Transcript BMI and Obesity

BMI and Obesity
Ashley Ziegenfus, RDH
10/12/2016
BMI (Body Mass Index)
• What is it? Who is it for?
• According to the American Heart Association, Body
Mass Index or BMI, is an indicator of the amount of
body fat for most people. It is used as a screening tool
to identify whether an adult is at a healthy weight.
• A separate BMI calculation should be used for children
and teens that take a child’s age and gender into
consideration.
• What is a limitation of BMI?
• Body Mass Index does not take into consideration body
composition in terms of muscle mass or bone mass.
• This is a common discrepancy with the screening tool.
How to Calculate BMI:
How does BMI calculate a healthy weight?
 It is determined by dividing a person’s weight (in kilograms) by the square of their height
(meters).
How do we convert?
 In order to convert pounds to kilograms you have to complete the following calculation:
 In order to convert inches to meters you have to complete the following calculation:
What do the values of BMI reveal?
A healthy person is considered to be within the 18.5-24.9 normal range.
Did you know?
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– Being overweight or obese is considered an epidemic in the united states
– More than one-third (36.5%) of U.S. adults have obesity.
– Approximately 17% (or 12.7 million) of children and adolescents aged 2—19 years
are obese
CDC Map of Prevalence: Self-Reported Obesity Among U.S. Adults by State and
Territory, BRFSS, 2015 (has increased in 2016):
So what is Obesity?
• What is obesity?
-Excess weight for height with a BMI of 30 or greater!
• What are some health conditions associated with
Obesity?
• • heart disease
• • psychological disorders
• • type 2 diabetes
• • stroke
• • arthritis
• • breathing problems ( Ex. sleep apnea)
• • depression
• • cancer (various types)
What does the AHA recommend?
The American Heart Association recommends a balanced diet consisting
of the following guidelines:
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Total Fat Intake should be no more than 30% of total calories
Saturated Fatty Acids should be 8-10% of total calories
Monounsaturated Fatty Acids should be 15% of total calories
Cholesterol intake should be less than 300 mg daily.
Sodium intake should be less than 2400mg daily. This is equivalent to a 1 ¼ tsp of salt.
Carbohydrates should make up 55-60% or more of total calories
Total calories should be adjusted to the individual in order to achieve and maintain a
healthy body weight.
AHA Diet Guidelines
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While the American Heart Association recommends this plan as a healthy guideline, some
people may have dietary restrictions and/or allergies.
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In this case, the American Heart Associate recommended diet would have to be modified
accordingly. The easiest way to achieve a healthy diet is by eating a variety of nutritious foods from
all the food groups.
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You may be eating plenty of food, but your body may not be getting the nutrients it needs to be healthy.
Nutrient-rich foods have minerals, protein, whole grains and other nutrients but are lower in calories. They
may help you control your weight, cholesterol and blood pressure.
Eat an overall healthy dietary pattern that emphasizes:
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Variation of fruits and vegetables
Whole Grains
Low-fat dairy products
Skinless poultry and fish
Nuts and legumes
Non-tropical vegetable oils
Limit saturated fat, Trans- fat, sodium, red meat, sweets and sugar-sweetened beverages, and artificial
sweeteners. If you choose to eat red meat, compare labels and select the leanest cuts available.
What causes obesity?
o Environment and Lifestyle Habits:
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Binge Eating Disorder (emotional/psychological component)
Fasting
Boredom
Anxiety
Living habits
Stressful environment
Alcohol consumption
Lack of physical activity
Beliefs and attitudes associated with food and physical well-being
Income level
o Genetics
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Some individuals are susceptible in becoming obese.
Weight of children and their biological parents resemble each other.
If both parents are overweight a child’s risk is 80%
If both parents are normal weight, a child’s risk for obesity significantly decreases to a 10% risk.
o Metabolic
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An individual in a disease state- hormones and medications can affect weight.
Some medications that can cause weight gain include:
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Steroids
Hormones
Antidepressants
Appetite stimulants
In 2016, what are the more recent
causes of Obesity?
