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Healthy Weight Management

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Zone Diet. Eat Right for Your Blood Type. South Beach Diet. Results of recent studies. NEJM, 2003. Samah et al, 348:21, 2074-81 (6 month) ... – PowerPoint PPT presentation

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Title: Healthy Weight Management


1
Healthy Weight Management
  • Judy Simon MS, RD,CD
  • University of Washington
  • Medical Center/Roosevelt Clinic

2
Outline
  • Obesity definition
  • Prevalence
  • Energy Homeostasis
  • Fad Diets
  • Lifelong Healthy Weight

3
Obesity
  • Over 50 of Americans are overweight
  • One in three adults is obese. Why?
  • Sedentary lifestyle
  • Dietary choices
  • Obsession with dieting
  • Lack of time
  • Stress

4
Increases in Obesity Among Adults, WA and US,
1990-2000
5
Body Mass Index
  • Your weight in kilograms divided by the square of
    your height in meters
  • Kg/ m2
  • BMI Categories
  • Overweight 25-30
  • Obese I 30-35
  • Obese II 35-40
  • Obese III 40

6
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7
Epidemiology of Obesity
Flegal KM. JAMA 2002 2881723-27
8
PREVALENCE OF OVERWEIGHT IN U.S.
9
PREVALENCE OF OBESITY IN U.S.
10
PREVALENCE OF OVERWEIGHT AND OBESITY IN U.S. BY
RACE
11
PREVALENCE OF OVERWEIGHT IN CHILDREN
12
Pediatric Obesity
Ogden CL. JAMA 2002 2881728-32
13
Pediatric Obesity
Strauss RS, JAMA 2001 2862845-48
14
WHR trumps BMI for Risk
15
Obesity may cause disease directly or indirectly
Risk Factor (high blood pressure, cholesterol,
glucose)
Obesity
Disease (osteoarthritis)
Disease (heart failure, sudden death)
16
Genes Causing Disease May Also Cause Obesity
Genetic Defect (lipid metabolism, glucose uptake,
insulin responses)
Obesity
Disease (hyperlipidemia, diabetes)
17
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18
Socioeconomic Contribution to Obesity-related
Illness
19
Which Path for the Obese?
Healthy Weight Journal 1998
  • Temporary wt. loss
  • Improved health
  • Euphoric attitude

Temporary wt. loss Euphoric attitude
Caloric restriction Healthier lifestyle
Weight Goal
Caloric restriction Healthier lifestyle
Weight Goal
Recidivism Weight cycling Fatalistic attitude
  • Recidivism
  • Weight cycling
  • Impaired health
  • Fatalistic attitude

  • Focus on nutrition
  • Prevention of further
  • weight gain
  • Improved health
  • Positive attitude

Prevention of further weight gain Improved
health Positive attitude
Health Goal
Healthier lifestyle
20
Want to take a walk?
21
THE AVERAGE AMERICAN WALKS JUST 300 YARDS PER DAY
22
The American Weight Paradox
  • Weight loss industry ()
  • Weight gain industry ()
  • Cultural obsession with weight
  • Greater prevalence of dieting
  • Increasing incidence of overweight/obesity
  • Is dieting (focus on weight loss) the answer?
  • Is dieting (focus on weight loss) the problem?

23
Problems with Dieting
  • Published data on (long-term) success rates
    indicate high recidivism
  • Dieting may increase risk for future weight gain
    (i.e., dieting may cause the thing its supposed
    to cure)
  • Fosters a yo-yo syndrome that undermines weight
    control efforts and may adversely affect health

24
Co-Morbid Conditions of Obesity
  • Cardiovascular
  • CAD, HTN, CHF, RHF, DVT, PE, CVA
  • Respiratory
  • OSA, asthma, hypoventilation syndrome
  • Endocrine
  • DM2, IR, IFG, IGT, dyslipidemia, PCOS,
    infertility, hypogonadism
  • Malignancy
  • Breast, colon, pancreas, prostate, uterine
  • Gastrointestinal
  • GERD, NASH, gallstones
  • Musculoskeletal
  • DJD, OA, LBP
  • Genitourinary
  • Incontinence, UTI
  • Skin
  • Venous stasis, cellulitis, panniculitis, skin
    infections
  • Psychologic/Neurologic
  • Depression, migraine, pseudotumor cerebri

