortisol is a stress hormone that causes the body to store fat –Antidepressants cause weight gain –When depressed we overeat because eating “makes us happier”

19. American Obesity Association Negative Effects of being Overweight Obesity is the second leading cause of unnecessary deaths, smoking is #1 Obesity is the second leading cause of unnecessary deaths, smoking is #1 Obesity is more damaging to the body than Smoking!!! Obesity is more damaging to the body than Smoking!!! –Obesity affects all major body systems including the heart, lungs, muscles and bones

20. American Obesity Association Negative Effects of being Overweight Increases risks of 30 diseases including: Increases risks of 30 diseases including: –Diabetes –Cardiovascular Disease –Certain Cancers –Sleep apnea –Osteoarthritis

21. American Obesity Association Negative Effects of being Overweight Table 1. Prevalence of Medical Conditions by BMI for Men Body Mass Index18.5 - 24.925 - 29.930 - 34.9> 40 Medical Condition Type 2 Diabetes2.034.9310.110.65 Coronary Heart Disease8.849.616.0113.97 High Blood Pressure23.4734.1648.9564.53 Osteoarthritis2.594.554.6610.04 Source: NHANES III, 1988 - 1994.

22. American Obesity Association Negative Effects of being Overweight Table 1. Prevalence of Medical Conditions by BMI for Women Body Mass Index18.5 - 24.925 - 29.930 - 34.9> 40 Medical Condition Type 2 Diabetes2.387.127.2419.89 Coronary Heart Disease6.6711.1312.5619.22 High Blood Pressure23.2638.7747.9563.16 Osteoarthritis5.228.519.9417.19 Source: NHANES III, 1988 - 1994.

23. American Obesity Association Negative Effects of being Overweight Increased BMI increases risks of: Increased BMI increases risks of: –Osteoarthritis (OA) Obesity is associated with the development of OA of the hand, hip, back and especially the knee. Obesity is associated with the development of OA of the hand, hip, back and especially the knee. Modest weight loss of 10 to 15 pounds is likely to relieve symptoms and delay disease progression of knee OA. Modest weight loss of 10 to 15 pounds is likely to relieve symptoms and delay disease progression of knee OA. –Rheumatoid Arthritis (RA) –Deep Vein Thrombosis (DVT) –Obesity increases the risk of DVT, a condition that disrupts the normal process of blood clotting. –Patients with obesity have an increased risk of DVT after surgery. –Gallstones –Obesity and rapid weight loss in obese persons are known risk factors for gallstones. –Gallstones are common among overweight and obese persons. Gallstones appear in persons with obesity at a rate of 30% versus 10% in non-obese.

24. American Obesity Association Negative Effects of being Overweight –Birth Defects –Maternal obesity (BMI > 29) has been associated with an increased incidence of neural tube defects (NTD) –Obesity is reportedly associated with the increased incidence of overdue births, induced labor and longer labors. –Women with maternal obesity have more Cesarean deliveries and higher incidence of blood loss during delivery as well as infection and wound complication after surgery. –Complications after childbirth associated with obesity include an increased risk of endometrial infection and inflammation, urinary tract infection and urinary incontinence.

25. American Obesity Association Negative Effects of being Overweight –Breast Cancer Postmenopausal women with obesity have a higher risk of developing breast cancer. Postmenopausal women with obesity have a higher risk of developing breast cancer. Women who gain nearly 45 pounds or more after age 18 are twice as likely to develop breast cancer after menopause than those who remain weight stable. Women who gain nearly 45 pounds or more after age 18 are twice as likely to develop breast cancer after menopause than those who remain weight stable. Premenopausal women diagnosed with breast cancer who are overweight appear to have a shorter life span than women with lower BMI. Premenopausal women diagnosed with breast cancer who are overweight appear to have a shorter life span than women with lower BMI. The risk of breast cancer in men is also increased by obesity. The risk of breast cancer in men is also increased by obesity. –Colorectal Cancer High BMI, high calorie intake, and low physical activity are independent risk factors of colorectal cancer. High BMI, high calorie intake, and low physical activity are independent risk factors of colorectal cancer. –Endometrial Cancer (EC) Women with obesity have three to four times the risk of EC than women with lower BMI. Women with obesity have three to four times the risk of EC than women with lower BMI. –Renal Cell Cancer Consistent evidence has been found to associate obesity with renal cell cancer, especially in women. Consistent evidence has been found to associate obesity with renal cell cancer, especially in women.

