dieta e esercizio fisico nell’obesita’...dieta e esercizio fisico nell’obesita’ francesco...
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Dieta e esercizio fisiconell’obesita’
Francesco SOFISOD Agenzia Nutrizione, Universita’ degli Studi di Firenze,
Azienda Ospedaliero-Universitaria Careggi
Preventing Chronic Diseases – A vital investment. WHO global report 2006
Preventing Chronic Diseases – A vital investment. WHO global report 2006
Risk factors
Preventing Chronic Diseases – A vital investment. WHO global report 2006
Prevalence of overweight (BMI>25 kg/m2) (year: 2005)
Prevalence of overweight (BMI>25 kg/m2) (year: 2015)
Preventing Chronic Diseases – A vital investment. WHO global report 2006
Body Mass Index (kg/m2)
0 15 20 25 30 35 40
Year
lyde
aths
per 1
,000
per
sons
8
16
32
64
Whitlock et al., Lancet 2009
Men
Women
All-cause mortality versus BMI in 900,000 adults
Collaborative analysis of 57 prospective studies
Men Women
Mortality rates versus BMI in 900,000 adults
Body Mass Index (kg/m2)
15 20 25 30 35
Year
lyde
aths
per 1
,000
per
sons
0
6
8
2
4
10
12
14
16
Body Mass Index (kg/m2)
15 20 25 30 35
Year
lyde
aths
per 1
,000
per
sons
0
6
8
2
4
10
12
14
16
Vascular
Cancer
Vascular
Cancer
Whitlock et al., Lancet 2009
Men Women
Body Mass Index (kg/m2)
15 20 25 30 35
Body Mass Index (kg/m2)
15 20 25 30 35
% a
live
0
60
80
20
40
100
Life span versus BMI in 900,000 adults
% a
live
0
60
80
20
40
100BMI 22-25
BMI 25-30
BMI >30
BMI 22-25
BMI 25-30
BMI >30
Whitlock et al., Lancet 2009
Obesity
Three obese womens with aproximately the same BMI but with different distribution of
adipose tissue
BMILimitations of BMI
They both have a BMI of 31
Abdominal obesity
Dispendio energetico
Qual è il modello di alimentazione
ideale???
Diets•Shangri-La Diet
•Slim-Fast Plan
•Sonoma Diet
•South Beach Diet
•South Beach Diet Supercharged
•The Spectrum
•Step Diet
•Sugar Busters
•Thin for Life
•3 Day Diet
•3-Hour Diet
•UltraMetabolism Diet
•Volumetrics
•WebMD Weight Loss Clinic
•Weight Loss Cure
•Weight Watchers
•Dr. Andrew Weil
•You – On a Diet
•The Zone
•Atkins Diet
•Best Life Diet
•Biggest Loser Diet
•Body for Life
•Cabbage Soup Diet
•Cheater's Diet
•Cookie Diet
•Dr. Phil's Ultimate WeightSolution
•Eat Right for Your Type
•Eat This, Not That
•Fast Food Diet
•Fat Smash Diet
•Flat Belly Diet
•5 Factor Diet
•Flavor Point Diet
•French Women Don't Get Fat
•Glycemic Index Diet
•Grapefruit Diet
•Hallelujah Diet
•Jenny Craig
•LA Weight Loss
•Living Low-Carb
•Macrobiotic Diet
•Martha's Vineyard Diet Detox
•Medifast Diet Plan
•Morning Banana Diet
•New Beverly Hills Diet
•NutriSystem Diet
•Ornish Diet
•Perricone Diet
•Personality Type Diet
•Pritikin Principle
•Protein Power
•Raw Foods Diet
•Rice Diet Solution
811 overweight adults
Four diets with different percentages of energy derivedfrom fat, protein and carbohydrates
Follow-up: 2 years
Comparison of weight-loss diets
Sacks et al., NEJM 2009
Sacks et al., NEJM 2009
Comparison of weight-loss diets
2-years trial: 233 moderately obese subject
Three diets: low-carb, low-fat, Mediterranean
Weight changes during 2 years according to diet
Weight loss with different diets
Shai et al., NEJM 2008
Shai et al., NEJM 2008
Weight loss with different diets
Mediterranean diet and BMI
Panagiotakos et al., Nutrition 2006
1514 men and 1528 women, 18-89 years old
Dansinger et al., Ann Intern Med 2007
Meta-analysis of 46 trials of dietary counseling
The effect of dietary counseling for weight loss: a meta-analysis
