1. Weight, Body Composition, and Health Maintaining a Healthy Body Weight

2. Weight and Health  Goal is to determine if an individual is: Underweight Underweight Health risksHealth risks Healthy weight Healthy weight Overweight (BMI > 25) Overweight (BMI > 25) Health risks if overweight and overfatHealth risks if overweight and overfat Huge health issue in US (see page 280)Huge health issue in US (see page 280)

3. Increasing Increasing Prevalence of Obesity (BMI >30) among U.S. Adults 1991: Only four states had obesity rates greater than 15 percent. _ 1996: Over half of the states had obesity rates greater than 15 percent. 2001: Only one state had an obesity rate below 15 percent, most had obesity rates greater than 20 percent and one had an obesity rate greater than 25 percent. Key: <10% No Data 10%–14% 15%–19% 20%–24% >25% _

4. Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

5. Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

6. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

7. Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

8. Obesity Trends* Among U.S. Adults BRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

9. Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

10. U.S. Data   Obesity has risen 75% in 10 years.   Obesity has risen nearly 100% in 20 years.   Rates have doubled in children in 20 years.   Rates have tripled in teens in 20 years.   Self-reported data indicate that 61% of adults   are overweight or obese.   Data based on direct measurements indicate that two-thirds of adults are overweight or obese.

11. U.S. Obesity Data by Race

12. Overweight Children  Children most likely to have a high BMI when: Either parent or both overweight or obese Either parent or both overweight or obese They live in smaller families They live in smaller families They are poor They are poor They consume a high proportion of calories from fat They consume a high proportion of calories from fat They are avid TV watchers – more screen time is associated with higher weight They are avid TV watchers – more screen time is associated with higher weight

13. Maine Obesity Data % ObeseYear 10-141995 15-191996 15-191997 15-191998 15-191999 15-192000 15-192001 20-242002 15-192003 20-24 2004 24.82007 25.8 2009 26.5 2011 26.5 2011 * BMI > 30, CDC

14. Evaluating Weight/Health Status  Compare weight to standard height-weight tables Tables are of limited value and use Tables are of limited value and use  Body Mass Index (BMI) Preferred measure for evaluating weight Preferred measure for evaluating weight Based on significant amount of research Based on significant amount of research

15. BMI  Upper end of BMI may not be a good indicator of health for: body builder or serious athlete’s weight/health body builder or serious athlete’s weight/health the elderly the elderly  Low end of the BMI is an appropriate measure of being underweight for all

16. BMIWeight/health Less than 18.5 Underweight* 18.5 - 24.9 Healthy 25 - 29.9 Overweight* 30 -39.9 Obese* Over 40 Severely obesity*

17. BMI  Calculating BMI – most use BMI calculators or charts (see page 341) Calculating BMI = weight in pounds x 703 (height, inches) 2 (height, inches) 2 Weight, lbs = desired BMI x (height, inches) 2 703 703

18. BMI  Calculating the weight associated with a desired BMI: Weight, lbs = desired BMI x (height, inches) 2 703 703

19. Health Risks and BMI Weight Class BMI Health Risks Overweight 25 – 29.9 Increased Class I Obesity 30 – 34.9 Moderate to significant Class II Obesity 35 – 39.9 High/very high Class III Obesity > 40 Extreme Underweight < 18.5 Increased, may be significant

20. Health Risks and Weight  Health risks in each category increase if: Waist is > 40” men, > 35” women Waist is > 40” men, > 35” women Smoke Smoke Physically inactive Physically inactive High blood glucose High blood glucose High LDL levels or low HDL levels High LDL levels or low HDL levels Family history of heart disease, stroke, hypertension, type II diabetes Family history of heart disease, stroke, hypertension, type II diabetes

21. Body Fat  Need enough body fat to meet basic needs, but not so much as to increase health risks Essential Body Fat: Essential Body Fat: Males: 3% body fatMales: 3% body fat Females: 12% body fat, 20% for reproductive health (menstruation and fertility)Females: 12% body fat, 20% for reproductive health (menstruation and fertility) The latter value has recently come into question The latter value has recently come into question

22. % Body Fat and Health  Desirable % body fat levels: text values Desirable % body fat levels Desirable % body fat levels Males: 8 - 24 % Males: 8 - 24 % Females: 21 – 33 % Females: 21 – 33 %

23. Measuring % Body Fat % body fat is difficult to measure accurately  Common methods for measuring: 1. Fat fold measures with calipers 2. Bioelectric impedance 3. Underwater weighing 4. Air displacement 5. X-ray, MRI, CT and other expensive techniques

24. Distribution of Body Fat Matters  Central Obesity (apple shape) Fat stored around the organs of the abdomen Fat stored around the organs of the abdomen Associated with increased risk of: Associated with increased risk of: Heart diseaseHeart disease StrokeStroke HypertensionHypertension Some cancersSome cancers

25. Distribution of Body Fat  More on central obesity More common in men and post-menopausal women More common in men and post-menopausal women Associated with smoking Associated with smoking Abdominal fat is likely to go directly to the liver and be used to make VLDL  LDL Abdominal fat is likely to go directly to the liver and be used to make VLDL  LDL

26. Distribution of Body Fat  Lower-Body Obesity (pear shape) Fat stores are concentrated around the hips and thighs Fat stores are concentrated around the hips and thighs Doesn’t raise health risks as much as central obesity. Doesn’t raise health risks as much as central obesity. See most often in women during reproductive years See most often in women during reproductive years

27. Waist Circumference  Health risks increase when waist circumference is: Greater than 40” in men Greater than 40” in men Greater than 35” in women Greater than 35” in women  Risk is even greater if BMI is also > 24.9

