This document summarizes the history and current state of obesity. It begins with a case study and outlines treatment. It then reviews how obesity was once seen positively in art but now stigmatized. Obesity increased with agriculture and reduced hunger. The document defines obesity using BMI and lists its complications. It examines obesity demographics, costs, and failed diet strategies. Some diets showed modest short term weight loss but long term success is challenging due to biological and behavioral factors. Sugar intake is linked to increased obesity and chronic diseases.
This set of fifteen slides tries to share why the morbidly obese are different from the general, non-obese population.
Where other pre-anaesthetic check-ups (PAC) end, it's from there that the PAC of the morbidly or the super-obese individual starts.
Obesity is defined as excessive unhealthy accumulation of body fat. India has the third largest obese population in the world after United States of America and China. Prevalence of obesity has reached epidemic proportions in parts of India. In some urban areas, up to a third of the population is either overweight or obese. Childhood and adolescent obesity is also rising rapidly. If this trend continues, certain sections of Indian society may start seeing declining life expectancy in India after many decades of steady progress. Early diagnosis of overweight and obesity may prevent progression to more severe forms associated with complications. In this review, we examine the usefulness of Body Mass Index in diagnosis of obesity in Asian Indian population and the debate surrounding the call for a downward revision of “normal” range in this population.
The health hazards associated with obesity. Mortality morbidity
Complications related to obesity
type 2 diabetes.
high blood pressure.
heart disease and strokes.
certain types of cancer.
sleep apnea.
osteoarthritis.
fatty liver disease.
This set of fifteen slides tries to share why the morbidly obese are different from the general, non-obese population.
Where other pre-anaesthetic check-ups (PAC) end, it's from there that the PAC of the morbidly or the super-obese individual starts.
Obesity is defined as excessive unhealthy accumulation of body fat. India has the third largest obese population in the world after United States of America and China. Prevalence of obesity has reached epidemic proportions in parts of India. In some urban areas, up to a third of the population is either overweight or obese. Childhood and adolescent obesity is also rising rapidly. If this trend continues, certain sections of Indian society may start seeing declining life expectancy in India after many decades of steady progress. Early diagnosis of overweight and obesity may prevent progression to more severe forms associated with complications. In this review, we examine the usefulness of Body Mass Index in diagnosis of obesity in Asian Indian population and the debate surrounding the call for a downward revision of “normal” range in this population.
The health hazards associated with obesity. Mortality morbidity
Complications related to obesity
type 2 diabetes.
high blood pressure.
heart disease and strokes.
certain types of cancer.
sleep apnea.
osteoarthritis.
fatty liver disease.
Resurge - The Godzilla Of Offers - Resurge weight loss.Med Gaith
Resurge- The Godzilla Offers is a blend of natural products that are helpful to losing weight, boosting the immune system, increasing metabolism, and relieving stress. it is effective against problems that in one way or another are related to weight gain. It is made in the USA and approved by the Food and Drug Administration (FDA).
Cancer is not all about what we inherit-- it's also about what we eat, how much we move and even how we stay connected. This is good news! This talk reviews the evidence for how we can reduce our risk of cancer through simple lifestyle changes.
“Weight loss money is money down the toilet” – Dee Edington
Here’s an alternative…Health At Every Size (HAES)
The underlying goal of traditional approaches to weight and health is for individuals to be smaller (i.e., lose weight). Little evidence exists supporting the efficacy of such approaches and concern is mounting that they may be violating the primary health care directive of “first, do no harm.” The basic conceptual framework of the HAES philosophy includes belief in:
The naturally existing diversity in body shapes and sizes.
The ineffectiveness and dangers of dieting for weight loss.
The importance of relaxed eating in response to internal body cues.
The critical contribution of social, emotional, spiritual, and physical factors to health and happiness.
Health For Every Body: At The Worksite
Incorporating the latest research, this webinar will explore the social, political, economic and scientific foundations of the War on Obesity. The philosophical and scientific basis of an alternative, evidence-based approach for helping people with weight- and eating-related concerns to improve their self-care, self esteem and health will be introduced. An example for worksite programming will be introduced.
