Promoting Healthy Lifestyles to Our Patients, Our Families, and Ourselves by Practicing What We Teach
Jeffrey P. Levine, MD, MPH Associate Professor and Director of Women’s Health Programs Department of Family Medicine UMDNJ – Robert Wood Johnson Medical School, NJ and Participant on the NBC Reality TV Show “The Biggest Loser”
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NOT AN EXPERT OBESITY SURVIVOR
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Body Mass Index (kg/m2) Table
Weight (lbs)
120 130 140 150 160 170 180 190 200 210 220 230 240 250 260 270 280 290 300 5'0" 5'2" 5'4"
Obesity Trends* Among U.S. Adults BRFSS, 1991, 1996, 2003, 2005
1991 1996
Height
2003
2005
5'6" 5'8" 5'10" 6'0" 6'2" 6'4"
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Behavioral Risk Factor Surveillance System, MMWR Surveillance Summaries. CDC.
No Data
10%–14%
15%–19%
20%–24%
≥25%-29%
> 30%
* BMI ≥30, or about 30 lbs overweight for 5’4” person
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Today, about 16 percent of all children and teens in the United States are overweight.
http://medialit.med.sc.edu/food_ad_articles.htm
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Statistics from the Centers for Disease Control and Prevention (CDC) (CDC)
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Persistence of Overweight
• Risk of persistence of overweight is 50% or greater after child surpasses 6 years of age
(Whitaker et al. N Engl J Med 1997;337:869-873)
Obesity-associated annual hospital costs for Obesitychildren more than tripled between 1979 and 1999.
(Wang G, Dietz WH. Economic burden of obesity in youths aged 5 to 17 years: 1979-1999. Pediatrics 2002;109(5):E81-E86)
• >70% of overweight adolescents are expected to remain overweight into adulthood
(Guo et al. Am J Clin Nutr 1994:59:810-819)
• Risk of persistence increases with the degree of adiposity • Risk of persistence is greater if child has one or more obese parents (Borjeson, Acta Pediatr 1962;51:2-76)
From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org
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Medical Complications of Obesity
Pulmonary disease • Abnormal PFTs • Obstructive sleep apnea • Hypoventilation syndrome Liver disease • Steatosis • NASH • Cirrhosis Gynecologic abnormalities • Abnormal menses • Infertility Osteoarthritis • PCOS Stroke Cardiovascular disease • Diabetes • Dyslipidemia • Hypertension • Insulin resistance syndrome Gall bladder disease Cancer • Breast, uterus, cervix • Colon Phlebitis • Prostate Gout
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PCOS = polycystic ovarian syndrome NASH = nonalcoholic steatohepatitis NIH/NHLBI. September 1998; NIH publication no. 98-4083. 98-
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Relationship Between BMI and Mortality
Mortality Risk as BMI Increases
300 250 200 150 100 50 0 15 20 25 30 35 40 Low risk Moderate risk High risk
People who are obese or overweight also have a lower life expectancy:
Mortality ratio
A 40-year-old nonsmoking male who is overweight will lose 3.1 years of 40- yearlife expectancy; one who is obese will lose 5.8 years. A 40-year-old 40- yearoverweight nonsmoking female will lose 3.3 years of life expectancy; one expectancy; who is obese will lose 7.1 years.
(Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A, Bonneux L. Overweight and obesity by middle age are associated with a shortened lifespan. Ann Intern Med 2003; 138:24-32)
Body Mass Index (kg/m2)
Adapted from: Bray GA. Ann Intern Med. 1985;103:1052-1062. Med. 1985;103:1052From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org
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In 1980, about 50 percent of high school seniors reported eating green vegetables “nearly every day or more.” By 2003, that figure had dropped to more.” about 30 percent.
(YES Occasional Papers. Paper 3. Ann Arbor, Mich.: Institute for Social Research, May 2003)
From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org
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In 1977-78, children ages 6-11 drank about four 19776times as much milk as soda. In 2001-02, they 2001drank about the same amounts of milk and soda.
(Cleveland L. U.S. Department of Agriculture; National Food Consumption Survey, 1977-78; What We Eat in America, NHANES 2001-02)
From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org
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http://www.supersizedkids.com/images/home/splash.jpg
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Studies have shown that, between 1977 and 1996, portion sizes for key food groups grew markedly in the United States, not only at fast-food outlets but fastalso in homes and at conventional restaurants.
