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- 1. Water • Your overall body is between 70 - 80% water. • Your muscles are about 75% water • Your body needs water to: – Digest food – Carry waste products out of your body – Regulate body temperature – Lubricate moving parts • Your body does not store water so you must take in a new supply every day. • The National Research Council’s Food and Nutrition Board recommends one milliliter (ml) of water for each calories of food we consume.
- 2. Obesity
- 3. Introduction • Obesity is a medical and public health problem and is much more common amongst affluent societies. 25/09/14 3
- 4. Overweight and obesity among adults Health Survey for England 2010-2012 More than 6 out of 10 men are overweight or obese (66.5%) More than 5 out of 10 women are overweight or obese (57.8%) Adult (aged 16+) overweight and obesity: BMI ≥ 25kg/m2 Patterns and trends in adult obesity 4
- 5. Measuring Obesity • >20% of “ideal” body weight for males • >30% of “ideal” body weight for females • Body Mass Index – Weight/(Height)2 – BMI >30 = obesity
- 6. Just the Facts! • According to WHO: As of 2005 – 1.6 billion adults (over 15 years old) are overweight – 400 million are obese – Projects by 2015, 2.3 billion will be overweight and 700 million obese
- 7. Obesity among adults Health Survey for England 2010-2012 One out of four men is obese (24.7%) One out of four women is obese (25.7%) Adult (aged 16+) obesity: BMI ≥ 30kg/m2 Patterns and trends in adult obesity 7
- 8. Diagnosis: Causes of Obesity • Hypothyroidism • Cushing's Syndrome • Medications (antipsychotics,antidepressants) • Other Rare causes: Prada-Willi syndrome (1/20,000) • Non-pathological - 99%
- 9. Pathways to Obesity • Fat intake (“cafeteria” diet) • Inactivity (25% get regular exercise) • Metabolic issues • Overeating • “Thrifty genome” • Alcohol intake • Combinations of above
- 10. Adult BMI Chart 55''00"" 55''44"" HHeeiigghhtt WWeeiigghhtt ((llbbss)) 55''22"" 55''66"" 55''88"" 55''1100"" 66''00"" 66''22"" 112200 113300 114400 115500 116600 117700 118800 119900 220000 221100 222200 223300 224400 225500 226600 227700 228800 229900 330000 66''44""
- 11. Examples of Highly Nutritious Snacks • Peanut butter and jelly on wheat bread • Apples and peanut butter • Low fat yogurt • Cheese sticks • Granola / trail mixes • Turkey Roll-ups
- 12. Fast Food Healthy choices What are today’s topics ?? Energy balance Portion size vs
- 13. Americans are eating more weight gain more than 200 calories per day increase in per capita consumption Source:Nestle, 2002
- 14. Alarming Trends in Health of the U.S.
- 15. Fast Food Healthy or Horrible?
- 16. FFrreenncchh FFrriieess 20 Years Ago Today 210 Calories 2.4 ounces 610 calories 6.9 ounces How many calories are in these fries? Calorie Difference: 400 calories How long will you have to walk to burn* 400 calories? How to burn* 400 calories: Walk leisurely for 1 hr 10 *Based Minutes on 160 pound person
- 17. 8 oz 12 oz 16 oz 20 oz 34 oz Courtesy of Dr. Kelly Brownell
- 18. SSooddaa 20 Years Ago Today 85 Calories 6 ½ ounces Calorie Difference: 165 calories 250 calories 20 ounces How many calories are in this soda? How long to burn* would 165 you have calories: to garden to burn 165 Garden calories?. *Based on 160 for pound 35 person Minutes
- 19. The Risks of Overweight coronary heart disease, congestive heart failure cancer of breast, prostate, colon, uterus, liver, kidney, pancreas, esophagus stroke Arthritis, gout gallbladder disease incontinence, poor female reproductive health sleep apnea, asthma, other respiratory problems hypertension, diabetes mellitus, high cholesterol
- 20. The Good Old 4-A Technique • ASK • ADVISE • ASSIST • ARRANGE
- 21. Obstacles • Unaware of current intake • Unaware of high calorie foods • Doesn’t like exercise or dieting • Feels fine
- 22. Assist (Readiness Stage: Preparation) Provide educational materials Test Motivation: Give diet diary (3-7 day) Decrease obstacles – Inform of support programs available in the community – Counsel or refer as needed for counseling
- 23. ASSIST How to assist depends on Stage of Readiness to Change!!!
