ObesityCarrie Miller, MSN, RN, CNE

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Acknowledgments World Health OrganizationThe World Health Organization is committed to promoting healthy outcomes for all of the worlds people. Providing leadership to world health matters and assessing trends of how everyone can be as healthy as possibleThis lecture is primarily based on the World Health Organization content to bring forth the most current and useful information.

WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.

In the 21st century, health is a shared responsibility, involving equitable access to essential care and collective defense against transnational threats.

Retrieved from: http://www.who.int/about/en

Please note, the major content of this lecture is obtained from the World Health Organization to be used by nursing students worldwide. *

Objectives Define obesity Describe health consequences of obesityExplain strategies to reduce obesity Explain how to reduce consequences of obesity Explain strategies to promote health

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Obesity Definition: excessive weight that may impair health How do we measure If someone is obese?Body Mass Index (BMI)BMI Categories: Normal weight = 18.5-24.9 Overweight = 25-29.9 Obesity = BMI of 30 or greater

Body Mass Index is defined as weight in kilos divided by height, squared..so it looks like this: kg/m2

Body mass index (BMI) is measure of body fat based on height and weight that applies to both adult men and women. BMI Categories: Normal weight = 18.5-24.9 Overweight = 25-29.9 Obesity = BMI of 30 or greater

Reference: US Department of Health and Human Services, retrieved from: http://www.nhlbisupport.com/bmi/bminojs.htm

The information you need is someone's weight in kilograms and then their height. The formula is:

Metric BMI Formula BMI = ( Weight in Kilograms / ( Height in Meters ) x ( Height in Meters ) )

For example: BMI = (75 kg/ 1.6 m) x (1.6 m) = 75/2.56 =29.29 BMI, which then rounds up to 29.3This BMI indicates this person is overweightnot quite obese, but getting close!

Exercise: Calculate your own BMI, where are you on the BMI scale? *

Just the Facts! According to WHO: As of 20051.6 billion adults (over 15 years old) are overweight400 million are obese Projects by 2015, 2.3 billion will be overweight and 700 million obese

Reference: World Health Organization.(2008). Obesity and overweight. Fact sheet #311. Retrieved from http://www.who.int/mediacentre/factsheets/fs311/en *

Cause of Obesity Simple equationwhen you eat more than you use..it is stored in your body as fat. CausesGlobal shift in how we eatWestern diet of processed foodHigher sugar, fat and calories in what we eatLess nutrientsReduced intake of vitamins and minerals

This in itself is alarmingwe are getting more and more overweight with most occurring in urban settings. As income rises, food intake increases. There is also a global shift in how we eat. More salt, more fat and more sugars. The more we process food, the more we change the food we eat, the less nutrient dense it is. There is a decrease in vitamins, minerals and micronutrients that help our bodies to stay healthy (WHO, Fact Sheet 311). The other issue is we exercise less than we used to. When life has many tools that can make our lives easierwe move our bodies less, we sit more, well, we do not burn calories. An increase of video games, electronics have caused kids to play less and eat more. The challenge is getting kids to get outside and play at least one hour a day. *

Low and Middle Income Countries Double Burden of Disease According to WHO there is a double burden of diseaseCountries that are developing are still having issues of infectious disease and under-nutrition There is also an increase of chronic disease related to obesityespecially in urban settingsCauses inadequate prenatal care, lack of infant and child nutrition and eating high fat and high sugar foods

Reference: World Health Organization, Retrieved from http://www.who.int/dietphysicalactivity/childhood_consequences/en/index.html *

What does obesity do to our bodies? With more people gaining too much weight..there are health issues to considerCardiovascular diseaseDiabetes type 2Musculoskeletal disorders Cancers-endometrial, cervical and colonInfertility Gallstones Premature death and disability

We know what obesity can do to our bodies..but what is interesting is that obesity is preventable. In the last slide, the information that obesity is caused by eating more than our bodies needso if we eat the right amount of foodwe will be healthier and have much less chance of being obeseseems to simple doesnt it? The challenge is, when we have so many choices and eat the Western diet, we have a strong tendency to eat more than we need.

Exercise: Is there anyone in your family that has health problems with obesity or being overweight? When did they start being overweight? Are they healthy? Do you have anyone in your family with diseases related to obesity?

What are your favorite foods? Are they processed and have lots of sugar and fat? Many people will say they like desserts, candy or soda popall can cause someone to gain weight.

Reference: World Health Organization.(2008). Obesity and overweight. Fact sheet #311. Retrieved from http://www.who.int/mediacentre/factsheets/fs311/en

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Heart Disease and DiabetesHeart DiseaseThe worlds number #1 cause of deathKills 17 million each year around the worldHeart attackStroke Diabetes type 2Becoming global epidemic WHO projects diabetes will increase by 50% across the world

Couple of comments about diabetes and obesity.

Diabetes is even more scary than heart disease and is primarily caused by obesitynow Type 2 diabetes is the not the same as Type 1. Type 1 diabetes is when the body makes no insulin and can happen at any age, any weight. Type 2 is a result of being overweight, the body struggles to make enough insulin and at some point is not able to make enough, but can make small amounts. The best way to control diabetes is to control weight and to exercise. Some people do not have to take any medicine to control diabetes. But some do.

According to WHO: Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.