One study of portion sizes for typical items showed that: Salty snacks increased from 132 calories to 225 calories. Soft drinks increased from 144 calories to 193 calories. French fries increased from 188 calories to 256 calories. Hamburgers increased from 389 calories to 486 calories.
(Nielsen SJ, Popkin BM. Patterns and trends in food portion sizes, 1977-1998. JAMA 2003;289:450-3)
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From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org
In 1970, about 25 percent of total food spending occurred in restaurants. By 1995, 40 percent of food dollars were spent away from home.
(Paeratakul S, Ferdinand D, Champagne C, Ryan D, Bray G. Fast-food consumption among US adults and children. J Am Diet Assoc 2003:103:1332-8)
Children eat nearly twice as many calories (770) at restaurants as they do during a meal at home (420).
(Zoumas-Morse C, Rock CL, Sobo EJ, Neuhouser ML. Children’s patterns of macronutrient intake and associations with restaurant and home eating. J Am Diet Assoc 2001;101-923-5)
From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org
From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org
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At least 30 minutes of moderate physical activity on most days of the week is the recommended minimum. However, nearly 23 percent of children and nearly 40 percent of adults get no free-time freephysical activity at all.
(Physical activity levels among children aged 9-13 years – United States, 2002. MMWR 2003;52[33]:785-8) and (National Center for Health Statistics. National Health Interview Survey, 1999-2001)
Six out of 10 children ages 9-13 don’t participate in 9- don’ any kind of organized sports/physical activity program outside of school, and children whose parents have lower incomes and education levels are even less likely to participate. Nearly 23 percent don’t engage in any free-time physical don’ freeactivity.
(Physical activity levels among children aged 9-13 years – United States, 2002. MMWR 2003;52[33]:75-8)
From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org
From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org
Communities with higher percentages of African-American residents tend to have fewer Africanavailable parks and green spaces, places to play sports, and public pools and beaches.
(Powell LM, Slater S, Chaloupka FJ. The relationship between physical activity settings and race,
According to a national study, 92 percent of elementary schools do not provide daily physical education classes for all students throughout the entire school year.
(School Health Policies and Programs Study. Journal of School Health 2001;71[7])
ethnicity, and socioeconomic status. Evidence-Based Preventive Medicine 2004;1[2]:135-44)
From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org
From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org
Physical Activity and Inactivity
• Parental inactivity is a strong predictor of child inactivity, while parent physical activity is not a strong predictor of child physical activity
(Fogelholm et al, Int J Obesity 1999;23:1262-1268)
The typical American child spends about 44.5 hours per week using media outside of school.
(Generation M: Media in the Lives of 8-18 Year Olds. Menlo Park, Calif.: Kaiser Family Foundation, 2005)
• Activity decreases with age among youth, especially among females • Females show 50% reduction in physical activity between ages 6.5 and 9.5 years
(Goran et al. Pediatrics 1998;101:887-91)
• Environmental factors that affect physical activity patterns may be more important than genetic factors in the development of overweight and obesity in youth.
