Obesity Diet and Physical Activity

1
Obesity Diet and Physical Activity

• Pennington Biomedical Research Center
• Division of Education

2
Obesity in the United States

• Approximately 66 (or two thirds) of U.S. adults
  are overweight or obese.
• Healthy People 2010 reduce the prevalence of
  obesity among adults to less than 15.
• The obesity rate increased from the late 1970s
  to 2003 from 15 to nearly 33 percent.

CDC
3
Obesity in the U.S.

• Body mass index (BMI) weight (kg)/ height squared
  (m2).
• BMI is significantly correlated with total body
  fat content.

With a BMI of You are considered
Below 18.5 Underweight
18.5 - 24.9 Healthy Weight
25.0 - 29.9 Overweight
30 or higher Obese
BMI tables
http//www.nhlbisupport.com/bmi
NIDDK
4
Obesity in the U.S.

• Obesity is further divided
  into three separate classes,
  with Class III obesity being
  the most extreme of the three.

Obesity class BMI (kg/m2)
Class I 30.0- 34.9
Class II 35.0-39.9
Class III (Extreme Obesity) 40.0
With a BMI of You are considered
Below 18.5 Underweight
18.5 - 24.9 Healthy Weight
25.0 - 29.9 Overweight
30 or higher Obese
CDC, NHLBI
5
Obesity in the United States

• In the United States, some minority groups are
  more affected than others. Income and education
  are also related to obesity prevalence.
• Some states have significantly higher rates
  of obesity than others.

Percent of Obese (BMI gt 30) in U.S. Adults
                                                                                                                                                                                                                                                                                                              
http//www.cdc.gov/nccdphp/dnpa/obesity/trend/maps
/
NIDDK, Womens Health
6
Obesity in the U.S.
Being overweight/obese substantially raises ones
risk of morbidity from

• Hypertension
• Dyslipidemia
• Type 2 Diabetes
• Coronary Heart Disease
• Stroke

• Gallbladder Disease
• Osteoarthritis
• Sleep apnea
• Certain cancers
  
  (endometrial, breast, prostate, colon)

Higher body weights are also associated
with increases
in all-cause mortality.
J La State Med Soc. 2005 156 S42-S49.
7
Obesity in the U.S.
Obesity is also associated with

• High blood cholesterol
• Complications of pregnancy
• Menstrual irregularities
• Hirsutism
  
  (presence of excess body
  and facial hair)

• Stress incontinence
  
  ( urine leakage caused by
  weak pelvic-floor muscles)
• Psychological disorders such as depression
• Increased surgical risk

NIDDK
8
What Causes Obesity?

• Energy imbalance over a long period of time.
• Energy in gt Energy out.
• Excess calories and lack of physical activity.

Energy balance is like a scale. When calories
consumed are greater than calories used, weight
gain is the result.
CDC
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Calories Used

• Eating, digestion, sleeping, breathing, and
  movement.
• Excess calories.
• Physical activity.

Energy Balance
Necessary physiological functions
Calories in
Calories used
(consumed)
(expended)
Physical activity
Food/beverages consumed
CDC
10
OverweightThe Right Approach

• If your BMI is between 25 and 30 and you are
  otherwise healthy
• Try to avoid gaining any additional weight
• Look into healthy ways of losing weight and
  increasing physical activity

NIDDK
11
OverweightThe Right Approach
Talk to your doctor about losing weight if you
fall into any one of the three scenarios

• BMI is 30 or above, or
• BMI is between 25 and 30 and
• You have other health conditions
• Waist measures gt 35 inches (women) or
• gt 40 inches
  (men)
• and
• You have other health conditions

NIDDK
12
Weight Loss MaintenanceStrategies to Consider

• Physical Activity
• Diet Therapy

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Why Treat Overweight and Obesity?
Because there is strong evidence that weight loss
reduces risk factors for diabetes and
cardiovascular disease, such as

• blood pressure
• serum triglycerides
• total serum cholesterol
• low-density lipoprotein cholesterol
• blood glucose levels

NHLBI
14
Weight Loss Programs
Any safe and effective weight-loss program should
include these components

• Healthy eating plans that reduces caloric intake
• Regular physical activity and/or exercise
  instruction
• Tips on healthy behavior
• Slow and steady weight loss of about ¾ to 2
  pounds a week
• Medical care if needed
• A plan to keep the weight off after you have lost
  it

NIDDK
15
Weight Loss

• The key to any successful weight loss is making
  changes in your eating and physical activity
  habits that you can keep for the rest of your
  life.

