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The Weight of the Nation: Obesity - The Disease that Started it All
 

The Weight of the Nation: Obesity - The Disease that Started it All

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Presentation by Dr. Ali Zentner at the Striking a Balance . . . Weight in with Knowledge, Research, Practice - Symposium 2013. September 30, 2013

Presentation by Dr. Ali Zentner at the Striking a Balance . . . Weight in with Knowledge, Research, Practice - Symposium 2013. September 30, 2013

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    The Weight of the Nation: Obesity - The Disease that Started it All The Weight of the Nation: Obesity - The Disease that Started it All Presentation Transcript

    • AH Mokdad, CDC M Shields, Statistics Canada, 2005
    • Gotye, et al, 2013
    • YEAR   2003 2005 Total 18 years of age or over 49.4 50.0 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 2007 2008 50.8 2009 51.1 51.6
    • Pulmonary Disease Idiopathic Intracranial Hypertension •  Abnormal function •  Obstructive sleep apnea • Pulmonary HTN Stroke Cataracts •  Hypoventilation syndrome Coronary Heart Disease CHF Nonalcoholic Fatty Liver Disease Hypertension Dyslipidemia •  Steatosis Diabetes •  Steatohepatitis Severe Pancreatitis •  Cirrhosis Cancer Gall Bladder Disease Breast, uterus, cervix, colon, esophagus, pancreas, kidney, prostate Gynecologic Abnormalities •  Abnormal menses •  Infertility Phlebitis •  Polycystic ovarian syndrome •  Venous stasis Osteoarthritis Peripheral Vascular Disease Gout
    • Adverse cardiometabolic effects of products of adipocytes ↑ Lipoprotein lipase ↑ Agiotensinogen ↑ IL-6 Inflammation Hypertension ↑ Insulin ↑ TNFα Adipose tissue ↑ Adipsin (Complement D) ↓ Adiponectin Atherosclerosis Lyon 2003; Trayhurn et al 2004; Eckel et al 2005 ↑ FFA Atherogenic dyslipidaemia ↑ Resistin ↑ Leptin ↑ Lactate ↑ Plasminogen activator inhibitor-1 (PAI-1) Thrombosis Type 2 diabetes
    • 45 40 35 30 25 20 15 10 5 0 39 35 19 5 4.5 22 11 12 10 0
    • 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
    • 2000 Exercise 15% Thermogenesis 15% calories Basal Metabolic Rate 70% 0 Duration and Intensity of Exercise Food Intake Cold Stress Thermogenic Drugs Fat Free mass Age Gender Hormones Drugs Protein Turnover
    • Energy Expenditure (%REE) Tissue weight 60 40 20 Liver, Brain, Kidneys, Gut, Heart Skeletal Muscle REE = Resting energy expenditure Adipose Tissue, Lean Person Owen O.. Mayo Clin Proc 1988;63:503-510. Adipose Tissue, Obese Person 0 Weight (% Body Weight) 80 Tissue energy expenditure
    • External factors NeuropeptideY Agouti-related protein galanin Orexin-A dynorphin Glucose + + CCK, GLP-1, Apo-A-IV Vagal afferents Melanocyte stimulating hormone Propiomelanocortin Glucagon-like-peptide-1 Cocaine/ amphetamine regulated transcript NE 5-HT Emotions Food characteristics Lifestyle behaviors Environmental cues Gastrointestinal tract Food Intake Insulin Ghrelin Leptin Adipose tissue Cortisol Adrenal glands
    • Adapted from Dr. R. Johns
    • Steiger, A. et al,2012, Obesity 20, 1212-1217
    • Johns et al, 1999: Obesity (23) 1335-1346
    • 395 calorie difference Coffee with cream and sugar 45 calories Grande Mocha Latte with whip cream 440 calories
    • Hiking uphill continuously for 35 minutes
    • Change in body fat (lb/y) 12 lbs per year Energy intake (kcal/y) Excess intake (kcal/d) 0 12 Rosenbaum M et al. N Engl J Med. 1997;337:396-408. 12 8 4 0 25 125
    • Adapted from Dr. R. Ross
    • 750 205
    • Control Group Stefanick 1998 Exercise Group Stefanick 1998a * * Anderssen 1995 Hammer 1989 Verity 1989 Rönnemaa 1988 Wood 1988 * * Weight loss (kg) *P<0.05 vs control group Duration of each study ranged from 4 to 12 months. Wing. Med Sci Sports Exerc 1999;31(suppl):S547. Wood 1983
    • *P<0.05 Loss of Fat-Free Mass (% Total Weight Loss) Men Women Diet Only Diet Plus Physical Activity Reprinted with permission from Int J Obes Relat Metab Disord, Ballor and Poehlman;18:35. Copyright 1994 Macmillan Publishers Ltd.
    • Relative Risk of CVD Mortality Aerobically fit Unfit Lean <16.7% Normal 16.7%-24.9% Obese >25% Body Fat Category (% Weight as Fat) Lee et al. Am J Clin Nutr 1999;69:373.
    • 1250 kcal of cookies 250 kcal of carrots
    • Percentage Increase 120 100 80 60 40 20 0 Fruits & Vegetables Sugars Pop Fats and Oils USDA 2008 data
    • Distance To McDonald’s SHARE: TWITTER FACEBOOK EMAIL The Contiguous United States, September 2010 READ MORE! OUR COMMUNITIES AND FOOD COPYRIGHT © 2009 - 2012 STEPHEN VON WORLEY. ALL RIGHTS RESERVED.
    • IF YOU WANT TO LOSE WEIGHT ASK ME HOW
    • •  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 Lau DCW et al, Can Med Assoc J 2007;176 (8 suppl):S1-S13 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
    • Almost a 50% reduction! Weng et al Lancet 2011; 378: 1244–53
    • Change in Weight (kg) Change in Physical Activity (MET-hr/wk) Medication Adherence (%) 4 2 Placebo 0 -2 -4 Metformin -6 -8 0.0 0.5 1.0 1.5 2.0 2.5 8 Lifestyle 3.0 3.5 4.0 Lifestyle 6 4 2 Metformin 0 0.0 0.5 Placebo 1.0 1.5 2.0 2.5 3.0 3.5 4.0 85 Placebo 80 75 70 65 60 0.0 0.5 Metformin 1.0 1.5 2.0 2.5 3.0 3.5 4.0 Year Diabetes Prevention Program Research Group. N Engl J Med 2002;346:393-403.
    • Absolute Changes in HbA1c of Individual Studies of Structured Exercise Training vs No Intervention Umpierre, D. et al. JAMA 2011;305:1790-1799