Obesity Crisis. Mary Beth Bolton, MD, FACP SVP and CMO, HAP HAP Worksite Wellness Forum September 24, 2007

Transcription

1 Obesity Crisis Mary Beth Bolton, MD, FACP SVP and CMO, HAP HAP Worksite Wellness Forum September 24,

2 Obesity Crisis Obesity How HAP can Help Childhood Obesity Benefits of Weight Loss Complications 2

3 Obesity 3

4 Defining Obesity Obesity can be defined as having a very high amount of body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or higher Body Mass Index (BMI) is a common measure expressing the relationship (or ratio) of weight to height, specifically the adult s weight in kilograms divided by the square of his or her height in meters BMI of 25 to 29.9 considered Overweight BMI of 30 or higher considered Obese 4

5 Causes of Obesity Obesity is caused by consuming more calories than the body needs, most commonly by eating a diet high in fat and calories, being inactive or both Many factors have to be considered when assessing Obesity Other causes of Obesity are: Behavior Genetics Hormones Environment Culture 5

6 Measuring Obesity Two primary tools are used to measure obesity Body Mass Index (BMI) Waist Circumference BMI is the most common method of measuring obesity. It measures an individuals weight in proportion to height. Assessing BMI helps physicians determine the severity of an individuals condition and class of obesity. 6

7 Measuring Obesity Waist circumference measures abdominal fat as a way to assess obesity Men with a waist measurement of more than 40 inches are considered overweight Women with a waist measurement of more than 35 inches are considered overweight Being overweight places people at a higher risk for obesity and obesity related medical conditions 7

8 Obesity Demographics Obesity is the second leading cause of preventable death in the U.S. Approximately 127 million adults in the U.S. are overweight, 60 million are obese An estimated 400,000 deaths per year may be attributed poor diet and low physical activity 8

9 Prevalence of Obesity BRFSS, 1990, 1998, 2006 The prevalence of obesity in the United States continually increased within the last 16 years No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% 9

10 Prevalence of Obesity On August 27, 2007, Trust for America s Health Reports identified Mississippi (30.6%) as having America s highest percentage of obese adults and Colorado (17.6%) as having the lowest Six in 10 U.S. adults are overweight or obese, including nearly a quarter who are obese The percentage of obese adults ranged from 17.6% to 30.6% among states in 2006 Michigan ranked #9 with 26.8% of obese adults Michigan ranked #20 with 14.5% of overweight youths ages

11 Obesity in Michigan The weight of Michigan s population has been steadily rising In Michigan adults, the prevalence of obesity has doubled over the past two decades Obesity has increased in people of all ethnic groups, all ages and both genders Rates of obesity in Michigan: African-American Females (49%) Mexican-American Females (38%) White Females (31%) African-American and White males (28%) Obesity Prevention Subcommittee of the Cardiovascular Health Advisory Committee, retrieved, June 30,

12 Obesity in Michigan 22.5% of adults in Michigan report that they do not engage in any physical activity. The national average is 22% Michigan is not one of the 17 states that require their school lunches, breakfasts, and snacks to meet higher nutritional standards than the U.S. Department of Agriculture (USDA) requires Michigan is not one of the 22 states that set nutritional standards for foods sold in vending machines, in school stores, or in bake sales in schools Michigan is not one of 16 states that screen students body mass index (BMI) or fitness status and confidentially provide information to parents or guardians 12

13 Obesity in Michigan Four Reasons for Concern: Weight trends reflect troubling cultural trends Higher weights are associated with health problems Economic costs (increased health care costs) Social pressure for slenderness leads to unsafe weight loss practices Obesity Prevention Subcommittee of the Cardiovascular Health Advisory Committee, retrieved, June 30,

14 Obesity in Michigan To fight against the increasing rate of obesity, individuals need to make healthy choices. Support from others is also necessary: Family support Community support Schools Employers Food and beverage industries Health professionals Government level 14

15 Childhood Obesity 15

16 Childhood Obesity Obesity is present in children when total body weight is more than 25% fat in boys and more than 32% fat in girls Childhood obesity is often defined as a weight-for-height in excess of 120% of ideal, skinfold measures are more accurate in determining excessive fat in children The triceps alone, triceps and subscapular, triceps and calf, and calf alone are areas used for measuring skinfolds A sum of skinfolds of mm is good for boys A sum of skinfolds of mm is good for girls (Skinfolds are an estimation or measurement of body fat by skinfold thickness) 16

17 Childhood Obesity The Centers for Disease Control (CDC) uses two levels of overweight in children The 85 th Percentile, an at risk level, The 95 th Percentile, the more severe level, The American Obesity Association (AOA) uses the 85 th percentile of BMI as a reference point for overweight and the 95 th percentile for obesity 17