NIDDK
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Physical Activity
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Physical InactivityIn the U.S.

• Many studies show that Americans are too
  sedentary.
• Due to
• Increased use of technology.
• Increased use of automobiles.

According to the Behavioral Risk Factor
Surveillance System, in 2000 more than 26 percent
of adults reported no leisure time physical
activity.
CDC
18
Physical InactivityIn the U.S.

• Physical inactivity contributes to premature
  deaths.
• Rates differ by race and ethnicity.
• Hispanic women - most inactive
• Hon-Hispanic women second
• Asian and Pacific islander women third and,
  lastly,
• White non-Hispanic women - fourth.

Womens Health
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Physical Activity

• Contributes to weight loss.
• Helpful for the prevention of overweight and
  obesity.
• Helps maintain weight loss.

CDC
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Physical Activity

• Occupational work
• Carpentry, construction, waiting tables, farming
• Household chores
• Washing floors or windows, gardening, or yard
  work
• Leisure time activities
• Walking, skating, biking, swimming, playing
  Frisbee,
  dancing, softball, tennis, football,
  aerobics

CDC
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Physical Activity
Regular physical activity is good for overall
health.

• Physical activity decreases the risk for
• Colon cancer
• Diabetes
• High blood pressure
• Physical activity also helps to
• Control weight
• Contribute to healthy bones, muscles, and joints
• Reduce falls among the elderly
• Relieve the pain of arthritis.

CDC
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How Much Physical Activity a Day?

• The 2005 Dietary
  Guidelines for Americans recommend the following
  for adults

To reduce the risk of chronic diseases in
adulthood
Engage in at least 30 minutes of
moderate-intensity physical activity,
above usual activity, at work
or home on most days of the week. To help manage
weight and prevent gradual, unhealthy weight gain
in adulthood Engage in approximately 60 minutes
of moderate- to vigorous-intensity activity
on most days of the week while not
exceeding caloric intake requirements. To
sustain weight loss in adulthood Participate in
at least 60 to 90 minutes of daily moderate- to
vigorous-intensity physical activity
while not exceeding caloric intake requirements.
(Some may need to contact their
healthcare provider before participating in this
level of activity.)
Dietary Guidelines for Americans
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How Much Physical Activity a Day?

• Any activity helps.
• Moderate physical activity brings health
  benefits.
• Make it personal.
• Start slowly (10 minute walk/day).

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Increasing Physical Activity
You can increase your physical activity by taking
small steps to change what you do everyday.
If you normally Then try this instead!
Park as close as possible to the store Park farther away
Let the dog out back Take the dog for a walk
Take the elevator Take the stairs
Have lunch delivered Walk to pick up lunch
Relax while the kids play Get involved in their activity
Womens Health
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How Many Calorie Am I Burning?
Calories burned/hour of activity
Activity 100 lb 150 lb 200 lb
Bicycling, 6 mph 160 240 312
Bicycling, 12 mph 270 410 534
Jogging, 7 mph 610 920 1,230
Jumping rope 500 750 1,000
Running, 5.5 mph 440 660 962
Running, 10 mph 850 1,280 1,664
Swimming, 25 yds/min 185 275 358
Swimming, 50 yds/min 325 500 650
Tennis singles 265 400 535
Walking, 2 mph 160 240 312
Walking, 3 mph 210 320 416
Walking, 4.5 mph 295 440 572
American Heart Association
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How Many Calories Do I Need?

• To maintain - use your current weight.
• To lose - use the average healthy weight
  recommended for your height.

