OBESITY

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OBESITY

• AN EPIDEMIC ON THE RISE

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WHATS THE BIG DEAL?

• Affecting many countries in the world
• Rise in numbers are a reflection of changes
  in society
• Affect over half of the the adult population
  in many countries

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• Compared to smoking in regards to the amount of
  lives affected
• EXCESS WEIGHT GAIN AND PHYSICAL INACTIVITY
  ACCOUNT FOR MORE THAN 300,000 premature deaths
  each year in the United States

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Definition

• Overweight is an increased bodyweight in relation
  to height
• Obesity is an excessively high amount of body fat
  in relation to lean body mass

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Body Mass Index

• Most common weight standard
• Bodyweight(kg)/Height(m)2

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BMI Standards

• Overweight 25-29.9
• Obese 30 and above
• Grade I 30-34.9
• Grade II 35-39.9
• Grade III 40 and above

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Body Mass Index

• All adults with a BMI of 25 or more are
  considered at risk for premature death and
  disability as a consequence of overweight and
  obesity

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Waist Circumference

• Used to measure abdominal fat content
• An independent predictor of risk factors
  associated with obesity
• AT Risk Men above 40 inches
• Women above 35

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WAIST-TO-HIP Ratio

• Ratio of a persons waist circumference to hip
  circumference
• Above 1.0 is considered at risk for men and 0.9
  is considerate at risk for women
• Men with high hip to waist ratios have a
  three-fold risk of coronary events

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• BMI used in children
• Dependent on age and sex
• Underweight BMI falling in less than the 5th
  percentile
• Overweight equal or greater than 85th percentile
• Obese equal or greater than 95th percentile

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Obesity Trends Among U.S. Adults BRFSS, 1991,
1995 and 2000
(BMI ? 30, or 30 lbs overweight for 54 woman)
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
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Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1986
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1987
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1988
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1989
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1991
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1992
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1993
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1994
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1996
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Prevalence

• 61 of U.S. adults obese (1999)
• Obesity has nearly doubled from 15 to 27 in 1999
• In 2000 38.8 million Americans were obese (19.6
  men and 19.2 women)

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Prevalence

• In Europe prevalence of obesity is 10-25 in
  most countries
• Britain is one of the fastest growing obesity
  populations (17 men and 20 women)
• Also on rise in countries such as China,
  Singapore and Thailand

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Childhood Obesity

• Three times as many American children are obese
  than 20 years ago
• Childhood obesity on rise globally
• 1991-1997 China (6.4-7.7)
• 1975-1999 Brazil (4-144)
• Russia demonstrated a 50 decrease

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Childhood Obesity Risk Factors

• Weight Gain occurs if the amount of calories
  consumed is more than those expended.
• Genetics
• Family history of obesity
• Psychological factors
• Social and cultural factors
• Medical Illnesses
• Medications
• Alcohol consumption
• Smoking Cessation

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Race

• Several studies have found that Black women have
  a lower resting metabolic rate when compared to
  white women

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New Research

• Low grade inflammation theory
• Measured by levels of C-Reactive protein in the
  blood
• Produced in response to inflammation

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Obesity Virus

• Researchers at the University of Wisconsin have
  been able to bring on obesity in animals by
  inoculation with adenovirus

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Population at Risk

• 1) Racial-ethnic Minorities
• Mexican American and Black adults more overweight
  than whites
• American Indians (80 for men and 67 in Arizona)

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Population at Risk

• 2) Women
• For all racial and ethnic groups combined women
  of lower socio-economic status are 50 more
  likely to be obese

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Population at Risk

• Black women 64.5
• Hispanic women 56.8
• White women 43

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Population at Risk

• 4) Children Adolescents
• In 1999 13 of children aged 6-11 years and 14
  aged 19-199 were overweight

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Population at Risk

• 5) Elderly
• Obesity among the elderly (those over 50) has
  nearly doubled from 1982-1999 (14.4-26.7)

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Importance Of Culture

• Many obesity related diseases are found in higher
  rates in minorities
• Diabetes, hypertension, cancer

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Importance Of Culture

• Studies have demonstrated that minorities are
  less preoccupied with their body image
• Larger bodies are more socially accepted in this
  community
• This can have a negative consequence Weight gain
  leading to obesity

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Other Concerns

• Low Self-Esteem Discrimination
• Low self-esteem most evidenced in children and
  adolescents
• Study done in the 1960s to assess childrens
  perception of obesity

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Other Concerns

• Discrimination of obese persons is common
• Especially common in the workplace

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Other Concerns

• Obese persons had lower wages
• Were considered lazy and possessing negative
  personality traits
• Discrimination also found in the health care
  arena
• Overweight patients were less likely to receive
  important preventative health care services

