Rita All, FNP-S

Michele Czerwinski, FNP-S

Julie Dillenbeck-Juers, FNP-S

Obesity and Nutrition

No commercial support was received for this

educational activity.

At the end of this session the learner will be able to: 1. Describe ways to reduce the risk for stroke and other cardiovascular diseases.2. Identify activity that boosts high-density lipoprotein (HDL) or "good" cholesterol and decreases unhealthy triglycerides.3. Discuss the impact of eating habits that help reduce overall caloric intake and lose weight.

Body mass index is a measure used to determine overweight and obesity.

Calculated using weight and height

Indicator of body fatness.

www.freebmicalculator.net (picture)

Adults

BMI= Mass (kg) (Height (m))2Convert pounds to kilograms (1lb=0.45kg) and

inches to meters (1inch=0.025m). The equation for BMI is weight(kg) divided by height(m) squared(kg/m2).

BMI=Mass (lb) x 704.5 (Height (in))2 Multiply the patients weight in pounds by 704.5

and then divide the results by the patients height in inches once and then for a second time

BMI Calculation Formula

Men: 106 lbs + 6 lbs/inch over 5 feet Women: 100 lbs + 5 lbs/inch over 5 feet Abdominal (android) obesity: Waist: hip

ratio >0.85 in women and > 0.95 in men (To obtain, divide waist measurement by hip measurement).

Simple Way to Determine Ideal Body Weight

Place a tape measure around your body at the top of your hipbone. This is usually at the level of your belly button.

Proper Method to Perform Waist Measurements

Overweight: An adult who has a BMI between 25 and 29.9.

Obese: An adult who has a BMI of 30 or higher.

Overweight or Obesity

Obesity related conditions include: Heart Disease Stroke Type 2 Diabetes Certain Types of Cancer These are some of the leading causes of

preventable death.

Center for Disease Control and Prevention (2013).

Consequences of Adult Obesity

Upper body also referred to as “apple shape”

Excessive body fat in the abdomen and flank areas

Greater risk for type 2 DM, CAD, stroke, and early death

More common in men

Lower body also referred to as “pear shape”

Excessive adipose tissue in the buttocks and thighs

More common in women

Dunphy, et al (2011)

Two Types of Obesity

Consequences of Obesity

Weight status is determined using an age-and-sex specific percentile for BMI rather than the BMI categories used for adults because their body composition varies as they age and varies between boys and girls.

www.nourishinteractive.com (picture).

Children

Overweight defined as a BMI at or above the 85th percentile and lower than the 95th percentile for children of the same age and sex.

Obesity defined as a BMI at or above the 95th percentile for children of the same age and sex.

Overweight or Obesity

High Blood Pressure High Cholesterol Increased Risk of

Impaired Glucose Tolerance

Insulin Resistance and Type 2 Diabetes

Sleep Apnea Joint problems and

Musculoskeletal Discomfort

Gallstones Gastro-esophageal

Reflux Greater risk of social

and psychological problems (discrimination and poor self esteem).

Fatty Liver Disease

Consequences of Childhood Obesity

Consequences

More than one-third of U. S. adults (37.5%) or 41 million women and more than 37 million men aged 20 and over are obese (CDC, 2013).

Approximately seven million boys and more than five million girls between the ages of 2-19 years are obese (CDC, 2013).

Approximately 17% of the Nations children are obese.

CDC (2013).

Statistics

Prevalence ranged from 20.5% in Colorado to 34.7% in Louisiana (CDC, 2012).

No state was less than 20%. Higher prevalence's of adult obesity were

found in the Midwest (29.5%) and the South (29.4%) (CDC, 2012).

Lower prevalence’s were in the Northeast (25.3%) and the West (25.1%) (CDC, 2012).

In 1995 most of the country had a less than 10% obesity rate; today as high as 33%.

