Preventing and Managing
Overweight and Obese Adults:
HAVING AN EFFECTIVE CONVERSATION
WITH OVERWEIGHT AND OBESE ADULTS
ELIZABETH PATRICK, MD
DISCLOSURE
I HAVE NO FINANCIAL RELATIONSHIPS
WITH ANY COMMERCIAL INTERESTS
RELATED TO THE CONTENT OF THIS
ACTIVITY TODAY.
America is Becoming Obese
 33% of American adults are obese
 Impacts work, leisure, and life expectancy
 Generating billions in health expenditures
 Who is obese?
-BMI > 25
- BMI = (weight in pounds)/ (height in inches)2
Complications of obesity include:
Obesity Trends* Among U.S. Adults
BRFSS, 1990, 2000, 2010
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2000
1990
2010
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Historical Issues
 “Good” food used to be less expensive
- i.e. wild game
 “Bad” food used to be expensive
-i.e. flour and sugar
Good vs. Bad Foods
 Food is more processed
 High fructose corn syrup
 Change in clothing elastic in 1950s
 Change in work
-i.e. laundry/ farming
Good vs. Bad Foods
 “Bad” food is 10 times cheaper*
-2000 calories of junk food= $3.52/day
 “Good” food is pricey*
-2000 calories of good food= $36/day
 “Good” food also has to be cooked
 Educational issues
-shopping and cooking
*University of Washington
Genetics
 Extremes
- Eskimo
-traditional diet vs. modern diet
- Pima Indians
-traditional diet vs. modern diet
 Mormon Genealogy
-Frank Moody, MD
Genetics cont…
 Every $1 spent on food, only $0.19 is food; the rest of
the money pays for marketing and packaging
 Calorie counts: restaurants are inaccurate
-269 food items- 20% has 100+ more calories than
reported (Tufts University)
- eat 100+ calories per meal, gain 30 pounds a year
 Americans consume 500 more calories a day now
than they did in 1970 according to the USDA
Decrease in Nutrients
 6% less protein
 16% less calcium
 15% less iron
 38% less riboflavin
 20% less vitamin C
 Chicken contains 266% more fat and 33% less
protein than it did 40 years ago
 Milk
Men’s Health 2011
Decrease in Nutrients cont…
 Weight = Energy in – Energy out
 Basal Energy Expenditure (Harris Benedict
Equation)
Men
BEE= 66.5 + (13.75* kg) + (5.003* cm) –
(6.7705*age)
Women
BEE= 655.1 + (9.563*kg) + (1.85*cm) +
(4.676*age)
Multiply by stress factor
Other Ways to Measure
 Tantina
-gyms/ weight loss centers
 Biometrics
-university/sports
 Metabolic testing
-Baptist
Other Ways to Consider
 1 pound= 3500 calories
…so under 2500 calories a day equals a
2 pound weight loss per month
Medications
 For patients with BMI ≥ 30 (or 27 with a serious
medical problem) facilitates 5-10% weight loss goal
-Sympathomimetic Drugs
-Meridia
-withdrawn US market
-Lipase Inhibitors
-Alli
-prevents action of lipases
-possible liver injury
Short Term
 Bontril (Phendimtreazine Tartarate)
 Tenuate (Diethylproprion)
 Didrex (Benzphetamine)
 Fastin/ Adipex (Phenteramine)
 These are all amphetamine derivatives
 Contraindicated heart disease and thyroid disease
Drugs Withdrawn from Market
 Redux/ Phen Phen
- Pulmonary Hypertension
 Rimonabant
-Related THC
-Suicide/ depression
 Meridia
- Cardiac Issue
Off Label
 Welbutrin




-weight loss for 1 year trial
Topamax
-several 6-12 month trials
-significant side effects
Zonisamide
-4 month trial
-significant weight loss
Byetta
-diabetic trials
Victoza
-diabetic trials
Phen-Prozac
 FDA Black Box
 Redux Study
-poor design
 Lots of psychiatric patients on SSRIs and
amphetamines with no increased incidence of
pulmonary hypertension
OTC
 Recent FDA removal of ephedrine due to serious
side-effects
 Recommend consulting physician prior to and
during use
HCG
Acai
 Contains antioxidants
 No studies supporting weight loss
 Avoid with berry/pollen allergies
 Oprah Winfrey disassociated herself with claims
 Hefty price
 85% berry is seed
 No adverse effects
WebMD
Hoodai
 Plant based Hoodiagordonii




