Publication # 21 ObesityDiet and Physical ActivityPennington Biomedical Research Center Division of Education
Obesity in the United States Approximately 66% (or two thirds) of U.S. adults are overweight or obese. 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. 2012CDC
Obesity in the U.S. Body mass index (BMI) weight (kg)/ height squared With a BMI of: You are considered: (m2). Below 18.5 Underweight 18.5 - 24.9 Healthy Weight 25.0 - 29.9 Overweight BMI is significantly correlated 30 or higher Obese with total body fat content. BMI tables: http://www.nhlbisupport.com/bmi 2012NIDDK
Obesity in the U.S. • Obesity is further divided into three separate classes, Obesity class BMI (kg/m2) with Class III obesity being the most extreme of the three. Class I 30.0- 34.9 Class II 35.0-39.9 Class III ≥ 40.0 With a BMI of: You are considered: (Extreme Obesity) Below 18.5 Underweight 18.5 - 24.9 Healthy Weight 25.0 - 29.9 Overweight 30 or higher Obese 2012CDC, NHLBI
Obesity in the United StatesPercent 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 / 2012NIDDK, Women’s Health
Obesity in the U.S. Being overweight/obese substantially raises one’s risk of morbidity from: Hypertension Gallbladder Disease Dyslipidemia Osteoarthritis Type 2 Diabetes Sleep apnea Coronary Heart Disease Certain cancers Stroke (endometrial, breast, prostate, colon) Higher body weights are also associated with increases in all-cause mortality. 2012J La State Med Soc. 2005; 156: S42-S49.
Obesity in the U.S. Obesity is also associated with: High blood cholesterol Stress incontinence ( urine leakage caused by Complications of pregnancy weak pelvic-floor muscles) Menstrual irregularities Psychological disorders such as depression Hirsutism (presence of excess body Increased surgical risk and facial hair) 2012NIDDK
What Causes Obesity? 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. 2012CDC
Calories Used Eating, digestion, sleeping, breathing, and movement. Excess calories. Physical activity. Energy Balance Necessary physiologica Calories in Calories used l functions (consumed) (expended) Food/beverage Physical activity s consumed 2012CDC
Overweight The Right Approach 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 2012NIDDK
Overweight The Right Approach Talk to your doctor about losing weight if you fall into any one of the three scenarios: 1. BMI is 30 or above, or 2. BMI is between 25 and 30 and: 1. You have other health conditions 3. Waist measures > 35 inches (women) or > 40 inches (men) and: 1. You have other health conditions 2012NIDDK
Weight Loss & Maintenance Strategies to Consider Physical Activity & Diet Therapy2012
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 2012NHLBI
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 2012NIDDK
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. 2012NIDDK
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. 2012CDC
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. 2012Women’s Health
Physical Activity Contributes to weight loss. Helpful for the prevention of overweight and obesity. Helps maintain weight loss. 2012CDC
Physical Activity 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 2012CDC
Physical Activity Regular physical activity is good for overall health. Physical activity decreases the risk for: Colon cancer Diabetes High blood pressure Physical activity also helps to: Control weight Contribute to healthy bones, muscles, and joints Reduce falls among the elderly Relieve the pain of arthritis. 2012CDC
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.) 2012Dietary Guidelines for Americans
How Much Physical Activity a Day? Any activity helps. Moderate physical activity brings health benefits. Make it personal. Start slowly (10 minute walk/day).2012
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 activity2012 Women’s Health
How Many Calories Do I Need? To maintain - use your current weight. To lose - use the average healthy weight recommended for your height. 2012ACS
Calculating Ideal Body Weight For men: A 5’9 man’s ideal body weight would be: Use 106 pounds of body weight First 5’0 = 106 lb standard weight for men for the first 5 feet of their height. Plus 9 additional inches 9 (6 lbs)= 54 lbs Add 6 pounds for each 106 + 54= 160 pounds (± 10%)= 144 to 176 additional inch. 144 to 176 pounds is this man’s idea weight For women: A 5’4 woman’s ideal body weight would be: Use 100 pounds of body weight First 5’0= 100 lb standard weight for women for the first 5 feet of their height. Plus 4 additional inches 4(5 lbs)= 20 Add 5 pounds for each 100 + 20= 120 pounds (± 10%)= 108 to 132 additional inch. 108 to 132 pounds is this woman’s ideal weight2012
How Many Calories Do I Need? 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.2012
Before Beginning an Exercise Program You should check with your doctor before beginning an exercise program if you: Are a man older than age 40 or Have had joint replacement surgery a woman older than age 50 Smoke Have had a heart attack Are overweight or obese Have a family history of heart-related problems before age 55 Tale medication to manage a chronic condition Have heart, lung, liver or kidney disease Have an untreated joint or muscle Feel pain in your chest, joints, or muscles injury, or persistent symptoms after during physical activity a joint or muscle injury Have high blood pressure, high Are pregnant cholesterol, diabetes, arthritis, osteoporosis, or asthma Unsure of your health status. 2012Mayo Clinic
Health Benefits of Physical ActivityHealth 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.2012 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 diabetes2012 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.2012 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.2012 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.2012 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. Osteoporosis2012 CMAJ. 2006;174(6): 801-809.
