Preventative Health Test 3

annual medical costs of obesity

$147 billion: $1429 per person higher than those of normal weight

productivity costs of obesity

$3.38-6.38 billion

statistics of adult obesity and overweight

1/3 U.S. adults are obese as of 2008 (> 78.6 million) •Non-Hispanic blacks: 47.8% •Hispanics: 42.5% •Non-Hispanic whites: 32.6%• Non-Hispanic Asians: 10.8% •Rates by age: young adults < elderly < middle aged adults •2/3 U.S. adults are overweight

overweight and obesity related deaths are

2nd only to tobacco related deaths

statistics of osteoporosis

40 million Americans have or are at risk for osteoporosis47% of women over 50 y/o have osteopenia (low bone mass) or osteoporosis1/3 of women and 1/6 of men have had at least 1 osteoporotic fracture by 90 y/o

statistics of hypertension

50 million in the U.S.! 2/3 of individuals > 65 y/o have systemic hypertension (HT)! Only 70% are aware of their condition! 90% chance of developing HT after 55 y/o

in 2030 it's expected that

51% of the adult population will be obese

prevalence of dyslipidemia

71 million US adults: 32.5% of men, 31% of women 1/3 of diagnosed patients are controlled!

statistics of metabolic syndrome

> 1 in 4 people around the world! > 1 in 3 Americans are diagnosed with the metabolic syndrome! Metabolic syndrome ahead of HIV/AIDS in morbidity and mortality

metabolic syndrome

A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes.

chronic pulmonary disease

Abnormal ventilation and gas exchange due to: progressive loss of elasticity and destruction of pulmonary tissue, progressive inflammation and thickening of respiratory airways and increased production of mucus and mucus plugs; Includes Chronic Bronchitis and Emphysema; Third leading cause of death in U.S.

assessing: metabolic syndrome continued

Additional diagnostic measurements ! Abnormal body fat distribution! General body fat (DEXA)!Central fat (CT/MRI)! Adipose tissue biomarkers: leptin, adiponectin! Liver fat (MRS)! Atherogenic dyslipidemia! ApoB lipoprotein increase! Small LDL particle increase! Elevated uric acid (protein metabolism byproduct) OGTT (oral glucose tolerance test)! Vascular dysregulation! Endothelial dysfunction! Microalbuminuria! Proinflammatory markers! CRP, TNF-alpha!Prothrombotic markers! Fibrinolytic factors and clotting factors! Hormonal! HPA (hypothalamic-pituitary-adrenal) axis

asthma

Affects more than 25 million people in the U.S.Chronic inflammation of the airways that flares up, resulting in acute and reversible narrowing of the airways, and consequently hypoxemic episodes

non-modifiable risk factors of metabolic syndrome

Age: > 40 y/o! Gender: men > women! Race: Central America, South Asia > Caucasian > African American! Family history: diabetes, hypertension, CVD!Personal history: gestational diabetes mellitus

non- Modifiable risk factors of coronary heart disease

Age> 45 in men, postmenopausal in women (>55 y/o) 82% deaths due to CAD occur in those > 65 y/oElderly women have a higher mortality due to CAD than elderly men GenderFamily history of premature heart disease Before 55 y/o in men, before 65 y/o in women

osteopersosis

An irreversible, chronic bone disorder characterized by bone fragility due to low bone mass density and structural deterioration Excessive bone resorption (increased osteoclast activity) or deficient bone formation (decreased osteoblast activity)

primary prevention of osteoporosis

Calcium1000-1300 mg/day Sources: low-fat dairy, dark green and leafy vegetable (broccoli, spinach), sardines and salmons with bones, tofu, almonds, calcium fortified foods Need increased quantities in childhood and puberty, pregnancy, breastfeeding, postmenopause/andropause, elderly, patients with chronic medical conditions

angina pectoris

Chest pain due to tissue damage Due to partial blockage/occlusion of coronary artery

pneumoconiosis

Chronic inflammation, as a result of inhaling occupational dusts or chemicals, results in lung tissue stiffening and scarring

Health Risks of Hypertension: Renal

Chronic kidney failure! Renal artery stenosis (narrowing of renal artery due to atherosclerotic plaques)!

