1. Obesity, Overweight and Weight Control Healthy Weight Network

2. Overweight and Obesity  An estimated 97 million adults in US are overweight or obese.  ~1 in 5 children in the US is overweight (>95% weight for height)  USATODAY.com - Obesity alone puts heart in jeopardy USATODAY.com - Obesity alone puts heart in jeopardy

4. Prevalence of Overweight Among Children & Adolescents 6-19 Years Age (Years) 1963-65 1966-70 1971- 74 1976- 80 1988- 94 1999- 2002 6-114% 7%11%16% 12-195%6%5%11%16% Source: National Center for Health Statistics

5. Overweight and Obesity Definitions  Height/Weight Tables Metropolitan Life Insurance, revised 1983 Based on weight-height mortality study Weights are ages 25 to 59 based on lowest mortality Height and Weight Chart - height weight chart, weight height chart Height and Weight Chart - height weight chart, weight height chart

6. Overweight and Obesity Definitions  BMI = weight (kg) height squared (m²)  Significantly correlated with total body fat content

7. Classification of Overweight and Obesity by BMI

8. Overweight and Obesity - Definitions  Waist Circumference  Presence of excess fat in abdomen out of proportion to total body fat is a independent predictor of risk and mortality.  Waist circumference is positively correlated with abdominal fat content. High Risk:  Men >102 cm (>40 in.);  Women > 88 cm (>35 in.)

10. Waist-to-Hip Ratio  Waist-to-hip ration measures waist at its narrowest point and hip at widest point.  Women with 35” waist and 46”hip =  35/46 = 0.76  Risk: Women with waist-to-hip ratio >0.8 Men with waist-to-hip ratio > 1.0

11. Assessment of Obesity  Anthropometrics  Medical  Psychological  Nutritional

12. Weight Control  Advantages of Weight Loss:  Blood Pressure  Serum/Plasma Lipids Reductions in serum triglycerides and increases in HDL Reductions in total cholesterol and LDL  Blood Glucose

13. Hypertension NHANES III Age-Adjusted Prevalence of Hypertension * According to BMI *Defined as mean systolic blood pressure  140 mm Hg, as mean diastolic  90 mm Hg, or currently taking antihypertensive medication. Brown C et al. Body Mass Index and the prevalence of Risk Factors for Cardiovascular Disease (in preparation). Percent

14. High Blood Cholesterol NHANES III Age-Adjusted Prevalence of High Blood Cholesterol * According to BMI *Defined as > 240 mg/dL. Brown C et al. Body Mass Index and the Prevalence of Risk Factors for Cardiovascular Disease (in preparation). Percent

15. Low HDL-Cholesterol NHANES III Age-Adjusted Prevalence of Low HDL-Cholesterol * According to BMI *Defined as <35 mg/dL in men and <45 mg/dL in women. Brown C et al. Body Mass Index and the Prevalence of Risk Factors for Cardiovascular Disease (in preparation). Percent

16. Nutritional Assessment  Weight History Age of onset Highest/lowest adult weights Patterns of weight gain and loss Environmental triggers  Current eating patterns  Nutritional Intake

17. Nutritional Assessment  Environmental Factors  Exercise history  Motivation and readiness to change

18. Treatment for Obesity BMI25-26.927-29.930-34.9 35- 39. 9 >40 Diet, Physical Activity & Behavior Therapy With co- morbiditie s Pharmco- therapy If not lost 1#/week after 6 mo. SurgeryWith co- morbiditie s

19. Position of ADA  Successful weight management requires a livelong commitment to healthful lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activity  Position Paper Position Paper

20. Goals for Weight Loss  Prevent weight gain or stop weight gain  Improvement in physical and emotional health  Small maintainable weight losses or more extensive weight loss through sensible eating and exercise patterns  Improvement in eating, exercise and other behaviors apart from any weight loss

21. Goals for Weight Loss  Initial goal to reduce body weight by approximately 10% from baseline.  1-2#/week for period of 6 months  1# body fat = 3500 calories  3500/7days = - 500 calories/day  Need to assess individual’s motivation and readiness to enter weight loss therapy.

22. How To Achieve Weight Loss  1,000 – 1,200 kcal/day for women and 1,200 – 1,600 kcal/day for men  Reducing dietary fat along with carbohydrates can facilitate calorie reduction.  Reducing dietary fat alone without reducing calories is not sufficient for weight loss.

23. How To Achieve Weight Loss  Physical activity is recommended as part of a comprehensive weight loss program because: contributes to weight loss may decrease abdominal fat increase cardio-respiratory fitness may help with maintenance of weight loss

24. How To Achieve Weight Loss  Behavior Therapy  Pharmacotherapy - weight loss drugs  Weight loss drugs may be used in combination with a comprehensive weight loss program, for patients with BMI>=30 with no risk factors & BMI >=27 with risk factors.  Weight loss drugs should never be used without concomitant lifestyle changes.

25. How To Achieve Weight Loss  Better weight loss results are achieved with diet therapy when the duration of the intervention is at least 6 months.  Long term weight loss is enhanced by a program of dietary therapy, physical therapy and behavioral therapy continued indefinitely.  “Habit is habit and not to be flung out of the window by any man, but coaxed downstairs a step at a time.”  –Mark Twain

26. How To Achieve Weight Loss  Outcome data on behavior therapy, Very Low Calorie Diets (VLCD) and Pharmacotherapy show weight regain in 3-5 years  Frequent contacts between professional counselors and patients promote weight loss and weight maintenance  Chicago Tribune | Biggest 'Lost' mystery: Why is Hurley still fat? Chicago Tribune | Biggest 'Lost' mystery: Why is Hurley still fat?

27. Tips for Weight Loss  Eat a variety of foods from the Food Guide Pyramid, including favorite foods  Increase intake of high-water/high-fiber foods Vegetables and fruits Whole grains and legumes Soups  Decrease consumption of energy dense foods High fat foods Foods with low moisture content

28. Mayo Clinic Food Guide

29. How to Calculate Energy Density  Energy Density = Calories/Grams  E.G. 150 Calories/100 grams = 1.5 Kcal/g  Energy density of 1 – Eat any quantity  Limit foods with energy density >2

30. Tips for Weight Loss  Limit consumption of beverages containing alcohol and sugars  Control Portion Sizes  Plan meals and snacks ahead  Establish regular eating habits  Shop on a full stomach

31. Shopping Tips  Use a shopping list  Read labels serving size and servings per container

32. Tips for Weight Loss  Eat from plates, not food packages  Portion foods before bringing them to the table  Eat slowly  Sit down to eat  Stop eating when you leave the table  Watch for food ‘triggers’

33. Tips for Weight Loss  Use of Meal Replacements?

35. Fad Diets  Americans spend >30 billion in the weight loss industry  Single food diets - grapefruit, rice etc.  High-protein, high fat diets  VLCD  Fasting  High fiber, low-calorie diets

36. Weight Loss Surgery