SlideShare a Scribd company logo
FANUS Conference
   Abuja, Nigeria 2011
The Obesity Epidemic
Pilar Riobo , MD, PhD
Madrid , Spain
obesity
Today discussion points
• Prevalence and Metabolic Syndrome
• Causes of obesity
   – Excessive Caloric intake
   – Psychological factors (binge eating, nocturnal eating synd)
   – Social factors:
          Excesive TV watching and videogames
          Family meals protective
          No breastfeeding
          Short sleep duration
          Light during night time
          Friends and environment
   – Female obesity
   – Communication oportunities in nutrition
The Rising
  Rate of
Childhood
Obesity is
 Alarming
   30% of children are overweight
       or at risk for overweight
Obesity Today: Future Impact

 “Because of increasing rates of
 obesity…we may see the first
 generation that will be less healthy
 and have a shorter life expectancy
 than their parents.”

     Surgeon General Richard Carmona
Prevalence of obesity in children
             in granada, spain




                  González Jiménez, et al. Nutr Hosp 2011
ALADINO STUDY. SPAIN
 6-10 years old children
Prevalence of overweight and obesity
       in European countries




    Where is the mediterranean diet?
Relation between BMI and chronic
                            diseases (NHS and PHS)
                    Type 2 diabetes                  Cholelithiasis            Hypertension         Coronary heart disease


                                                            Women                                                           Men
                   6

                   5
Relative Risk




                   4

                   3

                   2

                   1

                   0
                       <21 22    23    24    25    26    27    28    29   30       <21 22     23   24   25   26   27   28   29   30

                              Body Mass Index (kg/m2)                                       Body Mass Index (kg/m2)

                Willett WC, et al. N Engl J Med. 1999;341:427–434.
Obesity and overweight have been reported to be
associated with large decreases in life expectancy.
 Non-smoking women    Smoking women          Non-smoking men          Smoking men

                     Framingham Heart Study
                                                                             13.7

                                      Non-smoking women lost 7 years,
                             5.82     Non-smoking men 5.8 years

                                                                           13.3


                                      7.08


  0                    5                            10                            15

 Implications of obesity at age 40 on life expectancy.
                                    Peeters, A, et al. Ann Int Med 2003;138:24-32.
Obesity is associated with increased risk
                                                            for most cancers

                                                                                        1.44
                                                       Multiple myeloma (>35)
                                                                                       1.46
                                                        Colon & Rectum (>40)
Type of Cancer (Highest BMI category)




                                                                                        1.51
                                                                  Ovary (>35)
                                                                                         1.68
                                                                   Liver (>35)
                                                                                              1.88
                                                             All Cancers (>40)
                                                                                               1.95
                                              Non-Hodgkin’s Lymphoma (>35)
                                                                                                2.12
                                                                  Breast (>40)
                                                                                                2.13
                                                             Gallbladder (>30)
                                                                                                       2.51*
                                                       All Other Cancers (>40)
                                                                                                       2.64*
                                                             Oesophagus (>30)
                                                                                                         2.76
                                                                Pancreas (>40)
                                                                                                                3.20
                                                                  Cervix (>35)
                                                                                                                           4.75
                                                                 Kidney (>40)
                                                                                                                                          6.25
                                                                  Uterus (>40)

                                                                      0          1        2             3              4   5         6           7     8        9       10        11
                                                                                                                               Relative Risk of Death (95% Confidence Interval)
                                        Calle E et al. N Engl J Med 2003;348:1625-1638
                                        Mortality from Cancer According to BMI >30->40 for U.S.
                                        Women in the Cancer Prevention Study II, 1982 through 1998
Risk of Alzheimer’s disease (AD) in elderly
                                        with and without metabolic syndrome
                                     980 elderly subjects (337 male,622 female; 69-78) 13 cases AD in men 32 in women
                                      With metabolic syndrome              Without metabolic syndrome

                                      9                       P<0.001
Prevalence Alzheimer's disease (%)




                                      8
                                      7
                                      6
                                      5
                                      4
                                      3
                                      2
                                      1
                                      0
                                                                 Women                              Men
                             Vanhanen M, et al. Neurology 2006.67:843-47

                                          Increased risk for cognitive dysfunction and dementia in elder women
obesity
obesity
obesity
obesity
Obesity and other risk factors

          Blood       HDL-C     PCRP
         pressure


                                        pro-thrombotic
T-Cholesterol-t     OBESITY            factors



                                  Insulín
     Diabetes                     Resistance
                     TG,Lp(a)
                     sdLDL
Hypertension and Obesity
              Direct and lineal relationship




                         20        25        30         35          40
                                          IMC
Prevalence10.6% (BMI<20), 13.3% (BMI 20-25), 22.8% (BMI 30-40) y 61.3% (BMI>40).

           Australian Longitudinal Study on Women’s Health
                                             Brown WJ et al. Int J Obes 1998;22:520-528.
Diabetes and Obesity




                             20               25         30   35   40
                                                   IMC




Brown WJ et al. Int J Obes 1998;22:520-528.
obesity
ATP III Criteria for Identification of the Metabolic Syndrome

Abdominal obesity (waist circumference)
   Men                                       >102 cm
   Women                                     >88 cm
Triglycerides                                150 mg/dL
HDL cholesterol
   Men                                       <40 mg/dL
   Women                                     <50 mg/dL
Blood pressure                               >130 / 85 mm Hg
Fasting glucose                              >110 mg/dL


Diagnosis of the metabolic syndrome is made when 3 or more of the risk
                determinants shown above are present.
How Common is the Metabolic
       Syndrome?


• 24% all adults
• 42% over age 60 yrs
But....,


   …individuals who are genetically
predisposed to insulin resistance may
forestall or even prevent the development
of diabetes by staying thin and physically
active.
What’s the Cause of Obesity?
There is sometimes a tendency to focus
on one specific CAUSE ….
             But…

…there’s no simple answer to this
complex issue…
The Biological Cause of
   Obesity is Simple

An imbalance of calories IN
     and calories OUT!


                 But…
…The Social Factors that lead to
 the Imbalance are Complex
 • Changing food habits due to busy lifestyles
 • Declining physical activity during work and
   leisure time
 • Changing physical environment (urban, safety)
 • Decreased sleep duration
 • Hedonic and reward aspects of food
 • Psychological problems
 • Side effects of common drugs
Weight Issues

 It’s Much More than
 ENERGY BALANCE

Social factors play a role
Popularity of low-carb diets that    28




blame carbohydrates and sugar for everything




                               ?
obesity
Low-carb, high-protein, high-fat vs.
      conventional hypocaloric diet

PRCT, 63 obese
 Low-carb lost more
 weight at 3 and 6
 months but was
 similar at 12 months




                Foster GD et al. N Engl J Med 2003; 48:2082-2090
CARMEN Study                                      .

investigated the effects of replacing one-quarter
of daily fat intake by complex or simple CH
Energy intake was ad libitum


 A low-fat, high-polysaccharide
 diet led to long-term moderate
 weight loss and improved serum
 cholesterol

 Increasing simple carbohydrates
 did not promote weight gain



Poppitt S D et al. Am J Clin Nutr 2002;75:11-20
18000 U.S. male physicians
  reported measures of breakfast,
       cereal intake, weight

   After13 years of follow-up,
BMI and weight gain were inversely
            associated
 with intake of breakfast cereals,
   independently of other risk
             factors.
          Obes Res. 2005; 13:1952–1960
Fructose intake correlates closely
       with the rate of diabetes worldwide




Bray GA. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of
obesity. Am J Clin Nutr 2004; 79: 537-543.
Could Excessive Fructose Intake (>50 g/d)
      cause metabolic syndrome?

