Weight Management Overweight and Obesity Chapter 9 Dr Alisha Rovner NTDT 200 Fall 2013 Overweight and Obesity In adults BMI classifications Overweight 25 29 9 Obese 30 39 9 Major health problem in the U S Growing concern worldwide Prevalence continues to increase Epidemic is worldwide Not merely among industrialized countries Overweight and Obesity Adults More than one third of U S adults 35 7 are obese Non Hispanic blacks have the highest ageadjusted rates of obesity 49 5 compared with Mexican Americans 40 4 all Hispanics 39 1 and non Hispanic whites 34 3 http www cdc gov Overweight and Obesity Adults Among non Hispanic black and MexicanAmerican men those with higher incomes are more likely to be obese than those with low income Higher income women are less likely to be obese than low income women http www cdc gov Overweight and Obesity Adults There is no significant relationship between obesity and education among men Among women however there is a trend those with college degrees are less likely to be obese compared with less educated women Between 1988 1994 and 2007 2008 the prevalence of obesity increased in adults at ALL income and education levels http www cdc gov Increasing Prevalence of Obesity among US Adults Obesity Definition in Children Overweight is defined as a BMI at or above the 85th percentile and lower than the 95th percentile for children of the same age and sex Obesity is defined as a BMI at or above the 95th percentile for children of the same age and sex Obesity Children Approximately 17 or 12 5 million of 2 19 years are obese Since 1980 obesity prevalence among children and adolescents has almost tripled In 2007 2008 Hispanic boys were more likely to be obese than non Hispanic white boys and nonHispanic black girls were significantly more likely to be obese than non Hispanic white girls Complications of obesity in childhood High blood pressure and high cholesterol Increased risk of impaired glucose tolerance insulin resistance and type 2 diabetes Breathing problems sleep apnea asthma Musculoskeletal problems Fatty liver disease gallstones GERD Social and psychological problems such as discrimination and poor self esteem Long term complications Obese children are more likely to become obese adults If children are overweight obesity in adulthood is likely to be more severe Fat Cell Development Energy in exceeds energy out Stored in fat cells of adipose tissue Body fat Number and size of fat cells Periods in life when fat cell numbers increase Cell proliferation Energy out exceeds energy in Fat cell size decreases no change in number Fat Cell Development Causes of Overweight Obesity Genetics Epigenetics Causative role of genetics Genetic influences do seem to be involved Genetics may determine predisposition to obesity Genes interact with Diet and physical activity Satiety and energy balance Causes of Overweight Obesity Genetics Epigenetics Obesity gene Codes for the protein leptin Acts as a hormone in hypothalamus Promotes negative energy balance Suppresses appetite Increases energy expenditure Mice with and without Leptin Compared Causes of Overweight Obesity Genetics Epigenetics Obesity gene Genetic defect is a rare cause of obesity Ie Prader Willi syndrome is an uncommon genetic disorder characterized by mental retardation decreased muscle tone short stature emotional lability and an insatiable appetite which can lead to life threatening obesity Causes of Overweight Obesity Environment Encountered daily circumstances Interaction between environment and genetics Overeating Present and past eating and activity patterns influence current body weight Availability Serving sizes in restaurants Larger portions add up 18 We re finding that portion size can influence intake as much as taste Large packages and containers can lead to overeating foods we do not even find appealing Brian Wansink PhD John Dyson Endowed Chair in the Applied Economics and Management Department at Cornell University and author of Mindless Eating 19 Beware of the cost of extra calories 20 Portion distortion over the years Food portion sizes have changed in 20 years 21 Slides marked by this icon are adapted from Portion Distortion 21 by the National Heart Lung and Blood Institute at http hin nhlbi nih gov portion Guess the calorie difference 140 calories 350 calories 210 more calories 22 Guess the calorie difference 210 calories 610 calories 400 more calories 23 Guess the calorie difference 85 calories 250 calories 165 more calories 24 Guess the calorie difference 45 calories 350 calories 305 more calories 25 Causes of Overweight Obesity Environment Physical inactivity Life requires little exertion Modern technology Inactivity contributes to weight gain and poor health Sedentary activities and weight gain DRI for prevention of weight gain 60 minutes of moderate activity every day Problems of Overweight and Obesity Health Risks Health care professionals use 3 indicators BMI Waist circumference Disease risk profile family history blood lipid profile etc Beneficial weight loss Health status Motivation is key component Problems of Overweight and Obesity Health Risks Overweight in good health Sometimes health is not the motivation for weight loss Obese or overweight with risk factors Two or more risk factors Obese or overweight with life threatening condition Recommendation to lose weight Problems of Overweight Obesity Perceptions Prejudices Most obese people do not successfully lose weight and maintain the loss Social consequences Jobs school and in social situations Psychological problems Embarrassment Other feelings Problems of Overweight and Obesity Dangerous Interventions Intervention dangers Diet books and weight loss programs Little success with weight loss maintenance Fad diets Exaggerated or false theories Non prescription weight loss products Problems of Overweight and Obesity Dangerous Interventions Herbals and Dietary Supplements Marketed for Weight Loss Table 9 3 Few proven effective Some dangerous Ephedrine banned by FDA because implicated in heart attacks seizures and death Problems of Overweight and Obesity Dangerous Interventions As of April 11 2013 FDA had received 86 reports of illnesses and death associated with supplements containing DMAA FDA has warned companies using DMAA in dietary supplements that those products containing this ingredient are illegal http www fda gov ForConsumers ConsumerUpdates ucm347270 htm Weight Loss Gimmicks Gimmicks don t work Hot baths don t
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