DR. ED. BARRE PROFESSOR OF HUMAN NUTRITION CAPE BRETON UNIVERSITY ed_barre@cbu

1. DR. ED. BARRE PROFESSOR OF HUMAN NUTRITION CAPE BRETON UNIVERSITY ed_barre@cbu.ca

2. Population approaches to obesity Determinants of obesity and their management in addressing pre- and post-onset obesity 20 and 21March 2019

3. Topics for Today • What is obesity? • How is obesity measured? • Why is obesity a concern? • What causes obesity?-determinants of obesity • What approaches are there to pre- and post-onset obesity taking into account the various determinants of obesity? • Case study and a few NCLEX questions

4. Topics for Today • Determinants of obesity • Nutrition • Physical activity • Gender • Health (mental and physical) • Genetics (including epigenetics) • Ethnicity • Socioeconomic status • Education • Parenting • Corporate influence • Government

5. Topics for Today • Tailoring approaches to pre-and post-onset obesity dependent in terms of the determinants of obesity • Nutrition • Physical activity • Gender • Health (mental and physical) • Genetics (including epigenetics) • Ethnicity • Socioeconomic status • Education • Parenting • Corporate influence • Government

6. What is obesity? • Unhealthy accumulation of adipose tissue • Abdominal fat is the most dangerous as it sets up metabolic perturbations leading to atherosclerotic cardiovascular disease, hypertension, and type 2 diabetes etc., etc.

7. How is obesity measured? • BMI-rough indicator of overall fat accumulation • Waist circumference –surrogate measure of abdominal fat • MRI-abdominal fat-abdominal fat • Dual-x-ray absorptiometry (DXA)-abdominal fat • CAT-abdominal fat • MRI, DXA and CAT can distinguish subcutaneous from visceral abdominal fat

8. How is obesity measured? e.g. MRI below

9. BMI = kg body mass • height (m2)

10. Problems with BMI • Does not measure fat mass • Does not indicate where excess fat mass occurs

11. Waist circumference is better than BMI-waist circumference gives indication of abdominal fat distribution and is faster, cheaper and easier that MRI, DXA, and CAT • Thus waist circumference is a good screening tool for abdominal fat accumulation

12. Problems with BMI overcome by measuring waist circumference

13. Why is obesity a concern? • Obesity is increasing- world wide epidemic of obesity- Cape Breton has among the highest levels in Canada-39.7 % in 2012

14. Obesity across Canada – note Cape Breton

15. Obesity by the numbers • Measured children and youth (aged 5-17 years) body mass index (BMI) (World Health Organization classification), by age group and sex, Canada and provinces, Canadian Community Health Survey

16. Measured adults (aged 18 years and older) body mass index (BMI) (WHO classification) Canadian Community Health Survey

17. Why is obesity a concern? Obesity is a sensitive topic-comments are not criticism or a judgement on right or wrong However, obesity must be discussed for the reasons outlined in the next slide for to ignore it or downplay its consequences will only exacerbate matters

18. Why is obesity a concern? • Illnesses caused (type 2 diabetes, atherosclerosis (MI and stroke), end stage renal disease, some cancers (e.g. prostate, breast, endometrial, colon etc.), non-alcoholic fatty liver disease, gall bladder, hypertension, osteoarthritis, sleep apnea etc., etc.) • Millions of dollars each year in direct medical expenses and reduced workplace productivity due to obesity driven illnesses • Reduced productivity reduces tax base that pays for publicly funded healthcare-publicly funded healthcare is under immense strain presently due to lifestyle related chronic disease and an aging population; a higher ratio of older to younger people also reduces tax base- shorter lifespans of younger people may exacerbate this ratio (e.g. atherosclerosis in paediatric type 2 diabetes is much more aggressive than adult-onset type 2 diabetes • Strained healthcare system results in rationing which will only get worse if we do get lifestyle driven chronic diseases under control-rationing includes money available for salaries/benefits for health professionals • Who wants an American style healthcare system?

19. Obesity • So how does obesity occur? CDC

20. ObesityAn Overview • Overweight and obesity are both chronic conditions that are the result of an energy imbalance over a period of time. • The cause of this energy imbalance can be due to a combination of several different factors and varies from one person to another. • Individual behaviors, environmental factors, and genetics all contribute to the complexity of the obesity epidemic. CDC

21. Energy ImbalanceWhat is it? Weight Gain Calories Consumed > Calories Used Weight Loss Calories Consumed < Calories Used No Weight Change Calories Consumed = Calories Used • Energy balance can be compared to a scale. • An energy imbalance arises when the number of calories consumed is not equal to the number of calories used by the body. • Weight gain usually involves the combination of consuming too many calories and not expending enough through physical activity. CDC

22. Energy ImbalanceEffects in the Body • Excess energy is stored in fat cells, which enlarge or multiply. • Enlargement of fat cells is known as hypertrophy, whereas multiplication of fat cells is known as hyperplasia. • With time, excesses in energy storage lead to obesity. Fat cells

23. Determinants of obesity • Nutrition • Excessive consumption of simple sugars and fat-when calories consumed exceed the demand for calories the caloric energy is stored as fat- if eating more need to be proportionately more physical active to burn off the excess calories • Most are not born obese – the obesogenic environment (high fat and sugar diets) combined with little physical activity result in accumulated fat • Best way to manage obesity is to prevent it with good diet and exercise- much easier than trying to lose excess fat

24. we should eat like this…

28. Canada’s Food Guide Defines and Promotes Healthy Eating for Canadians • It translates the science of nutrition and health into a a healthy eating pattern • It emphasizes the importance of combining healthy eating and physical activity

29. Unfortunately we sit down and we chow down on high fat, high simple sugar foods and we start them early…

38. BMI = KG M2

39. Determinants of obesity • Physical activity • Recommended that people up to 17 years of age get 60 minutes of moderate (e.g. bicycle riding) to vigourous (e.g. running) physical activity each day and that adults get 150 minutes per week of moderate (e.g. walking at at least 5 km/hour) to vigourous exercise (jogging) • With too much convenience (e.g. cars- why walk when one can drive and loads of screen time), many people do not fit this time and intensity requirement

40. To overcome this energy imbalance we should do 150 minutes of moderate to vigourous exercise and eat well

44. So over time we have progressively gained fat weight as can be seen in the next two slides

47. Determinants of obesity • Gender • Males of all ages accumulate excess fat in the abdominal area (android fat accumulation) • Pre-menopausal females accumulate fat in the hip region (gynoid fat accumulation) but still waist circumference is important • Post-menopausal females accumulate excess body fat in the abdominal area (android fat accumulation)

48. Gynoid versus Android fat accumulation

49. Pear shape (gynoid fat accumulation) versus apple shape (android fat accumulation)

50. Determinants of obesity-gender