Obesity, Overweight and Weight Control Healthy Weight Network.
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Obesity, Overweight and Weight Control Healthy Weight Network
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
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
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
Overweight and Obesity Definitions BMI = weight (kg) height squared (m²) Significantly correlated with total body fat content
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.)
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
Assessment of Obesity Anthropometrics Medical Psychological Nutritional
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
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
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
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
Nutritional Assessment Weight History Age of onset Highest/lowest adult weights Patterns of weight gain and loss Environmental triggers Current eating patterns Nutritional Intake
Nutritional Assessment Environmental Factors Exercise history Motivation and readiness to change
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
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
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
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.
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.
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
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.
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
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?
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
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
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
Shopping Tips Use a shopping list Read labels serving size and servings per container
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’
Tips for Weight Loss Use of Meal Replacements?