The Critical Role of Healthy Eating Good nutrition leads to a healthier life. Many do not eat based on MyPyramid recommendations. 2012CDC
In 2000, the larger U.S. Eating Habits majority of U.S. adults reported that they did not consume 5 or more 82 81% servings of fruits and 80 vegetables/day. 78 77% Percentage of adults 76 reporting that they consumed fewer than 74 73% 5 servings of fruits and 72 vegetables/day, 2000 70 68 Men Women Total 2012CDC. Behavioral Risk Factor Surveillance System
Dietary Guidelines for Americans, 2010 Selected messages Balancing Calories Enjoy your food, but eat less. Avoid oversized portions. Foods to Increase Make half your plate fruits and vegetables. Make at least half your grains whole grains. Switch to fat-free or low-fat (1%) milk. Foods to Reduce Compare sodium in foods like soup, bread, and frozen meals and choose the foods with lower numbers. Drink water instead of sugary drinks. 2012MyPyramid: http://mypyramid.gov/
A Healthy Diet The 2010 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. 2012MyPyramid: http://mypyramid.gov/
Dietary Guidelines for Americans, 2010 Key Recommendations for the General Population Balancing calories to Manage weight Prevent and/or reduce overweight and obesity through improved eating and physical activity behaviors. Control total calorie intake to manage body weight. For people who are overweight or obese, this will mean consuming fewer calories from foods and beverages. Increase physical activity and reduce time spent in sedentary behaviors. Maintain appropriate calorie balance during each stage of life—childhood, adolescence, adulthood, pregnancy and breastfeeding, and older age. 2012MyPyramid: http://mypyramid.gov/
Dietary Guidelines for Americans, 2010 Key Recommendations for the General Population Foods and food components to reduce Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults. Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids. Consume less than 300 mg per day of dietary cholesterol 2012MyPlate: http://mypyramid.gov/
Dietary Guidelines for Americans, 2010 Key Recommendations for the General Population Foods and food components to reduce cont. Keep trans fatty acid consumption as low as possible by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils, and by limiting other solid fats. Reduce the intake of calories from solid fats and added sugars. Limit the consumption of foods that contain refined grains, especially refined grain foods that contain solid fats, added sugars, and sodium. If alcohol is consumed, it should be consumed in moderation—up to one drink per day for women and two drinks per day for men— and only by adults of legal drinking age. 2012MyPlate: http://mypyramid.gov/
Dietary Guidelines for Americans, 2010 Key Recommendations for the General Population Foods and nutrients to increase Individuals should meet the following recommendations as part of a healthy eating pattern while staying within their calorie needs. Increase vegetable and fruit intake. Eat a variety of vegetables, especially dark-green and red and orange vegetables and beans and peas. Consume at least half of all grains as whole grains. Increase whole-grain intake by replacing refined grains with whole grains. Increase intake of fat-free or low-fat milk and milk products, such as milk, yogurt, cheese, or fortified soy beverages. 2012MyPyramid: http://mypyramid.gov/
Dietary Guidelines for Americans, 2010 Key Recommendations for the General Population Foods and nutrients to increase cont. Choose a variety of protein foods, which include seafood, lean meat and poultry, eggs, beans and peas, soy products, and unsalted nuts and seeds. Increase the amount and variety of seafood consumed by choosing seafood in place of some meat and poultry. Replace protein foods that are higher in solid fats with choices that are lower in solid fats and calories and/or are sources of oils. Use oils to replace solid fats where possible. 2012MyPyramid: http://mypyramid.gov/
Dietary Guidelines for Americans, 2010 Key Recommendations for the General Population Foods and nutrients to increase cont. Choose foods that provide more potassium, dietary fiber, calcium, and vitamin D, which are nutrients of concern in American diets. These foods include vegetables, fruits, whole grains, and milk and milk products. 2012MyPyramid: http://mypyramid.gov/
Dietary Guidelines for Americans, 2010 Key Recommendations for the General Population Building healthy eating Patterns Select an eating pattern that meets nutrient needs over time at an appropriate calorie level. Account for all foods and beverages consumed and assess how they fit within a total healthy eating pattern. Follow food safety recommendations when preparing and eating foods to reduce the risk of foodborne illnesses. 2012MyPyramid: http://mypyramid.gov/
Weight loss:Goals for WeightManagement of Weight Lost
Calorie Deficit Needed For Weight Loss 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 2012ACS
Calorie Deficit Needed For Weight Loss A caloric deficit of 500 can be done by:Eating 250 kcal less per day: and burning 250 calories through exercise: Leave out mayonnaise in a Walk for 30 minutes sandwich Swimming 25 yards Leave out dessert Bicycling for 30 minutes Switch from soft drinks to water Gardening for 1 hr Reduce portion sizes2012
Exercise + Dieting Calorie Deficit 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. 2012NHLBI
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. 2012NHLBI
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. 2012NHLBI
Goals for Weight Loss And Management 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.2012
Pennington Biomedical Research Center Heli J Roy, PhD, RD, Associate Professor Beth Kalicki, BS Phillip Brantley, PhD, Director, Division of Education Steven Heymsfield, MD, Executive Director, Pennington Biomedical Research Center2012
About Our CompanyThe 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 ResearchExperimental ObesityFunctional FoodsHealth and Performance EnhancementNutrition and Chronic DiseasesNutrition and the BrainDementia, Alzheimer’s and healthy agingDiet, exercise, weight loss and weight loss maintenanceThe 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 andresearch areas, and coordinates educational events for the public on various health issues.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) 763-3000.2012
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.htm2012
References 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): 801-809.2012
References Dietary Guidelines for Americans 2005. Available at: http://www.health.gov/dietaryguidelines/dga2005/recommendations.htm 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/SM000592012
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