Chapter 4:

1. Chapter 4: Where Are You?

2. Nurses Health Study • 122,000 Nurses followed for 16 years • Low-risk women had: • BMI <25 • 30 minutes of exercise per day • 5 grams of alcohol per day • No tobacco use • Healthy diet

3. Nurses Health Study • Only 3% of all the nurses were in this low-risk group…but they were by far the healthiest group. • Others who were not low-risk had 6 times higher risk of heart disease and other chronic diseases.

4. So, How’s Your Risk?

5. Assess Yourself • Over the past week, what was your average number of fruit servings per day? __________ • Over the past week, what was your average number of vegetable servings per day? __________ Total: __________ • If your total is greater than 5, you are doing great (more is even better).

6. Assess Yourself • Last week, what was your average number of whole grain servings per day? (This includes whole-grain cereals, bread, rice, and pasta.)__________ • You should strive for about 6 servings a day.

7. Assess Yourself • How many servings of red meat did you eat last week? __________ • The best evidence we have so far indicates red meat should be eaten sparingly, 1–2 servings per week.

8. Assess Yourself • How many days in a typical week do you accumulate 30 minutes of moderate physical activity? __________ • To get the benefits associated with being physically active, you should accumulate 30 minutes of moderate physical activity most days of the week.

9. Assess Yourself • Have you ever been told by a physician that you have high blood pressure? Yes _____ No ______ Don’t Know ______ • Systolic Blood Pressure levels <120 Normal 120–139 Early High Blood Pressure 140–159 High ≥160 Dangerous

10. Assess Yourself • Have you ever been told by a physician that you have high blood cholesterol? Yes _____ No ______ Don’t Know ______ • Cholesterol Levels <200 Normal 200–239 Borderline High ≥240 High-risk

12. Body Mass Index (BMI) • What is your body mass index? __________ • Body Mass Index Categories <19 Underweight 19–24 Ideal weight, low-risk 25–29 Overweight, moderate risk ≥30 Obese, high-risk

13. Body Mass Index (BMI) • There is nothing magical or special about having a BMI of 30 (being obese), it just means your risk of many diseases and premature death is higher than for those who are not obese.

14. Body Mass Index (BMI) • Health risks increase as weight increases

15. Your Health Can Improve • 377 people experienced changes in health risks after just 6 weeks of lifestyle change.

16. Body Mass Index (BMI)

17. Systolic Blood Pressure Reductions mm/Hg

18. Diastolic Blood Pressure Reductions mm/Hg

19. Total Cholesterol Reductions mg/dl

20. LDL Cholesterol Reductions mg/dl

21. Glucose Reductions mg/dl

22. Reductions In Risk • There is a 2-3% decrease in heart disease risk for: • Every 1 mm decrease in diastolic • Every 1% decrease in total cholesterol

23. Diastolic BP mmHg Ideal -3.5 High -10.4 Dangerous -14.0 Total CHL % decrease Normal -9.2% Borderline -13.2% High -17.9% Changes in Diastolic BP and CHL for Some Participants

24. Total CHL Normal 18-28% Borderline 26-40% High 36-54% Reductions In Risk with These Changes Diastolic BP Ideal 7-11% High 21-31% Dangerous 28-42% 64 - 96% Reduction in Heart Disease Risk

25. Maintaining Is The Key • Most of these improvements lasted for as long as the participants maintained the healthy lifestyle behaviors.

26. Great News For Couch Potatoes! • Even little improvements in exercise can bring large improvements in health.

27. The Dose Response of Fitness Proven Health Benefits Low Moderate High Fitness Level

28. Many Risk Factors Increase Disease Risk Dramatically • 1 health risk + 1 health risk ≠ 2 • 1 health risk + 1 health risk = much more than 2

29. Metabolic Syndrome or Syndrome X • A condition characterized by: • insulin resistance • presence of obesity from abdominal fat • high blood cholesterol • high blood pressure • Caused by a hyperactive fork and a hypoactive foot

30. Metabolic Syndrome or Syndrome X • As many as 24 million Americans have it • 1in 4 are at risk of developing it • Greatly increased risk of coronary artery disease

31. Obesity

32. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 1985 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

33. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 1986 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

34. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 1987 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

35. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 1988 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

36. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 1989 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

37. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

38. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 1991 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

39. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 1992 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

40. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 1993 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

41. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 1994 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

42. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

43. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 1996 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

44. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 1997 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

45. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 1998 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

46. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 1999 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

47. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

48. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 2001 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

49. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 2002 (*BMI 30, or ~ 30 lbs overweight for 5’4” person) (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

50. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Obesity Trends* Among U.S. AdultsBRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)