   The primary sources of fructose are table sugar (sucrose)
   and high fructose corn syrup.

   Unlike other sugars, the ingestion of excessive fructose
   induces features of metabolic syndrome in laboratory
   animals

   Fructose appears to mediate the metabolic syndrome in
   part by raising uric acid
Could Excessive Fructose Intake and Uric
      Acid Cause Type 2 Diabetes?
Fat makes us fat??
Direct relationship between fat intake and weight:

     Higher caloric content/gram
     Difficult oxidation compared to carbs
     (Carbs are inmediatly oxidated)
     Higher palatability promotes increased
     consumption
Psychological problems
  severe depression in 32%
  suicidal risk in 23%.
  Anxiety : 50%

  Binge eating disorder (BED) : 1–4% of general
  population and about 30% of obese subjects
  attending weight control programs

  Night Eating Syndrome (NES) : morning anorexia,
  evening hyperphagia, and insomnia with awakenings
  followed by nocturnal food ingestion.
Lester D. Depression and suicidality in obese patients. Psychol Rep.2011:108(2):367-8.
Psycohological problems at first visit
    assessment of patients at obesity clinic:

           • Elevated scores for depression in 48%
           • Elevated scores for anxiety in 56%
           • Personality trait overlapping with eating disorders
             in 22%
           • Elevated scores for bulimia in 11.5%
           • Significant impairment in quality of life in 30%


A Tuthill et al. Q J Med, 2006: 9
Neurobiological mechanisms underlying food intake
             Brain dopamine, which regulates motivation for food intake,
                              is likely to be involved

    Obese individuals overeat to compensate for a reward deficit
    Have fewer striatal D2 receptors and show less striatal response to
    palatable food intake




Coronal section showing less activation in the right caudate in the weight-gain group versus the weight-
                       stable group during milkshake receipt–tasteless intake
                                                           Stice E et al. J. Neurosci. 2010;30:13105-13109
Short sleep and sleep abnormalities




             244 children, age 3 to 7.

    Each additional hour of sleep at ages 3-5
              was associated with a
            reduction in BMI of 0.48
  and a reduced risk of being overweight of 0.39
After 32 years follow-up, shorter childhood sleep times
 were significantly associated with higher adult BMI
The potential mechanisms through which short
   sleep duration could result in obesity.




   Taheri S Arch Dis Child 2006;91:881-884
Weight gain as side effect of
drugs
    Anti-depresants and psychotropic
    Anti-histaminics
    Corticoids
    Beta-blockers
    Contraceptives
    ........
Antipsychotic drugs



After a median of 11weeks treatment, weight
increased by:
     8.5 kg with conventional antipsychotic drugs
     6.1 kg with quetiapine
     5.3 kg with risperidone
     4.4 kg with aripiprazole

                        Correl et al. JAMA, 2009;302:16 1765
Contraceptives
   Daily energy intake was higher
and resting metabolic rate was lower
 in both follicular and luteal phases
     after medroxyprogesterone
       compared with placebo
Prolonged breast-feeding protects mothers
         from later-life obesity

20 years after their last pregnancy,
women who had breast-fed for
less than 6 months had higher fat mass
percentage, than mothers who had
breast-fed for longer than 6 months


   But rates of breast feeding are low
                   Wiklund P et al. Public Health Nutr. 2011;23:1-8
Frequency of Shared Family Meals
sharing 3 or more family meals per week reduces odds
            overweight (12%),
           eating disorders (35%)




                              Pediatrics 2011;127:e1565
Light at night increases body mass in mice


  • compared with mice in a standard light/dark cycle,
  • despite equivalent levels of caloric intake and total daily
  activity output.
  • Nocturnal rodents typically eat substantially more food at night

     Exposure to nighttime lighting and the resulting
changes in the daily pattern of food intake and activity
also may be contributing factors to obesity pandemic ??
                      Fonken LK. Proc Natl Acad Sci. 2010; 26:18664-9.
Activity Level and Risk of Overweight
 Professionals Health Study




Men watching 21 or more hours of TV per week were over 40% more likely to
       become overweight than were men viewing 1 hour per week
                                           Ching P. Am J Public Health 1996
The increased time spent in sedentary screen-based
activities has also been implicated as contributing to
                overweight and obesity
                           .
Television (TV) viewing:
the dominant recreational pastime at all ages
  Higher TV viewing hours are associated
  - higher body mass index (BMI),
  - lower levels of fitness
  - higher blood cholesterol levels.

   Potential mediators of the effect:
  - less time for physical activity
  - reduced resting metabolic rate
  - increased energy intake (eating while watching TV
  and exposure to marketing of energy dense foods).
Children who watched the most television during childhood had the
              greatest increase in body fat over time
 By age 11, children who watched 3.0 h or more television per day
 had a mean sum of skinfolds higher (106.2mm, vs 76.5mm) than
              those who watched less than 2 per day
70 children randomized to reduce
   their television viewing and computer use by 50% vs control




In the intervention group, reductions in BMI and
             energy intake were shown
                                               Epstein. ARCH PEDIATR ADOLESC MED/ 2008
70 children randomized to an intervention to reduce
  their television viewing and computer use by 50% vs control


Reducing television viewing and computer
   use may have an important role in
      preventing childhood obesity

  In the intervention group, reductions in BMI
          and energy intake were shown
                                              Epstein. ARCH PEDIATR ADOLESC MED/ 2008
Effects of active video games on body composition
           a randomized controlled trial


                                      BMI from baseline, at 24 wk
                                      control group increased 0.34
                                      intervention group reduction−0.24

 change in BMI by ethnic subgroup].



