Human Nutrition

Solution Preview

---

Key Recommendations

(From the Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults)
Weight loss to lower elevated blood pressure in overweight and obese persons with high blood pressure.
Weight loss to lower elevated levels of total cholesterol, LDL-cholesterol, and triglycerides, and to raise low levels of HDL-cholesterol in overweight and obese persons with dyslipidemia.
Weight loss to lower elevated blood glucose levels in overweight and obese persons with type 2 diabetes.
Use the BMI to assess overweight and obesity. Body weight alone can be used to follow weight loss, and to determine the effectiveness of therapy.
The BMI to classify overweight and obesity and to estimate relative risk of disease compared to normal weight.
The waist circumference should be used to assess abdominal fat content.
The initial goal of weight loss therapy should be to reduce body weight by about 10 percent from baseline. With success, and if warranted, further weight loss can be attempted.
Weight loss should be about 1 to 2 pounds per week for a period of 6 months, with the subsequent strategy based on the amount of weight lost.
Low calorie diets (LCD) for weight loss in overweight and obese persons. Reducing fat as part of an LCD is a practical way to reduce calories.
Reducing dietary fat alone without reducing calories is not sufficient for weight loss. However, reducing dietary fat, along with reducing dietary carbohydrates, can help reduce calories.
A diet that is individually planned to help create a deficit of 500 to 1,000 kcal/day should be an intregal part of any program aimed at achieving a weight loss of 1 to 2 pounds per week.
Physical activity should be part of a comprehensive weight loss therapy and weight control program because it: (1) modestly contributes to weight loss in overweight and obese adults, (2) may decrease abdominal fat, (3) increases cardiorespiratory fitness, and (4) may help with maintenance of weight loss.
Physical activity should be an integral part of weight loss therapy and weight maintenance. Initially, moderate levels of physical activity for 30 to 45 minutes, 3 to 5 days a week, should be encouraged. All adults should set a long-term goal to accumulate at least 30 minutes or more of moderate-intensity physical activity on most, and preferably all, days of the week.
The combination of a reduced calorie diet and increased physical activity is recommended since it produces weight loss that may also result in decreases in abdominal fat and increases in cardiorespiratory fitness.
Behavior therapy is a useful adjunct when incorporated into treatment for weight loss and weight maintenance.
Weight loss and weight maintenance therapy should employ the combination of LCD's, increased physical activity, and behavior therapy.
After successful weight loss, the likelihood of weight loss maintenance is enhanced by a program consisting of dietary therapy, physical activity, and behavior therapy which should be continued indefinitely. Drug therapy can also be used. However, drug safety and efficacy beyond 1 year of total treatment have not been established.
A weight maintenance program should be a priority after the initial 6 months of weight loss therapy.
Part 1: Assessing Your Risk

According to the NHLBI guidelines, assessment of overweight involves using three key measures:

body mass index (BMI)

waist circumference, and

risk factors for diseases and conditions associated with obesity.
The BMI is a measure of your weight relative to your height and waist circumference measures abdominal fat. Combining these with information about your additional risk factors yields your risk for developing obesity-associated diseases.

What is Your Risk?

1. Body Mass Index (BMI)
BMI is a reliable indicator of total body fat, which is related to the risk of disease and death. The score is valid for both men and women but it does have some limits. The limits are:

It may overestimate body fat in athletes and others who have a muscular build.
It may underestimate body fat in older persons and others who have lost muscle mass.
Appropriate weight gain during pregnancy varies and depends upon initial body weight or BMI level. Pregnant women should contact a health professional to assure appropriate weight gain during pregnancy.
Use the BMI calculator or tables to estimate your total body fat. The BMI score means the following:

BMI
Underweight Below 18.5
Normal 18.5 - 24.9
Overweight 25.0 - 29.9
Obesity 30.0 and Above

2. Waist Circumference

Determine your waist circumference by placing a measuring tape snugly around your waist. It is a good indicator of your abdominal fat which is another predictor of your risk for developing risk factors for heart disease and other diseases. This risk increases with a waist measurement of over 40 inches in men and over 35 inches in women

The table, Risks of Obesity-Associated Diseases by BMI and Waist Circumference, provides you with an idea of whether your BMI combined with your waist circumference increases your risk for developing obesity associated diseases or conditions.

3. Other Risk Factors

Besides being overweight or obese, there are additional risk factors to consider.

RISK FACTORS
high blood pressure (hypertension)
high LDL-cholesterol ("bad" cholesterol)
low HDL-cholesterol ("good" cholesterol)
high triglycerides
high blood glucose (sugar)
family history of premature heart disease
physical inactivity
cigarette smoking

4. Assessment

For people who are considered obese (BMI greater than or equal to 30) or those who are overweight (BMI of 25 to 29.9) and have two or more risk factors, the guidelines recommend weight loss. Even a small weight loss (just 10 percent of your current weight) will help to lower your risk of developing diseases associated with obesity. Patients who are overweight, do not have a high waist measurement, and have less than 2 risk factors may need to prevent further weight gain rather than lose weight.

