Obesity

1. Obesity Kate Gilmore Erik Haley Chronic diseases Spring 2013

2. Obesity- What is it and how defined? Defined as the accumulation of excess body fat A person’s Body Mass Index (BMI) is used to approximate how much body fat an individual has. The BMI is calculated from the person’s height and weight. BMI = Weight (kg)/ Height(m)2 An adult is normally considered overweight if BMI > 25 and obese if BMI > 30. In children and adolescents, obesity is generally defined as having an age- and gender-specific BMI at ≥95th percentile)

3. Prevalence In 2009-2010, over a third of adults in the US were obese (35.7%). In the same year, 16.9% of children were obese. The prevalence of obesity has not noticeably changed between 2007-2010. http://www.cdc.gov/nchs/data/databriefs/db82.htm

4. Obesity By Sex and Age

5. Childhood Obesity by Age and Sex

6. Obesity Trends Over Last 40 Years Top = Extreme Obesity, Middle= Obesity, Bottom = Overweight

7. Obesity Trends over Last Decade by Sex

8. Childhood Obesity Trends over Last Decade

9. Prevalence by Race and Socioeconomic Status Non-Hispanic blacks have the highest rates of obesity (49.5%), followed by Hispanics (39.1%) and then Non-Hispanic whites (34.3%). Higher income black and Hispanic men are more likely to be obese, while higher income women are less likely to be obese While there was no correlation between education and obesity for men, women with college degrees are less likely to be obese. Source: http://www.cdc.gov/obesity/data/adult.html

10. Geographic Differences in Obesity

11. Morbidity & Risk for Chronic Disease • Obesity directly and indirectly impacts multiple organ system • Therefore many severe, chronic health conditions are correlated with obesity, including: • heart disease • stroke • type 2 diabetes • certain types of cancerincluding colon, endometrial, and postmenopausal breast cancer

12. Obesity-Related Mortality • Studies have shown that obesity is associated with greater “all-cause and CVD-specific mortality”, but have not found the same association for just being overweight. (McGee 2005). • Over 300,000 people a year die due to illnesses related to obesity. • Age may be a modifier in obesity-related mortality. • In adults older than 70 yrs, there is no association. • However in children, overweight status also appears to be associated with overall increased CVD mortality in adulthood.

13. Screening for Obesity- Current Recommendations The U.S. Preventive Services Task Force (USPSTF) recommends screening for obesity in all adults based on BMI For adults with BMI greater than or equal to 30 kg/m2, the USPSTF recommends “intensive multicomponent behavioral interventions” (2012) The USPSTF recommends that clinicians screen children aged 6 years and older for obesity and “offer them or refer them to comprehensive, intensive behavioral interventions to promote improvement in weight status.” (2010)

14. International Context • Worldwide obesity has more than doubled since 1980. • In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese. • 65% of the world's population live in countries where overweight and obesity kills more people than underweight. • More than 40 million children under the age of five were overweight in 2010.http://www.who.int/mediacentre/factsheets/fs311/en/index.html • Global Database on Body Mass Index: (WHO) Of note both the obese and pre-obese distribution maps http://apps.who.int/bmi/index.jsp

15. International Context • All around the world, many countries face a “double burden” where under-nutrition and obesity may exist within the same country, community, or even household. • Children in low- and middle-income countries are more vulnerable to inadequate pre-natal, infant and young child nutrition • They are also exposed to high-fat, high-sugar, high-salt, energy-dense, micronutrient-poor foods, which tend to be lower in cost. • These dietary patterns, in addition to low levels of physical activity, result in increases in childhood obesity and under-nutrition.

16. Obesity & Genetics Does genetics contribute to obesity risk? Genes seem to play a role in how our bodies capture, store, and release energy from food According to the "thrifty genotype" hypothesis, the same genes that helped our ancestors survive occasional famines are now being challenged by environments in which food is plentiful year round. There have been some genes that have been found to be “associated” with higher frequencies of obesity though the identification of these genes is difficult and these have only been founded through association studies http://www.cdc.gov/features/obesity/

17. Obesity & Genetics • Genetics may also play a role in the following: • the drive to overeat (poor regulation of appetite and satiety) • the tendency to be sedentary (physically inactive) • a diminished ability to use dietary fats as fuel • an enlarged, easily stimulated capacity to store body fat.  • More about genetics and obesity: http://www.cdc.gov/features/obesity/

18. Modifiable Risk Factors • Excessive caloric consumption/ weight gain • Type of diet (carbohydrates, proteins, fiber, balanced diet) • Physical activity/energy expenditure • Television viewing • (behavior associated with including poor diet/food consumption, viewing of tv ads etc)

19. Treatment for Overweight and Obesity Conditions Weight loss/Reduction of excess body fat Dietary Modification/ Reduction of excess caloric intake Physical activity/ Increase energy expenditure Behavioral therapies including tracking food consumption and physical activity, setting goals, social support networks

20. Treatment for Severe Obesity • Clinical therapies are recommended for a select group of high-risk individuals with severe obesity • Pharmacological: FDA-approved drugs to treat obesity related weight loss including appetite suppressants and drugs that block the digestion and absorption of fat • Surgical: surgically changes the structure of the gastrointestinal tract designing it to reduce caloric intake. This can be done to change food intake or limit the absorption of nutrients • Associated with substantial weight loss and reduction in comorbidities and all-cause mortality, however there are medical complications and risks. Additionally, weight loss maintenance is still an issue.

