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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
