Transcript Overeating & Obesity

Overeating and Obesity
“Mmmm diabetes
here I come!”
What is considered
overweight?
The body mass index (BMI) is an internationally
recognised standard for classifying overweight
and obesity in adults. BMI is calculated by
dividing the weight in kilograms by the square
of the height in metres. For people aged 18 years
and over, a BMI of 25 or more is considered
overweight, and 30 or more is obese.
What causes overweight?
While many factors may influence an individual's weight, overweight and obesity is
due mainly to an imbalance of energy intake from the diet and energy expenditure
through physical activity. Genetic and environmental factors play a role, but attention
to diet and physical activity is important not only for preventing weight gain, but also
for weight loss and subsequent maintenance.
What are our options to fight our population
overeating and put an end to Obesity?...
Let the Fight Begin….
We can be proactive and implement as
many prevention initiatives and
programs as possible.
VS
We can continue to be reactive and wait for
Australians to develop chronic lifestyle
diseases and treat them with surgery or
medication. Putting a greater strain on the
health care system, increasing the cost to the
Australian society.
Overeating and Obesity
PREVENTION STRATEGIES
Healthy Eating Is an important prevention
strategy in regards to obesity. A balanced
diet requires a balanced intake of
'macronutrients' (fats, carbohydrates,
proteins) and 'nutrients' (vitamins and
minerals).
Healthy Eating Study
Holm (2002)
•
•
•
•
Health campaigns have been criticised for being
ineffective yet Holm (2002) conducted a survey that
investigated the efficiency of health companies in
Denmark. He claims that campaigns are effective
but they cannot stand by themselves. They can
establish a norm for what is considered healthy
behaviour.
A successful health campaign in Denmark aimed to
decrease the use of butter on rye bread sandwiches
that are a common lunch in the country. From 1985
to 2001 the number of people who said they did
not use butter on their sandwiches increased from
7 to 40%. The use of low fat milk has also changed
after health campaigns, showing that they can be
successful.
Holm claims that there was a long term effect of all
the health campaigns in Denmark as they
contributed to the people's knowledge and
motivation to change unhealthy habits.
According to Holm, successful campaigns must
address 3 levels: what the individual can do, what
can be done by the community and what the
government can do.
Healthy Eating Prymid
Models for healthy eating, such as
the 'Healthy eating pyramid' and the
'Eatwell plate' proposed by the
British Nutrition Foundation (2007)
advocate healthy eating by
suggesting the recommended
proportions, quantities and types of
food that people should eat.
Physical Activity
What is there for physical activity?
“Go from flab ….
Changing the physical environment (more stairs
and fewer escalators) can help individuals
undergo more physical activity. Also, creating
more exercise facilities, gyms and areas for
exercise can encourage physical activity.
Private or public health services that can help
people change their behaviour (for example,
doctors, pharmacies).
…..to FAB!”
Also, the government is funding personal
trainer courses, so that there will be more
people in that occupation. Their thinking is that
if more people go to personal training, the strain
on the healthcare system will be relieved.
Government Lifestyle Campaigns for
Obesity Prevention
• SWAPIT CAMPAIGN :The Australian
government has implemented many strategies
to help people win the battle with obesity.
One of the most recent of the government’s
strategies is the SwapIt campaign, in which
people are advised not to miss out the activity,
just do something similar that is a healthier
option. It encourages Australians to change
their mindset (cognitive) when dealing with
weightloss, so that they are not seen to be
‘dieting’. This may allow the negative stigma
associated with dieting to be alleviated: that
you have to miss out on the things that you
enjoy if you want to be healthy.
Australia’s 'Go For Your Life’ Campaign
The Australian prevention campaign 'Go For Your
Life' encourages children to enjoy healthy eating and
physical exercise. The program includes messages
such as…
• Drinking water everyday
• Decreasing screen time and increasing active play
• Putting more fruit and vegetables in your
lunchbox
• Increasing physical activity
• Limiting sugary foods
• Increase active modes of transport
Overeating and Obesity
TREATMENTS
Treatment Research
Foster (2006)
Treatments based on Classical Conditioning is successful as they help patients identify cues triggering inappropriate
eating and then learn new responses to them
Jackson (2008)
Reinforcing children for eating creates compulsions leading to obesity, Operant Conditioning in childhood is to blame
Hardeman et al. (2000)
Treating obesity by role models encouraging healthy lifestyles led to significant weight loss
Wing et al. (2002)
Treatments based on Classical Conditioning incur average weight loss of 15.6kg in 18 months, i.e. it works
Devlin (1995)
Treatments based on Operant Conditioning resulted in weight loss not being maintained
Weight loss after Social Learning Theory treatments tend to be short term, suggesting that other explanations should be
considered.
