ACD2010. Balanced Diet and Physical Activity. Kallaya Kijboonchoo, Ph.D. Institute of Nutrition. Mahidol University

Transcription

1 Balanced Diet and Physical Activity Kallaya Kijboonchoo, Ph.D. Institute of Nutrition Mahidol University Presented at the 5 th Asian Congress of Dietetics, Nov 10-12,2010, Bangkok, Thailand

2 Content Fact about overweight and obesity Component of the nutritious diet Intervention studies to promote PA in different settings Case study of behavior modification in the office

3 WHO report 1.9 million deaths worldwide are attributable to physical inactivity Chronic diseases associated with physical inactivity include cancer, diabetes and coronary heart disease.

4 WHO s projections in 2005 indicate that globally : approximately 1.6 billion adults (age 15+) were overweight; at least 400 million adults were obese. WHO further projects that by 2015 approximately 2.3 billion adults will be overweight more than 700 million will be obese WHO Obesity and overweight Fact sheet No.311September 2006

5 more than 1 billion overweight adults, at least 300 million of them obese pose a major risk for chronic diseases The key causes are increased consumption of energy-dense foods high in saturated fats and sugars, reduced physical activity. WHO Obesity and overweight Fact sheet No.311September 2006

6 at least 20 million children under the age of 5 years are overweight globally in 2005 over 42 million of overweight children under the age of five in million are living in developing countries.

7 Why is this happening? genes determine a person's susceptibility to weight gain energy balance is determined by caloric intake and physical activity.

8 Physical activity : an evolution perspective Over 50,000 yrs of evolution : genetic does not change high physical activity and famine feast and rest environmental change Saris W. et al. IASO Obesity review 4, 2003:

9 Is obesity a problem?

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13 Gene + Environment Energy intake Energy expenditure Energy Balance Body energy concept

14 A nutritious diet Adequacy Calorie control Variety Balance Moderation

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16 For individuals.. eating more fruit and vegetables, as well as nuts and whole grains; cutting the amount of fatty, sugary foods in the diet; moving from saturated animal-based fats to unsaturated vegetable-oil based fats. consuming low energy dense food

17 Lack of activity destroys the good condition of every human being while movement and methodical physical exercise save and preserve it PLATO

18 Secular trend in diet, obesity and activity in Britain Prentice AM and Jebb S. BMJ : 437-9

19 Prentice AM and Jebb S. BMJ : 437-9

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21 Child Obesity: does the mother feel the problem? Study in 920 Italian children aged 8 yrs Nutritional status was classified following IOTF Prevalence Ow/Ob: 25.9% Perceived by their mother 7% Toti E. et al. Obesity Reviews the 4 th SPOC, Stockholm 2010

22 School-based interventions for promoting physical activity and fitness in children and adolescents aged 6-18 Cochrane Review Dobbins M, DeCorby K, Robeson P, et al Article first published online: 16 DEC 2009 DOI: /ebch.461

23 13,841 titles were identified and screened and 482 articles were retrieved multiple publications on the same project were combined and counted as one project, resulting in 395 distinct studies out of the 395 studies 104 were deemed, 4 were assessed as having strong methodological quality, 22 were of moderate quality and 78 were considered weak.

24 In total 26 studies review. the interventions have a positive impact on four of the nine outcome measures for duration of physical activity, television viewing, VO2 max, and blood cholesterol. no effect on leisure time physical activity, blood pressure, BMI and pulse rate.

25 a combination of printed educational materials and changes to the school curriculum that promote physical activity result in positive effects.

26 Authors' conclusions there is some evidence of positive effects on lifestyle behaviors and physical health status measures, ongoing physical activity promotion in schools is recommended.

27 School-Based Interventions on Childhood Obesity: RCTs and clinical controlled trials published between 1995 and This meta-analysis showed that there was convincing evidence that school-based interventions are effective, at least short-term Longer-running programs were more effective than shorter programs. Gonzalez-Suarez, C et al. American Journal of Preventive Medicine 37(5) : November 2009

28 A study of cardiovascular risk and lifestyle factors 83,882 women in the second Nurses' Health Study, the relationship between the lifetime risk of heart failure and six lifestyle factors: obesity, exercise, smoking, alcohol intake, consumption of breakfast cereals, and consumption of fruits and vegetables.

