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Obesity

Obesity. Then and Now Why and Where How and When Will it End . Kathleen Colleran, MD Associate Professor of Medicine Medical Director, Multidisciplinary Metabolic Clinic Medical Director, Clinical Trials Center. Objectives. Understand the causes of obesity and its co-morbidities

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Obesity

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  1. Obesity Then and NowWhy and WhereHow and When Will it End Kathleen Colleran, MD Associate Professor of Medicine Medical Director, Multidisciplinary Metabolic Clinic Medical Director, Clinical Trials Center

  2. Objectives • Understand the causes of obesity and its co-morbidities • Understand normal eating behavior and regulation and disorders leading to dysregulation of appetite regulation • Understand current and emerging obesity treatments

  3. Class BMI (kg/m2) Health Risk Normal 20-24.9 None Overweight 25-29.9 Increased ObesityI 30-34.9 High Obesity II 35-39.9 Very high ObesityIII >40 Extremely high BMI and Health Risk

  4. Obesity Trends* Among U.S. AdultsBRFSS, 1985 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

  5. Obesity Trends* Among U.S. AdultsBRFSS, 1986 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

  6. Obesity Trends* Among U.S. AdultsBRFSS, 1987 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

  7. Obesity Trends* Among U.S. AdultsBRFSS, 1988 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

  8. Obesity Trends* Among U.S. AdultsBRFSS, 1989 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

  9. Obesity Trends* Among U.S. AdultsBRFSS, 1990 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

  10. Obesity Trends* Among U.S. AdultsBRFSS, 1991 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  11. Obesity Trends* Among U.S. AdultsBRFSS, 1992 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  12. Obesity Trends* Among U.S. AdultsBRFSS, 1993 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  13. Obesity Trends* Among U.S. AdultsBRFSS, 1994 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) <10% 10%–14% 15%–19%

  14. Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) <10% 10%–14% 15%–19%

  15. Obesity Trends* Among U.S. AdultsBRFSS, 1996 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) <10% 10%–14% 15%–19%

  16. Obesity Trends* Among U.S. AdultsBRFSS, 1997 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) <10% 10%–14% 15%–19% 20%

  17. Obesity Trends* Among U.S. AdultsBRFSS, 1998 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) <10% 10%–14% 15%–19% 20%

  18. Obesity Trends* Among U.S. AdultsBRFSS, 1999 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) <10% 10%–14% 15%–19% 20%

  19. Obesity Trends* Among U.S. AdultsBRFSS, 2000 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) <10% 10%–14% 15%–19% 20%

  20. Obesity Trends* Among U.S. AdultsBRFSS, 2001 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) <10% 10%–14% 15%–19% 20%–24% 25%

  21. Obesity Trends* Among U.S. AdultsBRFSS, 2002 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) <10% 10%–14% 15%–19% 20%–24% 25%

  22. Obesity Trends* Among U.S. AdultsBRFSS, 2003 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) <10% 10%–14% 15%–19% 20%–24% 25%

  23. Obesity Trends* Among U.S. AdultsBRFSS, 2004 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) <10% 10%–14% 15%–19% 20%–24% ≥25%

  24. Obesity Trends* Among U.S. AdultsBRFSS, 2005 (*BMI >30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% 30%

  25. The Pandemic Kopelman PG; Nature 404-635-643 (2000)

  26. Prevalence of Obesity in New Mexico Source: CDC, Behavioral Risk Factor Surveillance System, 1991-2005

  27. If you are not outraged, youhave not been paying attention How did this happen?

  28. 140 120 100 80 60 40 20 0 Obesity in the US Overweight Obese Persons of Obestiy (millions) 1958 1978 1988 1998 2004 1968 Year Diabetes Overview. October 1995 (updated 1996). NIDDK publication NIH 96-1468.Kenny SJ et al. In: Diabetes in America. 2nd ed. 1995:47-67.

  29. Basal Metabolic Rate Men=1kcal/hr/kg =1x24x70=1680 Women=0.9 kcal/hr/kg =0.9x24x70=1512 1 pound=3500 Kcal Energy expenditure of activity Sedentary 400-800 kcal/d Light: office 800-1200 Mod: walking, lifting 1200-1800 Heavy: const., athlete 1800-4500 Riding a century (100 miles) in under 6 hrs. burns 5000-6000 kcal Walking 3 miles/hour for 60 minutes burns 200-300 kcal The calorie facts

  30. BAGEL 20 Years Ago Today 140 calories 3-inch diameter 350 calories 6-inch diameter Calorie Difference: 210 calories

  31. COFFEE 20 Years Ago Coffee(with whole milk and sugar) Today Mocha Coffee(with steamed whole milk and mocha syrup) 45 calories 8 ounces 350 calories 16 ounces Calorie Difference: 305 calories

  32. CHEESEBURGER Today 20 Years Ago 333 calories 590 calories Calorie Difference: 257 calories

  33. FRENCH FRIES 20 Years Ago Today 210 Calories 2.4 ounces 610 Calories 6.9 ounces Calorie Difference: 400 Calories

  34. SODA 20 Years Ago Today 85 Calories 6.5 ounces 250 Calories 20 ounces Calorie Difference: 165 Calories

  35. SPAGHETTI AND MEATBALLS 20 Years Ago Today 500 calories 1 cup spaghetti with sauce and 3 small meatballs 1,025 calories 2 cups of pasta with sauce and 3 large meatballs Calorie Difference: 525 calories

  36. Then Breakfast Coffee/bagel Lunch Burger/fries/coke Dinner Spagetti Total kcal=1313 Now Breakfast Coffee/bagel Lunch Burger/fries/coke Dinner Spagetti Total kcal=3,175 Then and Now Difference=1,862 kcal =½ pound =50 mile bike ride @ 18 mph or 18 mile walk @ 20 mpm

  37. Luxury or the Latest Prison Abuse Scandal?Guantanamo Detainee Camp • 4200 calories/day • 60-90 minutes of exercise 3x/week • Underweight on arrival • Average 20 # weight increase • 1 detainee doubled his weight to 410 #s • 2 prisoners on hunger strikes remain at ideal body weight from forced feeds

  38. Obesity Is Multifactorial

  39. Peripheral Hormones That Regulate Feeding Behavior Schwartz, MW et al; Nature 418: 595-597 (2002)

  40. Monogenic Obesity Syndromes

  41. Mutations in the Leptin -Melanocortin Signaling Pathway Cummings DE et al; Annu.Rev.Med. 2003, 54:453-71

  42. Syndromes Associated with Obesity

  43. Acquired forms of Obesity • Hypercortisolism • Hypothyroidism • Hypothalamic disease • Atypical antipsychotics • HAART

  44. While obesity is an excessive accumulation of body fat Not all fat is equal

  45. High-Risk Obesity Phenotype:The Lifestyle Link Poirier: J Cardiopulm Rehabil, Volume 23(3).May/June 2003.161-169

  46. What can we do? • Society • Lifestyle • Behavioral • Pharmaceuticals • Surgery • Up and coming

  47. Life Style Strategies Talk to your patients • Size Matters-use dessert plates not dinner plates • Move forward in space • Drive by the Drive thrus • Better yet walk, jog, or cycle by the drive thrus • Diets work because they are hypocaloric • When all else fails, take drugs or • Have surgery

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