Embed Size (px)
Citation preview
OBESITY and OVERWEIGHT
PED 488
1
2
OVERWEIGHT and OBESITY
An excess of body fat frequently resulting in a significant impairment of health
Having a very high amount of body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or higher.
Estimated to be the biggest health challenge in the future
Will exceed that of smoking as a cause of death
Exercise is most effective in preventing and controlling body weight and/or body fat
CAUSE of DEATHS
4
Diseases associated excess body fat
Coronary Heart Disease
Hypertension
Diabetes
Hyperlipidemia
Cancer
Gallbladder Disease
Menstrual Irregularities
Reproductive Hormone Dysfunction
5
Associated Risk Factors
Predictive of CVD/CHD (especially central or visceral adiposity)
Metabolic Syndrome
Certain Cancers
Hypertension
Osteoarthritis
6
Obesity Trends Among U.S. Adults between 1985 and 2006
Data shown in maps were collected through CDC’s Behavioral Risk Factor Surveillance System (BRFSS).
http://www.cdc.gov/NCCDPHP/dnpa/obesity/trend/maps/index.htm
7
US Ranks Last in Preventable Deaths, Health Affairs, 2008
8
Process of Excess Body Fat
Storage of extra energy adipose cells unlimited storage capacities.
No spot reduction
Useful for times when food is not available
Food available year-round food stores occur in excess
Obesity occurs when adipose cells increase excessively size (hypertrophy) number (hyperplasia) Both size and number
9
Theories for Fat Gain
Caloric Balance you eat more calories than you expend, you gain fat
Biochemical Imbalance Hormone and other substance alteration is
associated with obesity
Set Point Theory body desires to have a specific amount of body always return to its own target percentage
Excess Fat Intake
WEIGHT CYCLINGWEIGHT CYCLING
• Twice as Long to Lose Weight
• Third the time to Regain the Weight
• Twice as Long to Lose Weight
• Third the time to Regain the Weight
SomatotypePear versus the Apple
12
Determining Obesity
Measure of “Body Build” or structure of the bodyMuscularityLinearityFatness
Body Mass Index (BMI) = weight (kg) / height (m2)Body size is determined by height and weight
Body fat percentageSkinfolds, underwater weighing, bioelectrical
impedance, etc.
13
Calculation of Ideal Body Weight Range
Women: 100 lbs for first 5 feet. plus 5 lbs for each additional inch
Men: 106 lbs for first 5 ft. 6lbs for each additional inch
Assumes Medium Frame add/subtract 10% 110% overwt. 120% obese
Hamwi 1974
14
Underweight
Normal
Overweight
Obesity
Extreme obesity
BMI(kg/m2)
<18.5
18.5 - 24.9
25.0 - 29.9
30.0 - 34.9
35.0 - 39.9
>40
ObesityClass
I
II
III
Men (<102 cm) <40 in Women (<88 cm) <35
in
--
--
Increased
High
Very High
Extremely High
Men (>102 cm) >40 in Women (>88 cm) >35
in
--
--
High
Very High
Very High
Extremely High
Disease Risk Relative to Normal Weight and Waist Circumference
Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. Obes Res 1998;6(suppl 2).
BMI - Values
15
Very
Low
Very
Low
Lo
wL
ow
Mod
erat
e
Mod
erat
e
HighHigh
OBESITY & MORTALITYOBESITY & MORTALITYM
orta
lity
Rat
io
Body Mass Index
16
BMI Measurement Limitations
Doesn’t differentiate between body fat and body muscle
Fails to account for the location of body fat Apple, pear, abdominal
As we age a slightly higher BMI may serve as a cushion against frailty– Low BMI may indicate poor nutrition or loss of
muscle
17
DESCRIPTION WOMEN MEN
Essential Fat 12-15% 2-5%
Athletes 16-20% 6-13%
Fitness 21-24% 14-17%
Acceptable 25-31% 18-25%
Obese 32%+ 25%+
Defining Obesity as % Body FatAmerican Council on Exercise
18
Children
Based on BMI for age and gender Overweight
at or above 95th percentile At risk for Overweight
85th to 95th percentile
Source: Expert Committee on Clinical Guidelines for Overweight Adolescent Preventative Services. (Pediatrics 1998;102(3). pediatrics.aappublications.org/cgi/content/full/102/3/e29
Overweight
At risk
Overweight
At risk
19
20Source: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overwght99.htm
21
Determine Body Mass
Index
Clinical Judgment
• Hypertension• Cardiovascular
Diseaes• Dyslipidemia• Type 2 Diabetes• Sleep Apnea• Osteoarthritis• Infertility• Other
Assess other Risk
Factors
• Progressive gain since adolescence
• Hx of Obesity• Bulimia Nervosa• Binge Eating Disorder• Depression/Anxiety/Stress• Relevant medical conditions• Overall Disease Burden• Quality of Life• Physical Inactivity
Clinical Management
• Waist-Hip • > 1.0 in • >0.8 in
• Waist Circumference• >40 in • >35 in
22
Obesity Treatment Pyramid
Surgery
Pharmacotherapy
Lifestyle Modification
Diet Physical Activity
BMI 40
35
30
25
Slide source: R.Kushner, Obesity: Current Research and Future Directions, Certificate of Training in Adult Weight Management, March 2004.