  Small but definite effect on BMI and body composition
        in overweight and obese children at 24 wk

                                       Maddison R et al. Am J Clin Nutr 2011;94:156-163
Friends
                                                         Framingham Heart Study cohort




Among married couples, when an alter became obese, the spouse was 37% more
likely to become obese.
If an ego stated that an alter was his friend, the ego’s chances of becoming obese
increase by 57% if the alter became obese.
 Between mutual friends, the ego’s risk of obesity increased by 171%
Having obese social contacts might lead to
           adopt specific behaviors

Could obesity be considered contagious???
Female obesity
 rates of obesity
 are higher in
                                      Effects during
 women                                pregnancy on
                                      offspring
          Metabolic effects
          during pregnancy




In an obesogenic environment, women are at greater risk for obesity
                                  .
Transgenerational issues: Nutrition during fetal and early life can influence risk
for obesity on offspring
Obesity and pregnancy
               Medical Complications                           Technical Complications
Early          Miscarriage
                                                               Difficult ultrasound
pregnancy      Twinning

                pregnancy induced hypertension                GDM occurs in ~4% of pregnancies
                pre-eclampsia
Antenatal       gestational diabetes
                                                               Overweight women have 17% risk
                venous thromboembolism

               Higher rates for
                induction of labor                            Operative: higher rates c-section
Intrapartum     planned and acute c-section                   infection, bleeding and thrombosis
                assisted delivery                             Anesthesia
                vaginal tears


Postpartum     Macrosomia, congenital
               Hemorrhage, infection, venous thromboembolism
Fetal          abnormalities, fetal distress,                  Birth injury
               Macrosomia, morbidity and mortality
               perinatal congenital abnormalities, fetal
Fetal          distress, perinatal morbidity and mortality
                                                               Birth injury
Body Mass Index predicts infertility in women
                                     with and without PCOS


                4.0

                3.5                                                                        With PCOS
                3.0
Relative Risk




                2.5

                2.0

                1.5

                1.0

                0.5
                                                                                                        Without PCOS
                  0
                      <16      16-17.9      18-19.9       20-21.0      22-23.9   24-25.9   26-27.9   28-29.9   30-31.9   >32   35
                                                                         BMI at Age 18
                Adapted from Rich-Edwards JW, Goldman MB, Willett WC, et al.
                Am J Obstet Gynecol 1994;171:171-7
Diabetes epidemic

                       300
                                                                       300 millions
                       250
Millones de personas




                       200


                         135 millions
                       150
                                      154 millionsio
                       100


                        50


                             0
                                   1995                  2000           2025
                                          King H. Diabetes Care 1998
Increasing Prevalence of Diabetes
        from 1990 to 2000
obesity
Insulin Resistance:
    A Primary Factor in Type 2 Diabetes


–   Condition in which greater than normal amounts of
    insulin are required to produce
    a normal biological response



                 Olefsky JM. In: Ellenberg and Rifkin’s Diabetes Mellitus. 5th ed. 1997:513-552.
obesity
Diabetes Mellitus
                 Health Impact of the Disease
                                   6th leading cause of
                                          death
             Renal                                                            Life expectancy
             failure*                                                             5 to 10 yr


Blindness*                                                                                Cardiovascular
                                       Diabetes                                         disease 2X to 4X


                                                                             Nerve damage in
               Amputation*                                                 60% to 70% of patients
*Diabetes is the no. 1 cause of renal failure, new cases of blindness, and nontraumatic amputations
                                      Diabetes Statistics. October 1995 (updated 1997). NIDDK publication NIH 96-3926.
                                                                    Harris MI. In: Diabetes in America. 2nd ed. 1995:1-13.
Decreased sleep duration or quality may
              increase diabetes risk
                                                                Selective suppression
                                                                of SWS, without any
                                                                change in total sleep
                                                                     time, results
                                                                in marked decreases
                                                                in insulin sensitivity,
                                                                 leading to reduced
                                                                       glucose
                                                                    tolerance and
                                                                 increased diabetes
                                                                         risk
Tasali et al. Slow-wave sleep and the risk of type 2 diabetes in humans PNAS, 2008; 105 1044–1049
Diabetes prevention studies
 • Malmo Preventive Trial withDiet&Exercise
 • DaQuing IGT
 • Orlistat
 • SOS (Swedish Obese Subjects)
 • Finnish Diabetes Prevention
 • Diabetes Prevention Program
 • TRIPOD
 • STOP-NIDDM
obesity
EXERCISE IS GOOD
    MEDICINE
But, changing habits is not easy
So, it’s critical that nutrition communicators help
 people and provide motivating tips so they can
             adopt more healthful habits
But consumers are
      confused
 about who and what to
believe when it comes to
       nutrition …
Many people find it
Consumers are                                                      difficult to separate
bombarded with                            Web                                      valid
nutrition               Food              Sites        TV and        recommendations
                                                       Radio
information from        Labels                         News       from fad diet advice.
a variety of
sources.        Popular                                         Medical
                    Magazines

                                          Consumer
                                                                Experts
                    Media                                       Fad
                                                                Diet
                                                                               Nutrition
                    Images                                      Gurus
                                                                         information is
                                Friends
                                and
                                                       Food                often seen as
                                                                         contradictory,
                                Family    Gov’t
                                          Guidelines   Ads                    even from
                                                                          equally valid
SOURCE: IFIC Foundation, 2004                                                   sources.
Most Popular Sources of Food
         and Nutrition Information
• Television                 62%
•   Magazines                48%
•   Newspapers               33%
•   Internet                 23%
•   diet books               19%
The information consumers encounter each day is filled
with messages that are often conflicting … and confusing
Difficult for consumers to determine WHO and WHAT is credible
The difficult relationship
   doctors-journalists


...”Never even whisper to a reporter
  anything you would not care to see
  in screaming headlines”...


           N Engl J Med, 1983
obesity
obesity
obesity
obesity
A Golden Opportunity for Health
                  Professionals
Nutrition Sources Rated “Very Valuable” by consumers

                   Doctors                                        92%
       Registered dietitians                                     90%
               Nutritionists                                     90%
                 Magazines                                      87%
                    Nurses                                    85%
               Newspapers                                  82%
                   TV news                                79%
         Family and friends                         69%
                Radio news                        65%
        Other non-news TV                     61%
                    Internet                  61%

ADA Trends Survey 2000     0%   20%   40%   60%         80%         100%
Thank you for your attention

More Related Content

Recently uploaded

BRIGADA ESKWELA OPENING PROGRAM KICK OFF.pptx
BRIGADA ESKWELA OPENING PROGRAM KICK OFF.pptxBRIGADA ESKWELA OPENING PROGRAM KICK OFF.pptx
BRIGADA ESKWELA OPENING PROGRAM KICK OFF.pptx
kambal1234567890
 
formative Evaluation By Dr.Kshirsagar R.V
formative Evaluation By Dr.Kshirsagar R.Vformative Evaluation By Dr.Kshirsagar R.V
formative Evaluation By Dr.Kshirsagar R.V
DrRavindrakshirsagar1
 
ENGLISH-7-CURRICULUM MAP- MATATAG CURRICULUM
ENGLISH-7-CURRICULUM MAP- MATATAG CURRICULUMENGLISH-7-CURRICULUM MAP- MATATAG CURRICULUM
ENGLISH-7-CURRICULUM MAP- MATATAG CURRICULUM
HappieMontevirgenCas
 