ACS
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Calculating Ideal Body Weight
A 59 mans ideal body weight would be
First 50 106 lb standard weight
for men Plus 9 additional inches?
9 (6 lbs) 54 lbs 106 54 160
pounds ( 10) 144 to 176
144 to 176 pounds is this mans idea weight A
54 womans ideal body weight would be
First 50 100 lb standard weight for
women Plus 4 additional inches ?
4(5 lbs) 20 100 20
120 pounds ( 10) 108 to 132
108 to 132 pounds is this womans ideal weight
For men Use 106 pounds of body weight
for the first 5 feet of their height. Add 6
pounds for each additional inch. For women
Use 100 pounds of body weight for the first 5
feet of their height. Add 5 pounds for each
additional inch.
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How Many Calories Do I Need?

• USDAs MyPyramid site http//www.mypyramid.gov/
• Determines calorie needs and calculates the
  servings needed from food groups.
• The American Cancer Society (ACS) site
  http//www.cancer.org/docroot/PED/content/PED_6_1x
  _Calorie_Calculator.asp
• The ACS site indicates the number of calories
  that are needed per day to maintain your current
  weight.

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On the Path to Increased Physical Activity
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Before Beginning an Exercise Program
You should check with your doctor before
beginning an exercise program if you

• Are a man older than age 40 or
  a woman older than age 50
• Have had a heart attack
• Have a family history of heart-related problems
  before age 55
• Have heart, lung, liver or kidney disease
• Feel pain in your chest, joints, or muscles
  during physical activity
• Have high blood pressure, high cholesterol,
  diabetes, arthritis, osteoporosis, or asthma

• Have had joint replacement surgery
• Smoke
• Are overweight or obese
• Tale medication to manage a chronic condition
• Have an untreated joint or muscle injury, or
  persistent symptoms after a joint or muscle
  injury
• Are pregnant
• Unsure of your health status.

Mayo Clinic
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Health Benefits of Physical Activity
Health benefits of physical activity. CMAJ. 2006
174(6) 801-809.
32
Physical ActivityPrimary Effects on Diabetes
Mellitus

• Aerobic and resistance types of exercise decrease
  the incidence of type 2 diabetes.
• A modest weight loss through diet and exercise
  reduces the incidence of diabetes.

CMAJ. 2006174(6) 801-809.
33
Physical ActivitySecondary Effects on Diabetes
Mellitus

• Exercise helps in the management of diabetes.
• Aerobic and resistance training help in the
  control of diabetes
  

CMAJ. 2006174(6) 801-809.
34
Physical ActivityPrimary Effects on Cancer

• Routine activity reduces the incidence cancers.
• Activity results in a 30-40 reduction in the
  relative risk of colon cancer and breast cancer.

Moderate physical activity is believed to exhibit
a greater protective effect than activities of
less intensity.
CMAJ. 2006174(6) 801-809.
35
Physical ActivitySecondary Effects on Cancer

• Regular physical activity - important.
• Increased self-reported physical activity
  decreased reoccurrence of cancer and a
  decreased risk of death from cancer.
• Reduced cancer-related death.

CMAJ. 2006174(6) 801-809.
36
Physical ActivityPrimary Effects on Osteoporosis

• Many studies have been conducted.
• According to findings, routine physical activity,
  especially weight-bearing and impact exercise,
  prevents bone loss associated with aging.

CMAJ. 2006174(6) 801-809.
37
Physical ActivitySecondary Effects on
Osteoporosis

• Regular physical activity can lead to stronger
  bones.
• Bone responds to physical stress at any age even
  in the elderly.

Osteoporosis
CMAJ. 2006174(6) 801-809.
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Eating for Weight Loss
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The Critical Role of Healthy Eating

• Good nutrition leads to a healthier life.
• Many do not eat based on MyPyramid
  recommendations.

CDC
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U.S. Eating Habits

• In 2000, the larger
• majority of U.S. adults
• reported that they
• did not consume 5 or more
• servings of fruits and
• vegetables/day.

