obesity epidemic

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Information about obesity epidemic
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Published on August 8, 2007

Author: GenX

Source: authorstream.com

Obesity: The Epidemic:  Obesity: The Epidemic Patrick McBride, MD, MPH Professor UW Medical School Overview:  Overview Obesity: The Epidemic U.S. Trends: Disease of the decade Costs, Causes, Consequences Obesity = 280,000 deaths annually Costs: $77 billion year U.S. Wisconsin = $1.4 billion / year (5 – 7% of all health care costs) Obesity is complex with genetic, behavioral and environmental causes Obesity - The Epidemic:  Obesity - The Epidemic Will soon overtake smoking as the leading preventable cause of death!* *Obesity greater morbidity than: Smoking Problem drinking Poverty * Public Health 2001;115:229-235 Obesity - The Epidemic:  Obesity - The Epidemic Overweight or obese in U.S. 1 in 4 adults in the 1960’s Overweight: 37% of U.S. adults WI = 37% Obese: 21% of U.S. adults WI = 22% (Doubled: 11% only 10 yrs ago!) Obesity* Trends Among U.S. AdultsBRFSS, 1991:  Obesity* Trends Among U.S. Adults BRFSS, 1991 (*BMI  30, or ~ 30 lbs overweight for 5’4' person) Source: BRFSS, CDC. Obesity* Trends Among U.S. AdultsBRFSS, 1992:  Obesity* Trends Among U.S. Adults BRFSS, 1992 (*BMI  30, or ~ 30 lbs overweight for 5’4' person) Source: BRFSS, CDC. Obesity* Trends Among U.S. AdultsBRFSS, 1993:  Obesity* Trends Among U.S. Adults BRFSS, 1993 (*BMI  30, or ~ 30 lbs overweight for 5’4' person) Source: BRFSS, CDC. Obesity* Trends Among U.S. AdultsBRFSS, 1994:  Obesity* Trends Among U.S. Adults BRFSS, 1994 (*BMI  30, or ~ 30 lbs overweight for 5’4' person) Source: BRFSS, CDC. Obesity* Trends Among U.S. AdultsBRFSS, 1995:  Obesity* Trends Among U.S. Adults BRFSS, 1995 (*BMI  30, or ~ 30 lbs overweight for 5’4' person) Source: BRFSS, CDC. Obesity* Trends Among U.S. AdultsBRFSS, 1996:  Obesity* Trends Among U.S. Adults BRFSS, 1996 (*BMI  30, or ~ 30 lbs overweight for 5’4' person) Source: BRFSS, CDC. Obesity* Trends Among U.S. AdultsBRFSS, 1997:  Obesity* Trends Among U.S. Adults BRFSS, 1997 (*BMI  30, or ~ 30 lbs overweight for 5’4' person) Source: BRFSS, CDC. Obesity* Trends Among U.S. AdultsBRFSS, 1998:  Obesity* Trends Among U.S. Adults BRFSS, 1998 (*BMI  30, or ~ 30 lbs overweight for 5’4' person) Source: BRFSS, CDC. Obesity* Trends Among U.S. AdultsBRFSS, 1999:  Obesity* Trends Among U.S. Adults BRFSS, 1999 (*BMI  30, or ~ 30 lbs overweight for 5’4' person) Source: BRFSS, CDC. Obesity* Trends Among U.S. AdultsBRFSS, 2000:  Obesity* Trends Among U.S. Adults BRFSS, 2000 (*BMI  30, or ~ 30 lbs overweight for 5’4' person) Source: BRFSS, CDC. Obesity - The Epidemic: Kids:  Obesity - The Epidemic: Kids 15% of children are overweight 5% in 1970 – 1980 and 11% in 1990 22% African-American andamp; Hispanic children are now overweight 27% of AA and Hispanic male children overweight Diabetes in kids: up 10 X in 10 years andlt; 25% children active regularly Slide16:  Slide17:  Obesity: Causes and Consequences:  Obesity: Causes and Consequences Physical Activity in U.S.:  Physical Activity in U.S. andlt; 20% Adults and Children get regular physical activity Trend unchanged in past 2 decades; exception is high school females getting less activity in past decade Physical activity classes decreasing in U.S. high schools Slide20:  Slide21:  is sedentary takes away time from other activities associated with eating 68% increase Video Games and Children. ERIC Digest Children’s