Obesity, Nutrition, and Excercise

Mohammed Alo

Copyright Mohammed Alo 2006. All Rights Reserved. May be used for educational purposes without alteration including the first slide.

Questions?

• Is being overweight bad?• Is it a serious problem in America?• How many think they are overweight?• How many want to lose weight?• What have you tried?• Did you gain your weight back?• How many of you had overweight parents?• Is obesity genetic?

Questions?

• What percentage of United States population is overweight?

• What percentage of population is obese?

• What percentage of children overweight?

Answers

• 67% of adults overweight

• 30% of adults obese

• 16% of children 6-19 years of age overweight

Costs of obesity?Q: What is the cost of overweight and obesity?A: Total cost: $117 billion , Direct cost: $61 billion,* Indirect cost: $56 billion

(comparable to the economic costs of cigarette smoking)

Q: What is the cost of heart disease related to overweight and obesity?A: Direct cost: $8.8 billion (17 percent of the total direct cost of heart disease,

independent of stroke) 

Q: What is the cost of type 2 diabetes related to overweight and obesity?A: Total cost: $98 billion (in 2001)[15]

Q: What is the cost of osteoarthritis related to overweight and obesity?A: Total cost: $21.2 billion, Direct cost: $5.3 billion, Indirect cost: $15.9 billion

Q: What is the cost of hypertension (high blood pressure) related to overweight and obesity?

A: Direct cost: $4.1 billion (17 percent of the total cost of hypertension)

Q: What is the cost of gallbladder disease related to overweight and obesity?A: Total cost: $3.4 billion, Direct cost: $3.2 billion, Indirect cost: $187 million

More costs…Q: What is the cost of cancer related to overweight and obesity?• Breast cancer: Total cost: $2.9 billion, Direct cost: $1.1 billion, Indirect cost: $1.8

billion

• Endometrial cancer: Total cost: $933 million, Direct cost: $310 million, Indirect cost: $623 million

• Colon cancer: Total cost: $3.5 billion, Direct cost: $1.3 billion, Indirect cost: $2.2 billion

Q: What is the cost of lost productivity related to obesity?• The cost of lost productivity related to obesity (BMI > 30) among Americans

ages 17–64 is $3.9 billion. This value considers the following annual numbers (for 1994):

• Workdays lost related to obesity: 39.3 million

• Physician office visits related to obesity: 62.7 million

• Restricted activity days related to obesity: 239.0 million

• Bed-days related to obesity: 89.5 million

Obesity?

Once all of the Lung Cancer generation has died off, the number one killer will be Obesity and it’s complications.

No 1 KILLER!

What is obesity?

We know it when we see it

Morbid Obesity

Morbid Obesity?

Fat Kids

The opposite of obese

The wise guy

Why fat kids?

Weight is not genetic!

Definition?

Obesity = Body Mass Index over 30

BMI =             Weight in Pounds                          x 703 (Height in inches) x (Height in inches)

Mohammed Alo

Wt: 175Ht: 68 inches

(175/(68x68)) x 703 175/4624 x 703 = 26.6

More BMI Definitions

< 18.5 Underweight

19 – 25 Normal

25 – 30 Overweight

30 – 40 Obese

40 + Extremely Obese

More on BMI

BMI is a good overall average. It does work for all, but there are some modifications.

1. Women should try to be at lower end of normal (18-23), men at higher end (23-25)

2. Athletes, body builders, etc will have “overweight” BMI.

3. BMI is one factor among many. Try to improve all factors.

BMI-Associated Disease RiskClassification BMI (kg/m2) Risk

Underweight <18.5 Increased

Normal 18.5-24.9 Normal

Overweight 25.0-29.9 Increased

Obese I 30.0-34.9 High

II 35.0-39.9 Very High

III >40 Extremely high

Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. Obes Res 1998;6(suppl 2).

Additional risks:• Large waist circumference (men>40 in; women >35 in)• 5 kg or more weight gain since age 18-20 y• Poor aerobic fitness• Specific races and ethnic groups

Source: Behavioral Risk Factor Surveillance System, CDC.

