530 likes | 649 Views
Disease X in 1985. No Data <10% 10%–14%. Disease X in 1986. No Data <10% 10%–14%. Disease X in 1987. No Data <10% 10%–14%. Disease X in 1988. No Data <10% 10%–14%. Disease X in 1989.
E N D
Disease X in 1985 No Data <10% 10%–14%
Disease X in 1986 No Data <10% 10%–14%
Disease X in 1987 No Data <10% 10%–14%
Disease X in 1988 No Data <10% 10%–14%
Disease X in 1989 No Data <10% 10%–14%
Disease X in 1990 No Data <10% 10%–14%
Disease X in 1991 No Data <10% 10%–14% 15%–19%
Disease X in 1992 No Data <10% 10%–14% 15%–19%
Disease X in 1993 No Data <10% 10%–14% 15%–19%
Disease X in 1994 No Data <10% 10%–14% 15%–19%
Disease X in 1995 No Data <10% 10%–14% 15%–19%
Disease X in 1996 No Data <10% 10%–14% 15%–19%
Disease X in 1997 No Data <10% 10%–14 15%–19% ≥20%
Disease X in 1998 No Data <10% 10%–14 15%–19% ≥20%
Disease X in 1999 No Data <10% 10%–14 15%–19% ≥20%
Disease X in 2000 No Data <10% 10%–14 15%–19% ≥20%
Disease X in 2001 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Disease X in 2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Disease X in 2003 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Disease X in 2004 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Disease X in 2005 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity* Among U.S. Adults, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Alcohol Medical Scholars Program
OBESITY: AN EXPANDING EPIDEMIC Alcohol Medical Scholars Program
Obesity • Major public health concern • Related to high calorie intake • Influenced by • Physiology • Environment • Genes Alcohol Medical Scholars Program
Covered Topics Obesity • Definition and epidemiology • Comorbid illness • Mechanism of disease • Treatment Alcohol Medical Scholars Program
Obesity Body mass index (BMI)=kg/m2 Alcohol Medical Scholars Program
Who is obese? • 66% in United States overweight or obese • 32% obese • 5% extreme obesity • Mexican American 76% • Non-Hispanic Black 76% • Non-Hispanic White 64% Alcohol Medical Scholars Program
Covered Topics Obesity • Definition and epidemiology • Comorbid illness • Mechanism of disease • Treatment Alcohol Medical Scholars Program
So what? • 300,000 obesity-related deaths/year in US • 5x risk for diabetes • 5x risk for gallbladder disease • More depression and bipolar disorder • More deaths from heart disease Alcohol Medical Scholars Program
Covered Topics Obesity • Definition and epidemiology • Comorbid illness • Mechanism of disease • Treatment Alcohol Medical Scholars Program
Mechanisms of Obesity • Environment • Types of food available • Increased portion size • Sedentary lifestyle Alcohol Medical Scholars Program
Mechanisms of Obesity • 50% of risk is genetic • Concordance: 60% dizygotic 75% monozygotic • Adoptee weight more like biological parents • Gene mutations • Leptin • Proopiomelanocortin (POMC) • Bred in or out of mice Alcohol Medical Scholars Program
Mechanisms of Obesity: Feeding • Dopamine with food • Opioids will feeding Ghrelin Leptin Alcohol Medical Scholars Program
ACTH Stress Eating and Opioids POMC β-endorphin • Stress consumption of comfort food • Opiates sugar intake Stress Reward Feeding α-MSH Alcohol Medical Scholars Program
Emotional factors Stress, boredom Intrinsic factors Leptin Ghrelin Dopamine Extrinsic factors food-related cue & availability Signals that Control Feeding Hypothalamus Alcohol Medical Scholars Program
Dopamine and Reward • Dopamine critical to reward • Pleasure dopamine • Drugs • Sex • Food • Too much pleasure dopamine • Drugs • Food Alcohol Medical Scholars Program
Control Obese Dopamine and Obesity p < 0.002 • Obese • Control BMI p = 0.3 Dopamine Receptor Concentration Dopamine D2 receptor imaging Wang et al, Lancet 2001 Alcohol Medical Scholars Program
Food Craving • When do we crave? • Chronic stress • Food deprivation • What do we crave? • Sweets • Carbohydrates Alcohol Medical Scholars Program
Carbohydrates (mmmm…) • Dopamine • Opiates • Serotonin • Alcohol is carbohydrate rich • Is food • Is drug Alcohol Medical Scholars Program
From Chocolate to Morphine • Sugar preferring rats • Increased cocaine • Increased morphine • Increased alcohol Alcohol Medical Scholars Program
Drug Withdrawal and Sweets • Increased sweets consumption after • Smoking cessation • Alcohol abstinence • Opiate withdrawal • Cocaine withdrawal • No impairment in taste Alcohol Medical Scholars Program
Weight Loss and Alcohol • Calorie restricted body wants calories • Prefers carbohydrates • Calorie deprived rats drink alcohol • Surgically treated obesity • Decreased calorie intake • Overcome size restriction by liquid calories • Standard drink = 100 calories Alcohol Medical Scholars Program
Covered Topics Obesity • Definition and epidemiology • Comorbid illness • Mechanism of disease • Treatment Alcohol Medical Scholars Program
Weight Loss Strategies • Improve health • Address behavioral change • Address neurobiological change? Alcohol Medical Scholars Program
Treatment: Surgery • Roux-en-Y • Restrict stomach size / decrease absorption • 25% in body weight • Vertical banded gastroplasty • Restrict stomach size • 15% in body weight Alcohol Medical Scholars Program
Treatment: Behavioral • Brief Intervention • Medical consequences • Impact of dietary change • Impact of exercise • Diet and exercise 5% in body weight Alcohol Medical Scholars Program
Treatment: Behavioral • Overeaters Anonymous • Get peer network • Change attitudes • Cognitive behavioral therapy • Help patient change view of eating • Help change behavior to weight loss • Help recognize and avoid risk situations Alcohol Medical Scholars Program
Treatment: Behavioral • Motivational interviewing • Emphasize change • Discuss resistance • Encourage acceptable change • Behavioral therapy alone 5% weight Alcohol Medical Scholars Program
Treatment: Medications • Decrease appetite / increase metabolism • Sibutramine: inhibits monoamine reuptake • Rimonabant: cannabinoid receptor antagonist • Decrease absorption • Orlistat: fat absorption in gut • Decrease appetite • Naltrexone?: opioid antagonist • Medications 5% in body weight Alcohol Medical Scholars Program
Conclusions • Obesity morbidity and mortality • Overlapping neuropathways with addiction • Treatments • Surgical • Behavioral • Pharmacological Alcohol Medical Scholars Program