As a chronic disease it is prevalent in both developed and developing countries, and affecting children(10-20%) as well as adults(20-40%).Excess weight gain invites many associated diseases.
The root cause of chronic diseases, cancer and aging is recently understood. It includes 1- A state of chronic low grade inflammation secondary to hyperglycemia and obesity leading to insulin resistance. 2- Mitochondrial dysfunction. Exercise play a significant rule in the salvage of these problems. Exercise is any bodily activity that enhances or maintain physical fitness and overall health, Exercise with its Countless Benefits is the logical salvage for a group of diseases related to inactivity . In view of the prevalence, global reach and health effect of these physical inactivity related diseases, the issue should be appropriately described as pandemic, with far-reaching health, economic, social and Environmental consequences.These diseases include, Obesity, Coronary artery disease, Diabetes, Hypertension, Cancer, Depression and anxiety, Arthritis, Osteoporosis, Etc, etc, etc… I think we have no option except doing regular exercises if we seriously searching for a salvage to escape the bad and serious consequences of these new life style diseases.
Join Doc Andrew to see what's new in health research that supports plant based diet recommendations. Share your questions via @DenverWWAD or email FreemanA@njhealth.org
Andrew Freeman, MD, FACC, FACP is a cardiologist and Director of Clinical Cardiology and Operations at National Jewish Health in Denver, Colorado. He holds leadership roles in the American College of Cardiology at the local and national levels. Dr. Freeman founded Denver's chapter of the Walk with a Doc program and heads Walk with a Doc-Colorado.
Walk with a Doc-Denver is a cost-free empowerment initiative powered by people improving their health, local doctors, and other health professionals who prescribe exercise-as-medicine. The mission? To elevate community health--one walk at a time! The program's Saturday walks include expert talks, health screenings, refreshments, and motivational giveaways. For more info visit: http://walkwithadoc.org/our-locations/denver/
Resurge - The Godzilla Of Offers - Resurge weight loss.Med Gaith
Resurge- The Godzilla Offers is a blend of natural products that are helpful to losing weight, boosting the immune system, increasing metabolism, and relieving stress. it is effective against problems that in one way or another are related to weight gain. It is made in the USA and approved by the Food and Drug Administration (FDA).
Cancer is not all about what we inherit-- it's also about what we eat, how much we move and even how we stay connected. This is good news! This talk reviews the evidence for how we can reduce our risk of cancer through simple lifestyle changes.
“Weight loss money is money down the toilet” – Dee Edington
Here’s an alternative…Health At Every Size (HAES)
The underlying goal of traditional approaches to weight and health is for individuals to be smaller (i.e., lose weight). Little evidence exists supporting the efficacy of such approaches and concern is mounting that they may be violating the primary health care directive of “first, do no harm.” The basic conceptual framework of the HAES philosophy includes belief in:
The naturally existing diversity in body shapes and sizes.
The ineffectiveness and dangers of dieting for weight loss.
The importance of relaxed eating in response to internal body cues.
The critical contribution of social, emotional, spiritual, and physical factors to health and happiness.
Health For Every Body: At The Worksite
Incorporating the latest research, this webinar will explore the social, political, economic and scientific foundations of the War on Obesity. The philosophical and scientific basis of an alternative, evidence-based approach for helping people with weight- and eating-related concerns to improve their self-care, self esteem and health will be introduced. An example for worksite programming will be introduced.
As a chronic disease it is prevalent in both developed and developing countries, and affecting children(10-20%) as well as adults(20-40%).Excess weight gain invites many associated diseases.
The root cause of chronic diseases, cancer and aging is recently understood. It includes 1- A state of chronic low grade inflammation secondary to hyperglycemia and obesity leading to insulin resistance. 2- Mitochondrial dysfunction. Exercise play a significant rule in the salvage of these problems. Exercise is any bodily activity that enhances or maintain physical fitness and overall health, Exercise with its Countless Benefits is the logical salvage for a group of diseases related to inactivity . In view of the prevalence, global reach and health effect of these physical inactivity related diseases, the issue should be appropriately described as pandemic, with far-reaching health, economic, social and Environmental consequences.These diseases include, Obesity, Coronary artery disease, Diabetes, Hypertension, Cancer, Depression and anxiety, Arthritis, Osteoporosis, Etc, etc, etc… I think we have no option except doing regular exercises if we seriously searching for a salvage to escape the bad and serious consequences of these new life style diseases.
