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Obesity and Life expectancy. January 2003 Life Table analysis of Framingham Data Obese at 40 live 6 to 7 years less than normal Overweight at 40 live 3 years less than normal Obese smoker live 14 years less than normal. Obesity Accounts for. 5% of heart attacks and strokes
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Obesity and Life expectancy • January 2003 Life Table analysis of Framingham Data • Obese at 40 live 6 to 7 years less than normal • Overweight at 40 live 3 years less than normalObese smoker live 14 years less than normal
Obesity Accounts for • 5% of heart attacks and strokes • 10% cases of osteoarthritis • 20% cases of hypertenstion • 40% of cancers • 80% cases of Type 2 diabetes. • There is limited data on the cost of obesity but evidence suggests that the direct cost accounts for 5 to 7% of total health care expenditure (WHO,1998).
What is Obesity? • Defined by World Health Organisation using body mass index (BMI) (Weight in Kg divided by height in meters squared) • 5’4” Normal 65kgs (10 stone 3 lbs) Obese 78kgs (12 stone 2 lbs) • 5’10” Normal 78kgs (12 stone 2 lbs) Obese 94kgs (14 stone 10 lbs)
Bray GA. Overweight is risking fate. Definition, classification, prevalence and risks. Ann NY Acad Sci 1987;499:14-28. Relationship of BMI to Excess Mortality 300 Age at Issue 20-29 250 30-39 200 150 Mortality Ratio 100 High Moderate Low Risk Risk Risk 50 0 15 20 25 30 35 40 Body Mass Index (kg/[m2])
Current Prevalence data in Ireland • Female: 33% Overweight 26% Obese (13% self report) • Male: 45% Overweight 24% Obese (16% self report) • Children: 20% Overweight or obese(5-12 yo)Slan 2007 Independently Measured
Grades of BMI Kg/M2 • BMI 19-25 -Normal • BMI 25-30 -OverweightObesity • BMI 30-35 -Grade 1 • BMI 35-40 -Grade 2 BMI >40 -Grade 3(Morbid) Overweight or obese USA 71%, UK 65% USA 5% have BMI > 40 Ireland 2% have BMI > 40
Grades of BMI Kg/M2 • BMI 19-25 -Normal • BMI 25-30 -OverweightObesity • BMI 30-35 -Grade 1 • BMI 35-40 -Grade 2 BMI >40 -Grade 3(Morbid) Overweight or obese USA 71%, UK 65% USA 5% have BMI > 40 Ireland 2% have BMI > 40
Normal weight finishes at • BMI 25 Male 12st 2lbs 78Kgs Female 10st 3lbs 65 kgs
BMI ranges BMI 1 BMI 2
BMI range <20 to 25 BMI 19 BMI 25
BMI range <20 to 25 BMI 19 Guess 20 BMI 25 Guess 23
BMI 4 BMI 3
BMI range 40 to 45 BMI 44 BMI 40
BMI range 40 to 45 BMI 44 Guess 35 BMI 40 Guess 32
BMI 5 BMI 6
BMI range 50 to 55 BMI 51 BMI 52
BMI range 50 to 55 BMI 51 Guess 43 BMI 52 Guess 42
BMI 7 BMI 8
BMI range 70 to >75 BMI 72 BMI 76
BMI range 70 to >75 BMI 72 Guess 50 BMI 76
Severe (Grade 3) Obesity • BMI 40 --- Male 20st 128kgsFemale 16st 10lbs 108kgs
Current Prevalence data (Adult) • Female: 33% Overweight 26% Obese (13% self report) • Male: 45% Overweight 24% Obese (16% self report)Slan 2007 Independently Measured
Obesity is associated with • Diabetes • Cancer • Sleep Apnoea • Osteoarthritis • Fatty liver disease • Psoriasis • Dementia • Cardiovascular Disease • Death from H1N1 (Swine Flu)
Excess weight is a MAJOR risk factor for diabetes in US adults, 2001 (n=195, 005) Prevalence of diabetes (%) 30 25.6 20 14.9 10 7.3 4.1 0 Normal OverweightBMI 25-29.9 ObeseBMI 30-39.9 ObeseBMI 40 Mokdad et al. JAMA 2003; 289: 76-9
Obesity also reduces survival in certain cancers • Colon • Breast • Endometrium • Prostate • Ovary
Increased risk of dementia • BMI and increased risk of dementia – analysis of prospective cohort study (Whitmer et al. 2005) • Increased risk of dimentia in later years for those overweight / obese in mid-life • Increased risk for • Males • Females
Obese patient with Acute abdomen • 30% chance of atelecasis/pneumonia • 2.8 times more likely than non obese
Overweight and obesity following Road Accidents • Study of 1,615 CrashesCrash factor adjusted odds for dying 2.08 for overweight 3.17 for obese Injury severity adjusted odds for dying 1.87 for overweight 3.89 for obese Ryb J.Trauma 2008(64)406-411 CIREN study
Role of weight and seatbelts • Seatbelts decrease risk of death and intraabdominal injury in obese and non obeseLack of seatbelt increases risk of death 9.7 fold in obese 5.2 fold in non obese Zarzaur & Marshall J Trauma 2008(64)412-417
A lot of equipment • Has upper weight limit of ~ 150kgsTrolleysBedsTheatre TablesRadiology – equipment and quality
Radiology Equipment in Ireland • Audit of 40 hospitals • CT, MRI, Fluoroscopy • Weight Limit • Aperture Diameter
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