-succulent
Little science claims “tricks your brain into feeling
full”
Study of 7 people
-3.3% weight loss
Mayo Clinic feels no conclusive claims
No data of adverse effects
Web MD
Sensia
 Works with sense of smell to eat less
 No stimulants
 Feel full sooner
 Contains Malodextrin (similar to MSG)
 Takes 10-20 minutes to work
Metabolife
 Ephedra removed
 Licorice an issue
 HTN
Bioslife 2
 Fiber
 Makes you feel full
 Similar modern product
-Purisalv
-chia seeds- expand
-natural stimulant
Source of Over-the-Counter Information
 http://www.weightloss-reportcard.info/
Diets
 Low carb = low fat
-at six months if compliant
 Vegetarian diet
-may be beneficial for post-menopausal women
Consider Personal Weight-loss Issues
 Past diets
 Personality
 Budget
 Special needs
-other health conditions, i.e. diabetes
-cultural/ethnic needs
Evaluate Diets
 What does it consist of?
 Who’s beyond diet?
 What are risks?
 What are results?
Low Carb
 Atkins
 Sugar busters
 South Beach
 Zone
-limit carbs, sometimes high fat, sometimes hard to
maintain
Lifestyle change
 Mayo Clinic Diet
 Learn Diet Program
(lifestyle, exercise, attitudes, relationships, and
nutrition)
 Change unhealthy habits and behaviors
Fad Diets
 Cabbage Soup
 Lemonade
 Grapefruit diet
-short term weight loss
-nowhere to go next
-weight usually regained
Low-Fat Diet
 Reduces fat in diet to < 20%
 Many low fat foods are high in sugar
 Ex: Ornish Pritakken
Meal Providers and Replacement
 Replace 1-2 meals per day with prepared products
 Can be effective
 Costly
 Examples
-Nutrisystem
-Slimfast
-Seattle Sutton
Very Low Calorie
 Needs to be physician supervised
 Difficult to transition back to real life
 cost
Points of Safe/Effective Weight loss Programs
 Flexible
 Balanced nutrition
 Enjoyment
 Physical activity
 Steady pace
-1 to 2 pounds per week
Weight Loss Hypnosis
 Only slight weight loss- around 6 pounds
 Studies poor
Weight Loss Plateau
 Decrease calories by 200
 Increase exercise by 15 to 30 minutes
 Increase daily activity
 Reassess food diary
 Stay above 1200 calories
Exercise
 2 ½ hours/ week divided
 2 episodes of strength training
 Think outside the box
-dance
-Wii
-chopping wood
Gain Control of Emotional Eating
 Connection between mood, food, and weight loss
 Address stress
 Check hunger
 Food diary
 Support
 Fight boredom
 Take away temptation
 Don’t deprive
 Snack healthily
 Get enough sleep
Seek Therapy
 Overeaters Anonymous
 Weigh Down
 Counselor
Support Groups
 Tops
 Weigh Down
 Overeaters Anonymous
 Jenny Craig
 Weight Watchers
Gastric Surgery
 Lap Band
 Roux-N-Y A Type of Gastric Bypass
 Newer
 Qualifications
-BMI ≥ 30 + co morbidities
-BMI ≥ 35
Calorie Counting
 Calorie King
 My Fitness Pal
 3500 calories = one pound of weight
Bottom Line
 Lifestyle change
 Exercise + Diet
250 calories/day = 2-3 pounds/ month
Pitfalls
 Multiple
 Overeating
-Tops
-Overeaters Anonymous
-Palmetto Behavioral
Resources
 Palmetto Behavioral Health





-overeating
-depression
ObesityinAmerica.org
-patient fact sheets
Myfitnesspal.com
E-mealz.com
-portion control
-$15/3 months
-download menus, shopping list every Thursday
www.obestiy.org
The Mayo Clinic Diet
-Mayo Clinic Healthy Weight Pyramid tool