Preventing and Managing Overweight and Obese
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Transcript Preventing and Managing Overweight and Obese
Preventing and Managing
Overweight and Obese Adults:
HAVING AN EFFECTIVE CONVERSATION
WITH OVERWEIGHT AND OBESE ADULTS
ELIZABETH PATRICK, MD
DISCLOSURE
I HAVE NO FINANCIAL RELATIONSHIPS
WITH ANY COMMERCIAL INTERESTS
RELATED TO THE CONTENT OF THIS
ACTIVITY TODAY.
America is Becoming Obese
33% of American adults are obese
Impacts work, leisure, and life expectancy
Generating billions in health expenditures
Who is obese?
-BMI > 25
- BMI = (weight in pounds)/ (height in inches)2
Complications of obesity include:
Obesity Trends* Among U.S. Adults
BRFSS, 1990, 2000, 2010
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2000
1990
2010
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Historical Issues
“Good” food used to be less expensive
- i.e. wild game
“Bad” food used to be expensive
-i.e. flour and sugar
Good vs. Bad Foods
Food is more processed
High fructose corn syrup
Change in clothing elastic in 1950s
Change in work
-i.e. laundry/ farming
Good vs. Bad Foods
“Bad” food is 10 times cheaper*
-2000 calories of junk food= $3.52/day
“Good” food is pricey*
-2000 calories of good food= $36/day
“Good” food also has to be cooked
Educational issues
-shopping and cooking
*University of Washington
Genetics
Extremes
- Eskimo
-traditional diet vs. modern diet
- Pima Indians
-traditional diet vs. modern diet
Mormon Genealogy
-Frank Moody, MD
Genetics cont…
Every $1 spent on food, only $0.19 is food; the rest of
the money pays for marketing and packaging
Calorie counts: restaurants are inaccurate
-269 food items- 20% has 100+ more calories than
reported (Tufts University)
- eat 100+ calories per meal, gain 30 pounds a year
Americans consume 500 more calories a day now
than they did in 1970 according to the USDA
Decrease in Nutrients
6% less protein
16% less calcium
15% less iron
38% less riboflavin
20% less vitamin C
Chicken contains 266% more fat and 33% less
protein than it did 40 years ago
Milk
Men’s Health 2011
Decrease in Nutrients cont…
Weight = Energy in – Energy out
Basal Energy Expenditure (Harris Benedict
Equation)
Men
BEE= 66.5 + (13.75* kg) + (5.003* cm) –
(6.7705*age)
Women
BEE= 655.1 + (9.563*kg) + (1.85*cm) +
(4.676*age)
Multiply by stress factor
Other Ways to Measure
Tantina
-gyms/ weight loss centers
Biometrics
-university/sports
Metabolic testing
-Baptist
Other Ways to Consider
1 pound= 3500 calories
…so under 2500 calories a day equals a
2 pound weight loss per month
Medications
For patients with BMI ≥ 30 (or 27 with a serious
medical problem) facilitates 5-10% weight loss goal
-Sympathomimetic Drugs
-Meridia
-withdrawn US market
-Lipase Inhibitors
-Alli
-prevents action of lipases
-possible liver injury
Short Term
Bontril (Phendimtreazine Tartarate)
Tenuate (Diethylproprion)
Didrex (Benzphetamine)
Fastin/ Adipex (Phenteramine)
These are all amphetamine derivatives
Contraindicated heart disease and thyroid disease
Drugs Withdrawn from Market
Redux/ Phen Phen
- Pulmonary Hypertension
Rimonabant
-Related THC
-Suicide/ depression
Meridia
- Cardiac Issue
Off Label
Welbutrin
-weight loss for 1 year trial
Topamax
-several 6-12 month trials
-significant side effects
Zonisamide
-4 month trial
-significant weight loss
Byetta
-diabetic trials
Victoza
-diabetic trials
Phen-Prozac
FDA Black Box
Redux Study
-poor design
Lots of psychiatric patients on SSRIs and
amphetamines with no increased incidence of
