Obesity Diet and Physical Activity Pennington Biomedical Research Center Division of Education
Obesity Diet and Physical Activity Pennington Biomedical Research Center Division of Education Obesity in the United States Approximately 66% (or two thirds) of U.S. Healthy People 2010: reduce the prevalence of obesity among adults to less than 15%. The obesity rate increased from the late 1970’s to 2003 from 15 to nearly 33 percent. 2009 CDC adults are overweight or obese. Obesity in the U.S. Body mass index (BMI) weight (kg)/ height squared (m2). BMI is significantly correlated with total body fat content. With a BMI of: You are considered: Below 18.5 Underweight 18.5 - 24.9 Healthy Weight 25.0 - 29.9 Overweight 30 or higher Obese BMI tables: http://www.nhlbisupport.com/bmi 2009 NIDDK Obesity in the U.S. • Obesity is further divided into three separate classes, with Class III obesity being the most extreme of the three. With a BMI of: You are considered: Below 18.5 Underweight 18.5 - 24.9 Healthy Weight 25.0 - 29.9 Overweight 30 or higher Obese 2009 CDC, NHLBI Obesity class BMI (kg/m2) Class I 30.0- 34.9 Class II 35.0-39.9 Class III ≥ 40.0 (Extreme Obesity) Obesity in the United States Percent of Obese (BMI > 30) in U.S. Adults In the United States, some minority groups are more affected than others. Income and education are also related to obesity prevalence. Some states have significantly higher rates of obesity than others. http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps 2009 NIDDK, Women’s Health / Obesity in the U.S. Being overweight/obese substantially raises one’s risk of morbidity from: Hypertension Dyslipidemia Type 2 Diabetes Coronary Heart Disease Stroke Gallbladder Disease Osteoarthritis Sleep apnea Certain cancers (endometrial, breast, prostate, colon) Higher body weights are also associated with increases in all-cause mortality. 2009 J La State Med Soc. 2005; 156: S42-S49. Obesity in the U.S. Obesity is also associated with: 2009 NIDDK High blood cholesterol Complications of pregnancy Stress incontinence ( urine leakage caused by weak pelvic-floor muscles) Menstrual irregularities Psychological disorders such as depression Hirsutism (presence of excess body and facial hair) Increased surgical risk What Causes Obesity? 2009 CDC Energy imbalance over a long period of time. Energy in > Energy out. Excess calories and lack of physical activity. Energy balance is like a scale. When calories consumed are greater than calories used, weight gain is the result. Calories Used Eating, digestion, sleeping, breathing, and movement. Excess calories. Physical activity. Energy Balance Food/beverages consumed 2009 CDC Calories in Calories used (consumed) (expended) Necessary physiological functions Physical activity Overweight The Right Approach 2009 NIDDK If your BMI is between 25 and 30 and you are otherwise healthy Try to avoid gaining any additional weight Look into healthy ways of losing weight and increasing physical activity Overweight The Right Approach Talk to your doctor about losing weight if you fall into any one of the three scenarios: 1. 2. BMI is 30 or above, or BMI is between 25 and 30 and: 1. 3. Waist measures > 35 inches (women) or > 40 inches (men) and: 1. 2009 NIDDK You have other health conditions You have other health conditions Weight Loss & Maintenance Strategies to Consider Physical Activity & Diet Therapy 2009 Why Treat Overweight and Obesity? Because there is strong evidence that weight loss reduces risk factors for diabetes and cardiovascular disease, such as: blood pressure serum triglycerides total serum cholesterol low-density lipoprotein cholesterol blood glucose levels 2009 NHLBI Weight Loss Programs Any safe and effective weight-loss program should include these components: Healthy eating plans that reduces caloric intake Regular physical activity and/or exercise instruction Tips on healthy behavior Slow and steady weight loss of about ¾ to 2 pounds a week Medical care if needed A plan to keep the weight off after you have lost it 2009 NIDDK Weight Loss The key to any successful weight loss is making changes in your eating and physical activity habits that you can keep for the rest of your life. 2009 NIDDK Physical Activity Physical Inactivity In the U.S. Many studies show that Americans are too sedentary. Due to Increased use of technology. Increased use of automobiles. According to the Behavioral Risk Factor Surveillance System, in 2000 more than 26 percent of adults reported no leisure time physical activity. 