FCSN 245 – Basic Nutrition
Summer 2005
Episode III – Dr. David Gee

Starting tomorrow, all lectures will be held
in PE 201
 Clicker

points: attendance sheets
Course web page
 www.cwu.edu/~geed

Grades so far posted on bulletin board
outside 136 Michaelsen
Healthy Weight and the
Non-Diet Approach
David L. Gee, PhD
Professor of Food Science and Nutrition
Central Washington University
Prevalence of Overweight in the
US

1990: 56% of Americans were overweight


2000: 64% of Americans were overweight


30% were obese
At this rate




23% were obese
In 2010: 73% overweight
In 2020: 84% overweight
In 2030: 96% overweight
Increases in overweight/obesity were seen in:



Both males and females
All age groups
All ethnic groups
Ethnicity and Overweight
(BMI>27.5) Prevalence
70
66
63
60
50
45
42
40
%
30
24
27
31
40
34
26
20
10
0
White
Black
Hispanic
Native Am Hawaiian
Male
Female
Prevalence of overweight in
children.

CDC (2004)
= above the 95th percentile for BMI
based on NHANES II data from 1970’s
 For adolescents 12-19 yrs:
 Overweight
1974 = 7.4%
 2002 = 15.6%

Prevalence of Overweight Children in the US
Epidemic Increase in Childhood
Overweight, 1986-1998
JAMA 286:2845-2848 (2001)
Epidemic Increase in Childhood
Overweight, 1986-1998
JAMA 286:2845-2848 (2001)

National Longitudinal Survey of Youth
 1986-1998
 8,270

children, aged 4-12 yrs
Prior studies show it took 30 years for
overweight prevalence to double. Current
study show doubling time to be less than 12
years.
 Rate
of increase particularly high in African
American and Hispanic children
Why lose weight?

Obesity is associated with greater risk of:
 Diabetes
 Hypertension
& stroke
 Coronary heart disease
 Most cancers (except lung cancer)
 Sleep apnea, arthritis, gall stones, ….

Overfat vs Underfit ????
 Good
question
 Vast majority of overfat are underfit
Obesity and Causes of Death in the US
Epilog: Supersize Me
The Food Industry Strikes Back
NY Times (July 7, 2005)
20 states have passed ‘Common sense
consumption laws’ preventing personal
injury lawsuits related obesity (11 states
pending)
 During elections of 2002 & 2004, the food
and restaurant industry gave $5.5 million to
politicians in the 20 states.


Institute on Money in State Politics.
Epilog: Supersize Me
The Food Industry Strikes Back
NY Times (July 7, 2005)
83% of public opposed to obesity lawsuits
against restaurants and fast food companies
 Pelman & Bradley vs McDonald’s

 Initial
personal injury lawsuit dismissed
 Jan 2005, panel of 3 Federal Judges reinstated
‘deceptive practices claim’ (McDonald’s falsely
presented their food as nutritionally beneficial
to consumers)
Is being overweight really that
dangerous?
Excess Deaths Associated with Underweight,
Overweight, and Obesity
JAMA 2005:293:1861-1867
“Underweight and obesity… were
associated with increased mortality…”
 “Overweight was not associated with
excess mortality.”
 “Study finds government overstated danger
of obesity” – USA Today – 4/19/05

 http://www.usatoday.com/news/health/2005-04-
19-obesity-danger_x.htm
For adults ages 25-59, increased mortality
in underweight and obese categories, but
not overweight category.
Is Obesity a Public Health Problem?
Obesity and Overweight prevalence is rising
rapidly
 Obesity is associated with increased risk of
mortality (overweight?)
 Overweight is a temporary period of
transition (many/most overweight people
become obese)

Is Obesity a Public Health Problem?
Obesity and Overweight are associated with
increased risk of diabetes, hypertension,
dyslipidemia
 While treatment of these diseases has
improved

 Health
care costs are rising
 Quality of life impacted
The Obesity Epidemic in America:
Who’s responsible?

