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Unformatted text preview: WEIGHT MANAGEMENT WEIGHT MANAGEMENT Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2006 (*BMI ≥ 30, or about 30 lbs. overweight for 5’4” person) 1998 1990 2006 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Trends* Among U.S. Adults Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity­Related Statistics Obesity­Related Statistics ► Billions of $ spent annually on illnesses ► 33 billion spent annually on weight loss products and services ► 300,000 deaths per year ► Preventable in terms of illness and death ► BMI > 35 = premature death Medical Complications of Obesity Idiopathic intracranial Idiopathic hypertension hypertension Pulmonary disease Pulmonary abnormal function obstructive sleep apnea hypoventilation syndrome Stroke Cataracts Nonalcoholic fatty liver Nonalcoholic disease disease Coronary heart disease Diabetes Diabetes Dyslipidemia Dyslipidemia Hypertension Hypertension steatosis steatohepatitis cirrhosis Severe pancreatitis Gall bladder disease Cancer Gynecologic abnormalities breast, uterus, cervix colon, esophagus, pancreas kidney, prostate abnormal menses infertility polycystic ovarian syndrome Osteoarthritis Phlebitis Skin venous stasis Gout NHANES III Prevalence of Hypertension* According to BMI BMI <25 BMI 25-<27 50 BMI 27-<30 BMI >30 41.9 37.8 Percent 40 32.7 20 27.7 27 30 22.1 15.2 14.9 10 0 Men *Defined as mean systolic blood pressure ≥ 140 mm Hg, mean diastolic ≥ 90 mm Hg, or currently taking antihypertensive medication. Brown C et al. Body Mass Index and the Prevalence of Hypertension and Dyslipidemia. Obes Res. 2000; 8:605-619. Women Fat Cell Development Fat Cell Development Genetic Causes of Obesity Genetic Opposing hormones – Leptin – Ghrelin Causes of Obesity Causes ► Environmental causes? ► Does it promote “EAT MORE”???? Overeating: $800 BILLION spent on food each year ►Increasing portion sizes for less $$$$ ►Advertising dollars spent on soda, fast food $33 BILLION a year (convenience foods, snacks, candy, $33 soft drinks) soft Physical inactivity ►We live in a sedentary-driven country Computers, Cars, TV Obesity Treatment Pyramid Obesity Treatment Pyramid Surgery Pharmacotherapy Lifestyle Modification Diet Physical Activity Health Benefits of Weight Loss Health 1. 2. 3. 4. 5. 6. 7. Decreased cardiovascular risk Decreased glucose and insulin levels Decreased blood pressure Decreased LDL and triglycerides, increased HDL Decreased severity of sleep apnea Reduced symptoms of degenerative joint disease Improved gynecological conditions Goals of Weight Management/Treatment Goals 1. Prevent further weight gain Prevent ► minimum goal 1. Reduce body weight 2. Maintain a lower body weight over long term Impact of Weight Loss on Risk Factors Impact of Weight Loss on Risk Factors HbA1c Blood Pressure Total Cholesterol HDL Cholesterol ~5% Weight Loss 1 5%­10% Weight Loss 1 2 2 3 3 3 3 Triglycerides 1. Wing RR et al. Arch Intern Med. 1987;147:1749-1753. 2. Mertens IL, Van Gaal LF. Obes Res. 2000;8:270-278. 3. Blackburn G. Obes Res. 1995;3 (Suppl 2):211S-216S. 4. Ditschunheit HH et al. Eur J Clin Nutr. 2002;56:264-270. 4 Weight Loss Therapy A combination of: Dietary Therapy Dietary •500-1000 kcal deficit per day to achieve a weight loss of 1-2 lb/week Physical Activity • Increases energy expenditure • • • Protects and builds lean body mass Improves psychological factors Reduces risk of morbidity and mortality Behavior Therapy-Self-Monitoring Behavior Keep records of: ► Amount and types of foods eaten ► Frequency, intensity, and type of physical activity ► Time, place, and feelings Behavior change techniques Behavior ► Learn to shop for healthy foods. ► Don’t shop when hungry. ► Keep high-calorie foods out of the home. ► Limit the times and places of eating. Behavior Therapy-Cognitive Restructuring Restructuring Rational thoughts designed to replace negative thoughts: Instead of. . . “I blew my diet this morning by eating that doughnut.” Use. . . “Well, I ate the doughnut, but I can still eat in a Well, healthy manner the rest of the day.” healthy Pharmacotherapy Drugs approved for long-term use by the FDA may be used as part of a comprehensive weight loss program including diet and physical activity. • Drugs should be used in combination with diet, exercise, and behavior modification. Weight Loss Drugs Weight Drug Sibutramine Action Serotonin (Meridia) Orlistat (Xenical) Inhibits pancreatic Decrease in absorption llipase, decreases ipase, of FSV, soft stools fat absorption. and anal leakage. Adverse Effects Increase in heart rate Increase Increase in BP Weight Loss