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Obesity-a global epidemic

Obesity-a global epidemic. “Leave gormandizing; know the grave doth gape for thee thrice wider than for other men” Henry IVPart 2 William Shakespeare. Peter Sims , Honorary teaching Fellow, Peninsula Medical School, England .

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Obesity-a global epidemic

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  1. Obesity-a global epidemic “Leave gormandizing; know the grave doth gape for thee thrice wider than for other men” Henry IVPart 2 William Shakespeare Peter Sims, Honorary teaching Fellow, Peninsula Medical School, England

  2. 1:6 of the world’s population are malnourished-a billion people go hungry In the rich world 1:4 are obese and 1:3 of us are overweight

  3. The Life of Mammals…and of Man • The threat of cold, the need to maintain body temperature around 37 C in a cold environment • The need for water, the need to drink at least 800ml/day • The need for food, a calorie need of 2-3,000 calories per day and limited capacity to store food

  4. Why do we need food? • Energy-To maintain body temperature -For the work of metabolism -For physical work • Growth` • Maintenance & Repair

  5. Evolve…..to conserve in a hostile environment • Around the world humans eat a wide variety of diets and maintain health • Food shortage and famine have occurred through human history • Fatness equated with wealth and power • In the 21st century fatness equates with poverty and ignorance • Fatness leads to chronic disease

  6. Food for…. Work Heat Comfort Celebration Religion Recreation Magic

  7. Protein 20-100gms Carbohydrate 300-500gms Fat 100gms Water 700-1000ml Minerals Vitamins Trace elements Daily Nutritional Needs

  8. Basal Metabolic Rate“-the energy required to do nothing” • Measured as heat output i.e. Kilocals/sq.metre/hour-fasting,awake • In an adult about 35Kc/m2/hr. with an average body area of 1.8 sq.metres is 35 x 1.8 =63Kilocals/hr. • In 24 hours 63 x 24 =1512 Kilocals • BMR changes during life • Affected by age,sex,genes,drugs,hormones

  9. Basal Metabolic Rate • The body is like a “clock” and it ticks faster when we are younger, faster in men than in women. • It ticks faster in smaller people who have a higher ratio of surface to volume. They lose more heat to the environment and in consequence have to generate more heat to maintain constant body temperature

  10. Basal Metabolic Rate BMR 52 35 Male Female Age 20 40

  11. 24 hour Metabolism KCals/hour BMR 0 6 12 18 24

  12. Protein 4K/g 50-100g =2-400Kcals (Protein) 50-100g=450-800Kcals(Fat) 4-500g=1600-2000Kcals(Sugar) 2-3000kilocals/day (1Kilocalorie raises 1000gm of water by 1 degree centigrade) Sugars 4K/g Fats 9K/g

  13. Maintenance of Body Weight • In a calendar year we eat 3 or 4 times our body weight in food • Most healthy adults neither lose nor gain weight. • It is quite common to have the same body weight at 20 as at 40 as at 60

  14. The Leptin Story 1

  15. THE Leptin Story 2

  16. The Leptin Story 3

  17. The Leptin Story 4

  18. Control of Body Weight when food intake and energy output vary • Food intake-blood sugar, hypothalamus centres,stomach, mouth,smell • Heat conservation-shivering,clothing,shelter,fire • Habit-plate and portion size • Conservative food habits • Energy output-physical work, training • Changes in BMR

  19. How many Calories per Day? • 24 hours of Basal Metabolism- 1200-1500 Kilocals • 8 hours “work” 400-2000 Kilocals • 8hours recreation 400-1,000 kilocals • 8 hours sleep • Working Man aet 40yrs.1908-3500Kilocals + • Working Man aet 40yrs. 2008-2500Kilocals

  20. 70 kg. Male, 40 yrs Basal Metabolism 1200Kilocals Work 400-1000Kilocals Recreation 100-800Kilocals Total 1700-3000Kilocals 100 kg. Male, 40 years Basal Metabolism 960Kilocals Work 500-1200Kilocals Recreation 100-800Kilocals Total 1600-3000Kilocals Energy Needs

  21. Number of Fat cells Capacity of Fat Cells Essential fat-padding Essential fat-insulate Essential fat-aesthetic Essential fat- reserve Fat control Genes Ob/Ob Leptins Hibernation Starvation Fat danger Fat as an Active Organ

  22. People who become overweight eat just a little more than the rest of us 100 Kilocalories per day-a half tin of coke means 4 Kilos of extra fat a year They exercise a little less-they walk less often, take the lift more, walk more slowly, play fewer games 30 minutes of moderate exercise is about 100 kilocalories Fat and getting fatter

  23. The Epidemiology of Obesity • Time • Place • Person • Incidence • Prevalence • Morbidity • Mortality • Treatment • Prevention • Cost

  24. The Epidemiology of Obesity • 20th Century phenomenon • 1st world…2….3rd • Rich……Poor • Incidence 1% per annum • Prevalence 25-50% • Illness and early death • Diet, drugs, surgery and exercise etc • Lifestyle, choice, tax and ration • Health, wealth, production

  25. Measuring Fatness • Appearance • Waist band • Waist/hip ratio • Body Mass index (Wt. in Kgs/Ht. in Mts.2 • Triceps skin thickness • Body Fat assessment-RA Isotope

  26. Starvation….Fasting • Loss of hunger feeling 48-72 hours • Apathetic, cold, constipated • Ketotic • Weak • Fat people do not live longer…6-8 weeks • Other factors-warmth, psyche, events

  27. Fat Balance=Energy Balance Change in Weight=Energy Intake-Energy Expenditure Calories BMR SDR Work

  28. Fat Stores • Rate of Change of Fat Stores is equal to Rate of Fat Intake –Rate of Fat Oxidation • Fat Intake and Fat Oxidation are not closely balanced • The difference in Body fat between people living in the same environment is a matter of normal physiological variation

  29. Equilibrium Fat Stores MEDIATORS + MODERATORS Energy Intake minus Energy Expenditure Physiological Adjustment Fat Energy Biology….Behaviour…Environment

  30. Fat Metabolism and Exercise Slim Obese Moderate Exercise Heavy Exercise

  31. Weight Loss and Weight Gain Weight Under 30 10% in 6/12 Over 40 3mths 6mths Time

  32. Eating patterns Exercise Patterns Choices Lifestyle/fashion Health Diets Medication Surgery Rationing Taxation Advertising Health warnings Legislation Environment Rewards Health care Solutions?Individual Community

  33. “Tell me what you eat and I will tell you what you are” Anthelme Brillat-Savarin

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