OBESITY

1
OBESITY

• Definitions and Overview
• Carl I. Fertman, PhD, MBA, CHES
• University of Pittsburgh
• In collaboration with
• Western Maryland Area Health Education Center

2
Section 1

• Obesity An Overview

3
Definition and Overview

• Obesity roughly translates into having excess
  body weight.
• Over 45 above ideal body weight for women
• Over 35 above ideal body weight for men

4
Definition and Overview

• One in Four Americans are roughly 30 pounds
  overweight.
• Six Million Americans are morbidly obese at 100
  or more pounds overweight.

5
Factors in Obesity

• Genetics
• Cultural Factors
• Behavioral Factors
• Psychological factors
• Social Factors
• Metabolic Factors

6
Social Implications

• Societal preoccupation with thinness.
• Negative societal attitudes towards obesity.

• The business of food as luxury instead of
  nutrients.
• Discrimination against obese persons (being
  charged for 2 airline seats, clothing, and job
  prospects).

7
Social Implications

• Disparities have been noted in prevalence based
  upon race, ethnicity, gender, and socioeconomic
  class.
• Predominant in lower incomes (especially women)
• Predominant in above factors for children and
  adolescents.

8
Food Facts

• Food portions have grown larger at restaurants!
• Dinner plates are now 2 1/2 inches larger!

• Super size it!-saves us money and expands our
  girth
• We consume 34 teaspoons of sugar a day much of it
  is soda!

9
Financial Facts

• 33 billion dollars are spent annually by
  consumers on weight loss products and services.

• Many professions are involved in weight loss and
  fitness, i.e. physician, nurse, nutritionist,
  fitness trainer, and occupational therapist etc

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Important Facts for your Profession

• It has been suggested we reassess our treatment
  goals.
• Helping patients attain reasonable weight
  (reduce by 10 of ones total weight) instead of
  aiming for drastic reductions might be
  unrealistic and self defeating.

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Section 1/Summary

• There are many contributing factors to obesity.
  Race, Gender, socioeconomic status are but a few
  of these factors. Obesity, in fact, effects one
  in four of the American Population.

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Section 1/ Sources Cited

• Government
• Organizational Publications

13
Section 1/Sources Cited

• Organizations Dealing With Weight Control Health
  Issues
• National Weight Control Registry -
  www.uchsc.edu/nutrition/nwer.htm
• AARP- www.eatright.org
• Center for Disease Control- National Center for
  Chronic Disease Prevention and Health
  Promotion-www.cdc.gov/nccdphp/dnpa/obesity/epidemi
  c.htm
• DietWatch- www.dietwatch.com
• International Association of Eating Disorder
  Professionals- www.iaedp.com

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Section 1/Sources Cited

• Childhood and Adolescent Obesity
• Berg, F.M. (1997). Afraid to eatChildren and
  teens in weight crisis. ND Healthy Weight
  Publishing Network
• Brownlee, S. (2002). Too Heavy, Too young. Time.
  Jan 21. NY, 88-90
• Calderon, L. (2002) Promoting a healthful
  lifestyle and encouraging advocacy among
  university and High school students. Journal of
  the American Dietetic Association, 102 (3) S71
• Daniel, K. (2001). Tackling teenage obesity.
  Community Practitioner, 74(12), 456-460
• Edmunds, L. (2001). Evidence based management of
  childhood obesity. British Medical Journal.
  323(7318) 916-919
• Field, A. (1999). Overweight, weight concerns,
  and bulimic behaviors among girls and boys.
  Journal of the American Academy of Child and
  Adolescent Psychiatry, 38(6) 754-761

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Section 1/Sources cited

• Gable, S. (2000). Household, parent and child
  contributions to childhood obesity. Family
  Relations, 49(3) 293-300
• Ge, X (2002). Pubertal transitions, perceptions
  of being overweight and adolescents
  psychological maladjustment Gender and ethnic
  differences. Social Psychology Quarterly, 64(4),
  363-375
• Hipsky, J (2002). Health Works! Weight management
  program for children and adolescents. Journal of
  the American Dietetic Association, 102(3) s64-68.
• Kiess, W., (2002). Obesity in the adolescent.
  Adolescent Medicine, 13(1), 181-188
• Lytle, L.A. (2002). Nutritional issues for
  adolescents. Journal of the American Dietetic
  Association, March, 2002, S8-S12

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Section 1/Sources cited

• Mackenzie, N.R. (2000) Childhood Obesity
  Strategies for prevention. Pediatric Nursing,
  26(5). 527
• Morrissette, P.J. (2002). Family counseling and
  childhood obesity A review of approaches. The
  Family Journal 10 (1)1694-1696
• Reinhardt, W.C. (2002). Integrating the food
  guide pyramid and physical activity pyramid for
  positive dietary and physical activity behaviors
  in adolescents. Journal of the American Dietetic
  Association. 102(3) S96-S100
• Rolls, B.J. Serving Portion size influences 5
  year old but not 3 year old childrens food
  intakes. Journal of the American Dietetic
  association, 100(2) 232-237
• Sothern, M.s. Committed to Kids An integrated, 4
  level team approach to weight management in
  adolescents. Journal of the American Dietetic
  Association, 102(3)

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Section 1/Sources Cited

• Strauss, R.S. (2001). Epidemic increase in
  childhood overweight, 1986-1998 JAMA,
  286(22)2845-2848.
• Whiting, S.J. (2002). Obesity is not protective
  for bones in childhood and adolescence. Nutrition
  Review, 601(1) 27-30.
• Wright, C.M. (2001). Implications of childhood
  obesity for adult health Findings from thousand
  families cohort study. British Medical Journal,
  323(7324) 1280-1284.