2009 CDC Physical Inactivity In the U.S. Physical inactivity contributes to premature deaths. Rates differ by race and ethnicity. Hispanic women - most inactive Hon-Hispanic women – second Asian and Pacific islander women – third and, lastly, White non-Hispanic women - fourth. 2009 Women’s Health Physical Activity 2009 CDC Contributes to weight loss. Helpful for the prevention of overweight and obesity. Helps maintain weight loss. Physical Activity 2009 CDC Occupational work Carpentry, construction, waiting tables, farming Household chores Washing floors or windows, gardening, or yard work Leisure time activities Walking, skating, biking, swimming, playing Frisbee, dancing, softball, tennis, football, aerobics Physical Activity Regular physical activity is good for overall health. Physical activity decreases the risk for: Physical activity also helps to: 2009 CDC Colon cancer Diabetes High blood pressure Control weight Contribute to healthy bones, muscles, and joints Reduce falls among the elderly Relieve the pain of arthritis. How Much Physical Activity a Day? The 2005 Dietary Guidelines for Americans recommend the following for adults: To reduce the risk of chronic diseases in adulthood: Engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week. To help manage weight and prevent gradual, unhealthy weight gain in adulthood: Engage in approximately 60 minutes of moderate- to vigorous-intensity activity on most days of the week while not exceeding caloric intake requirements. To sustain weight loss in adulthood: Participate in at least 60 to 90 minutes of daily moderate- to vigorous-intensity physical activity while not exceeding caloric intake requirements. (Some may need to contact their healthcare provider before participating in this level of activity.) 2009 Dietary Guidelines for Americans How Much Physical Activity a Day? 2009 Any activity helps. Moderate physical activity brings health benefits. Make it personal. Start slowly (10 minute walk/day). Increasing Physical Activity You can increase your physical activity by taking small steps to change what you do everyday. If you normally… Then try this instead! Park as close as possible to the store Park farther away Let the dog out back Take the dog for a walk Take the elevator Take the stairs Have lunch delivered Walk to pick up lunch Relax while the kids play Get involved in their activity 2009 Women’s Health How Many Calorie Am I Burning? Calories burned/hour of activity Activity 100 lb 150 lb 200 lb Bicycling, 6 mph 160 240 312 Bicycling, 12 mph 270 410 534 Jogging, 7 mph 610 920 1,230 Jumping rope 500 750 1,000 Running, 5.5 mph 440 660 962 Running, 10 mph 850 1,280 1,664 Swimming, 25 yds/min 185 275 358 Swimming, 50 yds/min 325 500 650 Tennis singles 265 400 535 Walking, 2 mph 160 240 312 Walking, 3 mph 210 320 416 Walking, 4.5 mph 295 440 572 2009 American Heart Association How Many Calories Do I Need? 2009 ACS To maintain - use your current weight. To lose - use the average healthy weight recommended for your height. Calculating Ideal Body Weight For men: Use 106 pounds of body weight for the first 5 feet of their height. Add 6 pounds for each additional inch. For women: Use 100 pounds of body weight for the first 5 feet of their height. Add 5 pounds for each additional inch. 2009 A 5’9 man’s ideal body weight would be: First 5’0 = 106 lb standard weight for men Plus 9 additional inches 9 (6 lbs)= 54 lbs 106 + 54= 160 pounds (± 10%)= 144 to 176 144 to 176 pounds is this man’s idea weight A 5’4 woman’s ideal body weight would be: First 5’0= 100 lb standard weight for women Plus 4 additional inches 4(5 lbs)= 20 100 + 20= 120 pounds (± 10%)= 108 to 132 108 to 132 pounds is this woman’s ideal weight How Many Calories Do I Need? 2009 USDA’s MyPyramid site: http://www.mypyramid.gov/ Determines calorie needs and calculates the servings needed from food groups. The American Cancer Society (ACS) site: http://www.cancer.org/docroot/PED/content/PED_6_1x_ Calorie_Calculator.asp The ACS site indicates the number of calories that are needed per day to maintain your current weight. On the Path to Increased Physical Activity Before Beginning an Exercise Program You should check with your doctor before beginning an exercise program if you: 2009 Mayo Clinic Are a man older than age 40 or a woman older than age 50 Have had a heart attack Have a family history of heart-related problems before age 55 Have heart, lung, liver or kidney disease Feel pain in your chest, joints, or muscles during physical activity Have high blood pressure, high cholesterol, diabetes, arthritis, osteoporosis, or asthma Have had joint replacement surgery Smoke Are overweight or obese Tale medication to manage a chronic condition Have an untreated joint or muscle injury, or persistent symptoms after a joint or muscle injury Are pregnant Unsure of your health status. Health Benefits of Physical Activity Health benefits of physical activity. CMAJ. 2006; 174(6): 801-809. Physical Activity Primary Effects on Diabetes Mellitus Aerobic and resistance types of exercise decrease the incidence of type 2 diabetes. A modest weight loss through diet and exercise reduces the incidence of diabetes. 