Transcript Weight and Health - FACS Nutrition and Food Science

Weight and Health
Susan Fullmer, PhD, RD, CD
Associate Teaching Professor
Nutrition, Dietetics, and Food Science
Brigham Young University
Assessing what is a
“healthy” weight
WOMEN
5’ = 100#
+ 1” + 5#
e.g. 5’7”
5’ = 100#
7” X 5 = 35#
135#
 10% = 135  13.5#
(121.5 - 148.5#)
MEN
5’ = 106#
+1” = + 6#
e.g. 5’7”
5” = 106#
7” X 6 = 42#
148#
 10% = 148  15#
(133 - 163#)
Adipose Tissue
 Fat
is metabolically active endocrine tissue
 Secretes hormones and chemical
messengers (adipokines) that travel to
other organs and alter organ function and
health
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Leptin
Adiponectin
Resistin
Inflammatory molecules (CRP, TNF, etc.)
Estrogens
Adipose tissue
 Subcutaneous
fat appears to be benign
 Central (visceral) fat is potentially more
harmful. Releases more “disease causing”
adipokines
 Excessive visceral accumulation can lead to
adipokine dysregulation (“lipotoxicity”)
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Liver (non-alcoholic fatty liver disease)
Pancreas (Type II diabetes)
Muscle (insulin resistance)
Heart (diabetic cardiomyopathy)
Waist to Hip ratio (WHR)
 Apple
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Shape (android body):
Visceral Fat
 risk of diabetes, cardiovascular disease
stroke, high blood pressure, breast cancer
 Pear
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waist
hip
shape (gynoid body):
Subcutaneous Fat (hips, etc)
Does not seem to carry same health risks
Interpretation of WHR
 Measure
girth at smallest abdominal
circumference and largest hip
circumference
 >1.0
in men is indicative of android
shape
 >.8
in women in indicative of
android shape
Waist Circumference
 Measure
of “intra-abdominal or visceral
fat”
 Measured at the top of the iliac crest
Desirable:
 Men:  40 in (102 cm)
 Women:  35 in (88 cm)
National Heart Lung and Blood Institute and the North American Association
for the Study of Obesity, 2001.
Body Mass Index (BMI [kg/m2])
Mortality risk and BMI
Flegal, et al. JAMA, 2005;293:1861-1867
Flegal, et al. JAMA, 2005;293:1861-1867
Flegal, et al. 2007 JAMA;298(17)2028-2037.
BMI and cause-specific
mortality in 900,000 adults:
collaborative analysis of 57
prospective studies.
(Lancet 2009; 373:1083-96)
Other findings
 BMI
> 30 was strongly associated with
heart attack
 Elevated BMI was strongly associated with
strokes, likely due to it’s association with
blood pressure
 Diabetes risk increased significantly with
BMI’s > 30
Summary of BMI and Health

“Healthiest” BMI’s ranges appear to be as
follows:
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18.5-25.0 (normal weight)
26-29 (overweight) most studies suggest this range
might even be healthier then “normal weight”
<18.5 (underweight) is associated with higher
mortalities
 Some BMI related health risks begin at 30-35
 Increased health risks really begin with BMI’s
>35
60
15
5
20
#
100
TYPES OF FAT
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ESSENTIAL FAT
Fat in nerves, heart,
brain, bone marrow,
mammary glands,
etc.
Not stored fuel
3% in men
12% in women
Considered part of
LBM
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STORAGE FAT
Adipose tissue
(visceral and
subcutaneous)
Cushions vital organs
Superb storage
system for extra
calories
1 lb = 3,500 kcals
Female: 5’3” Weight: 120#
Body Fat: 19%
120 X .19 = 22.8# total fat
120 X .12 = 14.4# essential fat
8.4# of stored fat
8.4 X 3,500 kcals = 29,400
29,400  2,300 = 12.8 days of stored fuel
Body Composition and Health
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Abdominal (visceral) fat is generally more
unhealthy than hip or subcutaneous fat
Currently there is no consensus on how total
body fat is linked with chronic disease
There are no accepted published “healthy” body
fat ranges
Low body fat does not guarantee “fit” or
“healthy”
Body composition changes with age
More fat in old age is likely beneficial
“Metabolically Healthy”
 Blood
pressure
 Triglyceride levels
 Low HDL levels
 Blood glucose levels
 Insulin resistance
 Systemic inflammation
The Obese Without Cardiometabolic Risk Factor Clustering and the Normal Weight
With Cardiometabolic Risk Factor Clustering.
Wildman, et al. Arch Intern Med. 2008;168(15):1617-1624.
Metabolically Healthy (54%)
Normal
weight
Overweight
Obese
Metabolically Abnormal (46%)
Normal
weight
Overweight
Obese
Percent (%)
of Adult
Americans
26.4
17.9
9.7
8.1
17.0
20.9
# of Adult
Americans
52,982,378
35,923,658
19,467010
16,255,957
34,117,440
41,944,382
Identification and Characterization of Metabolically Benign Obesity in
Humans.
Stefan, et al. Arch Intern Med. 2008;168(15)1609-1616.
What is a healthy lifestyle
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Healthy diet
Regular physical activity
Avoiding harmful substances and risky
behaviors (tobacco, substance abuse, seat
belts, car seats, promiscuity, high risk activities)
Adequate rest
Appropriate use of health care (screenings,
immunizations, prevention, following competent
medical advice)
The Elusive “Moderation”
Healthy eating and exercise (variety,
moderation)
Gradual, doable changes in lifestyle
Total “junk food” diet
Extreme dieting
Follow no guidelines
Fad diets
Totally sedentary
Too many rules/restrictions
Overly indulgent
Deprivation vs. self control
Cynicism
Over exercise
“Current” thinking in defining
successful weight loss
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A permanent decrease in 5-10% of initial body
weight
200 * .10 = 20 pounds
150 * .10 = 15 pounds
A reduction of 10% body weight often lowers
blood pressure, improves blood glucose control,
and lowers cholesterol
Following successful maintenance of 10%
weight loss further weight loss can be attempted
if necessary
Realistic goals for weight loss
A
caloric deficit of 500 to 1000 kcal a day
would result in 1-2 pounds of weight loss
per week
 Combination of dietary and physical
activity is recommended to achieve the
calorie deficit
 More rapid weight loss is not
recommended without competent medical
supervision
To Be Healthy…
Be
Realistic
Be Sensible
Be Patient
Be Consistent