Abazar Habibinia, MD, CSDTT, DFN

Overweight and Obesity

Definitions:
Overweight: Overweight specifically refers
to an excessive amount of body weight that
may come from muscles, bone, fat tissue,
and water.
Obesity: Obesity specifically refers to an
excessive amount of fat tissue.

BMI (Body Mass Index):

weight (kg)/height (m)
BMI

Classification

<18.5

Underweight

18.5-24.9

Normal weight

25.0-29.9

Overweight

30.0-34.9

Class I Obesity

35.0-39.9

Class II Obesity

40.0

Class III Obesity

Obesity in Canada

Causes of Obesity
Remember 4M:
Mother
Motivation
Metabolism
Medicine

Mother :
Genetics plays an important role in obesity.

Most overweight adults have some problems with their

weight during childhood and adolescence.

Family influences: eating patterns, food choices, self
image within family, and psychosocial attitudes.
Childhood obesity is increasing:
American children : %52
European children: %38
Asian children: %20

Motivation:
Lack of motivation results from:

1) Higher failure rate of fad diets (Rebound: 80% to 90 % ).

2) Sedentary life style.
3) Lack of exercise
4) Poor and unhealthy eating habits.
5) Stress

Metabolism:
Basal Metabolic Rate (BMR) or Resting Metabolic Rate

(RMR) is the daily amount of energy expenditure by the

body at rest, or it is the minimum calories needed for the
body to function properly at rest.

Factors affecting BMR:

Genetics
Gender: men have higher BMR than women.
Age: BMR reduces by age. After 20 years old, it deceases 2%
per decade.
Weight
Body surface area (BSA)
Body fat percentage
Diet
External temperature
Exercise

How to Calculate BMR:

The Harris-Benedict formula:
Men: BMR = 66 + (13.7 X wt in kg) + (5 X ht in cm) - (6.8 X age in years)
Women: BMR = 655 + (9.6 X wt in kg) + (1.8 X ht in cm) - (4.7 X age in

years)
Example:

You are female

You are 30 years old
You are 5' 6 " tall (167.6 cm)
You weigh 120 lbs. (54.5 kilos)
Your BMR = 655 + 523 + 302 - 141 = 1339 calories/day

Energy Expenditures:
Organs

Percentage of Expenditure

Liver

27

Brain

19

Skeletal muscles

18

Kidneys

10

Heart

Other organs

19

Total Daily Energy Expenditure (TDEE):

is the total amount of calories that your body expends in 24

hours, including all activities.

TDEE = BMR X Activity Multiplier
Activity Multiplier

Sedentary = BMR X 1.2 (little or no exercise, desk job)

Lightly active = BMR X 1.375 (light exercise/sports 1-3 days/wk)
Mod. active = BMR X 1.55 (moderate exercise/sports 3-5 days/wk)
Very active = BMR X 1.725 (hard exercise/sports 6-7 days/wk)
Extr. Active = BMR X 1.9 (hard daily exercise/sports & physical job or 2X day
training, i.e. marathon, contest etc.)

TDEE:
Example:

Your BMR is 1339 calories per day

Your activity level is moderately active (work out 3-4
times per week)
Your activity factor is 1.55
Your TDEE = 1.55 X 1339 = 2075 calories/day

Effects of Foods on BMR:

Calorimetery:
it is measuring the heat produced by chemical reactions

or physical changes of the body.

Direct Calorimetry :
Serves as the standard interpretation of energy
expenditure. However, direct calorimeters are difficult
devices to operate.
The whole body is placed inside the calorimeter for the

measurement.

Calorimetry:
Indirect Calorimetry:
is the preferred method to estimate metabolic energy

consumption in the body (BMR).

It measures the exchange of respiratory gases: O2 uptake,

and Co2 production, and ventilation.

Indirect Calorimetry: fitmate

Indirect Calorimetry: Quark RMR

Indirect Calorimetry: OxyconPro

Medicine:
Medical Conditions:
Low function thyroid
Liver and kidney diseases
Diabetes
Depression
Medications:
Antidepressants
Sedatives

Anti-epilepsy
Anti-anxiety
Birth control pills , Corticosteroids

Consequences of Obesity:
Cardiovascular: Heart Attack, High Blood Pressure.
Endocrinologic: Diabetes II.
Gynecologic: Polycystic Ovarian Syndrome, Infertility.
Neurologic: Stroke, Migraine, Dementia, Multiple Sclerosis,

Sleep Apnea.
Musculoskeletal: Gout, Osteoarthritis, Low Back Pain.
Gastrointestinal: Acid Reflux, Fatty Liver, Gallstones.
Oncologic: Breast, Ovarian, Colon, Liver, Pancreas, Uterine,
Prostate, Kidney.
Psychiatric: Depression (in women), Social Stigmatization.

Obesity is the archenemy of your health!

Weight Management:
Take a complete history. Try to know your
client`s occupation, eating pattern, physical

activity level, sleeping pattern, medical history etc.

