Justin Moore, MD, Medical Director of Via Christi Weight Management presented a talk on how to achieve a healthy weight.

1. Paths to a Healthy Weight
Justin Moore, MD
Via Christi Weight Management

2. Hello
My Name is Justin

7. Body Mass Index (BMI)
Heig h t (ft'in ") 5'0" 5'2" 5'4" 5'6" 5'8" 5'10" 6'0" 6'2" 6'4" 6'6"
Heig h t (in ) 60 62 64 66 68 70 72 74 76 78
BM I ( k g/m 2)
150 29. 4 27. 5 25. 8 24. 3 22. 9 21. 6 20. 4 19. 3 18. 3 17. 4
160 31. 3 29. 3 27. 5 25. 9 24. 4 23. 0 21. 7 20. 6 19. 5 18. 5
170 33. 3 31. 2 29. 2 27. 5 25. 9 24. 4 23. 1 21. 9 20. 7 19. 7
180 35. 2 33. 0 31. 0 29. 1 27. 4 25. 9 24. 5 23. 2 22. 0 20. 8
190 37. 2 34. 8 32. 7 30. 7 28. 9 27. 3 25. 8 24. 4 23. 2 22. 0
200 39. 1 36. 7 34. 4 32. 3 30. 5 28. 8 27. 2 25. 7 24. 4 23. 2
210 41. 1 38. 5 36. 1 34. 0 32. 0 30. 2 28. 5 27. 0 25. 6 24. 3
220 43. 1 40. 3 37. 8 35. 6 33. 5 31. 6 29. 9 28. 3 26. 8 25. 5
230 45. 0 42. 2 39. 6 37. 2 35. 0 33. 1 31. 3 29. 6 28. 1 26. 6
240 47. 0 44. 0 41. 3 38. 8 36. 6 34. 5 32. 6 30. 9 29. 3 27. 8
Overweight
250 48. 9 45. 8 43. 0 40. 4 38. 1 35. 9 34. 0 32. 2 30. 5 29. 0
Weight (lbs)
260 50. 9 47. 7 44. 7 42. 1 39. 6 37. 4 35. 3 33. 5 31. 7 30. 1
270 52. 8 49. 5 46. 4 43. 7 41. 1 38. 8 36. 7 34. 7 32. 9 31. 3
280 54. 8 51. 3 48. 2 45. 3 42. 7 40. 3 38. 1 36. 0 34. 2 32. 4
290 56. 8 53. 2 49. 9 46. 9 44. 2 41. 7 39. 4 37. 3 35. 4 33. 6
300 58. 7 55. 0 51. 6 48. 5 45. 7 43. 1 40. 8 38. 6 36. 6 34. 7 Obese
310 60. 7 56. 8 53. 3 50. 1 47. 2 44. 6 42. 1 39. 9 37. 8 35. 9
320 62. 6 58. 7 55. 0 51. 8 48. 8 46. 0 43. 5 41. 2 39. 0 37. 1
330 64. 6 60. 5 56. 8 53. 4 50. 3 47. 4 44. 8 42. 5 40. 3 38. 2
340 66. 5 62. 3 58. 5 55. 0 51. 8 48. 9 46. 2 43. 7 41. 5 39. 4
350 68. 5 64. 1 60. 2 56. 6 53. 3 50. 3 47. 6 45. 0 42. 7 40. 5 Morbidly
360 70. 5 66. 0 61. 9 58. 2 54. 9 51. 8 48. 9 46. 3 43. 9 41. 7 Obese
370 72. 4 67. 8 63. 6 59. 8 56. 4 53. 2 50. 3 47. 6 45. 1 42. 8
380 74. 4 69. 6 65. 4 61. 5 57. 9 54. 6 51. 6 48. 9 46. 4 44. 0
390 76. 3 71. 5 67. 1 63. 1 59. 4 56. 1 53. 0 50. 2 47. 6 45. 2
400 78. 3 73. 3 68. 8 64. 7 60. 9 57. 5 54. 4 51. 5 48. 8 46. 3
410 80. 2 75. 1 70. 5 66. 3 62. 5 59. 0 55. 7 52. 8 50. 0 47. 5

8. 6
Type 2 diabetes
5
4 Cholelithiasis
Relative Risk
3
Hypertension
2
1 Coronary heart
disease
0
Body-Mass Index
N Engl J Med 1999; 341:427-434

10. “Obesity can develop only
from an excess of energy
intake over expenditure.”
Rosenbaum M, Leibel RL, Hirsch
J. N Engl J Med 1997

11. Today: Mocha Coffee
20 Years Ago: Coffee (with steamed whole milk
(with whole milk and sugar) and mocha syrup)
45 calories How many calories
8 ounces are in today's coffee?
Portion Distortion, HHS, NIH, NHLBI

12. Today: Mocha Coffee
20 Years Ago: Coffee (with steamed whole milk
(with whole milk and sugar) and mocha syrup)
45 calories 350 calories
8 ounces 16 ounces
Calorie Difference: 305 calories
Portion Distortion, HHS, NIH, NHLBI

13. 20 Years Ago Today
140 calories How many calories
3-inch diameter are in this bagel?
Portion Distortion, HHS, NIH, NHLBI

14. 20 Years Ago Today
140 calories 350 calories
3-inch diameter 6-inch diameter
Calorie Difference: 210 calories
Portion Distortion, HHS, NIH, NHLBI