18 Childhood Obesity The 95 th percentile: Corresponds to a BMI of 30, which is the marker for obesity in adults. The 85 th percentile corresponds to the overweight reference point for adults, which is a BMI of 25 Recommended as a marker for children and adolescents to have an in-depth medical assessment Identifies children that are very likely to have obesity persist into adulthood Is associated with elevated blood pressure and lipids in older adolescents, and increases their risk of diseases Is criteria for more aggressive treatment 18

19 Childhood Obesity There are many factors that contribute to the cause of childhood obesity. Some factors can be changed whiles others can not. Factors that can be changed: Physical activity (lack of regular exercise) Sedentary behavior (watching television, etc.) Socioeconomic status (low income families, non-working parents) Eating habits (over consumption of high-calorie foods) Environment Factors that can t be changed: Genetics (obese parents) 19

20 Complications 20

21 Complications of Obesity Overweight and obese people are at an increased risk for developing the following conditions: Type II (non-insulin dependant) Diabetes Cardiovascular Disease Stroke Hypertension Hypothyroidism Dyslipidemia Insulin resistance/glucose intolerance Congestive Heart Failure Angina Pectoris Cholecystitis Osteoarthritis Cholelithiasis Death 21

22 Complications of Obesity Cont d Gout Sleep Apnea and other respiratory problems Fatty Liver disease Polycystic ovary syndrome Fertility complications Pregnancy complications Psychological disorders Uric Acid nephrolithiasis (kidney stones) Stress urinary incontinence Cancer of the kidney, endometrium, breast, colon and rectum, esophagus, prostate and gallbladder 22

23 Major Complications Heart Disease Hypertension Type II Diabetes Osteoarthritis Metabolic Syndrome Lipid Disorder 23

24 Preventing Obesity Physical activity along with a healthy diet, plays an important role in the prevention of overweight and obesity The body burns calories with everyday functions like breathing, digestion, and routine daily activities Increasing physical activity is the best way to burn extra calories and prevent weight gain Calories consumed must be balanced by calories used 24

25 Ways to Prevent Obesity Eat five to nine servings of fruit and vegetables daily Choose whole grain foods and whole wheat bread Weigh and measure food to gain an understanding of portion size Avoid foods that are high in calories Increase physical activity Accumulate at least 30 minutes of moderately intense activity several days a week Look for opportunities throughout the day to include at least 15 minutes of physical activity 25

26 Benefits of Weight Loss 26

27 Benefits of Weight Loss Weight loss is an essential part of managing and reducing obesity Losing weight provides many short term and long term health benefits Benefits associated with weight loss: Can lower the risk of heart disease or stroke Will likely slow the development of, and halt the symptoms associated with knee osteoarthritis May result in lowered blood pressure Can lower the risk of developing Type II Diabetes Can raise HDL and lower LDL cholesterol 27

28 Suggestions for Losing Weight Most experts recommend that someone attempting to lose a large amount of weight consult with a physician or health care professional before beginning a weight loss program The Surgeon General s Healthy Weight Advice for Consumers makes the following recommendations: Aim for a healthy weight Be active Eat well 28

29 Steps Leading to Weight Loss Diet Exercise Medication Surgery Community Support Workplace Support 29

30 Diet Diet plays a significant role in maintaining good health and reducing the risk of becoming overweight or obese. Managing your weight is a long-term process and should be maintained for a lifetime. While trying to maintain a healthy diet, keep the following in mind: Make realistic dietary and lifestyle changes that will benefit you and your family Watch what you drink Drink lots of water or other sugar free drinks Switch from whole to non-fat or low-fat milk and milk products Start small by gradually reducing portions and removing high calorie foods and beverages from your diet 30

31 Diet Stop eating when you re full Do not eat when you re bored, lonely, or stressed Eat less, more often Choose healthy snacks throughout the day Replace junk food with fruits and vegetables Eating at least five fruits or vegetables a day will help you lose weight and keep your heart and the rest of your body healthy 31

32 Exercise Its very important to maintain an effective level of physical activity. Exercise increases the rate at which your body uses energy and burns up stored energy, promoting weight loss. Increasing your level of physical activity will not only decrease the amount of fat your body is carrying, it will also improve your overall fitness. Remember the following points: When you exercise, your efforts must exceed that of your normal daily activities As the exercise becomes easier, the intensity needs to gradually be increased so that level of effort is maintained during the session 32

33 Medications Weight loss drugs are an option for obese people who have a difficult time losing weight through dieting and exercising. There are a number of FDA approved prescription drugs that may help. Most weight loss drugs work by suppressing the appetite. Other drugs break down dietary fat for use by the body, while others increases the levels of certain brain chemicals that help reduce appetite. There is no magic pill for obesity. Diet and exercise are the more efficient and effective ways to lose weight. 33

