HEALTHY EATING

AndLIVING

Kenneth E. Nixon MD

Problem Overweight and Obesity

• 97 million adults are overweight or obese• Medical Problems Associated with O and O

– Hypertension, high cholesterol, heart disease– Stroke, Arthritis, Sleep Apnea, Cancers– Increase in all cause mortality

ANTHROPOMETRICS

• Height• Weight• BMI• Waist Circumference

Definitions

• Overweight – BMI of 25 to 29.9

• Obesity – BMI of > 30• 55% increase in last decade• Higher rates of O and O in

– Minority groups– Lower incomes– Less education

Before Exercising…Ask the Doctor

• Metabolic Syndrome– Hypertension– Diabetes– Obesity

• Polycystic Ovary Syndrome• Anemia• Joint Pain• Evidence of heart disease

Treatment of O and O

• Dietary treatment• Use of low-calorie diet and low fat diet• Altering physical activity• Behavior therapy techniques• Drugs• Surgery

Mental Toughness and Motivation

• Examine why you are losing weight• What is your motivation?• Look at previous attempts at weight loss• Seek family, friends, work-site support• Examine time, attitudes, and capacity to

increase physical activityDepression, Stress, Eating Disorders, Bulimia

OBESITY

• $70 BILLON IN CHRONIC DISEASE• EPIDEMIC IN WEIGHT GAIN IN USA

1998

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1998, 2007

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

2007

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsBRFSS, 1985

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1986

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1987

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1988

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1989

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1990

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1991

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1992

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1993

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1994

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1995

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1996

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1997

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. AdultsBRFSS, 1998

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. AdultsBRFSS, 1999

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. AdultsBRFSS, 2000

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. AdultsBRFSS, 2001

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

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

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 2002

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

Obesity Trends* Among U.S. AdultsBRFSS, 2003

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

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

Obesity Trends* Among U.S. AdultsBRFSS, 2004

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

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

Obesity Trends* Among U.S. AdultsBRFSS, 2005

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsBRFSS, 2006

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsBRFSS, 2007

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Goal of Weight Loss

• 10 percent of baseline body weight in 6 months

• BMI between 27 to 35, 300 to 500 kcal/day• This will result in .5 to 1 lb/wk and 10% loss in

6 months• BMI > 35 need a caloric deficit of 500 to 1000

kcal/day for 10% loss in 6 months

Weight Maintenance

• Need continued dietary discretion• Continued physical activity• Continued behavior modification and

motivation

Components of Daily Energy Expenditure

Segal KR et al. Am J Clin Nutr. 1984;40:995-1000.

Thermic effect of feeding

Energy expenditure of physical activity

Resting energy expenditure

Sedentary Person (1800 kcal/d)

Physically Active Person (2200 kcal/d)

8% 17%

75%

8%

60%

32%

Slide Source: www.obesityonline.org

Joint Association of Walking and Vigorous Exercise with the Age-Adjusted Relative Risk of Cardiovascular Disease

Manson, J. et al. N Engl J Med 2002;347:716-725

Multivariate Relative Risk of Cardiovascular Disease and Relative Risk Adjusted for Age and Walking Time, According to Walking Pace

Manson, J. et al. N Engl J Med 2002;347:716-725

Conclusions• These prospective data indicate that

both walking and vigorous exercise are associated with substantial reductions in the incidence of cardiovascular events among postmenopausal women, irrespective of race or ethnic group, age, and body-mass index

• Prolonged sitting predicts increased cardiovascular risk