Personal responsibility
Environmental influences

Do we need a “Food Police”?

 http://www.nytimes.com/2005/06/12/business/yourmon
ey/12food.html?pagewanted=1
Discussion:
What role should American society play
in addressing the Obesity Crisis?


Name
1: Weight problems are a matter of personal
responsibility.
 No

significant changes need to be made.
2: Weight problems are significantly influenced by
environmental factors.
 Society

needs to implement changes.
3: Weight problems are highly influenced by
environmental factors and will lead to catastrophic
health problems.
 Society
needs to implement sweeping changes.
Why we gain weight
Genes/Biology vs Environment
 Overweight is a result of both
 Adoption studies (biology)
 Adopted
adults have BMI that are more similar
to biological parents than to adoptive parents.
 Animal
studies (biology)
genetically
obese rats and mice
Genes/Biology vs Environment
(cont.)
 Migration
studies (environment)
 Japanese
 Hawaiian
Japanese
 Californian Japanese
 Dietary
Change Studies
(biology and environment)
SW
Native Americans
Pima Indians
 Mexican Pima Indians
subsistence farming & ranching
20% fat diet, 40 hrs/wk physical work
 Arizona Pima Indians
mechanized agriculture, sedentary
lifestyle
40% fat diet
Pima Indians
Arizona
1
Pima Indians are:
inch taller
57 pounds heavier
70% obese
50% with diabetes by age 35
Genes vs Environment:
Conclusions
 Genes
for weight gain predisposes
some individuals towards weight gain.
 Environment determines which of
those individuals actually gain weight.
 The rapid change in obesity prevalence
is likely to be more due to changes in
the environment than changes in our
genetic pool.
What is a “Healthy Weight”?
A broad
range of weight
which allows for minimal
risks for chronic diseases.
Goes beyond using only
body weight as a criteria for
good health.
Determination of your "healthy
weight".
 Step
1. Body Mass Index
BMI
= BW(kg)/Ht2(m2)
 Dr. Phil
 from Nutrition Action Health Letter, Jan. 2004
6‘4"
= 78" x 0.0254(m/in)= 1.93m
240lbs / 2.2(lb/kg) = 109kg
 BMI

= 109/(1.932)=109/3.72
= 29.3
BMI Classifications
 BMI
= 19 - 25 => Desirable
 BMI = 25 - 30 => Overweight
 BMI = 30 - 35 => Obese, category 1
 BMI = 35 - 40 => Obese, category 2
 BMI > 40
=> Severe obesity
BMI and Mortality Risk
Healthy Weight (cont.)
If
your BMI > 25, then
consider presence of other
health risk factors.
Healthy Weight (cont.)
 Body
Fat Distribution
 upper
body fatness associated with
higher health risks
 Waist Circumference (1998 NIH)
>
35” for females,
> 40” for males
Healthy Weight (cont.):
Know your blood lipids!
 Hyperlipidemia/dyslipidemia
TC
> 240 mg/dl
LDL-C > 160 mg/dl
HDL-C < 40 mg/dl
TG > 200 mg/dl
Healthy Weight (cont.):
Know your blood pressure!
 High Blood Pressure
Systolic
BP > 140 mm Hg or
Diastolic BP > 90 mm Hg or
Borderline hypertensive
Pre-hypertensive
>130/85
Healthy Weight (cont.):
Know your blood sugar and history
 Hyperglycemia (Diabetes)
Fasting

Blood Glucose
> 126 mg/dl
Impaired
Glucose Tolerance
Pre-diabetic

>110 mg/dl
 Gestational
Diabetes
 Family History of Diabetes
Healthy Weight Summary

If your BMI is 19-25, you are at a Healthy
Weight.
 Health
problems are not weight related
If your BMI is > 25 and you have no other
risk factors, you are at a Healthy Weight.
 If your BMI is > 25 and you have one or
more risk factors, you are NOT at a Healthy
Weight.