Join Doc Andrew to see what's new in health research that supports plant based diet recommendations. Share your questions via @DenverWWAD or email FreemanA@njhealth.org
Andrew Freeman, MD, FACC, FACP is a cardiologist and Director of Clinical Cardiology and Operations at National Jewish Health in Denver, Colorado. He holds leadership roles in the American College of Cardiology at the local and national levels. Dr. Freeman founded Denver's chapter of the Walk with a Doc program and heads Walk with a Doc-Colorado.
Walk with a Doc-Denver is a cost-free empowerment initiative powered by people improving their health, local doctors, and other health professionals who prescribe exercise-as-medicine. The mission? To elevate community health--one walk at a time! The program's Saturday walks include expert talks, health screenings, refreshments, and motivational giveaways. For more info visit: http://walkwithadoc.org/our-locations/denver/
Preventing diabetes and obesity in mental health disordersHealthXn
Diabetes is common in people with mental health disorders. This presentation discusses why and what therapies may worsen the disorder and how to prevent obesity and diabetes
Professor Julio Licinio opens the First National Symposium on Translational Psychiatry, 4 -5 April 2011, at The John Curtin School of Medical Research, The Australian National University.
Guide to Creating an Outline Purpose Use this document as.docxwhittemorelucilla
Guide to Creating an Outline
Purpose: Use this document as a resource and guide for creating effective outlines according to APA 6th
edition style guidelines.
Outline Formatting:
1. For first-level headings, use Roman numerals (I, II, III, etc.) and present the information using all
uppercase letters.
2. For secondary headings, begin with a capital letter and present the information using upper and
lowercase letters.
3. For tertiary headings, start with Arabic numerals and present the information using upper and
lowercase letters.
4. Create parallel wording for headings and subheadings (secondary and tertiary headings). For instance,
if the first heading starts with a noun, the second heading must also start with a noun.
5. Include more general information in the first-level headings, while more specific information in the
secondary and tertiary headings.
6. Use double spacing in the outline.
7. Refine the outline by filling in other appropriate details to make it more precise.
Sample Outline:
I. INTERNAL AND EXTERNAL STAKEHOLDERS INVOLVING IN THE DEICSION
A. Internal stakeholders
1. Employees
2. Physicians
B. External stakeholders
II. IMPACTS TO VARIOUS STAKEHOLDERS OF ACQUIRING A CT UNIT
III. INTERNAL AND EXTERNAL FACTORS IMPACTING THE DECISION -MAKING
A. Internal factors
1. Financial stability
2. Leadership and management
B. External factors
Reference
Purdue Online Writing Lab. (2014). Developing an outline. Retrieved from
https://owl.english.purdue.edu/owl/resource/544/1/
Last reviewed: June 2016
Anatomy or system affected: Abdomen, blood vessels, circulatory system, endocrine system, gastrointestinal system, heart, intestines, joints, psychic-emotional system, respiratory system, stomach
Definition: A condition in which the body carries excessive and unhealthy amounts of fat tissue, leading the individual to weigh in excess of 20 percent more than his or her ideal weight
Causes and Symptoms
Obesity is a condition in which the body accumulates an abnormally large amount of adipose tissue, or fat. It is a multifactorial, chronic disease that is rapidly increasing and having devastating effects on health worldwide, especially in high- and middle-income countries. Overweight and obesity are linked to more deaths around the globe than underweight, and obesity is a major risk factor for cardiovascular disease, diabetes, musculoskeletal disorders such as osteoarthritis, and some cancers. The disease has social, cultural, genetic, metabolic, behavioral, and psychological components. People who are obese also face stigma and discrimination in work and social settings. Obesity is preventable. Obesity and overweight are the second leading cause of preventable deaths in the United States.