(Goran. Am J Clin Nutr 2001;73:158-171)
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From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org
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Olsen Twins Target "Anorexia" T-Shirt
http://www.thesmokinggun.com/archive/0922041_olsen_1.html
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http://www.hollywood.com/celebs/gallery/id/2400257
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http://www.kazabee.com/html/committed_to_kids.html
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Lessons Learned
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How Fit Am I? Am I Ready to Change? Set Realistic Goals / What Will Motivate & Sustain You? Calories In Vs Calories Out - BMI, BMR/AMR & THR Nutritional Knowledge is Power - Diary / Labels / Measures Don’t Deny, Starve, Punish Yourself - “All Foods Fit” Identify Food Triggers And Effective Strategies To Address Them Plan, Plan, Plan! - Shopping Lists / Menus / Eating Out Prepare Meals In Advance (When You Have The Time) Integrate Physical Activity Into Your Daily Activities Start Low / Go Slow Develop And Sustain Good Sleep Habits Make/Stick To Reasonable Regimens/Schedules Reduce Stress Through Relaxation & Exercise, Not Food Learn About / Use Local Health & Wellness Resources Make Fitness A Family Affair
~ Make Time For Yourself ~
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Promoting Healthy Lifestyles in Our Practices
• Waiting Room Posters, Handouts, Magazines, & Videos • Healthy Staff Lunches • BMI & Waist Circumference as Vital Signs • Cooking/Exercise Demonstrations • Group Visits • Facilitate Frequent Follow-up Visits • Interdisciplinary Team Approach • Community Partnering
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Americans In Motion
The New AIM to Change Toolkit
Americans In Motion
Physician primer Fitness posters BMI measuring tools Fitness prescription pad Patient fitness assessment Food & activity journal Health guides
Assessing Obesity: BMI
Now available through the AAFP Online Catalog (1-800-944-0000) and www.americansinmotion.org
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Assessment of Overweight and Obesity
• Body Mass Index (BMI) is the recommended weight-forheight assessment method for all children ≥ 2 years old and adults BMI = weight (kg) / height² (m²) • Age and gender-specific cut-off values must be used for individuals < 18 years of age • Biological development must be considered when assessing children and adolescents • At-risk for overweight: BMI > 85th but < 95th percentile for age and gender
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• Overweight youth should undergo body composition testing to confirm presence of excessive body fat
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Leading By Example As Parents
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Stop the “Do As I Say…Not As I Do” Hypocrisy If You Eat Healthy, Your Kids Will Follow Invest Time in Preparing Meals Involve Kids in Planning, Shopping, and Preparing Meals Invest in Sports and Physical Activities Plan/Schedule Active Family Activities Encourage Kids to Try New Foods/Activities Make Fresh Cold Water Easily Accessible
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DON’TS
Parents Should Choose What To Eat Children Should Choose To Eat or Not
• • • • • • • • Don’t Get “Emotional” Don’t Be a Short Order Cook Don’t Force Don’t Bribe / Reward Don’t Hide Foods Don’t Buy Impulsively Don’t Push The Juice Don’t Put TV’s in Kids Bedrooms Healthy Foods are Not Always More Expensive
A 2002 study of more than 200 neighborhoods found that there are three times as many supermarkets in wealthy neighborhoods as in poor neighborhoods, and four times as many supermarkets in predominantly white neighborhoods as in predominantly African-American ones. African(Morland K, Wing S, Diez Roux A, Poole C. Neighborhood characteristic associated with the location of food stores and food service places. Am J Prev Med 2002;22[1]:23-9)
From the statistical sourcebook “A Nation at Risk: Obesity in the United States.” To order, call 1-800-AHA-USA1 or email inquiries@heart.org
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Getting Involved in Our Communities
• Actively Seek Out Community Health Partners • Volunteer to speak to schools & community organizations • Support Physical Education in schools • Sponsor / Coach an Athletic Team • Advocate for more physical activity opportunities community • Organize activity leagues (e.g., softball, volleyball, bowling) • Plan field trips for hiking, biking, skiing, snowboarding, etc. • Set up community workshops on yoga, tai chi, self-defense, etc. • Organize and participate in walks for charity • Promote School-Based Healthy Lifestyle Programs • Support Healthier Food Options in Schools
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HELPFULL WEBSITES
Individuals • • • • • • • www.familydoctor.org www.obesityinamerica.org www.calorieking.com www.amihungry.com www.americaonthemove.org www.walk4life.com www.drjeff.tv Kids • www.mypyramid.gov www.kidnetics.com • www.kidshape.com • www.healthiergeneration.org
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Schools • www.kidnetics.com • www.actionforhealthykids.org • www.nutritionexplorations.org Communities • www.presidentschallenge.com
By Robert Frost
Two roads diverged in a yellow wood, And sorry I could not travel both And be one traveler, long I stood And looked down one as far as I could To where it bent in the undergrowth; Then took the other, as just as fair, And having perhaps the better claim, Because it was grassy and wanting wear; Though as for that the passing there Had worn them really about the same, And both that morning equally lay In leaves no step had trodden black. Oh, I kept the first for another day! Yet knowing how way leads on to way, I doubted I should ever come back. I shall be telling this with a sigh Somewhere ages and ages hence: Two roads diverged in a wood, and I took the one less traveled by, And that has made all the difference.
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