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Obesity is the excessive accumulation of adipose tissue to an extent that health is impaired.(1)

Check your BMI

Body Mass Index (BMI) is the standard measurement of choice for many health professionals. BMI is based on a weight-to-height ratio. Overweight is defined as a BMI>=25 and <30 kg/m². Obesity is defined as a BMI >=30 kg/m². Obesity correlates strongly with obesity related co-morbid conditions and mortality. To check your BMI see the chart on this page

Waist Circumference

Waist circumference is another widely used measurement to determine abdominal fat content. An excess of abdominal fat, when out of proportion to total body fat, is considered a predictor of risk factors related to obesity. Men with a waist measurement exceeding 40 inches are considered at risk. Women are at risk with a waist measurement of 35 inches or greater.

Several Health Risks and Conditions Associated with Obesity Include:

Diabetes
Heart Disease
Stroke
Hypertension
Some types of Cancer
Sleep Apnea
Osteoarthritis
Gallbladder Disease

Obesity - an Epidemic

Overweight and obesity has reached epidemic proportions in the United States, as well as worldwide.(3) Data collected by the National Center for Health Statistics indicate that the prevalence of obesity, defined as a body mass index >30 kg/m² has increased from 12.8% in 1976-1980 to 22.5% in 1988-1994 and 30% in 1999-2000. 4)

Roughly 31% of American adults meet the criterion for obesity - about 59 million American adults. More than 64% of the US adult population have a BMI >=25 kg/m².(4) In an effort to increase public awareness of the epidemic proportion of obesity, the Surgeon General has issued a call to action to prevent and treat overweight and obesity and their associated health complications.(5)

Decreasing Dietary Fat Is Associated with a Decrease in Body Weight

Let's talk about some of the dietary changes that can be considered to help reduce energy intake. There is a lot of clutter in the press and popular publications. Diet books usually occupy a couple of places in the top ten lists of nonfiction books, although in some cases I think they should probably be on the fiction list, depending on the particular diet. A lot of people are confused about what they are supposed to be eating to lose weight.

I want to emphasize that calories are very important. You may need to emphasize that to your patients because I think many people have lost sight of that. One number that you might want to remember for working with your patients is that 3,500 calories energy is contained in every pound of body fat, and so in order to lose a pound of body fat, not water, it's necessary to burn 3,500 calories more than you take in.

By the same token, the person who takes in 3,500 calories more than they burn would expect on average to gain a pound of body fat. Even a hundred calories a day difference between intake and expenditure, if continued in the same direction, over the course of a year can amount to a ten pound body fat difference.

This can certainly explain how it is that we can gain weight continuously over time, even when taking in a hundred extra calories a day. On the other hand, for the patient who is a little discouraged, pointing out some ways that they can reduce their energy intake by a hundred calories a day, and perhaps increase their expenditure by a hundred calories a day can make it seem much more manageable.

Apart from the calories, people want to know what the constituents of their diets should be. This slide is a summary of 37 studies that were conducted using cholesterol-lowering diet step 1 and step 2. They have been graphed according to the average reduction in body fat and dietary fat, compared to the change in body weight.

You can see that in general, the interventions that resulted in the greatest reduction in dietary fat also had the greatest effect on weight loss. So it obviously shows the wisdom of trying to lower dietary fat from the diet.

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Don't Just Sit There - DO SOMETHING!
Taking a Preventive Approach to Your Health

What are you waiting for? Many people wait to start a healthier lifestyle until...

...someone they love is diagnosed with or dies of cancer, heart disease, diabetes, or another devastating disease.

...they themselves are diagnosed with a disabling or life-threatening disease.

Think about what will motivate you to make a healthy change. Don't wait until a personal tragedy strikes - take action now!

You've heard it a thousand times before: clean living, healthy eating and regular exercise are the keys to a longer, healthier life. It's not rocket science, after all - it's just plain logical.

