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Obesity A Weighty Problem

Obesity A Weighty Problem

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Obesity A Weighty Problem

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  1. ObesityA Weighty Problem

  2. The “Top 10” The Associated Press

  3. The “Top 10” alternative reasons for obesity: • Inadequate sleep. (Average sleep amounts have fallen, and many studies tie sleep deprivation to weight gain.)

  4. The “Top 10” alternative reasons for obesity: 2. Endocrine disruptors, which are substances in some foods that might alter fats in the body.

  5. The “Top 10” alternative reasons for obesity: 3. Nice temperatures. (Air conditioning and heating limit calories burned from sweating and shivering.)

  6. The “Top 10” alternative reasons for obesity: 4. Fewer people smoking. (Less appetite suppression.)

  7. The “Top 10” alternative reasons for obesity: 5. Medicines that cause weight gains

  8. The “Top 10” alternative reasons for obesity: 6. Population changes. (More middle-agers and Hispanics, who have higher obesity rates.)

  9. The “Top 10” alternative reasons for obesity: 7. Older birth moms. (That correlates with heavier children.)

  10. The “Top 10” alternative reasons for obesity: 8. Genetic influences during pregnancy

  11. The “Top 10” alternative reasons for obesity: 9. Darwinian natural selection. (Fat people out survive skinny ones).

  12. The “Top 10” alternative reasons for obesity 10. Assortative mating, or like mating with like,” Allison puts it. Translation: fat people procreating with others of the same body type, gradually skewing the population toward the heavy end.

  13. Obesity Related Morbidity • The estimated number of deaths attributable to obesity among US adults is approximately 280,000.

  14. Obesity Related Morbidity • The estimated number of deaths attributable to obesity for nonsmokers is approximately 325,000

  15. Obesity • AHA and NIH have recognized obesity as a major modifiable risk factor for CHD • Obesity is a risk factor for development of hypertension, diabetes, and dyslipidemia • Obesity also linked to insulin resistance, particular intraabdominal fat estimated by waist circumference

  16. The Theories of Obesity Fall Into Three Categories

  17. Genetic Influence of Human Variation in Body Fat

  18. Defining Obesity • Body Mass Index (BMI)= Weight divided by Height squared (kg/m 2). • Normal Weight: 18.5 to 24.9 • Overweight: 25.0 to 29.9 • Obese I: 30.0 to 34.9 • Obese II: 35.0 to 39.9 • Obese III: > 40

  19. Relationship Between Cardiovascular Disease and Their Risk Factors

  20. Disease Risk Associated with Overweight and Obesity • “Disease risk in early life is associated with respiratory conditions and several risk factors for coronary heart disease and is predictive of hypertension, diabetes, coronary heart disease and all-cause mortality.” • Other risk factors include certain types of cancers, high blood cholesterol level, gall bladder disease, and osteoarthritis.

  21. Prevalence and Risk of Obesity • NHANES III shows approximately 60% of men and 50% of women are obese or overweight, with 20% of men and 25% of women having a BMI of 30 or greater • BMI 27-29 associated with a RR of total mortality of 1.6, BMI 29-32 RR 2.1, and BMI >=32 RR 2.2 vs. BMI <19 from Nurses’ Health Study.

  22. Increasing Prevalence of Overweight and Obesity • Obesity has increased in every state, in both sexes, across all age groups, educational levels, and smoking statuses. • Over the last 3 decades there has been a 25% increase in the number of people who qualify as overweight.

  23. Percentage of Overweight and Obesity in the United States • For adults 25 years and older the percentage of people who qualify as overweight is 63% for men and 55% for women. • Specifically, 42% of men and 28% of women are overweight. While 21% of men and 27% of women are obese.

  24. Prevalence of Obesity among US Adults From Years 1991, 1993, 1995, and 1998

  25. Prevalence of Obesity among US Adults From Years 1991, 1993, 1995, and 1998

  26. Increasing Prevalence of Overweight in U.S. Adults and of Obesity

  27. Age-Adjusted Standardized Prevalence of Overweight(BMI 25–29.9) and Obesity (BMI >30) Percent BMI 25–29.9 BMI > 30 CDC/NCHS, United States, 1960-94, ages 20-74 years

  28. NHANES III Age-Adjusted Prevalence of Hypertension* According to BMI Percent *Defined as mean systolic blood pressure  140 mm Hg, as mean diastolic  90 mm Hg, or currently taking antihypertensive medication. Brown C et al. Body Mass Index and the prevalence of Risk Factors for Cardiovascular Disease (in preparation).