80 of people with a BMI 30 have at least one
debilitating co-morbid illness
25
All-Cause Mortality and Obesity
Each year more than 300,000 Americans die of
causes related to their obesity
Mun EC, Gastroent. 2001 120669-81
26
Weight Loss
Effects of 5-10 decrease in body weight
  • Decrease in blood pressure
  • MacMahon S, Eur. Heart J. 1987 8(Suppl B) 57-70
  • Improve serum lipid profile
  • Dengel JL, Am. J. Clin. Nutr. 1995 62715-21
  • Improve glucose tolerance and decrease insulin
    resistance
  • Agurs-Collins TD, Diabetes Care. 1997
    201503-11

Blackburn G. Obes. Res. 1995, 3 Suppl. 2211s
27
Weight Loss Physics
Body Weight
Energy In
Energy Out
? Energy IN ? Energy OUT
Weight loss
28
Why do Diets Fail?
More than 80 of people who are actively trying
to lose weight choose Nutrition as their only
lifestyle modification
29
National Weight Control Registry
  • Since 1994
  • Widely advertised (including in diet books)
  • Now more than 3000 participants
  • Entry criteria are a documented 30 lbs weight
    loss maintained for 1 year
  • Participants followed with yearly questionnaires

30
Maintaining Weight Loss
  • Behavioral strategies that predicted success
  • Physical activity ?1 hour/day
  • Low fat/ high carbohydrate diet
  • Frequent self-monitoring of weight

Wing RR. Annu Rev Nutr. 200121323-41
31
Physical Activity
  • Baseline health cardiac risk factors, maximal
    weekly activity (PT, Cardiology, Pain
    clinic/Rheum)
  • Plan Increase activity!
  • Goal 60-90 min of low/mod activity every day
  • Aids Pedometer
  • Involve the spouse/family
  • No assist days

32
Popular Diets
  • Low carbohydrate diets- fad or trend?
  • Early 70s- no CHO diets
  • Protein sparing modified fasts
  • Liquid protein diets
  • Cambridge, Herbalife
  • Hospital based VLCD

33
Late 80s early 1990s
  • CHO the good guys
  • Easy message
  • High cho, low fat, no calorie counting

34
Late 90s
  • CHOs… going bad
  • Consumers eating CHO without considering calories
  • Physical activity decreasing
  • Industry introduces low-fat, no-fat foods

35
Late 90s-2004
  • High CHO are bad!
  • High CHO diets are fattening!
  • Protein is the best fuel for the body.

36
Why is low-CHO diets so popular?
  • Quick weight loss
  • The diet will jump start me into healthy eating
  • Maybe this one will work

37
Low-CHO Diet Plans Focus on one nutrient
  • Dr. Atkins
  • Carbohydrate Addicts Diet
  • Sugar Busters
  • Zone Diet
  • Eat Right for Your Blood Type
  • South Beach Diet

38
Results of recent studies
  • NEJM, 2003
  • Samah et al, 34821, 2074-81 (6 month)
  • Foster et al, 34821, 2082-90 (12 mo)

39
How to respond to clients on low CHO diets
  • Ask questions- find out what they are really
    doing and why?
  • Calories count.
  • Encourage less refined CHOs.
  • CHOs role in health
  • Exercise is important

40
How to Recognize a Fad Diet
  • IS the author credible?
  • Diets that advocate
  • Miracle foods
  • Rapid weight loss
  • No exercise
  • Rigid menus (good vs. bad)
  • Recommendations based on single foods

41
Diets Dont Work
  • 50 Americans diet annually
  • 5-50 maintain significant weight loss
  • Some cause significant health problems

42
Strategies for Success
  • How can you achieve an acceptable body weight and
    get off the dieting roller coaster?

43
Non Diet Approaches
  • DASH
  • Intuitive Eating
  • Mediterranean Food Pyramid
  • Plate Method
  • The Solution (Mellin)

44
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