Obesity

Diet and Physical Activity
Pennington Biomedical Research Center
Division of Education
2009
Obesity in the United States
 Approximately 66% (or two thirds) of U.S.
adults are overweight or obese.

 Healthy People 2010: reduce the prevalence of
obesity among adults to less than 15%.

 The obesity rate increased from the late 1970’s to
2003 from 15 to nearly 33 percent.
CDC
2009
Obesity in the U.S.
 Body mass index (BMI)
weight (kg)/ height squared
(m
2
).

 BMI is significantly correlated
with total body fat content.
With a BMI of: You are considered:
Below 18.5 Underweight
18.5 - 24.9 Healthy Weight
25.0 - 29.9 Overweight
30 or higher Obese
BMI tables:
http://www.nhlbisupport.com/bmi
NIDDK
2009
Obesity in the U.S.

• Obesity is further divided
into three separate classes,
with Class III obesity being
the most extreme of the three.

Obesity class BMI (kg/m
2
)
Class I 30.0- 34.9
Class II 35.0-39.9
Class III
(Extreme Obesity)
≥ 40.0
With a BMI of: You are considered:
Below 18.5 Underweight
18.5 - 24.9 Healthy Weight
25.0 - 29.9 Overweight
30 or higher Obese
CDC, NHLBI
2009
Obesity in the United States
 In the United States, some
minority groups are more
affected than others.
Income and education are
also related to obesity
prevalence.

 Some states have
significantly higher rates
of obesity than others.











NIDDK, Women’s Health
Percent of Obese (BMI > 30) in U.S. Adults




http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/
2009
Obesity in the U.S.
Being overweight/obese substantially raises one’s risk of morbidity from:
Higher body weights are also associated
with increases in all-cause mortality.

 Hypertension
 Dyslipidemia
 Type 2 Diabetes
 Coronary Heart Disease
 Stroke


 Gallbladder Disease
 Osteoarthritis
 Sleep apnea
 Certain cancers
(endometrial, breast, prostate, colon)

J La State Med Soc. 2005; 156: S42-S49.
2009
Obesity in the U.S.
Obesity is also associated with:
 High blood cholesterol

 Complications of pregnancy

 Menstrual irregularities

 Hirsutism
(presence of excess body
and facial hair)
 Stress incontinence
( urine leakage caused by
weak pelvic-floor muscles)

 Psychological disorders such
as depression

 Increased surgical risk

NIDDK
2009
What Causes Obesity?
 Energy imbalance over a long
period of time.
 Energy in > Energy out.
 Excess calories and lack of
physical activity.
Energy balance is like
a scale. When
calories consumed
are greater than
calories used, weight
gain is the result.
CDC
2009
Calories Used
 Eating, digestion, sleeping, breathing, and movement.
 Excess calories.
 Physical activity.
Food/beverage
s consumed
Necessary
physiologica
l functions
Physical activity






(consumed)
Calories in Calories used
(expended)
Energy Balance
CDC
2009
Overweight
The Right Approach
 If your BMI is between 25 and 30 and you are otherwise healthy
 Try to avoid gaining any additional weight
 Look into healthy ways of losing weight and increasing physical activity

NIDDK
2009
Overweight
The Right Approach
1. BMI is 30 or above, or
2. BMI is between 25 and 30 and:
1. You have other health conditions
3. Waist measures > 35 inches (women) or
> 40 inches (men)
and:
1. You have other health conditions
Talk to your doctor about losing weight if you fall into any one of the three scenarios:
NIDDK
2009
Weight Loss & Maintenance
Strategies to Consider


Physical Activity
&
Diet Therapy
2009
Why Treat Overweight and Obesity?
blood pressure
serum triglycerides
total serum cholesterol
low-density lipoprotein cholesterol
blood glucose levels

Because there is strong evidence that weight
loss reduces risk factors for diabetes and
cardiovascular disease, such as:
NHLBI
2009
Weight Loss Programs
 Healthy eating plans that reduces caloric intake
 Regular physical activity and/or exercise instruction
 Tips on healthy behavior
 Slow and steady weight loss of about ¾ to 2 pounds a week
 Medical care if needed
 A plan to keep the weight off after you have lost it
Any safe and effective weight-loss program should include these components:
NIDDK
2009
Weight Loss
The key to any successful weight loss is making
changes in your eating and physical activity
habits that you can keep for the rest of your life.
NIDDK
Physical Activity
2009
Physical Inactivity
In the U.S.
 Many studies show that Americans are too sedentary.
 Due to
 Increased use of technology.
 Increased use of automobiles.