  29. NHANES III Age-Adjusted Prevalence of High Blood Cholesterol* According to BMI Percent *Defined as > 240 mg/dL. Brown C et al. Body Mass Index and the Prevalence of Risk Factors for Cardiovascular Disease (in preparation).

  30. NHANES III Age-Adjusted Prevalence of Low HDL-Cholesterol* According to BMI Percent *Defined as <35 mg/dL in men and <45 mg/dL in women. Brown C et al. Body Mass Index and the Prevalence of Risk Factors for Cardiovascular Disease (in preparation).

  31. Carbo-Lipo-Terrorism in the U.S. A Report To: Orange County On: 2/18/04

  32. Percent Overweight ChildrenU.S.&Orange County Percent Overweight (>95% weight/height) Year Data from the CDC & Prevention, NCHS, NHANES, HHNES, NHES, Report on the Conditions of Children in Orange County, 2002

  33. No Data <4% 4%-6% 6%-8% 8%-10% >10% Obesity (> 120%tile ideal body weight) in U.S. Adults 1992 Diabetes in U.S Adults 1992

  34. No Data <4% 4%-6% 6%-8% 8%-10% >10% Obesity 1994 Diabetes 1994

  35. No Data <4% 4%-6% 6%-8% 8%-10% >10% Obesity 1996 Diabetes 1996

  36. No Data <4% 4%-6% 6%-8% 8%-10% >10% Obesity 1998 Diabetes 1998

  37. No Data <4% 4%-6% 6%-8% 8%-10% >10% Obesity 1999 Diabetes 1999

  38. No Data <4% 4%-6% 6%-8% 8%-10% >10% Obesity 2000 Diabetes 2000

  39. Tracking BMI-for-Age from Birth to 18 Years with % of Overweight Children who Are Obese at Age 25 Whitaker et al. NEJM:1997;337:869-873

  40. BMI-for-Age Cutoffs > 95th percentile Overweight 85th to < 95th Risk of overweight percentile < 5th percentile Underweight

  41. National Longitudinal Survey of Youth Prospective Cohort Study of 8270 Children (4-12 years old) - 1999 Risk of Overweight Overweight > 85th %ile BMI> 95th %ile BMI African American 38.4% 21.5% Hispanics 37.9% 21.8% Caucasian 25.8% 12.3%

  42. Secular Increases in Relative Weight and Adiposity in Children (5-14 years old)- Bogalusa Heart Study - * Change adjusted for height, age, race, and sex Source: Pediatrics 99:420-426, 1997

  43. Prevalence of Overweight and Obesity Among US Children (6-19 years old)1999-2002 Source: Hedley et al., JAMA 291:2847-2850, 2004

  44. Overweight in Children*(> 95th percentile BMI) * 4722 children from NHANES; overweight > 95th adjusted for age ** > 23% of African American and Mexican American adolescents Source: Ogden et al., JAMA 288:1728-1732, 2002

  45. Correlations of Weight and BMI at 7.7 and 23.6 Years r=0.605 r=0.612 Source: Minneapolis Children’s BP Study, Circulation 99:1471, 1999

  46. For Children, BMI Changes with Age BMI BMI Example: 95thPercentileTracking Age BMI 2 yrs 19.3 4 yrs 17.8 9 yrs 21.0 13 yrs 25.1 Boys: 2 to 20 years BMI BMI

  47. BMI BMI Boys: 2 to 20 years Age 8 years: 85th Age 13 years: <50th BMI BMI BMI Changes with age BMI = 18 Age 4 years: >95th

  48. Can you see risk? • This boy is 3 years, 3 weeks old. • Is his BMI-for-age • - >85th to <95th percentile: at risk for overweight? Photo from UC Berkeley Longitudinal Study, 1973