19961991

Obesity Trends* Among U.S. AdultsBRFSS, 1991, 1996, 2004

(*BMI 30, or about 30 lbs overweight for 5’4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

2004

Pulmonary diseasePulmonary diseaseabnormal functionobstructive sleep apneahypoventilation syndrome

Nonalcoholic fatty liver Nonalcoholic fatty liver diseasediseasesteatosissteatohepatitiscirrhosis

Coronary heart diseaseCoronary heart disease

DiabetesDiabetes

DyslipidemiaDyslipidemia

HypertensionHypertension

Gynecologic abnormalitiesGynecologic abnormalitiesabnormal mensesinfertilitypolycystic ovarian syndrome

OsteoarthritisOsteoarthritis

SkinSkin

Gall bladder diseaseGall bladder disease

CancerCancerbreast, uterus, cervixcolon, esophagus, pancreaskidney, prostate

PhlebitisPhlebitisvenous stasis

GoutGout

Medical Complications of ObesityIdiopathic intracranial Idiopathic intracranial hypertensionhypertension

StrokeStroke

CataractsCataracts

Severe pancreatitisSevere pancreatitis

Complications no one talks about

• Not fitting in CT scanner

• Abdominal surgery and healing

• Medical emergencies-can they carry you?

• Difficulty dosing medications

• Operating tables not capable

• Not fitting in airplane

Slide Source:www.obesityonline.org

0.6

1.0

1.4

1.8

2.2

2.6

3.0

Relationship Between BMI and Relationship Between BMI and Cardiovascular Disease MortalityCardiovascular Disease Mortality

Rel

ativ

e R

isk

of D

eath

Body Mass index

<18.5

MenMen

WomenWomen

Calle et al. N Engl J Med 1999;341:1097.

18.5–

20.4

20.5–

21.9

22.0–

23.4

23.5–

24.9

25.0–

26.4

26.5–

27.9

28.0–

29.9

30.0–

31.9

32.0–

34.9

35.0–

39.9

>40.0

Lean Overweight Obese

Obesity Is Caused by Long-Term Positive Energy Balance

FatFatStoresStores

Diet or Exercise?

What is more important in determining your body

composition?

85% Diet 15% Exercise

Diet or Exercise Study

• JAMA March 22/29 2006• 27,000 women since 1992• BMI or Activity level?

High BMI was more strongly related to adverse cardiovascular biomarker levels than physical inactivity. However, within BMI categories, physical activity was generally associated with more favorable cardiovascular biomarker levels than inactivity.

You are what you eat!

How many Calories do I need?

Determine Calorie NeedsEstimated Energy Requirements* for males

1000

1200

1400

1600

1800

2000

2200

2400

2600

2800

3000

3200

3400

3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 20 25 30 35 40 45 50 55 60 65 70 75 80

Age

Cal

orie

s

ACTIVE

SEDENTARY

*From the National Academy of Sciences, Institute of Medicine Dietary Reference Intakes Macronutrient Report

0

500

1000

1500

2000

2500

3000

Discrepancy Between Reported and Actual Energy Intake and Expenditure

Kca

l/d

Reported*P<0.05 vs reported.Lichtman et al. N Engl J Med 1992;327:1893.

Energy Intake

Actual Reported Actual

Energy Expenditure

**

**

Calories to lose weight?

Total 1800 calories per day

500 less calories per day than what you need (3500/week)

Results in stable weight loss of 1-2 pounds per week.

Lifetime Food Intake

*kcal in millions

Water

45,300 kg

Fat

2300 kg

21 kcal*

Carbs

8000 kg

31 kcal*

Protein

1900 kg

7 kcal*

-20

-15

-10

-5

0

5

Short-term Obesity Therapy Does Not Result in Long-term Weight Loss

Cha

nge

in W

eigh

t (kg

)

Wadden et al. Int J Obes 1989;13 (Suppl 2):39.

5-yearFollow-up

1-yearFollow-up

End ofTreatment

Baseline

Diet alone

Behavior therapy

Combined therapy

-18-16-14-12-10

-8-6-4-20

Long-term Weight Loss is Improved with Long-term Maintenance Therapy

Wei

ght L

oss

(%)

Perri et al. J Consult Clin Psychol 1988;56:529.