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Section 2

• Adolescent Obesity

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Adolescent Obesity

• Behavioral and Environmental Factors are seen as
  providing the greatest cause of obesity and the
  greatest opportunities for intervention.

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Adolescent Obesity

• Approximately 13 of children are overweight.

• There are almost 3x as many overweight
  adolescents as in 1980.
• Obese adolescents are likely to become obese
  adults.

21
Adolescent Obesity Factors

• Genetics
• Metabolic factors
• Behavioral factors
• Environmental factors
• Cultural factors
• Socioeconomic factors

22
Programs

• The Surgeon Generals Call to Action to Prevent
  and Decrease Overweight Obesity (2001)
• Interventions in five key settings families and
  communities, schools, health care, media and
  communications, and worksites.
• Framework CARE- Communication, Action, and
  Research and Evaluation

23
Framework CARE

• Communication-Dissemination of information and
  tools to motivate and empower.
• Action- Interventions and activities that assist
  decision makers.

• Research and Evaluation- Investigations to better
  understand the causes of obesity.
• Schools- Identified as a key setting for public
  health strategies for children and adolescents.

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School Health Strategies

• Provide opportunities to engage children in
  health eating and activity.
• Should extend to include school policy, the
  schools social environment and community.

• Physical Education should stress lifetime
  exercise.
• Health Education curricula should feature
  learning strategies that follow the National
  Health Education Standards

25
Treatment Approaches

• Behavior modification
• Family involvement
• Dietary Therapy
• Physical Activity

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Section 2/Summary

• The contributing factors for adolescent obesity
  are very similar to the contributing factors of
  obesity in various age groups. The treatment
  suggestions include proactive school and
  community action.

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Section 2/Sources Cited

• Websites
• Girls and Obesity Initiative http//www.4woman.go
  v/owh/education.htm
• Healthy people 2010 Initiative
  http//www/health.gov/healthypeople
• Promoting Better Health for Young People Through
  Physical Activity and Sports http//www.cdc.gov/n
  ccdphp/dash/presshysactrot/index.htm

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Section 2/Sources Cited

• Websites
• National Cancer Institute Eat 5 a Day For Better
  Health http//www/5aday.gov/publications-cdc.shtm
  l
• American Dietetic Association www.eatright.org

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Section 3

• Adult Obesity

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Adult Obesity

• Behavioral and Environmental factors are seen as
  the greatest cause for obesity and the greatest
  opportunities for providing action and
  intervention.

31
Adult Obesity

• Over 60 of Americans aged 20 years and older are
  overweight.
• 25 of overweight Americans are obese.

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Adult Obesity Factors

• Genetics
• Metabolic factors
• Behavioral factors
• Environmental factors
• Cultural factors
• Socioeconomic factors

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Adult Obesity

• Mortality is increased markedly for adults who
  are overweight or obese. They are at risk for
• Coronary heart disease
• Type 2 diabetes
• Endometrial, colon, postmenopausal breast, and
  other cancers
• Musculoskeletal disorders

34
Programs

• The Surgeon Generals Call to Action to Prevent
  and Decrease Overweight Obesity (2001)
• Interventions in five key settings families and
  communities, schools, health care, media and
  communications, and worksites.
• Framework CARE- Communication, Action, and
  Research and Evaluation

35
Framework Care

• Communication-Dissemination of information and
  tools to motivate and empower.
• Action- Interventions and activities that assist
  decision makers

• Research and Evaluation- Investigations to better
  understand the causes of obesity.
• Schools- A key setting for public health
  strategies for children and adolescents.

36
Work Site Strategies

• Worksite policy and links with family and
  community settings
• Employers should be informed about cost of obesity

• Provide flexible work hours to create
  opportunities for physical activity.
• Begin workplace workouts, low cost weight
  management programs.

37
Treatment Approaches

• Behavior modification
• Family involvement
• Dietary Therapy
• Physical Activity
• Some cases- weight loss drugs
• Some extreme cases- gastrointestinal surgery

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Section 3/Summary

• Approximately 60 of all American adults are
  overweight. Treatment suggestions include
  proactive attention in the work place and
  social/community environments.

39
Section 3/ Sources Cited

• Websites
• Weight Control Information Network
  www.niddk.nih.gov/health/nutrit.htm
• Healthy People 2010 Initiative
  http//www.health.gov.healthypeople
• Centers for Disease Control Ready, Set, Its
  Everywhere You Go http//www.cdc.gov/nccdphp/dnpa
  /readyset/index-htm
• American Obesity Association http//www.obesity.o
  rg

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Section 4

• Obesity in the Elderly

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Elderly Obesity

• Obesity is usually less a important problem in
  the elderly than in young persons.
• The risk/benefit ration of any therapy needs to
  be evaluated.

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Treatment Approaches

• Physical Activity- e.g. walking (mall walking)
• For people with osteoarthritis, an upper body
  exercise program is recommended.

43
Treatment Approaches

• Diet Therapy
• Limited calorie intake with vitamin and trace
  minerals supplements
• Behavioral Modification Program
• Weight Loss Drugs are not recommended for the
  elderly.

44
Section 4/Summary

• Obesity does not seem to be as great a factor in
  the health of the elderly. Treatment suggestions
  vary according to capabilities, and walking is
  strongly encouraged.

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Section 4/ Sources cited

• Websites
• Exercise A video from the National Institute on
  Aging http//www.nia.nih.gov/excercisevideo/
• healthfinder/ Gateway to Reliable Consumer Helath
  Information on the Internet http//www.healthfind
  er.gov
• National Aging Information Center
  http//www/aoa.dhhs.gov/naic/

46
Sections Summary

• Obesity affects many Americans. Regardless of
  age, behavioral and environmental factors are
  seen as the greatest cause for obesity and the
  greatest opportunities for providing action and
  intervention.