Imagination in Computer Science Research
Imagination in Computer Science ResearchImagination in Computer Science Research
Imagination in Computer Science Research
Abhik Roychoudhury
 
Odoo 17 Social Marketing - Lead Generation On Facebook
Odoo 17 Social Marketing - Lead Generation On FacebookOdoo 17 Social Marketing - Lead Generation On Facebook
Odoo 17 Social Marketing - Lead Generation On Facebook
Celine George
 
C# Interview Questions PDF By ScholarHat.pdf
C# Interview Questions PDF By ScholarHat.pdfC# Interview Questions PDF By ScholarHat.pdf
C# Interview Questions PDF By ScholarHat.pdf
Scholarhat
 
How To Create a Transient Model in Odoo 17
How To Create a Transient Model in Odoo 17How To Create a Transient Model in Odoo 17
How To Create a Transient Model in Odoo 17
Celine George
 
C Interview Questions PDF By Scholarhat.pdf
C Interview Questions PDF By Scholarhat.pdfC Interview Questions PDF By Scholarhat.pdf
C Interview Questions PDF By Scholarhat.pdf
Scholarhat
 
Webinar Innovative assessments for SOcial Emotional Skills
Webinar Innovative assessments for SOcial Emotional SkillsWebinar Innovative assessments for SOcial Emotional Skills
Webinar Innovative assessments for SOcial Emotional Skills
EduSkills OECD
 
How to Create Sequence Numbers in Odoo 17
How to Create Sequence Numbers in Odoo 17How to Create Sequence Numbers in Odoo 17
How to Create Sequence Numbers in Odoo 17
Celine George
 
matatag curriculum education for Kindergarten
matatag curriculum education for Kindergartenmatatag curriculum education for Kindergarten
matatag curriculum education for Kindergarten
SarahAlie1
 
Principles of Roods Approach!!!!!!!.pptx
Principles of Roods Approach!!!!!!!.pptxPrinciples of Roods Approach!!!!!!!.pptx
Principles of Roods Approach!!!!!!!.pptx
ibtesaam huma
 
The basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxThe basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptx
heathfieldcps1
 
SEQUNCES Lecture_Notes_Unit4_chapter11_sequence
SEQUNCES  Lecture_Notes_Unit4_chapter11_sequenceSEQUNCES  Lecture_Notes_Unit4_chapter11_sequence
SEQUNCES Lecture_Notes_Unit4_chapter11_sequence
Murugan Solaiyappan
 
Lecture_Notes_Unit4_Chapter_8_9_10_RDBMS for the students affiliated by alaga...
Lecture_Notes_Unit4_Chapter_8_9_10_RDBMS for the students affiliated by alaga...Lecture_Notes_Unit4_Chapter_8_9_10_RDBMS for the students affiliated by alaga...
Lecture_Notes_Unit4_Chapter_8_9_10_RDBMS for the students affiliated by alaga...
Murugan Solaiyappan
 
2024 KWL Back 2 School Summer Conference
2024 KWL Back 2 School Summer Conference2024 KWL Back 2 School Summer Conference
2024 KWL Back 2 School Summer Conference
KlettWorldLanguages
 
How to Manage Access Rights & User Types in Odoo 17
How to Manage Access Rights & User Types in Odoo 17How to Manage Access Rights & User Types in Odoo 17
How to Manage Access Rights & User Types in Odoo 17
Celine George
 
1-NLC-MATH7-Consolidation-Lesson1 2024.pptx
1-NLC-MATH7-Consolidation-Lesson1 2024.pptx1-NLC-MATH7-Consolidation-Lesson1 2024.pptx
1-NLC-MATH7-Consolidation-Lesson1 2024.pptx
AnneMarieJacildo
 
DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY N...
DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY N...DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY N...
DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY N...
thanhluan21
 
Year-to-Date Filter in Odoo 17 Dashboard
Year-to-Date Filter in Odoo 17 DashboardYear-to-Date Filter in Odoo 17 Dashboard
Year-to-Date Filter in Odoo 17 Dashboard
Celine George
 

Recently uploaded (20)

BRIGADA ESKWELA OPENING PROGRAM KICK OFF.pptx
BRIGADA ESKWELA OPENING PROGRAM KICK OFF.pptxBRIGADA ESKWELA OPENING PROGRAM KICK OFF.pptx
BRIGADA ESKWELA OPENING PROGRAM KICK OFF.pptx
 
formative Evaluation By Dr.Kshirsagar R.V
formative Evaluation By Dr.Kshirsagar R.Vformative Evaluation By Dr.Kshirsagar R.V
formative Evaluation By Dr.Kshirsagar R.V
 
ENGLISH-7-CURRICULUM MAP- MATATAG CURRICULUM
ENGLISH-7-CURRICULUM MAP- MATATAG CURRICULUMENGLISH-7-CURRICULUM MAP- MATATAG CURRICULUM
ENGLISH-7-CURRICULUM MAP- MATATAG CURRICULUM
 
Imagination in Computer Science Research
Imagination in Computer Science ResearchImagination in Computer Science Research
Imagination in Computer Science Research
 
Odoo 17 Social Marketing - Lead Generation On Facebook
Odoo 17 Social Marketing - Lead Generation On FacebookOdoo 17 Social Marketing - Lead Generation On Facebook
Odoo 17 Social Marketing - Lead Generation On Facebook
 
C# Interview Questions PDF By ScholarHat.pdf
C# Interview Questions PDF By ScholarHat.pdfC# Interview Questions PDF By ScholarHat.pdf
C# Interview Questions PDF By ScholarHat.pdf
 
How To Create a Transient Model in Odoo 17
How To Create a Transient Model in Odoo 17How To Create a Transient Model in Odoo 17
How To Create a Transient Model in Odoo 17
 
C Interview Questions PDF By Scholarhat.pdf
C Interview Questions PDF By Scholarhat.pdfC Interview Questions PDF By Scholarhat.pdf
C Interview Questions PDF By Scholarhat.pdf
 
Webinar Innovative assessments for SOcial Emotional Skills
Webinar Innovative assessments for SOcial Emotional SkillsWebinar Innovative assessments for SOcial Emotional Skills
Webinar Innovative assessments for SOcial Emotional Skills
 
How to Create Sequence Numbers in Odoo 17
How to Create Sequence Numbers in Odoo 17How to Create Sequence Numbers in Odoo 17
How to Create Sequence Numbers in Odoo 17
 
matatag curriculum education for Kindergarten
matatag curriculum education for Kindergartenmatatag curriculum education for Kindergarten
matatag curriculum education for Kindergarten
 
Principles of Roods Approach!!!!!!!.pptx
Principles of Roods Approach!!!!!!!.pptxPrinciples of Roods Approach!!!!!!!.pptx
Principles of Roods Approach!!!!!!!.pptx
 
The basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxThe basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptx
 
SEQUNCES Lecture_Notes_Unit4_chapter11_sequence
SEQUNCES  Lecture_Notes_Unit4_chapter11_sequenceSEQUNCES  Lecture_Notes_Unit4_chapter11_sequence
SEQUNCES Lecture_Notes_Unit4_chapter11_sequence
 
Lecture_Notes_Unit4_Chapter_8_9_10_RDBMS for the students affiliated by alaga...
Lecture_Notes_Unit4_Chapter_8_9_10_RDBMS for the students affiliated by alaga...Lecture_Notes_Unit4_Chapter_8_9_10_RDBMS for the students affiliated by alaga...
Lecture_Notes_Unit4_Chapter_8_9_10_RDBMS for the students affiliated by alaga...
 