There's plenty of evidence that these healthier habits can prevent - or at least delay - many diseases and deaths. And yet, most Americans just aren't doing what it takes to be healthy.

As a result, cardiovascular disease remains the nation's number one killer, taking the lives of nearly 1 million Americans annually and afflicting at least 50 million more. Cancer adds another 500,000 deaths each year and forever alters the lives of approximately 7.4 million living Americans who have a history of the disease.

Another 16 million people have diabetes - often undetected - causing thousands of deaths each year and increasing risk for heart disease, blindness, kidney failure and amputation.

All told, these three highly preventable diseases alone cost our nation an estimated $455 billion a year in health care, lost productivity and mortality costs. (Source: Center for Disease Control and Prevention) Add osteoporosis, arthritis and other preventable diseases and the numbers are even more staggering.

The Power of Prevention

"Prevention is a simple concept", says Kevin Waters, MD, of the Duke Executive Health Program at the Center for Living. "If you have bad lifestyle habits, you're more likely to get ill. If you change to better habits, you're less likely to get ill."

"The fact is, we're all going to get some disease in our later years, even if we do everything right", he acknowledges. "But we want to prevent illness while people are in their 50s, 60s and early 70s rather than having them be disabled and spending their time in doctors' offices."

Dr. Waters notes that a healthy lifestyle is not just an investment in your future - it also has important benefits now. "If you're overweight, out of shape and tired all the time, begin exercising moderately and eating better and you'll feel better now.

In a very short period of time, you can start losing weight, lower your cholesterol and blood pressure and sometimes reduce medications for these conditions, perform better at work, sleep better and have more energy."

You can significantly decrease your risk for many diseases by taking five simple preventive steps:

1. Exercise moderately several times a week. Shoot for four to five times a week for at least 30 minutes a day - more is better, but some activity is better than none. If you've been inactive, start with walking, doing yard work, or taking the stairs - just do what you can to be more active.
2. Eat sensibly. Instead of dieting, start incorporating healthier eating habits that you can sustain for the rest of your life. Reduce saturated fats and increase carbohydrates while controlling portion sizes and eat less red meat and more fruits and vegetables throughout the day.
3. Reduce stress in your life. Everyone has stress, although it manifests itself in different ways. Stress raises your blood pressure and increases your risk for many illnesses. [Take our Quick Stress Assessment for a brief check on your stress level.) Learn to manage and reduce stress through exercise and other relaxation techniques, and ask your doctor for guidance.
4. Change other unhealthy habits. Quitting smoking alone will significantly reduce your risk for lung cancer, heart disease and many other conditions. And if you're drinking a lot, cut back: alcohol provides empty calories, reduces your motivation to exercise and eat well and increases your risk for certain cancers.
5. Have a plan for your health. Map out what you are going to do to be healthy over the next few years. Include your goals for regular exercise, healthy eating and stress management, as well as plans to take regular vacations and to get regular health check-ups (including mammographies and breast self-exams for women and prostate cancer screenings for men). If you have any chronic diseases or major risk factors, include management plans for those conditions. Review and update your plan annually with your primary care physician.

Just Do Something!

If you have already adopted these healthy habits for yourself: Bravo! If you're doing just a bit, give yourself a pat on the back - then try doing just a bit more, since you'll get great incremental benefits. And if you haven't made any healthy changes yet, Dr. Waters says simply: "try to do something!"

If you have children, set a good example for them about how to eat right and exercise. Plan physical activities you can do together, such as bike riding or walking. And if you're using work as an excuse for not having time to exercise, keep in mind that you won't do well professionally if you're not taking care of yourself personally.

Even if you're not ready to make a change yet, bear in mind that there are many resources available if and when you decide to get started. The Duke Center for Living's local and residential programs emphasize better health and vitality through prevention and early detection.

You can also get support from other programs and health professionals in your area, like local fitness centers, dietitians, yoga and tai chi and other stress management classes and psychologists, as well as through books and Internet resources.

