Obesity, Overweight and Weight Control

Healthy Weight Network

Prevalence of Overweight Among Children & Adolescents 6-19 Years

Age(Years)

1963-651966-70

1971-74

1976-80

1988-94

1999-2002

6-11 4% 4% 7% 11% 16%

12-19 5% 6% 5% 11% 16%

Source: National Center for Health Statistics

Overweight and Obesity Definitions

Height/Weight Tables Metropolitan Life Insurance, revised 1983 Based on weight-height mortality study Weights are ages 25 to 59 based on lowest

mortality

Height and Weight Chart - height weight chart, weight height chart

Overweight and Obesity Definitions

BMI = weight (kg) height squared (m²) Significantly correlated with total body

fat content

Obesity Class BMI kg/m2

Underweight <18.5

Normal 18.5–24.9

Overweight 25–29.9

Obesity I 30.0–34.9

II 35.0–39.9

Extreme Obesity III 40.0

Classification of Overweight and Obesity by BMI

Overweight and Obesity - Definitions

Waist Circumference Presence of excess fat in abdomen out of

proportion to total body fat is a independent predictor of risk and mortality.

Waist circumference is positively correlated with abdominal fat content. High Risk:

Men >102 cm (>40 in.); Women > 88 cm (>35 in.)

Waist-to-Hip Ratio

Waist-to-hip ration measures waist at its narrowest point and hip at widest point.

Women with 35” waist and 46”hip = 35/46 = 0.76 Risk:

Women with waist-to-hip ratio >0.8 Men with waist-to-hip ratio > 1.0

Assessment of Obesity

Anthropometrics Medical Psychological Nutritional

Weight Control

Advantages of Weight Loss: Blood Pressure Serum/Plasma Lipids

Reductions in serum triglycerides and increases in HDL

Reductions in total cholesterol and LDL Blood Glucose

NHANES III Age-Adjusted Prevalence of HypertensionHypertension* According to BMI

16.518.221.922.5 24.025.2

32.2

38.4

0

10

20

30

40

50

Men Women

BMI <25 BMI 25-26 BMI 27-29 BMI >30

*Defined as mean systolic blood pressure 140 mm Hg, as mean diastolic 90 mm Hg, or currently taking antihypertensive medication .

Brown C et al. Body Mass Index and the prevalence of Risk Factors for Cardiovascular Disease (in preparation).

Per

cen

t

NHANES III Age-Adjusted Prevalence of High Blood CholesterolHigh Blood Cholesterol* According to BMI

15.714.7

27.9

17.5

28.2

20.424.7

20.2

0

10

20

30

40

50

Men Women

BMI <25 BMI 25-26 BMI 27-29 BMI >30

*Defined as > 240 mg/dL.

Brown C et al. Body Mass Index and the Prevalence of Risk Factors for Cardiovascular Disease (in preparation).

Per

cen

t

NHANES III Age-Adjusted Prevalence of Low HDL-CholesterolLow HDL-Cholesterol* According to BMI

16.5

9.1

27.0

17.2

27.223.1

41.5

31.4

0

10

20

30

40

50

60

Men Women

BMI <25 BMI 25-26 BMI 27-29 BMI >30

*Defined as <35 mg/dL in men and <45 mg/dL in women.

Brown C et al. Body Mass Index and the Prevalence of Risk Factors for Cardiovascular Disease (in preparation).

Per

cen

t

Nutritional Assessment

Weight History Age of onset Highest/lowest adult weights Patterns of weight gain and loss Environmental triggers

Current eating patterns Nutritional Intake

Nutritional Assessment

Environmental Factors Exercise history Motivation and readiness to change

Treatment for Obesity

BMIBMI 25-26.925-26.9 27-29.927-29.9 30-34.930-34.9 35-35-39.39.99

>40>40

Diet, Physical Activity & Behavior Therapy

With co- morbidities

With co- morbidities

Pharmco-therapy

If not lost 1#/week after 6 mo.

Surgery With co- morbidities

Position of ADA

Successful weight management requires a livelong commitment to healthful lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activity

Position Paper

Goals for Weight Loss

Prevent weight gain or stop weight gain Improvement in physical and emotional

health Small maintainable weight losses or more

extensive weight loss through sensible eating and exercise patterns

Improvement in eating, exercise and other behaviors apart from any weight loss

Goals for Weight Loss

Initial goal to reduce body weight by approximately 10% from baseline.

1-2#/week for period of 6 months 1# body fat = 3500 calories 3500/7days = - 500 calories/day Need to assess individual’s motivation

and readiness to enter weight loss therapy.

How To Achieve Weight Loss

1,000 – 1,200 kcal/day for women and 1,200 – 1,600 kcal/day for men

Reducing dietary fat along with carbohydrates can facilitate calorie reduction.

Reducing dietary fat alone without reducing calories is not sufficient for weight loss.

How To Achieve Weight Loss

Physical activity is recommended as part of a comprehensive weight loss program because:contributes to weight lossmay decrease abdominal fatincrease cardio-respiratory fitnessmay help with maintenance of weight

loss

How To Achieve Weight Loss

Behavior Therapy Pharmacotherapy - weight loss drugs Weight loss drugs may be used in

combination with a comprehensive weight loss program, for patients with BMI>=30 with no risk factors & BMI >=27 with risk factors.

Weight loss drugs should never be used without concomitant lifestyle changes.

How To Achieve Weight Loss

Better weight loss results are achieved with diet therapy when the duration of the intervention is at least 6

months. Long term weight loss is enhanced by a

program of dietary therapy, physical therapy and behavioral therapy continued indefinitely.

“Habit is habit and not to be flung out of the window by any man, but coaxed downstairs a step at a time.”

–Mark Twain

How To Achieve Weight Loss

Outcome data on behavior therapy, Very Low Calorie Diets (VLCD) and Pharmacotherapy show weight regain in 3-5 years

Frequent contacts between professional counselors and patients promote weight loss and weight maintenance

Chicago Tribune | Biggest 'Lost' mystery: Why is Hurley still fat?

Tips for Weight Loss

Eat a variety of foods from the Food Guide Pyramid, including favorite foods

Increase intake of high-water/high-fiber foods Vegetables and fruits Whole grains and legumes Soups

Decrease consumption of energy dense foods High fat foods Foods with low moisture content

Mayo Clinic Food Guide

How to Calculate Energy Density

Energy Density = Calories/Grams E.G. 150 Calories/100 grams = 1.5 Kcal/g Energy density of 1 – Eat any quantity Limit foods with energy density >2

Tips for Weight Loss

Limit consumption of beverages containing alcohol and sugars

Control Portion Sizes Plan meals and snacks ahead Establish regular eating habits Shop on a full stomach

Shopping Tips

Use a shopping list Read labels

serving size and servings per container

Tips for Weight Loss

Eat from plates, not food packages Portion foods before bringing them to the

table Eat slowly Sit down to eat Stop eating when you leave the table Watch for food ‘triggers’

Tips for Weight Loss

Use of Meal Replacements?

Fad Diets

Americans spend >30 billion in the weight loss industry

Single food diets - grapefruit, rice etc. High-protein, high fat diets VLCD Fasting High fiber, low-calorie diets

Weight Loss Surgery