other Modifiable risk factors of coronary heart disease

Chronic stress Alcohol Chronic inflammatory disorders (high CRP): periodontal disease Sleep apnea Pre-eclampsia

assessing coronary artery disease

Clinical diagnosisCBC and lipid panel Electrocardiogram Measures electrical activity of heart by use of electrodes At restHolter monitor: ECG monitor connected to body continuously for 24-48 hoursStress test: ECG done during effort (treadmill)!! Cardiac markers Proteins and inflammatory markers released from cardiac cells that are dying Elevated during MI Echocardiogram (cardiac ultrasound) Use of sound waves to form image depending on different densities of tissue Nuclear myocardial perfusion imaging AngiogramDye injected into arteries to view occlusions, aneurysms or ruptures

secondary prevention of metabolic syndrome continued

Correct atherogenic dyslipidemia ! Reduce triglycerides! Increase HDL! Reduce small, dense LDL! Pharmacological: fibrates (increase HDL), statins (reduce LDL and ApoB lipoproteins)! Correct prehypertension and hypertension! Primarily lifestyle! ACE inhibitors, ARBs!Reduce coagulation: daily aspirin

Assessing Osteoporosis

DEXA scan! Dual energy x-ray absorptiometry to measure density of bone! T-score is provided to provide a value for the bone mineral density (BMD)! Normal bone density: T score of -1.0 and above! Osteopenia (low bone density): T score between -2.5 and -1.0! Osteoporosis: T score of -2.5 and below

health effects of metabolic syndrome

Diabetes (x5 chance mortality)! Cardiovascular disease! Atherosclerosis and hypercoagulability! Hypercholesterolemia! Hypertension! Peripheral arterial disease! Coronary Artery Disease and Heart attack (x2 chance mortality) ! Stroke (x2 chance mortality)! High uric acid retention and increased CRP levels

assessing: metabolic syndrome

Diagnosed when at least 3 of the following criteria met:! 1.Abdominal Obesity! •Visceral fat! •Increased waist circumference! 2.High TG! 3.Low HDL! 4.Hypertension! 5.Impaired fasting plasma glucose International Diabetes Federation Definition: central/abdominal/visceral obesity (waist circumference or BMI > 30) plus at least 2 of the following criteria met! 1.High triglycerides (>150)! 2.Low HDL! 3.High blood pressure! 4.High fasting plasma glucose, FPG

modifiable risk factors for atherosclerosis

Diet Lack of physical activity Smoking Alcohol Hypertension Low HDL Medications: steroids, beta blockers, OCP Diabetes Liver disorders Endocrinological disorders

Modifiable risk factors of coronary heart disease

Dyslipidemia (total cholesterol > 181) Hypertension (systolic blood pressure >120) Metabolic syndrome and Diabetes mellitus SmokingPhysical inactivity and sedentariness Diet and Nutrition Overweight and obesity

secondary prevention of osteoporosis

Early detection and screening for osteopenia and osteoporosis Nutrition, calcium and vitamin D Exercise Pharmacological Biphosphonates: alendronateSelective estrogen receptor modulators (SERMs): raloxifene Calcitonin Parathyroid hormone Testosterone therapy in males

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Evaluate your patient! -Assess lifestyle and other CVD risk factors! -Identify other causes for high BP! -Identify presence or absence of target organ damage and CVD! Cardiovascular disease (CVD) risk factors (many coincide with risk factors for hypertension, HT)! -HT!Smoking! -Obesity! -Physical inactivity! -Dyslipidemia! -Diabetes mellitus! -Age! -Family history of premature CVD