Obesity Prevalence by States

Prevalence of Obesity in States

Non-Hispanic blacks have the highest age-adjusted rates of obesity, 49.5%

Mexican-Americans, 40.4% All Hispanics, 39.1% Non-Hispanic Whites, 34.3% Adults aged 60 years and over were more likely to

be obese than younger adults. Men: No significant difference in obesity

prevalence by age. Women: 42.3% of those aged 60 and over were

obese compared with 31.9% of women aged 20-30. CDC (2012 & 2013).

Highest Groups Affected

Among non-Hispanic black and Mexican-American men, those with higher incomes are more likely to be obese than those with low incomes.

Higher income women are less likely to be obese than low-income women.

No relationship between obesity and education among men.

College educated women are less likely to be obese compared with less educated women.

CDC (2012).

Obesity and Socioeconomic Status

What Do We Do?

The Answer is…

To lose weight and keep it off, a high amount of physical activity is required.

Diet needs to be adjusted to reduce the amount of calories being consumed.

Exercise!

150 minutes of moderate intensity aerobic activity

75 minutes of vigorous-intensity aerobic activity

Or an equivalent mix of the two each week

You may need to do more than the 150 minutes to maintain your weight.

To Maintain Weight

Get Off of the Couch!

Move!

Control your weight Reduce risk of

cardiovascular disease

Reduce risk for type 2 diabetes and metabolic syndrome

Reduce risk for some cancers

Strengthens bones and muscles

Improve mental health and mood

Improves ability to do daily activities

Prevents falls if you’re an older adult

Increases chances of living longer

Benefits of Physical Activity

Boosts high-density lipoprotein (HDL) or “good” cholesterol and decreases unhealthy triglycerides.

Keeps the blood flowing smoothly, which decreases cardiovascular diseases.

Stimulates various brain chemicals that may leave you feeling happier and more relaxed.

More Benefits of Physical Activity

What Else Can We Do?

Better Nutrition!

How Do We Eat Healthy?

Food Portion Sizes

Grains: ½ Cup cooked rice or pasta=one ice cream scoop ½ Cup hot cereal=a fist 1 Pancake-a computer disk (CD) Vegetables: 1 Cup green salad= a baseball ½ Cup cooked broccoli= a light bulb 1 Baked Potato=a fist Oils: 1 Teaspoon butter or margarine=a postage stamp 1 Tablespoon salad dressing=a silver dollar

Correct Portion Sizes

Fruits: ½ Cup fresh or canned fruit=7 cotton balls ¼ Cup raisins= a large egg Dairy Products: ½ ounce cheese=3 dominoes 2 slices cheese= 2 CDs Meats, Nuts, and Beans: 2 Tablespoons peanut butter=a golf ball 3 ounces cooked meat, fish, or poultry=a deck of

cards 1 ounce nuts=1 cupped handful, 20-24 almonds or

48 pistachios.

Correct Portion Sizes, cont…

Maintain glucose and insulin levels. Avoid the negative cycle of high and low blood

sugar by eating small frequent meals. Eating smaller portions, but eating more often, will

keep glucose and insulin levels stable. Regulating glucose and insulin production usually

reduces food cravings, because your body doesn’t experience hypoglycemia.

Eating smaller portions can curve cravings and help reduce overall caloric intake and lose weight.

Eating smaller portions helps physically and financially.

Benefits of Consuming Correct Portion Sizes

CDC Recommends 3oz. Of Protein

Anyone NOT Guilty of This?

OR this???

I eat a garden

salad every day for lunch…I

don’t understand why I am gaining weight!

Would you pick up that drink if you knew?

Anything Else We Can Do?

Delete late night snacking Track what you eat and drink (food diary) Fresh foods, less prepackaged foods Meal planning and preparation Don’t eat straight from the package. Instead

serve a reasonable portion in a bowl or container. When eating out, split the entrée with your guest

or put half the meal in a “doggie bag.” To control hunger between meals, encourage

patients to eat a snack, like a piece of fruit or small salad.

Behavior Modifications

Time Constraints Lack of financial resource Fragile emotional state Poor self esteem Education Illness Dissatisfaction with life circumstances Cultural beliefs

Barriers to Healthy Eating and Exercise

On The Lighter Side…

Fuel Up and Play 360 Started by the National Dairy Council and the

National Football League to encourage healthy lifestyles in children.