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increased availability of a variety of palatable and affordable foods
decreased physical demands of many jobs- ( technology)
increased "screen time" – television, computers and smart phones
“nutritional programming” -- overweight and obese mothers who may
be increasing their unborn child’s risk of obesity (nurture habits)
changes in sleep patterns and stress
possible changes in the bacteria in the digestive track
Temperature of our houses and workplaces (American Heart Association)
Research says:
Obesity IS preventable!
What approaches are available to help
promote and maintain weight loss?
A healthy diet/ diet modifications
• Low Calorie/balanced diet Weight Watchers” for example, records food choices with a point system
application.
 “Weight Watchers” promotes an intake of a balanced diet similar to what
the American Heart Association recommends.
 Fruit and vegetables are considered non-point items on their point system
because these are important sources of nutrients.
 These balanced diets are considered the safest and healthiest.
 Lower chance of feeling restricted in food options.
• Liquid Protein Diets (not recommended) SlimFast or OptiFast
 Great as a supplement, not intended for long term weight loss.
 Formerly used a supplement for ill patients.
A healthy diet/ diet modifications
• Low Carbohydrate/High Protein Diet Diets including Atkins, Zone, South Beach Diet, Ketogenic diet
(very low carb, high fat), Paleo diet (“caveman diet”),
Mediterranean diet, etc.
 Risk of Ketosis – which is the accumulation of ketones in the
body- If there is lack of glucose to burn, the body switches
metabolic pathways and creates this particular acid. In later
phases, it starts to reduce muscle mass after fat.
• Low Glycemic ,High Fiber, High Protein Diet Nutrisystem, Jenny Craig
 Pre-packaged foods with dietary goal in mind.
 Promotes good compliance (can be costly)
Physical Activity
 A review: “The first law of thermodynamics states that
change in weight equals caloric intake minus caloric output.
Caloric intake is the number of calories you eat and drink
each day, and caloric output is your resting metabolic rate
plus any physical activity expenditure.”- UCLA
o Voluntary movement of the skeletal muscles is crucial for weight
loss
o In order to achieve successful weight loss or weight maintenance,
requires AT LEAST 30 minutes of activity in adults and 60 minutes
of activity in children daily.
RFO Weight Management Program at the UCLA Center for Human
Nutrition found that engaging in regular physical activity is a
predictor for substantial long-term weight maintenance and shows
an advantage in cardiovascular strength and fitness capability.
Physical Activity
How much are we burning in daily activities?
Physical Activity
• How long does it take during my exercise to burn 500
calories?
Physical Activity
• “If you are trying to lose weight, then the
National Academy of Sports Medicine
recommends, 3-5 days of cardio per week, 2060 minutes at a time, at 60%-90% of your
maximum heart rate. Though, given our busy
lives, it may be more realistic to go with 5-7
days with 30 minutes of cardio at a given
time.”- NASM
Behavioral Modification / Psychological and
Social Support
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“Studies show that diet alone, exercise alone, diet and exercise, or diets with
appetite-suppressants usually result in minimal weight loss with rapid weight
regain.” – UCLA
Programs exist to help patients understand food triggers and how to break
unhealthy habits.
Using a combination of weight loss approaches is the best way to initiate and
maintain healthy habits/behaviors in the long term
These programs use a system of individual and group educational and clinical
therapies. These emphasize the following:
– Failure Syndrome and Recovery
– Anger/ Stress Management
– Exercise
– Calculating Energy Expenditure
– Nutrition Cancer and You
– Compulsive/Emotional Overeating
– Meal Analyzing and Planning
Different types of cognitive behavioral strategies are promoted and used to gain
solutions for an individual’s specific needs.
How much weight is healthy to lose
and what should I avoid?
Avoiding Alcohol
High in calories and
dehydrates the body
What is considered a healthy loss over time?
o Aiming to lose 10% of your weight over 6
months
o A loss of .5 lbs. to 2 lbs. per week is
considered safe
Weight Loss Surgeries
1. Gastric Bypass- Used to reduce the stomach size by
decreasing its reserve capacity.