 Weight
loss is likely to improve your health
Should everybody who is overweight try to lose
weight?
Will weight loss improve your quality of life?
A Prospective Study of Weight Change and Health-Related
Quality of Life in Women
JAMA Dec. 1999
 Nurse’s Health Study

 40,098
women, 4 yr longitudinal study
 Weight changes
 Quality of life questionnaire
 Physical
function
 Vitality
 Freedom
from bodily pain
 Mental health
The effect of weight gain/loss on:
Vitality Score

Weight gain:


associated with
declines in
vitality scores in
all BMI
categories
Weight loss

associated with
improved
vitality scores
only in women
with BMI>25
The effect of weight gain/loss on:
Mental Health Score

Weight gain


associated with a
decline in mental
health scores in
all weight
categories
Weight loss

associated with
improved mental
health scores only
in obese class I
women and
declined in
normal weight
women.
A Prospective Study of Weight Change and
Health-Related Quality of Life in Women.
Conclusions:

For women at all BMI categories:
 Don’t
gain weight
 Reduced quality of life

For overweight and obese women:
 Weight
loss is generally associated with improved
quality of life

For normal weight women
 Weight

loss does not improve quality of life
May actually reduce quality of life
Do media images
affect your idea of
what you should look
like?
2000 Grammy Awards
Do media images actually
Contribute to weight
problems?
Bottom Line on Weight Loss

Lose weight for the right reasons
 Improve

health and your quality of life
Losing weight to attain the ‘perfect body’
 May
lead to frustration
 And,
 May
ironically, weight gain
lead to eating disorders
Dietary Means to a Healthy Weight

Weight loss occurs when in negative energy
balance
Weight loss is only half the battle
 Maintenance of weight loss is the critical
problem

Dietary Means to a Healthy Weight
Balanced Reduced Calorie Diet

Characteristics
 Calories
reduced by 500-1000 Cal/day
 CHO:PRO:FAT = 50-60%: 10-15%: 20-30%

Examples
 Weight

Watchers, Jenny Craig, Slim Fast
What the research shows:
 Short-term

Modest weight loss, improved health
 Long-term

outcomes
outcomes
Success rate not great
Dietary Means to a Healthy Weight
Low Carbohydrate Diets

Characteristics
 Very
low in CHO
 Restricted intakes of fruit, cereals, pasta, bread,
potatoes, rice
 Caloric intake not specified

Examples
 Atkins

diet
What the research shows:
 Short-term

6 month studies, good weight loss, no substantial change in
heart disease risk factor, drop-out rate significant
 Long-term

outcomes
outcomes
No long term studies, health risks?
Dietary Means to a Healthy Weight
The Carbohydrate ‘Restrained’ Diets

Characteristics
 Lower
in CHO than Dietary Guidelines but
higher than Low Carb diets (~40% CHO,
30%FAT, 30%PRO)
 Low glycemic index foods encouraged
 Monounsaturated fats encouraged

Examples
 Zone

Diet, South Beach Diet
What the research shows:
 Little
research available on these diets
Dietary Means to a Healthy Weight
Healthy Diet/Non-Diet Approach

Characteristics
 Focus
on quality of the diet, not quantity
 Attaining good health is primary goal, not weight loss

Examples
 DASH

diet, Dietary Guidelines, Food Guide Pyramid
What the research shows:
 Short-term

outcomes
Slow, limited weight loss, health benefits
 Long-term
outcomes
U. Colorado’s Weight Loss Registry
 Diet most adopt in order to maintain weight loss

Summer 2005 – Final Exam


Thursday, July 28, 12:50PM, 201 PE
Gee
 Lecture
materials
 Chapter 11-Achieving and Maintaining a Healthful
Body Weight
 Chapter 9 – Nutrients Involved in Bone Health
 20 MC/TF questions
 See www.cwu.edu/~geed tomorrow for study guide
 Take Home essay question (turn in with final)
What is the role of American Society in Addressing the US
Obesity Crisis?
 1 page, double space, 12 pt font, 1” margins
 10 pts: grammatically perfect, well thought out, clearly states
and defends position.


