Transcript Eight Weeks to Wellness (Week 5)

Achieve and
Maintain a
Healthy Weight
Week 5 – Eight Weeks to Wellness™
Developed by Don Hall, DrPH, CHES
© 1997 - 2004 LifeLong Health®
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• Sponsored by:
Lassen Foundation
2801 Williams Rd.
Butte Valley, CA 95965
• Your name, Health Educator
© 1997 - 2004 LifeLong Health®
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Overweight, the Problem
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Each year in the U.S. over 400,000 people die
prematurely due to excess fat weight
In the U.S., 2 out of 3 adults adults (62%)
exceed the “Healthy Weight” standard
The prevalence of obesity has increased by
74% since 1991 to 41.3 million U.S. adults
(BMI 30+)
The current trend is a significant increase in
obesity in both adults and children
JAMA, Jan 1, 2003; 289:76-79
© 1997 - 2004 LifeLong Health®
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Excess Weight Increases the Risk For…
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Heart disease
Stroke
Type 2 diabetes
Osteoarthritis
Certain cancers
Early death
Poorer health related quality of life than
smoking, problem drinking, or poverty
JAMA, Jan 1, 2003; 289:229-30
© 1997 - 2004 LifeLong Health®
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The Good News About Weight
• If you need to lose weight, even
a loss of 10-15 pounds can make
big improvements to your health
– Improved glucose levels
– Improved blood fat levels
– Improved blood pressure
– Significant decrease in health risks
© 1997 - 2004 LifeLong Health®
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What is a Healthy Weight?
• For young adults, the weight at which
you look and feel your best
• For athletes, the weight at which
you perform your best
• For everyone, the range of weights for a
given height that correspond to the
lowest rate of morbidity and mortality
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Overweight and Mortality
1.75
1.60
1.5
1.35
1.25
1.20
1.00
1.10
1
19 to 21.9
Lean
22 to 24.9
25 to 26.9
27 to 28.9
29 to 31.9
Body Mass Index (BMI) Obese
NEJM, Aug. 5, ’99, 430
© 1997 - 2004 LifeLong Health®
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Overweight and Mortality
1.75
1.50
1.50
1.30
1.25
1.10
1.00
1.00
19 to 21.9
22 to 24.9
1.00
Lean
© 1997 - 2004 LifeLong Health®
25 to 26.9
27 to 28.9
Body Mass Index (BMI)
29 to 31.9
Obese
NEJM, Aug. 5, ’99, 430
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Weight Risk Categories
BMI
% of Pop.
<18.5
---
18.5-24.9
40%
Overweight
25+
58%
Obese
30+
21%
Very obese
40+
Underweight
Normal weight
2.3%
Prevalence of Obesity, JAMA Jan 1, 2003; 289:76-9
© 1997 - 2004 LifeLong Health®
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Weight Ranges Based on BMI
Ht (in)
BMI 20
BMI 25*
BMI 30**
58 in.
96 lb
119 lb
143 lb
60
102
128
153
62
109
136
164
64
116
145
174
66
124
155
186
68
131
164
197
70
139
174
209
72
147
184
221
74
155
194
233
76
164
205
246
* People with a BMI less than 25 live the longest
** Obesity is defined as a BMI of 30+
© 1997 - 2004 LifeLong Health®
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BMI and Life Expectancy
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Men with a BMI of
23-25 live the longest
A 30 year old male
who has a BMI of 38
will lose 4 years from
his life
The same person
with a BMI of 45+ will
lose 11 years of life
JAMA, Jan 8, 2003; 289:187-193
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Life expectancy (yrs)
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77
75
73
71
69
67
65
24 30 32 35 38 40 45+
BMI, Men Age 30
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BMI and Life Expectancy
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Women with a BMI of
23-25 live the longest
A 30 year old female
who has a BMI of 38
will lose 4 years from
her life
The same women
with a BMI of 45+ will
lose 9 years of life
JAMA, Jan 8, 2003; 289:187-193
© 1997 - 2004 LifeLong Health®
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Life expectancy (yrs)
•
77
75
73
71
69
67
65
24 30 33 36 38 40 45+
BMI, Women Age 30
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Weight and Prevalence of Diabetes