- 24. ADVISE Give brief personalized advice: her risks of overweight benefits to her of controlling weight
- 25. ASK Assess readiness to change “Do you want to work on losing weight”? If ready, assess previous and current efforts and obstacles
- 26. Basic Nutrition Understand the fuel your body needs and how it is used.
- 27. Why is proper nutrition important? • All living things need food and water to live. • All human beings need “good food” to live well. • Food = energy (measured in calories) Carbohydrates - 1 gram = 4 calories Protein - 1 gram = 4 calories Fats - 1 gram = 9 calories • Proper nutrition provides the body with the nutrients necessary to build, maintain, and repair tissues.
- 28. • Macro-NutrTienytsp – eessse notiafl fNor huumtraine sunrvtisval and growth – Carbohydrates – Proteins – Fats – Water • Micro-Nutrients – essential for growth and enhance the function and usability of macro-nutrients – Vitamins – Minerals The difference between macro and micro nutrients is the amount your need each day. Macro-nutrients must exceed one gram per day.
- 29. Carbohydrates • Provide energy for your body by converting to glucose. Three types of carbohydrates: 1. Simple – one or two units of sugar 2. Complex – more than two units of sugar 3. Dietary fiber – complex carbohydrates that are not a source of energy and add no calories to your diet. • Protect your muscles. • Regulate the amount of sugar circulating in your body. • Assist in the body’s absorption of calcium. • May help lower cholesterol levels and regulate blood pressure.
- 30. Proteins • Used for tissue growth and repair. Two types of Proteins: 1. Complete Proteins – contain sufficient amounts of all essential amino acids. 2. Incomplete Proteins – missing or do not have enough essential amino acids. • Amino Acids are the building blocks for protein (20 different types). • Within six months, every protein molecule in your body is broken down and replaced. • The more intensely you train, the more protein is required for repair and growth. • Consuming more protein than the body needs can result in an increase in fat storage.
- 31. Fats • A healthy body needs fat. Major uses for FAT 1. Provides a source of stored fat. 2. Gives shape to your body. 3. Cushions your skin. 4. Acts as an insulator in order to reduce heat loss. 5. Protects your organs if you fall or are injured.
- 32. Vitamins and Minerals • Vitamins and minerals act as regulators and catalysts for a variety of bodily functions. • Vitamins are essential for: – Building body tissues such as bones, skin, glands, nerves, and blood. – Assisting in the metabolizing of proteins, fats, and carbohydrates so you receive energy from food. – Promoting healing – Preventing nutritional deficiency diseases. • Minerals are essential for: – The formation of strong bones and teeth – Helping to control the nervous system – Fluid balance in tissues – Muscle contractions • Minerals and most vitamins must be supplied through diet since they are not made in the body.
- 33. Water • Your overall body is between 70 - 80% water. • Your muscles are about 75% water • Your body needs water to: – Digest food – Carry waste products out of your body – Regulate body temperature – Lubricate moving parts • Your body does not store water so you must take in a new supply every day. • The National Research Council’s Food and Nutrition Board recommends one milliliter (ml) of water for each calories of food we consume.
