weight as a measure of health vs. health at every size slides/sneb 201… · the south beach diet...

Weight as a Measure of Health vs.

Health at Every Size

Society for Nutrition Education and Behavior

49th Annual Conference – 2016

Glenn Gaesser, PhD Arizona State University

([email protected])

Non-weight-loss-centered approach to treating “obesity-related” health conditions

Two Billion Reasons for a New Perspective on Obesity

Prevention and Treatment

THE SCIENCE OF FAT After ‘The Biggest Loser,’ Their Bodies Fought to Regain Weight Contestants lost hundreds of pounds during Season 8, but gained them back. A study of their struggles helps explain why so many people fail to keep off the weight they lose. By GINA KOLATA MAY 2, 2016

Obesity, 2016

http://topics.nytimes.com/top/reference/timestopics/people/k/gina_kolata/index.html

Weight, fat-free mass, and fat mass changes after 30 weeks of Biggest Loser competition

and 6 years later

Changes in RMR and Metabolic Adaptation after 30 weeks of Biggest Loser competition

and 6 years later

American Journal of Public Health, July 16, 2015 (online)

• United Kingdom’s Clinical Practice Research Datalink from 2004 to 2014

• 76,704 obese men and 99,791 obese women

• 9 years of follow-up

Results • 1283 men and 2245 women attained normal

body weight • Annual probability of attaining normal weight:

• 1 in 210 for men; 1 in 124 for women, • 1 in 1290 for men and 1 in 677 for women with

BMI 40.0–44.9

• Annual probability of achieving a 5% weight reduction was 1 in 8 for men and 1 in 7 for women with BMI 40.0-44.9

Two Billion Reasons for a New Perspective on Obesity

Prevention and Treatment

Obesity Prevalence by State, 1985 - 2010

Prevalence of Weight Loss Attempts 1980’s – 2000’s

Yaesmiri et al, Int J Obes 2011; Bish et al, Obes Res 2005; Serdula et al, JAMA 1999; Serdula et al, Am J Publ Health 1994

Chart1

1980's1980's

1900's1900's

2000's2000's

Wt Loss Attempt

% of U.S. Adults

31

36

39.4

Sheet1

1980's1900's1990's2000's

Wt Loss Attempt31363639.4

Cumulative Weight-Loss Attempts by U.S. Adults, 1980 - present

• ~ 2 Billion weight-loss attempts • ~ 7 weight loss attempts for

every U.S. adult during the past thirty years

Dr. Phil’s Ultimate Weight Solution

The South Beach Diet

Dr. Atkin’s New Diet Revolution

Sugar Busters!

Enter the Zone

Protein Power

Pritikin

Ornish

Mediterranean Diet

Gluten-Free

Paleo

Prevalence of Desire to Weigh Less National Health and Nutrition Examination Surveys 2003-2008

Yaemsiri et al, Int J Obes 2011;35:1063-1070

Chart1

30

Women

Men

BMI

Percentage

48.2

11.6

84.4

60.3

95.9

89.8

Sheet1

WomenMen

3095.989.8

To resize chart data range, drag lower right corner of range.

Prevalence of Trying to Lose Weight Among BMI Categories BRFSS 2000

Bish et al. Obes Res 2005; 13:596-607

Chart1

30

Women

Men

BMI

Percentage

48.2

48.2

9.5

59.9

35.9

70

62.8

Sheet1

WomenMen

307062.8


Most obese persons will not stay in treatment for obesity.

Of those who stay in treatment,

most will not lose weight and of those who do lose weight,

most will regain it.

--Albert Stunkard, 1958

Nurses’ Health Study II: 1989 -1993 Binge Eating and Weight Control Practices by Weight Cycling Status

Field et al. Int J Obes 2004; 28: 1134-1142

Chart1

Weight StableWeight StableWeight StableWeight StableWeight StableWeight Stable

Noncyclers, Not Weight StableNoncyclers, Not Weight StableNoncyclers, Not Weight StableNoncyclers, Not Weight StableNoncyclers, Not Weight StableNoncyclers, Not Weight Stable

Mild CyclersMild CyclersMild CyclersMild CyclersMild CyclersMild Cyclers

Severe CyclersSevere CyclersSevere CyclersSevere CyclersSevere CyclersSevere Cyclers