Know his/her current weight and desired weight.
Learn the reasons(s) for weight loss, e.g.:
a) My mom thinks I am overweight.
b) I want to be in a good shape for my wedding.
c) I want to stay healthy/I have diabetes.
Remember 4 Must-To-Do Things:

1) Explain patterns of weight loss

Everybody has a different pattern of losing weight:
a) Sharp weight loss.
b) Diagonal weight loss (Steady and slow)
c) Staircase weight loss.
d) Initial Resistance Late Accelerated (IRLA) weight
loss.
e) Complex pattern of weight loss.

2) Explain plateau in weight loss

Plateau means that there is no change in weight or

percentage of body fat for 3 weeks or more.

Some clients do not hit plateau at all, while some hit

once, and some may hit more than two times.

The clients who hit plateau more than 2 times, they

would have what I call it staircase weight loss.

3) Explain body resistance

Explain to your client that he/she might resist

losing weight at the beginning in the following

conditions (7D):

Dysfunctional thyroid.
Diabetes.
Diseases of the liver, and kidneys.
Depression.
Drugs for depression, anxiety, epilepsy,

corticosteroids, and birth control pills.

Diet yo-yo.
Distress.

4) Make weight loss a journey, not a

process. And do NOT give any false
hope.

Weight can be managed by:

Exercise

Diet
Food Supplementations
Medications

Surgery

The cornerstones of a successful weight loss are diet and

exercise. However, anti-obesity medications and surgery
might be needed in severe obesities.
Bariatric Medicine is a branch of medicine that deals with
causes, prevention, and treatment of obesity.

Stages of Weight Loss

Abazar`s Classification of Weight Loss for NonGym Goers:
Step 1: Diet and Behavioral Modifications.
Step 2: Diet + Slight Food Supplementation.
Step 3: Diet + Moderate Food Supplementation.
Step 4: Diet + Food Supplementation + Exercise.
Step 5: Diet + Detoxification / Body Cleansing.
Step 6: Aggressive Weight Loss (Celebrity-Type Weight

Loss).

Step 1: Diet and Behavioral Modifications

Ask your client to:
1) Eat small frequent meals throughout the day and not to
skip any meals.
2) Try to eat every 2-3 hours even if you are not hungry.
3) Keep your body hydrated by drinking one glass of water
every 2 hours (average 2 liters a day).
4) Increase protein intake to 1.5 gr/kg/day ( maximum 40
grams per meal).
5) Avoid taking simple carbs (sugar and any sweets).
6) Do three changes with complex carbs:
a) Choose low GI.
b) Reduce carbs intake at least %50.
c) Avoid having them after Carbs Cut Off Time.
7) Keep fiber intake at 30 gr/day or more.

Step 1: Diet and Behavioral Modifications

8) Eat most of your foods early in the day.
9) Drink 1-2 glass of water about 30 minutes before
meals to reduce appetite.
10) Eat slowly and chew food well.
11) Practice food combining.
12) Eat variety of foods (Food Rotations).
13) Use smaller plates and portions.
14) Fill up first on low-calories foods, such as soups and
vegetables.
15) Avoid high-calories snacks and desserts.
16) Avoid overeating when being at a restaurant.

Step 1: Diet and Behavioral Modifications

17) Take at least 20 to 30 minutes to eat a meal.
18) Avoid eating while watching TV, driving, or doing
other things.
19) Do grocery shopping after eating, not when hungry.
20) Make a list of your healthy foods, shop for them,
and carry them with you wherever you go if possible.
21) Put snacks and sweet foods away at home.
22) Learn about foods: carbs, fats and proteins.
23) Check your weight with the same scale at the same
time.
24) If you were off the track, go right back to your plan,
and do not make it an excuse to indulge.

Step 1: Diet and Behavioral Modifications

25) Plan activities to occupy your free time when you
might binge.
26) Learn about Travel Diet.
27) Allow yourself to indulge (within reason) once a
week without guilt or self-judgement (Have a cheat
day).
28) Keep a good self-image and positive attitude
toward life.
29) Tell family and friends to support you and not push
foods.
30) See your nutrition advisor for any help or food
adjustment you might need.

Step 2:
Diet + Slight Food Supplementation
A) Follow all instructions in step 1.
B) Add CLA (Conjugated Linoleic Acid).
C) Add a high quality Vitamin B-Complex.

Step 3:
Diet + Moderate Food Supplementation
A) Follow all instructions in step 1.
B) Stop taking CLA.
C) Add ALA (Alpha Lipoic Acid).

D) Keep Vitamin B-Complex.

E) Add Chromium Picolinate.

Step 4:
Diet + Food Supplementation + Exercise
A) Follow all instructions in step 3.
B) Do two major changes in your client`s life style:
1) Remove dairy products, nuts and acidic
foods (if possible) from your client`s diet for 3
weeks .
2) Ask your client to do WJR (Walk-Jog-Run):
- 4 times a week.
- 30 to 40 minutes (3-3-3/3-3-3/3-3-3/3-3-3)
Or at least a brisk walking.

Step 5:
Diet + Detoxification/ Body Cleansing:
Follow all instruction in step 4.
Do Detox or Body Cleansing.

Step: 6
Aggressive Weight Loss
(Celebrity-Type Weight Loss)
Only less than %5 of weight loss-seeking clients

might end up following advices in step 6.

Step 6 includes a blend of thermogenic-stimulatory

food supplements, ketogenic diet, and medications.

Thank you for your time

and
for listening to this
lecture.