15. 20 Years Ago Today
500 calories How many calories
1 cup spaghetti with do you think are in
sauce and 3 small today's portion of
meatballs spaghetti and
meatballs?
Portion Distortion, HHS, NIH, NHLBI

16. 20 Years Ago Today
500 calories 1,025 calories
1 cup spaghetti with 2 cups of pasta with
sauce and 3 small sauce and 3 large
meatballs meatballs
Calorie Difference: 525 calories
Portion Distortion, HHS, NIH, NHLBI

18. “…adding 1 oz of a sugar-sweetened beverage and
walking 1 minute less per day creates a temporary
energy surplus of about 13 kcal/d, leading to a
weight gain of 0.6 kg (1.4 lb). Repeating changes
in diet and physical activity of this magnitude on an
annual basis for 28 years would produce the 370
kcal/d “energy gap” and 16-kg (35-lb) weight gain.”
Journal of the American Medical Association, 2010

19. Biology≠fate.

20. http://www.pcrm.org/magazine/gm07autumn/health_pork.html

24. J Hosp Med 2012, PMID 22086862

25. 80 lbs.

27. There’s no free lunch…
 Bariatric surgery has not been
shown to extend life
 Postoperative care is somewhat
complicated

30. hCG does not work...

31. 1992
 34-week, double-blind clinical trial of 60 mg
extended-release fenfluramine (Pondimin®)
plus 15 mg phentermine vs. placebo (added
to behavior modification, caloric
restriction, and exercise):
 Drug group lost 14.2 +/- 0.9 kg, or 15.9% +/- 0.9% of initial
weight (n = 58)
 Control group lost 4.6 +/- 0.8 kg or 4.9% +/- 0.9% of initial
weight (n = 54; p<0.001)
 Weintraub M, Clin Pharmacol Ther, PMID
1587072

32. 1995
 Results of study are
printed in Allure
magazine and in
Reader’s Digest
 Cohen K, Fen-Phen
Nation, pbs.org

33. 1996
 Redux® (dexfenfleuramine) is approved over the
objections of several FDA reviewers concerned
with pulmonary hypertension
 Weight loss specialists cautioned that only those
“moderately to severely” obese should take Fen-
Phen
 $52 million marketing campaign results in $300
million in sales of Pondimin® and Redux® for
American Home Products (now Wyeth)
• Cohen K, Fen-Phen Nation, pbs.org

34. 1997
Connolly H, NEJM, PMID 9271479

35. 1997
 Both Pondimin® and Redux® voluntarily
withdrawn from the market on September 15
(Cohen K, Fen-Phen Nation, pbs.org)
 Sibutramine (Meridia®) approved November
24

36. 2010
 Sibutramine (Meridia®) voluntarily withdrawn
from the marked on October 9
 16% increase in risk for major adverse
cardiovascular events
 2.5% weight loss at 60 months
 (Pollock A, NYTimes.com)

37. Qnexa
 Combination phentermine/topiramate
 Patients on Qnexa lost an average 11% of
their starting weight at one year
 Initial approval denied
 Cognitive disorders
 Metabolic acidosis
 Tachycardia
 Awaiting FDA approval (will decide by July
17)

38. Lorcaserin
 Originally turned down in 2010 over FDA
scientists’ concerns that the drug carried
heart-valve risks
 Patients lost an average of 3.1% of their
starting weight over a year versus placebo
 Awaiting FDA approval (expected to
announce its decision by June 27)

39.  Orlistat (Xenical, Alli)
 Phentermine
 Diethylpropion
 Benzphetamine
 Phendimetrazine

41. “Every system is perfectly
designed to achieve the results
that it achieves.”
 Don Berwick, MD

42. “Handing out nutrition brochures
does not work.”
 Eileen Kennedy, Dean of the Friedman
School of Nutrition Science and Policy, Tufts
University

49. 12 pounds per year
 Volunteers sleeping 5.6 hours per night
for three weeks experienced an average
8 percent decrease in resting metabolic
rate
 Theoretical weight
gain: one bowling ball
per year
 Science Translational
Medicine

50. When we talk about
diabetes, we’re really
talking about obesity
cdc.gov

53. It’s not like we’re not trying…
 40 percent of obese Americans say they’ve
lost >5% of their weight in the last year
 Another 20 percent said they had lost 10
percent or more
 Most of the successful weight losers used a
“multipronged approach” of exercising
more, eating fewer calories, and taking
prescription diet medications
 American Journal of Preventive Medicine

54. It’s not like we’re not trying…
 Those who lost the most weight also joined a
formal weight-loss program
 Programs may be more effective if they cost
money, requiring people to “put some skin in
the game”
 People who tried to lose weight by eating diet
foods and products were the most likely to
gain weight
 American Journal of Preventive Medicine

55. Justin’s “To Do” list for weight
reduction
 Stop drinking calories
 Move through space at least 30 additional
minutes per day
 Eat at least five servings (cups) of fruits and
vegetables daily
 Eat at least one “meal replacement” daily
 Go to bed at night
 Get tested for sleep apnea if you don’t sleep
well
 If you must work nights, get a new job
 If you can’t lose weight, get help

56. Conclusions
 Blame obesity: It’s partially to blame for most
chronic health problems affecting women in
the modern era.
 Multiple "paths"--exist for weight
management, each with its own set of
advantages and disadvantages.
 The solution to the obesity epidemic involves
all paths, but its foundation is behavioral and
dietary intervention at both the personal and
societal level.

57. Photo credits
 Jumprope, by Edward Boatman for the noun
project, 2012
 Pondera fm, the noun project, 2012
 Likecool.com