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					           OBESITY



AN EPIDEMIC ON THE RISE
 WHAT’S THE BIG DEAL?
Affecting many countries in the world

 Rise in numbers are a reflection of changes
in society

 Affect over half of the the adult population
in many countries
   Compared to smoking in regards to the
    amount of lives affected

   EXCESS WEIGHT GAIN AND
    PHYSICAL INACTIVITY ACCOUNT
    FOR MORE THAN 300,000 premature
    deaths each year in the United States
                 Definition
   Overweight is an increased bodyweight in
    relation to height

   Obesity is an excessively high amount of
    body fat in relation to lean body mass
          Body Mass Index
   Most common weight standard

   Bodyweight(kg)/Height(m)2
           BMI Standards
 Overweight: 25-29.9
 Obese      : 30 and above
 Grade I    : 30-34.9
 Grade II   : 35-39.9
 Grade III   : 40 and above
           Body Mass Index
   All adults with a BMI of 25 or more are
    considered at risk for premature death and
    disability as a consequence of overweight
    and obesity
       Waist Circumference
 Used to measure abdominal fat content
 An independent predictor of risk factors
  associated with obesity
 AT Risk: Men:       above 40 inches
            Women: above 35
        WAIST-TO-HIP Ratio
   Ratio of a person’s waist circumference to
    hip circumference

   Above 1.0 is considered at risk for men and
    0.9 is considerate at risk for women

   Men with high hip to waist ratios have a
    three-fold risk of coronary events
 BMI used in children
 Dependent on age and sex
 Underweight: BMI falling in less than the
  5th percentile
 Overweight: equal or greater than 85th
  percentile
 Obese: equal or greater than 95th percentile
            Obesity Trends* Among U.S. Adults
                       BRFSS, 1991, 1995 and 2000
                   (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
                1991                                                    1995




                                         2000




        No Data         <10%         10%-14%           15-19%
        20%
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
            Obesity Trends* Among U.S. Adults
                       BRFSS, 1985
                     (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)




         No Data           <10%          10%-14%            15-19%
         20%
Source: Mokdad AH.
            Obesity Trends* Among U.S. Adults
                       BRFSS, 1986
                     (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)




        No Data            <10%          10%-14%            15-19%
        20%
Source: Mokdad AH.
            Obesity Trends* Among U.S. Adults
                       BRFSS, 1987
                     (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)




        No Data            <10%          10%-14%            15-19%
        20%
Source: Mokdad AH.
            Obesity Trends* Among U.S. Adults
                       BRFSS, 1988
                     (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)




        No Data            <10%          10%-14%            15-19%
        20%
Source: Mokdad AH.
            Obesity Trends* Among U.S. Adults
                       BRFSS, 1989
                     (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)




        No Data            <10%          10%-14%            15-19%
        20%
Source: Mokdad AH.
            Obesity Trends* Among U.S. Adults
                       BRFSS, 1990
                     (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)




        No Data            <10%          10%-14%            15-19%
        20%
Source: Mokdad AH.
Obesity Trends* Among U.S. Adults
           BRFSS, 1991
    (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. Adults
           BRFSS, 1992
    (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. Adults
           BRFSS, 1993
    (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. Adults
           BRFSS, 1994
    (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. Adults
           BRFSS, 1995
    (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. Adults
           BRFSS, 1996
    (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. Adults
           BRFSS, 1997
    (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. Adults
           BRFSS, 1998
    (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
             Obesity Trends* Among U.S. Adults
                        BRFSS, 1999
                     (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)




         No Data             <10%          10%-14%          15-19%
         20%
Source: Mokdad A H, et al. J Am Med Assoc 2000;284:13
              Obesity Trends* Among U.S. Adults
                         BRFSS, 2000
                      (*BMI  30, or ~ 30 lbs overweight for 5’4” woman)




          No Data             <10%          10%-14%          15-19%
          20%
Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10
                Prevalence
   61% of U.S. adults obese (1999)

   Obesity has nearly doubled from 15 to 27%
    in 1999

   In 2000 38.8 million Americans were obese
    (19.6 men and 19.2 women)
                 Prevalence
   In Europe prevalence of obesity is 10-25%
    in most countries

   Britain is one of the fastest growing obesity
    populations (17% men and 20% women)

   Also on rise in countries such as China,
    Singapore and Thailand
           Childhood Obesity
   Three times as many American children are
    obese than 20 years ago

   Childhood obesity on rise globally
    – 1991-1997 China (6.4-7.7%)
    – 1975-1999 Brazil (4%-144%)
    – Russia demonstrated a 50% decrease
      Childhood Obesity Risk
             Factors
 Weight Gain occurs if the amount of calories
  consumed is more than those expended.
 Genetics
 Family history of obesity
 Psychological factors
 Social and cultural factors
 Medical Illnesses
 Medications
 Alcohol consumption
 Smoking Cessation
                    Race
   Several studies have found that Black
    women have a lower resting metabolic rate
    when compared to white women
             New Research
   Low grade inflammation theory

   Measured by levels of C-Reactive protein in
    the blood

   Produced in response to inflammation
              Obesity Virus

   Researchers at the University of Wisconsin
    have been able to bring on obesity in
    animals by inoculation with adenovirus
           Population at Risk
   1) Racial-ethnic Minorities

   Mexican American and Black adults more
    overweight than whites

   American Indians (80% for men and 67% in
    Arizona)
           Population at Risk
   2) Women

   For all racial and ethnic groups combined
    women of lower socio-economic status are
    50% more likely to be obese
          Population at Risk
   Black women   64.5%

   Hispanic women 56.8%

   White women   43%
           Population at Risk
   4) Children & Adolescents

   In 1999 13% of children aged 6-11 years
    and 14% aged 19-199 were overweight
           Population at Risk
   5) Elderly