World Health Organization (2010). Diabetes: Fact sheet 312. Retrieved from http://www.who.int/mediacentre/factsheets/fs312/en/index.html

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Diabetes Type 2 Increasing at alarming rates in all age groups Mostly caused by being overweight and obeseAccording to WHO Diabetes affects more than 200 million people in the worldDiabetes effects mostly low and middle income countriesOver half of the deaths were women55% Can be prevented

According to WHO, Fact sheet 312. Retrieved from http://www.who.int/mediacentre/factsheets/fs312/en/index.html

More than 220 million people worldwide have diabetes. In 2005, an estimated 1.1 million people died from diabetes.1Almost 80% of diabetes deaths occur in low- and middle-income countries. Almost half of diabetes deaths occur in people under the age of 70 years; 55% of diabetes deaths are in women. WHO projects that diabetes deaths will double between 2005 and 2030.Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use can prevent or delay the onset of diabetes.

What are common consequences of diabetes? (WHO Fact Sheet 312)

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.Diabetes increases the risk of heart disease and stroke. 50% of people with diabetes die of cardiovascular disease (primarily heart disease and stroke).Combined with reduced blood flow, neuropathy in the feet increases the chance of foot ulcers and eventual limb amputation.Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. After 15 years of diabetes, approximately 2% of people become blind, and about 10% develop severe visual impairment.Diabetes is among the leading causes of kidney failure. 10-20% of people with diabetes die of kidney failure.Diabetic neuropathy is damage to the nerves as a result of diabetes, and affects up to 50% of people with diabetes. Although many different problems can occur as a result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or weakness in the feet and hands.The overall risk of dying among people with diabetes is at least double the risk of their peers without diabetes.

What is the economic impact of diabetes? Diabetes and its complications have a significant economic impact on individuals, families, health systems and countries. For example, WHO estimates that in the period 2006-2015, China will lose $558billion in foregone national income due to heart disease, stroke and diabetes alone.

Exercise: Who in your family and community has diabetes? How has it affected their daily lives? How do they manage and take care of their diabetes? *

Diabetes Type 2Symptoms Blurred visionErectile dysfunctionFatigueFrequent or slow-healing infectionsIncreased appetiteIncreased thirstIncreased urination

Diabetes is an insidious disease. According to the American Diabetes Association, there are several symptoms to screen for.

References: American Diabetes Association. (2010). Diabetes. Retrieved from: http://www.diabetes.org/diabetes-basics/type-2

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Complications of Diabetes Heart disease and stroke GlaucomaNeuropathyespecially the feetSkin complications...wounds do not heal well Diabetic retinopathy (eye disease)Kidney disease and kidney failureDamage to blood vessels that supply the legs and feet (peripheral vascular disease)

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What about children?

When children are overweight, they are more likely to be overweight and obese as adults.

How can children avoid being obese? This starts as soon as we are born.

With children, the challenges of obesity are even more important to recognize. When a child is overweight or obese, there is more likelihood of becoming obese as an adult.no matter where you live. More and more children are gaining too much weight. The next few slides will discuss the issues surrounding childhood obesity, starting with pregnancy and infants. How babies start in life is very important to being as healthy as possible.

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Healthy StartsBefore we are bornMothers who:Normal BMI during pregnancyEat healthy and exercise moderately Gain 11.5-16 kg Prenatal care When we are babies Study shows babies weaned before 4 months gained more weight than recommended According to WHO: Breastfeed for at least 6 months exclusively and beyond if possible

When mothers are pregnant, it is important to be as healthy as possible.

For pregnant women, it is important to be as healthy as possible before and during pregnancy with eating healthy foods, being active and getting prenatal care. Prenatal care will help to make sure mothers are gaining the right amount of weight..not too much or too little. Prenatal care is also vital to make sure mothers are as healthy as they can be during their pregnancy. In prenatal care, the mom and baby are checked, this includes weight, blood pressure, growth of the baby and how active the baby is. Providers may draw blood to check for health status as well.

Prenatal care and monitoring weight gain according to Lowdermilk & Perry (2006). Progressive weight gain is critical for optimal health of both mom and baby. If a women is underweight, she needs to gain about 12.5-18 kg. For women who are of normal BMI, she should gain 11.5-16 kg and for women who are overweight: 7-11.5kg. If a woman is obese, weight gain needs to occur, but will be closer to 7 kg of gain. This covers the weight of the baby, extra fluid, changes in her body, and finally the weight of the placenta. The pattern of weight gain during pregnancy is important for the health of mom and baby.during the first trimester, most women do not gain any weight and may lose because of morning sickness and nausea. In 2nd trimester (week 13-26) and third trimester (week 27-40), women should gain 0.3 kg per week for women who are overweight or obese.

When babies are breastfed, there is less chance of being overweight as a child. In a study done by Sloan, Gildea, Stewart, Sneddan and Iwaniec (2007) studied babies that are weaned before 4 months and babies weaned after 4 months. Babies that were weaned early, before 4 months and formula fed were more likely to be overweight as children. Overweight children are more likely to be overweight adults. Results of the study indicated that mothers need to strongly consider breastfeeding their babies for at least 4 months. However, longer is better. If moms can breastfeed for at least 6 months, that will help even more. The best scenario is for moms to breastfeed exclusively for 6 months, then start to supplement with other juices, water and solids. Babies can be breastfed until both mom and baby are ready to wean. Some babies and moms will breastfeed for a short time, and some moms/babies will breastfeed for several years. Each mom and baby are unique in what works best for them.

The World Health Organization recommends that women breastfeed their babies for at least 6 months to help keep babies as healthy as possible. Breastfeeding helps to reduce risk of childhood obesity and reduces infant infections and death.

According to WHO: Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large.