Offers 101 tips for educators to promote healthy eating habits and teaching nutritional concepts to improve long term health in children.

Encouraging healthy nutrition in patients- programs for children

School nutrition program- Provides well balanced breakfast and lunches to children while at school

Offers healthy meals with healthy alternative choices with appropriate serving sizes.

Encourages healthy eating habits that can be modeled while not at school.

Encouraging healthy nutrition in patients- programs for children

My Plate- Government program by the United States Departments of Agriculture and Health and Human Services

Came from the 2010 Dietary Guidelines for Americans to improve healthy nutrition

Offers better visualization than the food pyramid

Used in conjunction with other programs

Encouraging healthy nutrition in patients- programs for children

Michelle Obama◦ Let’s Move initiative- an effort to turn around the

childhood obesity trend with this generation of children.

◦ Giving parents helpful information and fostering environments that support healthy choices.

◦ Providing healthier foods in our schools. ◦ Ensuring that every family has access to healthy,

affordable food.◦ Helping kids become more physically active.◦ Announced schools will no longer be able to advertise

sugary drinks or junk food on billboards, score boards, cups, posters, or menus.

Encouraging healthy nutrition in patients- programs for Children

Let’s Move!

Let’s Move!

Usual food intake: How many sugared drinks do you drink in a day? What do you eat after meals?

Do you play organized sports? Do you take any vitamin supplements? Juice versus fruit? Fruit is best! Eat with COLOR!! How many fruits and vegetables did you eat

today? Ketchup doesn’t count!!

Conversing with young patients

United States Department of Agriculture program offered to low income families- income range based on community poverty levels

Federal grants to States for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk.

WIC programs

Nutritional diaries- 24 to 72 hour account of all foods and liquids consumed to determine average daily calorie intake and excess of calories

24 hour nutrition recalls- a verbal account of what has been consumed in the past 24 hours.

Nutritional referrals- Covered by most insurance companies, can determine where healthy choices can be made based on height/ weight and current health status.

My plate handouts- provided at each appointment visit.

Routine follow up appointments for accountability

What do we do about adult patients?

Encourage the most unprocessed form of nutrition as possible

Vitamins are helpful ‘supplement’, but not a substitute for the ‘real’ thing

“I am healthy! I take my gummy vitamin every morning!”

How many servings of fruits and veggies a day?

Put up your fingers!!

http://school.fueluptoplay60.com/documents/NASPE-101-Tips-TeachingNutrition.pdf

March is National Nutrition Month

Centers for Disease Control and Prevention:Nutrition for Everyone. (2014). Retrieved from http://www.cdc.gov/nutrition/everyone/resources/.

Centers for Disease Control and Prevention: Overweight and Obesity. (2013). Retrieved from http://www.cdc.gov/obesity.

Decrease Portion Sizes (2013). Retrieved from www.choosemyplate.gov/weight-management-calories/weight-management/better-choices/decrease-portions.html.

Gripshover, S., & Markman, E. (2013, August 24). Teaching young children a theory of nutrition: conceptual change and the potential for increased vegetable consumption. Psychological Science, 24(8):1541-53. doi: 10.1177/0956797612474827.

Mikulak, A. (2013). Getting Kids to Eat Their Veggies: A New Approach to an Age-Old Problem. Association For Psychological Science. Retrieved from https://www.psychologicalscience.org/index.php/news/releases/getting-kids-to-eat-their-veggies-study-suggests-a-new-approach-to-an-age-old-problem.html.

National Association for sports and education. (2014). Retrieved from http://school.fueluptoplay60.com/documents/NASPE-101-Tips-TeachingNutrition.pdf.

School Nutrition Organization. (2014). Retrieved from http://www.schoolnutrition.org/Content.aspx?id=94.

United States Department of Agriculture. (2013). MyPlate, Dietary Guidelines and General Nutrition. Retrieved from https://snap.nal.usda.gov/resource-library/eat-healthy-every-day/myplate-dietary-guidelines-and-general-nutrition.

References