Bergman & Bennett
 Study
old exams and example question on their
web pages
 40 MC/TF questions
Key Points:
Diet and Weight Loss
Prevention is far easier than the cure
 People lose weight using many types of
dietary programs

 Always

energy balance
People are far more likely to maintain
weight loss eating a balanced healthy diet
Exercise and Weight Loss

U. Colorado’s Weight Loss Registry
 Exercised
used by nearly 100%
 Walking the most common form of exercise

Benefits of Exercise
 Rate
of weight loss greater
 Caloric restriction not as great
 Quality of weight loss better
 Proactive choice vs dieting
 Health benefits independent of weight loss
Rates of physical inactivity in the US
Exercise and Weight Loss
Structured Exercise

Aerobic Exercise
 Burns
more calories, more fat
 Stress duration initially

Strength Training
 Builds
more lean tissue
 Increases basal metabolic rate
Exercise for Weight Loss:
Walking vs Running
Going 4 miles
Calories burned
Walking @
15min/mile
400 Cal
Jogging @ 8
min/mile
400 Cal
Fuels burned:
CHO:FAT
Calories CHO
50:50
75:25
200 Cal
300 Cal
Calories FAT
200 Cal
100 Cal
Exercise for Weight Loss:
Walking vs Running
Going 1 hour
Distance covered
Walking @
15min/mile
4 miles
Jogging @ 8
min/mile
7.5 miles
Calories burned
400 Calories
750 Calories
Fuels burned:
CHO:FAT
Calories CHO
50:50
75:25
200 Calories
560 Calories
Calories FAT
200 Calories
190 Calories
Exercise and Weight Loss
Structured Exercise

Successful Programs:
 Convenient
 Enjoyable
 Safe
 affordable
 Subject
realizes net benefit over costs
Exercise and Weight Loss
Lifestyle Activity

24 hr day
 Sleep/rest
= 10 hrs
 Structured exercise = 1 hr
 What you do the remaining 13 hrs of the
day?

Burn extra 25 Cal/hr = 325 Cal/day
=



33 pounds of fat loss per year
Develop a new attitude about being
active
Pedometers and 10,000 step programs
Health benefits significant
Weight Loss/Weight Maintenance
Behavior/Attitude Changes

Pay attention to what you eat
 Success

of weight loss programs
Examine:
 Triggers
for eating
Emotional eating
 It’s not just what your eating, it’s what’s eating you!

 Risky

situations
Behavior Modification Programs
 Track/record
eating behaviors
 Identifies problems
 Sets goals and establishes rewards
 Continual reassessment/problem solving
For more severe weight loss:

Prescription Drugs
 For
those with BMI > 30 or
 For those with BMI >27 and risk factors

Meridia (Sibutramine, Abbott Lab)
 Suppresses

Xenical (Orlistat, Roche)
 Inhibits

appetite
fat absorption
Long term success and risks
For those with Severe Obesity

Surgical Methods
 For
those with BMI >40
For those with Severe Obesity

Gastroplasty
 Reduces
size of stomach by
banding or stapling

Gastric Bypass Surgery
 Reduces
size of stomach
 Bypasses much of the small
intestine

Outcomes
 Rapid
and substantial weight
loss
 Side effects
 Dangers
Tips from the National Weight
Control Registry (est. 1994)
 Focus
on successful weight loss
 >3000 people
 kept >30 lbs off > 1year
Average:
 80%
60 lbs for 5 yrs
female
 many
had “bad” genes
2/3rds
were overweight as children
46% w/one or both parents overweight
60% had family history of obesity
 any
age
average
age 45 yrs
Tips from the National Weight
Control Registry
 Failed
to lose weight in the past
Don’t
view past failures as signs you
can’t succeed
 Found
No
process difficult
pain, no loss
 Made
smaller lifestyle goals
 Planned indulgences
How they lost weight
 10%
lost weight with diet only
 1% w/ exercise only
 89% w/ diet + exercise
 used many types of diets to lose
weight
 50% did it on their own
How they maintained their
weight loss
Low fat diets
 Watched calories
 Daily exercise

 averaged
+ 2600 Cal/week, ~ 1 hr/day
 70% walked or walked + other exercise
 20% weight training
 20% bicycling
 18% aerobic dance
 avg 3 hrs/week of TV
Tips from the National Weight
Control Registry
 Do
what you want, not what you
should