2. Adjustable gastric banding (Lap-band) - Inflatable silicone
band is placed around the top portion of the stomach in order
to reduce how much food is consumed.
Weight Loss Surgeries
Who is allowed?
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Those who meet requirements of body mass index (BMI) and have
health conditions such as type 2 diabetes or HBP
A BMI of 40 or more- usually at least 100 pounds over their suggested
weight.
o A BMI of 35 or more and has a serious medical disorder that might improve if they
lose weight through the surgery.
o Examples of conditions are: obstructive sleep apnea, type 2 diabetes, and heart
disease.
What are the restrictions?
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“surgery is not a quick fix for obesity”
It will significantly change lifestyle.
After surgeries, you must:
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eat healthy foods/ control portion sizes of what you eat
exercise consistently
take medications and supplements
risks are dependent on person- increased risk of vomiting if eating too much food
( which may affect oral health)
Prescription Medications for the Treatment
of Obesity:
1. Orlistat (Xenical)a.
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Available since 1999- used in adults and children over 12.
Blocks fat from being able to get absorbed by the body.
Over the counter version is called “Alli” and is for adult usage only
Some side effects include pain, gas, diarrhea, and leakage of oily stools
This drug should never be taken with cyclosporine
2. Phenotermine-topiramate (Qysmia)a.
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Available since July 2012
Combines two FDA approved drugs
Used to suppress appetite and to treat seizure/migraines
Adult use only
Must stop if 5% of weight is not lost by 12 weeks of drug use.
Side effects include: tingling of hands/feet, dizziness, taste change, trouble
sleeping, constipation, dry mouth
g. Leads to birth defects, contraindicated for those who are planning pregnancy
or pregnant.
Prescription Medications for the Treatment
of Obesity:
3. Locaserin (Belviq)-
a. Works by affecting chemicals in
brain – feel full quickly, resulting in
lower caloric intake
b. Must lose 5% of weight by 12 week
mark or discontinue
c. Side effects include: headaches,
dizziness, feeling tired, nausea, dry
mouth, cough, constipation
d. May NOT be combined with SSRI’s
and MAOI’s.
e. ADULT use only.
4. Appetite suppressant drugs ( all FDA approved for short term use only)
a. Phentermine
b. Bezphetamine
c. Diethylpropion
d. Phendimetrazine
NEW Prescription Medications for the
Treatment of Obesity:
5. Contravea.
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g.
h.
2014 combo of two FDA-approved drugsnaltrexone and bupropion
extended-release formula
safe for long-term use
Naltrexone is appropriate to treat alcohol and
opioid dependence
Bupropion is appropriate to treat types of
depression, seasonal affective disorder, and to
help individuals quit smoking
Side effects include nausea, constipation,
headache, vomiting, dizziness, insomnia, dry
mouth, diarrhea, increased blood pressure,
increased risk of suicide, and increased risk of
seizures.
MAY NOT be used with those suffering from
seizures
Must lose 5% of weight by 12 week mark or
discontinue
6. Saxenda (liraglutide)a.
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A higher dose of the type 2 diabetes drug called
Victoza
Mimics an intestinal hormone which tells the brain
your stomach is full.
Approved 2015 for long-term use
Side effects include: nausea, vomiting, diarrhea,
constipation, low blood pressure, and increased
appetite
Serious side effects may inclde: raised heart rate,
pancreatitis, gallbladder disease, kidney problems,
and suicidal thoughts
If you don't lose 4% of your weight after 16 weeks,
discontinue use
“Off Label” Used Prescriptions:
• 1. Bupropion- Used for
depression, reduces
over eating.
• 2. Metformin- used to
treat type 2 diabetesincreased fullness.
“Off Label” newly used prescriptions:
3. Vyvansea. ADHD medication
b. 2015 FDA approved for binge eating disorder
c. This is not intended for weight loss
d. It has been known to help reduce binge eating tendencies and
behaviors in those who suffer from binge eating disorders.