GeneticsGenetics
Eating HabitsEating Habits
ExerciseExercise
The etiology of overweight and obesity is a combination of genetic and life-style factors. The life-style factors will
contribute to overweight and obesity provided the genetic predisposition exists.
Trends in Health Education…what is missing
25
Physical Activity and Obesity
Minimal weight loss in the absence of caloric restriction
Best predictor of weight loss maintenance
Include both programmed and lifestyle
Utilize self monitoring tools – for example pedometers
Is recommended for health benefits whether or not it directly results in wt. loss Decreases visceral inflammation Increases Insulin Sensitivity Reduces Mortality regardless of BMI
Exercise in OBESITYExercise in OBESITY
Oscai et al J Lipid Research 13:588-592, 1972.
Cal
orie
s pe
r D
aySedentary
Free EatersSedentary
Pair Weighted Exercise
Percent Fat (%)Percent Fat (%)Body Weight (g)Body Weight (g)
Exercise in OBESITYExercise in OBESITY
Fat Cell SizeFat Cell Size Fat Cell NumberFat Cell Number
Exercise in OBESITYExercise in OBESITY
29
Lifestyle Management
Most effective treatments require a gradual long-term approach
Sensible diet, moderate physical activity, behavioral counseling
In isolation these approaches do not lead to significant weight loss
10% wt. loss is associated with a decrease in obesity related health consequences
A Multilevel, Transdisciplinary,
Ecological Model of Factors
that Influence What Children Eat
. L Kolbe & M Story,
2007
30
Push—Pull Factors
31
Estimating Energy Needs
Level of Activity and Cal/kg
Goal: Low Moderate High
Lose Wt. 15kcal/kg 20kcal/kg 25kcal/kg
Maintain Wt. 20kcal/kg 25kcal/kg30kcal/kg
GROUP CALORIES/lb.
Men/Active Women 15
Women/Sedentary Men/>55 13
Sedentary women/obese adults 10
32
M: 662 – (9.53 X Age) + PA{(15.91 X W in kg) + (539.6 X Ht in m)}
F: 354 – (6.91 X Age) + PA {(9.36 X Wt in kg) + 726 X Ht in m)}
PA Values for Different Activity Levels
Sed Low Active Active Very Active
M 1.00 1.11 1.25 1.48
F 1.00 1.12 1.27 1.45
Energy Expenditure Rate
(Formula based on Physical Activity)
33
Pharmacological Approaches
Should only be considered with high BMI and/or comorbidities
Need to consider cost, side effects, and rebound weight gain
Noradrenergic Agents Appetite Suppression
Serotonergic Agents Appetite Suppression
Mixed Noradrenergic/Serotonergic LIPASE INHIBITORS Reduction of Nutrient Absorption
34
GASTRIC BYPASS
GASTRIC BYPASS
• Roux en-Y
• Laparoscopi
c
• Adjustable Gastric Binding
• Bilio Pancreatic
Diversion
• Distal Bypass
• Roux en-Y
• Laparoscopi
c
• Adjustable Gastric Binding
• Bilio Pancreatic
Diversion
• Distal Bypass34
GASTRIC BYPASS
GASTRIC BYPASS
• Roux en-Y
• Laparoscopi
c
• Adjustable Gastric Binding
• Bilio Pancreatic
Diversion
• Distal Bypass
• Roux en-Y
• Laparoscopi
c
• Adjustable Gastric Binding
• Bilio Pancreatic
Diversion
• Distal Bypass
35
36
Obesity Resources for Practitioners
Partnership for healthy Weight Management
http://www.consumer.gov/weightloss
Weight Information Network
http://win.niddk.nih.gov/publications/choosing.htmThe
Practical Guide: Identification, Evaluation, and treatment of Overweight and Obesity in Adults
http://www.nhlbi.nih.gov/about/oei/index.htm
North American Association for the Study of Obesity
http://www/nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf
North American Obesity Association
http://www.naaso.orghttp://www.obesity.org