2009 CMAJ. 2006;174(6): 801-809. Physical Activity Secondary Effects on Diabetes Mellitus Exercise helps in the management of diabetes. Aerobic and resistance training help in the control of diabetes 2009 CMAJ. 2006;174(6): 801-809. Physical Activity Primary Effects on Cancer Routine activity reduces the incidence cancers. Activity results in a 30-40% reduction in the relative risk of colon cancer and breast cancer. Moderate physical activity is believed to exhibit a greater protective effect than activities of less intensity. 2009 CMAJ. 2006;174(6): 801-809. Physical Activity Secondary Effects on Cancer Regular physical activity - important. Increased self-reported physical activity = decreased reoccurrence of cancer and a decreased risk of death from cancer. Reduced cancer-related death. 2009 CMAJ. 2006;174(6): 801-809. Physical Activity Primary Effects on Osteoporosis Many studies have been conducted. According to findings, routine physical activity, especially weight-bearing and impact exercise, prevents bone loss associated with aging. 2009 CMAJ. 2006;174(6): 801-809. Physical Activity Secondary Effects on Osteoporosis Regular physical activity can lead to stronger bones. Bone responds to physical stress at any age; even in the elderly. Osteoporosis 2009 CMAJ. 2006;174(6): 801-809. Eating for Weight Loss The Critical Role of Healthy Eating 2009 CDC Good nutrition leads to a healthier life. Many do not eat based on MyPyramid recommendations. U.S. Eating Habits 82 81% 80 78 77% Percentage of adults reporting that they consumed fewer than 5 servings of fruits and vegetables/day, 2000 76 74 73% 72 70 68 In 2000, the larger majority of U.S. adults reported that they did not consume 5 or more servings of fruits and vegetables/day. Men Women Total 2009 CDC. Behavioral Risk Factor Surveillance System Dietary Guidelines for Americans, 2005 Tips for Healthy Eating MyPyramid, which is the newest Food Guide Pyramid, recommends the following for a healthy lifestyle: 1. 2. 3. 4. 5. 6. Make half your grains whole Vary your veggies Focus on fruit Get your calcium rich foods Go lean with protein Find your balance between food and physical activity 2009 MyPyramid: http://mypyramid.gov/ A Healthy Diet The 2005 Dietary Guidelines for Americans defines a healthy diet as one that: Emphasizes fruits, vegetables, whole grains, fat-free or low-fat milk, & milk products; Includes lean meats, poultry, fish, beans, eggs, and nuts Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars. 2009 MyPyramid: http://mypyramid.gov/ Dietary Guidelines for Americans, 2005 Key Recommendations for the General Population 1. Adequate Nutrients Within Calorie Needs Consume a variety of nutrient-dense foods (whole grains, fruits and vegetables, lean meats, low-fat dairy) and beverages within and among the basic food groups while choosing foods that limit the intake of saturated fats and trans fats, cholesterol, added sugars, salt, and alcohol. Meet recommended intakes within energy needs by adopting a balanced eating pattern, such as the USDA Food Guide or the Dietary Approaches to Stop Hypertension (DASH) Eating Plan. 2009 MyPyramid: http://mypyramid.gov/ Dietary Guidelines for Americans, 2005 Key Recommendations for the General Population 2009 MyPyramid: http://mypyramid.gov/ 2. Weight Management To maintain body weight in a healthy range, balance calories from foods and beverages with calories expended. To prevent gradual weight gain over time, make small decreases in food and beverage calories and increase physical activity. Dietary Guidelines for Americans, 2005 Key Recommendations for the General Population 3. Physical activity Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a healthy body weight. Achieve physical fitness by including cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises for muscle strength and endurance. 2009 MyPyramid: http://mypyramid.gov/ Dietary Guidelines for Americans, 2005 Key Recommendations for the General Population 4. Food Groups to Encourage Consume a sufficient amount of fruits and vegetables while staying within energy needs. Choose a variety of fruits and vegetables each day. Select from all five vegetable subgroups (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week. Consume 3 or more ounce-equivalents of whole-grain products per day, with the rest of the recommended grains coming from enriched or whole-grain products. At least half the grains should come from whole grains. Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products. 2009 MyPyramid: http://mypyramid.gov/ Dietary Guidelines for Americans, 2005 Key Recommendations for the General Population 5. Fats Keep total fat intake between 20 - 35 percent of calories (With most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils). Limit intake of fats and oils high in saturated and/or trans fatty acids, and choose products low in such fats and oils. Consume less than 10 percent of calories from saturated fatty acids Consume less than 300 mg/day of cholesterol Keep trans fatty acid consumption as low as possible When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low-fat, or fat-free. 2009 MyPyramid: http://mypyramid.gov/ Dietary Guidelines for Americans, 2005 Key Recommendations for the General Population 6. Carbohydrates Choose fiber-rich fruits, vegetables, and whole grains often. Choose and prepare foods and beverages with little added sugars or caloric sweeteners. Reduce the incidence of dental caries by practicing good oral hygiene and consuming sugar- and starch-containing foods and beverages less frequently. 7. Sodium and Potassium Consume less than 2,300 mg (approximately 1 teaspoon of salt) of sodium per day. Choose and prepare foods with little salt. At the same time, consume potassium-rich foods, such as fruits and vegetables. 2009 MyPyramid: http://mypyramid.gov/ Dietary Guidelines for Americans, 2005 Key Recommendations for the General Population 8. Alcoholic Beverages Those who choose to drink alcoholic beverages should do so sensibly and in moderation (≤ 1 drink for women/day and ≤ 2 drinks for men/day). Alcoholic beverages should be avoided by individuals engaging in activities that require attention, skill, or coordination, such as driving or operating machinery. Alcoholic beverages should not be consumed by some individuals, including: those who cannot restrict their alcohol intake, women of childbearing age who may become pregnant, pregnant and lactating women, children and adolescents, individuals taking medications that can interact with alcohol, and those with specific medical conditions. 2009 MyPyramid: http://mypyramid.gov/ Dietary Guidelines for Americans, 2005 Key Recommendations for the General Population 9. Food Safety To avoid microbial food borne illness: Clean hands, food contact surfaces, fruits, and vegetables. Meat and poultry should not be washed or rinsed. Separate raw, cooked, and ready-to-eat foods while shopping, preparing, or storing foods. Cook foods to a safe temperature to kill microorganisms. Chill (refrigerate) perishable food promptly and defrost foods properly. Avoid raw (unpasteurized) milk or any products made from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, unpasteurized juices, and raw sprouts. 2009 MyPyramid: http://mypyramid.gov/ Weight loss: Goals for Weight Management of Weight Lost Calorie Deficit Needed For Weight Loss ACS A calorie deficit of no more than 500 kcal/day. This can be achievable through the combination of diet + exercise. An example of how to create a calorie deficit of 500 kcal/day through diet + exercise would be: eating 250 kcal less per day, along with burning 250 calories through exercise 2009 Calorie Deficit Needed For Weight Loss A caloric deficit of 500 can be done by: 2009 Eating 250 kcal less per day: Leave out mayonnaise in a sandwich Leave out dessert Switch from soft drinks to water Reduce portion sizes burning 250 calories through exercise: Walk for 30 minutes Swimming 25 yards Bicycling for 30 minutes Exercise + Dieting Calorie Deficit 2009 NHLBI Initially physical activity, in combination with dieting, is an important component of weight loss. However, after around 6 months, physical activity will not lead to substantially greater weight losses when combined with dieting. The benefit of sustained physical activity thereafter is mainly through its role in the prevention of weight gain. In addition, it has a benefit in reducing cardiovascular and diabetes risks beyond that produced by weight gain alone. Goals for Weight Loss And Management The initial goal of weight loss therapy is to reduce body weight by approximately 10 percent from baseline. Once this goal is achieved, then further weight loss can be attempted, if necessary. A reasonable time line for a 10 percent reduction in body weight is 6 months. Experience reveals that lost weight is usually regained unless a weight maintenance program, consisting of diet therapy, physical activity and behavior therapy, is continued indefinitely. 