CDC
According to the Behavioral Risk Factor Surveillance System, in 2000 more
than 26 percent of adults reported no leisure time physical activity.
2009
Physical Inactivity
In the U.S.
 Physical inactivity contributes to premature deaths.
 Rates differ by race and ethnicity.
 Hispanic women - most inactive
 Hon-Hispanic women – second
 Asian and Pacific islander women – third and, lastly,
 White non-Hispanic women - fourth.
Women’s Health
2009
Physical Activity
 Contributes to weight loss.
 Helpful for the prevention of overweight and obesity.
 Helps maintain weight loss.
CDC
2009
Physical Activity

 Occupational work
 Carpentry, construction, waiting tables, farming

 Household chores
 Washing floors or windows, gardening, or yard work

 Leisure time activities
 Walking, skating, biking, swimming, playing Frisbee,
dancing, softball, tennis, football, aerobics


CDC
2009
Physical Activity
 Physical activity decreases the risk for:
 Colon cancer
 Diabetes
 High blood pressure

 Physical activity also helps to:
 Control weight
 Contribute to healthy bones, muscles, and
joints
 Reduce falls among the elderly
 Relieve the pain of arthritis.

Regular physical activity is good for overall health.
CDC
2009
How Much Physical Activity a
Day?
To reduce the risk of chronic diseases in adulthood:
Engage in at least 30 minutes of moderate-intensity physical activity,
above usual activity, at work or home on most days of the week.

To help manage weight and prevent gradual, unhealthy weight gain in
adulthood: Engage in approximately 60 minutes of moderate- to vigorous-
intensity activity on most days of the week while not exceeding
caloric intake requirements.

To sustain weight loss in adulthood:
Participate in at least 60 to 90 minutes of daily moderate- to vigorous-
intensity physical activity while not exceeding caloric intake
requirements. (Some may need to contact their healthcare
provider before participating in this level of activity.)

The 2005 Dietary Guidelines for Americans recommend the following for adults:

Dietary Guidelines for Americans
2009
 Any activity helps.
 Moderate physical activity brings
health benefits.
 Make it personal.
 Start slowly (10 minute walk/day).
How Much Physical Activity a Day?
2009
Increasing Physical Activity
You can increase your physical activity by taking small steps to change what you do everyday.
If you normally… Then try this instead!
Park as close as possible to the store Park farther away
Let the dog out back Take the dog for a walk
Take the elevator Take the stairs
Have lunch delivered Walk to pick up lunch
Relax while the kids play Get involved in their activity
Women’s Health
2009
How Many Calorie Am I Burning?
Activity 100 lb 150 lb 200 lb
Bicycling, 6 mph 160 240 312
Bicycling, 12 mph 270 410 534
Jogging, 7 mph 610 920 1,230
Jumping rope 500 750 1,000
Running, 5.5 mph 440 660 962
Running, 10 mph 850 1,280 1,664
Swimming, 25 yds/min 185 275 358
Swimming, 50 yds/min 325 500 650
Tennis singles 265 400 535
Walking, 2 mph 160 240 312
Walking, 3 mph 210 320 416
Walking, 4.5 mph 295 440 572
American Heart Association
Calories burned/hour of activity
2009
How Many Calories Do I Need?
 To maintain - use your current weight.
 To lose - use the average healthy weight recommended for your height.
ACS
2009
Calculating Ideal Body Weight
A 5’9 man’s ideal body weight would be:
First 5’0 = 106 lb standard weight for men
Plus 9 additional inches 9 (6 lbs)= 54 lbs
106 + 54= 160 pounds (± 10%)= 144 to 176
144 to 176 pounds is this man’s idea weight