Once again, exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. Exclusive breastfeeding means no other source of nutrition expect breastmilk. Please keep in mind, if babies are not growing well, are dehydrated or not gaining weight may need to have other sources of nutrition in the first 6 months, such as formula. The key is to make sure babies and moms are as healthy as they can be, but babies and moms should not gain extra weight that their bodies do not need. This is a fine line and as nurses we need to make sure that both moms and babies are at a healthy weight (Lowdermilk & Perry, 2006). References:

Lowdermilk, D. & Perry, S. (2006) Maternity Nursing. (7th ed). St. Louis: Mosby

Sloan, S., Gildea, A., Stewart, M., Sneddon, H. & Iwaniec, D. (2007). Early weaning is related to weight and rate of weight gain in infancy. Child: care, health and development, 34:59-64. doi: 10.1111/j.1365-2214.2007.00771.x

Exercise: How many women in your family and community breastfeed their infants? Is breastfeeding important in your community? Why or why not?

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Childhood Obesity Rates of childhood obesity are alarming Problem is worldwideEstimated in 2010 42 million children under age 5 are considered overweightTripled in past 30 yearsAge 6-116.5% to 19.6% Age 12-195.0% to 18.1%

Childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and is steadily affecting many low- and middle-income countries, particularly in urban settings. The prevalence has increased at an alarming rate. Globally, in 2010 the number of overweight children under the age of five, is estimated to be over 42 million. Close to 35 million of these are living in developing countries.

Overweight and obese children are likely to stay obese into adulthood and more likely to develop noncommunicable diseases like diabetes and cardiovascular diseases at a younger age. Overweight and obesity, as well as their related diseases, are largely preventable. Prevention of childhood obesity therefore needs high priority.

WHO Fact Sheet Pediatric Obesity, Retrieved from http://www.who.int/dietphysicalactivity/childhood/en

When talking about obesity in children, the thought is, oh there are not that many children..and they will lose their baby fat as they grow up. This is no longer true. Children are becoming more challenged with being overweight and obese. There are several issues to consider. According to Centers for Disease Control (2010), there are several issues that need to be addressed. The rate of childhood obesity has increased over the past 30 years. The rates of increase are alarming and need to considered carefully. What can we do to help reduce obesity in children? Well, there are many things we can do. But, first, what the numbers? Over the past 30 years, the rate of obesity in children is risingfor ages 6-11, the rate has increased from 6.5% to 19.6%. For children 12-19, the rates are about the same, in 1980, 5% were obese, now it is 18.1% and rising (Centers for Disease Control, 2010). And with the WHO estimating that 42 million children worldwide under 5 are overweight, the prognosis is not good. There are many issues that need to be considered, as this crisis is not easing off or decreasing, but increasing at fast rates all over the world. Centers for Disease Control. (2010). Health topics: Childhood obesity. Retrieved from http://www.cdc.gov/HealthyYouth/obesity

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Childhood Obesity Genetic Link Multifactorial condition related to sedentary lifestyle, too much good intake and choice of foods actually alter genetic make-up, creating higher risk of obesityBehavioralChildren will more likely choose healthier foods if they are offered to them at young ages and in the home Environment In homes where healthy food is not available, or the food choices are not healthy. Obesity can occur

Early in this lecture, in defining obesity, the basic premise is when someone eats more than they need for energy, the extra weight is added. This is also true for children. But, obesity is a bit more than just how many caloriesthere are issues surrounding genetics. Does obesity run in the family? Are there other members of the family, say the mother or father, or brothers and sisters that are also obese? If so, there is a risk of children being obese as they grow older.

Because obesity is a complex condition, there are many factors to consider, one is genetics. In a study by Boutin and Froquel (2001), there is strong evidence to suggest the genetic link to obesity. The genetic codes are influenced by sedentary lifestyle, food choices and constant access to food puts stress on genes that are predisposed to weight gain.

Boutin, P. & Froquel, P. (2001). Genetics of human obesity. Clinical Endocrinology and Metabolism, 15: 391-404. Retrieved from http://www.bprcem.com/article/S1521-690X%2801%2990153-8/abstract

Behavioral activity needs to be considered. What kids choose to eat is learned from parents and other adults. Children are more likely to choose healthy foods if they are offered in the home.

Environment. This is some things a child and their parents may not have control over. Most humans will try and live in the best place they can. To have shelter, clean water and healthy food. But this may not be possible. Sadly, food that is over processed may also be the cheapest and can be stretched further in the household budget, or perhaps there is no money for food and children eat only when they can. It may be very challenging to find healthy food. Even in America, many children do not have access to fresh fruits and vegetables. There are no grocery stores close by or there is no money to purchase fresh fruits and vegetables.

Centers for Disease Control. (2010). Health topics: Childhood obesity. Retrieved from http://www.cdc.gov/HealthyYouth/obesity *

Childhood Obesity Why does this matter? Premature deathDeveloping heart disease at younger agesDeveloping diabetes type 2 at younger agesWhat can be done? Childhood obesity is preventableRole of the schools Role of health care professionals

Overweight and obesity, as well as related noncommunicable diseases, are largely preventable. It is recognized that prevention is the most feasible option for curbing the childhood obesity epidemic since current treatment practices are largely aimed at bringing the problem under control rather than effecting a cure. The goal in fighting the childhood obesity epidemic is to achieve an energy balance which can be maintained throughout the individual's life-span. World Health Organization, Retrieved from http://www.who.int/dietphysicalactivity/childhood_what_can_be_done/en/index.html

When talking about obesity in children, the thought is, oh there are not that many children..and they will lose their baby fat as they grow up. This is no longer true. Children are becoming more challenged with being overweight and obese. There are several issues to consider. According to Centers for Disease Control (2010), there are several issues that need to be addressed. The rate of childhood obesity has increased over the past 30 years. The rates of increase are alarming and need to considered carefully. What can we do to help reduce obesity in children? Well, there are many things we can do.

