FCSN 245 – Basic NutritionSummer 2005

Episode III – Dr. David Gee Starting tomorrow, all lectures will be held

in PE 201 Clicker points: attendance sheets

Course web page www.cwu.edu/~geed

Grades so far posted on bulletin board outside 136 Michaelsen

Healthy Weight and the Non-Diet Approach

David L. Gee, PhDProfessor of Food Science and Nutrition

Central Washington University

Prevalence of Overweight in the US 1990: 56% of Americans were overweight

23% were obese 2000: 64% of Americans were overweight

30% were obese At this rate

In 2010: 73% overweight In 2020: 84% overweight In 2030: 96% overweight

Increases in overweight/obesity were seen in: Both males and females All age groups All ethnic groups

Ethnicity and Overweight (BMI>27.5) Prevalence

White Black Hispanic Native Am Hawaiian

24 27 26

45

31

4234

40

66 63

0

10

20

30

40

50

60

70

%

White Black Hispanic Native Am Hawaiian

MaleFemale

Prevalence of overweight in children. CDC (2004)

Overweight = above the 95th percentile for BMI based on NHANES II data from 1970’s

For adolescents 12-19 yrs: 1974 = 7.4% 2002 = 15.6%

Prevalence of Overweight Children in the US

Epidemic Increase in Childhood Overweight, 1986-1998JAMA 286:2845-2848 (2001)

Epidemic Increase in Childhood Overweight, 1986-1998JAMA 286:2845-2848 (2001)

National Longitudinal Survey of Youth 1986-1998 8,270 children, aged 4-12 yrs

Prior studies show it took 30 years for overweight prevalence to double. Current study show doubling time to be less than 12 years. Rate of increase particularly high in African

American and Hispanic children

Why lose weight? Obesity is associated with greater risk of:

Diabetes Hypertension & stroke Coronary heart disease Most cancers (except lung cancer) Sleep apnea, arthritis, gall stones, ….

Overfat vs Underfit ???? Good question Vast majority of overfat are underfit

Obesity and Causes of Death in the US

Epilog: Supersize MeThe Food Industry Strikes Back

NY Times (July 7, 2005) 20 states have passed ‘Common sense

consumption laws’ preventing personal injury lawsuits related obesity (11 states pending)

During elections of 2002 & 2004, the food and restaurant industry gave $5.5 million to politicians in the 20 states. Institute on Money in State Politics.

Epilog: Supersize MeThe Food Industry Strikes Back

NY Times (July 7, 2005)

83% of public opposed to obesity lawsuits against restaurants and fast food companies

Pelman & Bradley vs McDonald’s Initial personal injury lawsuit dismissed Jan 2005, panel of 3 Federal Judges reinstated

‘deceptive practices claim’ (McDonald’s falsely presented their food as nutritionally beneficial to consumers)

Is being overweight really that dangerous?

Excess Deaths Associated with Underweight, Overweight, and Obesity

JAMA 2005:293:1861-1867 “Underweight and obesity… were associated

with increased mortality…” “Overweight was not associated with excess

mortality.” “Study finds government overstated danger

of obesity” – USA Today – 4/19/05 http://www.usatoday

.com/news/health/2005-04-19-obesity-danger_x.htm

For adults ages 25-59, increased mortality in underweight and obese categories, but not overweight category.

Is Obesity a Public Health Problem?

Obesity and Overweight prevalence is rising rapidly

Obesity is associated with increased risk of mortality (overweight?)

Overweight is a temporary period of transition (many/most overweight people become obese)

Is Obesity a Public Health Problem?

Obesity and Overweight are associated with increased risk of diabetes, hypertension, dyslipidemia

While treatment of these diseases has improved Health care costs are rising Quality of life impacted

The Obesity Epidemic in America:Who’s responsible?

Personal responsibility Environmental influences

Do we need a “Food Police”? http://www.nytimes.com/2005/06/12/business/

yourmoney/12food.html?pagewanted=1

Discussion: What role should American society play

in addressing the Obesity Crisis? Name 1: Weight problems are a matter of personal responsibility.

No significant changes need to be made. 2: Weight problems are significantly influenced by

environmental factors. Society needs to implement changes.

3: Weight problems are highly influenced by environmental factors and will lead to catastrophic health problems. Society needs to implement sweeping changes.

Why we gain weightGenes/Biology vs Environment Overweight is a result of both Adoption studies (biology)

Adopted adults have BMI that are more similar to biological parents than to adoptive parents.

Animal studies (biology) genetically obese rats and mice

Genes/Biology vs Environment (cont.)

Migration studies (environment) Japanese Hawaiian Japanese Californian Japanese

Dietary Change Studies (biology and environment) SW Native Americans

Pima IndiansMexican Pima Indians

subsistence farming & ranching 20% fat diet, 40 hrs/wk physical work

Arizona Pima Indians mechanized agriculture, sedentary lifestyle 40% fat diet

Pima IndiansArizona Pima Indians are:

1 inch taller 57 pounds heavier 70% obese 50% with diabetes by age 35

Genes vs Environment: Conclusions

Genes for weight gain predisposes some individuals towards weight gain.

