PDF Ebook Weight Management and Eating Disorders
The newest NHANES study reported that 65% of Americans are overweight or obese. The survey used a body mass index (BMI of 25 for males and females. The current Federal Obesity Guidelines published in 1998 define overweight as a BMI > 24.9, which is consistent with definitions used in other countries. Overweight and obese( BMI >30) individuals are thought to be at risk of developing many chronic diseases such as diabetes mellitus, cardiovascular disease, and hypertension. In South Carolina, approximately 28% of the adult population is obese. Weight for height tables are of limited value in determining healthy weights. The tables represent mostly middle to upper income whites. They are untested in minority populations. A healthy weight table has been published with the new Dietary Guidelines. This new table may be more appropriate to use with the new emphasis on healthy weights instead of ideal weights.
A more reliable way of determining overweight status is to use a body mass index. This is weight in kilograms divided by height in meters squared. The BMI should be between 19 and 24.9. Overweight persons have BMIs greater than 25. Obese persons have BMIs greater than 30. Some athletes will not fit the usual ranges for normal BMI. They have a greater percent lean body mass. Since muscle weighs more than fat, these persons will appear overweight on the usual tables. Waist circumference, which is strongly associated with metabolically active abdominal fat, can be used in conjunction with BMI to determine disease risk. A waist circumference of over 40 inches in men and over 35 inches in women is an indicator of increased risk in persons with BMIs >24.9. The waist should be measured one inch below the umbilicus. New research from McMaster University found that waist to hip ratio (waist measurement divided by hip measurement) is a very good predictor of a person’s risk for heart disease. Ratios greater than 0.85 for women and 0.9 for men indicates greater risk.
Genetics is now known as a major factor in predicting a person’s chance of becoming overweight. New research has even linked certain genotypes to food preferences, which in turncause affected persons to eat more Calories each day. Psychological factors play a role in the development of obesity. It is always a good idea to have some form of psychological support available for the person who is trying to lose weight (family or professional). Social and environmental factors should also be considered when determining the best approach to weight management.
There are many weight reduction methods being used today. They range from very low kcalories diets to gastric surgery. In between, fall conventional kcalorie restricted and low fat diets, plus the newer behavior modification approaches. Traditional treatment of obesity by defined weight loss in a defined period of time has not been found to be successful long term. Life style changes which include exercising and improved food selection are behavioral modifications that show promise in long-term weight management.
The Federal Obesity Clinical Guidelines suggest use of lifestyle changes: moderate physical activity of 45-60 minutes or more most days of the week and a low fat, kcal controlled diet. The goal should be a 10 percent reduction in body weight in six months. If this fails, then pharmacological management can be considered in addition to lifestyle changes.
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