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4. Triiodothyronine (T3 hormone)
a. Doctors may prescribe small doses of this thyroid hormone (T3) to
increase metabolic rate.
b. Exercise has more significant effect on the result of T3
supplementation in weight loss.
c. T3 increases the amount of available energy, and practically
encourages the user to exercise.
d. Unlike stimulants like caffeine and synephrine, T3 increases the rate
of metabolism without such side effects as jitters
a. It does not make the user “hyper”
b. Energizes the user without the crash that comes from
overstimulation with stimulants.
e. Goal is to increase the levels of T3 to increase metabolism while not
setting off hyperthyroidism, which is a risk of this particular therapy.
Dental Hygiene Considerations:
 To maintain healthy body weight, always
balance calories from foods and beverages
with calories expended.
 Be aware of healthy BMI and unhealthy
BMI
 Choose nutrient dense foods in each group
to avoid discretionary calories, including
added sugars or artificial sweeteners.
 Focus on amount eaten by watching
portion sizes.
 Follow progress by tracking food intake
and physical activity (as well as oral selfcare).
 Discuss with patients the oral risks (acid
attacks and increased caries risk) of eating
certain foods/ processed foods.
 Promote increased physical activity to
reach and maintain a healthy weight.
Keep in Mind: Social
Responsibility!!!
“Social responsibility is an
ethical framework and
suggests that an entity, be it
an organization or individual,
has an obligation to act for
the benefit of society at
large”
Keep in Mind: Social
Responsibility !!!
o As a dental hygienist, you have a
huge impact on your patients. It is
important to always use your
knowledge to assist in emphasizing
the important connection between
oral health and total systemic
health.
o In the event that there are oral
manifestations that may link to
other systemic health conditions
(such as obesity or an eating
disorder) remember to always
make recommendations for oral
health first and then circle back to
how this can help other systemic
conditions that the patient may be
struggling with.
o Nutrition plays an important
role in both oral and systemic
health!
o To maintain professional appeal,
be sure to provide evidencebased research while educating
patients. Always encourage
patients to see their primary
healthcare provider routinely.
PRACTICE: Body Mass Index
Calculations
Instructions: On a separate sheet of paper, use the correct formulas to obtain the
approximate BMI of each patient. Please show work. Use the BMI chart to note if the
patient is Underweight, Normal, Overweight, or Obese. (Use calculator if necessary).
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132 lbs. female, 5’2
108 lbs. female, 5’6
170 lbs. male, 5’10
140 lbs. male, 5’11
180 lbs. female, 5’4
180 lbs. female, 5’8-- Is she considered normal,
overweight, or obese?
*Now find your own BMI -you do not have to share this,
for personal awareness only!
THANK YOU!
Are there any questions???
Sources/Websites
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http://clinicalnutrition.ucla.edu/behavior-modification
https://breakingmuscle.com/strength-conditioning/20-ways-to-burn-500-calories
https://medlineplus.gov/ency/article/007199.htm
http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/The-American-HeartAssociations-Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp#.V_5gKvkrLIU
http://www.heart.org/HEARTORG/HealthyLiving/WeightManagement/Obesity/Understanding-theAmerican-Obesity-Epidemic_UCM_461650_Article.jsp#.V_5PoPkrLIU
https://www.cdc.gov/obesity/data/adult.html
http://www.who.int/mediacentre/factsheets/fs311/en/
Excellent resource- http://stateofobesity.org/rates/
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm432543.htm
http://www.progressivehealth.com/using-t3-triiodothyronine-to-help-weight-loss.htm
http://www.fasebj.org/content/19/11/1552.full.pdf
http://www.ncbi.nlm.nih.gov/pubmed/19215985
http://www.ncbi.nlm.nih.gov/pubmed/6694559
http://www.webmd.com/diet/obesity/weight-loss-prescription-weight-loss-medicine#2-5