Dieta e esercizio fisiconell’obesita’

Francesco SOFISOD Agenzia Nutrizione, Universita’ degli Studi di Firenze,

Azienda Ospedaliero-Universitaria Careggi

Preventing Chronic Diseases – A vital investment. WHO global report 2006

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)

Prevalence of overweight (BMI>25 kg/m2) (year: 2015)

Preventing Chronic Diseases – A vital investment. WHO global report 2006

Body Mass Index (kg/m2)

0 15 20 25 30 35 40

Year

lyde

aths

per 1

,000

per

sons

8

16

32

64

Whitlock et al., Lancet 2009

Men

Women

All-cause mortality versus BMI in 900,000 adults

Collaborative analysis of 57 prospective studies

Men Women

Mortality rates versus BMI in 900,000 adults

Body Mass Index (kg/m2)

15 20 25 30 35

Year

lyde

aths

per 1

,000

per

sons

0

6

8

2

4

10

12

14

16

Body Mass Index (kg/m2)

15 20 25 30 35

Year

lyde

aths

per 1

,000

per

sons

0

6

8

2

4

10

12

14

16

Vascular

Cancer

Vascular

Cancer

Whitlock et al., Lancet 2009

Men Women

Body Mass Index (kg/m2)

15 20 25 30 35

Body Mass Index (kg/m2)

15 20 25 30 35

% a

live

0

60

80

20

40

100

Life span versus BMI in 900,000 adults

% a

live

0

60

80

20

40

100BMI 22-25

BMI 25-30

BMI >30

BMI 22-25

BMI 25-30

BMI >30

Whitlock et al., Lancet 2009

Obesity

Three obese womens with aproximately the same BMI but with different distribution of

adipose tissue

BMILimitations of BMI

They both have a BMI of 31

Abdominal obesity

Dispendio energetico

Qual è il modello di alimentazione

ideale???

Diets•Shangri-La Diet

•Slim-Fast Plan

•Sonoma Diet

•South Beach Diet

•South Beach Diet Supercharged

•The Spectrum

•Step Diet

•Sugar Busters

•Thin for Life

•3 Day Diet

•3-Hour Diet

•UltraMetabolism Diet

•Volumetrics

•WebMD Weight Loss Clinic

•Weight Loss Cure

•Weight Watchers

•Dr. Andrew Weil

•You – On a Diet

•The Zone

•Atkins Diet

•Best Life Diet

•Biggest Loser Diet

•Body for Life

•Cabbage Soup Diet

•Cheater's Diet

•Cookie Diet

•Dr. Phil's Ultimate WeightSolution

•Eat Right for Your Type

•Eat This, Not That

•Fast Food Diet

•Fat Smash Diet

•Flat Belly Diet

•5 Factor Diet

•Flavor Point Diet

•French Women Don't Get Fat

•Glycemic Index Diet

•Grapefruit Diet

•Hallelujah Diet

•Jenny Craig

•LA Weight Loss

•Living Low-Carb

•Macrobiotic Diet

•Martha's Vineyard Diet Detox

•Medifast Diet Plan

•Morning Banana Diet

•New Beverly Hills Diet

•NutriSystem Diet

•Ornish Diet

•Perricone Diet

•Personality Type Diet

•Pritikin Principle

•Protein Power

•Raw Foods Diet

•Rice Diet Solution

811 overweight adults

Four diets with different percentages of energy derivedfrom fat, protein and carbohydrates

Follow-up: 2 years

Comparison of weight-loss diets

Sacks et al., NEJM 2009

Sacks et al., NEJM 2009

Comparison of weight-loss diets

2-years trial: 233 moderately obese subject

Three diets: low-carb, low-fat, Mediterranean

Weight changes during 2 years according to diet

Weight loss with different diets

Shai et al., NEJM 2008

Shai et al., NEJM 2008

Weight loss with different diets

Mediterranean diet and BMI

Panagiotakos et al., Nutrition 2006

1514 men and 1528 women, 18-89 years old

Dansinger et al., Ann Intern Med 2007

Meta-analysis of 46 trials of dietary counseling

The effect of dietary counseling for weight loss: a meta-analysis

WHO, Global strategy on diet, physical activity and health 2007

Physical activity and health

Effect size estimates of lifestyle and dietary changes on all-cause mortality

A systematic review of all the intervention studies

0

13

25

38

50

Physical activity Physical activity plusdietary modifications

CAD patients General population

25%20%

45%

35%

Perc

enta

ge c

hang

es o

f all-

caus

e m

orta

lity

Iestra et al., Circulation 2005

Available data and guidelines forprimary prevention suggest that a volume of moderate-intensityaerobic physical activity of about1,000 kcal/week

An energy expenditure of 1000 kcal/week is achievable byparticipating in 30 minutes or more of moderate-intensityaerobic physical activity on 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 activerecreational pursuits

AHA Statement for Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease. Circulation 2003

Physical activity

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 enjoyable30 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 motivationAdded benefits include a sense of well-being, weight reduction and better self-esteem

Fourth Joint Task Force Guidelines on cardiovascular diseaseprevention in clinical practice

Jakicic et al., JAMA 2003

Exercise and weight loss: an intervention study

Risk parameter N° studies(subjects)

Mean change(95% CI)

p value

BMI 18 (562) - 0.38 (- 0.05; -0.72) 0.03

Systolic bloodpressure

12 (468) -3.8 (-1.7; -5.9) < 0.001

Diastolic bloodpressure

12 (468) -0.3 (-0.02; -0.46) 0.01

Triglycerides 7 (192) -0.26 (-0.11; 0.11) 0.009

A systematic review with meta-analysis26 studies including 2,767 subjects

Using pedometers to increase physical activity and improve health

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

96.8

90.7

95.4

98.4

86

88

90

92

94

96

98

100

Physical activity No Physical Acitvity

Baseline3 months

P<0.005 P<0.005

Tota

l bod

y w

eigh

t, K

g

94.2

90.1

95.1 95.8

84

86

88

90

92

94

96

98

100

Personalizedrecommendations

Generalrecommendations

Baseline3 months

P<0.005

Tota

l bod

y w

eigh

t, K

g

Physical activity and weight loss

34.8

30.532.5

31.5

0

5

10

15

20

25

30

35

40

45

50

Personalizedrecommendations

Generalrecommendations

Baseline3 monhs

P<0.005

Fatm

ass,

Kg

Physical activity and weight loss

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Survey 1 31,4% 29,6% 33,4% 23,0% 23,3% 22,4% 18,9% 19,2% 25,0%Survey 2 40,1% 33,6% 37,5% 30,6% 36,8% 23,6% 28,2% 28,0% 32,6%Survey 3 37,9% 26,4% 36,8% 43,1% 49,3% 29,4% 26,5% 39,1% 38,0%

Czech Rep. Finland France Germany Hungary Italy Nether-

lands Slovenia ALL

Euroaspire III

P=0.0003

199520002006

Prevalence of obesity

Take-home messagesDon’t trust in anyone…!