Silhouettes and waist circumferences representing normal, overweight, and obese. Public domain, via Wikimedia Commons
Because it is not practical to measure body fat content directly but it is easy ...
Taking account of research around the relationship between genetics and our new ‘food environment’, Dr Robyn Toomath (endocrinologist and Clinical Director Wellington Hospital) argues that we are in the middle of an obesity epidemic which impacts widely on public health. She advocates for new approaches to obesity based not on blame or impossible personal goals, but on outcomes. She argues it is the responsibility of all to become informed and active (personally and politically), in working for change to present health policies and gives examples of what can be done.
http://dosomething.org.nz
Similar to Obesity Grand Rounds by Dr. Susan Beland (20)
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
1. Obesity Update 2014
Susan S. Beland, M.D.
Associate Professor
General Internal Medicine
2. The Case
35-year-old woman
5’4” tall, weight 190 lbs (BMI = 32.6 kg/m2)
BP 150/100
FBS 240, HbA1C 8.5%
LDL 180
Strong family history of diabetes, HTN, and CHD
Referred to dietician, started on lisinopril, metformin,
and statin; also instructed to begin a walking program.
We can treat these problems, but how successful will we
be on changing her underlying problem of obesity?
3. History of Obesity
Term “obesity” does not appear in English language
until the 17th century.
Prior to modern times, corpulence was associated
with power and influence.
Art in Middle Ages and Renaissance portrays
statuesque women (Michelangelo and Rubens).
In literature, the corpulent were portrayed as jolly
and lovable.
Not until the latter half of the 20th century did obesity
become stigmatized.
4. History of Obesity (Cont.)
Burden of disease was that of pestilence and famine for
early hunter-gatherers in prehistoric times.
Natural selection rewarded the “thrifty” genotypes of
those who could store the greatest amount of fat.
Discovery of agriculture and domestication of animals
gradually reduced the precarious food supply.
Hunger remained and the Bible is filled with food
imagery (promise of a land of milk and honey, etc.).
5. Obesity in Art and Literature
“Let me have men about me
that are fat, sleek-headed men
and such as sleep a nights.
Yon Cassius has a lean and
hungry look. He thinks too
much.”
Julius Caesar, Shakespeare
“Falstaff sweats to
death, and lards the lean
earth as he walks along”
Henry IV, Shakespeare
6. Obesity in Art and Literature
“But wait a bit,” the Oysters
cried, “before we have our chat.
For some of us are out of breath,
and all of us are fat!”
“Through the Looking Glass”, Lewis Carroll
“No woman can
ever be too rich or
too thin.”
Duchess of Windsor
8. Definition of Obesity
Body Mass Index (BMI; kg/m2) is the most helpful
measure:
Underweight = <18.5
Normal BMI = 20.0 - 24.9
Overweight = 25.0 - 29.9
Class I = 30.0 - 34.9
Class II = 35.0 - 39.9
Class III = >40.0
9. Complications of Obesity
Hypertension
Hyperlipidemia
Metabolic syndrome
Coronary heart disease
Type II diabetes
Respiratory disease (OSA)
Gastrointestinal disease (NAFLD and NASH)
Cancer
Rheumatologic disease (osteoarthritis, gout)
Psychiatric
Increased risk of mortality
12. Demographics of Obesity
Results from 2011-12 National Health and Nutrition
Examination Survey (NHANES).
9100 participants in cross-sectional national surveys.
Last survey completed in 2003-04.
Odgen et al., JAMA 311:806-814 (2014)
13. Demographics of Obesity
Overweight or obese Obese
White men 72.7% 33.4%
Black men 69.1% 37.0%
Hispanic men 77.9% 40.1%
White women 64.6% 33.7 %
Black women 82.1% 56.7%
Hispanic women 76.2%
43.3%
Overall 33.7% of men and 36.5% of women were obese,
and 6.4% overall had class III obesity.
No significant increase since the last survey in 2003-04.