34 Medications FDA approved weight loss drugs: Xenical (works in the digestive system to reduce absorption of fat) Tenuate (appetite suppressant) Sanorex (appetite suppressant) Meridia (appetite suppressant) Bontril (short term/appetite suppressant ) Adipex P (short term/appetite suppressant) 34

35 Medications Common side affects associated with weight loss drugs: Increased blood pressure Headache Dry mouth Constipation Insomnia Cramping Diarrhea Intestinal discomfort Flatulence 35

36 Surgery Weight loss surgery is an option for those who have been unsuccessful at losing weight through diet and exercise. Under the direction of a physician, candidates must meet certain criteria to be approved for surgery. Types of weight loss surgery: Laparoscopic adjustable gastric banding (Lap-Band) Gastric Bypass 36

37 Surgery Lap-Band Surgery: A silicone belt that goes around the top of the stomach resulting in the ability to control hunger and achieve a feeling of fullness. The band is adjustable. Candidates of Lap-Band Surgery: BMI greater than 40 associated medical problems not required BMI 35 and 30 Co-morbid conditions or severe medical problems (examples of complications of obesity) Diabetes Hypertension High Cholesterol 37

38 Surgery Complications of Lap-Band Surgery: Bleeding Infections Heartburn or vomiting caused by the band slipping as weight loss occurs Enlarged stomach pouch Deflated band caused by leakage Stomach outlet can become blocked 38

39 Surgery Gastric Bypass Surgery: A more complex type of bariatric surgery, designed to reduce food intake. Gastric Bypass can greatly improve the quality of life not only because of an improvement in appearance and mobility, but it can also reduce the number of health problems common in overweight and obese people. Two types of techniques are available for gastric bypass: Roux-en-Y-gastric bypass (traditional and laparoscopic) Biliopancreatic diversion bypass In both techniques, a small pouch is created, to curb food intake, by stapling a portion of the stomach. The bypasses of the small intestine are formed to decrease absorption of food nutrients 39

40 Surgery Gastric Bypass Surgery: Roux-en-Y-gastric bypass surgery (traditional or laparoscopic) Most common, considered less complicated Does not remove portions of the stomach Traditional, performed through open surgery with a long incision Laparoscopic, performed through, multiple smaller incisions 40

41 Surgery Gastric Bypass Surgery: Biliopancreatic Diversion Bypass Less common, considered more complicated Portions of the stomach are removed More risk of nutritional deficiencies Performed through open surgery with one long incision, leaving a permanent scar 41

42 Community Support Trying to lose weight on your own can be difficult at times, and almost impossible. Medically supervised weight loss programs provide group support in addition to individualized counseling. Research shows that obese patients find it easier to improve eating and exercise habits when they receive proper advice and encouragement. It is imperative that overweight and obese people have a core network of support. This is usually a group of individuals who themselves are dealing with overweight or obesity. They can provide a more personal perspective on obesity and its impact on one s quality of life. 42

43 Community Support For some, obesity may lead to: Low self-esteem Depression Anxiety Examples of national support groups that help overweight and obese people cope with pressures: America on the move American Diabetes Association Overeaters Anonymous (OA) 43

44 Workplace Support Workplace support is a benefit to the employer and employee. It sends a clear message to employees, that management values them and their well being. It also contributes to: Lower health care costs Reduced absenteeism Increased productivity Improved morale Decreased employee turnover 44

45 Workplace Support Examples of workplace support programs: Health risk assessment Health screenings On-site classes Incentive programs Monthly newsletters 45

46 How HAP can Help 46

47 HAP s Programs To improve healthy eating habits, HAP expanded the nutritional counseling benefit, making it available to all HAP members. HAP also partnered with Weight Watchers, offering HAP HMO members a discounted fee of $25 to join a 12-week session. These new programs for 2007 will encourage healthy eating habits. 47

48 HAP s Programs HAP partnered with Curves and Global Fit to encourage active lifestyles. Members joining Curves receive 50% off the registration fee and HAP pays $10.00 toward the monthly fee, up to 12 months. Increasing physical activity will help prevent and better manage certain diseases. 48

49 HAP s Programs istrive for better health Online wellness program for all HAP members Includes Balance program for weight management Weight Wise SM Featuring Zonya Foco, RD, author of Lickety Split Meals for health conscious people on the go! And host of PBS show Zonya s Health Bites Focus on the non-diet approach to weight loss, including eight healthy habits for lasting weight management 49

50 HAP s Programs Worksite Support Health Screenings (e.g. blood pressure, BMI, waist circumference) Educational displays, models and printed materials Wellness Workshops (30 60 minute) Walk for Better Health Weight Wise at Work For more information on HAP s health promotion programs, visit 50