Transcript Baseline Info

Baseline
Caloric Balance
Caloric Intake + Expenditure =
+/- Caloric Balance
Case 1
50 year old woman, in good health, no
history of cigarettes, in for check up. BMI
29.
Should you tell her she is overweight?
What further assessment and treatment
should you begin?
An Office-Based Approach
 Make the diagnosis (and communicate it)
 Assess readiness for change
 Prescribe diet and exercise
 Consider medications and surgery
HEALTH PROFESSIONAL ADVICE
AND WEIGHT LOSS
12,835 adults, BMI over 30 kg/m2, check-up in
last year
Random-digit, population-based sample, 50
states
42% told by health professional to lose weight
 Those told to lose weight more likely to report
trying to lose weight: OR 2.79 (95% CI 2.533.08)
INTENTIONAL WEIGHT LOSS
AND DEATH
Prospective CDC cohort study, 6391 adults,
followed for 9 years
Those reporting intentional weight loss had 24%
reduction in mortality
Those reporting unintentional weight loss had
31% higher mortality
Those reporting attempted but unsuccessful
weight loss also had 20% reduction in mortality
Gregg, Ann Int Med 2003
GOALS OF MANAGEMENT



Be as fit as possible at
current weight
Prevent further weight gain
If successful at 1 and 2,
begin weight loss
Case 2
50 year old woman, in good health, in for
check up. BMI 32 with metabolic
syndrome.
She says, “ I have to lose weight, and
I am planning on doing that. I am about
to try the South Beach diet.”
VLCD’s vs LCD’s:
Meta-analysis of 29 U.S. Studies
Weight loss studies with > two year f/u
13 VLCDs, 14 LCDs
Mostly observational studies (few RCT’s)
Weight loss (as % of initial weight):
LCDs
VLCDs
1y 2y 3y 4y 5y
7.2 4.2 3.5 2.8 2.0
16.1 9.7 7.8 7.0 6.2
Anderson, Am J Clin Nutr, 2001
COMPARISON OF ATKINS, ORNISH, WEIGHT
WATCHERS, AND ZONE
160 patients, randomly assigned
Atkins
2.1
53
Ornish
3.3
50
WW
3.0
65
Zone
3.2
65
Completers at 1 year
Atkins
Wt Loss (kg)
3.9
Ornish
6.6
WW
4.6
Zone
4.9
Wt Loss (kg)
Completers (%)
Dansinger, JAMA 2005
FITNESS AND MORTALITY
Aerobics Center Longitudinal Study
25,714 men, 44 years old, 14 year observational study
CV death (RR)
Fit
Not fit
normal
1.0
3.1
Total death (RR)
normal
Fit
1.0
Not fit
2.2
overweight
1.5
4.5
overweight
1.1
2.5
obese
1.6
5.0
obese
1.1
3.1
Wei, JAMA 1999
SUCCESSFUL WEIGHT LOSS MAINTENANCE
 3000 subjects in National Weight Control
Registry: 30-lb weight loss for 1-year
 Average weight loss 30kg (10 BMI units less),
average weight maintenance 5.5 years
 45 years old, 80% women, 97% Caucasian
 46% overweight as child, 46% one parent
obese, 27% both parents
Wing and Hill, Ann Rev Nutr, 2001
SUCCESSFUL WEIGHT LOSS
MAINTENANCE
High levels of physical activity
• Women 2545 kcal/week, men 3293 kcal/week
• (1-hour moderate intensity per day
• Only 9% report no physical activity
Diet low in fat, high in carbohydrate
• 1381 kcal day, 24% fat, 19% protein, 56% CHO
• 4.87 meals or snacks/day
• Fast food 0.74/week
Regular self-monitoring of weight
• 44% weigh once per day; 31% once per week
Wing and Hill, Ann Rev Nutr, 2001
Issues
History: Modified PA Questionnaire &
Weight Gain Patient handout.
Baseline Data
Plan