2024 KWL Back 2 School Summer Conference
2024 KWL Back 2 School Summer Conference2024 KWL Back 2 School Summer Conference
2024 KWL Back 2 School Summer Conference
 
How to Manage Access Rights & User Types in Odoo 17
How to Manage Access Rights & User Types in Odoo 17How to Manage Access Rights & User Types in Odoo 17
How to Manage Access Rights & User Types in Odoo 17
 
1-NLC-MATH7-Consolidation-Lesson1 2024.pptx
1-NLC-MATH7-Consolidation-Lesson1 2024.pptx1-NLC-MATH7-Consolidation-Lesson1 2024.pptx
1-NLC-MATH7-Consolidation-Lesson1 2024.pptx
 
DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY N...
DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY N...DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY N...
DANH SÁCH THÍ SINH XÉT TUYỂN SỚM ĐỦ ĐIỀU KIỆN TRÚNG TUYỂN ĐẠI HỌC CHÍNH QUY N...
 
Year-to-Date Filter in Odoo 17 Dashboard
Year-to-Date Filter in Odoo 17 DashboardYear-to-Date Filter in Odoo 17 Dashboard
Year-to-Date Filter in Odoo 17 Dashboard
 

Featured

2024 State of Marketing Report – by Hubspot
2024 State of Marketing Report – by Hubspot2024 State of Marketing Report – by Hubspot
2024 State of Marketing Report – by Hubspot
Marius Sescu
 
Everything You Need To Know About ChatGPT
Everything You Need To Know About ChatGPTEverything You Need To Know About ChatGPT
Everything You Need To Know About ChatGPT
Expeed Software
 
Product Design Trends in 2024 | Teenage Engineerings
Product Design Trends in 2024 | Teenage EngineeringsProduct Design Trends in 2024 | Teenage Engineerings
Product Design Trends in 2024 | Teenage Engineerings
Pixeldarts
 
How Race, Age and Gender Shape Attitudes Towards Mental Health
How Race, Age and Gender Shape Attitudes Towards Mental HealthHow Race, Age and Gender Shape Attitudes Towards Mental Health
How Race, Age and Gender Shape Attitudes Towards Mental Health
ThinkNow
 
AI Trends in Creative Operations 2024 by Artwork Flow.pdf
AI Trends in Creative Operations 2024 by Artwork Flow.pdfAI Trends in Creative Operations 2024 by Artwork Flow.pdf
AI Trends in Creative Operations 2024 by Artwork Flow.pdf
marketingartwork
 
Skeleton Culture Code
Skeleton Culture CodeSkeleton Culture Code
Skeleton Culture Code
Skeleton Technologies
 
PEPSICO Presentation to CAGNY Conference Feb 2024
PEPSICO Presentation to CAGNY Conference Feb 2024PEPSICO Presentation to CAGNY Conference Feb 2024
PEPSICO Presentation to CAGNY Conference Feb 2024
Neil Kimberley
 
Content Methodology: A Best Practices Report (Webinar)
Content Methodology: A Best Practices Report (Webinar)Content Methodology: A Best Practices Report (Webinar)
Content Methodology: A Best Practices Report (Webinar)
contently
 
How to Prepare For a Successful Job Search for 2024
How to Prepare For a Successful Job Search for 2024How to Prepare For a Successful Job Search for 2024
How to Prepare For a Successful Job Search for 2024
Albert Qian
 
Social Media Marketing Trends 2024 // The Global Indie Insights
Social Media Marketing Trends 2024 // The Global Indie InsightsSocial Media Marketing Trends 2024 // The Global Indie Insights
Social Media Marketing Trends 2024 // The Global Indie Insights
Kurio // The Social Media Age(ncy)
 
Trends In Paid Search: Navigating The Digital Landscape In 2024
Trends In Paid Search: Navigating The Digital Landscape In 2024Trends In Paid Search: Navigating The Digital Landscape In 2024
Trends In Paid Search: Navigating The Digital Landscape In 2024
Search Engine Journal
 
5 Public speaking tips from TED - Visualized summary
5 Public speaking tips from TED - Visualized summary5 Public speaking tips from TED - Visualized summary
5 Public speaking tips from TED - Visualized summary
SpeakerHub
 
ChatGPT and the Future of Work - Clark Boyd
ChatGPT and the Future of Work - Clark Boyd ChatGPT and the Future of Work - Clark Boyd
ChatGPT and the Future of Work - Clark Boyd
Clark Boyd
 
Getting into the tech field. what next
Getting into the tech field. what next Getting into the tech field. what next
Getting into the tech field. what next
Tessa Mero
 
Google's Just Not That Into You: Understanding Core Updates & Search Intent
Google's Just Not That Into You: Understanding Core Updates & Search IntentGoogle's Just Not That Into You: Understanding Core Updates & Search Intent
Google's Just Not That Into You: Understanding Core Updates & Search Intent
Lily Ray
 
How to have difficult conversations
How to have difficult conversations How to have difficult conversations
How to have difficult conversations
Rajiv Jayarajah, MAppComm, ACC
 
Introduction to Data Science
Introduction to Data ScienceIntroduction to Data Science
Introduction to Data Science
Christy Abraham Joy
 
Time Management & Productivity - Best Practices
Time Management & Productivity -  Best PracticesTime Management & Productivity -  Best Practices
Time Management & Productivity - Best Practices
Vit Horky
 
The six step guide to practical project management
The six step guide to practical project managementThe six step guide to practical project management
The six step guide to practical project management
MindGenius
 
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
RachelPearson36
 

Featured (20)

2024 State of Marketing Report – by Hubspot
2024 State of Marketing Report – by Hubspot2024 State of Marketing Report – by Hubspot
2024 State of Marketing Report – by Hubspot
 
Everything You Need To Know About ChatGPT
Everything You Need To Know About ChatGPTEverything You Need To Know About ChatGPT
Everything You Need To Know About ChatGPT
 