25.0
25.6
20.0
15.0
14.9
10.0
5.0
7.3
4.1
0.0
Normal
N=195 005
Overweight
Obese
Very obese
Weight Status
JAMA Jan 1, 2003; 289:76-79
© 1997 - 2004 LifeLong Health®
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Weight and Prevalence of
High Blood Pressure
50.0
50.9
40.0
40.9
30.0
27.8
20.0
15.9
10.0
0.0
Normal
N=195 005
Overweight
Obese
Very obese
Weight Status
JAMA Jan 1, 2003; 289:76-79
© 1997 - 2004 LifeLong Health®
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Weight and Prevalence of
High Cholesterol
40.0
39.4
34.1
30.0
20.0
23.5
10.0
0.0
Normal
N=195 005
Overweight
Obese
Weight Status
JAMA Jan 1, 2003; 289:76-79
© 1997 - 2004 LifeLong Health®
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Weight and Prevalence of Arthritis
50.0
40.0
44.2
30.0
32.1
20.0
23.7
17.7
10.0
0.0
Normal
N=195 005
© 1997 - 2004 LifeLong Health®
Overweight
Obese
Very obese
Weight Status
JAMA Jan 1, 2003; 289:76-79
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Weight and Prevalence of
“Fair or Poor Health”
40.0
37.6
30.0
20.0
22.5
10.0
11.8
14.1
0.0
Normal
N=195 005
© 1997 - 2004 LifeLong Health®
Overweight
Obese
Very obese
Weight Status
JAMA Jan 1, 2003; 289:76-79
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Weight and Health Care Costs
BMI
40+
BMI
35+
$3,753
$3,182
Obese BMI 30+
Over
$2,801
Wt
$2,388
Healthy Wt $2,225
Under Wt
$3,184
$2,000
177,971
subjects
$2,500
$3,000
$3,500
Annual Median Medical Charges
© 1997 - 2004 LifeLong Health®
American J Health Promotion, Jan-Feb 2003
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Waist Girth Measurement
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Waist girth measures intraabdominal fat, the most
dangerous kind of fat
Waist girth is a better risk
indicator than BMI alone
Measure your waist:
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At the level of the navel
Pull tape firm but not tight
Relax and don’t “suck it in”
Compare results to norms
© 1997 - 2004 LifeLong Health®
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Cardiovascular Disease Risks (RR)
Waist Girth and Health Risk
Men
2.37
2.0
1.0
1.00
0.0
<35"
n=4,388
© 1997 - 2004 LifeLong Health®
1.19
90 cm
100 cm
35"
39"
Waist Girth in Inches
The Lancet, Mar. 3, 2001
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Cardiovascular Disease Risks (RR)
Waist Girth and Health Risk
3.0
3.16
Women
2.0
1.56
1.0
1.00
83 cm
0.0
<33"
n=4,631
33"
93 cm
37"
Waist Girth in Inches
American Journal of Clinical Nutrition, Oct. 2002
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Waist Girth Action Steps
Waist Girth
Men Women
Action
<35”
<33”
Low risk. Maintain with healthy
eating and regular physical activity.
35”
33”
90 cm
83 cm
39” +
37”+
100 cm
93 cm
Moderate risk. Warning! Limit future
weight gain, eat more healthfully,
be more physically active.
High risk. Risk reduction & weight loss
necessary. Develop a weight loss
program (diet and physical activity)
with a health professional’s guidance
and support.
American Journal of Clinical Nutrition, Oct. 2002
© 1997 - 2004 LifeLong Health®
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Trends in Eating Practices
in Last 19 Years
1. Portion sizes and
energy intake has
increased significantly
2. More meals are
eaten out of home
- 35% of calories come
from fast food and
restaurant meals
- Soft drinks
49 cal
- Salty snacks
93 cal
- French fries
68 cal
3. Snack calories has
increased by 73%
- Hamburgers
97 cal
- About 20% of all
- Mexican dishes
133 cal
JAMA Jan 22/29, 2003; 289:450-53
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calories now come
from snack foods
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Nutrient Intake and Weight
Gain over 10 Years
176
Weight (lbs)
174
Low intake, Q1
175
High intake, Q5
172
171.6
170
170
168
169
166
164
162
167.1
166.7
Q1
167
Q5
Fiber
N=1602
169.4
Fat
Carbohydrate
Protein
Low v. High Intake (Q1 v. Q5)
© 1997 - 2004 LifeLong Health®
JAMA 282:1539-46
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Study Conclusions
• A low fiber intake predicted weight gain
and other CVD risk factors more strongly
than did saturated or total fat intake.