- 34. Caloric Content of Foods Carbohydrates 4 cal/g Protein 4 cal/g Fats 9 cal/g Alcohol 7 cal/g 34 Concepts of Fitness and Wellness 6e
- 35. Obesity-associated Morbidities • Type 2 diabetes • Heart disease • Hypertension • Stroke • Cancer • Sleep apnea • Asthma • Urinary incontinence • Gallbladder disease • Nonalcoholic FLD • Osteoarthritis • Psychological disorders
- 36. Heart Disease and Diabetes • Heart Disease – The world’s number #1 cause of death – Kills 17 million each year around the world – Heart attack – Stroke • Diabetes type 2 – Becoming global epidemic – WHO projects diabetes will increase by 50% across the world
- 37. Therapeutic Approaches Behavioral – dietary changes – increase activity – decrease inactivity Pharmacologic Surgical
- 38. But the obesity epidemic is NOT just an individual problem…
- 39. Diets and Drugs for Obesity: A Critical Review
- 40. AHA Guidelines for Healthy Diets • Protein: 15-20% of calories not excessive (50-100g/d) proportional to carbohydrate and fat • Carbohydrates: ~55% of calories Minimum of 100g/d • Fat: ~30% of calories, 10% sat fat • Protein foods should not contribute excess total fat, sat fat or cholesterol • Diet should provide adequate nutrients and support dietary compliance St. Jeor ST, etal. Circulation 104:1869-74, 2001.
- 41. Diets Description A particular food or nutrient causes weight loss. Usually low in calories. May lead to protein calorie malnutrition leading to breakdown of lean muscle mass. Right for your type Beverly Hills Fit for Life Grapefruit Diet Cabbage diet Low calorie, generally levels of 1200 or less. Jenny Craig Weight Watchers Slim Fast Richard Simmons Limit carbohydrates; increase protein and sometimes fat. Atkin’s Diet The Zone Sugar Busters Protein Power Carbohydrate Addict’s diet
- 42. Weight Loss Diet • Individually planned caloric deficit diet • Generally 500-1000 Kcal/day deficit – 30% calories from fat – 10% saturated fat • Must reduce calories—not just fat—to promote weight loss.
- 43. Why is proper nutrition important? • All living things need food and water to live. • All human beings need “good food” to live well. • Food = energy (measured in calories) Carbohydrates - 1 gram = 4 calories Protein - 1 gram = 4 calories Fats - 1 gram = 9 calories • Proper nutrition provides the body with the nutrients necessary to build, maintain, and repair tissues.
- 44. Ways to Get More Fiber • Eat more fruits and vegetables • Eat whole grain foods 44 Concepts of Fitness and Wellness 6e
- 45. Antioxidant All-Stars • Broccoli • Cantaloupe • Carrot • Kale • Mango • Pumpkin • Red Pepper • Spinach • Strawberries • Sweet potato 45 Concepts of Fitness and Wellness 6e
- 46. A Grain of Wheat Return to presentation BRAN - B vitamins - minerals - dietary fiber ENDOSPERM 46 Concepts of Fitness and Wellness 6e - starch - protein - some iron and GERM B vitamins - essential fats - minerals - vitamins (B's , E and folacin)
- 47. Physical Activity • Modestly contributes to weight loss. • May decrease abdominal fat. • Increases cardiorespiratory fitness. • Improves sense of well being and self efficacy.