14. Body-Mass Index and Cause-Specific
Mortality in 900,000 Adults: Collaborative
Analyses of 57 Prospective Studies
900,000 participants, primarily from Western Europe
and North America.
Mean age 46.
Analysis adjusted for age, sex and smoking status.
Mortality lowest at BMI of 22.5 - 25.0.
BMI 30 - 35, median survival reduced by 2 - 4 years.
BMI 40 - 45, median survival reduced by 8 - 10 years.
BMI < 22.5, excess mortality mainly due to smoking.
Prospective Studies Collaboration, Lancet 373:1083-1096 (2009)
15. Body-Mass Index and Cause-Specific
Mortality in 900,000 Adults: Collaborative
Analyses of 57 Prospective Studies (Cont.)
Overall mortality for each 5 kg/m2 increase was 30%.
40% for mortality due to vascular disease.
60-120% for diabetic, renal and hepatic mortality.
10% for neoplastic mortality.
Obesity is approaching cigarette smoking as a
leading avoidable cause of premature death.
Prospective Studies Collaboration, Lancet 373:1083-1096 (2009)
16. Body-Mass Index and Cause-Specific
Mortality in 900,000 Adults: Collaborative
Analyses of 57 Prospective Studies (Cont.)
Cause-Specific Mortality Hazard ratio
(BMI 25-50)
Ischemic heart disease 1.39
Stroke 1.39
Diabetes 2.16
Kidney disease 1.59
Liver disease 1.82
Respiratory disease 1.20
All causes 1.29
Prospective Studies Collaboration, Lancet 373:1083-1096 (2009)
17. Obesity and Mortality
In adult life, it may be easier to avoid substantial
weight gain than to lose weight.
By avoiding a further increase from 28 kg/m2 to 32
kg/m2, a typical person in early middle age would
gain ~2 years of life expectancy, and avoiding an
increase from 24 kg/m2 to 32 kg/m2, a young adult
would on average gain ~3 extra years of life.
19. Childhood Obesity
Weight >85th percentile defines overweight, and
>95th percentile defines obesity in children (based
on standard CDC thresholds).
2011-12 NHANES data:
Overall, 31.8% of children between 2-19 years
old are overweight.
16.9% are obese, with Hispanic (22.4%) and
black (20.2%) at greater risk.
Odgen et al., JAMA 311:806-814 (2014)
20. Childhood Obesity
Data from the Early Childhood Longitudinal Study,
Kindergarten Class 1998-99.
>700 participants followed through 8th grade.
At entry (mean age 5.6 yrs) 12.4% were obese and
14.9% were overweight.
By 8th grade (mean age 14.1 yrs) 20.8% were obese
and 17.0% were overweight.
Overweight 5-year-olds were 4x as likely as normal
weight children to become obese.
Cunningham et al., NEJM 370:403-411 (2014)
21. Economic Costs of Obesity
Data from US Medical Expenditure Panel Survey
Impact on annual medical costs estimated to
be $3,613 for women and $1,152 for men.
Estimate of costs of obesity-related illness is
$209.7 billion (in 2008 dollars).
20.6% of US national health expenditures are
spent in treating obesity-related illness.
Cawley & Meyerhoefer, J Health Econ 31:219-230 (2012)
22. Leptin
Control of body weight is complex, involving hormones
and neurotransmitters.
Leptin and the OB gene were discovered in 1994.
Secreted by adipocytes - signals brain to reduce food
intake.
Mouse model.
Not found to be of use clinically, as obese people have
increased leptin levels but are resistant to its effects.
23. There is No Magic Pill
FTC Cracks Down on Fad Weight-Loss Products
24. FDA-Approved Diet Pills
Phentermine: Amphetamine-like action.
Xenical (Orlistat).
Contrave (Bupropion/Naltrexone).
Qsymia (Phentermine/Topiramate).
Belviq (Lorcacerin): 5HT receptor agonist.
Concern over cardiovascular events with Qsymia and
Belviq. Post-marketing trials are not to be completed
until 2017.
Meridia (Sibutramine) was one of the most popular pills
but was taken off the market due to cardiovascular risks.