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Economic Costs

• Total costs due to obesity
• 99 Billion in 1995
• 117 billion in 2000

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Solutions

• HEALTHY PEOPLE GOALS 2010
• Reduce the proportion of children and adolescents
  who are overweight or obese
• From 11 to 5 in children 6-11 years
• From 11 to 5 in adolescents 12-19

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Solutions

• Increase the proportion of adults who are at a
  healthy weight from 42 to 60
• Reduce the proportion of adults who engage in no
  leisure-time physical activities from 40 to 20

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Solutions

• Increase the proportion of adults who engage
  regularly in moderate physical activity for at
  least 30 minutes per day from 30 to 15

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Obesity Risk Factors

• Genetics
• Family history of obesity
• Psychological factors
• Social and cultural factors
• Medical Illnesses
• Medications
• Alcohol consumption
• Smoking Cessation

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Obesity Causes

• Causes
• Biology
• Lack of Physical Activity
• Eating Patterns

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Obesity Consequences

• Diabetes
• Hypertension
• Myocardial infarction
• Cerebrovascular attack (CVA)

• Peripheral Vascular Disease (PVD)
• Hyperlipidemia
• Degenerative Joint disease
• Gallbladder Disease

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Obesity Consequences

• Obese persons had lower wages
• Were considered lazy and possessing negative
  personality traits
• Discrimination also found in the health care
  arena
• Overweight patients were less likely to receive
  important preventative health care services

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Weight Issues vs. Health

• White Americans believe thinness to be a
  desirable health goal, whereas other groups such
  as Haitians, consider thin people to be in poor
  health.
• Hispanic older women believe weight gain is
  inevitable, only young people should be concerned
  about their weight.

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Why Most Commercial Weight Loss Programs Do Not
Work

• Negative Impact
• Temporary
• Perfect- Orientation
• Project Mentality
• Do not Address Cause

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Types of Weight Loss Diets

• Low Carbohydrate aka High Protein
• Low Fat aka High Carbohydrate
• Very Low Calorie aka Modified Fast
• Novelty Diets
• Weight Loss Programs

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Consequences of Dieting

• Decrease in rate of weight loss
• Loss of lean tissue with fat loss
• Decrease in metabolism, 10-40
• Decrease in Protein turnover
• Preoccupation with food
• Increase in irritability, moodiness
• Tires easier, less physical activity
• Apathy, depression

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Re-feeding after Weight Loss

• Increase in pre-dieting food intake
• Preference for high fat foods
• Regain in weight, but greater increase in BF
• Metabolism slow to return to normal
• Regain Weight quicker with each diet
• Increase in abdominal fat deposits
• Less likely to return to pre-diet physical
  activity
• Decrease in self-efficacy/esteem

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Recognizing an Unsound Weight Control Diet

• Promotes Quick Weight Loss
• Limits Food Selection
• Testimonials or Famous People/Places
• Expensive Supplements or Products
• No Attempt to Permanently change eating or
• physical activity
• Critical of Scientific Community
• They know more, or something new

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Characteristics of a Sound Weight Control Diet

• Nutritionally adequate yet low in calories
• Fit into current lifestyle
• Foods that are liked
• Slow rate of weight loss
• Followed for life

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Healthy Eating Recommendations for Weight
Management

• PLAN meals through the day
• Eat a VARIETY of foods (at each meal)
• Center meals around CARBOHYDRATE foods
• (real foods with no mother)
• Watch the FAT (always) and
• Sugar (at any one time)
• Dont worry about the PROTEIN

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CARBOHYDRATE (CHO)

• Percentage of calories can vary
• Individualize based on
• Individual eating habits
• Blood glucose and lipid goals

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Glucose in the Body
Blood sugar of 80-100mg/dl
5 grams 20 Calories Liver glycogen (20 of
reserve) 75 gm 300
Calories Muscle glycogen (80 of reserve)
300 gm 1200 Calories
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FAT

• lt 10 of kcal/day from saturated fat
• Percentage of calories from total fat can vary
• Dietary cholesterol lt 300 mg/day
• Research amount of MUFA/PUFA versus amount of
  CHO (?)

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SODIUM

• Persons with hypertension lt 2,400 mg/day
• To choose low sodium in food
• Single serving of food sodium lt 400 mg
• Entrees or convenience meals sodium lt 800 mg
• Buy fresh or low sodium foods and salt at the
  table

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Solutions

• Solutions will be found in prevention policies
  aimed at
• promoting healthy lifestyles
• Increased physical activity
• Behavior changes which emphasize long term weight
  management rather than short term weight reduction