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.

Obesity

25/09/14 3

Introduction

• Obesity is a medical and public health problem and is much more common amongst affluent societies.

Overweight and obesity among adultsHealth Survey for England 2010-2012

4Patterns and trends in adult obesity

Adult (aged 16+) overweight and obesity: BMI ≥ 25kg/m2

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%)

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

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

Obesity among adultsHealth Survey for England 2010-2012

7Patterns and trends in adult obesity

Adult (aged 16+) obesity: BMI ≥ 30kg/m2

One out of four men is obese (24.7%)

One out of four women is obese (25.7%)

Diagnosis: Causes of Obesity

• Hypothyroidism

• Cushing's Syndrome

• Medications (antipsychotics,antidepressants)

• Other Rare causes: Prada-Willi syndrome (1/20,000)

• Non-pathological - 99%

Pathways to Obesity

• Fat intake (“cafeteria” diet)

• Inactivity (25% get regular exercise)

• Metabolic issues

• Overeating

• “Thrifty genome”

• Alcohol intake

• Combinations of above

Adult BMI Chart

5'45'4""

HeightHeight

Weight (lbs)Weight (lbs)

5'25'2""

5'05'0""

5'105'10""

5'85'8""

5'65'6""

6'06'0""

6'26'2""

120120 130130 150150 160160 170170 180180 190190 200200 210210 220220 230230 240240 250250140140 260260 270270 280280 290290 300300

6'46'4""

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

What are today’s topics ??

Fast Food Healthy choices

Energy balance

Portion size

vs

more than 200 calories per

day

weight gain

increase in per capita consumptionSource:Nestle, 2002

Americans are eating more

Alarming Trends in Health of the U.S.

Fast Food

Healthy or Horrible?

French FriesFrench Fries 20 Years Ago Today

210 Calories2.4 ounces

How many calories are in these fries?610 calories6.9 ounces

Calorie Difference: 400 calories

*Based on 160 pound person

How long will you have to walk to burn* 400 calories?How to burn* 400 calories: Walk leisurely for 1 hr 10 Minutes

8 oz 12 oz 16 oz 20 oz 34 oz

Courtesy of Dr. Kelly Brownell

SodaSoda20 Years Ago Today

85 Calories 6 ½ ounces

Calorie Difference: 165 calories

How many calories are in this soda? 250 calories 20 ounces

*Based on 160 pound person

How long would you haveto garden to burn 165 calories?.

How to burn* 165 calories:

Garden for 35 Minutes

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

The Good Old 4-A Technique

• ASK

• ADVISE

• ASSIST

• ARRANGE

Obstacles

• Unaware of current intake

• Unaware of high calorie foods

• Doesn’t like exercise or dieting

• Feels fine

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

ASSIST

How to assist depends on Stage of Readiness to Change!!!

ADVISE

Give brief personalized advice:

her risks of overweight

benefits to her of controlling weight

ASK

Assess readiness to change“Do you want to work on

losing weight”?

If ready, assess previous and current efforts and obstacles

Basic Nutrition

Understand the fuel your body needs and how it is used.

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 caloriesProtein - 1 gram = 4 caloriesFats - 1 gram = 9 calories

• Proper nutrition provides the body with the nutrients necessary to build, maintain, and repair tissues.

Types of Nutrients• Macro-Nutrients – essential for human survival 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 perday.

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.

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.

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.

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.

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 Concepts of Fitness and Wellness 6e

Caloric Content of Foods

Carbohydrates 4 cal/g

Protein 4 cal/g

Fats 9 cal/g

Alcohol 7 cal/g

Obesity-associated Morbidities

• Type 2 diabetes• Heart disease• Hypertension• Stroke• Cancer• Sleep apnea

• Asthma• Urinary incontinence• Gallbladder disease • Nonalcoholic FLD• Osteoarthritis• Psychological disorders

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

Therapeutic Approaches

� Behavioral– dietary changes– increase activity – decrease inactivity

� Pharmacologic� Surgical

But the obesity epidemic is NOT just an individual problem…

Diets and Drugs for Obesity: A Critical Review

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.

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 typeBeverly HillsFit for LifeGrapefruit DietCabbage diet

Low calorie, generally levels of 1200 or less.

Jenny CraigWeight WatchersSlim FastRichard Simmons

Limit carbohydrates; increase protein and sometimes fat.

Atkin’s DietThe ZoneSugar BustersProtein PowerCarbohydrate Addict’s diet

DescriptionDiets

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.

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 caloriesProtein - 1 gram = 4 caloriesFats - 1 gram = 9 calories

• Proper nutrition provides the body with the nutrients necessary to build, maintain, and repair tissues.

44 Concepts of Fitness and Wellness 6e

Ways to Get More Fiber

• Eat more fruits and vegetables

• Eat whole grain foods

45 Concepts of Fitness and Wellness 6e

Antioxidant All-Stars

• Broccoli• Cantaloupe• Carrot• Kale• Mango• Pumpkin• Red Pepper• Spinach• Strawberries• Sweet potato

46 Concepts of Fitness and Wellness 6e

A Grain of Wheat

BRAN - B vitamins - minerals - dietary fiber

ENDOSPERM - starch - protein - some iron and B vitamins GERM

- essential fats - minerals - vitamins (B's , E and folacin)

Return to presentation

Physical Activity

• Modestly contributes to weight loss.

• May decrease abdominal fat.

• Increases cardiorespiratory fitness.

• Improves sense of well being and self efficacy.

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

*Based on 160-pound person

If you walk leisurely for 1 hour and 10 minutes you will burn approximately 400 calories.*

Calories In = Calories Out

Adapted from http://hin.nhlbi.nih.gov/portion/keep.htm

Professional Education Materials

ConclusionsConclusions

51

ConclusionsConclusions

Working with patients & families to change attitudes & behaviors:

• Assess

• Educate

• Motivate

Working within communities to change cultures & environments:

• Promote

• Collaborate

• Advocate52

Winning the fight against obesity requires a comprehensive system that involves:

09/25/14 53

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

What Can Physicians Do

• Counsel

• Diets

• Drugs

• Surgery

• Advocacy

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