0 1 2 3 4 5 6 7 8 9 10 11 12

Time (mo)

13 14 15 16 17

PP <0.05 <0.05

No maintenance tx

Maintenance tx

Diet andbehaviormodificationtherapy

Diet everyday for the rest of your life

• A diet is a long term commitment.

• Just like you have to sleep every night, you have to diet every day.

• Any time you eat, you are dieting.

• You have to diet everyday for the rest of your life!

• 95% of people gain all their weight back, is not true!

Total Garbage!

95% of people that lose weight will gain it back!

Why?

• Body is very smart• Human Body has set point for weight• Takes 8-12 months to reset• Inmate experiments with

over/underfeeding• Body detects less food as starvation and

lowers metabolism• Eating once a day and skipping meals

reinforces starvation signal.

Pattern of Changes In Energy Intake, Body Fat, and Fat-

free Weight100% + 78% of Control

100% ControlValue

Hyp

erp

hag

ia

Restricted Ad libtium

C12 S12 S24 R12 R20C12 S12 S24 R12 R20

Semistarvation Refeeding

Fat-free Wt

Fat Wt

100% Control

Value

Feeding 40% of Control

Keys, 1950; Dulloo, AJCN - 1997Keys, 1950; Dulloo, AJCN - 1997

Obesity Treatment Pyramid

DietDiet Physical ActivityPhysical Activity

Lifestyle ModificationLifestyle Modification

PharmacotherapyPharmacotherapy

SurgerySurgery

History of USDA’s Food Guidance

1940s

1950s-1960s

1970s

1992

2005

Food for Young

Children

1916

--1992--Food Guide Pyramid

Reasons for Revising—Updating the Science

• To ensure that the guidance reflects the latest nutrition science – New nutrient standards—DRI – New Dietary Guidelines – Food consumption and composition data– Americans still gaining weight with old

pyramid

--2005--MyPyramid

Print materials: Mini Poster

Focus on fruits.Focus on fruits.

Vary your veggies.Vary your veggies.

Get your calcium-rich foods.Get your calcium-rich foods.

Make half your grains whole.Make half your grains whole.

Go lean with protein.Go lean with protein.

Know the limits on fats, salt, and sugars.Know the limits on fats, salt, and sugars.

Key food group messages from the Dietary Guidelines and MyPyramid:

Daily Amountsin cups or ounces

Print materials: Mini Poster

Implementation

• Implementation is the challenge ahead.

• Health/education professionals are vital for success.

• It will be an ongoing process.

• Working together, we can help Americans to be healthier.

What types of calories?

• Carbohydrates- sugar, bread, rice, pasta

• Protein- meat, beans

• Fat- butter, oil, margarine, fat on meat

Also…

• Fiber- fruits, veggies, bran

Carbohydrates?• Sugars, flour, oat, grain, bread, rice, pasta

Protein?• Meat and beans

Fats?

• Oil, butter, parts of meat, skin

Saturated Fat

• Fat that is Solid at room temperature

-Butter, cheese, margarine, ice cream, meat fat, skin, peanut oil, palm oil

Fiber?

• Fruits, veggies, whole everything

Indigestible, fills you up, lowers cholesterol

What diets?

• All diets work• You have to do them and be dedicated• Human Body has set point for weight• Takes 8-12 months to reset• Inmate experiments with over/underfeeding• Women can’t lose weight as easily• Skipping meals send wrong signal (starvation,

body lowers metabolism)• Eat smaller spread out meals

All Diets

Low Calorie/Low Fat

High Protein/Low Carb

21

Low Calorie/Low Fat Diets

• Eat less of everything• Eat less fat• Monitor caloric intake closely• Count calories• Many choices: Zone Diet, Jenny Craig, Weight

Watchers• Many physicians endorse these, Dr. Koop, Dr.