29 Compared to those who followed none of the rules 0.3 % of the women who followed six lifestyle rules : 80 % lower incidence of high BP 0.8 % of the women who followed five rules: 72% lower 1.6 % of the women following four rules : 58 % lower 3.1% of the women who followed three rules: 53 % lower obesity was found to be the most important risk factor, followed by exercise

30 Small differences in lifestyle can have a substantial potential impact on risk. over men and women aged living in Norfolk for four positive health behaviors: currently non-smoking, physically active, eating at least five servings of fruit and vegetables per day, and drinking a moderate amount of alcohol. Myint PK et al.. BMJ 2009;338:b349

31 people with none of these health behaviours were over twice as likely to suffer a stroke than those with all four Myint PK et al.. BMJ 2009;338:b349.

32 Socioeconomic inequality in adult obesity in France Study was carried out between Obesity increased from 12% to 22% in the decile with lowest income Obesity increased only 1% in the decile with highest income

33 How to promote PA and exercise in daily lifestyle Use staircase than lift Walk to work Have some breaks during work hours Treadmill office

34 Obesity may begins at the office

35 'Walk and Work' Station Helps Obese Shed Pounds E burned while sitting at a desk: 72 kcal/hr "walk and work" desk: 191 kcal/hr equivalent of one mile in an hour. kg a year 15 obese people used the "walk and work" desk and when they sat at a conventional desk were compared. They could boost their energy expenditure by 100 kcal/hr, which works out to a loss of 20-30

36 Case study of behavior modification in the office

37 Behavior modification 3 Self Self care Self regulation Self efficacy Promise P- Positive reinforcement R- Result based management O- Optimism M- Motivation I - Individual or client centered SE- Self esteem

38 The concept is done in 5 events (DIY): 1. Raising awareness 2. Nutrition and physical activity education and how to check the progress 3. Providing exercise class 4. Lifestyle counseling 5. Giving recognition and rewards More than half of the participants lost weight in 2-5 mo. Supported by National Health Security Office (สปสช)

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40 Food environment Food production, manufacturing, trade/distribution Food/beverages labeling Food/beverage marketing/advertising Food price control policy Built environment Urban planning Transport and road safety Active transport Sporting facilities Leisure facilities Norlund L. et al The EURO PROVOB Policy checklist ICO 2010

41 Roads of the Future

42 Mahidol University, Salaya campus

43 Mahidol University, Salaya campus

44 For individuals.. Conclusions Creating supportive population-based environments through public policies engaging in daily moderate physical activity for at least 30 minutes; ensure effective support for those affected to lose weight or avoid further weight gain through nutrition and physical activity

45 Thank you

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47 (the 6 Th Global conference for health Promotion in a Globaled world,bkk Aug 2005) A Global pledge The Bangkok Charter for health promotion in a global world Policies and partnership to empower communities health and health equality improvement government, political al all level civil society private sector and internal organization

48 precontemplation ไม สนใจป ญหา contemplation ล งเล prepare เตร ยมต ว เตร ยมใจ action ปฏ บ ต maintenance Stage of change never ไม แม แต จะค ด sometime เปล ยนในบางโอกาส soon จะท าแล ว now ท าได forever ต อเน อง ท าได ตลอด

49 Caloric intake of ancestral humans was estimated to be 3000 kcal/d and PA was around 1000 kcal/d Subsistence efficiency affluent societies caloric intake 2100 kcal/d with expenditure 300 kcal/d Subsistence efficiency of 7:1 A person consuming 2100 kcal/d would need an expenditure of 700 kcal/d An additional 400 kcal/d an equivalent of an hour aerobic activity Saris W. et al. IASO Obesity review 4, 2003:

50 Gender difference PA and obesity o Evidence for the same exercise doses o Men lost twice as much as women o Women might have compensated by EI o Adherence and perceive barriers are similar o Beliefs are different - men believe in vigorous PA, but not for women

51 Do these gender difference influence different recommendation? Not realistic 30 min might not be enough, but put together at least 30 min Attitude o As much as possible benefit o Use the opportunity in as many ways as you can Enjoy regular vigorous exercise for regular health

52 How much is enough to prevent weight regain? min physical activity to prevent wt gain recommendation mod intensity or lesser amount of vigorous intensity activity min mod. Intensity to prevent transition from overweight to 40 obese children need more time Approach : reduce sedentary behavior political action Environment setting : transportation infrastructure school / work place Stock Conference, Bangkok, Thailand 2001

53 The Dose Response Curve Between Physical Activity and Health Benefit Benefit Low A B C Baseline Activity Status High Pate et al. JAMA (5): A=Sedentary B=Moderately Active C=Active