Childhood obesity must be taken into consideration with short and long term issues. These include:

When children are obese or overweight, they are most likely to develop high blood pressure or high cholesterol. According to the Center for Disease Control (2010) children who are overweight or obese were more likely to have more than one risk of heart disease. In a population-based study, children ages 5-17 years, 70% of the kids had at least one risk factor for heart disease. One has to consider, when the body has too much weight, there are more problems with joints, how hard the heart has to work, diabetes, sleep issues with sleep apnea. The issues behind obesity go far beyond the bodybut think about self-esteem and being stigmatized. These were also studied and results are clear, obesity is more than being overweight, but it also affects how people and children view themselves and how others view them.

Exercise: When you see someone who is overweight or obesesomeone that you do knowwhat comes to your mind? How do you judge themwhat thoughts do you have?

http://www.cdc.gov/HealthyYouth/obesity

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Nutrition Nutrition counts! Nutrition is everything! Healthy foods, fruits, vegetables, legumesa colorful diet is best! Low sugar, low fatPlay an hour a day!

General recommendations:

Generally speaking, this lecture has been about healthy eating, exercise and the implications of what can happen if a person does notbut the question that needs to be asked is sohow much is enoughwhat kind of nutrition is correct? Although this lecture will not discuss nutrition in depth, there is some basic information that can be helpful. According to World Health Organization (2010), children need to have a varied diet, the more colorful the better.however, children need to simply eat more fruits and vegetables, fresh is best. Canned has too much sugar and salt. Lean proteins such as chicken and fish. Beef, veal and lamb are very high in fat. When having breads, whole grain is best. With rice, brown rice is preferred. The key is to have as much fresh, wholesome food as possible for children, and adults.

Children also need to play outside, or inside if outside is not a good choice, but play with moderate activity at least one hour a day. Playing soccer, swimming, walking, running, playing basketballanything that helps children to move their bodies.

Reference: WHO Childhood Obesity, from http://www.who.int/dietphysicalactivity/childhood_what_can_be_done/en/print.html

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What can Schools do to help? Create healthy eating policy during school hours. Meaningno junk food Provide healthy snacks for children to have or purchaselocal fruits and vegetables that children like to eatHave an exercise activity every day during school hours of at least 20 minutesUse activities as a reward rather than food

When children are in school, they are dependant, many times, on the school to help with meals. Schools have a large part in helping children to learn how to eat healthy. There are several simple things that schools can do to help children to be healthier and more active. Teachers and school administrators can help students learn what is a good diet and what is a bad diet. To help students learn what healthy means. *

Reducing Childhood Obesity Takes collaborative effort from everyoneFrom Nursing:Advocate for healthy eating Advocate obtaining nutritious food Advocate for exerciseone hour a day to playAdvocate for health promoting exercise Educate the public

To reduce obesity, there needs to be a dynamic group effort of all disciplines coming together. Parents, teachers, doctors and nurses. We all need to work together. To help children and parents to eat as healthy as they can, exercise and have less risk of adult diseases. *

WHO Strategy WHO Strategy for preventing overweight and obesityAdopted by World Health Assembly in 2004 and WHO Global Strategy on Diet, Physical Activity and HealthFour objectivesReduce risk factors of chronic diseaseIncrease awareness and understandingImplement global, regional, national policies actions plansMonitor science and promote research

Objectives for these strategies are to: World Health Organization.(2008). Obesity and overweight. Fact sheet #311. Retrieved from http://www.who.int/mediacentre/factsheets/fs311/en

Advocate for health promotion and chronic disease prevention and controlPromote health, especially in areas of poverty and disadvantaged populationsPrevent premature deaths at all ages

The reality is, we have control over this epidemicbut our work is not working as well as we might want. As nurses, we need to take an active role in helping those in our care, our communities and our families to take care of themselves. To eat as well as they can, be active and get rest. As nurses, we set the tone, we are role models. Our role is to advocate and teach our patients to take good care of themselves. *

Lets talk about each oneReduce risk factors for chronic diseaseTo reduce, there needs to be more exercise and better eating habits

Increase awareness and understandingTo understand the influence of diet and why physical activity makes a difference

Over and over again, we hear the same thingthe more we eat and the less we move, the bigger we getpure and simple. WHO is actively trying to create opportunities for all persons to have enhanced understanding to what obesity is, how to prevent and the consequences of obesity. From here, we need to talk about the best known ways to prevent being overweight and obese. It really is very simplehealthy eating and exercise. Do before we begin. Ask yourself this question.

What did you eat yesterday? Was your diet varied with lean proteins, fruits, vegetables, whole grains? Or was your food choices yesterday full of high salt, fat and sugar? How much exercise do you get each week? None? Once a week? Three times a week? Every day? How do you exercise? Walking, running, swimming, playing soccer? Playing with children?

As nurses, we need to be role models. This means we need to work on our own health and well being. Eating well, getting enough exercise and also enough rest. So, the question you need to ask yourselfwhat do you do to reduce chronic disease in your community? Can you help your family to better understand how diet and exercise can reduce the risk of overweight and obesity?

Reference: World Health Organization, Global Strategy on Diet, Physical Activity and Health. Retrieved from http://www.who.int/dietphysicalactivity/goals/en *

And the last twoTo develop and implement global, regional, national policies and action plansWork to improve diets and definition of physical activity

Monitor Science and promote researchOn how diet affects the body, how to influences How much physical activity is best for most

Exercise: What polices and plans are in place where you live that can help to prevent obesity in children and adults?

