Transcript Dr. Doubek  Diplomat: American Board of Bariatric Medicine  Family Physician of the Year in Kansas 2013  Fellow: American Board of.

Dr. Doubek
 Diplomat: American Board of Bariatric Medicine
 Family Physician of the Year in Kansas 2013
 Fellow: American Board of Family Physicians
 LBWA: Learned by Wandering Around
 Private practice in Manhattan for 22 years
 Director of Mercy Light for the past year and a half
 Middle aged athlete: completed 2 marathons, 6 triathlons, Flint Hills
Death Ride
Libby
 Dog Trainer ExtraordinaireLady Liberty of Barrington
 Therapy assisted activity
 Graduate of the Delta Society
Pet Partner Program
 Cannie Good Citizen Award
Mercy Light
Stonecreek
Body Mass Index (BMI)
 Screening tool
 Indirect measure of body fat
 Can be used to tract body size throughout life cycle
 Relates to health risks
 In children and adolescents, used as BMI- for-age and
graphed as percentile
Definitions of Obesity
 BMI describes relative weight for height: weight
(kg)/height (m2)
 Overweight = 25 − 29.9 BMI
 Obesity = 30 or greater BMI
 Morbid Obesity = 40 or greater BMI (Usually 100 lbs
overweight)
Shifts in Conception of Obesity
What Obesity is
 True disease with genetic
What Obesity is NOT
  A character flaw
determinants
 Major public health threat
  A “cosmetic” issue
 Recurring weight gain
  Drug treatment is a failure
indicates chronic disease
Obesity Leads to Increased
Risk of…
 Hypertension
 Sleep Apnea
 Type II Diabetes
 Gastroesophageal Reflux
 Coronary Heart Disease
 Complications of Pregnancy
 High Cholesterol
 Congestive Heart Failure
 Stroke
 Cancers:
 Gallbladder Disease
 Depression
 Endometrial, breast, prostate
 Gout
***Two out of Three Americans are overweight or
obese
Health Benefits of Modest
Weight Loss
 Each 2 lbs of weigh loss = 2 mm drop of BP. After a 5%
to 10 % weight loss, many times high BP meds can be
reduced or discontinued
 A 10 % weight loss is associated with a 34 % drop in
triglyceride levels
 A 10 % weight loss is associated with a 16% decrease
in total cholesterol, and a 12% decrease in LDL
cholesterol
“The American Medical Association
voted Tuesday to declare obesity a
disease, a move the effectively defines
78 million America adults and 12 million
children as having a medical condition
requiring treatment.”
Close to half of the US
population is expected to have
a BMI greater or equal to 40
kg/m by 2030
Am.J.Prev.Med. 2012; 42:563-70
Cost of Obesity
 Obese individuals are about 42% more expensive than
their normal weight counterparts
 The estimated annual health care costs of obesityrelated illness are a staggering $192.2 billion, or nearly
21% of annual medical spending in the US.
 Childhood obesity alone is responsible for $14 billion in
direct medical costs
2013 Obesity Society and the Americ
Society of Metabolic
and Bariatric Surgery
Consequences of Obesity
1. Increased morbidity and mortality
2. Reduced productivity and functioning
3. Increased healthcare costs
4. Discrimination: social and economic
As of 2013, Mexico has higher rates of
adult obesity than the US. Taxes in
Mexico have been implemented on
junk foods-those foods higher in
saturated fat, sugar, and salt by 8%. The
money raised is intended to go towards
health programs and increased access
to drinking water in schools. Mexicans
drink 43 gallons of soda per person per
day.
Sitting Disease
 Americans used to get in a lot more activity on the job
 We lifted, carried, hammered and nailed
 Technology advances have made it almost a
requirement for people to be sitting at a desk or in front
of a computer.
 Students sit for long periods of time- studying from
books or studying in front of computers
Sitting Disease Continued..
