Friday, August 22, 2008

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Editor’s note: Today’s guest blog is by Melinda S. Sothern, Ph.D., Louisiana State University Health Sciences Center, School of Public Health, New Orleans. She also is the author of “Trim Kids” and the “Handbook of Pediatric Obesity.”

The increase in high blood pressure in children in recent years is an example of why obesity hurts children now, not just later when they are adults. In addition to being limited physically, overweight children have many medical problems associated with their obesity besides high blood pressure. They display a cluster of early signs for diabetes and heart disease, such as high cholesterol, excess abdominal fat and insulin resistance (called the metabolic syndrome).

Here at the LSU Health Sciences Center School of Public Health in New Orleans we are conducting studies to determine the benefits of healthy nutrition and exercise on medical conditions associated with childhood obesity like asthma, high blood pressure and diabetes. We are looking for early markers for diabetes in 7- to 9-year-old children and provide a free obesity and diabetes screening to study participants. Call 1-888-92 SILLY (1-888-927-4559) or go to our School of Public Health Web site.

Overweight kids with high blood pressure are not the only ones with limited physical activity. All kids are being robbed of their childhoods. They are pushed too hard in school and are forced to sit for 6-8 hours a day without breaks to play outside. They have little or no physical education instruction. They are given hours of homework each night and have limited green space and few safe places to play outdoors.

Parents grew up during a time when there were recess breaks in the morning and afternoon and adequate time at lunch for children to play outside. Homework was minimal and neighborhoods were safe with lots of green areas to meet friends for games of tag, hide-and-seek, riding bikes or climbing monkey bars. What happened? Why does today’s society expect children to be adults – expecting so much more than what was ever expected of them when they were kids?

Parents of all children, especially of overweight children, are faced with a great challenge – to keep their children physically active and healthy in a world that does not provide opportunities to engage in active play or have access to healthy foods. Our book and online program, “Trim Kids” (Harper Collins, 2001), provides parents with a proven 12-week plan that has helped thousands of children in New Orleans achieve a healthier weight. It has three months of menu plans, recipes and shopping lists, an exercise program especially designed for overweight children with varied fitness levels, lots of ideas to keep kids moving, alternatives to TV watching and computer games, and tips to help parents set limits and redirect and establish realistic nutrition and physical activity goals.

Working in conjunction with their child’s pediatrician or family physician, parents can help prevent obesity in their children who are at risk and assist their overweight children to achieve a healthier weight. We published “Trim Kids” with the parents in mind. We wanted to provide them with the tools needed to keep their kids happy and healthy for a lifetime.

Melinda S. Sothern

Wednesday, August 20, 2008

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(Editor’s note: Today’s guest blogger is Donna H. Ryan, M.D., Associate Executive Director for Clinical Research at the Pennington Biomedical Research Center)

One of the most difficult aspects in counseling for weight loss is agreeing on an achievable goal with my patients. My standard recommendation is to set a weight loss goal of 10 percent and set it for six months. Patients usually think this is too little. My average patient is 220 pounds, and that's a weight loss of 22 pounds in six months, about a pound a week. Many times patients want to lose 50 pounds, or even more, so it takes some convincing that 10 percent is a good goal. Frequently, people set their expectations too high at 20 percent or 30 percent. I always tell the patient, if we can make the 10% goal, then we can set another goal! There is no limit on the number of goals, but the key is to achieve the first goal.

People often ask me how many calories they should aim for to lose weight, and I usually tell them we think it is achievable to sustain a 500- to 800-calorie per day deficit during the weight loss phase. Over seven days that means 3,500 to 5,600 calories, or one to 1 1/2 pounds lost. We like that weight loss because it is usually something people can live with over a reasonable period of six months or so to enable them to reach that realistic weight loss goal of 10 percent.

The next questions that usually follow are: How many total calories does it take to maintain my weight? How much do I aim to achieve the 500-800 calorie deficit?

Determining calorie needs can be a challenge. We have done studies where we try to define energy needs as accurately as possible, and a number of challenges make it difficult. By far the biggest variable is the amount of physical activity that people do. There is also the challenge imposed by the reduction in metabolic rate that the reduced obese state imposes. This means that as you lose weight, your metabolism slows, and you actually require fewer calories to maintain the weight.

A useful rule of thumb is that it takes about 10 calories per pound to maintain your weight. So for that 220-pound person, that's 2,200 calories a day. You can subtract 500-800 calories to promote weight loss and/or maintenance.