- 48. Physical Activity • Most important in preventing weight regain • Start slowly and increase gradually — Can be single session or intermittent — Start with walking 30 minutes 3 days/week — Increase to 45 minutes 5 or more days/week — Encourage increased “lifestyle” activities – don’t have to join a gym — Get pedometer –increase steps by 2,000/day
- 49. Calories In = Calories Out If you walk leisurely for 1 hour and 10 minutes you will burn approximately 400 calories.* *Based on 160-pound person Adapted from http://hin.nhlbi.nih.gov/portion/keep.htm
- 52. CCoonncclluussiioonnss Working with patients families to change attitudes behaviors: • Assess • Educate • Motivate Working within communities to change cultures environments: • Promote • Collaborate • Advocate 52 Winning the fight against obesity requires a comprehensive system that involves:
- 53. 09/25/14 53
- 54. Fruits and Vegetables • WHO states: – Fruits and vegetables need to be part of the daily diet to prevent disease such as obesity and noncommunicable disease – The statistics are startling • Lack of enough fruits and vegetables cause – 19% of GI deaths – 31% of Ischemic heart disease – 11% of stroke
- 55. What Can Physicians Do • Counsel • Diets • Drugs • Surgery • Advocacy
- 56. Assist (Readiness Stage: Preparation) Provide educational materials Test Motivation: Give diet diary (3-7 day) Decrease obstacles – Inform of support programs available in the community – Counsel or refer as needed for counseling
Notas del editor
- The published Health Survey for England data used to produce this graphic are available from: http://www.hscic.gov.uk/catalogue/PUB13219
- Reference: World Health Organization.(2008). Obesity and overweight. Fact sheet #311. Retrieved from http://www.who.int/mediacentre/factsheets/fs311/en
- The published Health Survey for England data used to produce this graphic are available from: http://www.hscic.gov.uk/catalogue/PUB13219
- Do You Know Your Own BMI? BMI is a vital sign. It should be recorded as routinely as blood pressure or pulse. BMI can be easily determined with a chart such as this one. BMI, although invaluable for evaluating obesity, is not the only tool available. Fat mass and the distribution of body fat are also important, and no measurement can be a substitute for the clinician’s judgment.
- Take an informal survey: Let’s say I place in front of you 5 chocolate chip cookies. How many are you likely to eat? Chances are, you’ll eat more than the “serving size” of one or two chocolate chip cookies. Recent article supports this idea and showed that when offered a large or a small portion of a food, women consumed an average of 184 additional kcals and men at an average of 311 additional kcals. These studies show that for a variety of different foods, both in controlled lab studies and in a restaurant, large portions lead to increased calorie intake Children would likely have similar results—and the impact on weight gain may be more dramatic. The amazing thing is that when people were given smaller portions and/or less calorie dense food it didn't leave them hungry. Even though the study participants consumed 221 fewer calories when offered a smaller meal of lower calorie density, they felt just as full and satisfied as when they had consumed a larger meal of higher calorie density. Can it work for children? Possibly, if we give them tools to assist them in determining appropriate portion sizes. Other Talking Points: Marion Nestle, in her book, Food Politics, noted that between 1970 and the late 1990s the daily food supply in America increased by 500 calories. Although the food supply is an overestimation of what people consume, dietary intake surveys show an average increase of more than 200 calories per day. Such small increases in calories can translate into significant weight gain unless there is a change in physical activity or metabolism. 200 calories/day = 20 # weight gain/year (large vs. small bagel, extra cookies, 2 cups of fruit/2 bananas) Possible Activities: Ask the audience to discuss if they think they are eating 200 more calories a day than they did 15 years ago. If so, what is the source of those calories?
- “Overweight and obesity have certainly been in the news. It is affecting everyone and is linked to serious health problems. One newsworthy item that has received some attention is that overweight and obesity may soon cause as much preventable death and disease as cigarette smoking” (300,000 for obesity and 400,000 for smoking).
- The driving force of “portion size” in the environment is one that requires our attention. Here you can see how the size of a coke has increased 4 times over the years. A coke that used to be 8 oz is now available to us in 34 oz. Not only are we given more coke than we would ever need or ever want, but also more calories than we typically burn up. Show Hershey bar!! And as you will see from the latest research on portion size, when people are given the choice, they are likely to drink all of this coke.