A 5’4 woman’s ideal body weight would be:
First 5’0= 100 lb standard weight for women
Plus 4 additional inches  4(5 lbs)= 20
100 + 20= 120 pounds (± 10%)= 108 to 132
108 to 132 pounds is this woman’s ideal weight
For men:
Use 106 pounds of body weight
for the first 5 feet of their height.
Add 6 pounds for each
additional inch.


For women:
Use 100 pounds of body weight
for the first 5 feet of their height.
Add 5 pounds for each
additional inch.
2009
How Many Calories Do I Need?
 USDA’s MyPyramid site: http://www.mypyramid.gov/
 Determines calorie needs and calculates the servings
needed from food groups.
 The American Cancer Society (ACS) site:
http://www.cancer.org/docroot/PED/content/PED_6_1x_
Calorie_Calculator.asp
 The ACS site indicates the number of calories that are
needed per day to maintain your current weight.
On the Path to Increased Physical
Activity
2009
Before Beginning an Exercise
Program
 Are a man older than age 40 or
a woman older than age 50
 Have had a heart attack
 Have a family history of heart-related
problems before age 55
 Have heart, lung, liver or kidney disease
 Feel pain in your chest, joints, or muscles
during physical activity
 Have high blood pressure, high
cholesterol, diabetes, arthritis,
osteoporosis, or asthma
 Have had joint replacement surgery
 Smoke
 Are overweight or obese
 Tale medication to manage a
chronic condition
 Have an untreated joint or muscle
injury, or persistent symptoms after
a joint or muscle injury
 Are pregnant
 Unsure of your health status.

You should check with your doctor before beginning an exercise program if you:
Mayo Clinic
Health Benefits of
Physical Activity
Health benefits of physical activity. CMAJ. 2006; 174(6): 801-809.
2009
Physical Activity
Primary Effects on Diabetes Mellitus
 Aerobic and resistance types of
exercise decrease the incidence of type
2 diabetes.

 A modest weight loss through diet and
exercise reduces the incidence of
diabetes.
CMAJ. 2006;174(6): 801-809.
2009
Physical Activity
Secondary Effects on Diabetes Mellitus
 Exercise helps in the management
of diabetes.

 Aerobic and resistance training
help in the control of diabetes
CMAJ. 2006;174(6): 801-809.
2009
Physical Activity
Primary Effects on Cancer
 Routine activity reduces the incidence cancers.

 Activity results in a 30-40% reduction in the relative risk of
colon cancer and breast cancer.
Moderate physical activity is believed to exhibit a greater
protective effect than activities of less intensity.
CMAJ. 2006;174(6): 801-809.
2009
Physical Activity
Secondary Effects on Cancer
 Regular physical activity - important.

 Increased self-reported physical activity =
decreased reoccurrence of cancer and a
decreased risk of death from cancer.

 Reduced cancer-related death.
CMAJ. 2006;174(6): 801-809.
2009
Physical Activity
Primary Effects on Osteoporosis
 Many studies have been conducted.

 According to findings, routine physical
activity, especially weight-bearing and
impact exercise, prevents bone loss
associated with aging.
CMAJ. 2006;174(6): 801-809.
2009
Physical Activity
Secondary Effects on Osteoporosis
 Regular physical activity can lead to stronger
bones.

 Bone responds to physical stress at any age; even
in the elderly.
CMAJ. 2006;174(6): 801-809.
Osteoporosis
Eating for Weight Loss
2009
The Critical Role of Healthy Eating
 Good nutrition leads to a healthier life.
 Many do not eat based on MyPyramid recommendations.
CDC
2009
U.S. Eating Habits
68
70
72
74
76
78
80
82
Men Women Total
Percentage of adults
reporting that they
consumed fewer than
5 servings of fruits and
vegetables/day, 2000
81%
73%
77%
CDC. Behavioral Risk Factor Surveillance System
In 2000, the larger
majority of U.S. adults
reported that they
did not consume 5 or more
servings of fruits and
vegetables/day.