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Exercise Based on Wolff's law: bone grows or remodels in response to forces or demands placed upon it Weight bearing exercise is best for increasing bone density Walking, hiking, jogging, climbing stairs, weight training, tennis, dancing

non-modifiable risk factors for atherosclerosis

Family History! Ethnicity! Non-hispanic white < Non-hispanic black < Mexican American! Age! Genetic disorders

primary prevention of metabolic syndrome

For healthy patients with no known risk factors that would put them at higher risk than the general population! Preventing and treating the metabolic syndrome reduces the chances of T2DM by more than 58%! LIFESTYLE: main preventive intervention! DASH diet! ACSM physical activity recommendations!Avoid smoking! Prevent insulin resistance! Maintain healthy weight! Maintain healthy physical activity! ADA meal plan guidelines recommended

primary prevention of hypertension

For healthy patients with no known risk factors! Community programs! Increase awareness and detection! Increase recognition of importance of healthy and controlled blood pressure! Reduce ethnic, socioeconomic and regional variation in blood pressure! Improve accessibility to prevention and management programs! Community education, health fairs

tertiary prevention of hypertension

For patients experiencing health effects of hypertension! Constant screening and monitoring! Regular check-ups/follow-ups: every 3-6 months if BP at goal and stable! Self and family measurement at home! Frequency increases with complications and comorbidities

secondary prevention of metabolic syndrome

For patients that appear healthy, but have risk factors or already have the metabolic syndrome! LIFESTYLE modification! DASH and ADA diets! ACSM physical activity recommendations! Stop smoking! Correct insulin resistance! Reduce weight! Increase physical activity! ADA meal plan guidelines recommended

coronary heart disease risk factor assessment

Framingham Heart Study general cardiovascular disease Provides tailored overall risk status of individual Provides overall risk age

non-modifiable risk factors of osteoporosis

GenderWomen: less bone tissue and faster bone loss due to menopause Age: thinner and weaker bones with age Body frame: small frame Ethnicity: caucasian and Asian Family history Personal history of fractures

cystic fibrosis

Genetically transmitted disorder (CFTR gene) Accumulation of mucus in body tracts, including respiratory tracts

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Healthy diet ! Maintain electrolyte balance! Physical activity! Lifestyle! Avoid smoking! Moderate alcohol intake!Limit recreational screen time to < 2 hours/day! Develop coping strategies to combat stress

primary prevention atherosclerosis

Healthy, no risk factors! Maintain healthy diet! Maintain healthy physical activity! Maintain healthy lifestyle! Do not start smoking! Moderate alcohol intake!Maintain healthy weight

complications of coronary heart disease

Heart failure (HF) Arrhythmia Cardiac arrest: heart stops beating

non-Modifiable Risk Factors of hypertension

Idiopathic: essential HT! Pregnancy! Aging! Ethnicity! -African American > Puerto Rican > Hispanic American > Caucasian > Cuban American

modifiable risk factors of osteoporosis continued

Kidney disease! Diabetes! Nutritional! Calcium, vitamin D! Medications! Corticosteroids, anticonvulsants! Lifestyle! Inactivity, sedentariness! Cigarette smoking, alcohol use! Immobility

modifiable risk factors of metabolic syndrome

LIFESTYLE! Overweight/obesity! Apple > Pear shape! BMI > 25, high waist circumference! Personal history of type 2 diabetes mellitus! Personal history of other chronic disease: cardiovascular disease, nonalcoholic fatty liver disease, polycystic ovarian syndrome!

statistics of coronary heart disease

Leading cause of death in the U.S. (men and women) 1 in 3 deaths in the U.S. is due to CAD 1 death due to CAD every 34 seconds Eliminating CAD would add 7 years to the life span

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Lifestyle Stop smoking Moderate alcohol consumption: 2-3 ounces/day alcohol has been shown to damage bone in men and women Be aware of medications that can reduce bone mineral density Glucocorticoids (corticosteroids), GnRH drugs, excess thyroid hormones Anticonvulsants and some sedatives Aluminum based antacids Some cancer treatments

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Medications: corticosteroids, cold medicines, OCPs (oral contraceptives), HRT(hormone replacement therapy, such as estrogen)! Renal! -Chronic kidney disease!Primary aldosteronism! -Renovascular disease (affects blood vessels of kidney)! -Cause of hypertension especially in children < 10 y/o! Endocrine! -Thyroid or parathyroid disease! -Cushing syndrome (excessive cortisol levels)! -Pheochromocytoma (excessive epinephrine and norepinephrine levels)! -Sleep apnea (difficulty breathing during sleep)

tertiary prevention of osteoporosis

Nutrition, calcium, vitamin D Exercise Pharmacological Regular eye check-ups Be aware of medications causing drowsiness or dizziness Surgical Joint replacement

modifiable risk factors of osteoporosis

Optimal peak bone mass not reached during bone formation years Up to 30 y/o Hormones Amenorrhea: athletes, anorexia nervosa Low estrogen/testosterone: menopause/andropause Cushing syndrome: high cortisol High parathyroid hormone