Good luck, and please let us know how we can help you meet your health and prevention goals!

At Last, Reasonable Fitness Guidelines for the Rest of Us

"The key finding [of the Surgeon General's report is that people of all ages can improve the quality of their lives through a lifelong practice of moderate physical activity. You don't have to be training for the Boston Marathon to derive real health benefits from physical activity."

Donna Shalala
Former U.S. Secretary of Health and Human Services

For decades, the United States has led the world in understanding and promoting the benefits of physical activity. In the 1950s, a national campaign encouraged young Americans to be physically active. In the 1970s, we learned about the cardiovascular benefits of vigorous activity. And in the past two decades, we found out that moderate-intensity activities such as walking, gardening and dancing could reap health benefits as well.

Still, until recently, the prevailing philosophy was that vigorous exercise was required to make a difference. And that left a lot of people discouraged, unmotivated and frankly – inactive. Sixty percent of Americans, in fact, are not regularly active, and 25 percent aren't active at all.

But thanks to a comprehensive report on physical activity and health issued by the U.S. Surgeon General, there is a new philosophy that may change the way Americans look at physical activity.

The Surgeon General Says

"The Surgeon General's report provides a synopsis of all the research on physical activity and health that has been done to date," explains Michael Scholtz, MS, exercise physiologist at the Duke Diet and Fitness Center (DFC). "As opposed to past recommendations, which were geared toward athletes and then applied to the average person, this report focuses on prevention and health for the average person."

"The most important finding is that even moderate amounts of activity can improve your health and your risk for diseases like premature heart disease, arthritis, hypertension and cancer," says Duke Center for Living Fitness Manager Jami Norris, MS. "There are additional benefits to doing more, but there are huge health benefits to going from doing nothing to doing a little bit. It's getting away from that "no pain, no gain" mentality."

Among its many conclusions, the comprehensive report states that:

1. Physical activity is an important part of disease prevention for people of all ages.
2. Accumulating 30 minutes of activity every day on most days of the week can yield significant health benefits and the activity need not be strenuous to achieve positive results.
3. Additional health benefits can be gained through greater amounts of physical activity.

"The report found that accumulating 30 minutes of moderate activity each day - that can even be broken up into 10 minutes three times a day - on a consistent basis of most days of the week, adds up to really significant health benefits," says Jami. "The focus is on moderate rather than strenuous exercise, which is why the Rating of Perceived Exertion (RPE or Borg scale) is being used more as a guide to adjust your intensity to work somewhat hard but not excessively."

"It's a serious health risk to be inactive," Michael warns. "The report documents the fact that physical activity is an important component of disease prevention and better health, just like quitting smoking and cutting fat in your diet." He notes that if you have heart disease, pulmonary disease, diabetes, a joint problem or other medical condition, you should consult a physician before beginning any exercise program. "But if you're reasonably healthy, you can begin to do something that involves moving your body, even if it's something simple like working in your garden."

The Activity Pyramid

The Activity Pyramid shows how to incorporate physical activity into your life in accordance with the Surgeon General's recommendations.

Start by building a strong base at the bottom of the pyramid and move upward, say Jami and Michael. Like a building a house, each level supports the levels above, making your body more capable of doing the activities above and making them more fun.

First, build a foundation of 30 minutes of activities of daily living on most days of the week. Then, add a layer of basic cardiovascular work, and if you have the time, add activities to gain strength and flexibility a few times a week. If your schedule and interests permit, you can add recreational sports - or even competitive sports or high intensity training.

But keep in mind, says Michael, "the highest levels of the pyramid are not required to gain strong benefits. Some people will stop at the activities of daily living, and that's great. What's important is that you incorporate activity in a way that works best for you."

Some Moderate Activities to Incorporate Into Your Day

o Taking a stroll
o Washing your car
o Gardening
o Dancing
o Raking leaves
o Taking a bike ride
o Shoveling snow
o Playing basketball
o Stairwalking
o Cleaning your house

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