2009
Dietary Guidelines for Americans,
2005
Tips for Healthy Eating

1. Make half your grains whole
2. Vary your veggies
3. Focus on fruit
4. Get your calcium rich foods
5. Go lean with protein
6. Find your balance between food and physical activity
MyPyramid, which is the newest Food Guide Pyramid,
recommends the following for a healthy lifestyle:

MyPyramid: http://mypyramid.gov/
2009
A Healthy Diet
 Emphasizes fruits, vegetables, whole grains, fat-free or low-fat milk, & milk products;
 Includes lean meats, poultry, fish, beans, eggs, and nuts
 Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.
The 2005 Dietary Guidelines for Americans defines a healthy diet as one that:
MyPyramid: http://mypyramid.gov/
2009

 1. Adequate Nutrients Within Calorie Needs
 Consume a variety of nutrient-dense foods (whole grains, fruits and vegetables,
lean meats, low-fat dairy) and beverages within and among the basic food groups
while choosing foods that limit the intake of saturated fats and trans fats,
cholesterol, added sugars, salt, and alcohol.

 Meet recommended intakes within energy needs by adopting a balanced eating
pattern, such as the USDA Food Guide or the Dietary Approaches to Stop
Hypertension (DASH) Eating Plan.
Dietary Guidelines for Americans,
2005
Key Recommendations for the General
Population
MyPyramid: http://mypyramid.gov/
2009
Dietary Guidelines for Americans,
2005
Key Recommendations for the General
Population
 2. Weight Management
 To maintain body weight in a healthy range, balance
calories from foods and beverages with calories expended.

 To prevent gradual weight gain over time, make small
decreases in food and beverage calories and increase
physical activity.
MyPyramid: http://mypyramid.gov/
2009
Dietary Guidelines for Americans,
2005
Key Recommendations for the General
Population
 3. Physical activity
 Engage in regular physical activity and reduce sedentary
activities to promote health, psychological well-being,
and a healthy body weight.
 Achieve physical fitness by including cardiovascular
conditioning, stretching exercises for flexibility, and
resistance exercises for muscle strength and endurance.
MyPyramid: http://mypyramid.gov/
2009
Dietary Guidelines for Americans,
2005
Key Recommendations for the General
Population
 4. Food Groups to Encourage
 Consume a sufficient amount of fruits and vegetables while
staying within energy needs.
 Choose a variety of fruits and vegetables each day. Select
from all five vegetable subgroups (dark green, orange,
legumes, starchy vegetables, and other vegetables) several
times a week.
 Consume 3 or more ounce-equivalents of whole-grain
products per day, with the rest of the recommended grains
coming from enriched or whole-grain products. At least half
the grains should come from whole grains.
 Consume 3 cups per day of fat-free or low-fat milk or
equivalent milk products.
MyPyramid: http://mypyramid.gov/
2009
Dietary Guidelines for Americans,
2005
Key Recommendations for the General
Population
 5. Fats
 Keep total fat intake between 20 - 35 percent of calories
(With most fats coming from sources of polyunsaturated
and monounsaturated fatty acids, such as fish, nuts, and vegetable oils).
 Limit intake of fats and oils high in saturated and/or trans fatty acids,
and choose products low in such fats and oils.
 Consume less than 10 percent of calories from saturated fatty acids
 Consume less than 300 mg/day of cholesterol
 Keep trans fatty acid consumption as low as possible
 When selecting and preparing meat, poultry, dry beans, and milk or milk
products, make choices that are lean, low-fat, or fat-free.
MyPyramid: http://mypyramid.gov/
2009
Dietary Guidelines for Americans,
2005
Key Recommendations for the General
Population

 6. Carbohydrates
 Choose fiber-rich fruits, vegetables, and whole grains often.
 Choose and prepare foods and beverages with little added sugars or caloric sweeteners.
 Reduce the incidence of dental caries by practicing good oral hygiene and consuming
sugar- and starch-containing foods and beverages less frequently.