Fenfluramine/Phentermine (Fen-Phen) also banned due to
risk of pulmonary HTN and valvular heart disease.
25. FDA Approved Diet Pills (Cont.)
None is approved for long-term use.
Weight loss benefits modest at best.
FDA approval only for BMI >30 (or BMI >27,
with a weight-related illness).
26. Diets and Weight Loss
Many diet fads have come and gone over the years.
General agreement that if dieting is going to work
long-term, weight loss must be accomplished slowly
and consistently.
Diets only work if people adhere to them.
“Miracle diets” that cause acute weight loss
invariably fail.
Long-term success rates are low for many reasons:
Set-point theory of weight control.
Failure to make behavioral modifications.
Adherence to restrictive regimens diminishes with
time.
27. Comparative Effectiveness of Weight-
Loss Interventions in Clinical Practice
415 obese patients with at least one cardiovascular
risk factor recruited from primary care practices.
Two behavioral interventions:
Remote support through telephone, web site,
and email.
In-person support with group and individual
sessions + the three remote means.
Control group weight loss was self-directed.
PCP’s had a supportive role and received regular
progress reports.
Appel et al., NEJM 365:1959-1968 (2011)
28. Comparative Effectiveness of Weight-
Loss Interventions in Clinical Practice
(Cont.)
Appel et al., NEJM 365:1959-1968 (2011)
29. Effects of Low-Carbohydrate and Low-
Fat Diets: A Randomized Trial
147 adults with BMI 30 - 45.
73 randomized to low fat diet (< 30% of intake).
75 randomized to low carbohydrate diet (< 40
g/day).
Total caloric intake was similar in each group.
At 12 months, low carb group had significantly
greater weight loss (5.3 kg vs. 1.8 kg), increase
in HDL, and decrease in Framingham 10-year
CHD risk score.
Bazzano et al., Ann Intern Med 161:309-318 (2014)
30. Effects of Dietary Composition on
Energy Expenditure During Weight-Loss
Maintenance
Maintaining significant weight loss over the long
term is problematic.
Hypothesis is that weight loss leads to decline in
energy expenditure and an increase in hunger,
resulting in weight gain.
Examined effects of 3 diets on energy expenditure
after weight loss.
21 young adults with BMI >27.
Run-in diets achieved 10-15% weight loss.
Ebbeling et al., JAMA 307:2627-2634 (2012)
31. Effects of Dietary Composition on
Energy Expenditure During Weight-Loss
Maintenance (Cont.)
3 diets:
Isocaloric low-fat (60% carbs, 20% fat, & 20% protein).
Low-glycemic index (40% carbs, 40% fat, & 20%
protein).
Very low carbohydrate (10% carbs, 60% fat, & 30%
protein).
All participants were fed each diet in random order
for 4 weeks each.
Resting energy expenditure (REE) measured by
indirect calorimetry.
Ebbeling et al., JAMA 307:2627-2634 (2012)
32. Effects of Dietary Composition on
Energy Expenditure During Weight-Loss
Maintenance (Cont.)
Decrease from baseline REE was greatest in the low-fat
diet (-205 kcal/d).
Low glycemic index diet decrease was -166 kcal/d.
Very low carbohydrate decrease was -138 kcal/d.
Total energy expenditure showed a similar pattern.
Authors maintain that this study challenges the notion
that a calorie is a calorie from a metabolic perspective.
Very low carbohydrate diets are likely not to work in
practice due to adherence issues.
Moderate carbohydrate restriction seems to be of benefit.
33. Long-Term Persistence of Hormonal
Adaptations to Weight Loss
Caloric restriction results in reduction of
circulating leptin as well as other neuropeptides
that control appetite.
One year after initial weight reduction, levels of
these mediators of appetite that encourage
weight regain do not revert to the levels
recorded before weight loss.
Sumithran et al., NEJM 365:1597-1604 (2011)
34. Exercise and Weight Loss
Exercise alone does not result in significant
weight loss.
Increased activity should, however, be a part of
any weight loss strategy.
NHANES data show that about 50% of all
Americans do not have any significant physical
activity.