 Scientists and healthcare professionals are beginning
to talk about a condition called “sitting disease”
 It has been associated with increases in diabetes,
blood pressure, cancer, heart attacks and death
 Nearly half of us sit 6 or more hours a day
 Work, driving, watching TV, studying, class, ect.
Sitting Disease Continued…
 If you’ve been sitting for an hour, that’s too long!
 You should try to be up for 10 minutes every hour
 Sitting for an hour or more slows the metabolism and
lowers the level of good HDL cholesterol
James Levine, professor of medicine and
endocrinology and an expert in inactivity studies at
the Mayo clinic in Rochester, MN
Food Portions
 Portions over time have grown larger, increasing the
number of calories consumed.
Pizza
1984; 500 Calories per slice
2004: 850 Calories per slice
Hamburger
Plain Bagel
Orange Soda
1993: 3-inch diameter=140 Calories
2003: 5-6 inch diameter= 350 Calories
1950: 8oz bottle, 97 calories
1990: 20oz can, 242 calories
1983: 333 calories
2003: 590- Calories
Fries
Popcorn
1983: 2.4 oz, 210 Calories
2003: 6.9 oz, 610 Calories
1984: 5 cups, 270 Calories
2004: Tub, 630 Calories
Environmental Factors to Obesity
 Convenience- abundance of fast food restaurants and
vending machines
 Variety- People can continue to rotate restaurants and
never get bored
 Cost- People can get a lot of food and energy for a
small amount of money
Big Mac:
540 kcal
Large Fries:
400kcal
Large soda:
400 kcal
−−−−−−−−−−−−−−−−−−−−−
TOTAL:
1510 kcal
Obesity in College Population
 34% of college students reported a BMI of 25 or higher
according to the 2012 American College Health AssnNat College Health Assessment survey of 76,481
students
www.acha-hcha.org
Freshman 15
 Studies show that significant weight gain during the first
semester of college is a real phenomenon and can be
attributed to tangible environmental stimuli.
Levitsky Halbmaier Mrdjenovic: Internation
Journal of Obesity: 2004:28,1435-1443
Freshman 15 Example
 4191 Freshman at Auburn University in 2007 were
followed for 4 years
Changed included:
1. Significant (p<0.0001) gain weight(3.0 Kg)
2. BMI(1.0kg/m2)
3. Body fat(3.6%)
4. Absolute fat mass(3.2 kg)
College Patterns
 All you can eat dining halls
 Snacking patters, particularly evening snacking
 Eating high-fat “junk food”
 Sedentary behavior due to studying
 Substance Abuse
 ACHA-NCHA data indicate that 37% of college students
consumed > 5 alcoholic beverages at one sitting during
the past 2 weeks (binge drinking)
 Sleep deprivation
Sleep Deprivation
 Leptin is a hormone secreted by fat cells to tell the
brain when the body doesn’t need food. “Lovely Leptin”
 Ghrelin is a gut hormone that tells the brain to eat
more. “Greedy Ghrelin”
 Sleep deprivation leads to lower levels of leptin and
high levels of ghrelin in the body
 8 hours of sleep seems to be what the average
American needs.
Management of Obesity in the
College Population
There are 3 broad goals for weight management
1. Reduce the risk of obesity- related comorbidies
2. Reduce and maintain the desired body weight over the
long term
3. To reduce body weight, a daily energy deficit of approx
500 to 1,000 kcal is targeted.
Campus weight loss interventions can
offer support and guidance when
nutrition and lifestyle habits are being
formed. Focusing on healthy
eating/healthy body rather than on
body size can minimize eating
disorders.
Weight Loss Expectations
 Adults often wish to lose at least 30% of body weight, a
more realistic goal is 10% within 6 months.
 It should be noted that setting realistic goals does not
lead to disappointment. There is a large disparity
between what the clinician’s goal is, and what the
student’s goal is
Which Weight Loss Programs
Work the Best?