Television Resource andamp; Education Center Slide22:  Slide23:  3.7 to 4.2 14% increase USDA statistics show that the average daily caloric intake of Americans has risen from 1,854 calories to 2,002 calories during the last 20 years. That increase - 148 calories per day - theoretically works out to an extra 15 pounds per year. 32% are fast food 27% sit down restaurants 24% convenience stores (USDA 1995) Slide24:  Small Medium Large Super-Size 1950-60 200 calories 1970’s 200 calories 320 calories 1980’s 320 calories 400 calories 1990’s 450 calories 540 calories 2000 450 calories 540 calories 610 calories The History of French Fries in America Obesity Health Consequences:  Obesity Health Consequences Heart Disease Other Vascular Dz Stroke Dementia Cancer (breast, colon, other) Type 2 DM Sleep Apnea Depression Osteoarthritis Back pain Gallstones Surgery complications Congenital malformations Urinary stress incontinence Psychological Slide26:  Diabetes Mellitus in the US: Increasing Prevalence of Diagnosed Cases Persons With Diagnosed Diabetes (millions) Diabetes Overview. October 1995 (updated 1996). NDDK publication NIH 96-1468. Kenny SJ et al. In: Diabetes in America 2nd ed. 1995:47-67. Year Slide27:  What to do?:  What to do? Individuals Families Industry Schools Policymakers Government National Guidelines:  National Guidelines American Obesity Association www.aoa.org National Institute of Health - Obesity Research 1998;6:S51-S209 www.nhlbi.nih.gov/guidelines American Heart Association www.americanheart.org BMI calculator: www.nhlbisupport.com/bmi The Metabolic Syndrome:  The Metabolic Syndrome High Risk Syndrome: Overweight / central obesity as the primary contributor to insulin resistance with genetic predisposition Multiple metabolic abnormalities Target: insulin resistance andamp; metabolism Emphasis on weight reduction andamp; physical activity to reverse How Common is the Metabolic Syndrome?:  How Common is the Metabolic Syndrome? US NHANES survey Adults andgt; 20 years of age 24% all adults, 42% over age 60 yrs Similar for men and women! Mexican Americans 32% African American women andgt;andgt; men 47 million adults in the U.S. JAMA 2002;287:356 Waist Circumference:  Waist Circumference Waist circumference, independent of BMI / weight, confers additional health risk with: Glucose intolerance / Diabetes mellitus Hypertension Dyslipidemia Important - WC in any weight category confers similar risk Arch Intern Med 2002;162:2074 Slide33:  New Emphasis of ATP III:The Metabolic Syndrome:  New Emphasis of ATP III: The Metabolic Syndrome Risk Factor Abdominal Obesity Men Women Triglycerides HDL cholesterol Men Women Blood pressure Serum glucose Defining Level Waist Circumference andgt; 40 inches andgt; 35 inches andgt; 150 mg/dL andlt; 40 mg/dL andlt; 50 mg/dL andgt; 130/ 85 mmHg andgt; 110-125 mg/dL Insulin Resistance and Atherosclerosis:  Insulin Resistance and Atherosclerosis Obesity Preventionand Management:  Obesity Prevention and Management Can Lifestyle Change Work?:  Can Lifestyle Change Work? Prevention of Type 2 Diabetes Mellitus Changes in lifestyle: NEJM 2001;344:1343-1350 Changes in lifestyle or metformin NEJM 2002;346:393-403 Metabolic Syndrome Prevention:  Metabolic Syndrome Prevention 3234 patients with GINT / high FBG Randomized for 3 years to: Placebo Metformin Lifestyle intervention Results in reducing diabetes: Lifestyle 58% (NNT = 7) Metformin 31% (NNT = 14) N Engl J Med 2002;346:393 Diabetes Preventionin Metabolic Syndrome:  Diabetes Prevention in Metabolic