2009 NHLBI Goals for Weight Loss And Management For overweight individuals with BMIs in the typical range of 27 to 35 kg/m2, a decrease of 300 to 500 kcal/day will result in weight losses of about ½ to 1 lb per week. A 10 percent weight loss could be achieved within 6 months. For more severely obese individuals (BMI > 35), deficits of up to 500 to 1,000 kcal/day will lead to weight losses of about 1 to 2 lb per week. A 10 percent weight loss could be achieved within 6 months. 2009 NHLBI Goals for Weight Loss And Management 2009 After 6 months of weight loss treatment, the individual should be assessed. If no further weight loss is needed, then the current weight should be maintained. Sustained physical activity is particularly important in the prevention of weight regain. If further weight loss is desired, another attempt at weight reduction can be made. Pennington Biomedical Research Center 2009 Division of Education Phillip Brantley, PhD, Director Pennington Biomedical Research Center Claude Bouchard, PhD, Executive Director Heli J Roy, PhD, RD, Associate Professor Beth Kalicki About Our Company The Pennington Biomedical Research Center is a world-renowned nutrition research center. Mission: To promote healthier lives through research and education in nutrition and preventive medicine. The Pennington Center has several research areas, including: Clinical Obesity Research Experimental Obesity Functional Foods Health and Performance Enhancement Nutrition and Chronic Diseases Nutrition and the Brain Dementia, Alzheimer’s and healthy aging Diet, exercise, weight loss and weight loss maintenance The research fostered in these areas can have a profound impact on healthy living and on the prevention of common chronic diseases, such as heart disease, cancer, diabetes, hypertension and osteoporosis. The Division of Education provides education and information to the scientific community and the public about research findings, training programs and research areas, and coordinates educational events for the public on various health issues. 2009 We invite people of all ages and backgrounds to participate in the exciting research studies being conducted at the Pennington Center in Baton Rouge, Louisiana. If you would like to take part, visit the clinical trials web page at www.pbrc.edu or call (225) 763-3000. References Centers for Disease Control and Prevention (CDC): Prevalence of Overweight and Obesity Among Adults: U.S., 2003-2004. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/obese03_04/overwght_adult_03.htm Womenshealth.gov. Physical Activity. Available at: http://www.womenshealth.gov/pub/steps/Physical%20Activity.htm National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Do You Know the Health Risks of Being Overweight? Available at: http://win.niddk.nih.gov/publications/health_risks.htm National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Statistics Related to Overweight and Obesity. Available at: http://win.niddk.nih.gov/statistics/index.htm National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Weight and Waist Measurement: Tools for Adults. Available at: http://win.niddk.nih.gov/publications/tools.htm 2009 References 2009 Bellanger T, Bray G. Obesity related morbidity and mortality. J La State Med Soc. 2005; 156: S43-49. National Heart, Lung, and Blood Institute (NHLBI). Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Available at: http://www.nhlbi.nih.gov/guidelines/obesity/ob_exsum.pdf National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Choosing a Safe and Successful Weight-loss Program. Available at: http://win.niddk.nih.gov/publications/choosing.htm National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Weight Loss for Life. Available at: http://win.niddk.nih.gov/publications/for_life.htm Warburton D, Nicol C, Bredin S. Health benefits of physical activity: the evidence. 2006; CMAJ; 174(6): 801-809. References Dietary Guidelines for Americans 2005. Available at: http://www.health.gov/dietaryguidelines/dga2005/recommendations.htm 2009 American Heart Association (AHA). Physical Activity Calorie Use Chart. Available at: http://www.americanheart.org/presenter.jhtml?identifier=756 American Cancer Society (ACS). Exercise Counts. How Many Calories Will Your Activity Burn? Available at: http://www.cancer.org/docroot/PED/content/PED_6_1x_Calorie_Calculator.asp Mayo Clinic. Exercise: When To Check With Your Doctor First. Available at: http://www.mayoclinic.com/health/exercise/SM00059
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