Modifiable Risk Factors of hypertension

Overweight and obesity! Diet! High sodium, low potassium! Alcohol, smoking! Sedentariness! Chronic stress

secondary prevention coronary artery disease

Patient appears healthy, but has risk factors or early stages of disease! Lose weight! Increase physical activity! Lifestyle modification! Stop smoking! Reduce alcohol intake! Reduce stress

secondary prevention of hypertension

Patient appears healthy, but has risk factors or has been diagnosed with prehypertension or early stages of condition! Weight reduction! BMI: 18.5-24.9!5-20 mmHg/ 10 kg weight loss! DASH diet! Fruits, vegetables, low fat dairy! Can lower blood pressure by 8-14 mmHg! Reduce dietary sodium! Moderate intake: < 2.4 g sodium/day! Can lower blood pressure by 2-8 mmHg! Reduce alcohol consumption!Moderate intake: < 2 drinks/day in men! Moderate intake: < 1 drink/day in women and small individuals! Can lower blood pressure by 2-4 mmHg

primary prevention coronary artery

Patient is healthy, with no known risk factors Heart healthy diet DASH diet Total fats < 30% total dietIncrease fiber intake Maintain healthy sodium and increased potassium intake!!! Maintain healthy physical activity Minimum 30 minutes of moderate intensity activity 5-7 days/week Maintain healthy lifestyle Moderate alcohol intake Avoid smoking Avoid stress, develop healthy coping strategies

tertiary prevention coronary artery disease

Patient presents with signs and symptoms of disease Prevent complications Manage dyslipidemia, weight, blood pressure and glycemic control RevascularizationPTCA: percutaneous transluminal angioplasty (minimally invasive)- use of ballon dilation or stent placement within coronary artery to remove occlusion CABG: coronary artery bypass grafting (open heart surgery)- placement of coronary artery graft to bypass occlusion (reroute blood flow) Pharmacological!

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Pharmacological! Loop diuretics: lowers levels of most electrolytes in body by increasing urination! Thiazide diuretics: lowers level of sodium by increasing urination, however, retains calcium! Potassium sparing diuretics: lowers level of sodium by increasing urination, however, retains potassium!Beta blockers: relaxes heart and blood vessels (vasodilation)! Alpha blockers, calcium channel blockers! Vasodilators! ACE-I (angiotensin converting enzyme inhibitors) and ARBs (aldosterone receptor blockers): has renal protective effects, and therefore used as first line therapy for patients with hypertension and diabetes! Pregnancy- methyldopa, beta blockers, vasodilators

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Physical therapy Posture exercises Hip and back strengthening exercises Weight bearing exercises Balance exercisesFunctional exercises: for everyday activities Occupational therapy Fall prevention techniques: cane/walker, avoid slippery surfaces, tripping hazards (mats, rugs, clutter), grab bars (bathroom, stairs), well lit areas, cordless phone

Complications and Sequelae of osteoporosis

Posture! States of increased fall risk! Pathological fractures! Hip (highest mortality)! Compression fractures (mostly vertebrae and feet)! Colle's fractures (wrist)! Complications of fracture:!Immobility: muscle atrophy, deep vein thrombosis, pulmonary embolism! Infection! 25% mortality rate within first year of fracture

systolic blood pressure

Pressure during contraction, required to pump blood from heart ventricles to all parts of the body!

diastolic blood pressure

Pressure during relaxation, builds up as heart ventricles fill with blood

Assessing Osteoporosis continued

Quantitative CT! More expensive, similar accuracy! Used mostly for vertebral body density to predict fracture risk! Quantitative Ultrasound! Cannot measure density! Used at the bones of the heel to predict fracture risk

other non- Modifiable risk factors of coronary heart disease

Race Socioeconomic status

Health Risks of Hypertension:Cardiovascular!