Reference: World Health Organization, Global Strategy on Diet, Physical Activity and Health. Retrieved from http://www.who.int/dietphysicalactivity/goals/en *

Evidence Where is the evidence? The Global Strategy on Diet, Physical Activity and Health have determined: When threats to health are addressed, people can remain health into their 80s and 90sRisk reductioneven modest has sustainable benefitsHealthy living with not smoking is considered effective in reducing threats of noncommunicable disease

With all that has been presented, overweight and obesity is as simple as making different choices. The next several slides address what can be done, by anyone. Parents, children, teenagers, adultsboth young and old. This epidemic is truly in our hands to change.

Reference: World Health Organization, Global Strategy on Diet, Physical Activity and Health. Retrieved from http://www.who.int/dietphysicalactivity/goals/en *

Evidence Something as simple as eating fruits and vegetables can save millions of lives; according to WHO, 2002: Low fruit and vegetable intake 2.7 million lives could be saved with enough fruits and vegetables

Reference: World Health Organization. (2004) Promoting fruit and vegetable consumption around the world. Retrieved from http://www.who.int/dietphysicalactivity/fruit/en/index.html *

Fruits and Vegetables WHO states: Fruits and vegetables need to be part of the daily diet to prevent disease such as obesity and noncommunicable diseaseThe statistics are startlingLack of enough fruits and vegetables cause19% of GI deaths31% of Ischemic heart disease11% of stroke

Reference: World Health Organization. (2004) Promoting fruit and vegetable consumption around the world. Retrieved from http://www.who.int/dietphysicalactivity/fruit/en/index.html *

How much fruit is enough? WHO recommends at least 400 gms of fruit and vegetables each dayThis will prevent chronic disease related to overweight and obesityHeart diseaseDiabetesCancers

Keep in mind, that even with more fruits and vegetables in the diet, there is still need to reduce the fats, sugars and processed foods. Keep in mind that tubers, such as potatoes and cassava are not included in fruits and vegetables.

Reference: World Health Organization. (2004) Promoting fruit and vegetable consumption around the world. Retrieved from http://www.who.int/dietphysicalactivity/fruit/en/index.html

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Essential Understandings It is well known that obesity is preventable. It is caused by eating more than we needso how can we prevent obesity? Each of us canaccording to WHOHave a balance of energy and healthy weightLimit how much fat we eatwe need to eat some..but not too much. Increase fruits and vegetablesLimit sugarsIncrease exercise to at least 30-60 minutes per day on most days!

Obesity is one the most preventable diseases. When the human body is healthy, active and eating well, most can expect to live well into their 80s or 90s. Obesity creates opportunity for an unhealthy life with higher risk of heart disease, diabetes type 2, cancers of the uterus, cervix and colon. Obesity, because of the extra weight makes it harder to move and increases the risk of osteoarthritis. Each one of us can make such a difference by being role models and helping others to understand why obesity rates need to be reduced.

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Helpful Websites World Health Organization

http://www.who.int/topics/obesity/en Calculate your BMI

http://www.nhlbisupport.com/bmi/bminojs.htm Nutrition Facts

http://www.nutritiondata.com

Each of these websites offer more information that can be used to help better understand obesity and how to prevent it. *

Carrie Miller MSN, RN, CNEcwmiller@wsu.edu

Contact Information

*WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.

In the 21st century, health is a shared responsibility, involving equitable access to essential care and collective defense against transnational threats.

Retrieved from: http://www.who.int/about/en

Please note, the major content of this lecture is obtained from the World Health Organization to be used by nursing students worldwide. *

*Body Mass Index is defined as weight in kilos divided by height, squared..so it looks like this: kg/m2

Body mass index (BMI) is measure of body fat based on height and weight that applies to both adult men and women. BMI Categories: Normal weight = 18.5-24.9 Overweight = 25-29.9 Obesity = BMI of 30 or greater

Reference: US Department of Health and Human Services, retrieved from: http://www.nhlbisupport.com/bmi/bminojs.htm

The information you need is someone's weight in kilograms and then their height. The formula is:

Metric BMI Formula BMI = ( Weight in Kilograms / ( Height in Meters ) x ( Height in Meters ) )

For example: BMI = (75 kg/ 1.6 m) x (1.6 m) = 75/2.56 =29.29 BMI, which then rounds up to 29.3This BMI indicates this person is overweightnot quite obese, but getting close!

Exercise: Calculate your own BMI, where are you on the BMI scale? *Reference: World Health Organization.(2008). Obesity and overweight. Fact sheet #311. Retrieved from http://www.who.int/mediacentre/factsheets/fs311/en *This in itself is alarmingwe are getting more and more overweight with most occurring in urban settings. As income rises, food intake increases. There is also a global shift in how we eat. More salt, more fat and more sugars. The more we process food, the more we change the food we eat, the less nutrient dense it is. There is a decrease in vitamins, minerals and micronutrients that help our bodies to stay healthy (WHO, Fact Sheet 311). The other issue is we exercise less than we used to. When life has many tools that can make our lives easierwe move our bodies less, we sit more, well, we do not burn calories. An increase of video games, electronics have caused kids to play less and eat more. The challenge is getting kids to get outside and play at least one hour a day. *Reference: World Health Organization, Retrieved from http://www.who.int/dietphysicalactivity/childhood_consequences/en/index.html *We know what obesity can do to our bodies..but what is interesting is that obesity is preventable. In the last slide, the information that obesity is caused by eating more than our bodies needso if we eat the right amount of foodwe will be healthier and have much less chance of being obeseseems to simple doesnt it? The challenge is, when we have so many choices and eat the Western diet, we have a strong tendency to eat more than we need.

