the weight of the nation: obesity - the disease that started it all
DESCRIPTION
Presentation by Dr. Ali Zentner at the Striking a Balance . . . Weight in with Knowledge, Research, Practice - Symposium 2013. September 30, 2013TRANSCRIPT
AH Mokdad, CDC M Shields, Statistics Canada, 2005
Gotye, et al, 2013
YEAR 2003 2005 2007 2008 2009
Total 18 years of age or over
49.4 50.0 50.8 51.1 51.6
Males 57.3 58.1 58.7 58.6 59.2
Females 41.3 41.8 42.9 43.5 43.9
Canadian Community Health Survey 2009
Pulmonary Disease
• Abnormal function
• Obstructive sleep apnea
• Pulmonary HTN
• Hypoventilation syndrome
Nonalcoholic Fatty Liver Disease
• Steatosis
• Steatohepatitis
• Cirrhosis
Gall Bladder Disease
Gynecologic Abnormalities
• Abnormal menses
• Infertility
• Polycystic ovarian syndrome
Idiopathic Intracranial Hypertension
Stroke Cataracts
Coronary Heart Disease
CHF
Hypertension Dyslipidemia
Diabetes Severe Pancreatitis
Cancer
Breast, uterus, cervix, colon, esophagus, pancreas, kidney, prostate
Phlebitis
• Venous stasis
Gout Peripheral Vascular Disease
Osteoarthritis
Adverse cardiometabolic effects of products of adipocytes
Adipose tissue
↑ IL-6
↓ Adiponectin
↑ Leptin
↑ TNFα
↑ Adipsin (Complement D)
↑ Plasminogen activator inhibitor-1
(PAI-1)
↑ Resistin
↑ FFA
↑ Insulin
↑ Agiotensinogen
↑ Lipoprotein lipase
↑ Lactate
Inflammation
Type 2 diabetes
Hypertension
Atherogenic dyslipidaemia
Thrombosis Atherosclerosis
Lyon 2003; Trayhurn et al 2004; Eckel et al 2005
5
39 35
4.5
19 11
22 12
0 0 5
10 15 20 25 30 35 40 45
10
Identical Twins Fraternal Twins Borjeson, Acta Pediatrca Scand, 1976
Heritability refers to the proportion of the variance in a trait in the population that can be attributed to genes. Calculations are based on Stunkard et al, JAMA,256:1, 1986
Exercise 15%
Thermogenesis 15%
Basal Metabolic
Rate 70%
Duration and Intensity of Exercise
Food Intake Cold Stress Thermogenic Drugs
Fat Free mass Age Gender Hormones Drugs Protein Turnover
calories
0
2000
REE = Resting energy expenditure
En
ergy
Exp
end
itu
re (%
RE
E)
Liver, Brain, Kidneys, Gut, Heart
Tissue energy expenditure
Tissue weight
Weigh
t (% B
ody W
eight)
80
60
40
20
0 Skeletal Muscle
Adipose Tissue,
Lean Person
Adipose Tissue, Obese Person
Owen O.. Mayo Clin Proc 1988;63:503-510.
NeuropeptideY Agouti-related protein galanin
Orexin-A dynorphin
Melanocyte stimulating hormone Propiomelanocortin Glucagon-like-peptide-1
Cocaine/amphetamine regulated transcript NE 5-HT
Glucose
CCK, GLP-1, Apo-A-IV Vagal afferents
Insulin Ghrelin
Leptin
Cortisol + -
-
+
Gastrointestinal tract
Adipose tissue
Food Intake
Adrenal glands
External factors Emotions Food characteristics Lifestyle behaviors Environmental cues
Adapted from Dr. R. Johns
Steiger, A. et al,2012, Obesity 20, 1212-1217
Johns et al, 1999: Obesity (23) 1335-1346
Coffee with cream and sugar 45 calories
Grande Mocha Latte with whip cream 440 calories
395 calorie difference
Hiking uphill continuously for 35 minutes
0 12 25 125
0 4 8 12
Excess intake (kcal/d)
Rosenbaum M et al. N Engl J Med. 1997;337:396-408.
Energy intake
(kcal/y)
Change in body fat (lb/y)
12 lbs per year
Adapted from Dr. R. Ross
750 205
Wing. Med Sci Sports Exerc 1999;31(suppl):S547.
*P<0.05 vs control group Duration of each study ranged from 4 to 12 months.
Stefanick 1998
Stefanick 1998a
Anderssen 1995
Hammer 1989
Verity 1989
Rönnemaa 1988
Wood 1988
Wood 1983
Weight loss (kg)
Control Group Exercise Group
* *
* *
Diet Only
Loss
of F
at-F
ree
Mas
s (%
Tot
al W
eigh
t Los
s)
Diet Plus Physical Activity
Men Women
*P<0.05
Reprinted with permission from Int J Obes Relat Metab Disord, Ballor and Poehlman;18:35. Copyright 1994 Macmillan Publishers Ltd.
Lean <16.7%
Rel
ativ
e R
isk
of C
VD
Mor
talit
y
Body Fat Category (% Weight as Fat) Lee et al. Am J Clin Nutr 1999;69:373.
Normal 16.7%-24.9%
Obese >25%
Aerobically fit Unfit
250 kcal of carrots
1250 kcal of cookies
0
20
40
60
80
100
120
Fruits & Vegetables
Sugars Pop Fats and Oils
Percentage Increase
USDA 2008 data
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Lau DCW et al, Can Med Assoc J 2007;176 (8 suppl):S1-S13
• The waist circumference is measured by locating the upper hip bone and the top of the right iliac crest and placing a measuring tape in a horizontal plane around the abdomen at the level of the iliac crest
• Before reading the tape measure, the tape should be snug but not compressing the skin and should be parallel to the floor
• The measurement is made at the end of normal expiration
A4_1
Alberti KGMM et al. Lancet 2005;366:1059-1062. | Grundy SM et al. Circulation 2005;112:2735-2752.
Padwal, et al, CMAJ 2011
Weng et al Lancet 2011; 378: 1244–53
Almost a 50% reduction!
Diabetes Prevention Program Research Group. N Engl J Med 2002;346:393-403.
Year
Chan
ge
in
Wei
ght
(kg)
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 -8 -6 -4 -2 0 2 4
Chan
ge
in P
hys
ical
Act
ivity
(MET-
hr/
wk)
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 0
2
4
6
8
Placebo
Metformin Lifestyle
Med
icat
ion
Adher
ence
(%
)
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 60
65
70
75
80
85
Lifestyle
Metformin
Placebo
Metformin
Placebo
Absolute Changes in HbA1c of Individual Studies of Structured Exercise Training vs No Intervention
Umpierre, D. et al. JAMA 2011;305:1790-1799