Prevalence of Overweight Among Children & Adolescents 6-19 Years
Age(Years)
1963-651966-70
1971-74
1976-80
1988-94
1999-2002
6-11 4% 4% 7% 11% 16%
12-19 5% 6% 5% 11% 16%
Source: National Center for Health Statistics
Overweight and Obesity Definitions
Height/Weight Tables Metropolitan Life Insurance, revised 1983 Based on weight-height mortality study Weights are ages 25 to 59 based on lowest
mortality
Height and Weight Chart - height weight chart, weight height chart
Overweight and Obesity Definitions
BMI = weight (kg) height squared (m²) Significantly correlated with total body
fat content
Obesity Class BMI kg/m2
Underweight <18.5
Normal 18.5–24.9
Overweight 25–29.9
Obesity I 30.0–34.9
II 35.0–39.9
Extreme Obesity III 40.0
Classification of Overweight and Obesity by BMI
Overweight and Obesity - Definitions
Waist Circumference Presence of excess fat in abdomen out of
proportion to total body fat is a independent predictor of risk and mortality.
Waist circumference is positively correlated with abdominal fat content. High Risk:
Men >102 cm (>40 in.); Women > 88 cm (>35 in.)
Waist-to-Hip Ratio
Waist-to-hip ration measures waist at its narrowest point and hip at widest point.
Women with 35” waist and 46”hip = 35/46 = 0.76 Risk:
Women with waist-to-hip ratio >0.8 Men with waist-to-hip ratio > 1.0
Weight Control
Advantages of Weight Loss: Blood Pressure Serum/Plasma Lipids
Reductions in serum triglycerides and increases in HDL
Reductions in total cholesterol and LDL Blood Glucose
NHANES III Age-Adjusted Prevalence of HypertensionHypertension* According to BMI
16.518.221.922.5 24.025.2
32.2
38.4
0
10
20
30
40
50
Men Women
BMI <25 BMI 25-26 BMI 27-29 BMI >30
*Defined as mean systolic blood pressure 140 mm Hg, as mean diastolic 90 mm Hg, or currently taking antihypertensive medication .
Brown C et al. Body Mass Index and the prevalence of Risk Factors for Cardiovascular Disease (in preparation).
Per
cen
t
NHANES III Age-Adjusted Prevalence of High Blood CholesterolHigh Blood Cholesterol* According to BMI
15.714.7
27.9
17.5
28.2
20.424.7
20.2
0
10
20
30
40
50
Men Women
BMI <25 BMI 25-26 BMI 27-29 BMI >30
*Defined as > 240 mg/dL.
Brown C et al. Body Mass Index and the Prevalence of Risk Factors for Cardiovascular Disease (in preparation).
Per
cen
t
NHANES III Age-Adjusted Prevalence of Low HDL-CholesterolLow HDL-Cholesterol* According to BMI
16.5
9.1
27.0
17.2
27.223.1
41.5
31.4
0
10
20
30
40
50
60
Men Women
BMI <25 BMI 25-26 BMI 27-29 BMI >30
*Defined as <35 mg/dL in men and <45 mg/dL in women.
Brown C et al. Body Mass Index and the Prevalence of Risk Factors for Cardiovascular Disease (in preparation).
Per
cen
t
Nutritional Assessment
Weight History Age of onset Highest/lowest adult weights Patterns of weight gain and loss Environmental triggers
Current eating patterns Nutritional Intake
Treatment for Obesity
BMIBMI 25-26.925-26.9 27-29.927-29.9 30-34.930-34.9 35-35-39.39.99
>40>40
Diet, Physical Activity & Behavior Therapy
With co- morbidities
With co- morbidities
Pharmco-therapy
If not lost 1#/week after 6 mo.
Surgery With co- morbidities
Position of ADA
Successful weight management requires a livelong commitment to healthful lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activity
Position Paper
Goals for Weight Loss
Prevent weight gain or stop weight gain Improvement in physical and emotional
health Small maintainable weight losses or more
extensive weight loss through sensible eating and exercise patterns
Improvement in eating, exercise and other behaviors apart from any weight loss
Goals for Weight Loss
Initial goal to reduce body weight by approximately 10% from baseline.
1-2#/week for period of 6 months 1# body fat = 3500 calories 3500/7days = - 500 calories/day Need to assess individual’s motivation
and readiness to enter weight loss therapy.
How To Achieve Weight Loss
1,000 – 1,200 kcal/day for women and 1,200 – 1,600 kcal/day for men
Reducing dietary fat along with carbohydrates can facilitate calorie reduction.
Reducing dietary fat alone without reducing calories is not sufficient for weight loss.
How To Achieve Weight Loss
Physical activity is recommended as part of a comprehensive weight loss program because:contributes to weight lossmay decrease abdominal fatincrease cardio-respiratory fitnessmay help with maintenance of weight
loss
How To Achieve Weight Loss
Behavior Therapy Pharmacotherapy - weight loss drugs Weight loss drugs may be used in
combination with a comprehensive weight loss program, for patients with BMI>=30 with no risk factors & BMI >=27 with risk factors.
Weight loss drugs should never be used without concomitant lifestyle changes.
How To Achieve Weight Loss
Better weight loss results are achieved with diet therapy when the duration of the intervention is at least 6
months. Long term weight loss is enhanced by a
program of dietary therapy, physical therapy and behavioral therapy continued indefinitely.
“Habit is habit and not to be flung out of the window by any man, but coaxed downstairs a step at a time.”
–Mark Twain
How To Achieve Weight Loss
Outcome data on behavior therapy, Very Low Calorie Diets (VLCD) and Pharmacotherapy show weight regain in 3-5 years
Frequent contacts between professional counselors and patients promote weight loss and weight maintenance
Chicago Tribune | Biggest 'Lost' mystery: Why is Hurley still fat?
Tips for Weight Loss
Eat a variety of foods from the Food Guide Pyramid, including favorite foods
Increase intake of high-water/high-fiber foods Vegetables and fruits Whole grains and legumes Soups
Decrease consumption of energy dense foods High fat foods Foods with low moisture content
How to Calculate Energy Density
Energy Density = Calories/Grams E.G. 150 Calories/100 grams = 1.5 Kcal/g Energy density of 1 – Eat any quantity Limit foods with energy density >2
Tips for Weight Loss
Limit consumption of beverages containing alcohol and sugars
Control Portion Sizes Plan meals and snacks ahead Establish regular eating habits Shop on a full stomach
Tips for Weight Loss
Eat from plates, not food packages Portion foods before bringing them to the
table Eat slowly Sit down to eat Stop eating when you leave the table Watch for food ‘triggers’
Fad Diets
Americans spend >30 billion in the weight loss industry
Single food diets - grapefruit, rice etc. High-protein, high fat diets VLCD Fasting High fiber, low-calorie diets