Obesity, Overweight and
Weight Control
Healthy Weight Network
Prevalence of Overweight Among Children &
Adolescents 6-19 Years
Age
1963-65
(Years) 1966-70
197174
197680
198894
19992002
6-11
4%
4%
7%
11%
16%
12-19
5%
6%
5%
11%
16%
Source: National Center for Health Statistics
Overweight and Obesity
Definitions
 Height/Weight




Tables
Metropolitan Life Insurance, revised 1983
Based on weight-height mortality study
Weights are ages 25 to 59 based on lowest
mortality
Height and Weight Chart - height weight chart,
weight height chart
Overweight and Obesity
Definitions


BMI = weight (kg)
height squared (m²)
Significantly correlated with total body
fat content
Classification of Overweight and Obesity by BMI
Obesity Class BMI kg/m2
Underweight
<18.5
Normal
18.5–24.9
Overweight
25–29.9
Obesity
Extreme Obesity
I
30.0–34.9
II
35.0–39.9
III
 40.0
Overweight and Obesity - Definitions



Waist Circumference
Presence of excess fat in abdomen out of
proportion to total body fat is a
independent predictor of risk and
mortality.
Waist circumference is positively
correlated with abdominal fat content.

High Risk:
 Men >102 cm (>40 in.);
 Women > 88 cm (>35 in.)
Waist-to-Hip Ratio




Waist-to-hip ration measures waist at its
narrowest point and hip at widest point.
Women with 35” waist and 46”hip =
35/46 = 0.76
Risk:


Women with waist-to-hip ratio >0.8
Men with waist-to-hip ratio > 1.0
Assessment of Obesity




Anthropometrics
Medical
Psychological
Nutritional
Weight Control



Advantages of Weight Loss:
Blood Pressure
Serum/Plasma Lipids



Reductions in serum triglycerides and
increases in HDL
Reductions in total cholesterol and LDL
Blood Glucose
NHANES III Age-Adjusted Prevalence of
Hypertension* According to BMI
BMI <25
BMI 25-26
BMI 27-29
BMI >30
50
38.4
Percent
40
32.2
30
20
22.5
25.2
18.2
21.9
24.0
16.5
10
0
Men
Women
*Defined as mean systolic blood pressure  140 mm Hg, as mean diastolic 
90 mm Hg, or currently taking antihypertensive medication .
Brown C et al. Body Mass Index and the prevalence of
Risk Factors for Cardiovascular Disease (in preparation).
NHANES III Age-Adjusted Prevalence of
High Blood Cholesterol* According to BMI
BMI <25
BMI 25-26
BMI 27-29
BMI >30
Percent
50
40
27.9
30
20
14.7
17.5
20.4
28.2
20.2
15.7
10
0
Men
*Defined as > 240 mg/dL.
Brown C et al. Body Mass Index and the
Prevalence of Risk Factors for Cardiovascular
Disease (in preparation).
Women
24.7
NHANES III Age-Adjusted Prevalence of
Low HDL-Cholesterol* According to BMI
BMI <25
BMI 25-26
BMI 27-29
BMI >30
Percent
60
50
41.5
40
31.4
30
23.1
17.2
20
10
27.0
27.2
16.5
9.1
0
Men
*Defined as <35 mg/dL in men and <45 mg/dL in women.
Brown C et al. Body Mass Index and the Prevalence of
Risk Factors for Cardiovascular Disease (in
preparation).
Women
Nutritional Assessment

Weight History






Age of onset
Highest/lowest adult weights
Patterns of weight gain and loss
Environmental triggers
Current eating patterns
Nutritional Intake
Nutritional Assessment



Environmental Factors
Exercise history
Motivation and readiness to change
Treatment for Obesity
BMI
25-26.9
27-29.9
Diet,
Physical
Activity &
Behavior
Therapy
With comorbiditie
s
With comorbiditie
s
Pharmcotherapy
Surgery
30-34.9
If not lost
1#/week
after 6 mo.
With comorbiditie
s
3539.
9
>40
Position of ADA


Successful weight management requires
a livelong commitment to healthful
lifestyle behaviors emphasizing
sustainable and enjoyable eating
practices and daily physical activity
Position Paper
Goals for Weight Loss




Prevent weight gain or stop weight gain
Improvement in physical and emotional
health
Small maintainable weight losses or more
extensive weight loss through sensible
eating and exercise patterns
Improvement in eating, exercise and other
behaviors apart from any weight loss
Goals for Weight Loss





Initial goal to reduce body weight by
approximately 10% from baseline.
1-2#/week for period of 6 months
1# body fat = 3500 calories
3500/7days = - 500 calories/day
Need to assess individual’s motivation
and readiness to enter weight loss
therapy.
How To Achieve Weight Loss



1,000 – 1,200 kcal/day for women and
1,200 – 1,600 kcal/day for men
Reducing dietary fat along with
carbohydrates can facilitate calorie
reduction.
Reducing dietary fat alone without
reducing calories is not sufficient for
weight loss.
How To Achieve Weight Loss
 Physical
activity is recommended as
part of a comprehensive weight loss
program because:
 contributes to weight loss
 may decrease abdominal fat
 increase cardio-respiratory fitness
 may help with maintenance of weight
loss
How To Achieve Weight Loss




Behavior Therapy
Pharmacotherapy - weight loss drugs
Weight loss drugs may be used in
combination with a comprehensive weight
loss program, for patients with BMI>=30
with no risk factors & BMI >=27 with risk
factors.
Weight loss drugs should never be used
without concomitant lifestyle changes.
How To Achieve Weight Loss

Better weight loss results are achieved
with diet therapy when




the duration of the intervention is at least 6
months.
Long term weight loss is enhanced by a
program of dietary therapy, physical
therapy and behavioral therapy
continued indefinitely.
“Habit is habit and not to be flung out of the
window by any man, but coaxed downstairs a
step at a time.”
–Mark Twain
How To Achieve Weight Loss

Outcome data on behavior therapy, Very
Low Calorie Diets (VLCD) and
Pharmacotherapy show



weight regain in 3-5 years
Frequent contacts between professional
counselors and patients promote weight
loss and weight maintenance
Chicago Tribune | Biggest 'Lost' mystery:
Why is Hurley still fat?
Tips for Weight Loss
Eat a variety of foods from the Food Guide
Pyramid, including favorite foods
 Increase intake of high-water/high-fiber
foods





Vegetables and fruits
Whole grains and legumes
Soups
Decrease consumption of energy dense
foods


High fat foods
Foods with low moisture content
Mayo Clinic Food Guide
How to Calculate Energy Density




Energy Density = Calories/Grams
E.G. 150 Calories/100 grams = 1.5 Kcal/g
Energy density of 1 – Eat any quantity
Limit foods with energy density >2
Tips for Weight Loss





Limit consumption of beverages containing
alcohol and sugars
Control Portion Sizes
Plan meals and snacks ahead
Establish regular eating habits
Shop on a full stomach
Shopping Tips


Use a shopping list
Read labels
 serving size and servings
per container
Tips for Weight Loss






Eat from plates, not food packages
Portion foods before bringing them to the
table
Eat slowly
Sit down to eat
Stop eating when you leave the table
Watch for food ‘triggers’
Tips for Weight Loss
 Use
of Meal Replacements?
Fad Diets






Americans spend >30 billion in the
weight loss industry
Single food diets - grapefruit, rice etc.
High-protein, high fat diets
VLCD
Fasting
High fiber, low-calorie diets
Weight Loss Surgery