This document discusses obesity, overweight, and their health risks. It defines obesity as a BMI of 30 or higher, or excessive body fat. Obesity is estimated to exceed smoking as a leading cause of preventable death. While genetics play a role, lifestyle factors like diet and exercise are the primary determinants of weight gain. Maintaining a healthy weight through a balanced diet and regular physical activity can help prevent obesity-related diseases like heart disease, diabetes, and some cancers. Treatment involves lifestyle modifications like diet, exercise and behavior therapy, while very severe obesity may also be treated with medications or surgery in some cases.

1. OBESITY and OVERWEIGHT PED 4881

2. OVERWEIGHT and OBESITYAn excess of body fat frequently resulting in a significant impairment of healthHaving a very high amount of body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or higher.Estimated to be the biggest health challenge in the futureWill exceed that of smoking as a cause of deathExercise is most effective in preventing and controlling body weight and/or body fat2

3. CAUSE of DEATHS

4. Diseases associated excess body fat Coronary Heart DiseaseHypertensionDiabetesHyperlipidemiaCancerGallbladder DiseaseMenstrual IrregularitiesReproductive Hormone Dysfunction4

5. Associated Risk FactorsPredictive of CVD/CHD (especially central or visceral adiposity)Metabolic SyndromeCertain CancersHypertensionOsteoarthritis5

6. Obesity Trends Among U.S. Adults between 1985 and 2006Data shown in maps were collected through CDC’s Behavioral Risk Factor Surveillance System (BRFSS). http://www.cdc.gov/NCCDPHP/dnpa/obesity/trend/maps/index.htm6

7. US Ranks Last in Preventable Deaths, Health Affairs, 20087

8. Process of Excess Body FatStorage of extra energy adipose cellsunlimited storage capacities. No spot reductionUseful for times when food is not available Food available year-round food stores occur in excessObesity occurs when adipose cells increase excessively size (hypertrophy) number (hyperplasia)Both size and number 8

9. Theories for Fat GainCaloric Balanceyou eat more calories than you expend, you gain fatBiochemical ImbalanceHormone and other substance alteration is associated with obesitySet Point Theorybody desires to have a specific amount of bodyalways return to its own target percentage Excess Fat Intake9

10. WEIGHT CYCLINGTwice as Long to Lose Weight

11. Third the time to Regain the WeightSomatotypePear versus the Apple

12. Determining ObesityMeasure of “Body Build” or structure of the bodyMuscularityLinearityFatnessBody Mass Index (BMI) = weight (kg) / height (m2)Body size is determined by height and weightBody fat percentageSkinfolds, underwater weighing, bioelectrical impedance, etc. 12

13. Calculation of Ideal Body Weight RangeWomen: 100 lbs for first 5 feet. plus 5 lbs for each additional inchMen: 106 lbs for first 5 ft. 6lbs for each additional inchAssumes Medium Frame add/subtract 10%110% overwt.120% obeseHamwi 197413

14. BMI - ValuesDisease Risk Relative to Normal Weight and Waist CircumferenceBMI(kg/m2)<18.518.5 - 24.925.0 - 29.930.0 - 34.935.0 - 39.9>40ObesityClassIIIIIIMen (<102 cm) <40 in Women (<88 cm) <35 in ----IncreasedHighVery HighExtremely HighMen (>102 cm) >40 in Women (>88 cm) >35 in ----HighVery HighVery HighExtremely HighUnderweightNormalOverweightObesityExtreme obesityClinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. Obes Res 1998;6(suppl 2).14

15. OBESITY & MORTALITYMortality RatioHighModerateLowVeryLowBody Mass Index15

16. BMI Measurement LimitationsDoesn’t differentiate between body fat and body muscleFails to account for the location of body fatApple, pear, abdominalAs we age a slightly higher BMI may serve as a cushion against frailtyLow BMI may indicate poor nutrition or loss of muscle16

17. Defining Obesity as % Body FatAmerican Council on Exercise17

18. ChildrenBased on BMI for age and genderOverweight at or above 95th percentileAt risk for Overweight 85th to 95th percentileSource: Expert Committee on Clinical Guidelines for Overweight Adolescent Preventative Services.(Pediatrics 1998;102(3). pediatrics.aappublications.org/cgi/content/full/102/3/e2918

19. OverweightOverweightAt riskAt risk19

20. Source: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overwght99.htm20

21. 21Clinical ManagementAssess other Risk FactorsDetermine Body Mass IndexClinical Judgment Hypertension

22. Cardiovascular Diseaes

23. Dyslipidemia

24. Type 2 Diabetes

25. Sleep Apnea

26. Osteoarthritis

27. Infertility

28. Other

29. Progressive gain since adolescence

30. Hx of Obesity

31. Bulimia Nervosa

32. Binge Eating Disorder

33. Depression/Anxiety/Stress

34. Relevant medical conditions

35. Overall Disease Burden

36. Quality of Life