Dieta e esercizio fisico nell’obesita’
Francesco SOFI SOD Agenzia Nutrizione, Universita’ degli Studi di Firenze, Azienda Ospedaliero-Universitaria Careggi Preventing Chronic Diseases – A vital investment. WHO global report 2006 Risk factors
Preventing Chronic Diseases – A vital investment. WHO global report 2006 Prevalence of overweight (BMI>25 kg/m2) (year: 2005)
Preventing Chronic Diseases – A vital investment. WHO global report 2006 Prevalence of overweight (BMI>25 kg/m2) (year: 2015)
Preventing Chronic Diseases – A vital investment. WHO global report 2006 All-cause mortality versus BMI in 900,000 adults Collaborative analysis of 57 prospective studies
64
Men
32 Women
16 Yearly deaths per 1,000 persons
8 0 15 20 25 30 35 40 Body Mass Index (kg/m2) Whitlock et al., Lancet 2009 Mortality rates versus BMI in 900,000 adults
Men Vascular Women 16 16
14 14 Vascular 12 12
10 10
8 Cancer 8
6 6 Cancer
4 4 Yearly deaths per 1,000 persons
Yearly deaths persons per 1,000 2 2
0 0 15 20 25 30 35 15 20 25 30 35
Body Mass Index (kg/m2) Body Mass Index (kg/m2)
Whitlock et al., Lancet 2009 Life span versus BMI in 900,000 adults
Men Women BMI 22-25 100 100 BMI 22-25 BMI 25-30 80 80 BMI 25-30 BMI >30 BMI >30 60 60
% alive 40 40 % alive
20 20
0 0 15 20 25 30 35 15 20 25 30 35
Body Mass Index (kg/m2) Body Mass Index (kg/m2)
Whitlock et al., Lancet 2009 Obesity
Three obese womens with aproximately the same BMI but with different distribution of adipose tissue BMI Limitations of BMI
They both have a BMI of 31 Abdominal obesity Dispendio energetico Qual è il modello di alimentazione ideale??? Diets
•Shangri-La Diet •Atkins Diet •Grapefruit Diet •Slim-Fast Plan •Best Life Diet •Hallelujah Diet •Sonoma Diet •Biggest Loser Diet •Jenny Craig •South Beach Diet •Body for Life •LA Weight Loss •South Beach Diet Supercharged •Cabbage Soup Diet •Living Low-Carb •The Spectrum •Cheater's Diet •Macrobiotic Diet •Step Diet •Cookie Diet •Martha's Vineyard Diet Detox •Sugar Busters •Dr. Phil's Ultimate Weight •Medifast Diet Plan Solution •Morning Banana Diet •Thin for Life •Eat Right for Your Type •New Beverly Hills Diet •3 Day Diet •Eat This, Not That •NutriSystem Diet •3-Hour Diet •Fast Food Diet •Ornish Diet •UltraMetabolism Diet •Fat Smash Diet •Perricone Diet •Volumetrics •Flat Belly Diet •Personality Type Diet •WebMD Weight Loss Clinic •5 Factor Diet •Pritikin Principle •Weight Loss Cure •Flavor Point Diet •Protein Power •Weight Watchers •French Women Don't Get Fat •Raw Foods Diet •Dr. Andrew Weil •Glycemic Index Diet •Rice Diet Solution •You – On a Diet •The Zone 811 overweight adults Four diets with different percentages of energy derived from fat, protein and carbohydrates Follow-up: 2 years Comparison of weight-loss diets
Sacks et al., NEJM 2009 Comparison of weight-loss diets
Sacks et al., NEJM 2009 2-years trial: 233 moderately obese subject Three diets: low-carb, low-fat, Mediterranean Weight loss with different diets
Weight changes during 2 years according to diet
Shai et al., NEJM 2008 Weight loss with different diets
Shai et al., NEJM 2008 Mediterranean diet and BMI
1514 men and 1528 women, 18-89 years old
Panagiotakos et al., Nutrition 2006
The effect of dietary counseling for weight loss: a meta-analysis Meta-analysis of 46 trials of dietary counseling
Dansinger et al., Ann Intern Med 2007 Physical activity and health
WHO, Global strategy on diet, physical activity and health 2007 Effect size estimates of lifestyle and dietary changes on all-cause mortality
A systematic review of all the intervention studies
CAD patients General population 50 45%
38 35% 25% 20% 25
cause mortality 13 Percentage changes of all- Percentage changes 0 Physical activity Physical activity plus dietary modifications
Iestra et al., Circulation 2005 Physical activity
An energy expenditure of 1000 Available data and guidelines for kcal/week is achievable by primary prevention suggest that a participating in 30 minutes or volume of moderate-intensity more of moderate-intensity aerobic physical activity of about aerobic physical activity on 1,000 kcal/week most, or preferably all, days of the week
Examples of aerobic physical activity: • running or jogging • skating • bycicling • swimming, but also lifestyle common activities such as walking briskly, climbing stairs, doing more hours of hard work, and engaging in active recreational pursuits AHA Statement for Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease. Circulation 2003 Fourth Joint Task Force Guidelines on cardiovascular disease prevention in clinical practice
Managing total CVD risk
Stress that the positive health benefits occur with almost any increase in activity; small amounts of exercise have an additive effect; exercise opportunities exist also in the workplace (e.g. stairs instead of lift)
Try to find leisure activities that are positively enjoyable 30 minutes of moderately vigorous exercise on most days of the week will reduce risk and increase fitness
Exercising with family or friends tends to improve motivation Added benefits include a sense of well-being, weight reduction and better self-esteem Exercise and weight loss: an intervention study
Jakicic et al., JAMA 2003 Using pedometers to increase physical activity and improve health
A systematic review with meta-analysis 26 studies including 2,767 subjects
Risk parameter N° studies Mean change p value (subjects) (95% CI) BMI 18 (562) - 0.38 (- 0.05; -0.72) 0.03 Systolic blood 12 (468) -3.8 (-1.7; -5.9) < 0.001 pressure Diastolic blood 12 (468) -0.3 (-0.02; -0.46) 0.01 pressure Triglycerides 7 (192) -0.26 (-0.11; 0.11) 0.009
Bravata et al, JAMA 2007 Physical activity and health Physical activity and weight loss
106 overweight and obese patients that underwent a weight-loss program with a physical activity program Physical activity and weight loss
P<0.005 P<0.005 100 98.4
98 96.8 95.4 96
94 Baseline 92 90.7 3 months
Total body weight, Kg 90
88
86 Physical activity No Physical Acitvity Physical activity and weight loss
100 P<0.005
98 95.1 95.8 96 94.2
94
92 90.1 Baseline 3 months 90
Total body weight, Kg 88
86
84 Personalized General recommendations recommendations Physical activity and weight loss
50 P<0.005 45
40 34.8 32.5 35 30.5 31.5
30
25 Baseline 3 monhs Fat mass, Kg 20
15 10
5 0 Personalized General recommendations recommendations Euroaspire III
Prevalence of obesity
100%
90%
80%
70% P=0.0003 60%
50%
40%
30%
20%
10%
0% Czech Nether- Finland France Germany Hungary Italy Slovenia ALL Rep. lands
1995 Survey 1 31,4% 29,6% 33,4% 23,0% 23,3% 22,4% 18,9% 19,2% 25,0% 2000 Survey 2 40,1% 33,6% 37,5% 30,6% 36,8% 23,6% 28,2% 28,0% 32,6% 2006 Survey 3 37,9% 26,4% 36,8% 43,1% 49,3% 29,4% 26,5% 39,1% 38,0% Take-home messages
Don’t trust in anyone…!