1. Chapter 4 Where Are You

2. Nurses Health Study 122,000 Nurses followed for 16 years
Low risk women had:
BMI <25
30 exercise/day
5 gram of alcohol/day
No tobacco use
Healthy diet
Hu, FB. N Engl J Med 345(11) , 2001

3. Only 3% of all the nurses were in this low risk group…but they were by far the healthiest group.
Others who were not low risk had 6 times higher risk of heart disease and other chronic diseases

4. So, how’s your risk?

5. Over the past week, what was your average number of fruit servings per day? ________
Over the past week, what was your average number of vegetable servings per day? _______
Total ________
If your total is greater than 5, you are doing great (more is even better).

6. Last week, what was your average number of whole grain servings per day? (This includes whole-grain cereals, bread, rice, and pasta.) ________
You should strive for about 6 servings a day.

7. How many servings of red meat did you eat last week? ________
The best evidence we have so far indicates red meat should be eaten sparingly, 1–2 servings per week.

8. How many days in a typical week do you accumulate 30 minutes of moderate physical activity? ________
To get the benefits associated with being physically active, you should accumulate 30 minutes of moderate physical activity most days of the week

9. Yes _____ No ______ Don’t Know ______ Systolic Blood Pressure levels
Have you ever been told by a physician that you have high blood pressure?
Yes _____ No ______ Don’t Know ______
Systolic Blood Pressure levels
< Normal
120–139 Early High Blood Pressure
140–159 High
> Dangerous

10. Have you ever been told by a physician that you have high blood cholesterol?
Yes _____ No ______ Don’t Know ______
Cholesterol Levels
<200 Normal
200–239 Borderline High
>240 High risk

11. Weight (lbs)
Height
120
130
140
150
160
170
180
190
200
210
220
230
240
250
260
270
280
>290
4'5"   30 33 35 38 40 43 45 48 50 53 55 58 60 63 65 68 70 73
  4'6"   29 31 34 36 39 41 46 51
  4'7"   28 37 42 44 49 56 67
  4'8"   27 47 52 54 61
  4'9"   26 32
  4'10"   25 59
  4'11"   24 57
  5'0"   23
  5'1"  
  5'2"   22
  5'3"   21
  5'4"  
  5'5"   20
  5'6"   19
  5'7"  
  5'8"   18
  5'9"  
  5'10"   17
  5'11"  
  6'0"   16
  6'1"  
  6'2"   15
  6'3"  
  6'4"  
  6'5"   14
  6'6"  
  6'7"  
  6'8"   13
  6'9"  
  6'10"  

12. What is your body mass index? ________
Body Mass Index Categories
<19 Underweight
19–24 Ideal weight, low risk
25–29 Overweight, moderate risk
30 Obese, high risk

13. There is nothing magical or special about having a BMI of 30 (being obese), it just means your risk of many diseases and premature death is higher than for those who are not obese

14. Health risks increase as weight increases

16. Here’s some proof that your health can improve
377 people experienced changes in health risks after just 6 weeks of lifestyle change

17. BMI

18. Systolic Blood Pressure Reductions mm/Hg

19. Diastolic Blood Pressure Reductions mm/Hg

20. Total Cholesterol Reductions mg/dl

21. LDL Cholesterol Reductions mg/dl

22. Glucose Reductions mg/dl

23. Reductions in risk There is a 2-3% decrease in heart disease risk for:
Every 1 mm decrease in diastolic
Every 1% decrease in total cholesterol

24. Changes is Diastolic BP and CHL for some participants
Diastolic BP mmHg
Ideal
High
Dangerous
Total CHL % decr.
Normal %
Borderline %
High %

25. Reductions in risk with these changes
Diastolic BP
Ideal %
High %
Dangerous %
Total CHL
Normal %
Borderline %
High % %
Reduction in heart disease risk

26. Most of these improvements last for as long and the participants maintained the healthy lifestyle behaviors

27. There is great news for couch potatoes!
Even little improvements in exercise bring large improvements in health

28. The Dose Response of Fitness
Proven Health Benefits
low
moderate
high
Fitness level

29. Many risk factors increase disease risk dramatically
1 health risk + 1 health risk ≠ 2
1 health risk + 1 health risk = much more than 2

30. Metabolic Syndrome or Syndrome X
A condition characterized by:
insulin resistance
presence of obesity from abdominal fat
high blood cholesterol
high blood pressure
Caused by a hyperactive fork and a hypoactive foot

31. As many as 24 million Americans have it
1in 4 are at risk of developing it
Greatly increased risk of coronary artery disease

32. Obesity

33. Obesity Trends* Among U.S. Adults BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14%

34. Obesity Trends* Among U.S. Adults BRFSS, 1986
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14%

35. Obesity Trends* Among U.S. Adults BRFSS, 1987
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14%

36. Obesity Trends* Among U.S. Adults BRFSS, 1988
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14%

37. Obesity Trends* Among U.S. Adults BRFSS, 1989
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14%

38. Obesity Trends* Among U.S. Adults BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14%

39. Obesity Trends* Among U.S. Adults BRFSS, 1991
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19%

40. Obesity Trends* Among U.S. Adults BRFSS, 1992
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19%

41. Obesity Trends* Among U.S. Adults BRFSS, 1993
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19%

42. Obesity Trends* Among U.S. Adults BRFSS, 1994
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19%

43. Obesity Trends* Among U.S. Adults BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19%

44. Obesity Trends* Among U.S. Adults BRFSS, 1996
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19%

45. Obesity Trends* Among U.S. Adults BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19% ≥20

46. Obesity Trends* Among U.S. Adults BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19% ≥20

47. Obesity Trends* Among U.S. Adults BRFSS, 1999
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19% ≥20

48. Obesity Trends* Among U.S. Adults BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19% ≥20

49. Obesity Trends* Among U.S. Adults BRFSS, 2001
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19% %–24% ≥25%

50. Obesity Trends* Among U.S. Adults BRFSS, 2002
(*BMI 30, or ~ 30 lbs overweight for 5’4” person)
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19% %–24% ≥25%
Source: Behavioral Risk Factor Surveillance System, CDC

51. Obesity* Trends Among U.S. Adults BRFSS, 2003
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% %–14% %–19% %–24% ≥25%

52. Obesity Trends* Among U.S. Adults BRFSS, 2004
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative.
About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
No Data <10% %–14% %–19% %–24% ≥25%

53. Percent of U.S. Adults Who Are Overweight or Obese

54. Obesity Prevalence by Country
WHO 2000

55. Prevalence of Obesity in Children Age 6-11
National Center for Health Statistics, 2001

56. It’s not age that causes obesity, it’s our Western Lifestyle!

57. Risks of Obesity Psychological burden Increased high blood pressure
Increased cholesterol
Increased risk of gallstones, osteoarthritis, diabetes, cancer, heart disease
Increased risk of early death

58. Obesity and Risk of Hypertension
Relative risk of hypertension
Body Mass Index

59. Obesity and Risk of Gallstones
Relative risk of gallstones
Body Mass Index

60. Excess Body Weight and Reduction of Lifespan
-3.1
-3.3
-5.8
-7.1
Ann Intern Med. 2003;138:24-32

61. Physical activity levels have been relatively flat over the past 15 years

62. Trends in Physical Activity

63. Our diets haven’t improved much

65. Lifetime Risk of Diabetes for Children Born in 2000
Venkat Narayan, JAMA 2003;290:1884

66. Diabetes and Reduction in Lifespan
-14.3 yrs
-11.6 yrs
JAMA 2003;290:

67. There’s hope
A health lifestyle can reverse weight gain and can prevent, arrest and even reverse many chronic diseases