Risk doubles with each 20/10 mmHg increment after 115/75 mmHg! Coronary heart disease! Myocardial infarction! Left ventricular hypertrophy! Heart failure! Aortic aneurysm (severe dilation/ballooning of a portion of the artery that causes weakening of the vessel wall and can result in rupture and life threatening bleeding/hemorrhage)! Peripheral vascular disease (atherosclerotic plaques lead to reduced blood flow in the arteries supplying peripheral tissue, causing damage to these tissues)! Arteriosclerosis (atherosclerosis is a form of arteriosclerosis associated with dyslipidemia)

assessing dyslipidemia

Risk ratio TC/HDL = risk ratio Risk ratio < 3.0 = half average risk Risk ratio 4.4 = average risk Risk ratio > 6.2 = double average risk! framingham study

secondary prevention coronary artery disease continued

Screening for risk factors and early detection Manage risk factors Lose weightImprove lipid profile of patient Reduce blood pressure Maintain glycemic control PharmacologicalDaily aspirin Beta blocker Statins

ages: 19-30

Sedentary: M:2400-2600 F:1800-2000 Moderately active: M:2600-2800 F:2000-2200 Active: M:3000 F:2400

Health Risks of Hypertension: Cerebrovascular

Stroke (ischemia of brain tissue due to occlusion of cerebral blood vessels or hemorrhage)! Hypertensive encephalopathy (brain tissue damage due to hypertension)! Cerebral aneurysms and hemorrhage! Dementia and cognitive impairment!

benefits of lowering hypertension

Stroke incidence reduced by 35-40%! Myocardial infarction incidence reduced by 20-25%! Heart failure risk reduced by 50%! Stage 1 HT! Sustained 12 mmHg reduction in SBP over 10 years can prevent 1 death for every 11 patients treated

secondary prevention atherosclerosis

TLC diet Appears healthy, has risk factors or early stages of condition!Increase physical activity! 30 min/day, 7 days/week! Reduces total cholesterol and LDL! Reduces triglycerides!Increases HDL! Weight loss!!!! Lifestyle modification ! Stop smoking! Reduce alcohol intake! Control blood pressure! Pharmacological! Statins: simvastatin, pravastatin, atorvastatin! Side effects of statins: hyperglycemia, liver damage! When needed, aggressive lipid lowering has better patient outcomes than less aggressive lipid lowering

health risks of atherosclerosis

Thrombosis and embolism Coronary heart disease Carotid artery disease Peripheral arterial disease Stroke Chronic kidney disease

myocardial infarction

Tissue death/ischemia Due to complete occlusion of coronary artery

coronary heart disease/ ischemic heart disease

Unstable atherosclerotic plaques result in narrowing of coronary arteries or thrombus formation >> Decreased coronary blood flow to heart muscle >> Cardiac muscle ischemia. Evidence suggests that plaque build-up starts in childhood, and becomes permanent by adolescence

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Vitamin D1000-2000 IU/day (if not vitamin D deficient) Sources: egg yolks, saltwater fish, liver, fortified foods Need good store of cholesterol (precursor to Vitamin D production), 15-30 minutes of sunlight per dayInactive Vitamin D production is stimulated by U.V. light in skin, Vitamin D is then activated in kidneys (only activated Vitamin D can be used by body)

Dyslipidemia

abnormal blood lipid levels, including high total, low-density lipoprotein, and triglyceride levels as well as low high-density lipoprotein levels

hypertension

high blood pressure

assessing blood pressure

in office! -2 reading 5 minutes apart! -Both arms! -Auscultatory method! Ambulatory blood pressure monitor! -to evaluate "white coat" HT! -HT and CVD risk confirmed when there is no 10-20% drop in blood pressure during sleep! Self measurement! -To evaluate "white coat" HT!Improve adherence! -Monitor response to interventions