Syndrome 522 men andamp; women IGT - mean BMI 31 RCT Individualized counseling vs UC RX 4.2 kg weight loss (vs 0.8 kg UC)* Diabetes incidence 11% vs 23% UC* (58% risk reduction, pandlt; 0.001*) 3 yrs. Achieving either 5% wt. loss or fitness reduced risk of DM by 70% NEJM 2001;344:1343-50 Diabetes Therapy Trial*:  Diabetes Therapy Trial* 160 patients with Type 2 DM + PU Trial of 'Intensive Therapy': Lowfat diet + exercise + tobacco cslg. ACE or ARB + HTN treatment Multivitamin Statin or Fibrate depending on cholesterol disorder Diabetes treatment if needed: metformin, gliclazide, insulin NEJM 2003;348:383-93 Slide41:  Diabetes Therapy Trial*:  Diabetes Therapy Trial* Intensive Therapy vs. Usual Care Outcomes in 8 years (160 patients): 85 events in 35 patients Usual Care 33 events in 19 patients Intensive RX 53% decrease in CVD 61% decrease in nephropathy 58% decrease in retinopathy 63% decrease in autonomic neuropathy NEJM 2003;348:383-93 Slide43:  Body Weight Management Patients BMI andgt; 25 or WC increased: nutrition and physical activity counseling Goal: IBW - BMI 19 - 25? Goal: WC andlt; 35' women, 40' male? OR Emphasize weight loss to achieve normal BP, cholesterol levels, and glucose? Achieve Ideal Body Weightor Achieve a 5% loss?:  Achieve Ideal Body Weight or Achieve a 5% loss? 200# 5% = 10 loss Total cholesterol down 15% TG down 20% HDL up 15% Sys BP / Dias BP down 12/9 mmHg Improved hyperglycemia Improved life expectancy Weight Loss:  Weight Loss Obese adults can lose 1# per week reducing kcalories 500-1000 below maintenance for current weight Exercise is most important to add for sustained weight loss Combining caloric restriction and exercise leads to 5 - 10% weight loss in a 4 - 6 month period NEJM 2002;346:591 Activity - Vital:  Activity - Vital Modest energy balance = Wt. Gain 10 calories / day excess = LB / year 100 calories / day excess = 10 LB / yr Additional activity daily changes calories consumed and the Basal Metabolic Rate (BMR) Slide47:  Physical Activity Minimum goal - 30 minutes, 3 - 4x per week Ideal goal: 30 - 45 minutes daily Encourage moderate intensity aerobic activity supplemented by daily lifestyle activities Resistance training has positive effects on metabolism and visceral obesity Medically supervised programs for moderate to high-risk patients demonstrate benefits JAMA 2002;288:1622-31 Websites for Patients:  Websites for Patients Atkins alert: www.atkinsdietalert.org/physician Evaluate diets: www.pcrm.org/new/health010109.html www.niddk.nih.gov/health/nutrit/pubs/myths/index.htm Good sites www.shapeup.org/index.htm www.nhlbi.nih.gov/health/public/heart Summary:  Summary Obesity and it’s consequences are an epidemic in the U.S. Metabolic and medical outcomes are poor, with serious morbidity Population change is the only reasonable approach Medical management is very limited - emphasize health benefits and encourage patients with lifestyle Body Mass Index (kg/m2):  Body Mass Index (kg/m2) Dose - Response Risk Relationship Underweight andlt; 18.5 Normal 18.5 - 25 Overweight 25 - 30 Obese andgt; 30 Class I 30 - 34.9 Class II 35 - 39.9 Class III andgt;40 Exercise & Intra- Abdominal Body Fat:  Exercise andamp; Intra- Abdominal Body Fat RCT of 173 post-menopausal women Moderate intensity exercise vs. stretching program control group 12 month data: Body weight difference 1.4 kg Total body fat - 1% Intra-abdominal fat - 8.6 g/cm Subcutaneous abdominal fat - 29 g/cm JAMA 2003;289:323-330

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