Exercise: Is there anyone in your family that has health problems with obesity or being overweight? When did they start being overweight? Are they healthy? Do you have anyone in your family with diseases related to obesity?

What are your favorite foods? Are they processed and have lots of sugar and fat? Many people will say they like desserts, candy or soda popall can cause someone to gain weight.

Reference: World Health Organization.(2008). Obesity and overweight. Fact sheet #311. Retrieved from http://www.who.int/mediacentre/factsheets/fs311/en

*Couple of comments about diabetes and obesity.

Diabetes is even more scary than heart disease and is primarily caused by obesitynow Type 2 diabetes is the not the same as Type 1. Type 1 diabetes is when the body makes no insulin and can happen at any age, any weight. Type 2 is a result of being overweight, the body struggles to make enough insulin and at some point is not able to make enough, but can make small amounts. The best way to control diabetes is to control weight and to exercise. Some people do not have to take any medicine to control diabetes. But some do.

According to WHO: Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.

World Health Organization (2010). Diabetes: Fact sheet 312. Retrieved from http://www.who.int/mediacentre/factsheets/fs312/en/index.html

*According to WHO, Fact sheet 312. Retrieved from http://www.who.int/mediacentre/factsheets/fs312/en/index.html

More than 220 million people worldwide have diabetes. In 2005, an estimated 1.1 million people died from diabetes.1Almost 80% of diabetes deaths occur in low- and middle-income countries. Almost half of diabetes deaths occur in people under the age of 70 years; 55% of diabetes deaths are in women. WHO projects that diabetes deaths will double between 2005 and 2030.Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use can prevent or delay the onset of diabetes.

What are common consequences of diabetes? (WHO Fact Sheet 312)

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.Diabetes increases the risk of heart disease and stroke. 50% of people with diabetes die of cardiovascular disease (primarily heart disease and stroke).Combined with reduced blood flow, neuropathy in the feet increases the chance of foot ulcers and eventual limb amputation.Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. After 15 years of diabetes, approximately 2% of people become blind, and about 10% develop severe visual impairment.Diabetes is among the leading causes of kidney failure. 10-20% of people with diabetes die of kidney failure.Diabetic neuropathy is damage to the nerves as a result of diabetes, and affects up to 50% of people with diabetes. Although many different problems can occur as a result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or weakness in the feet and hands.The overall risk of dying among people with diabetes is at least double the risk of their peers without diabetes.

What is the economic impact of diabetes? Diabetes and its complications have a significant economic impact on individuals, families, health systems and countries. For example, WHO estimates that in the period 2006-2015, China will lose $558billion in foregone national income due to heart disease, stroke and diabetes alone.

Exercise: Who in your family and community has diabetes? How has it affected their daily lives? How do they manage and take care of their diabetes? *Diabetes is an insidious disease. According to the American Diabetes Association, there are several symptoms to screen for.

References: American Diabetes Association. (2010). Diabetes. Retrieved from: http://www.diabetes.org/diabetes-basics/type-2

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*With children, the challenges of obesity are even more important to recognize. When a child is overweight or obese, there is more likelihood of becoming obese as an adult.no matter where you live. More and more children are gaining too much weight. The next few slides will discuss the issues surrounding childhood obesity, starting with pregnancy and infants. How babies start in life is very important to being as healthy as possible.

*When mothers are pregnant, it is important to be as healthy as possible.

For pregnant women, it is important to be as healthy as possible before and during pregnancy with eating healthy foods, being active and getting prenatal care. Prenatal care will help to make sure mothers are gaining the right amount of weight..not too much or too little. Prenatal care is also vital to make sure mothers are as healthy as they can be during their pregnancy. In prenatal care, the mom and baby are checked, this includes weight, blood pressure, growth of the baby and how active the baby is. Providers may draw blood to check for health status as well.

Prenatal care and monitoring weight gain according to Lowdermilk & Perry (2006). Progressive weight gain is critical for optimal health of both mom and baby. If a women is underweight, she needs to gain about 12.5-18 kg. For women who are of normal BMI, she should gain 11.5-16 kg and for women who are overweight: 7-11.5kg. If a woman is obese, weight gain needs to occur, but will be closer to 7 kg of gain. This covers the weight of the baby, extra fluid, changes in her body, and finally the weight of the placenta. The pattern of weight gain during pregnancy is important for the health of mom and baby.during the first trimester, most women do not gain any weight and may lose because of morning sickness and nausea. In 2nd trimester (week 13-26) and third trimester (week 27-40), women should gain 0.3 kg per week for women who are overweight or obese.

When babies are breastfed, there is less chance of being overweight as a child. In a study done by Sloan, Gildea, Stewart, Sneddan and Iwaniec (2007) studied babies that are weaned before 4 months and babies weaned after 4 months. Babies that were weaned early, before 4 months and formula fed were more likely to be overweight as children. Overweight children are more likely to be overweight adults. Results of the study indicated that mothers need to strongly consider breastfeeding their babies for at least 4 months. However, longer is better. If moms can breastfeed for at least 6 months, that will help even more. The best scenario is for moms to breastfeed exclusively for 6 months, then start to supplement with other juices, water and solids. Babies can be breastfed until both mom and baby are ready to wean. Some babies and moms will breastfeed for a short time, and some moms/babies will breastfeed for several years. Each mom and baby are unique in what works best for them.