81
77
73
CDC. Behavioral Risk Factor Surveillance System
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Dietary Guidelines for Americans, 2005Tips for
Healthy Eating
MyPyramid, which is the newest Food Guide
Pyramid, recommends the following for a healthy
lifestyle

1. Make half your grains whole
2. Vary your veggies
3. Focus on fruit
4. Get your calcium rich foods
5. Go lean with protein
6. Find your balance between food and physical
   activity

MyPyramid http//mypyramid.gov/
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A Healthy Diet
The 2005 Dietary Guidelines for Americans defines
a healthy diet as one that

• Emphasizes fruits, vegetables, whole grains,
  fat-free or low-fat milk, milk products
• Includes lean meats, poultry, fish, beans, eggs,
  and nuts
• Is low in saturated fats, trans fats,
  cholesterol, salt (sodium), and added sugars.

MyPyramid http//mypyramid.gov/
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Dietary Guidelines for Americans, 2005Key
Recommendations for the General Population

• 1. Adequate Nutrients Within Calorie Needs
• Consume a variety of nutrient-dense foods (whole
  grains, fruits and vegetables, lean meats,
  low-fat dairy) and beverages within and among the
  basic food groups while choosing foods that limit
  the intake of saturated fats and trans fats,
  cholesterol, added sugars, salt, and alcohol.
• Meet recommended intakes within energy needs by
  adopting a balanced eating pattern, such as the
  USDA Food Guide or the Dietary Approaches to Stop
  Hypertension (DASH) Eating Plan.

MyPyramid http//mypyramid.gov/
44
Dietary Guidelines for Americans, 2005Key
Recommendations for the General Population

• 2. Weight Management
• To maintain body weight in a healthy range,
  balance calories from foods and beverages with
  calories expended.
• To prevent gradual weight gain over time, make
  small decreases in food and beverage calories and
  increase physical activity.

MyPyramid http//mypyramid.gov/
45
Dietary Guidelines for Americans, 2005Key
Recommendations for the General Population

• 3. Physical activity
• Engage in regular physical activity and reduce
  sedentary activities to promote health,
  psychological well-being, and a healthy body
  weight.
• Achieve physical fitness by including
  cardiovascular conditioning, stretching exercises
  for flexibility, and resistance exercises for
  muscle strength and endurance.

MyPyramid http//mypyramid.gov/
46
Dietary Guidelines for Americans, 2005Key
Recommendations for the General Population

• 4. Food Groups to Encourage
• Consume a sufficient amount of fruits and
  vegetables while staying within energy needs.
• Choose a variety of fruits and vegetables each
  day. Select from all five vegetable subgroups
  (dark green, orange, legumes, starchy vegetables,
  and other vegetables) several times a week.
• Consume 3 or more ounce-equivalents of
  whole-grain products per day, with the rest of
  the recommended grains coming from enriched or
  whole-grain products. At least half the grains
  should come from whole grains.
• Consume 3 cups per day of fat-free or low-fat
  milk or equivalent milk products.

MyPyramid http//mypyramid.gov/
47
Dietary Guidelines for Americans, 2005Key
Recommendations for the General Population

• 5. Fats
• Keep total fat intake between 20 - 35 percent of
  calories (With
  most fats coming from sources of polyunsaturated
  and
  monounsaturated fatty acids, such as fish, nuts,
  and vegetable oils).
• Limit intake of fats and oils high in saturated
  and/or trans fatty acids,
  and choose products low in such fats and oils.
• Consume less than 10 percent of calories from
  saturated fatty acids
• Consume less than 300 mg/day of cholesterol
• Keep trans fatty acid consumption as low as
  possible
• When selecting and preparing meat, poultry, dry
  beans, and milk or milk products, make choices
  that are lean, low-fat, or fat-free.

MyPyramid http//mypyramid.gov/
48
Dietary Guidelines for Americans, 2005Key
Recommendations for the General Population

• 6. Carbohydrates
• Choose fiber-rich fruits, vegetables, and whole
  grains often.
• Choose and prepare foods and beverages with
  little added sugars or caloric sweeteners.
• Reduce the incidence of dental caries by
  practicing good oral hygiene and consuming sugar-
  and starch-containing foods and beverages less
  frequently.
• 7. Sodium and Potassium
• Consume less than 2,300 mg (approximately 1
  teaspoon of salt) of sodium per day.
• Choose and prepare foods with little salt. At the
  same time, consume potassium-rich foods, such as
  fruits and vegetables.