• High-fiber diets may protect against
obesity and CVD by lowering insulin
levels.
JAMA 282:1539-46
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Practical Steps to a
Healthy Weight
© 1997 - 2004 LifeLong Health®
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Adopt a Healthy Lifestyle
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Dieting doesn’t work long-term.
You need a plan you can live
with for the rest of your life:
– healthy eating habits
– regular physical activity
– good coping skills and behavior change
techniques
© 1997 - 2004 LifeLong Health®
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Set an Achievable Goal
• Start with a weight loss goal of 5-10% of
•
your weight (10-15 pounds)
This is sufficient to see healthy changes in:
– blood pressure
– blood fats (lower triglycerides and higher
HDLs)
– insulin resistance (lower blood sugar and
insulin levels)
© 1997 - 2004 LifeLong Health®
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Weekly Weight Loss Goal
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Weight loss of 1/2 to 2 pounds/week is ideal
Rapid weight loss usually involves water loss
and loss of protein stores (more than fat loss)
– Very restrictive diets that promise quick results are
not good long-term solutions.
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After achieving this goal, maintain the loss for
a few months before attempting to lose
additional weight.
© 1997 - 2004 LifeLong Health®
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Be Active
If you can’t get skinny, get fit!
– Physical activity burns calories
– It reduces your risk of diabetes,
heart problems, and even
certain cancers
– Physical activity counteracts
many of the health problems
linked to excess fat weight
© 1997 - 2004 LifeLong Health®
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Calories Burned in Exercise
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Every minute of
activity burns 3-12
times more calories
than sitting.
Notice the relative
increase in calories
burned for the
various activities
listed on the right
Activity
Increase
Sitting
1X
Calisthenics
3-8 X
Climbing hills
5-10X
Biking 10 mph
7X
Aerobic dance
3-9 X
Walking, 4 mph
4.3 X
Skipping rope, 70/min
9X
Running, 9 min/mile
11.2X
Tennis
4-9 X
Swimming
4-8 X
Source: ACSM Resource Manual
© 1997 - 2004 LifeLong Health®
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Change in body fat (%)
Exercise and Body Fat Changes
0.0
-0.5
-2.5
-2.5
-3.8
-5.0
Total body fat
Intra-abdominal fat
-4.2
-6.1
-6.9
-7.5
N=172
Control
© 1997 - 2004 LifeLong Health®
Low activity
Moderate
activity
High activity
JAMA Jan 15, 2003; 289:329
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Body Weight, Fitness Level, and
Risk of Mortality from All Causes
Fit
Unfit
3.00
Relative risk,
all cause
mortality
2.00
(n)=25,714
10.1 years of
1.00
follow-up
3.1
2.5
2.2
1.0
1.1
1.1
0.00
Normal Weight
Overweight
Obese
JAMA, Oct. 27, 1999, pp. 1547-53
© 1997 - 2004 LifeLong Health®
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Eat Well
Choose healthy foods
– Lower in calories
– Unrefined, high in
fiber and nutrients
– Eaten at regular
meals
– Limit snacks
– Limit portion sizes
– Limit fast foods
© 1997 - 2004 LifeLong Health®
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Choose Lower Calorie Foods
• Fresh fruits
• Vegetables and
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•
salads
Nonfat or low fat
dairy, or soy milk
Choose whole-grains
– whole-wheat breads
– whole grain cereals
– brown rice
© 1997 - 2004 LifeLong Health®
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Limit Refined and Snack Foods
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Soda pop, other sugar rich drinks
Snack foods
Cookies
Chips
Candy and sweets
Alcohol containing drinks
Desserts
– pastry, cookies, cake, pie, ice cream,
cheese cake
© 1997 - 2004 LifeLong Health®
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Limit Foods High in Saturated Fats
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Fast foods
Fried foods such as
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Fatty meats
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– French fries
– Onion rings
– Fried chicken
– Hamburgers, hot dogs, bacon, sausage, fried chicken
Cream sauce and gravies
Whole milk or yogurt
Ice cream, cheese, sour cream, cream cheese
© 1997 - 2004 LifeLong Health®
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Watch Portion Size and 2nd Helpings
Servings Defined
• Grains
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– Breads, 1 slice
– Cereal, 1/2 cup cooked,
2/3 cup dry
– Pasta, 1/2 cup cooked
Meats/proteins
– 2-3 oz. of meat, poultry, fish
– Beans 2/3 cup, nuts 1 oz
Fruits and vegetables
– 1 cup fresh, 1/2 cup cooked
– One small fresh fruit
© 1997 - 2004 LifeLong Health®
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Limit Snack Foods
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Eating between meals can add extra calories
quickly
•
Snack foods are usually highest
in calories and lowest in nutrition
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10 extra calories per day can add up an
additional pound of fat in one year!