The World Health Organization recommends that women breastfeed their babies for at least 6 months to help keep babies as healthy as possible. Breastfeeding helps to reduce risk of childhood obesity and reduces infant infections and death.

According to WHO: Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large.

Once again, exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. Exclusive breastfeeding means no other source of nutrition expect breastmilk. Please keep in mind, if babies are not growing well, are dehydrated or not gaining weight may need to have other sources of nutrition in the first 6 months, such as formula. The key is to make sure babies and moms are as healthy as they can be, but babies and moms should not gain extra weight that their bodies do not need. This is a fine line and as nurses we need to make sure that both moms and babies are at a healthy weight (Lowdermilk & Perry, 2006). References:

Lowdermilk, D. & Perry, S. (2006) Maternity Nursing. (7th ed). St. Louis: Mosby

Sloan, S., Gildea, A., Stewart, M., Sneddon, H. & Iwaniec, D. (2007). Early weaning is related to weight and rate of weight gain in infancy. Child: care, health and development, 34:59-64. doi: 10.1111/j.1365-2214.2007.00771.x

Exercise: How many women in your family and community breastfeed their infants? Is breastfeeding important in your community? Why or why not?

*Childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and is steadily affecting many low- and middle-income countries, particularly in urban settings. The prevalence has increased at an alarming rate. Globally, in 2010 the number of overweight children under the age of five, is estimated to be over 42 million. Close to 35 million of these are living in developing countries.

Overweight and obese children are likely to stay obese into adulthood and more likely to develop noncommunicable diseases like diabetes and cardiovascular diseases at a younger age. Overweight and obesity, as well as their related diseases, are largely preventable. Prevention of childhood obesity therefore needs high priority.

WHO Fact Sheet Pediatric Obesity, Retrieved from http://www.who.int/dietphysicalactivity/childhood/en

When talking about obesity in children, the thought is, oh there are not that many children..and they will lose their baby fat as they grow up. This is no longer true. Children are becoming more challenged with being overweight and obese. There are several issues to consider. According to Centers for Disease Control (2010), there are several issues that need to be addressed. The rate of childhood obesity has increased over the past 30 years. The rates of increase are alarming and need to considered carefully. What can we do to help reduce obesity in children? Well, there are many things we can do. But, first, what the numbers? Over the past 30 years, the rate of obesity in children is risingfor ages 6-11, the rate has increased from 6.5% to 19.6%. For children 12-19, the rates are about the same, in 1980, 5% were obese, now it is 18.1% and rising (Centers for Disease Control, 2010). And with the WHO estimating that 42 million children worldwide under 5 are overweight, the prognosis is not good. There are many issues that need to be considered, as this crisis is not easing off or decreasing, but increasing at fast rates all over the world. Centers for Disease Control. (2010). Health topics: Childhood obesity. Retrieved from http://www.cdc.gov/HealthyYouth/obesity

*Early in this lecture, in defining obesity, the basic premise is when someone eats more than they need for energy, the extra weight is added. This is also true for children. But, obesity is a bit more than just how many caloriesthere are issues surrounding genetics. Does obesity run in the family? Are there other members of the family, say the mother or father, or brothers and sisters that are also obese? If so, there is a risk of children being obese as they grow older.

Because obesity is a complex condition, there are many factors to consider, one is genetics. In a study by Boutin and Froquel (2001), there is strong evidence to suggest the genetic link to obesity. The genetic codes are influenced by sedentary lifestyle, food choices and constant access to food puts stress on genes that are predisposed to weight gain.

Boutin, P. & Froquel, P. (2001). Genetics of human obesity. Clinical Endocrinology and Metabolism, 15: 391-404. Retrieved from http://www.bprcem.com/article/S1521-690X%2801%2990153-8/abstract

Behavioral activity needs to be considered. What kids choose to eat is learned from parents and other adults. Children are more likely to choose healthy foods if they are offered in the home.

Environment. This is some things a child and their parents may not have control over. Most humans will try and live in the best place they can. To have shelter, clean water and healthy food. But this may not be possible. Sadly, food that is over processed may also be the cheapest and can be stretched further in the household budget, or perhaps there is no money for food and children eat only when they can. It may be very challenging to find healthy food. Even in America, many children do not have access to fresh fruits and vegetables. There are no grocery stores close by or there is no money to purchase fresh fruits and vegetables.

Centers for Disease Control. (2010). Health topics: Childhood obesity. Retrieved from http://www.cdc.gov/HealthyYouth/obesity *Overweight and obesity, as well as related noncommunicable diseases, are largely preventable. It is recognized that prevention is the most feasible option for curbing the childhood obesity epidemic since current treatment practices are largely aimed at bringing the problem under control rather than effecting a cure. The goal in fighting the childhood obesity epidemic is to achieve an energy balance which can be maintained throughout the individual's life-span. World Health Organization, Retrieved from http://www.who.int/dietphysicalactivity/childhood_what_can_be_done/en/index.html

When talking about obesity in children, the thought is, oh there are not that many children..and they will lose their baby fat as they grow up. This is no longer true. Children are becoming more challenged with being overweight and obese. There are several issues to consider. According to Centers for Disease Control (2010), there are several issues that need to be addressed. The rate of childhood obesity has increased over the past 30 years. The rates of increase are alarming and need to considered carefully. What can we do to help reduce obesity in children? Well, there are many things we can do.