Episodes of Overeating

Binge Eating

Prescription or OTC Diet Pills

Laxatives or Vomiting

OTC Diet Pills, Laxative, or Dieting

Exercises Frequently

Odds Ratio

0.7

0.8

0.7

0.7

0.3

1.1

1

1

1

1

1

1

1.6

1.8

2

3

1.8

1

2.2

2.5

3.1

6.8

3.8

0.8

Sheet1

Episodes of OvereatingBinge EatingPrescription or OTC Diet PillsLaxatives or VomitingOTC Diet Pills, Laxative, or DietingExercises Frequently

Weight Stable0.70.80.70.70.31.1

Noncyclers, Not Weight Stable111111

Mild Cyclers1.61.8231.81

Severe Cyclers2.22.53.16.83.80.8


Published Risks Associated With Weight Cycling:

• Higher mortality rates • Cardiovascular Disease • Metabolic Syndrome/Diabetes • Hypertension • Higher HbA1c • Hyperinsulinemia • Dyslipidemias; lower HDL • Decreased resting and endothelium-dependent

myocardial blood flow • Decreased adiponectin • Inflammation (elevation in CRP) • Gall bladder disease; cholecystectomy

Published Risks Associated With Weight Cycling: • Endometrial cancer • Renal Cancer • Colorectal cancer • Lymphohematopoietic cancers • Decreased Natural killer cell activity

(compromised immune function) • Poor physical function • Attenuated improvements in health markers

with weight loss • Android fat pattern • Decreased BMD • Forearm fractures • Hip fractures • Decreased telomere length • Loss of lean body mass

BMI and Mortality Typically a U- or J-Shaped Relationship

Rel

ativ

e R

isk

BMI 20 25 30 35

Weight cycling? Use of weight-loss medications? Low fitness?

Current Sports Medicine Reports, 2015

Association of BMI and all-cause mortality in U.S. adults [from Flegal et al, JAMA 2013]

Association of cardiorespiratory fitness, BMI, and all-cause mortality in U.S. adults

[from Barry et al, Prog Cardiovasc Dis, 2014]

Social & Personality Psychology Compass, 2013

Change in systolic and diastolic blood pressure by amount of weight loss maintained

Change in blood glucose by amount of weight loss maintained

Change in cholesterol and triglycerides by amount of weight loss maintained

Non-weight-loss-centered approach to treating “obesity-related” health conditions

BRFSS 2000 Prevalence of Dieting and Physical Activity Among

Those Trying to Lose Weight

Bish et al. Obes Res 2005; 13:596-607

Chart1

Cut CalsCut Cals

plus >150 min/wkplus >150 min/wk




Women

Men

Percentage

46.1

44.2

19.4

22

12.9

16.2

7.2

10.4

3.8

6.7

Sheet1

WomenMen

Cut Cals46.144.2

plus >150 min/wk19.422

plus >200 min/wk12.916.2

plus >300 min/wk7.210.4

plus >420 min/wk3.86.7


Weight as a Measure of Health�vs.�Health at Every Size�Slide Number 2Non-weight-loss-centered approach �to treating “obesity-related” health conditions Two Billion Reasons�for a New Perspective on Obesity Prevention and TreatmentSlide Number 5Weight, fat-free mass, and fat mass changes�after 30 weeks of Biggest Loser competition and 6 years laterSlide Number 7Slide Number 8ResultsTwo Billion Reasons�for a New Perspective on Obesity Prevention and TreatmentObesity Prevalence by State, �1985 - 2010Prevalence of Weight Loss Attempts�1980’s – 2000’sCumulative Weight-Loss Attempts by U.S. Adults, 1980 - presentSlide Number 14Slide Number 15Slide Number 16Prevalence of Desire to Weigh Less�National Health and Nutrition Examination Surveys 2003-2008Prevalence of Trying to Lose Weight Among BMI Categories �BRFSS 2000Most obese persons will not stay�in treatment for obesity.��Of those who stay in treatment,�most will not lose weight�and of those who do lose weight,�most will regain it.��--Albert Stunkard, 1958Nurses’ Health Study II: 1989 -1993�Binge Eating and Weight Control Practices by Weight Cycling Status Published Risks Associated With Weight Cycling:Published Risks Associated With Weight Cycling:Slide Number 23Slide Number 24Association of BMI and all-cause mortality in U.S. adults�[from Flegal et al, JAMA 2013]Association of cardiorespiratory fitness, BMI, and all-cause mortality in U.S. adults�[from Barry et al, Prog Cardiovasc Dis, 2014]Slide Number 27Change in systolic and diastolic blood pressure by amount of weight loss maintainedSlide Number 29Slide Number 30Non-weight-loss-centered approach �to treating “obesity-related” health conditions BRFSS 2000�Prevalence of Dieting and Physical Activity Among Those Trying to Lose Weight Slide Number 33

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