21. Long Term Weight Loss/Maintenance • Key to reducing morbidity and mortality related to obesity • National Weight Loss Registry strategies: • Engaging in high-level physical activity (60 min/day)- some studies indicate even more may be necessary • Eating low calorie/low fat diets • Eating breakfast • Monitoring weight regularly • Consistent diet/patterns • Addressing small regains immediately/early • http://www.nwcr.ws/Research/default.htm

22. Prevention- Global Strategies • Main goal of prevention strategies is to prevent unhealthy weight gain • WHO Global Strategy on Diet, Physical Activity, and Health (2004) and 2008-2013 Action plan for the global strategy for the prevention and control of non-communicable diseasesprovides recommendations to member states on: • Increase the knowledge and skills of the population related to diet, physical activity, and weight; • Reduce population exposure to an obesity-promoting environment • http://www.who.int/dietphysicalactivity/en/index.html

23. Current Prevention Efforts in the U.S. • Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation- Institute of Medicine (2012) • The IOM evaluated prior obesity prevention strategies and identified recommendations to meet the following goals and accelerate progress • Integrate physical activity every day in every way • Market what matters for a healthy life • Make healthy foods and beverages available everywhere • Activate employers and health care professionals • Strengthen schools as the heart of health Info graphic: http://www.iom.edu/Reports/2012/Accelerating-Progress-in-Obesity-Prevention/Infographic.aspx

24. Current Prevention Efforts in the U.S. CDC initiatives and grants: http://www.cdc.gov/obesity/stateprograms/cdc.html Childhood Obesity Demonstration Project The aim of the project is to identify effective health care and community strategies to help combat childhood obesity. Communities Putting Prevention to Work CPPW is a locally driven initiative supporting 50 communities to tackle obesity and tobacco use.

25. Prevention Efforts Programs Government Launched- Let’s Move! –launched by Michelle Obama (2010) http://www.letsmove.gov/ Foundation/Non-Profit- Healthy Kids, Healthy Communities: http://www.healthykidshealthycommunities.org/ Advocacy/Campaign- Campaign to End Obesity http://www.obesitycampaign.org/

26. Financial/Economic Impact of Obesity In 1999, it was estimated that $78.5 billion in direct medical costs could be attributed to overweight and obesity related conditions. Medical costs associated with obesity are estimated at $147 billion If all obesity related illness and disability included at $190.2 billion 21% of of medical spending is on obesity-related illness Obesity accounts for nearly $4.3 billion in annual losses to companies due to obesity-related job absenteeism. In 2008, the medical costs for people who are obese were $1,429 higher than those of normal weight.  Data Sources: http://www.iom.edu/Reports/2012/Accelerating-Progress-in-Obesity-Prevention.aspx http://www.cdc.gov/obesity/data/adult.html

27. Current Research Efforts National Institutes of Health (current studies in active recruitment or underway): http://www.clinicaltrials.gov/ Change in Cognitive Function in Obese Patients After Bariatric Surgery - an Observational Study Obesity and Financial Incentives Course of Obesity and Extreme Obesity in Adolescents Use of Electronic Health Records for Addressing Overweight and Obesity in Primary Care Does Treating Obstructive Sleep Apnea in Obese Canadian Youth Improve Blood Sugar Control? Economic Aspects of Extreme Obesity in Adolescent Sleep and Obesity in Teenagers Evaluating the Transferability of a Successful, Hospital-based, Childhood Obesity Clinic to Primary Care: a Pilot Study Identification and Characterization of Youth With Extreme Obesity Mitochondrial Function in Pediatric Obesity A Child Care-based Obesity Prevention Intervention Expiratory Airflow Limitation in Subjects With Obesity Parents As The Agent Of Change For Childhood Obesity (PAAC) Virtual Environments For Supporting Obesity Treatment Parents as the Agent of Change for Childhood Obesity Community Based Obesity Prevention Among Black Women Healthy Children, Strong Families: American Indian Communities Preventing Obesity Internet Obesity Treatment Enhanced With Motivational Interviewing Observational Study of Early Metabolic and Vascular Changes in Obesity Microarray Analysis in Syndromic Obesity

28. Ongoing and Future Research Needs • Translational Research • How to facilitate wide scale implementation of interventions in communities • Communication Strategies Research • Research to identify effective communication strategies for relaying information about physical activity, diet, and obesity to the public • Research related to demographic-level disparity in obesity levels for • Research on morbidly obese populations (as this group increases) • Effective and appropriate timing for weight loss strategies in children and adolescents • Maintenance of weight loss • Better evidenced based approaches for effective, sustainable public health approaches to weight loss • Enhanced research in cost and cost-effectiveness of various approaches to preventing and addressing obesity and obesity-related conditions

29. Additional References and Links http://www.surgeongeneral.gov/news/testimony/obesity07162003.html http://www.cdc.gov/nchs/data/databriefs/db82.htm http://www.cdc.gov/obesity/data/adult.html http://www.cdc.gov/nchs/data/databriefs/db82.htm