Laura Pawlow, Ph
Laura Pawlow, Ph.D.
Weight Management Center
Dept. of Psychiatry and Behavioral Sciences
Medical University of South Carolina
Charleston, South Carolina
Body Mass Index
Body Mass Index (BMI)
“Underweight” Eating Disorders
Anorexia Nervosa
Bulimia Nervosa
Anorexia Nervosa (Anorexia)
Self-starvation
0.1 - 1.0% of U.S. women have
Characterized by low body wt. (< 85% of normal for ht. & age), distorted body image, intense fear of gaining wt.
Dangers: cardiac, hematological (blood), hormonal, skeletal, LOSS OF GRAY MATTER, DEATH.
Bulimia Nervosa (Bulimia)
Binging and Purging
4% of U.S. female adolescents
Characterized by excessive exercise or fasting, weird eating rituals, vomiting, inappropriate use of laxatives
Dangers: malnutrition, esophageal and tooth damage.
“Overweight” Eating Disorders
Binge Eating Disorder
Night Eating Syndrome
Obesity
Binge Eating Disorder
1% of U.S. women
Characterized by Binge Eating (out of control, too much, too fast, physical and psychological discomfort)
May or may not be overweight/obese
No purging
Night Eating Syndrome
1.5% of the general population
Characterized by < 50% of total daily intake after 6 pm, difficulty sleeping and morning anorexia
May or may not be overweight/obese
OBESITY
Obesity is an excess of body fat frequently resulting in significant impairment of health.
ENERGY BALANCE EQUATION
Calories in = Calories out = No Change
Calories in < Calories out = Weight loss
Calories in > Calories out = Weight gain
CALORIES-TO-FAT EXCHANGE RATE
3500 CALORIES =
1 POUND BODYFAT (APPROX.)
LONG-TERM EFFECTS
OF CALORIC IMBALANCE
100 extra CALORIES/DAY =
10 POUNDS/YEAR
500 extra CALORIES/DAY =
50 POUNDS/YEAR
SOURCES OF CALORIES
CARBOHYDRATES 4 KCAL/GM
PROTEIN 4 KCAL/GM
FAT 9 KCAL/GM
ALCOHOL 7 KCAL/GM
COMPONENTS OF
ENERGY EXPENDITURE
RESTING METABOLISM 60-70%
PHYSICAL ACTIVITY 20-30%
THERMIC EFFECT OF FOOD 10%
100%
RELATION OF RMR TO BODY WEIGHT
EXAMPLE: 30-YEAR-OLD WOMAN, 5’6”
WEIGHT PREDICTED RMR
120 POUNDS 1345 KCAL/DAY
170 POUNDS 1562 KCAL/DAY
220 POUNDS 1779 KCAL/DAY
CALORIES EXPENDED PER HOUR
IN VARIOUS ACTIVITIES
WEIGHT OF PERSON
130 lb. 190 lb.
AT REST 78 114
WALKING 324 414
RUNNING (9 MIN/MILE) 786 996
SWIMMING (SLOW CRAWL) 456 660
RAKING 192 276
DIGGING 444 648
Obesity Trends* Among U.S. Adults
1985
Obesity Trends* Among U.S. Adults
BRFSS, 1986
Obesity Trends* Among U.S. Adults
BRFSS, 1987
Obesity Trends* Among U.S. Adults
BRFSS, 1988
Obesity Trends* Among U.S. Adults
BRFSS, 1989
Obesity Trends* Among U.S. Adults
BRFSS, 1990
Obesity Trends* Among U.S. Adults
BRFSS, 1991
Obesity Trends* Among U.S. Adults
BRFSS, 1992
Obesity Trends* Among U.S. Adults
BRFSS, 1993
Obesity Trends* Among U.S. Adults
BRFSS, 1994
Obesity Trends* Among U.S. Adults
BRFSS, 1995
Obesity Trends* Among U.S. Adults
BRFSS, 1996
Obesity Trends* Among U.S. Adults
BRFSS, 1997
Obesity Trends* Among U.S. Adults
BRFSS, 1998
Obesity Trends* Among U.S. Adults
BRFSS, 1999
Obesity Trends* Among U.S. Adults
BRFSS, 2000
TRENDS IN PREVALENCE OF ADULT OBESITY BY ETHNICITY
Prevalence of Obesity, U.S. Adolescents,
Ages 12-17, by Sex
Beverages Available in the U.S. Food Supply (Gallons/Person/Year)
Percentage of Adolescents, Ages 12-19, Who Consumed Milk and Carbonated Soft Drinks On a Given Day in 1994, by Sex
On Average, Adolescents Aged 12-17
Get from Soft Drinks*:
Prevalence of Obesity by Hours of TV per Day:
NHES Youth Aged 12-17 in 1967-70
and NLSY Youth Aged 10-15 in 1990
HEALTH RISKS OF OBESITY
HYPERTENSION
CARDIOVASCULAR DISEASE
DIABETES
STROKE
JOINT DISEASE
SLEEP APNEA
CANCER
NHANES III Age-Adjusted Prevalence of
Hypertension* According to BMI
Body Mass Index and Mortality in Nonsmoking Women and Men
UPPER BODY OBESITY
Upper body obesity = increased risk*
Waist greater than 35" in women
Waist greater than 40" in men
* Most accurate when BMI is between 25 and 34.9.
National Heart, Lung, and Blood Institute. Obes Res. 1998:6(suppl 2):51S-209S.
THE ABCD’S OF LIFESTYLE CHANGE
ACTIVITY INCREASE
BEHAVIOR CHANGE
COGNITIVE CHANGE
DIETARY CHANGE
SOCIAL SUPPORT
Diet Counseling
Eat 5 servings of fruits/vegetables daily
Limit fat to no more than 30% of the daily diet
Control portion size, restrict calories
Limit high-fat foods
Moderation, not abstinence
National Heart, Lung, and Blood Institute. Obes Res. 1998; 6(2, suppl):112S-113S.
Food Guide Pyramid
Medications
Types: Appetite suppressants,Lipase Inhibitors
Names: Meridia, Xenical, Buproprion
WEIGHT LOSS GOALS OF OBESE
WOMEN ENTERING TREATMENT
(FOSTER ET AL., JCCP, 1996)
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