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increase Physical Activity! Aerobic physical activity > 30 min/day for most days of the week! Lower intensity exercise seems to be equally, if not more, effective in lowering BP as higher intensities! Avoid high intensity exercise and heavy lifting in patient with excessively high BP that is not well controlled! Pediatric patients: 1-2 hours/day! Can lower blood pressure by 4-11 mmHg! Constant screening/monitoring! Self and family measurement at home

spirometry

measures amount of air inhaled and exhaled, measures velocity of exhalation

ages: 51+

sedentary: M:2000-2200 F:1600 moderately active: M: 2200-2400 F: 1800 active: M:2400-2800 F:2200

ages: 31-50

sedentary: M:2200-2400 F:1800 moderately active: M: 2400-2600 F:2000 active: M:2800-3000 F:2200

statistics of child obesity

•17% U.S. pediatric population obese: 12.5 million!•Significant reduction in obesity in 2-5 y/o: from 13.9% in 2003 to 8.4% in 2012 •Hispanics: 22.4%•Non-Hispanic black: 20.2% •Non-Hispanic white: 14.1% •Non-Hispanic Asian: 8.6% •Higher Rates of obesity in 12-19 y/o > 6-11 y/o > 2-5 y/o •Children living in low-income neighborhoods are 20%- 60% more likely to be obese or overweight than children living in high SES neighborhoods and healthier built environments. -16.9% are obese, 31.8% are overweight/ obese

benefits of weight loss

•5-10% weight loss -Reduces HbA1c -Reduces blood pressure -Reduces total cholesterol -Increases HDL cholesterol -Reduces triglycerides •2 kg weight loss reduces chances of CHD (chronic heart disease) by more than 40%

accessing obesity

•Body Mass Index -Class I obesity: 30.0-34.9 -Class II obesity: 35.0-39.9 -Class III obesity: 40.0-49.9 -Morbid obesity: > 50.0 •Body Adiposity Index -Hydrostatic weighing and Bod Pod (air displacement): most accurate -Skinfold measurement -Bioelectric impedance analysis: fat is not a good conductor, measures amount of electricity conducted through body -Scans: CT, MRI, DEXA etc.

secondary prevention: dietary intake

•Calculate your BMR -Male BMR= 66 + ( 6.23 x pounds body weight) + ( 12.7 x height in inches ) - ( 6.76 x age) -Female BMR= 655 + (4.35 x pounds body weight) + (4.7 x height in inches) - (4.7 x age) •Daily caloric requirement based on individual BMR and lifestyle -Sedentary (little to no exercise): calories needed = BMR x 1.2 -Slightly active (light 1-3x/week): calories needed = BMR x 1.375 -Moderately active (moderate 3-5x/week): calories needed = BMR x 1.55 -Active (intense/heavy 6-7x/week): calories needed = BMR x 1.725 -Very active (very intense/heavy 2x/day): calories needed = BMR x 1.9

ideal body weight

•Depends on -BMI -Waist-hip ratio- ideal ratio < 0.8 in women and < 0.9 in men -Waist-to-height ratio- ideal ratio < 1:2 -Total body fat: ideally <25% in women and <18% in men

obesity prevention

•Early recognition and prevention is key -Critical periods: prenatal period, infancy and preadolescence, pregnancy -Those with family history •Implementing preventive measures after individual is already overweight or obese is usually inefficient •Specific strategies -Increase awareness and education of healthcare professional and patient -Improve management of overweight or obese individuals -Improve lifelong healthy eating and physical activity -Reduce sedentarianism -Increase policy and environmental supports -Increase and maintain effective public health responses to the obesity epidemic

modifiable factors of obesity

•Energy consumption and expenditure. •Lean body mass •Lifestyle and behavior -Dietary intake -Physical activity -Sleep quality and quantity -Smoking cessation •Disorders -Cushing syndrome, hypothyroidism -Medications: anti-depressants, steroids •Hormonal balance •Psychosocial and psychosomatic

primary prevention obesity

•For patients that are healthy with no apparent risk factors that would increase their chances of being obese more than the general population present •Implementing preventive measures after individual is already overweight or obese is usually inefficient •Increase awareness and education of healthcare professional and patient •Improve lifelong healthy eating and physical activity •Increase policy and environmental supports •Increase and maintain effective public health responses to the obesity epidemic •Avoid sedentariness

secondary prevention obesity

•For patients with risk factors, or those already overweight or obese •Early recognition and prevention is key -Critical periods in life that increase risk: prenatal period, infancy and preadolescence, pregnancy -Those with family history •Improve management of overweight or obese individuals -Lifestyle modifications