Talk to your doctor to see if you are at an increased risk and if you should lose weight. Your doctor will evaluate your BMI, waist measurement, and others risk factors for heart disease. People who are overweight or obese have a greater chance of developing high blood pressure, high blood cholesterol or other lipid disorders, type 2 diabetes, heart disease, stroke, and certain cancers, and even a small weight loss (just 10 percent of your current weight) will help to lower your risk of developing those diseases.

Body Mass Index Table
for BMI greater than 35, go to Table 2

To use the table, find the appropriate height in the left-hand column labeled Height. Move across to a given weight (in pounds). The number at the top of the column is the BMI at that height and weight. Pounds have been rounded off.
BMI 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35
Height
(inches) Body Weight (pounds)
58 91 96 100 105 110 115 119 124 129 134 138 143 148 153 158 162 167
59 94 99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173
60 97 102 107 112 118 123 128 133 138 143 148 153 158 163 168 174 179
61 100 106 111 116 122 127 132 137 143 148 153 158 164 169 174 180 185
62 104 109 115 120 126 131 136 142 147 153 158 164 169 175 180 186 191
63 107 113 118 124 130 135 141 146 152 158 163 169 175 180 186 191 197
64 110 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204
65 114 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 210
66 118 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216
67 121 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223
68 125 131 138 144 151 158 164 171 177 184 190 197 203 210 216 223 230
69 128 135 142 149 155 162 169 176 182 189 196 203 209 216 223 230 236
70 132 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243
71 136 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250
72 140 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 258
73 144 151 159 166 174 182 189 197 204 212 219 227 235 242 250 257 265
74 148 155 163 171 179 186 194 202 210 218 225 233 241 249 256 264 272
75 152 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272 279
76 156 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287

Table 2
Body Mass Index Table
To use the table, find the appropriate height in the left-hand column labeled Height. Move across to a given weight. The number at the top of the column is the BMI at that height and weight. Pounds have been rounded off.
BMI 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54
Height
(inches) Body Weight (pounds)
58 172 177 181 186 191 196 201 205 210 215 220 224 229 234 239 244 248 253 258
59 178 183 188 193 198 203 208 212 217 222 227 232 237 242 247 252 257 262 267
60 184 189 194 199 204 209 215 220 225 230 235 240 245 250 255 261 266 271 276
61 190 195 201 206 211 217 222 227 232 238 243 248 254 259 264 269 275 280 285
62 196 202 207 213 218 224 229 235 240 246 251 256 262 267 273 278 284 289 295
63 203 208 214 220 225 231 237 242 248 254 259 265 270 278 282 287 293 299 304
64 209 215 221 227 232 238 244 250 256 262 267 273 279 285 291 296 302 308 314
65 216 222 228 234 240 246 252 258 264 270 276 282 288 294 300 306 312 318 324
66 223 229 235 241 247 253 260 266 272 278 284 291 297 303 309 315 322 328 334
67 230 236 242 249 255 261 268 274 280 287 293 299 306 312 319 325 331 338 344
68 236 243 249 256 262 269 276 282 289 295 302 308 315 322 328 335 341 348 354
69 243 250 257 263 270 277 284 291 297 304 311 318 324 331 338 345 351 358 365
70 250 257 264 271 278 285 292 299 306 313 320 327 334 341 348 355 362 369 376
71 257 265 272 279 286 293 301 308 315 322 329 338 343 351 358 365 372 379 386
72 265 272 279 287 294 302 309 316 324 331 338 346 353 361 368 375 383 390 397
73 272 280 288 295 302 310 318 325 333 340 348 355 363 371 378 386 393 401 408
74 280 287 295 303 311 319 326 334 342 350 358 365 373 381 389 396 404 412 420
75 287 295 303 311 319 327 335 343 351 359 367 375 383 391 399 407 415 423 431
76 295 304 312 320 328 336 344 353 361 369 377 385 394 402 410 418 426 435 443

Classification of Overweight and Obesity by BMI, Waist Circumference,
and Associated Disease Risks

Disease Risk* Relative to Normal Weight and Waist Circumference

BMI
(kg/m2) Obesity
Class Men 102 cm (40 in) or less
Women 88 cm (35 in) or less Men > 102 cm (40 in)
Women > 88 cm (35 in)
Underweight < 18.5
- -
Normal 18.5 - 24.9
- -
Overweight 25.0 - 29.9
Increased High
Obesity 30.0 - 34.9 I High Very High

35.0 - 39.9 II Very High Very High
Extreme Obesity 40.0 + III Extremely High Extremely High

* Disease risk for type 2 diabetes, hypertension, and CVD.
+ Increased waist circumference can also be a marker for increased risk even in persons of normal weight.