Environment determines which of those individuals actually gain weight.

The rapid change in obesity prevalence is likely to be more due to changes in the environment than changes in our genetic pool.

What is a “Healthy Weight”?

A broad range of weight which allows for minimal risks for chronic diseases.

Goes beyond using only body weight as a criteria for good health.

Determination of your "healthy weight". Step 1. Body Mass Index

BMI = BW(kg)/Ht2(m2) Dr. Phil

from Nutrition Action Health Letter, Jan. 2004 6‘4" = 78" x 0.0254(m/in)= 1.93m 240lbs / 2.2(lb/kg) = 109kg

BMI = 109/(1.932)=109/3.72 = 29.3

BMI Classifications

BMI = 19 - 25 => Desirable BMI = 25 - 30 => Overweight BMI = 30 - 35 => Obese, category 1 BMI = 35 - 40 => Obese, category 2 BMI > 40 => Severe obesity

BMI and Mortality Risk

Healthy Weight (cont.)

If your BMI > 25, then consider presence of other health risk factors.

Healthy Weight (cont.) Body Fat Distribution upper body fatness associated with

higher health risks Waist Circumference (1998 NIH)

> 35” for females, > 40” for males

Healthy Weight (cont.):Know your blood lipids! Hyperlipidemia/dyslipidemia

TC > 240 mg/dl LDL-C > 160 mg/dl HDL-C < 40 mg/dl TG > 200 mg/dl

Healthy Weight (cont.):Know your blood pressure! High Blood Pressure

Systolic BP > 140 mm Hg or Diastolic BP > 90 mm Hg or Borderline hypertensive

Pre-hypertensive>130/85

Healthy Weight (cont.):Know your blood sugar and history Hyperglycemia (Diabetes)

Fasting Blood Glucose > 126 mg/dl

Impaired Glucose TolerancePre-diabetic >110 mg/dl

Gestational Diabetes Family History of Diabetes

Healthy Weight Summary If your BMI is 19-25, you are at a Healthy

Weight. Health problems are not weight related

If your BMI is > 25 and you have no other risk factors, you are at a Healthy Weight.

If your BMI is > 25 and you have one or more risk factors, you are NOT at a Healthy Weight. Weight loss is likely to improve your health

Should everybody who is overweight try to lose weight?

Will weight loss improve your quality of life?A Prospective Study of Weight Change and Health-Related

Quality of Life in Women

JAMA Dec. 1999 Nurse’s Health Study

40,098 women, 4 yr longitudinal study Weight changes Quality of life questionnaire

Physical function Vitality Freedom from bodily pain Mental health

The effect of weight gain/loss on:Vitality Score Weight gain:

associated with declines in vitality scores in all BMI categories

Weight loss associated with

improved vitality scores only in women with BMI>25

The effect of weight gain/loss on:Mental Health Score Weight gain

associated with a decline in mental health scores in all weight categories

Weight loss associated with

improved mental health scores only in obese class I women and declined in normal weight women.

A Prospective Study of Weight Change and Health-Related Quality of Life in Women.

Conclusions: For women at all BMI categories:

Don’t gain weight Reduced quality of life

For overweight and obese women: Weight loss is generally associated with improved

quality of life For normal weight women

Weight loss does not improve quality of life May actually reduce quality of life

Do media images affect your idea of

what you should look like?

2000 Grammy Awards

Do media images actually Contribute to weight problems?

Bottom Line on Weight Loss

Lose weight for the right reasons Improve health and your quality of life

Losing weight to attain the ‘perfect body’ May lead to frustration

And, ironically, weight gain May lead to eating disorders

Dietary Means to a Healthy Weight

Weight loss occurs when in negative energy balance

Weight loss is only half the battle Maintenance of weight loss is the critical

problem

Dietary Means to a Healthy WeightBalanced Reduced Calorie Diet

Characteristics Calories reduced by 500-1000 Cal/day CHO:PRO:FAT = 50-60%: 10-15%: 20-

30% Examples

Weight Watchers, Jenny Craig, Slim Fast What the research shows:

Short-term outcomes Modest weight loss, improved health

Long-term outcomes Success rate not great

Dietary Means to a Healthy WeightLow Carbohydrate Diets

Characteristics Very low in CHO Restricted intakes of fruit, cereals, pasta, bread, potatoes, rice Caloric intake not specified

Examples Atkins diet

What the research shows: Short-term outcomes

6 month studies, good weight loss, no substantial change in heart disease risk factor, drop-out rate significant

Long-term outcomes No long term studies, health risks?