26. American Obesity Association Negative Effects of being Overweight –Cardiovascular Disease (CVD) –Obesity increases CVD risk due to its effect on blood lipid levels. –Weight loss improves blood lipid levels by lowering triglycerides and LDL (“bad”) cholesterol and increasing HDL (“good”) cholesterol. –Weight loss of 5% to 10% can reduce total blood cholesterol. –The effects of obesity on cardiovascular health can begin in childhood, which increases the risk of developing CVD as an adult. –Overweight and obesity increase the risk of illness and death associated with coronary heart disease. –Obesity is a major risk factor for heart attack, and is now recognized as such by the American Heart Association.

27. American Obesity Association Negative Effects of being Overweight –Carpal Tunnel Syndrome (CTS) –Obesity has been established as a risk factor for CTS. –The odds of an obese patient having CTS were found in one study to be almost four times greater than that of a non-obese patient. –Seventy percent of persons in a recent CTS study were overweight or obese. –Chronic Venous Insufficiency (CVI) –Patients with CVI, an inadequate blood flow through the veins, tend to be older, male, and have obesity. –Daytime Sleepiness –People with obesity frequently complain of daytime sleepiness and fatigue, two probable causes of mass transportation accidents.

28. American Obesity Association Negative Effects of being Overweight –Diabetes (Type 2) –As many as 90% of individuals with type 2 diabetes are reported to be overweight or obese. –Obesity has been found to be the largest environmental influence on the prevalence of diabetes in a population. –Obesity complicates the management of type 2 diabetes by increasing insulin resistance and glucose intolerance, which makes drug treatment for type 2 diabetes less effective. –A weight loss of as little as 5% can reduce high blood sugar.

29. American Obesity Association Negative Effects of being Overweight –Gout –Obesity contributes to the cause of gout -- the deposit of uric acid crystals in joints and tissue. –Heat Disorders –Obesity has been found to be a risk factor for heat injury and heat disorders. –Hypertension –Over 75% of hypertension cases are reported to be directly attributed to obesity. –Weight or BMI in association with age is the strongest indicator of blood pressure in humans. –The risk of developing hypertension is five to six times greater in obese adult Americans, age 20 to 45, compared to non-obese individuals of the same age.

30. American Obesity Association Negative Effects of being Overweight –Impaired Immune Response –Obesity has been found to decrease the body’s resistance to harmful organisms. –A decrease in the activity of scavenger cells, that destroy bacteria and foreign organisms in the body, has been observed in patients with obesity. –Impaired Respiratory Function –Obesity is associated with impairment in respiratory function. –Obesity has been found to increase respiratory resistance, which in turn may cause breathlessness. –Decreases in lung volume with increasing obesity have been reported. –Infections Following Wounds –Obesity is associated with the increased incidence of wound infection. –Burn patients with obesity are reported to develop pneumonia and wound infection with twice the frequency of non-obese.

31. American Obesity Association Negative Effects of being Overweight –Infertility –Obesity increases the risk for several reproductive disorders, negatively affecting normal menstrual function and fertility. –Weight loss of about 10% of initial weight is effective in improving menstrual regularity, ovulation, hormonal profiles and pregnancy rates. –Liver Disease –Excess weight is reported to be an independent risk factor for the development of alcohol related liver diseases including cirrhosis and acute hepatitis. –Low Back Pain –Obesity may play a part in aggravating a simple low back problem, and contribute to a long-lasting or recurring condition. –Women who are overweight or have a large waist size are reported to be particularly at risk for low back pain.