I find that using round numbers such as 1,200-1,500 calories for most women, and 1,500-1,800 calories for most men is usually effective. Patients need to understand that at a lower weight they actually need fewer calories. Of course, very active people need more. But, again, most people are not active and tend to overestimate what they are doing. What most people fail to understand is that even if we have the best technology available to estimate energy needs, most people do a poor job at estimating energy intake.

Yes, there are many formulas to estimate calorie needs per day, but none is perfect. The Harris Benedict is one of the most common, but it is quite complicated.

A much easier approach is to use 10 calories per pound of body weight as an estimate of calorie needs – independent of exercise or other activities.

Here is how to use the formula:

The Harris Benedict Formula for estimating Basal Metabolic Rate (BMR):

Men :

BMR (Kcal)=66 + (13.8 x weight in kg) + (5 x height in cm) – (6.8 x age)

Women :

BMR (Kcal)=655 + (9.6 x weight in kg) + (1.8 x height in cm) – (4.7 x age)

To estimate total daily energy expenditure, we must multiply the Basal Metabolic rate with an Activity Factor:

Daily energy expenditure (kcal) = Basal Metabolic Rate * Activity Factor

Activity factors range from 1.3 for sedentary, 1.5 for lightly active, 1.6 for moderately active and can be up to 2.5 for athletes. Most people use 1.3 because most people are pretty sedentary and tend to overestimate the amount of activity they get. In general, 1 mile usually burns about 100 calories.

Here is an example for a 50-year-old female, 200 pounds and 60 inches tall:

Harris Benedict Formula for estimating Basal Metabolic Rate:

BMR (Kcal) = 655 + (9.6 x weight in kg 91) + (1.8 x height in cm 152) – (4.7 x age 50) = 1567

To get daily energy expenditure, multiply the BMR with an activity factor:

1567 * Activity factor of 1.3 = 2037 calories

So, my long-winded explanation will have to end with a statement that the bottom line is the scale. We encourage self-monitoring, and daily weights. We ask people to keep a record of their daily weights and adjust their eating/activity behaviors daily in response to that they see on the scale. For a trend upward, no matter what we have constructed at the energy intake goal, we cut back!

Congratulations to Chancellor Richardson on his improved health and lifestyle! And best of luck to all those who are emulating him. You can lose weight and improve your eating and exercise behaviors. I hope this explanation is helpful to all of you in achieving your goals.

Donna Ryan

Tuesday, August 19, 2008

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There was a letter to the editor in this morning’s paper from a representative of the American Heart Association asking all of us to continue the fight against childhood obesity. The writer also reminded us that September is Go Healthy Month. Good advice for us! Childhood obesity is still a problem and we cannot let up on the push to help our children become healthier. Obesity and type II diabetes are subjects we have addressed in this blog before. The answer to obesity in our children? Nutrition and exercise.

September is a wonderful month for exercise. The weather is beginning to cool a little. I just find the fall months with drier air and milder weather conducive to exercise. What a great month to go healthy! If you are not exercising, get started. See you doctor first. Then make that most difficult step of all – the first one out the door. We can and should set a role model for our children. If we don’t exercise and eat right, they might not see the necessity of do so. We can sit around all day and talk about how life was when we were young. You know, walking three miles to school barefooted in the snow and such tales. But we have to address the obesity issues in the time that our children are living and become present-day role models.

So for September get out and go healthy. East right and make smart choices and exercise.

Bill Richardson

Monday, August 18, 2008

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I find that having someone to work out with keeps you honest. Over the past three days, I have had two wonderful workouts. Both times I worked out I had someone who also wanted to work out, and the one day I missed, my workout partner was not available. It seems as though having someone to share the experience with helps maintain the commitment to work out. I had read a lot over the years about positive addictions, and I consider exercise a positive addiction. Having a support group or some link sure helps. When I was running, I often ran alone but had regularly road races to help me stay on a training schedule. I have often said that the most difficult step to take in an exercise routine is the first one out the door.

There are a lot of resources to help all of us as we embark on lifestyle changes. There are an infinite number of advice and support groups on the Internet. I strongly encourage an exercise buddy support group – people who will give you the support you need to deal with nutrition and fitness issues. The Live Fit program initiated in the AgCenter has been well-received, and many of our employees have formed their own teams and groups to embark on exercise and nutrition plans.

You have to find out what works for you because one size does not fit all. Everyone can hold his breath under water for a short period of time. We all can lose a little weight or exercise for a short period of time. But the theme of this blog has been long-term lifestyle changes, and for that you have to learn to swim rather than just holding your breath. Did I just use a metaphor? Maybe this blog is getting to me. My goal is not to be a writer but rather someone who exercises regularly. That I can do without worrying about subject-verb agreement.

Bill Richardson