Childhood obesity must be taken into consideration with short and long term issues. These include:

When children are obese or overweight, they are most likely to develop high blood pressure or high cholesterol. According to the Center for Disease Control (2010) children who are overweight or obese were more likely to have more than one risk of heart disease. In a population-based study, children ages 5-17 years, 70% of the kids had at least one risk factor for heart disease. One has to consider, when the body has too much weight, there are more problems with joints, how hard the heart has to work, diabetes, sleep issues with sleep apnea. The issues behind obesity go far beyond the bodybut think about self-esteem and being stigmatized. These were also studied and results are clear, obesity is more than being overweight, but it also affects how people and children view themselves and how others view them.

Exercise: When you see someone who is overweight or obesesomeone that you do knowwhat comes to your mind? How do you judge themwhat thoughts do you have?

http://www.cdc.gov/HealthyYouth/obesity

*General recommendations:

Generally speaking, this lecture has been about healthy eating, exercise and the implications of what can happen if a person does notbut the question that needs to be asked is sohow much is enoughwhat kind of nutrition is correct? Although this lecture will not discuss nutrition in depth, there is some basic information that can be helpful. According to World Health Organization (2010), children need to have a varied diet, the more colorful the better.however, children need to simply eat more fruits and vegetables, fresh is best. Canned has too much sugar and salt. Lean proteins such as chicken and fish. Beef, veal and lamb are very high in fat. When having breads, whole grain is best. With rice, brown rice is preferred. The key is to have as much fresh, wholesome food as possible for children, and adults.

Children also need to play outside, or inside if outside is not a good choice, but play with moderate activity at least one hour a day. Playing soccer, swimming, walking, running, playing basketballanything that helps children to move their bodies.

Reference: WHO Childhood Obesity, from http://www.who.int/dietphysicalactivity/childhood_what_can_be_done/en/print.html

*When children are in school, they are dependant, many times, on the school to help with meals. Schools have a large part in helping children to learn how to eat healthy. There are several simple things that schools can do to help children to be healthier and more active. Teachers and school administrators can help students learn what is a good diet and what is a bad diet. To help students learn what healthy means. *To reduce obesity, there needs to be a dynamic group effort of all disciplines coming together. Parents, teachers, doctors and nurses. We all need to work together. To help children and parents to eat as healthy as they can, exercise and have less risk of adult diseases. *Objectives for these strategies are to: World Health Organization.(2008). Obesity and overweight. Fact sheet #311. Retrieved from http://www.who.int/mediacentre/factsheets/fs311/en

Advocate for health promotion and chronic disease prevention and controlPromote health, especially in areas of poverty and disadvantaged populationsPrevent premature deaths at all ages

The reality is, we have control over this epidemicbut our work is not working as well as we might want. As nurses, we need to take an active role in helping those in our care, our communities and our families to take care of themselves. To eat as well as they can, be active and get rest. As nurses, we set the tone, we are role models. Our role is to advocate and teach our patients to take good care of themselves. *Over and over again, we hear the same thingthe more we eat and the less we move, the bigger we getpure and simple. WHO is actively trying to create opportunities for all persons to have enhanced understanding to what obesity is, how to prevent and the consequences of obesity. From here, we need to talk about the best known ways to prevent being overweight and obese. It really is very simplehealthy eating and exercise. Do before we begin. Ask yourself this question.

What did you eat yesterday? Was your diet varied with lean proteins, fruits, vegetables, whole grains? Or was your food choices yesterday full of high salt, fat and sugar? How much exercise do you get each week? None? Once a week? Three times a week? Every day? How do you exercise? Walking, running, swimming, playing soccer? Playing with children?

As nurses, we need to be role models. This means we need to work on our own health and well being. Eating well, getting enough exercise and also enough rest. So, the question you need to ask yourselfwhat do you do to reduce chronic disease in your community? Can you help your family to better understand how diet and exercise can reduce the risk of overweight and obesity?

Reference: World Health Organization, Global Strategy on Diet, Physical Activity and Health. Retrieved from http://www.who.int/dietphysicalactivity/goals/en *Exercise: What polices and plans are in place where you live that can help to prevent obesity in children and adults?

Reference: World Health Organization, Global Strategy on Diet, Physical Activity and Health. Retrieved from http://www.who.int/dietphysicalactivity/goals/en *With all that has been presented, overweight and obesity is as simple as making different choices. The next several slides address what can be done, by anyone. Parents, children, teenagers, adultsboth young and old. This epidemic is truly in our hands to change.

Reference: World Health Organization, Global Strategy on Diet, Physical Activity and Health. Retrieved from http://www.who.int/dietphysicalactivity/goals/en *Reference: World Health Organization. (2004) Promoting fruit and vegetable consumption around the world. Retrieved from http://www.who.int/dietphysicalactivity/fruit/en/index.html *Reference: World Health Organization. (2004) Promoting fruit and vegetable consumption around the world. Retrieved from http://www.who.int/dietphysicalactivity/fruit/en/index.html *Keep in mind, that even with more fruits and vegetables in the diet, there is still need to reduce the fats, sugars and processed foods. Keep in mind that tubers, such as potatoes and cassava are not included in fruits and vegetables.

Reference: World Health Organization. (2004) Promoting fruit and vegetable consumption around the world. Retrieved from http://www.who.int/dietphysicalactivity/fruit/en/index.html

*Obesity is one the most preventable diseases. When the human body is healthy, active and eating well, most can expect to live well into their 80s or 90s. Obesity creates opportunity for an unhealthy life with higher risk of heart disease, diabetes type 2, cancers of the uterus, cervix and colon. Obesity, because of the extra weight makes it harder to move and increases the risk of osteoarthritis. Each one of us can make such a difference by being role models and helping others to understand why obesity rates need to be reduced.

*Each of these websites offer more information that can be used to help better understand obesity and how to prevent it. *