 7. Sodium and Potassium
 Consume less than 2,300 mg (approximately 1 teaspoon of salt) of sodium per day.
 Choose and prepare foods with little salt. At the same time, consume potassium-rich
foods, such as fruits and vegetables.
MyPyramid: http://mypyramid.gov/
2009
Dietary Guidelines for Americans,
2005
Key Recommendations for the General
Population
 8. Alcoholic Beverages
 Those who choose to drink alcoholic beverages should do so sensibly and in
moderation (≤ 1 drink for women/day and ≤ 2 drinks for men/day).
 Alcoholic beverages should be avoided by individuals engaging in activities that
require attention, skill, or coordination, such as driving or operating machinery.
 Alcoholic beverages should not be consumed by some individuals, including:
those who cannot restrict their alcohol intake, women of childbearing age who
may become pregnant, pregnant and lactating women, children and adolescents,
individuals taking medications that can interact with alcohol, and those
with specific medical conditions.

MyPyramid: http://mypyramid.gov/
2009
Dietary Guidelines for Americans,
2005
Key Recommendations for the General
Population
 9. Food Safety
 To avoid microbial food borne illness:
 Clean hands, food contact surfaces, fruits, and vegetables.
Meat and poultry should not be washed or rinsed.
 Separate raw, cooked, and ready-to-eat foods while shopping,
preparing, or storing foods.
 Cook foods to a safe temperature to kill microorganisms.
 Chill (refrigerate) perishable food promptly and defrost foods properly.
 Avoid raw (unpasteurized) milk or any products made from unpasteurized milk,
raw or partially cooked eggs or foods containing raw eggs, raw or undercooked
meat and poultry, unpasteurized juices, and raw sprouts.

MyPyramid: http://mypyramid.gov/
Weight loss:
Goals for Weight
Management of Weight Lost
2009
Calorie Deficit
Needed For Weight Loss
 A calorie deficit of no more than 500 kcal/day.
 This can be achievable through the combination of diet + exercise.
 An example of how to create a calorie deficit of 500 kcal/day through diet + exercise
would be: eating 250 kcal less per day, along with burning 250 calories through exercise
ACS
2009
Calorie Deficit
Needed For Weight Loss
 Eating 250 kcal less per day:
 Leave out mayonnaise in a
sandwich
 Leave out dessert
 Switch from soft drinks to water
 Reduce portion sizes

 burning 250 calories through exercise:
 Walk for 30 minutes
 Swimming 25 yards
 Bicycling for 30 minutes

A caloric deficit of 500 can be done by:
2009
Exercise + Dieting
Calorie Deficit
 Initially physical activity, in combination with dieting, is an important
component of weight loss.
 However, after around 6 months, physical activity will not lead to
substantially greater weight losses when combined with dieting.
 The benefit of sustained physical activity thereafter is mainly
through its role in the prevention of weight gain.
 In addition, it has a benefit in reducing cardiovascular and
diabetes risks beyond that produced by weight gain alone.

NHLBI
2009
Goals for Weight Loss
And Management
 The initial goal of weight loss therapy is to reduce body
weight by approximately 10 percent from baseline.
Once this goal is achieved, then further weight loss can be
attempted, if necessary.
 A reasonable time line for a 10 percent reduction in body
weight is 6 months.
 Experience reveals that lost weight is usually regained
unless a weight maintenance program, consisting of diet
therapy, physical activity and behavior therapy, is
continued indefinitely.
NHLBI
2009
Goals for Weight Loss
And Management
 For overweight individuals with BMIs in the typical range of 27 to 35 kg/m
2
, a decrease
of 300 to 500 kcal/day will result in weight losses of about ½ to 1 lb per week.
 A 10 percent weight loss could be achieved within 6 months.
 For more severely obese individuals (BMI > 35), deficits of up to 500 to 1,000 kcal/day
will lead to weight losses of about 1 to 2 lb per week.
 A 10 percent weight loss could be achieved within 6 months.
NHLBI
2009
Goals for Weight Loss
And Management
 After 6 months of weight loss treatment, the individual should be assessed.
 If no further weight loss is needed, then the current weight should be maintained.
 Sustained physical activity is particularly important in the prevention of weight regain.
 If further weight loss is desired, another attempt at weight reduction can be made.
2009
Pennington Biomedical Research
Center
 Division of Education
Phillip Brantley, PhD, Director
Pennington Biomedical
Research Center
Claude Bouchard, PhD,
Executive Director
 Heli J Roy, PhD, RD, Associate
Professor
 Beth Kalicki