Dietary Means to a Healthy WeightThe Carbohydrate ‘Restrained’ Diets

Characteristics Lower in CHO than Dietary Guidelines but

higher than Low Carb diets (~40% CHO, 30%FAT, 30%PRO)

Low glycemic index foods encouraged Monounsaturated fats encouraged

Examples Zone Diet, South Beach Diet

What the research shows: Little research available on these diets

Dietary Means to a Healthy WeightHealthy Diet/Non-Diet Approach

Characteristics Focus on quality of the diet, not quantity Attaining good health is primary goal, not weight loss

Examples DASH diet, Dietary Guidelines, Food Guide Pyramid

What the research shows: Short-term outcomes

Slow, limited weight loss, health benefits Long-term outcomes

U. Colorado’s Weight Loss Registry Diet most adopt in order to maintain weight loss

Summer 2005 – Final Exam Thursday, July 28, 12:50PM, 201 PE Gee

Lecture materials Chapter 11-Achieving and Maintaining a Healthful Body

Weight Chapter 9 – Nutrients Involved in Bone Health 20 MC/TF questions See www.cwu.edu/~geed tomorrow for study guide Take Home essay question (turn in with final)

What is the role of American Society in Addressing the US Obesity Crisis?

1 page, double space, 12 pt font, 1” margins 10 pts: grammatically perfect, well thought out, clearly states and

defends position.

Bergman & Bennett Study old exams and example question on their

web pages 40 MC/TF questions

Key Points: Diet and Weight Loss Prevention is far easier than the cure People lose weight using many types of

dietary programs Always energy balance

People are far more likely to maintain weight loss eating a balanced healthy diet

Exercise and Weight Loss U. Colorado’s Weight Loss Registry

Exercised used by nearly 100% Walking the most common form of exercise

Benefits of Exercise Rate of weight loss greater Caloric restriction not as great Quality of weight loss better Proactive choice vs dieting Health benefits independent of weight loss

Rates of physical inactivity in the US

Exercise and Weight LossStructured Exercise

Aerobic Exercise Burns more calories, more fat Stress duration initially

Strength Training Builds more lean tissue Increases basal metabolic rate

Exercise for Weight Loss:Walking vs Running

Going 4 miles

Walking @ 15min/mile

Jogging @ 8 min/mile

Calories burned 400 Cal 400 Cal

Fuels burned:CHO:FAT

50:50 75:25

Calories CHO 200 Cal 300 Cal

Calories FAT 200 Cal 100 Cal

Exercise for Weight Loss:Walking vs Running

Going 1 hour

Walking @ 15min/mile

Jogging @ 8 min/mile

Distance covered 4 miles 7.5 miles

Calories burned 400 Calories 750 Calories

Fuels burned:CHO:FAT

50:50 75:25

Calories CHO 200 Calories 560 Calories

Calories FAT 200 Calories 190 Calories

Exercise and Weight LossStructured Exercise

Successful Programs: Convenient Enjoyable Safe affordable Subject realizes net benefit over costs

Exercise and Weight LossLifestyle Activity

24 hr day Sleep/rest = 10 hrs Structured exercise = 1 hr What you do the remaining 13 hrs of the day?

Burn extra 25 Cal/hr = 325 Cal/day = 33 pounds of fat loss per year

Develop a new attitude about being active Pedometers and 10,000 step programs Health benefits significant

Weight Loss/Weight MaintenanceBehavior/Attitude Changes

Pay attention to what you eat Success of weight loss programs

Examine: Triggers for eating

Emotional eating It’s not just what your eating, it’s what’s eating you!

Risky situations Behavior Modification Programs

Track/record eating behaviors Identifies problems Sets goals and establishes rewards Continual reassessment/problem solving

For more severe weight loss: Prescription Drugs

For those with BMI > 30 or For those with BMI >27 and risk factors

Meridia (Sibutramine, Abbott Lab) Suppresses appetite

Xenical (Orlistat, Roche) Inhibits fat absorption

Long term success and risks

For those with Severe Obesity Surgical Methods

For those with BMI >40

For those with Severe Obesity

Gastroplasty Reduces size of stomach by

banding or stapling Gastric Bypass Surgery

Reduces size of stomach Bypasses much of the small

intestine Outcomes

Rapid and substantial weight loss

Side effects Dangers

Tips from the National Weight Control Registry (est. 1994) Focus on successful weight loss >3000 people kept >30 lbs off > 1year

Average: 60 lbs for 5 yrs 80% female

many had “bad” genes 2/3rds were overweight as children 46% w/one or both parents overweight 60% had family history of obesity

any age average age 45 yrs

Tips from the National Weight Control Registry Failed to lose weight in the past

Don’t view past failures as signs you can’t succeed

Found process difficult No pain, no loss

Made smaller lifestyle goals Planned indulgences

How they lost weight

10% lost weight with diet only 1% w/ exercise only 89% w/ diet + exercise used many types of diets to lose

weight 50% did it on their own

How they maintained their weight loss Low fat diets Watched calories Daily exercise

averaged + 2600 Cal/week, ~ 1 hr/day 70% walked or walked + other exercise 20% weight training 20% bicycling 18% aerobic dance avg 3 hrs/week of TV

Tips from the National Weight Control Registry

Do what you want, not what you should