Baseline

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					Baseline
       Caloric Balance
Caloric Intake + Expenditure =
+/- Caloric Balance
             Case 1
50 year old woman, in good health, no
history of cigarettes, in for check up. BMI
29.

Should you tell her she is overweight?

What further assessment and treatment
should you begin?
        An Office-Based Approach


 Make the diagnosis (and communicate it)
 Assess readiness for change
 Prescribe diet and exercise
 Consider medications and surgery
       HEALTH PROFESSIONAL ADVICE
            AND WEIGHT LOSS

  12,835 adults, BMI over 30 kg/m2, check-up in
  last year
  Random-digit, population-based sample, 50
  states

  42% told by health professional to lose weight

 Those told to lose weight more likely to report
  trying to lose weight: OR 2.79 (95% CI 2.53-
  3.08)
INTENTIONAL WEIGHT LOSS
       AND DEATH
 Prospective CDC cohort study, 6391 adults,
 followed for 9 years
 Those reporting intentional weight loss had 24%
 reduction in mortality
 Those reporting unintentional weight loss had
 31% higher mortality
 Those reporting attempted but unsuccessful
 weight loss also had 20% reduction in mortality


                             Gregg, Ann Int Med 2003
    GOALS OF MANAGEMENT

   Be as fit as possible at
    current weight
   Prevent further weight gain
   If successful at 1 and 2,
    begin weight loss
            Case 2
50 year old woman, in good health, in for
check up. BMI 32 with metabolic
syndrome.

    She says, “ I have to lose weight, and
I am planning on doing that. I am about
to try the South Beach diet.”
           VLCD’s vs LCD’s:
     Meta-analysis of 29 U.S. Studies

Weight loss studies with > two year f/u
13 VLCDs, 14 LCDs
Mostly observational studies (few RCT’s)

Weight loss (as % of initial weight):

              1y 2y 3y 4y 5y
   LCDs       7.2 4.2 3.5 2.8 2.0
   VLCDs      16.1 9.7 7.8 7.0 6.2
                           Anderson, Am J Clin Nutr, 2001
    COMPARISON OF ATKINS, ORNISH, WEIGHT
           WATCHERS, AND ZONE


160 patients, randomly assigned

                    Atkins   Ornish    WW           Zone
  Wt Loss (kg)        2.1     3.3       3.0         3.2
  Completers (%)      53      50        65          65

  Completers at 1 year
                    Atkins   Ornish    WW           Zone
  Wt Loss (kg)         3.9    6.6       4.6         4.9




                                      Dansinger, JAMA 2005
               FITNESS AND MORTALITY
            Aerobics Center Longitudinal Study

25,714 men, 44 years old, 14 year observational study
  CV death (RR)
                   normal      overweight              obese
  Fit                 1.0           1.5                1.6
  Not fit             3.1           4.5                5.0

  Total death (RR)
                 normal     overweight                 obese
  Fit                1.0            1.1                1.1
  Not fit            2.2            2.5                3.1




                                            Wei, JAMA 1999
 SUCCESSFUL WEIGHT LOSS MAINTENANCE

 3000 subjects in National Weight Control
  Registry: 30-lb weight loss for 1-year

 Average weight loss 30kg (10 BMI units less),
  average weight maintenance 5.5 years

 45 years old, 80% women, 97% Caucasian

 46% overweight as child, 46% one parent
  obese, 27% both parents


                            Wing and Hill, Ann Rev Nutr, 2001
   SUCCESSFUL WEIGHT LOSS
        MAINTENANCE
High levels of physical activity
 • Women 2545 kcal/week, men 3293 kcal/week
 • (1-hour moderate intensity per day
 • Only 9% report no physical activity
Diet low in fat, high in carbohydrate
 • 1381 kcal day, 24% fat, 19% protein, 56% CHO
 • 4.87 meals or snacks/day
 • Fast food 0.74/week
Regular self-monitoring of weight
 • 44% weigh once per day; 31% once per week


                          Wing and Hill, Ann Rev Nutr, 2001
             Issues
History: Modified PA Questionnaire &
Weight Gain Patient handout.
Baseline Data
Plan

				
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posted:8/9/2011
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