Obesity

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 Definition

Body Mass Index is a term used to define obesity.  It is ratio of weight to height.  Calculated as Wt.(kg)/Ht.(m^2)

BMI over 25 is overweight, BMI of 30 is obese

Height:                              overweight wt.:                                         obese wt.:

5’4”:                                       145                                                         174

5-6:                                        155                                                         186

5-8:                                        164                                                         197

5-10:                                      174                                                         209

6’:                                          184                                                          221

6-2”:                                       194                                                         233

6-4”:                                       205                                                         246

Body Fat method:

May be used as an addendum, especially for muscular builds from weight training.  Various techniques to measure.

  • Fit women 21-24%
  • Fit men 14-17%, a six pack abdominals is 8%.

Obesity:

  • Women:32%
  • Men:25%

Body Fat charts and pictures, 

http://www.builtlean.com/2012/09/24/body-fat-percentage-men-women/

Prevalence

Adult

  • 1/3 of U.S. adults are obese, 78.6 million people

Childhood

  • 17%, 13 million children and adolescents
  • Increased 3 to 6 fold (600%) since the 1970’s.
    • associated with head of household educational levels and socioeconomic status

by State and Country

  • highest Arkansa, Mississippi, West Virginia
  • Lowest: Colorado, California

by Race

  • Blacks: 48 %
  • Hispanics: 43 %
  • Whites: 33 %
  • Asians: 11 %

by Age

  • highest age 40-59 (39.5%)

Causes:

Genetic

  • drive to eat,
  • sedentary nature,
  • metabolism, minimal differences in most people
  • fat burning capacity or increased tendency to store fat.

Psychological

  • Overeating and eating “comfort foods”
  • can be associated with stress and depression.

Social/Cultural

  • Our social events can be centered around food,
  • often high fat and carbohydrate items
    • When the last time you had your family over to meet at the park or recreation center and go for a walk or swim or bike ride.

Behavioral

  • Habits of eating are developed over time.
  • Family habits from childhood are reflected in adult habits.
  • Lack of education on nutritional principles can be perpetuated in families.
  • Lack of motivation for long term health consequences of our behavior and lifestyle

Associated Medical Conditions:

  • Diabestes
  • Heart and VascularDisease
    • Coronary Artery Disease, Atrial Fibrillation, Congestive Heart Failure, Stroke, Hypertension, blood clots
  • Obstructive Sleep Apnea
  • Cancer
    • virtually every organ and type of cancer is associated with obesity
      • obesity can increase breast cancer risk by 30%
  • Arthritis
    • every pound of body weight contributes 7 psi to joint surface pressure
    • an extra 50 pounds contributes 350 psi on back and hips and knees
  • Infertility
    • Polycystic Ovarian Syndrome
    • increased incidence of labor and delivery consequences, like c/sections
  • Hormones
    • low testosterone
    • elevated estrogens in men and women
      • “man boobs” and female hormone related cancers
  • Psychological health
    • depression
  • Sleep pathology, Obstructive Sleep Apnea

Costs:

  • 190 Billion Dollars annually in the U.S. in direct and indirect costs are related to obesity
  • 21% of all health care spending in the U.S.
  • Obese individuals have medical costs estimated to be 30% greater than normal weight peers
    • $3,000 per obese individual per year

Treatments:

Lifestyle

  • Losing weight is not achieved by going on a diet or starting a fitness program.
  • Losing and maintaining a healthy weight requires a lifestyle change.
  • Lifestyle is defined by components involving nutrition, activity level, hobbies, and habits.

Nutritional Principles:

  • 3 meals and 3 snacks, with good eating habits:
    • eat slowly, put fork down after each bite
    • put your food on a plate, don’t graze around a buffet
    • environment:
      • don’t eat in front of TV, it’s distracting and leads to overeating.
      • drink plenty of water with your meal, have a glass of water before the meal
  • low added sugars (10% of calories from added sugars)
  • low in saturated fats(10% of calories),
  • Mediterranean dietary principles
    • fish, lean meats, legumes, fruits, vegetables, nuts, whole grain breads, plant based fats- canola and olive oil).
  • See the new guidelines: http://health.gov/dietaryguidelines/

Exercise: 

  • 30 min/day most days of the week,
  • 2 resistance weight training sessions per week.

        Adults exercise recommendations:

  • 150 minutes per week of moderate aerobics and 2 or more sessions of resistance weight training for all major muscle groups.

        Children exercise recommendations:

  • 60 minutes of physical activity every day, including at least 3 sessions of muscle building activities and 3 sessions of more intense aerobic activity like running.

Worksite Physical Activity

  • park and walk,
  • take the stairs,
  • stand up at work station,
  • use breaks to walk,
  • short walk after lunch.
  • Wellness programs:
    • motivate employees to attain health goals,
    • pay for fitness memberships,
    • give discounts on health insurance,
    • office contests to promote healthy goals.
    • Work station design:
      • stand up desks.
      • treadmill desks.

Medications:

  • Meds can reduce weight by 10-20% while taking.
  • May not result in persistent weight loss if stopped unless significant lifestyle changes are adopted.

Available Medications: 24 drugs on the market for obesity

Phentermine, generic

  • formerly part of infamous Phen/Phen combination
  • stimulant, acts to inhibit apetite

Orlistat, called Xenical

  • blocks absorption of some of the fats we eat
  • GI side effects are poorly tolerated

SGLT-2 inhibitors (Farxiga, Invoking, Jardiance)

  • Diabetes drugs, very expensive

GLP-1 agonists (Byetta, Victoza, Bydureon, Tanzeum, Trulicity)

  • Diabetes meds, very expensive, injections

Buproprion/Naloxone, called called Contrave

  • can be poorly tolerated with GI side effects

Topiramate/Phentermine, called Qsymia

  • can be poorly tolerated

Lorcaserin, called Belviq

  • 5 HT 2 serotoninergic receptor agonist

Surgery for obesity:

Restrictive procedures, shrink the stomach capacity:

  • Gastric Band
  • Gastric Sleeve
    • most popular modern procedure

Malabsorption surgeries, to prevent the digestion of calories:

  • Gastric Bypass
    • may have increased mortality and complications in some centers

Results of surgical procedures :

  • surgery can reduce all cause mortality by 50% in 5-7 years
  • surgery can reduce incidence of diabetes by 80% in 5 years

Summary/Call to action:

     Obesity is a common American malady.  Obesity has dramatic and expensive adverse affects on our health.  There are several successful strategies and treatments for obesity.  There is plenty of research showing the positive affects of losing weight.  Set a goal for your weight, develop a strategy to achieve your goal.  Measure your progress.  If not achieving your goals then seek help from friends, family, obesity support groups, or see your doctor for assistance in achieving this important goal.

References:

USPSTF

Up To Date

AAFP

CDC, http://www.cdc.gov/healthyweight/index.html