Product Design Trends in 2024 | Teenage Engineerings
Product Design Trends in 2024 | Teenage EngineeringsProduct Design Trends in 2024 | Teenage Engineerings
Product Design Trends in 2024 | Teenage Engineerings
 
How Race, Age and Gender Shape Attitudes Towards Mental Health
How Race, Age and Gender Shape Attitudes Towards Mental HealthHow Race, Age and Gender Shape Attitudes Towards Mental Health
How Race, Age and Gender Shape Attitudes Towards Mental Health
 
AI Trends in Creative Operations 2024 by Artwork Flow.pdf
AI Trends in Creative Operations 2024 by Artwork Flow.pdfAI Trends in Creative Operations 2024 by Artwork Flow.pdf
AI Trends in Creative Operations 2024 by Artwork Flow.pdf
 
Skeleton Culture Code
Skeleton Culture CodeSkeleton Culture Code
Skeleton Culture Code
 
PEPSICO Presentation to CAGNY Conference Feb 2024
PEPSICO Presentation to CAGNY Conference Feb 2024PEPSICO Presentation to CAGNY Conference Feb 2024
PEPSICO Presentation to CAGNY Conference Feb 2024
 
Content Methodology: A Best Practices Report (Webinar)
Content Methodology: A Best Practices Report (Webinar)Content Methodology: A Best Practices Report (Webinar)
Content Methodology: A Best Practices Report (Webinar)
 
How to Prepare For a Successful Job Search for 2024
How to Prepare For a Successful Job Search for 2024How to Prepare For a Successful Job Search for 2024
How to Prepare For a Successful Job Search for 2024
 
Social Media Marketing Trends 2024 // The Global Indie Insights
Social Media Marketing Trends 2024 // The Global Indie InsightsSocial Media Marketing Trends 2024 // The Global Indie Insights
Social Media Marketing Trends 2024 // The Global Indie Insights
 
Trends In Paid Search: Navigating The Digital Landscape In 2024
Trends In Paid Search: Navigating The Digital Landscape In 2024Trends In Paid Search: Navigating The Digital Landscape In 2024
Trends In Paid Search: Navigating The Digital Landscape In 2024
 
5 Public speaking tips from TED - Visualized summary
5 Public speaking tips from TED - Visualized summary5 Public speaking tips from TED - Visualized summary
5 Public speaking tips from TED - Visualized summary
 
ChatGPT and the Future of Work - Clark Boyd
ChatGPT and the Future of Work - Clark Boyd ChatGPT and the Future of Work - Clark Boyd
ChatGPT and the Future of Work - Clark Boyd
 
Getting into the tech field. what next
Getting into the tech field. what next Getting into the tech field. what next
Getting into the tech field. what next
 
Google's Just Not That Into You: Understanding Core Updates & Search Intent
Google's Just Not That Into You: Understanding Core Updates & Search IntentGoogle's Just Not That Into You: Understanding Core Updates & Search Intent
Google's Just Not That Into You: Understanding Core Updates & Search Intent
 
How to have difficult conversations
How to have difficult conversations How to have difficult conversations
How to have difficult conversations
 
Introduction to Data Science
Introduction to Data ScienceIntroduction to Data Science
Introduction to Data Science
 
Time Management & Productivity - Best Practices
Time Management & Productivity -  Best PracticesTime Management & Productivity -  Best Practices
Time Management & Productivity - Best Practices
 
The six step guide to practical project management
The six step guide to practical project managementThe six step guide to practical project management
The six step guide to practical project management
 