- This slide shows the calorie content of different food stuffs
- Couple of comments about diabetes and obesity. Diabetes is even more scary than heart disease and is primarily caused by obesity…now Type 2 diabetes is the not the same as Type 1. Type 1 diabetes is when the body makes no insulin and can happen at any age, any weight. Type 2 is a result of being overweight, the body struggles to make enough insulin and at some point is not able to make enough, but can make small amounts. The best way to control diabetes is to control weight and to exercise. Some people do not have to take any medicine to control diabetes. But some do. According to WHO: “Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.” World Health Organization (2010). Diabetes: Fact sheet 312. Retrieved from http://www.who.int/mediacentre/factsheets/fs312/en/index.html
- AHA publication: “A STATEMENT FOR HEALTHCARE PROFESSIONALS FROM THE NUTRITION COMMITTEE OF THE COUNCIL ON NUTRIITON, PHYSICAL ACTIVITY AND METABOLISM OF THE AMERICAN HEART ASSOCIATION”
- To succeed with weight loss, diets need to be planned with the individual in mind. They need to take into account what the patient is currently consuming. A deficit of 500 to 1,000 kcal/day will produce a weight loss of 1 to 2 lb/week. For weight loss, a diet of 1,000 to 1,200 kcal for women and 1,200 to 1,500 kcal for men is recommended. The LCD recommended in this report also contains nutrient compositions that will decrease other risk factors, notably, high serum cholesterol and hypertension Also, reducing fat alone without reducing calories will not help patients lose weight.
- Most American diets are deficient in fiber. The RDA for fiber is 25-40 grams per day. Most Americans probably get about 12-14 grams in their diet. Ways to get more fiber in the diet is to eat more fruits and vegetables and to eat more whole grain foods. (This slide provides a lead in for next slide)
- The following list is of the foods that have the most significant health benefits.
- This diagram shows a grain of wheat. Go over the parts in the following order Bran: outer layer with fiber, vitamins, and minerals Endosperm: inner starch layer with carbohydrates Germ: core with vitamins, minerals During processing the bran and germ are typically removed along with the important vitamins, minerals and fiber. By eating whole grain foods you get a more nutritionally dense food that is better for overall health.
- Physical activity should be recommended as part of a comprehensive weight loss and maintenance program. There is strong evidence that increased physical activity alone can create a caloric deficit and can modestly contribute to weight loss. Efforts to achieve weight loss through physical activity alone generally produce an average of a 2 to 3 percent decrease in body weight or BMI. Physical activity may decrease abdominal fat. There is strong evidence that increased physical activity increases cardiorespiratory fitness, with or without weight loss. Improved cardiovascular fitness also improves the quality of life in overweight patients by improving mood, self-esteem, and physical function in daily activities.
- Physical activity is most important in helping to prevent weigh regain. In addition, sustained physical activity has the benefit of reducing overall CHD risk beyond that produced by weight reduction alone. For most obese patients, physical activity should be initiated slowly, and the intensity should be increased gradually. Initial activities may be walking or swimming at a slow pace. With time, depending on progress, the amount of weight lost, and functional capacity, the patient may engage in more strenuous activities. A regimen of daily walking is attractive; patients can start by walking 30 minutes, 3 days a week, and can build to 30 to 45 minutes of more intense walking at least 5 days a week and preferably most, if not all, days. With this regimen, an additional 100 to 200 calories per day of physical activity can be expended. Caloric expenditure will vary depending on the individual’s body weight and intensity of the activity. People can select activities that they enjoy and that fit into their daily lives. Getting a pedometer and encouraging 10,000 steps a day.
- One such product was the an abbreviated version of the guideline in the form of The Practical Guide. This was developed In partnership with the North American Association for the Study of Obesity. And, the American Academy of Family Physicians provided 100,000 copies to its members. Other tools developed to disseminate the messages include a primary care provider kit and the Aim for a Healthy Weight Website. The site provides practical information on nutrition and physical activity for health professionals and the public.
- This image was cropped from an infographic that supports a report from the IOM on preventing obesity.
- Reference: World Health Organization. (2004) Promoting fruit and vegetable consumption around the world. Retrieved from http://www.who.int/dietphysicalactivity/fruit/en/index.html