   Obesity among the elderly (those over 50)
    has nearly doubled from 1982-1999 (14.4-
    26.7%)
        Importance Of Culture
   Many obesity related diseases are found in
    higher rates in minorities

   Diabetes, hypertension, cancer
        Importance Of Culture
   Studies have demonstrated that minorities
    are less preoccupied with their body image

   Larger bodies are more socially accepted in
    this community

   This can have a negative consequence:
    Weight gain leading to obesity
             Other Concerns
   Low Self-Esteem & Discrimination

   Low self-esteem most evidenced in children
    and adolescents

   Study done in the 1960’s to assess
    children’s perception of obesity
            Other Concerns
   Discrimination of obese persons is common

   Especially common in the workplace
           Other Concerns
 Obese persons had lower wages
 Were considered lazy and possessing
  negative personality traits
 Discrimination also found in the health care
  arena
 Overweight patients were less likely to
  receive important preventative health care
  services
             Economic Costs
   Total costs due to obesity:

   $99 Billion in 1995

   $117 billion in 2000
               Solutions
   HEALTHY PEOPLE GOALS 2010

 Reduce the proportion of children and
  adolescents who are overweight or obese
 From 11% to 5% in children 6-11 years
 From 11% to 5% in adolescents 12-19
                  Solutions
   Increase the proportion of adults who are at
    a healthy weight from 42% to 60%

   Reduce the proportion of adults who engage
    in no leisure-time physical activities from
    40% to 20%
                  Solutions
   Increase the proportion of adults who
    engage regularly in moderate physical
    activity for at least 30 minutes per day from
    30 % to 15%
          Obesity: Risk Factors
 Genetics
 Family history of obesity
 Psychological factors
 Social and cultural factors
 Medical Illnesses
 Medications
 Alcohol consumption
 Smoking Cessation
     Obesity: Causes

Causes
 Biology
 Lack of Physical Activity
 Eating Patterns
          Obesity: Consequences
   Diabetes             Peripheral Vascular
                          Disease (PVD)
   Hypertension
                         Hyperlipidemia
   Myocardial
                         Degenerative Joint
    infarction
                          disease
   Cerebrovascular      Gallbladder Disease
    attack (CVA)
        Obesity: Consequences
 Obese persons had lower wages
 Were considered lazy and possessing
  negative personality traits
 Discrimination also found in the health care
  arena
 Overweight patients were less likely to
  receive important preventative health care
  services
  Weight Issues vs. Health
 White Americans believe thinness to
 be a desirable health goal, whereas
 other groups such as Haitians, consider
 thin people to be in poor health.
  – Hispanic older women believe weight
   gain is inevitable, only young people
   should be concerned about their weight.
 Why Most Commercial
Weight Loss Programs Do
        Not Work
   Negative Impact
   Temporary
   Perfect- Orientation
   Project Mentality
   Do not Address Cause
   Types of Weight Loss
          Diets
Low Carbohydrate aka High Protein

Low Fat aka High Carbohydrate

Very Low Calorie aka Modified Fast

Novelty Diets

Weight Loss Programs
   Consequences of Dieting
Decrease in rate of weight loss
Loss of lean tissue with fat loss
Decrease in metabolism, 10-40%
Decrease in Protein turnover
Preoccupation with food
Increase in irritability, moodiness
Tires easier, less physical activity
Apathy, depression
     Re-feeding after Weight
                    Loss intake
Increase in pre-dieting food
Preference for high fat foods
Regain in weight, but greater increase in % BF
Metabolism slow to return to normal
Regain Weight quicker with each diet
Increase in abdominal fat deposits
Less likely to return to pre-diet physical activity
Decrease in self-efficacy/esteem
  Recognizing an Unsound
    Weight Control Diet
Promotes Quick Weight Loss
Limits Food Selection
Testimonials or Famous People/Places
Expensive Supplements or Products
No Attempt to Permanently change eating or
   physical activity
Critical of Scientific Community‘
They know more, or something new
       Characteristics of a
      Sound Weight Control
              Diet
Nutritionally adequate yet low in calories
Fit into current lifestyle
Foods that are liked
Slow rate of weight loss
Followed for life
           Healthy Eating
         Recommendations
       for Weight Management
   PLAN meals through the day
   Eat a VARIETY of foods (at each meal)
   Center meals around CARBOHYDRATE foods
    (real foods with no mother)
   Watch the FAT (always) and
    Sugar (at any one time)
   Don’t worry about the PROTEIN
CARBOHYDRATE (CHO)
 Percentage   of calories can vary
 Individualize   based on:
  – Individual eating habits

  – Blood glucose and lipid goals
   Glucose in the Body
Blood sugar of 80-100mg/dl
            = 5 grams = 20 Calories

Liver glycogen (20% of reserve)
            = 75 gm = 300 Calories

Muscle glycogen (80% of reserve)
            = 300 gm = 1200 Calories
                  FAT
 < 10% of kcal/day from saturated fat
 Percentage of calories from total fat can
  vary
 Dietary cholesterol < 300 mg/day
 Research: amount of MUFA/PUFA
  versus amount of CHO (?)
                   SODIUM
   Persons with hypertension < 2,400 mg/day

   To choose low sodium in food:
    – Single serving of food: sodium < 400 mg
    – Entrees or convenience meals: sodium < 800 mg


   Buy fresh or low sodium foods and salt at the table
              Solutions
 Solutions will be found in prevention
  policies aimed at
 promoting healthy lifestyles
 Increased physical activity
 Behavior changes which emphasize long
  term weight management rather than short
  term weight reduction

				
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posted:8/5/2012
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