MyPyramid http//mypyramid.gov/
49
Dietary Guidelines for Americans, 2005Key
Recommendations for the General Population

• 8. Alcoholic Beverages
• Those who choose to drink alcoholic beverages
  should do so sensibly and in moderation ( 1
  drink for women/day and 2 drinks for men/day).
  
• Alcoholic beverages should be avoided by
  individuals engaging in activities that require
  attention, skill, or coordination, such as
  driving or operating machinery.
• Alcoholic beverages should not be consumed by
  some individuals, including those who cannot
  restrict their alcohol intake, women of
  childbearing age who may become pregnant,
  pregnant and lactating women, children and
  adolescents, individuals taking medications that
  can interact with alcohol, and those
  with specific medical conditions.

MyPyramid http//mypyramid.gov/
50
Dietary Guidelines for Americans, 2005Key
Recommendations for the General Population

• 9. Food Safety
• To avoid microbial food borne illness
• Clean hands, food contact surfaces, fruits, and
  vegetables.
  Meat and poultry should not be washed or rinsed.
• Separate raw, cooked, and ready-to-eat foods
  while shopping,
  preparing, or storing foods.
• Cook foods to a safe temperature to kill
  microorganisms.
• Chill (refrigerate) perishable food promptly and
  defrost foods properly.
• Avoid raw (unpasteurized) milk or any products
  made from unpasteurized milk, raw or partially
  cooked eggs or foods containing raw eggs, raw or
  undercooked meat and poultry, unpasteurized
  juices, and raw sprouts.

MyPyramid http//mypyramid.gov/
51
Weight loss

• Goals for Weight
• Management of Weight Lost

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Calorie DeficitNeeded For Weight Loss

• A calorie deficit of no more than 500 kcal/day.
• This can be achievable through the combination of
  diet exercise.
• An example of how to create a calorie deficit of
  500 kcal/day through diet exercise would be
  eating 250 kcal less per day, along with burning
  250 calories through exercise

ACS
53
Calorie DeficitNeeded For Weight Loss
A caloric deficit of 500 can be done by

• Eating 250 kcal less per day
• Leave out mayonnaise in a sandwich
• Leave out dessert
• Switch from soft drinks to water
• Reduce portion sizes

• burning 250 calories through exercise
• Walk for 30 minutes
• Swimming 25 yards
• Bicycling for 30 minutes

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Exercise DietingCalorie Deficit

• Initially physical activity, in combination with
  dieting, is an important component of weight
  loss.
• However, after around 6 months, physical activity
  will not lead to substantially greater weight
  losses when combined with dieting.
• The benefit of sustained physical activity
  thereafter is mainly through its role
  in the prevention of weight gain.
• In addition, it has a benefit in reducing
  cardiovascular and diabetes risks
  beyond that produced by weight gain alone.

NHLBI
55
Goals for Weight LossAnd Management

• The initial goal of weight loss therapy is to
  reduce body weight by approximately 10 percent
  from baseline. Once this goal is
  achieved, then further weight loss can be
  attempted, if necessary.
• A reasonable time line for a 10 percent reduction
  in body weight is 6 months.
• Experience reveals that lost weight is usually
  regained unless a weight maintenance program,
  consisting of diet therapy, physical activity and
  behavior therapy, is continued
  indefinitely.

NHLBI
56
Goals for Weight LossAnd Management

• For overweight individuals with BMIs in the
  typical range of 27 to 35 kg/m2, a decrease of
  300 to 500 kcal/day will result in weight losses
  of about ½ to 1 lb per week.
• A 10 percent weight loss could be achieved within
  6 months.
• For more severely obese individuals (BMI gt 35),
  deficits of up to 500 to 1,000 kcal/day will lead
  to weight losses of about 1 to 2 lb per week.
• A 10 percent weight loss could be achieved within
  6 months.

NHLBI
57
Goals for Weight LossAnd Management

• After 6 months of weight loss treatment, the
  individual should be assessed.
• If no further weight loss is needed, then the
  current weight should be maintained.
• Sustained physical activity is particularly
  important in the prevention of weight regain.
• If further weight loss is desired, another
  attempt at weight reduction can be made.

