A Public Health Challenge
Poor Nutrition and Obesity
The Public Health Issue
It is estimated that 55% of the adult
population in the United States are either
obese or overweight.*
Obesity substantially increases an
individual’s risk of suffering from chronic
diseases such as hypertension, coronary
artery disease, and diabetes.
Those with excess fat in the abdominal
area are at increased health risk*
*National Institutes of Health, National Heart Lung, and Blood Institute, 1998
The Relationship between Fat Loss,
Exercise, and Diet
The addition of exercise to a diet with
restricted caloric intake promotes fat loss,
while maintaining fat free mass.
Physical activity, without caloric
restriction, minimally if at all affects fat
loss.
To optimize weight loss, a combination of
diet and exercise is best, and that exercise
alone will not suffice.
Predictors or Mediators of Poor
Nutrition
An unhealthy lifestyle,
Bad health,
Low self-rated care of one’s own health,
Perceived susceptibility of cardiovascular
disease,
Motivation towards dietary changes and
Low self-efficacy about increasing physical
activity, and
Overweight and impaired glucose
tolerance.
Diet or Exercise: Which is Better
to Lose Weight?
According to the Pew Research
Center, about a third (34 percent) of
Americans are neither exercising nor
dieting;
Seventeen percent are doing both;
Eight percent are dieting but not
exercising; and
Forty percent are exercising but not
dieting.
So, Who is Right?
A recent study appearing in the
Journal of Clinical Endocrinology &
Metabolism demonstrated that
dieting and exercise are equally good
at taking off the pounds
The key is that as long as the
number of calories consumed is the
same as the number of calories
burned you will loose weight.
It Depends!*
If you can exercise enough to burn more
calories and would rather do that than cut
calories, then exercise is the way to go.
If, however, you're more willing to trim
your portions than go out running, dieting
will work better."
Think about which you would rather do:
Skip the mayo on your burger, or walk it
off for 35 minutes?
*According to David L. Katz, M.D., associate professor of public health and director of the
Prevention Research Center at Yale University School of Medicine
The View from the Top
It's clear from the research that the
majority of people who have lost
weight and kept it off for five years
or more combine diet and exercise.
It's nearly impossible to exercise
enough to control weight without
attention to diet.
Conversely, it's nearly impossible to
sustain weight loss without some
increase in physical activity.
An Added Benefit
An increase in physical activity offers
other benefits, including:
– cardiovascular health, and strength
training
– can add muscle, which can burn extra
calories at rest (each pound of muscle
added will increase the calories your
body burns by about 30-50).
Not a Well Known Fact*
Many truly obese people don't eat
much but don't move much, either
(hence their weight stays the same).
Some are eating at starvation levels
but sit in a chair all day.
Once they start moving, they lose
weight..
*Stephen Rice, M.D., Ph.D., M.P.H., a sports medical expert at the Jersey Shore Medical
Center in Neptune, NJ
Lifestyle Changes: Should you eat
three or six meals per day?
The answer is that it really depends on
whether those six meals are going to
increase or decrease how many calories you
take in for the day overall.
A small amount of research says that eating
mini-meals consisting of less food more
frequently may help rev metabolism and
prevent extreme variations in blood sugar.
At the very least you should eat three times
daily. Some people reap benefits from
eating about every four or five hours daily.
Lifestyle Changes: Scheduling
Exercise
Which is better for you--walking for 15
minutes each day or going on an all-day
hike on the weekend?
– It’s pretty much unanimous among
health experts*: The daily walk, even
for a few minutes, is better than the allday hike on the weekend.
– If you have the time to walk 15 minutes
each day, it is better for your health and
fitness.
EXERCISE WITHOUT WEIGHT
LOSS: THE HEALTH CONNECTION
Excess fat in the abdominal area
independently increases an individual’s risk
of insulin resistance and high blood lipids.
This distribution of body fat is also a strong
predictor of cardiovascular disease.*
It has been shown that weight management
programs resulting in a loss of total body fat
also reduce a person’s amount of abdominal
fat. This loss of abdominal fat is associated
with a decreased risk of cardiovascular
disease.
*Grundy et al., 1999, National Institutes of Health, National Heart Lung, and Blood Institute, 1998.
EXERCISE WITHOUT WEIGHT
LOSS: THE HEALTH CONNECTION
However, it has been shown that exercising
individuals, who do not experience any overall
weight loss still decrease their risk of suffering
from cardiovascular disease.**
In the event that weight loss is not achieved, a
person who is at increased risk of coronary artery
disease (CAD), or its comorbid conditions (i.e.,
high blood pressure, glucose intolerance, insulin
resistance), still benefits from regular aerobic
exercise participation.
** Ross & Janssen, 1999.
The Public Health Goal
Regular, moderate-intensity physical
activity, such as brisk walking, for 30 to
60 minutes on most days of the week.
Daily exercise performed at a moderate
intensity for 45 to 60 minutes a day
without deceasing caloric intake.
More research is needed with overweight
and obese female populations to validate
these benefits in women.
Doctors skimp on diet, exercise advice
New findings from one of the most comprehensive health
surveys in the nation may shed light on one of the reasons
obesity and diabetes are tough problems to solve - primary
care physicians, the main gatekeepers of health
information, aren't talking enough about the need for
good nutrition and exercise.
Data from the California Health Interview Survey, an
analysis of phone interviews from about 46,000 residents in
the state, showed just 34 percent of adults said their
doctors discussed exercise with them and 28 percent
discussed nutrition.
The research "suggests that physician involvement may be
a piece of the puzzle in obesity.“*
*Sue Holtby, senior research scientist at the Public Health
along with the UCLA Center for Health Policy Research.
Institute, which conducted the survey
The Problem from a Public Health
Perspective*
Physicians have so many competing
demands in the office.
They have more adults coming in with
chronic illnesses, and their focus is on
addressing patients' immediate needs.
Preventative needs tend to get relegated
to the back burner, especially when the
patient is in and out in 15 minutes.
*Dr. Lisa Santora, chief medical officer for the California Beach Cities Health District
Other Opportunities to Educate
Most hospitals have nutrition programs
and dieticians on staff.
City Health District holds numerous
community programs and works closely
with schools. One of the focuses of
education has been improving healthful
eating at home, with the hope that
children will be encouraged to change.
Since nearly three-quarters of adolescents
discuss nutrition and exercise with their
doctors, encourage doctors to educate
young patients.
What Does the Public Health
Research Say to Do?