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

...
Pulmonary Disease

Idiopathic Intracranial
Hypertension

•  Abnormal function
•  Obstructive sleep apnea
• Pulmonary HTN

...
Adverse cardiometabolic effects
of products of adipocytes
↑ Lipoprotein lipase

↑ Agiotensinogen

↑ IL-6

Inflammation

Hy...
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.
Calcul...
2000
Exercise
15%
Thermogenesis
15%

calories

Basal
Metabolic
Rate
70%
0

Duration and Intensity of Exercise
Food Intake
...
Energy Expenditure (%REE)

Tissue weight

60
40
20

Liver, Brain,
Kidneys,
Gut, Heart

Skeletal
Muscle

REE = Resting ener...
External factors

NeuropeptideY
Agouti-related
protein
galanin

Orexin-A
dynorphin

Glucose

+
+

CCK, GLP-1,
Apo-A-IV
Vag...
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 En...
Adapted from Dr. R. Ross
750

205
Control Group

Stefanick 1998

Exercise Group

Stefanick 1998a

*

*

Anderssen 1995
Hammer 1989
Verity 1989
Rönnemaa 1988...
*P<0.05
Loss of Fat-Free Mass
(% Total Weight Loss)

Men
Women

Diet Only

Diet Plus
Physical Activity

Reprinted with per...
Relative Risk of CVD Mortality

Aerobically fit
Unfit

Lean
<16.7%

Normal
16.7%-24.9%

Obese
>25%

Body Fat Category (% W...
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 COMMUN...
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 m...
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
...
Absolute Changes in HbA1c of Individual Studies of Structured
Exercise Training vs No Intervention

Umpierre, D. et al. JA...
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
The Weight of the Nation: Obesity - The Disease that Started it All
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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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

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

  1. 1. AH Mokdad, CDC M Shields, Statistics Canada, 2005
  2. 2. Gotye, et al, 2013
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. 45 40 35 30 25 20 15 10 5 0 39 35 19 5 4.5 22 11 12 10 0
  7. 7. Identical Twins Fraternal Twins Borjeson, Acta Pediatrca Scand, 1976
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. Adapted from Dr. R. Johns
  13. 13. Steiger, A. et al,2012, Obesity 20, 1212-1217
  14. 14. Johns et al, 1999: Obesity (23) 1335-1346
  15. 15. 395 calorie difference Coffee with cream and sugar 45 calories Grande Mocha Latte with whip cream 440 calories
  16. 16. Hiking uphill continuously for 35 minutes
  17. 17. 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
  18. 18. Adapted from Dr. R. Ross
  19. 19. 750 205
  20. 20. 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
  21. 21. *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.
  22. 22. 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.
  23. 23. 1250 kcal of cookies 250 kcal of carrots
  24. 24. Percentage Increase 120 100 80 60 40 20 0 Fruits & Vegetables Sugars Pop Fats and Oils USDA 2008 data
  25. 25. 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.
  26. 26. IF YOU WANT TO LOSE WEIGHT ASK ME HOW
  27. 27. •  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
  28. 28. Alberti KGMM et al. Lancet 2005;366:1059-1062. | Grundy SM et al. Circulation 2005;112:2735-2752.
  29. 29. Padwal, et al, CMAJ 2011
  30. 30. Almost a 50% reduction! Weng et al Lancet 2011; 378: 1244–53
  31. 31. 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.
  32. 32. Absolute Changes in HbA1c of Individual Studies of Structured Exercise Training vs No Intervention Umpierre, D. et al. JAMA 2011;305:1790-1799

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