32. American Obesity Association Negative Effects of being Overweight –Pain –Bodily pain is a prevalent problem among persons with obesity. –Greater disability, due to bodily pain, has been reported by persons with obesity compared to persons with other chronic medical conditions. –Obesity is known to be associated with musculoskeletal or joint-related pain. –Foot pain located at the heel, known as Sever’s disease, is commonly associated with obesity. –Pancreatitis –Obesity is a predictive factor of outcome in acute pancreatitis. Obese patients with acute pancreatitis are reported to develop significantly more complications, including respiratory failure, than non-obese. –Sleep Apnea –Obesity, particularly upper body obesity, is the most significant risk factor for obstructive sleep apnea. –There is a 12 to 30-fold higher incidence of obstructive sleep apnea among morbidly obese patients compared to the general population. –Among patients with obstructive sleep apnea, at least 60% to 70% are obese.

33. American Obesity Association Negative Effects of being Overweight –Stroke –Elevated BMI is reported to increase the risk of ischemic stroke independent of other risk factors including age and systolic blood pressure. –Abdominal obesity appears to predict the risk of stroke in men. –Obesity and weight gain are risk factors for ischemic and total stroke in women. –Surgical Complications –Obesity is a risk factor for complications after a surgery. –Surgical patients with obesity demonstrate a higher number and incidence of hospital acquired infections compared to normal weight patients. –Urinary Stress Incontinence –Obesity is a well-documented risk factor for urinary stress incontinence, involuntary urine loss, as well as urge incontinence and urgency among women. –Obesity is reported to be a strong risk factor for several urinary symptoms after pregnancy and delivery, continuing as much as 6 to 18 months after childbirth.

34. American Obesity Association Negative Effects of being Overweight –Several other obesity-related conditions have been reported by various researchers including: abdominal hernias, acanthosis nigricans, endocrine abnormalities, chronic hypoxia and hypercapnia, dermatological effects, depression, elephantitis, gastroesophageal reflux, heel spurs, hirsutism, lower extremity edema, mammegaly (causing considerable problems such as bra strap pain, skin damage, cervical pain, chronic odors and infections in the skin folds under the breasts, etc.), large anterior abdominal wall masses (abdominal paniculitis with frequent panniculitis, impeding walking, causing frequent infections, odors, clothing difficulties, low back pain), musculoskeletal disease, prostate cancer, pseudo tumor cerebri (or benign intracranial hypertension), and sliding hiatil hernia. abdominal hernias, acanthosis nigricans, endocrine abnormalities, chronic hypoxia and hypercapnia, dermatological effects, depression, elephantitis, gastroesophageal reflux, heel spurs, hirsutism, lower extremity edema, mammegaly (causing considerable problems such as bra strap pain, skin damage, cervical pain, chronic odors and infections in the skin folds under the breasts, etc.), large anterior abdominal wall masses (abdominal paniculitis with frequent panniculitis, impeding walking, causing frequent infections, odors, clothing difficulties, low back pain), musculoskeletal disease, prostate cancer, pseudo tumor cerebri (or benign intracranial hypertension), and sliding hiatil hernia.

35. Calories In – Calories Out = Weight Loss Weight loss can be achieved either by eating fewer calories or by burning more calories with physical activity, preferably both. A healthy weight loss program consists of: Weight loss can be achieved either by eating fewer calories or by burning more calories with physical activity, preferably both. A healthy weight loss program consists of: A reasonable, realistic weight loss goal – 2.5 lbs/week A reasonable, realistic weight loss goal – 2.5 lbs/week A reduced calorie, nutritionally-balanced eating plan A reduced calorie, nutritionally-balanced eating plan Regular physical activity Regular physical activityphysical activityphysical activity A behavior change plan to help you stay on track with your goals A behavior change plan to help you stay on track with your goals American Obesity Association