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If you must snack, choose healthy snacks –
fresh fruit, vegetables, whole wheat bread
© 1997 - 2004 LifeLong Health®
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Meal Planning
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Eat regular meals (avoid skipping meals and
frequent snacking on “junk” foods)
Develop new cooking techniques,
– limit high-calorie ingredients (e.g., fats, oils, and
sugar)
– do less frying (or use vegetable sprays for oil)
Read nutrition labels, look for calorie content
Limit eating out, and when you do, look for
healthy, low calorie choices (ask your waiter
or waitress for help)
© 1997 - 2004 LifeLong Health®
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New Food Pyramid
© 1997 - 2004 LifeLong Health®
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Eating Summary
Limit…
– Fatty meats, whole
milk, cheese, cream
– Pastry, deep fried
foods, snacks
– Most desserts: ice
cream, pie, cake,
candy, and soda pop
– Serving sizes
– Second helpings
– Eating out
© 1997 - 2004 LifeLong Health®
Increase…
– Fresh fruits/vegetables
– Soy and other legumes
– Whole grain breads
and other unrefined
cereals
– High fiber foods
– Lower calorie foods
– Water
– Physical activity
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Behavior Change Techniques
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Develop a strong system of
social support
Avoid cues or triggers to
overeat
Develop problem-solving
skills in relation to
eating/exercise
Change self-defeating
thoughts
© 1997 - 2004 LifeLong Health®
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Keep Records
• You are more likely to succeed
if you set goals and keep records
– weekly weight chart
– daily exercise log
– eating goals
• Keep goals realistic and attainable
• Reward your progress
© 1997 - 2004 LifeLong Health®
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Maintain Good Coping Skills and
a Positive Mental Outlook
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Overeating often takes place when
discouraged, overwhelmed, frustrated, or
stressed out
Keep life balanced and stress within limits
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Plan time to relax and have fun
Keep stress within manageable limits
Be nice to yourself
Avoid discouragement, don’t focus on failures
Keep a positive, “can do” mental outlook
© 1997 - 2004 LifeLong Health®
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Lifetime Weight Control
• For long-term success keep in mind that
•
you are not dieting but developing a
healthy lifestyle you can maintain for a
lifetime.
For further help, get guidance from:
– A dietitian
– Your doctor
– A weight loss support group
© 1997 - 2004 LifeLong Health®
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Quiz
1.
2.
T/F About 2 out of every 3 adults are overweight.
Excess weight is closely related to what 3 major risk
factors?
3.
4.
T/F Obesity increases health care costs on the average of
over $600/year.
A waist girth of ___ men, ___ for women indicates high risk.
5.
6.
7.
T/F 25% of calories eaten today are from restaurant foods.
A realistic starting weight loss goal is __ - __% of body wt.
The kind of body fat that increases risk the most is ___ fat.
8. T/F Being fit reduces most of the risk linked to overweight.
9. The food group at the base of the new food pyramid is ___.
10. The best approach to permanent weight loss is _____.
© 1997 - 2004 LifeLong Health®
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www.LifeLongHealth.us
MakingHealthyChoices.info
© 1997 - 2004 LifeLong Health®
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Finally
A healthy diet low in calories, combined
with increased physical activity,
behavior therapy, and group support,
provides the best chance for permanent
weight control.
Source: NHLBI, Obesity Education Initiative
© 1997 - 2004 LifeLong Health®
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Overweight & Disease Risk
10
9
8
7
6
5
4
3
2
1
0
BMI 22
BMI 30
Heart
disease
High BP Gallbladder Diabetes
NEJM, Aug. 5, ’99, 430
© 1997 - 2004 LifeLong Health®
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