HAVING AN EFFECTIVE CONVERSATION WITH OVERWEIGHT AND OBESE ADULTS

ELIZABETH PATRICK, MD

Preventing and Managing Overweight and Obese

Adults:

I HAVE NO FINANCIAL RELATIONSHIPS WITH ANY COMMERCIAL INTERESTS RELATED TO THE

CONTENT OF THIS ACTIVITY TODAY.

DISCLOSURE

America is Becoming Obese

33% of American adults are obeseImpacts work, leisure, and life expectancyGenerating billions in health expendituresWho is obese?

-BMI > 25- BMI = (weight in pounds)/ (height in inches)2

2000

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 2000, 2010

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

2010

1990

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

Complications of obesity include:

Historical Issues

“Good” food used to be less expensive - i.e. wild game

“Bad” food used to be expensive-i.e. flour and sugar

Good vs. Bad Foods

Food is more processedHigh fructose corn syrupChange in clothing elastic in 1950sChange in work

-i.e. laundry/ farming

Good vs. Bad Foods

“Bad” food is 10 times cheaper*-2000 calories of junk food= $3.52/day

“Good” food is pricey*-2000 calories of good food= $36/day

“Good” food also has to be cookedEducational issues

-shopping and cooking

*University of Washington

Genetics

Extremes- Eskimo

-traditional diet vs. modern diet- Pima Indians

-traditional diet vs. modern dietMormon Genealogy

-Frank Moody, MD

Every $1 spent on food, only $0.19 is food; the rest of the money pays for marketing and packaging

Calorie counts: restaurants are inaccurate-269 food items- 20% has 100+ more calories than reported (Tufts University)- eat 100+ calories per meal, gain 30 pounds a year

Americans consume 500 more calories a day now than they did in 1970 according to the USDA

Genetics cont…

Decrease in Nutrients

6% less protein16% less calcium15% less iron38% less riboflavin20% less vitamin CChicken contains 266% more fat and 33%

less protein than it did 40 years agoMilk

Men’s Health 2011

Weight = Energy in – Energy outBasal Energy Expenditure (Harris Benedict

Equation)Men

BEE= 66.5 + (13.75* kg) + (5.003* cm) – (6.7705*age)Women

BEE= 655.1 + (9.563*kg) + (1.85*cm) + (4.676*age)Multiply by stress factor

Decrease in Nutrients cont…

Other Ways to Measure

Tantina-gyms/ weight loss centers

Biometrics -university/sports

Metabolic testing-Baptist

Other Ways to Consider

1 pound= 3500 calories…so under 2500 calories a day equals a 2 pound weight loss per month

Medications

For patients with BMI ≥ 30 (or 27 with a serious medical problem) facilitates 5-10% weight loss goal

-Sympathomimetic Drugs-Meridia-withdrawn US market

-Lipase Inhibitors-Alli-prevents action of lipases-possible liver injury

Short Term

Bontril (Phendimtreazine Tartarate)

Tenuate (Diethylproprion)

Didrex (Benzphetamine)

Fastin/ Adipex (Phenteramine)

These are all amphetamine derivatives

Contraindicated heart disease and thyroid disease

Drugs Withdrawn from Market

Redux/ Phen Phen- Pulmonary Hypertension

Rimonabant-Related THC-Suicide/ depression

Meridia - Cardiac Issue

Off Label

Welbutrin-weight loss for 1 year trial

Topamax-several 6-12 month trials-significant side effects

Zonisamide-4 month trial-significant weight loss

Byetta-diabetic trials

Victoza-diabetic trials

Phen-Prozac

FDA Black BoxRedux Study

-poor designLots of psychiatric patients on SSRIs and

amphetamines with no increased incidence of pulmonary hypertension

OTC

Recent FDA removal of ephedrine due to serious side-effects

Recommend consulting physician prior to and during use

HCG

Acai

Contains antioxidants No studies supporting weight lossAvoid with berry/pollen allergiesOprah Winfrey disassociated herself with

claimsHefty price85% berry is seedNo adverse effects

WebMD

Hoodai

Plant based Hoodiagordonii-succulent

Little science claims “tricks your brain into feeling full”

Study of 7 people-3.3% weight loss

Mayo Clinic feels no conclusive claimsNo data of adverse effects

Web MD

Sensia

Works with sense of smell to eat less

No stimulants

Feel full sooner

Contains Malodextrin (similar to MSG)

Takes 10-20 minutes to work

Metabolife

Ephedra removed

Licorice an issue

HTN

Bioslife 2

Fiber

Makes you feel full

Similar modern product-Purisalv

-chia seeds- expand-natural stimulant

http://www.weightloss-reportcard.info/

Source of Over-the-Counter Information

Diets

Low carb = low fat-at six months if compliant

Vegetarian diet-may be beneficial for post-menopausal women

Consider Personal Weight-loss Issues

Past diets

Personality

Budget

Special needs-other health conditions, i.e. diabetes-cultural/ethnic needs

Evaluate Diets

What does it consist of?

Who’s beyond diet?

What are risks?

What are results?

Low Carb

Atkins

Sugar busters

South Beach

Zone-limit carbs, sometimes high fat, sometimes

hard to maintain

Lifestyle change

Mayo Clinic Diet

Learn Diet Program (lifestyle, exercise, attitudes, relationships, and nutrition)

Change unhealthy habits and behaviors

Fad Diets

Cabbage Soup

Lemonade

Grapefruit diet-short term weight loss-nowhere to go next-weight usually regained

Low-Fat Diet

Reduces fat in diet to < 20%

Many low fat foods are high in sugar

Ex: Ornish Pritakken

Meal Providers and Replacement

Replace 1-2 meals per day with prepared products

Can be effective

Costly

Examples-Nutrisystem-Slimfast-Seattle Sutton

Very Low Calorie

Needs to be physician supervised

Difficult to transition back to real life

cost

Points of Safe/Effective Weight loss Programs

Flexible

Balanced nutrition

Enjoyment

Physical activity

Steady pace-1 to 2 pounds per week

Weight Loss Hypnosis

Only slight weight loss- around 6 pounds

Studies poor

Weight Loss Plateau

Decrease calories by 200

Increase exercise by 15 to 30 minutes

Increase daily activity

Reassess food diary

Stay above 1200 calories

Exercise

2 ½ hours/ week divided

2 episodes of strength training

Think outside the box-dance-Wii-chopping wood

Gain Control of Emotional Eating

Connection between mood, food, and weight lossAddress stressCheck hungerFood diarySupportFight boredomTake away temptationDon’t depriveSnack healthilyGet enough sleep

Seek Therapy

Overeaters Anonymous

Weigh Down

Counselor

Support Groups

Tops

Weigh Down

Overeaters Anonymous

Jenny Craig

Weight Watchers

Gastric Surgery

Lap Band

Roux-N-Y- A Type of Gastric Bypass

Newer

Qualifications-BMI ≥ 30 + co morbidities-BMI ≥ 35

Calorie Counting

Calorie King

My Fitness Pal

3500 calories = one pound of weight

Bottom Line

Lifestyle change

Exercise + Diet250 calories/day = 2-3 pounds/ month

Pitfalls

Multiple

Overeating-Tops-Overeaters Anonymous-Palmetto Behavioral

Resources Palmetto Behavioral Health

-overeating-depression

ObesityinAmerica.org-patient fact sheets

Myfitnesspal.com E-mealz.com

-portion control-$15/3 months-download menus, shopping list every Thursday

www.obestiy.org The Mayo Clinic Diet

-Mayo Clinic Healthy Weight Pyramid tool