36. Keep in Mind Calories count Calories count Portions count Portions count Nutrition counts Nutrition counts Even a small amount of weight loss can lead to big health benefits Strive to develop good habits to last a lifetime Even a small amount of weight loss can lead to big health benefits Strive to develop good habits to last a lifetime Feel free to discuss your weight loss plans with us! Feel free to discuss your weight loss plans with us! To lose about 1 pound per week, subtract 500 calories each day from the daily amount. To lose about 2 pounds per week, subtract 1000 calories daily. To lose about 1 pound per week, subtract 500 calories each day from the daily amount. To lose about 2 pounds per week, subtract 1000 calories daily. DO NOT LET A SLIP TURN INTO A SUBSTANTIAL WEIGHT GAIN! DO NOT LET A SLIP TURN INTO A SUBSTANTIAL WEIGHT GAIN! American Obesity Association

37. New Orleans Diet Red Beans and Rice- Use brown rice- Helps Lower LDL Red Beans and Rice- Use brown rice- Helps Lower LDL Grill or Bake fish instead of Frying it Grill or Bake fish instead of Frying it Boil Seafood instead of Frying it- DO NOT FRY ANYTHING! Boil Seafood instead of Frying it- DO NOT FRY ANYTHING! Add a Salads to your meals Add a Salads to your meals Avoid anything with High Fructose Corn Syrup Avoid anything with High Fructose Corn Syrup American Obesity Association

38. New Orleans Diet Drink More Water- 8 Glasses Drink More Water- 8 Glasses Eat more Fiber- Whole Weat, Use Whole Grain Wheat Bread instead of White/French Bread Eat more Fiber- Whole Weat, Use Whole Grain Wheat Bread instead of White/French Bread Add vegetables to every meal Add vegetables to every meal If you must drink alcohol, choose light beer, wine If you must drink alcohol, choose light beer, wine American Obesity Association

39. New Orleans Diet By Lean Meats By Lean Meats Eat smaller portions throughout the day Eat smaller portions throughout the day Avoid Trans-Fat Avoid Trans-Fat Boost Fiber to lose weight/prevent cancer Boost Fiber to lose weight/prevent cancer –All Bran Cereal –Fruit/Vegetables –Eat skin on Fruits/Potatoes American Obesity Association

40. The Key to Weight Loss! It’s like putting gas in a car! It’s like putting gas in a car! Join a gym, and hire a personal trainer Join a gym, and hire a personal trainer Find a friend and go walk/jog/run Find a friend and go walk/jog/run Buy light weights and exercise at home Buy light weights and exercise at home Take stairs at work Take stairs at work Park far away from work or store (ensure safety) Park far away from work or store (ensure safety) Use a pedometer and aim for 5,000/steps/day Use a pedometer and aim for 5,000/steps/day American Obesity Association

41. Exercise Dance Dance Improve posture Improve posture Play with your kids/ grandkids Play with your kids/ grandkids Resistance Bands Resistance Bands Yoga/Pilates Class Yoga/Pilates Class American Obesity Association

42. Goal Gradual Change of Lifestyle Gradual Change of Lifestyle Slip ups are okay, just bounce back Slip ups are okay, just bounce back Small changes exponentially add years to your life! Small changes exponentially add years to your life! American Obesity Association

43. Cardio 5 days/week 5 days/week 30 min/day 30 min/day Anything that gets you moving! Anything that gets you moving! American Obesity Association

44. Weight lifting tips Endurance training- 12-15 reps Endurance training- 12-15 reps Toning training 8-10 reps Toning training 8-10 reps Strength training 3-6 reps Strength training 3-6 reps Burnouts!! To Lose Weight! Burnouts!! To Lose Weight! Warmup Warmup Stretch Stretch Muscle is 70% water! Muscle is 70% water! American Obesity Association

45. Weight Lifting Tips 3x per week, but if can just do once a week that’s okay 3x per week, but if can just do once a week that’s okay Work out entire body/workout Work out entire body/workout One exercise per muscle group is enough One exercise per muscle group is enough Stay hydrated Stay hydrated American Obesity Association