Modifiable risk factors of obesity

•Genetic disorders -Prader-Willi syndrome (child is unable to feel satiety) •Socio-economic status •Personal biology -Resting energy expenditure/ basal metabolic rate (BMR) •Environment -School and workplace settings -Safe and pedestrian friendly environments -Recreational opportunities -http://www.cdc.gov/ cdctv/ ObesityEpidemic/

secondary prevention continued

•Improve Dietary Intake -Dieting alone is not conducive to weight loss or weight maintenance -According to U.N.: minimum caloric requirement is 1800 kcal/day; Depends on age, size, height, gender, lifestyle, general health status •Create healthy nutritional plan -Balance energy IN and energy OUT -Portion size, chew food longer, eat a good breakfast -Eat more low energy dense foods (a specific quantity of low energy dense food will have fewer calories than the same quantity of high energy dense food) •Involve the family •Decreasing dietary fat is associated with reduction in body weight

health effects of obesity

•Increased mortality -Mortality rate doubles compared to non-obese individuals -Reduces life expectancy by 10-20 years •Associated disorders -Dyslipidemia -Gallbladder and kidney disease -Impaired immunity -Dermatologic disease -Impotence and reduced libido -Back pain and disorders -Type II diabetes •Mental health -Shame -Self-blame -Low self-esteem -Depression

modifiable risk factors and etiologies in children (at individual level)

•Lack of daily, quality physical activity at home -Portion sizes •Lack of breastfeeding support and pregnancy education •Amount of screen time

primary prevention continued

•Maintain healthy diet and physical activity -Patients should concentrate on health status not dieting •Lifestyle Changes -Minimize time spent in front of the TV improves BMI numbers in pediatric patients •Recommend < 2 hour of non-work/non-homework related screen time -Monitor yourself and your family •Weight, BMI, waist circumference -Community programs: "WeCan! Ways to enhance children's activity and nutrition" •Provide parents of children with the WeCan brochure: http:// www.nhlbi.nih.gov/health/educational/wecan/downloads/ physician2.pdf •Breastfeeding reduces the risk of pediatric obesity

socioeconomic status and obesity

•Men with higher incomes have increased risk of obesity •Women with higher incomes have reduced risk of obesity •Women with college degrees have reduced risk of obesity

preventative intervantions:

•Patients should concentrate on health status not dieting•Dieting alone is not conducive to weight loss or weight maintenance•According to U.N.: minimum caloric requirement is 1800 kcal/day -Depends on age, size, height, gender, lifestyle, general health status •Create healthy nutritional plan -Balance energy IN and energy OUT -Portion size, chew food longer, eat a good breakfast -Involve the family •Decreasing dietary fat is associated with reduction in body weight

secondary prevention: physical activity

•Physical activity plan -Involve the family -At least 200 minutes of moderate intensity exercise each week, spread over at least 3 days in order to maintain weight loss •Physical activity alone results in minimal weight loss •Physical activity does help to preserve fat-free body tissue during weight loss •Considerable activity is required to maintain weight loss

secondary prevention: lifestyle changes

•Reducing time spent in front of the TV improves BMI weight in pediatric patients -Recommend < 2 hour of non-work/non-homework related screen time •Monitor yourself and your family -Weight, BMI, waist circumference •Community programs: "WeCan! Ways to enhance children's activity and nutrition" -Provide parents of children with the WeCan brochure: •Breastfeeding reduces the risk of pediatric obesity

non-modifiable risk factors and etiologies in children (at individual level)

•School campuses or child care centers •Sugary drinks, less healthy food choices •Advertising, television and media •Access to healthy affordable foods •Access to high energy dense foods and sugary drinks •Safe and appealing recreational area in community

accessing obesity continued

•Waist Circumference -Use tape measure, wrap around waist at topmost point of iliac crest -Men: < 40 inches -Women: < 35 inches -Used in patients with BMI = 25-34.9 •Height-weight charts