These programs are successful in achieving weight
losses of 5% to 10 %
 Jenny Craig
 NutriSystem
 Weight Watchers
 Slimming Word
** The best diet is one that leads to weight loss and that is
able to adopt long-term to support weight maintenance.
Exercise
 The American College of Sports Medicine recommends
moderate-intensity physical activity 150 to 250
minutes/week
 An energy equivalent of 1200 to 200 kcal/week
 Heart Rate should be at that of a fast walk
Donnelly JE, et al: Med Sci Sports
Exerc 2009:41 (2):459-471
Weight Loss Programs that
Work Best
1. Can be easily followed to improve compliance
2. Lower total calories
3. Lower in refined carbohydrates
4. Lower fat-CAD and elevated LDL cholesterol
Shame Campaigns
 Billboards: Stocky, chubby, and chunky are still fat
 People feel much more motivated and empowered to
make healthy lifestyle changes when campaign
messages are supportive and encourage specific health
behaviors
Treatment of Obesity by
Active Design Planners
Active design: A large movement to combat obesity in the
work place involving companies, architects, and space
planners.
1. Design work spaces to encourage activity- stand up desks
2. Design stairways as the primary mode of moving people
from floor to floor, not tucked out of sight. Tuck elevators out
of sight
3. Create outdoor spaces like post offices, grocery stores,
coffee shops to promote walking
4. Colleges do a good job of designing dorms and off campus
housing near campus
Food Companies Cut Calories
in Products
 2010 pledge taken by 16 companies to cut 1 trillion calories
in their manufactured food products from 2007 through 2012
and 1.5 trillion calories by 2015.
How will this be done??
1. Lower portion sizes to persuade consumers to eat less
2. Develop new lower-calories options
3. Change existing products so they have fewer calories
Robert Wood Johnson signed on to
hold companies accountable. Hired
researchers from the University of NC
at Chapel Hill to painstakingly count
the calories in almost every single
packaged item in the grocery store.
More Transparency in Labels
 First Lady Michelle Obama has initiated a campaign to
make food labels have calories easily read in LARGE
type.
 If any sugars/high fructose corn syrup is added- must
be on label.
Mexico City “Drink the Water”
 Mexico City’s health department has mandated the
65,000 restaurants to install filters with a $125 to $650
fine to those not complying
 It will be difficult for the public to change their habits
and trust what comes out of their taps.
 To let the public see the purity of the filtered tap water,
some restaurants are installing an ultraviolet-light
filters, visible to customers from behind the bar to prove
that the water is filtered and pure
Lawrence Kansas 2013
 Lawrence, KS Parks and Recreation plans healthier foods at
city owned concession stands. The city will require each
concession stand to offer at least one fresh fruit or vegetable
juices with no added caloric sweeteners.
Healthy Foods Will Need To:
1. Contain 200 or fewer calories
2. A fat content of 35% or less
3. Saturated fat of no more than 10%
4. No more than 35% sugar by weight
K-State #8 out of 50 fittest Colleges
in America
 The Active Times had rated KSU # 8 out of the 50 fittest
colleges in the US.
 KSU recreational services is recognized for having one
of the largest college recreation centers and for its new
Wildcat Wellness Coalition Program.
Wildcat Wellness Coalition Program
 Collaborates on providing information and activities on
health and wellness issues to the campus community
 Focuses on student development via physical and
emotion wellness
 Wellness defined by 7 dimensions: spiritual, physical,
environmental, occupational, social, intellectual, and
emotional
Wildcat Wellness Coalition
 Domestic Violence
 Increase in sexually transmitted disease
 Alcohol/ drug addiction
 Increase in Obesity
 Increase in suicide rates on college campuses
 Campus safety
 Spring Break safety
Be Stress Free
 Wildcat Wellness Coalition program is working on a
stress free event during the dead weak before finals.
 Free Yoga
 Free nutritional peer education to duel the body and brain
for finals
 Free counseling: biofeedback, mediation,
cognitive/behavioral therapy