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Pennington Biomedical Research Center

• Division of EducationPhillip Brantley, PhD,
  DirectorPennington Biomedical Research
  CenterClaude Bouchard, PhD, Executive Director
• Heli J Roy, PhD, RD, Associate Professor
• Beth Kalicki
• Edited October 2009

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About Our Company

• The Pennington Biomedical Research Center is a
  world-renowned nutrition research center.
•  
• Mission
• To promote healthier lives through research and
  education in nutrition and preventive medicine.
•  
• The Pennington Center has several research areas,
  including
•  
• Clinical Obesity Research
• Experimental Obesity
• Functional Foods
• Health and Performance Enhancement
• Nutrition and Chronic Diseases
• Nutrition and the Brain
• Dementia, Alzheimers and healthy aging
• Diet, exercise, weight loss and weight loss
  maintenance
•  
• The research fostered in these areas can have a
  profound impact on healthy living and on the
  prevention of common chronic diseases, such as
  heart disease, cancer, diabetes, hypertension and
  osteoporosis.
•  
• The Division of Education provides education and
  information to the scientific community and the
  public about research findings, training programs
  and research areas, and coordinates educational
  events for the public on various health issues.

60
References

• Centers for Disease Control and Prevention (CDC)
  Prevalence
  of Overweight and Obesity Among Adults U.S.,
  2003-2004. Available at http//www.cdc.gov/nchs/p
  roducts/pubs/pubd/hestats/obese03_04/overwght_adul
  t_03.htm
• Womenshealth.gov. Physical Activity. Available
  at http//www.womenshealth.gov/pub/steps/Physical
  20Activity.htm
• National Institute of Diabetes and Digestive and
  Kidney Diseases (NIDDK). Do You
  Know the Health Risks of Being Overweight?
  Available at http//win.niddk.nih.gov/publication
  s/health_risks.htm
• National Institute of Diabetes and Digestive and
  Kidney Diseases (NIDDK).
  Statistics Related to Overweight and Obesity.
  Available at http//win.niddk.nih.gov/statistics/
  index.htm
• National Institute of Diabetes and Digestive and
  Kidney Diseases (NIDDK). Weight and
  Waist Measurement Tools for Adults. Available
  at http//win.niddk.nih.gov/publications/tools.ht
  m

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References

• Bellanger T, Bray G. Obesity related morbidity
  and mortality. J La State Med Soc. 2005 156
  S43-49.
• National Heart, Lung, and Blood Institute
  (NHLBI). Clinical Guidelines on the
  Identification, Evaluation, and Treatment of
  Overweight and Obesity in Adults. Available at
  http//www.nhlbi.nih.gov/guidelines/obesity/ob_exs
  um.pdf
• National Institute of Diabetes and Digestive and
  Kidney Diseases (NIDDK). Choosing a Safe and
  Successful Weight-loss Program. Available at
  http//win.niddk.nih.gov/publications/choosing.htm
  
• National Institute of Diabetes and Digestive and
  Kidney Diseases (NIDDK). Weight Loss for Life.
  Available at http//win.niddk.nih.gov/publication
  s/for_life.htm
• Warburton D, Nicol C, Bredin S. Health benefits
  of physical activity the evidence. 2006 CMAJ
  174(6) 801-809.

62
References

• Dietary Guidelines for Americans 2005. Available
  at http//www.health.gov/dietaryguidelines/dga20
  05/recommendations.htm
• American Heart Association (AHA). Physical
  Activity Calorie Use Chart. Available at
  http//www.americanheart.org/presenter.jhtml?ident
  ifier756
• American Cancer Society (ACS). Exercise Counts.
  How Many Calories Will Your Activity Burn?
  Available at http//www.cancer.org/docroot/PED/co
  ntent/PED_6_1x_Calorie_Calculator.asp
• Mayo Clinic. Exercise When To Check With Your
  Doctor First. Available at http//www.mayoclinic.
  com/health/exercise/SM00059