Resource Guide - Nutrition and Physical Activity to Address Overweight and Obesity

The state of being overweight or obese are epidemic in the United States. Since 1980, obesity rates have doubled for adults and continue to rise across all racial/ethnic groups and geographical regions. In adults, obesity is defined as a body mass index (BMI) greater than or equal to 30.  An adult is considered overweight if the BMI is between 25.0 and 29.9. More than one fourth of U.S. women are overweight; more than one third are obese (Flegal, JAMA 2010).  Obesity is a risk factor for several conditions, including diabetes, hypertension, high cholesterol, stroke, heart disease, certain cancer, and arthritis (Flegal, 2010). In 2008, medical care costs related to obesity were estimated at $147 billion. Sedentary lifestyles and high dietary fat intake are two key factors in the rising rates of overweight and obesity. Only 31% of US adults report that they engage in regular leisure-time physical activity (light to moderate activity for 30 minutes 5 times per week).

These disturbing statistics underscore the need for the obstetrician-gynecologist to provide nutrition and physical activity guidance for their patients. Providing such guidance in the busy office setting can be challenging. Many women benefit from general nutritional guidance. There are, however, several special populations of women who may require individualized counseling and specialized resources, such as women with or at risk for type 2 diabetes and hypertension, women with reproductive complications (e.g. infertility) and women at risk for or survivors of obesity-related cancers (breast, colorectal, endometrial).

The purpose of this resource guide is to provide obstetrician-gynecologists with a list of easily accessible educational tools and references to assist in their discussions of nutrition and physical activity with their patients to address overweight and obesity. Several of the listed resources can also be provided to patients as they continue their efforts to make important changes in their lifestyle behaviors.

The following resources are available from ACOG: 

Obesity in pregnancy. ACOG Committee Opinion No. 315. American College of Obstetricians and Gynecologists. Obstet Gynecol 2005;106:671-5.

Motivational interviewing: a tool for behavioral change. ACOG Committee Opinion No. 423. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009;113:243-6.

Challenges for overweight and obese urban women. Committee Opinion No. 470. American College of Obstetricians and Gynecologists. Obstet Gynecol 2010;116:1011-4

Exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 267. American College of Obstetricians and Gynecologists. Obstet Gynecol 2002;99:171-3.

Primary and preventive care: periodic assessments. Committee Opinion No. 483. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;117:1008-15.

American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for perinatal care. 6th ed. Elk Grove Village (IL): AAP; Washington, DC: ACOG; 2007.

American College of Obstetricians and Gynecologists. Guidelines for women's health care: a resource manual. 3rd ed. Washington, DC: ACOG; 2007.

American College of Obstetricians and Gynecologists. Getting in shape after your baby is born. ACOG Patient Education Pamphlet AP131. Washington, DC: ACOG; 2009.

American College of Obstetricians and Gynecologists.  Guidelines for Adolescent Health Care [CD-ROM]. 2nd ed. Washington, DC: American College of Obstetricians and Gynecologists; 2011.

REFERENCES FOR PATIENTS AND PROFESSIONALS

Clinical Guides
Borushek A. The CalorieKing calorie, fat, and carbohydrate counter. 2012 ed. Costa Mesa (CA): Family Health Publications; 2011.

Kumanyika S, Brownson C, editors. Handbook of obesity prevention: a resource for health professionals. New York (NY): Springer; 2007.

Nonas CA, Foster GD, editors. Managing obesity: a clinical guide. 2nd ed. Chicago (IL): American Dietetic Association; 2009.

Published articles
Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. Writing Group of the PREMIER Collaborative Research Group. JAMA 2003;289:2083-93.

Svetkey LP, Stevens VJ, Brantley PJ, Appel LJ, Hollis JF, Loria CM, et al. Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. Weight Loss Maintenance Collaborative Research Group. JAMA 2008;299:1139-48.

Ratner RE, Christophi CA, Metzger BE, Dabelea D, Bennett PH, Pi-Sunyer X, et al. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. Diabetes Prevention Program Research Group. J Clin Endocrinol Metab 2008;93:4774-9.
Nutrition and physical activity materials available at:
www.diabetespreventioprogram.com

Screening for obesity in adults: recommendations and rationale. U.S. Preventive Services Task Force. Ann Intern Med 2003;139:930-2.
Additional information available at:
www.uspreventiveservicestaskforce.org/recommendations.htm

AVAILABLE RESOURCES AND ONLINE SOURCES

We have provided information on the following organizations and web sites because they have information that may be of interest to our readers. The American College of Obstetricians and Gynecologists (ACOG) does not necessarily endorse the views expressed or the facts presented by these organizations or on these web sites. Further, ACOG does not endorse any commercial products that may be advertised or available from these organizations or on these web sites. 