Sears (Zone)

Low Calorie/Low Fat Diet

Advantages:• Easy to tolerate• Lots of low fat

foods• Can still be doing

this in 2010• Weight Watchers is

best choice• Slow weight loss

Disadvantages:• Becomes boring,

people lose interest• Has lead to more

weight gain• Very tight caloric

control• Slow weight loss

High Protein/Low Carb Diet

Eat protein and fat: eggs, chicken, beef, bacon, cheese

Avoid: bread, rice, sugar, pasta, potatoesEat as much as you wantNo need to count caloriesSeparated into 3 or 4 stagesFast initial resultsAvoid fruits and veggies in initial stageMany to chose from: Atkins Diet, South Beach DietEndorsed by many physicians and cardiologists:

Dr. Agatston (invented heart scan)

High Protein/Low Carb Diet

Advantages:• Easy to follow• Quick weight loss

initially• No calorie counting• Reduces many

cardiovascular risk factors (diabetes, weight, LDL, HDL, CRP, etc)

• Atkins and South Beach both work great

Disadvantages:• If you don’t like

meat you are in trouble (use protein shakes)

• May be costly• Maybe difficult to

still be doing this in 2010

Other Tips

• Drink plenty of water

• Eat slowly

• Eat half your plate

• Sugar alternatives

• Low fat usually = More Sugar (better to find lower calorie)

• Stop telling kids to eat whole plate

• Substitute good for bad

Substitution?

• Splenda instead of Sugar• Oil instead of butter, margarine, lard, fat• Ground turkey instead of beef (or low fat beef)• Chicken or fish instead of beef• Whole grain instead of plain• Low carb pasta instead of pasta (even whole

grain pasta is available)• Fruit instead of cake, desert• Lettuce wrap instead of sandwich• Oil spread instead of cheese

Sugar Alternatives?

• Splenda• Nutrasweet• Equal

• Splenda seems to be the best, tastes best, not artificial, can cook with it at high temperatures.

Exercise?

Physical activity that keeps your heart rate above 65% of predicted maximum

(220 – Age) x 65%

Mohammed:

220 – 29 = 191 x 0.65 = 124

At least 30 minutes of 65% or higher for 3-4 days a week!

Does not include time it takes to reach 65%.

Exercise?

For most people, your diet is the problem.

Changing your diet will change 85% of your life.

For some people, you have to exercise to shed the weight. When you lose weight your body knows and slows down your metabolism, so you need to exercise in order to increase it.

This is especially true for women. Women have a much harder time losing weight, and must exercise to get to healthy weight.

Making Physical Activity a Part of Your Life • Do housework yourself instead of hiring someone else to do it. • Work in the garden or mow the grass. Using a riding mower doesn't

count! Rake leaves, prune, dig and pick up trash. • Go out for a short walk before breakfast or after dinner or both! Start with

5-10 minutes and work up to a minimum of 30 minutes. • Walk or bike to the corner store instead of driving.• When walking, pick up the pace from leisurely to brisk. Choose a hilly

route.• When watching TV, sit up instead of lying on the sofa. Better yet, spend a

few minutes pedaling on your stationary bicycle while watching TV. Throw away your video remote control. Instead of asking someone to bring you a drink, get up off the couch and get it yourself.

• Do leg lifts talking on the telephone. • Walk the dog.• Park farther away at the shopping mall and walk the extra distance. Wear

your walking shoes and sneak in an extra lap or two around the mall. • Stretch to reach items in high places and squat or bend to look at items at

floor level. • Keep exercise equipment repaired and use it!

At Work?• Brainstorm project ideas with a co-worker while taking a walk. • Stand while talking on the telephone. • Walk down the hall to speak with someone rather than using the telephone.• Take the stairs instead of the elevator. Or get off a few floors early and take

the stairs the rest of the way. • Walk while waiting for the plane at the airport. • Stay at hotels with fitness centers or swimming pools while on business

trips. • Take along a jump rope in your suitcase when you travel. Jump and do

calisthenics in your hotel room. • Participate in or start a recreation league at your company. • Form a sports team to raise money for charity events. • Join a fitness center or Y near your work. Work out before or after work to

avoid rush hour traffic, or drop by for a noon workout. • Schedule your exercise time on your business calendar and treat it as any

other important appointment. • Get off the bus a few blocks early and walk the rest of the way to work or

home.• Walk around your building for a break during the work day or during lunch.

Goals and Results?

• Not cosmetic • Goal is to improve health• Life style changes• Slow and steady change• Long term goals• Change family habits• Change friends and society• Live longer and healthier• Less miserable life at the end• Save future generations (kids)

Solution?