Overweight
Body Mass Index
Chart display (Refer to chart)
Definition
B. M. I.
Weight in pounds
Height in inches squared (squared means a number multiplied by itself)
Divide weight in pounds by the square of the height in inches and multiply the final answer by 704.5
Interpretation
Under 18.5 = underweight
Under 27 = not obese or overweight
27 to 29.9 = overweight
Over 30 = obese
Over 40 = extremely obese
Waist Circumference
Men = over 40 inches
Women = over 35 inches
Should be used as well if the B.M.I. is 25 to 35
Prevalence
97 million in the United States are overweight or obese
54.9% of adults age 20 and older in the United States
Risk Factor for Illnesses
Blood pressure
Heart attack
Stroke
Diabetes mellitus
Cancer
Breast
Prostate
Colon
Uterine and endometrial (uterine lining)
Sleep apnea
Gallbladder disease
Osteoarthritis
Respiratory problems
Urinary stress incontinence (loss of urine when you sneeze or cough)
Elevated blood fats
Treatments
Diet
Should focus on substantial weight loss over a prolonged period of time
Keeping a food diary
Document all food calories
Document all liquid calories
Low calories diets are recommended
Reducing fats (especially saturated fats) as part of a diet low in calories is a practical way to reduce the calories
Reducing dietary fat without reducing calories is not sufficient for weight loss
Individually planned to create a deficit of 500 to 1000 calories per day should be an integral part of any program aimed at losing 1 to 2 pounds per week
Physical activity
Refer to attached activity chart
The more you weigh, the fewer the minutes of exercise to lose a pound
The less you weigh, the more the minutes of exercise to lose a pound
Recommended as part of a comprehensive weight loss program and weight maintenance program
Contributes to weight loss
May decrease abdominal fat
Increases cardio-respiratory fitness
Helps with maintenance of weight loss
Initially, moderate levels of physical activity for 30 to 45 minutes on 3 to 5 days per week. All adults should set a long term goal of at least 30 minutes or more of moderate intensity physical activity on most, and preferably all, days of the week.
Activity increase alone is not likely to result in significant sustained and substantial weight loss
Behavior therapy
Assess motivation to start weight loss
Assess readiness to implement plan
Strategies to promote diet and physical activity
Combined therapy
For weight loss
For weight maintenance
Includes
Diets low in calories
Increased physical activity
Behavior therapy
Pharmacotherapy
F. D. A. approved drugs
Considered if coupled with diet low in calories and a physical activity program
If B. M. I. is 30 or more with no obesity-associated risk factors or diseases
If B. M. I. is 27 or more with existing obesity-associated risk factors or diseases
Should never be used without lifestyle modifications
Continual assessment for efficacy (i.e., to see if it is getting results) and for safety
Many with cardiovascular stimulation potential and must therefore be used with caution
Newer drugs with ability to block fat absorption from the bowel
Safety and efficacy of treatment beyond 1 year has not been established
Surgery
An option if B. M. I. is 40 or more
An option if B. M. I. is 35 or more
When comorbid conditions exist
When less invasive methods of weight loss have failed, and
When the patient is at high risk for obesity-associated morbidity or mortality (i.e., illness or death)
Weight Loss Strategies
(Refer to hand-out on Diet and Wt. Loss Tips)Eating and nutrition
Mind Set
Physical Activity
Benefits of Ideal Weight
Lower blood pressure
Lower cholesterol, low-density lipoprotein cholesterol (i.e., harmful cholesterol), and triglycerides.
Raise low levels of high-density lipoprotein cholesterol (i.e., helpful cholesterol)
Lower blood glucose (sugar) levels in diabetics
Special treatment groups
All smokers, regardless of their weight status, should quit smoking
Care must be taken to ensure that any weight reduction program minimizes the likelihood of adverse effects on bone health or other aspects of nutritional status
A decision to not use obesity treatments in older adults should be guided by an evaluation of the potential benefits of weight reduction for day-to-day functioning and reduction of the risk of future cardiovascular events, as well as the patient’s motivation for weight reduction
Possibility that a standard approach to weight loss will work differently in diverse populations must be considered when setting expectations about treatment outcomes.
Goals
Weight loss of 10% from baseline. With success, further loss can be attempted.
Rate of 1 to 2 pounds per week for a 6 month period, with the subsequent strategy based on the amount of weight loss
After successful weight loss, diet, physical activity, and behavior therapy should be continued indefinitely
Weight maintenance program should be a priority after the initial 6 months of weight loss