Dieting
“A special course of food to which one restricts oneself, either to
lose weight or for medical reasons”
Dieting Studies
• Wadden (1993) reviewed several studies to establish the
effect of moderate and severe calorie restriction on weight
loss. It was found that if an individual stayed in a
treatment programme for 20 weeks or more, 50% lost 9kg
or more. However it was also found that in the long term
participants tended to regain the lost weight, leading to the
conclusion that weight gain after the treatment is the norm.
• Brownell et al. (1989) researched weight loss in rats and
found that repeated weight loss was followed by weight
regain. Weight loss therefore becomes difficult due to
decreased metabolism and an increase in the percentage of
body fat. The researchers found similar results in human
dieters and athletes who yo-yo dieted.
• Heatherton et al. (1991) claims dieting can predict weight
fluctuations in the non-obese.
CBT - Cognitive behavioural Therapy
To deal with problematic aspects of
the condition:
•
•
•
•
Eating Behaviour
Involvement in physical activity
Body image dissatisfaction
Participation in social life
CBT Study
Stahre et al. (2007)
They conducted a randomized trial with
Swedish women who were overweight.
Half were exposed to CBT treatment and
the other were exposed to exercise
treatment. At the end of the 10 week trial
the participants weight was controlled
after an 18-month period and only little
fall outs came from both groups.
Weight loss was 5.9kg after the 18-month
follow up with sufferers exposed to CBT
treatment. The control group gained on
average 0.3kg after the 18-month follow
up.
CBT Study
Kylie Ball (Deakin University)
Kylie Ball monitored trends of obesity in
Australia. Despite increased awareness
and focus on the importance of fitness and
healthy living Australians continue to
gain weight. In order to effectively
address obesity and to maintain good
health the underlying problems of the
condition must be addressed.
CBT allows this as it also improves selfesteem and quality of life. The problem
with CBT is that it demands a lot of work
from the client which may not always be
accepted or followed through.
Drug Treatments
Drug treatments are recommended in combination with
healthy eating and regular physical exercise.
Few studies have evaluated the safety and long term
effectiveness of such drugs and some are concerned they
are over prescribed.
Appetite suppressant drugs decrease appetite or increase
the feeling of being full by increasing the number of
neurotransmitters that affect mood and appetite (serotonin
and adrenaline). They are generally considered effective
yet they can side effects such as nausea, constipation and a
dry mouth.
Lipase inhibitors act on the gastro intestinal system to
reduce fat absorption. They can have unpleasant side
effects, particularly after a meal with a high fat content.
This in itself could have a preventative effect as eating fat
becomes associated with unpleasant consequences.
Drug Treatments Study
Berkowitz et al. (2006)
• It was a longitude study
• Trial with a sample of adolescent boys and girls
• Investigated if a appetite-suppressant drug reduced weight more than a
placebo in obese adolescents
• Participants also received counselling about how to eat less food, increase
physical activity, reduce stress and keep track of how much they ate
• Average rate of participants at the beginning of the study was 97.7kg
• Those who took the drug averaged weight loss of 6.4kg
• Those who took the placebo averaged weight gain of 1.8kg
Surgical Treatment
Gastric bypass involves cutting off
part of the stomach, such as through
stapling so that it can no longer absorb
food.
Gastric banding involves putting a
band around the upper part of the
stomach so that only a small part can
receive food, causing the patient to
feel full sooner.
Surgical Treatment Study
Maggard et al. (2005)
They conducted a meta-analysis
of 147 studies. Surgery resulted in
weight loss of 20-30kg which was
maintained for up to 10 years and
also resulted in a general
improvement in health.
Gastric bypass was concluded to
be more efficient than gastric
banding.
Himpens, Cadiere & Bazi et al (2011)
The University Obesity Centre in Brussels, Belgium
82 patients, 12 years after the surgery.
Half of the people no longer had their gastric bands
Some had them removed, some didn’t want it, and some
didn’t work well enough
• 4 in 10 had serious complications
• 6 in 10 needed follow up operations
• Concluded that gastric band surgery had a mean weight loss
of 42.8% after 12 years. However, since nearly 50% of
patients required the removal of the band, it can be concluded
that gastric band surgery has poor long-term outcomes.
•
•
•
•