Surgery Weight Option for limited number of patients with clinically Option severe obesity. BMI >40 or >35 with comorbid conditions BMI 40 Medical therapy has failed Medical Gastric restriction or gastric bypass Gastric Integrated program must be in place before and after surgery. after Gastric Bypass Surgery Complications Complications Surgical Complications Number of Patients % of Patients Vitamin B12 deficiency 239 39.9 Readmit for various reasons 229 38.2 Incisional hernia 143 23.9 Depression 142 23.7 Staple line failure 90 15.0 Gastritis 79 13.2 Cholecystitis 68 11.4 Anastomotic problems 59 9.8 Dehydration, malnutrition 35 5.8 Dilated pouch 19 3.2 Data derived from source (Pories et al.) and modified based on personal communication. Source: Pories WJ, Swanson MS, MacDonald KG Jr, et al. Who would have thought it? An operation proves to be the most effective therapy for adult­onset diabetes mellitus. Ann Surg. 1995;222:339­350; discussion 350­352. Guide for Selecting Obesity Treatment Guide for Selecting Obesity Treatment BMI Category (kg/m2) Treatment 25­26.9 27­29.9 30­34.9 35­39.9 >40 Diet, Exercise, Behavior Tx + + + + + With co­ morbidities + + + With co­ morbidities + Pharmaco­ therapy Surgery The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. October 2000, NIH Pub. No.00-4084 Fad Diets Fad Fad Diets, the list goes on & on… Fad High-protein, low carbohydrate diets High-protein, ► What’s the appeal? ► Is there research on the Is efficacy of using these efficacy diets for a long diets period of time? period High-protein, low carbohydrate diets High-protein, ► Don’t count calories, but can be very low in calories ► Satisfy hunger loss of appetite with ketosis ► Follow a plan ► Limit choices ► Promote 71-162 g protein/day or 28-64% of Promote calories* calories* ► Limit carbohydrates to 7-56 g/day or 3-16% of Limit calories* calories* * Circulation. 2001;104:1869 2001;104:1869 Research on High Protein vs High CHO diets diets Effect of high pro diet vs high CHO intake in DM Effect ► 12 patients with DM: 6 high pro, 6 high CHO 12 ► Study length: 2 months ► Both groups lost weight (~5 lb), Both ► In the high CHO group: glucose levels decreased ► In the high Pro group: BP decreased ► Little to no effects on lipid levels (cholesterol, LDL or HDL) *JADA. 2005;105(4)573-80 Research on High Protein vs High CHO diets diets Effect of high pro diet vs high CHO intake ► 100 patients: 50 high pro, 50 high CHO 100 ► Study length: 3 months ► Both groups lost weight (16 lb) ► Glucose, cholesterol, HDL and LDL levels Glucose, decreased in both groups both ► TG concentrations decreased more in the high Pro group TG than high CHO group than *AJCN. 2005;81(6)1298-1306 How about Non-Dieting? How ► Significant Significant improvements CAN be made in health indices WITHOUT dieting. dieting. ► Follow our internal Follow hunger cues— hunger EAT WHEN YOU ARE EAT HUNGRY!! HUNGRY!! Eating Disorders Eating Disorders ► Causes of eating disorders Excessive pressure to be thin ►Athletes and dancers are at high risk Eating Disorders Eating Disorders Eating Disorders Eating Disorders ► ≈85% of eating disorders start during adolescents Eating Disorders Eating Disorders Anorexia Nervosa: ► A distorted body image that overestimates body fatness Eating Disorders Eating Disorders ► Anorexia Nervosa : Self­Starvation Discipline is used to strictly limit portions of low­calorie foods Hunger is denied Becoming accustomed to little food one can feel full after eating as little as a half­dozen carrot sticks Calorie contents of foods are memorized Calorie costs of exercises are memorized Eating Disorders Eating Disorders Consequences of Anorexia Nervosa Eating Disorders Eating Disorders ► Treatment of Anorexia Nervosa Requires a multidisciplinary approach Eating Disorders Eating Disorders ► Bulimia Nervosa: Binge Eating and Purging Food is not consumed for its nutritional value During a binge, eating is accelerated by hunger from previous caloric restriction During a binge, nearly 1,000 extra calories are consumed There may be several binges in a day Eating Disorders Eating Disorders ► Vomiting can cause: Irritation and infection of the pharynx, esophagus, salivary glands Erosion of the teeth and dental caries The esophagus or stomach may rupture or tear Overuse of emetics can lead to death by heart failure Eating Disorders Eating Disorders ► Treatment of Bulimia Nervosa To regain control over food and establish regular eating patterns requires adherence to a structured eating plan Regular exercise may be of benefit Restrictive dieting is forbidden ...
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