Even in the overweight and obese, exercise can
lower risks, especially for CHD.
37. Sugar Intake and Obesity (Cont.)
Sugar consumption has tripled worldwide over the
past 50 years, primarily due to added sugars
Sugar is added to nearly all processed foods, often in
the form of high fructose corn syrup.
High fructose corn syrup is composed of 55%
fructose, which is not vastly different from sucrose.
There is growing evidence that fructose intake is
linked to several chronic diseases:
Metabolic syndrome
Obesity
Hypertension
Dyslipidemia
Hepatic dysfunction (NASH)
38. Metabolism of Glucose and Fructose
Glucose
Insulin
Liver
Glucose-6-phosphate
Glycogen
80% Brain and muscle
2% Pyruvate Acetyl CoA
FFA’s
VLDL
Glucokinase
39. Metabolism of Glucose and Fructose
(Cont.)
Fructose (Nearly all ingested
fructose goes to the
liver)
Liver
(Only a small amount of
fructose is converted to
glycogen under normal
circumstances)
Fructose-1-phosphate
Pyruvate Acetyl CoA de novo
lipogenesis
Fructokinase
40. Fructose: It’s “Alcohol Without the Buzz”
Ethanol enters the liver through osmosis, and is
metabolized to acetaldehyde
This can generate reactive oxygen species
Large doses of ethanol result in metabolism to
acetyl CoA and the generation of FFA’s
“The dose determines the “poison”of either
ethanol or fructose, since both uniquely drive de
novo lipogenesis, leading to fatty liver,
inflammation, and insulin resistance.”
Lustig, Adv Nutr 4:226-235 (2013)
41. The Toxic Truth About Sugar
Sugar consumption is linked to a rise in non-communicable
disease.
Sugar’s effects on the body can be similar to
those of alcohol.
Regulation could include tax, limiting sales
during school hours, and/or placing age limit
on purchases.
Lustig et al., Nature 482:27-29 (2012)
42. Nation’s First Soda Tax Is Passed
Berkeley, Calif., became the first U.S. city to pass a
law taxing sugary drinks including sodas.
More than three-quarters of the votes cast were in
favor of Measure D, according to the Alameda
County Registrar of Voters. The measure will place a
1-cent-an-ounce tax on soft drinks.
In nearby San Francisco, city voters rejected a
similar measure to tax sugary drinks.
USA Today 5 Nov 14
43. F Stands for Fructose and Fat
In overweight humans, diet high in fructose (25%
of total caloric intake) promotes development of
the metabolic syndrome.
Mice lacking the enzyme fructokinase are
incapable of processing fructose.
Wild type mice fed a Western diet (high in fat and
sucrose) developed severe non-alcoholic
steatohepatitis, while the mice lacking
fructokinase did not.
Lyssiotis & Cantley, Nature 502:181-183 (2013)
44. Storm Brewing Over WHO Sugar
Proposal
Industry Backlash Expected Over Suggested Cut
12-ounce serving of Coke
contains 38 grams of sugar
and 140 calories
1 g ≈ 4 cal
1 teaspoon ≈ 4 g = 16 cal
Owens, Nature 507:150 (2014)
in Intake
45. WHO Sugar Proposal (Cont.)
In 2003, proposed guideline that no more than 10%
of daily calories should come from sugar.
Current proposal cuts this in half to 5%, citing the
need to fight obesity.
Sugar in the average person should only account
for 100 cal/day which translates to ~26 grams or 6
teaspoons
Opposed by the food industry – “If people follow
this advice, that would be very bad for business”.
Owens, Nature 507:150 (2014)
47. Summary
One-third of Americans are obese.
Obesity has a significant impact on morbidity and
mortality, approaching that of cigarette smoking.
Diets work only if adhered to and lifestyle is
modified.
Long-term maintenance of weight loss remains
problematic.
Obesity in children is increasing and fat children
tend to become fat adults.
Sugar consumption is a major factor in obesity and
related diseases due to increased caloric intake and
the effects of fructose metabolism.
There is no magic bullet - “We are what we eat.”