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
 

obesity

  • 1. FANUS Conference Abuja, Nigeria 2011 The Obesity Epidemic Pilar Riobo , MD, PhD Madrid , Spain
  • 3. Today discussion points • Prevalence and Metabolic Syndrome • Causes of obesity – Excessive Caloric intake – Psychological factors (binge eating, nocturnal eating synd) – Social factors:  Excesive TV watching and videogames  Family meals protective  No breastfeeding  Short sleep duration  Light during night time  Friends and environment – Female obesity – Communication oportunities in nutrition
  • 4. The Rising Rate of Childhood Obesity is Alarming 30% of children are overweight or at risk for overweight
  • 5. Obesity Today: Future Impact “Because of increasing rates of obesity…we may see the first generation that will be less healthy and have a shorter life expectancy than their parents.” Surgeon General Richard Carmona
  • 6. Prevalence of obesity in children in granada, spain González Jiménez, et al. Nutr Hosp 2011
  • 7. ALADINO STUDY. SPAIN 6-10 years old children
  • 8. Prevalence of overweight and obesity in European countries Where is the mediterranean diet?
  • 9. Relation between BMI and chronic diseases (NHS and PHS) Type 2 diabetes Cholelithiasis Hypertension Coronary heart disease Women Men 6 5 Relative Risk 4 3 2 1 0 <21 22 23 24 25 26 27 28 29 30 <21 22 23 24 25 26 27 28 29 30 Body Mass Index (kg/m2) Body Mass Index (kg/m2) Willett WC, et al. N Engl J Med. 1999;341:427–434.
  • 10. Obesity and overweight have been reported to be associated with large decreases in life expectancy. Non-smoking women Smoking women Non-smoking men Smoking men Framingham Heart Study 13.7 Non-smoking women lost 7 years, 5.82 Non-smoking men 5.8 years 13.3 7.08 0 5 10 15 Implications of obesity at age 40 on life expectancy. Peeters, A, et al. Ann Int Med 2003;138:24-32.
  • 11. Obesity is associated with increased risk for most cancers 1.44 Multiple myeloma (>35) 1.46 Colon & Rectum (>40) Type of Cancer (Highest BMI category) 1.51 Ovary (>35) 1.68 Liver (>35) 1.88 All Cancers (>40) 1.95 Non-Hodgkin’s Lymphoma (>35) 2.12 Breast (>40) 2.13 Gallbladder (>30) 2.51* All Other Cancers (>40) 2.64* Oesophagus (>30) 2.76 Pancreas (>40) 3.20 Cervix (>35) 4.75 Kidney (>40) 6.25 Uterus (>40) 0 1 2 3 4 5 6 7 8 9 10 11 Relative Risk of Death (95% Confidence Interval) Calle E et al. N Engl J Med 2003;348:1625-1638 Mortality from Cancer According to BMI >30->40 for U.S. Women in the Cancer Prevention Study II, 1982 through 1998
  • 12. Risk of Alzheimer’s disease (AD) in elderly with and without metabolic syndrome 980 elderly subjects (337 male,622 female; 69-78) 13 cases AD in men 32 in women With metabolic syndrome Without metabolic syndrome 9 P<0.001 Prevalence Alzheimer's disease (%) 8 7 6 5 4 3 2 1 0 Women Men Vanhanen M, et al. Neurology 2006.67:843-47 Increased risk for cognitive dysfunction and dementia in elder women
  • 17. Obesity and other risk factors Blood HDL-C PCRP pressure pro-thrombotic T-Cholesterol-t OBESITY factors Insulín Diabetes Resistance TG,Lp(a) sdLDL
  • 18. Hypertension and Obesity Direct and lineal relationship 20 25 30 35 40 IMC Prevalence10.6% (BMI<20), 13.3% (BMI 20-25), 22.8% (BMI 30-40) y 61.3% (BMI>40). Australian Longitudinal Study on Women’s Health Brown WJ et al. Int J Obes 1998;22:520-528.
  • 19. Diabetes and Obesity 20 25 30 35 40 IMC Brown WJ et al. Int J Obes 1998;22:520-528.
  • 21. ATP III Criteria for Identification of the Metabolic Syndrome Abdominal obesity (waist circumference) Men >102 cm Women >88 cm Triglycerides 150 mg/dL HDL cholesterol Men <40 mg/dL Women <50 mg/dL Blood pressure >130 / 85 mm Hg Fasting glucose >110 mg/dL Diagnosis of the metabolic syndrome is made when 3 or more of the risk determinants shown above are present.
  • 22. How Common is the Metabolic Syndrome? • 24% all adults • 42% over age 60 yrs
  • 23. But...., …individuals who are genetically predisposed to insulin resistance may forestall or even prevent the development of diabetes by staying thin and physically active.
  • 24. What’s the Cause of Obesity? There is sometimes a tendency to focus on one specific CAUSE …. But… …there’s no simple answer to this complex issue…
  • 25. The Biological Cause of Obesity is Simple An imbalance of calories IN and calories OUT! But…
  • 26. …The Social Factors that lead to the Imbalance are Complex • Changing food habits due to busy lifestyles • Declining physical activity during work and leisure time • Changing physical environment (urban, safety) • Decreased sleep duration • Hedonic and reward aspects of food • Psychological problems • Side effects of common drugs
  • 27. Weight Issues It’s Much More than ENERGY BALANCE Social factors play a role
  • 28. Popularity of low-carb diets that 28 blame carbohydrates and sugar for everything ?
  • 30. Low-carb, high-protein, high-fat vs. conventional hypocaloric diet PRCT, 63 obese Low-carb lost more weight at 3 and 6 months but was similar at 12 months Foster GD et al. N Engl J Med 2003; 48:2082-2090
  • 31. CARMEN Study . investigated the effects of replacing one-quarter of daily fat intake by complex or simple CH Energy intake was ad libitum A low-fat, high-polysaccharide diet led to long-term moderate weight loss and improved serum cholesterol Increasing simple carbohydrates did not promote weight gain Poppitt S D et al. Am J Clin Nutr 2002;75:11-20
  • 32. 18000 U.S. male physicians reported measures of breakfast, cereal intake, weight After13 years of follow-up, BMI and weight gain were inversely associated with intake of breakfast cereals, independently of other risk factors. Obes Res. 2005; 13:1952–1960
  • 33. Fructose intake correlates closely with the rate of diabetes worldwide Bray GA. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. Am J Clin Nutr 2004; 79: 537-543.
  • 34. Could Excessive Fructose Intake (>50 g/d) cause metabolic syndrome? The primary sources of fructose are table sugar (sucrose) and high fructose corn syrup. Unlike other sugars, the ingestion of excessive fructose induces features of metabolic syndrome in laboratory animals Fructose appears to mediate the metabolic syndrome in part by raising uric acid
  • 35. Could Excessive Fructose Intake and Uric Acid Cause Type 2 Diabetes?
  • 36. Fat makes us fat?? Direct relationship between fat intake and weight: Higher caloric content/gram Difficult oxidation compared to carbs (Carbs are inmediatly oxidated) Higher palatability promotes increased consumption
  • 37. Psychological problems severe depression in 32% suicidal risk in 23%. Anxiety : 50% Binge eating disorder (BED) : 1–4% of general population and about 30% of obese subjects attending weight control programs Night Eating Syndrome (NES) : morning anorexia, evening hyperphagia, and insomnia with awakenings followed by nocturnal food ingestion. Lester D. Depression and suicidality in obese patients. Psychol Rep.2011:108(2):367-8.
  • 38. Psycohological problems at first visit assessment of patients at obesity clinic: • Elevated scores for depression in 48% • Elevated scores for anxiety in 56% • Personality trait overlapping with eating disorders in 22% • Elevated scores for bulimia in 11.5% • Significant impairment in quality of life in 30% A Tuthill et al. Q J Med, 2006: 9
  • 39. Neurobiological mechanisms underlying food intake Brain dopamine, which regulates motivation for food intake, is likely to be involved Obese individuals overeat to compensate for a reward deficit Have fewer striatal D2 receptors and show less striatal response to palatable food intake Coronal section showing less activation in the right caudate in the weight-gain group versus the weight- stable group during milkshake receipt–tasteless intake Stice E et al. J. Neurosci. 2010;30:13105-13109
  • 40. Short sleep and sleep abnormalities 244 children, age 3 to 7. Each additional hour of sleep at ages 3-5 was associated with a reduction in BMI of 0.48 and a reduced risk of being overweight of 0.39
  • 41. After 32 years follow-up, shorter childhood sleep times were significantly associated with higher adult BMI
  • 42. The potential mechanisms through which short sleep duration could result in obesity. Taheri S Arch Dis Child 2006;91:881-884
  • 43. Weight gain as side effect of drugs Anti-depresants and psychotropic Anti-histaminics Corticoids Beta-blockers Contraceptives ........