 Edited :October 2009
About Our Company
 The Pennington Biomedical Research Center is a world-renowned nutrition research center.

 Mission:
 To promote healthier lives through research and education in nutrition and preventive medicine.

 The Pennington Center has several research areas, including:

 Clinical Obesity Research
 Experimental Obesity
 Functional Foods
 Health and Performance Enhancement
 Nutrition and Chronic Diseases
 Nutrition and the Brain
 Dementia, Alzheimer’s and healthy aging
 Diet, exercise, weight loss and weight loss maintenance

 The research fostered in these areas can have a profound impact on healthy living and on the prevention of common chronic diseases, such as heart
disease, cancer, diabetes, hypertension and osteoporosis.

 The Division of Education provides education and information to the scientific community and the public about research findings, training programs
and research areas, and coordinates educational events for the public on various health issues.

 We invite people of all ages and backgrounds to participate in the exciting research studies being conducted at the Pennington Center in Baton
Rouge, Louisiana. If you would like to take part, visit the clinical trials web page at www.pbrc.edu or call (225) 763-3000.
2009
2009
References
 Centers for Disease Control and Prevention (CDC):
Prevalence of Overweight and Obesity Among Adults: U.S., 2003-2004. Available at:
http://www.cdc.gov/nchs/products/pubs/pubd/hestats/obese03_04/overwght_adult_03.htm
 Womenshealth.gov. Physical Activity. Available at:
http://www.womenshealth.gov/pub/steps/Physical%20Activity.htm
 National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Do You Know the Health Risks of Being Overweight? Available at:
http://win.niddk.nih.gov/publications/health_risks.htm
 National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Statistics Related to Overweight and Obesity. Available at:
http://win.niddk.nih.gov/statistics/index.htm
 National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Weight and Waist Measurement: Tools for Adults. Available at:
http://win.niddk.nih.gov/publications/tools.htm
2009
References
 Bellanger T, Bray G. Obesity related morbidity and mortality. J La State Med Soc.
2005; 156: S43-49.
 National Heart, Lung, and Blood Institute (NHLBI). Clinical Guidelines on the
Identification, Evaluation, and Treatment of Overweight and Obesity in Adults.
Available at: http://www.nhlbi.nih.gov/guidelines/obesity/ob_exsum.pdf
 National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Choosing a Safe and Successful Weight-loss Program. Available at:
http://win.niddk.nih.gov/publications/choosing.htm
 National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Weight Loss for Life. Available at: http://win.niddk.nih.gov/publications/for_life.htm
 Warburton D, Nicol C, Bredin S. Health benefits of physical activity: the evidence.
2006; CMAJ; 174(6): 801-809.
2009
References
 Dietary Guidelines for Americans 2005. Available at:
http://www.health.gov/dietaryguidelines/dga2005/recommendations.htm
 American Heart Association (AHA). Physical Activity Calorie Use Chart.
Available at: http://www.americanheart.org/presenter.jhtml?identifier=756
 American Cancer Society (ACS). Exercise Counts. How Many Calories Will Your
Activity Burn? Available at:
http://www.cancer.org/docroot/PED/content/PED_6_1x_Calorie_Calculator.asp
 Mayo Clinic. Exercise: When To Check With Your Doctor First. Available at:
http://www.mayoclinic.com/health/exercise/SM00059