Selecting a Weight Loss Program
Check It Out
Before You Sign Up For Any Weight Loss Program
Some people lose weight on their own; others like the support of a structured program. Overweight people who are successful at losing weight, and keeping it off, can reduce their risk factors for heart disease. If you decide to join any kind of weight control program, here are some questions to ask before you join.

Does the program provide counseling to help you change your eating activity, and personal habits?
The program should teach you how to change permanently those eating habits and lifestyle factors, such as lack of physical activity that have contributed to weight gain.

Is the staff made up of a variety of qualified counselors and health professionals such as nutritionists, registered dietitians, doctors, nurses, psychologists, and exercise physiologists?
You need to be evaluated by a physician if you have any health problems, are currently taking any medicine, or plan on taking any medicine, or plan to lose more than 15 to 20 pounds. If your weight control plan uses a very low-calorie diet (a special liquid formula that replaces all food for 1 to 4 months), an exam and follow up visits by a doctor are also needed.

Is training available on how to deal with times when you may feel stressed and slip back to old habits?
The program should provide long-term strategies to deal with weight problems you may have in the future. These strategies might include things like setting up a support system and establishing a physical activity routine.

Is attention paid to keeping the weight off? How long is this phase?
Choose a program that teaches skills and techniques to make permanent changes in eating habits and levels of physical activity to prevent weight gain.

Are food choices flexible and suitable? Are weight goals set by the client and the health professional?
The program should consider your food likes and dislikes and your lifestyle when your weight loss goals are planned.

There are other questions you can ask about how well a program works. Because many programs don't gather this information, you may not get answers. But it's still important to ask them:

What percentage of people complete the program?

What is the average weight loss among people who finish the program?

What percentage of people have problems or side effects? What are they?

Are there fees or costs for additional items, such as dietary supplements?

Remember, quick weight loss methods don't provide lasting results. Weight loss methods that rely on diet aids like drinks, prepackaged foods, or diet pills don't work in the long run. Whether you lose weight on your own or with a group, remember that the most important changes are long term. No matter how much weight you have to lose, modest goals and a slow course will increase your chances of both losing the weight and keeping it off.
References:
Methods for Voluntary Weight Loss and Control. National Institutes of Health Technology Assessment Conference. Annals of Internal Medicine.119(7, Part 2), October 1, 1993.

Choosing a Safe and Successful Weight-Loss Program, U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes & Digestive & Kidney Diseases, NIH Publication No. 94-3700, December 1993.
Use the exchange list to give yourself more choice.

Energy
(Kcal) Fat
(GM) %FAT Exchange for:
Breakfast
Whole Wheat Bread, 1 med. Slice 70 1.2 15 (1Bread/Starch)
Jelly, regular, 2 tsp. 30 0 0 (1/2 Fruit)
Cereal, Shredded Wheat, 1/2 cup 104 1 4 (1 Bread/Starch)
Milk, 1%, 1 cup 102 3 23 (1 Milk)
Orange Juice 3/4 cup 78 0 0 (1 1/2 Fruit)
Coffee, Regular, 1 cup 5 0 0 (Free)
Breakfast Total 389 5.2 10

--------------------------------------------------------------------------------

Lunch
Roast Beef Sandwich
Whole Wheat Bread, 2 med. Slices 139 2.4 15 (2 Bread/Starch)
Lean Roast Beef, unseasoned 2 oz 60 1.5 23 (2 Lean Protein)
Lettuce, 1 Leaf 1 0 0
Tomato 3 med slices 10 0 0 (1 Vegetable)
Mayonnaise, low-calorie, 1 tsps. 15 1.7 96 (1/3 Fat)
Apple, 1 med. 80 0 0 (1 Fruit)
Water, 1 cup 0 0 0 (Free)
Lunch Total 305 56 16

--------------------------------------------------------------------------------

Dinner
Salmon. 2 oz edible 103 5 40 (2 Lean Protein)
Vegetable oil, 11/2 tsps 60 7 100 (1 1/2 Fat)
Baked Potato, 3/4 med. 100 0 0 (1 Bread/Starch)
Margarine, 1 tsp 34 4 100 (1 Fat)
Green Beans seasoned, with margarine, 1/2 cup 52 2 4 (1 Vegetable) (1/2 Fat)
Carrots, seasoned 35 2 0 (1 Vegetable)
White Dinner Roll, 1 sm 70 2 26 (1 Bread/Starch)
Iced Tea, unsweetened, 1 cup 0 0 0 (Free)
Water, 2 cups 0 0 0 (Free)
Dinner total 454 20 39

--------------------------------------------------------------------------------

Snack
Popcorn, 2 1/2 cups 69 0 0 (1 Bread/Starch)
Margarine, 3/4 tsp 30 3 100 (3/4 Fat)

--------------------------------------------------------------------------------

Total 1247 34-36 24-26

Calories: 1,247 SFA, % kcals: 7
Total ...