Weight Assessment

Body mass index (BMI) calculator for adults
The NIH’s National Heart, Lung, and Blood Institute provide BMI tables and a BMI calculator on its “Aim for a Healthy Weight” website. An additional table assesses health risks of weight associated diseases using BMI combined with waist circumference measurements. 
www.nhlbisupport.com/bmi/

Body mass index calculator for adolescents
The Centers for Disease Control and Prevention’s (CDC) Healthy Weight program provides a BMI calculator for adolescents up through age 19.  This calculator displays BMI and the corresponding BMI-for-age percentile on a CDC BMI-for-age growth chart, and offers interpretation of the findings.
apps.nccd.cdc.gov/dnpabmi/Calculator.aspx

Nutrition and Dietary Guidance

Dietary Guidelines for Americans 2010
U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, December 2010. This detailed report and executive summary presents science-based guidelines for caloric intake and nutritional needs of Americans ages 2 and older. Data are to be used in educating clinicians and developing educational tools for use in clinical practice. Numerous nutrition tools and educational materials are based on these guidelines.
www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/PolicyDoc.pdf
  

Choose My Plate
This website sponsored by the United States Department of Agriculture (USDA) includes multiple nutritional resources for professionals and patients. ChooseMyPlate, launched in 2011, is an updated version of the MyPyramid food guidance system, and is based on the 2010 Dietary Guidelines.  The site offers information on food groups, nutrition tips, and interactive tools for consumers that demonstrate portion sizes and types of foods necessary for a balanced meal as well as the nutritional content of their foods.
www.choosemyplate.com

ChooseMyPlate - Spanish version
www.choosemyplate.com/sp-index.html

Interactive Daily Reference Intake for Healthcare Professionals
Based on scientific knowledge about nutrient needs developed by the National Academy of Science’s Institute of Medicine, this interactive tool designed by USDA’s Food and Nutrition Center  helps healthcare professionals counsel their patients about proper daily nutrition and individual nutrients.
fnic.nal.usda.gov/interactiveDRI/

Healthy Weight: It’s Not a Diet, It’s a Lifestyle!
This consumer-oriented CDC website provides general information and tools to help adults achieve and maintain a healthy weight, as well as learn what can be done to fight and prevent obesity.  These resources are also available in Spanish.
www.cdc.gov/healthyweight

African-American Women - Sisters Together Initiative
Sisters Together is a national initiative of the Weight Control Information Network , an information service of the National Institute of Diabetes and Digestive and Kidney Diseases. The initiative is aimed toward African-American women, ages 18 and older, to encourage them to develop healthy lifestyles through physical activity and healthier eating. The program offers brochures targeting different age groups. Copies of the Sister Together brochures and tools can be ordered free of charge from the website.
win.niddk.nih.gov/sisters/index.htm

Daily Food Plans for Pregnancy and Breastfeeding
The ChooseMyPlate website provides an interactive guide to food plans for women who are pregnant or breastfeeding. Topics include nutritional needs, appropriate weight gain, dietary supplements, weight loss during pregnancy, and special dietary needs.
www.choosemyplate.gov/mypyramidmoms/index.html

Shopping, Cooking, and Meal Planning
The National Agricultural Library of USDA compiles a wide array of consumer-focused materials on smart and economical food shopping and meal planning, including a list of farmer’s markets by state, low-calorie and lower-fat alternative foods, money saving tips, and ways to stretch the fruit and vegetable budget. www.nutrition.gov/nal_display/index.php?info_center=11&tax_level=2&tax_subject=391&topic_id=1756&placement_default=0

Ethnic Cooking
This website presents ideas for healthy foods and recipes geared toward specific racial/ethnic groups, including African Americans, American Indian Alaska Natives, and Latinos.
www.nutrition.gov/nal_display/index.php?info_center=11&tax_level=2&tax_subject=391&topic_id=1760&placement_default=0.

Vegetarian Diets
USDA presents information and tips designed to help vegetarians maintain a diet that meets all nutrient requirements as outlined by the 2010 Dietary Guidelines. www.choosemyplate.gov/tipsresources/vegetarian_diets.html
www.choosemyplate.gov/downloads/TenTips/DGTipsheet8HealthyEatingforVegetarians.pdf

Food Desert Locator
This website, depicting a U.S. map, displays populations with low access to healthy and affordable food according to census tract.
www.ers.usda.gov/Data/FoodDesert

Physical Activity

How Much Physical Activity Do You Need?
The CDC offers updated information on national physical activity guidelines for children (6-17 years), adults (18-64 years), and older adults (65 and older). The website also provides strategies for adults and children to achieve their physical activity goals. www.cdc.gov/physicalactivity/everyone/guidelines/index.html

Pregnant and Postpartum Women
The CDC website provides guidelines for low and moderate intensity physical activity for pregnant and postpartum women.
www.cdc.gov/physicalactivity/everyone/guidelines/pregnancy.html

Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines. Washington, DC: National Academies Press; 2009.

Growing Stronger - Strength Training for Older Adults
This website explains the benefits of strength training for proper weight control and other chronic diseases, and describes approaches to a strengthening exercise program for older adults.
www.cdc.gov/physicalactivity/growingstronger/index.html

The Weight Management Research to Practice Series summarizes emerging research in obesity for public health and medical care professionals.
www.cdc.gov/weightr2p

 ADDITIONAL RESOURCES

American Dietetic Association
www.eatright.org

American Heart Association
www.heart.org/HEARTORG

National Agriculture Library
www.nutrition.gov

National Association for Health and Fitness
www.physicalfitness.org

National Heart, Lung and Blood Institute
www.nhlbi.nih.gov

NHLBI Health Information Center
www.nhlbi.nih.gov/health/infoctr/index.htm

Nutrition.gov
National Agriculture Library
www.nutrition.gov

Contact:

Alicia Luchowski, MPH
Director
Health Care for Underserved Women/ LARC Program
aluchowski@acog.org