28. What are the Health Issues?  Health issues associated with being overweight or obese: Type II diabetes Type II diabetes Hypertension Hypertension High cholesterol High cholesterol Heart disease Heart disease

29. Health Issues  Health issues continued Gall bladder disease Gall bladder disease Osteoarthritis Osteoarthritis Respiratory problems Respiratory problems Hernias Hernias Varicose veins Varicose veins Flat feet Flat feet Complications during surgery and pregnancy Complications during surgery and pregnancy

30. Health Issues - Underweight Increased risk of infection and illness Increased risk of infection and illness Tired and weak (may be anemic) Tired and weak (may be anemic) Amenorrhea (periods stop) Amenorrhea (periods stop) Reduced fertility Reduced fertility Complications during surgery Complications during surgery Poor growth and development in kids Poor growth and development in kids

31. Summary Methods for Evaluating Weight/Health Status 1. Compare weight to standard tables (not useful) 2. Calculate BMI 3. Determine % body fat 4. Evaluate fat distribution 5. Measure waist circumference 6. Consider other risk factors

32. Who should lose weight?  For people who are overweight or obese and have 2 or more risk factors weight loss is recommended even a small weight loss (10% of body weight) will significantly decrease health risks even a small weight loss (10% of body weight) will significantly decrease health risks

33. Who should lose/gain weight?  Healthy BMI - maintain current weight.  Overweight, desirable waist measurement, less than 2 other risk factors  prevent further weight gain  Obese – lose weight  Individuals who are have a BMI of less than ______ should gain weight.

34. Strategies for Weight Loss  In general need to decrease caloric intake and increase physical activity Generally need both for long-term weight loss and health Generally need both for long-term weight loss and health  To lose 1 pound per week you need to reduce caloric intake (or increase caloric output) by: 500 kcal per day = 3500 kcal/week 500 kcal per day = 3500 kcal/week

35. Strategies for Weight Loss  Set reasonable goals 1-2 pounds per week 1-2 pounds per week Loss of 10% of body weight Loss of 10% of body weight May set interim goals if a large amount of weight loss is desired May set interim goals if a large amount of weight loss is desired

36. Making a Change!

37. Strategies for Weight Loss  Avoid fad diets and weight loss supplements  Avoid very low calorie diets and skipping meals Never less than 1200 kcal per day Never less than 1200 kcal per day Why?? Why??

38. Strategies for Weight Loss  Increase level of physical activity 30-45 minutes moderate intensity, 5 days a week 30-45 minutes moderate intensity, 5 days a week Add weight bearing exercise to build muscle Add weight bearing exercise to build muscle Why?Why?

39. Strategies for Weight Loss  Reduce portion size  Increase intake of fiber (why?) More fruits and veggies More fruits and veggies More whole grain products More whole grain products  Eliminate empty calories Soda, alcohol, candy….. Soda, alcohol, candy…..  Decrease calories from liquid sources

40. Strategies for Weight Loss  Drink plenty of water  Eat a salad before dinner Low calorie dressing Low calorie dressing  Buy/make fixed size portions  Avoid buffets and family style serving  Reduce fat content of foods w.o increasing portion size

41. Strategies for Weight Loss  Avoid starving all day…..leads to binging  Join a weight loss group Provides support and accountability Provides support and accountability Some offer nutritional guidance as well Some offer nutritional guidance as well

42. Extreme Measures  Extreme weight loss measures may be called in cases of severe obesity (BMI >40) When health issues of weight are greater than the health issues associated with the treatment When health issues of weight are greater than the health issues associated with the treatment

43. Extreme Measures  Treatment is usually: Surgery to drastically reduce stomach size and to bypass some of the SI Surgery to drastically reduce stomach size and to bypass some of the SI Long-term success depends upon compliance with dietary restrictionsLong-term success depends upon compliance with dietary restrictions Lifetime medical supervision is neededLifetime medical supervision is needed At high risk of many vitamin and mineral deficienciesAt high risk of many vitamin and mineral deficiencies Medications Medications

44. Weight Gain  Goal is to add lean body mass (as well as body fat if extremely underweight) Exercise is an important component of weight gain Exercise is an important component of weight gain  Weight gain can be just as challenging as weight loss!

46. Strategies for Weight Gain  Chose energy dense foods May be higher fat choices May be higher fat choices Someone who is seriously underweight can afford a little more fat Someone who is seriously underweight can afford a little more fat Examples: Examples: 2% milk vs. skim milk2% milk vs. skim milk Peanut butter on anythingPeanut butter on anything Salmon vs. haddockSalmon vs. haddock

47. Strategies for Weight Gain  Eat regular meals Do not call a “non-meal” a meal Do not call a “non-meal” a meal Lettuce or carrots or an apple are not lunch Lettuce or carrots or an apple are not lunch  Leave salad for last  Increase portion size Extra meat or cheese on sandwich Extra meat or cheese on sandwich Larger bowl of cereal, add a banana Larger bowl of cereal, add a banana

48. Strategies for Weight Gain  Snack between meals, but not too close to meals! Chose nutritionally /calorie dense snacks Chose nutritionally /calorie dense snacks Peanut butter on apple or crackersPeanut butter on apple or crackers Bowl of cereal with milkBowl of cereal with milk Trail mix (seeds, nuts, raisins….)Trail mix (seeds, nuts, raisins….) Slimfast or instant breakfastSlimfast or instant breakfast  Drink caloric beverages Milk, juice ….. Milk, juice …..