pulmonary hypertension
OTC
Recent FDA removal of ephedrine due to serious
side-effects
Recommend consulting physician prior to and
during use
HCG
Acai
Contains antioxidants
No studies supporting weight loss
Avoid with berry/pollen allergies
Oprah Winfrey disassociated herself with claims
Hefty price
85% berry is seed
No adverse effects
WebMD
Hoodai
Plant based Hoodiagordonii
-succulent
Little science claims “tricks your brain into feeling
full”
Study of 7 people
-3.3% weight loss
Mayo Clinic feels no conclusive claims
No data of adverse effects
Web MD
Sensia
Works with sense of smell to eat less
No stimulants
Feel full sooner
Contains Malodextrin (similar to MSG)
Takes 10-20 minutes to work
Metabolife
Ephedra removed
Licorice an issue
HTN
Bioslife 2
Fiber
Makes you feel full
Similar modern product
-Purisalv
-chia seeds- expand
-natural stimulant
Source of Over-the-Counter Information
http://www.weightloss-reportcard.info/
Diets
Low carb = low fat
-at six months if compliant
Vegetarian diet
-may be beneficial for post-menopausal women
Consider Personal Weight-loss Issues
Past diets
Personality
Budget
Special needs
-other health conditions, i.e. diabetes
-cultural/ethnic needs
Evaluate Diets
What does it consist of?
Who’s beyond diet?
What are risks?
What are results?
Low Carb
Atkins
Sugar busters
South Beach
Zone
-limit carbs, sometimes high fat, sometimes hard to
maintain
Lifestyle change
Mayo Clinic Diet
Learn Diet Program
(lifestyle, exercise, attitudes, relationships, and
nutrition)
Change unhealthy habits and behaviors
Fad Diets
Cabbage Soup
Lemonade
Grapefruit diet
-short term weight loss
-nowhere to go next
-weight usually regained
Low-Fat Diet
Reduces fat in diet to < 20%
Many low fat foods are high in sugar
Ex: Ornish Pritakken
Meal Providers and Replacement
Replace 1-2 meals per day with prepared products
Can be effective
Costly
Examples
-Nutrisystem
-Slimfast
-Seattle Sutton
Very Low Calorie
Needs to be physician supervised
Difficult to transition back to real life
cost
Points of Safe/Effective Weight loss Programs
Flexible
Balanced nutrition
Enjoyment
Physical activity
Steady pace
-1 to 2 pounds per week
Weight Loss Hypnosis
Only slight weight loss- around 6 pounds
Studies poor
Weight Loss Plateau
Decrease calories by 200
Increase exercise by 15 to 30 minutes
Increase daily activity
Reassess food diary
Stay above 1200 calories
Exercise
2 ½ hours/ week divided
2 episodes of strength training
Think outside the box
-dance
-Wii
-chopping wood
Gain Control of Emotional Eating
Connection between mood, food, and weight loss
Address stress
Check hunger
Food diary
Support
Fight boredom
Take away temptation
Don’t deprive
Snack healthily
Get enough sleep
Seek Therapy
Overeaters Anonymous
Weigh Down
Counselor
Support Groups
Tops
Weigh Down
Overeaters Anonymous
Jenny Craig
Weight Watchers
Gastric Surgery
Lap Band
Roux-N-Y A Type of Gastric Bypass
Newer
Qualifications
-BMI ≥ 30 + co morbidities
-BMI ≥ 35
Calorie Counting
Calorie King
My Fitness Pal
3500 calories = one pound of weight
Bottom Line
Lifestyle change
Exercise + Diet
250 calories/day = 2-3 pounds/ month
Pitfalls
Multiple
Overeating
-Tops
-Overeaters Anonymous
-Palmetto Behavioral
Resources
Palmetto Behavioral Health
-overeating
-depression
ObesityinAmerica.org
-patient fact sheets
Myfitnesspal.com
E-mealz.com
-portion control
-$15/3 months
-download menus, shopping list every Thursday
www.obestiy.org
The Mayo Clinic Diet
-Mayo Clinic Healthy Weight Pyramid tool