WHO, Global strategy on diet, physical activity and health 2007
Physical activity and health
Effect size estimates of lifestyle and dietary changes on all-cause mortality
A systematic review of all the intervention studies
0
13
25
38
50
Physical activity Physical activity plusdietary modifications
CAD patients General population
25%20%
45%
35%
Perc
enta
ge c
hang
es o
f all-
caus
e m
orta
lity
Iestra et al., Circulation 2005
Available data and guidelines forprimary prevention suggest that a volume of moderate-intensityaerobic physical activity of about1,000 kcal/week
An energy expenditure of 1000 kcal/week is achievable byparticipating in 30 minutes or more of moderate-intensityaerobic physical activity on most, or preferably all, days of the week
Examples of aerobic physical activity:
• running or jogging
• skating
• bycicling
• swimming, but also lifestyle common activities such as walking briskly, climbing stairs, doing more hours of hard work, and engaging in activerecreational pursuits
AHA Statement for Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease. Circulation 2003
Physical activity
Managing total CVD risk
Stress that the positive health benefits occur with almost any increase in activity; small amounts of exercise have an additive effect; exercise opportunities exist also in the workplace (e.g. stairs instead of lift)
Try to find leisure activities that are positively enjoyable30 minutes of moderately vigorous exercise on most days of the week will reduce risk and increase fitness
Exercising with family or friends tends to improve motivationAdded benefits include a sense of well-being, weight reduction and better self-esteem
Fourth Joint Task Force Guidelines on cardiovascular diseaseprevention in clinical practice
Jakicic et al., JAMA 2003
Exercise and weight loss: an intervention study
Risk parameter N° studies(subjects)
Mean change(95% CI)
p value
BMI 18 (562) - 0.38 (- 0.05; -0.72) 0.03
Systolic bloodpressure
12 (468) -3.8 (-1.7; -5.9) < 0.001
Diastolic bloodpressure
12 (468) -0.3 (-0.02; -0.46) 0.01
Triglycerides 7 (192) -0.26 (-0.11; 0.11) 0.009
A systematic review with meta-analysis26 studies including 2,767 subjects
Using pedometers to increase physical activity and improve health
Bravata et al, JAMA 2007
Physical activity and health
Physical activity and weight loss
106 overweight and obese patients that underwent a weight-loss program with a physical activity
program
Physical activity and weight loss
96.8
90.7
95.4
98.4
86
88
90
92
94
96
98
100
Physical activity No Physical Acitvity
Baseline3 months
P<0.005 P<0.005
Tota
l bod
y w
eigh
t, K
g
94.2
90.1
95.1 95.8
84
86
88
90
92
94
96
98
100
Personalizedrecommendations
Generalrecommendations
Baseline3 months
P<0.005
Tota
l bod
y w
eigh
t, K
g
Physical activity and weight loss
34.8
30.532.5
31.5
0
5
10
15
20
25
30
35
40
45
50
Personalizedrecommendations
Generalrecommendations
Baseline3 monhs
P<0.005
Fatm
ass,
Kg
Physical activity and weight loss
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Survey 1 31,4% 29,6% 33,4% 23,0% 23,3% 22,4% 18,9% 19,2% 25,0%Survey 2 40,1% 33,6% 37,5% 30,6% 36,8% 23,6% 28,2% 28,0% 32,6%Survey 3 37,9% 26,4% 36,8% 43,1% 49,3% 29,4% 26,5% 39,1% 38,0%
Czech Rep. Finland France Germany Hungary Italy Nether-
lands Slovenia ALL
Euroaspire III
P=0.0003
199520002006
Prevalence of obesity
Take-home messagesDon’t trust in anyone…!
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