  • 44. Antipsychotic drugs After a median of 11weeks treatment, weight increased by: 8.5 kg with conventional antipsychotic drugs 6.1 kg with quetiapine 5.3 kg with risperidone 4.4 kg with aripiprazole Correl et al. JAMA, 2009;302:16 1765
  • 45. Contraceptives Daily energy intake was higher and resting metabolic rate was lower in both follicular and luteal phases after medroxyprogesterone compared with placebo
  • 46. Prolonged breast-feeding protects mothers from later-life obesity 20 years after their last pregnancy, women who had breast-fed for less than 6 months had higher fat mass percentage, than mothers who had breast-fed for longer than 6 months But rates of breast feeding are low Wiklund P et al. Public Health Nutr. 2011;23:1-8
  • 47. Frequency of Shared Family Meals sharing 3 or more family meals per week reduces odds overweight (12%), eating disorders (35%) Pediatrics 2011;127:e1565
  • 48. Light at night increases body mass in mice • compared with mice in a standard light/dark cycle, • despite equivalent levels of caloric intake and total daily activity output. • Nocturnal rodents typically eat substantially more food at night Exposure to nighttime lighting and the resulting changes in the daily pattern of food intake and activity also may be contributing factors to obesity pandemic ?? Fonken LK. Proc Natl Acad Sci. 2010; 26:18664-9.
  • 49. Activity Level and Risk of Overweight Professionals Health Study Men watching 21 or more hours of TV per week were over 40% more likely to become overweight than were men viewing 1 hour per week Ching P. Am J Public Health 1996
  • 50. The increased time spent in sedentary screen-based activities has also been implicated as contributing to overweight and obesity .
  • 51. Television (TV) viewing: the dominant recreational pastime at all ages Higher TV viewing hours are associated - higher body mass index (BMI), - lower levels of fitness - higher blood cholesterol levels. Potential mediators of the effect: - less time for physical activity - reduced resting metabolic rate - increased energy intake (eating while watching TV and exposure to marketing of energy dense foods).
  • 52. Children who watched the most television during childhood had the greatest increase in body fat over time By age 11, children who watched 3.0 h or more television per day had a mean sum of skinfolds higher (106.2mm, vs 76.5mm) than those who watched less than 2 per day
  • 53. 70 children randomized to reduce their television viewing and computer use by 50% vs control In the intervention group, reductions in BMI and energy intake were shown Epstein. ARCH PEDIATR ADOLESC MED/ 2008
  • 54. 70 children randomized to an intervention to reduce their television viewing and computer use by 50% vs control Reducing television viewing and computer use may have an important role in preventing childhood obesity In the intervention group, reductions in BMI and energy intake were shown Epstein. ARCH PEDIATR ADOLESC MED/ 2008
  • 55. Effects of active video games on body composition a randomized controlled trial BMI from baseline, at 24 wk control group increased 0.34 intervention group reduction−0.24 change in BMI by ethnic subgroup]. Small but definite effect on BMI and body composition in overweight and obese children at 24 wk Maddison R et al. Am J Clin Nutr 2011;94:156-163
  • 56. Friends Framingham Heart Study cohort Among married couples, when an alter became obese, the spouse was 37% more likely to become obese. If an ego stated that an alter was his friend, the ego’s chances of becoming obese increase by 57% if the alter became obese. Between mutual friends, the ego’s risk of obesity increased by 171%
  • 57. Having obese social contacts might lead to adopt specific behaviors Could obesity be considered contagious???
  • 58. Female obesity rates of obesity are higher in Effects during women pregnancy on offspring Metabolic effects during pregnancy In an obesogenic environment, women are at greater risk for obesity . Transgenerational issues: Nutrition during fetal and early life can influence risk for obesity on offspring
  • 59. Obesity and pregnancy Medical Complications Technical Complications Early Miscarriage Difficult ultrasound pregnancy Twinning  pregnancy induced hypertension GDM occurs in ~4% of pregnancies  pre-eclampsia Antenatal  gestational diabetes Overweight women have 17% risk  venous thromboembolism Higher rates for  induction of labor Operative: higher rates c-section Intrapartum  planned and acute c-section infection, bleeding and thrombosis  assisted delivery Anesthesia  vaginal tears Postpartum Macrosomia, congenital Hemorrhage, infection, venous thromboembolism Fetal abnormalities, fetal distress, Birth injury Macrosomia, morbidity and mortality perinatal congenital abnormalities, fetal Fetal distress, perinatal morbidity and mortality Birth injury
  • 60. Body Mass Index predicts infertility in women with and without PCOS 4.0 3.5 With PCOS 3.0 Relative Risk 2.5 2.0 1.5 1.0 0.5 Without PCOS 0 <16 16-17.9 18-19.9 20-21.0 22-23.9 24-25.9 26-27.9 28-29.9 30-31.9 >32 35 BMI at Age 18 Adapted from Rich-Edwards JW, Goldman MB, Willett WC, et al. Am J Obstet Gynecol 1994;171:171-7
  • 61. Diabetes epidemic 300 300 millions 250 Millones de personas 200 135 millions 150 154 millionsio 100 50 0 1995 2000 2025 King H. Diabetes Care 1998
  • 62. Increasing Prevalence of Diabetes from 1990 to 2000
  • 64. Insulin Resistance: A Primary Factor in Type 2 Diabetes – Condition in which greater than normal amounts of insulin are required to produce a normal biological response Olefsky JM. In: Ellenberg and Rifkin’s Diabetes Mellitus. 5th ed. 1997:513-552.
  • 66. Diabetes Mellitus Health Impact of the Disease 6th leading cause of death Renal Life expectancy failure* 5 to 10 yr Blindness* Cardiovascular Diabetes disease 2X to 4X Nerve damage in Amputation* 60% to 70% of patients *Diabetes is the no. 1 cause of renal failure, new cases of blindness, and nontraumatic amputations Diabetes Statistics. October 1995 (updated 1997). NIDDK publication NIH 96-3926. Harris MI. In: Diabetes in America. 2nd ed. 1995:1-13.
  • 67. Decreased sleep duration or quality may increase diabetes risk Selective suppression of SWS, without any change in total sleep time, results in marked decreases in insulin sensitivity, leading to reduced glucose tolerance and increased diabetes risk Tasali et al. Slow-wave sleep and the risk of type 2 diabetes in humans PNAS, 2008; 105 1044–1049
  • 68. Diabetes prevention studies • Malmo Preventive Trial withDiet&Exercise • DaQuing IGT • Orlistat • SOS (Swedish Obese Subjects) • Finnish Diabetes Prevention • Diabetes Prevention Program • TRIPOD • STOP-NIDDM
  • 70. EXERCISE IS GOOD MEDICINE
  • 71. But, changing habits is not easy
  • 72. So, it’s critical that nutrition communicators help people and provide motivating tips so they can adopt more healthful habits
  • 73. But consumers are confused about who and what to believe when it comes to nutrition …
  • 74. Many people find it Consumers are difficult to separate bombarded with Web valid nutrition Food Sites TV and recommendations Radio information from Labels News from fad diet advice. a variety of sources. Popular Medical Magazines Consumer Experts Media Fad Diet Nutrition Images Gurus information is Friends and Food often seen as contradictory, Family Gov’t Guidelines Ads even from equally valid SOURCE: IFIC Foundation, 2004 sources.
  • 75. Most Popular Sources of Food and Nutrition Information • Television 62% • Magazines 48% • Newspapers 33% • Internet 23% • diet books 19% The information consumers encounter each day is filled with messages that are often conflicting … and confusing Difficult for consumers to determine WHO and WHAT is credible
  • 76. The difficult relationship doctors-journalists ...”Never even whisper to a reporter anything you would not care to see in screaming headlines”... N Engl J Med, 1983
  • 81. A Golden Opportunity for Health Professionals Nutrition Sources Rated “Very Valuable” by consumers Doctors 92% Registered dietitians 90% Nutritionists 90% Magazines 87% Nurses 85% Newspapers 82% TV news 79% Family and friends 69% Radio news 65% Other non-news TV 61% Internet 61% ADA Trends Survey 2000 0% 20% 40% 60% 80% 100%
  • 82. Thank you for your attention