OBESITY
AN EPIDEMIC ON THE RISE
WHAT’S THE BIG DEAL?
Affecting many countries in the world
Rise in numbers are a reflection of changes
in society
Affect over half of the the adult population
in many countries
Compared to smoking in regards to the
amount of lives affected
EXCESS WEIGHT GAIN AND
PHYSICAL INACTIVITY ACCOUNT
FOR MORE THAN 300,000 premature
deaths each year in the United States
Definition
Overweight is an increased bodyweight in
relation to height
Obesity is an excessively high amount of
body fat in relation to lean body mass
Body Mass Index
Most common weight standard
Bodyweight(kg)/Height(m)2
BMI Standards
Overweight: 25-29.9
Obese : 30 and above
Grade I : 30-34.9
Grade II : 35-39.9
Grade III : 40 and above
Body Mass Index
All adults with a BMI of 25 or more are
considered at risk for premature death and
disability as a consequence of overweight
and obesity
Waist Circumference
Used to measure abdominal fat content
An independent predictor of risk factors
associated with obesity
AT Risk: Men: above 40 inches
Women: above 35
WAIST-TO-HIP Ratio
Ratio of a person’s waist circumference to
hip circumference
Above 1.0 is considered at risk for men and
0.9 is considerate at risk for women
Men with high hip to waist ratios have a
three-fold risk of coronary events
BMI used in children
Dependent on age and sex
Underweight: BMI falling in less than the
5th percentile
Overweight: equal or greater than 85th
percentile
Obese: equal or greater than 95th percentile
Obesity Trends* Among U.S. Adults
BRFSS, 1991, 1995 and 2000
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
1991 1995
2000
No Data <10% 10%-14% 15-19%
20%
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16,
2001;286:10.
Obesity Trends* Among U.S. Adults
BRFSS, 1985
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19%
20%
Source: Mokdad AH.
Obesity Trends* Among U.S. Adults
BRFSS, 1986
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19%
20%
Source: Mokdad AH.
Obesity Trends* Among U.S. Adults
BRFSS, 1987
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19%
20%
Source: Mokdad AH.
Obesity Trends* Among U.S. Adults
BRFSS, 1988
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19%
20%
Source: Mokdad AH.
Obesity Trends* Among U.S. Adults
BRFSS, 1989
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19%
20%
Source: Mokdad AH.
Obesity Trends* Among U.S. Adults
BRFSS, 1990
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19%
20%
Source: Mokdad AH.
Obesity Trends* Among U.S. Adults
BRFSS, 1991
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. Adults
BRFSS, 1992
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. Adults
BRFSS, 1993
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. Adults
BRFSS, 1994
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. Adults
BRFSS, 1995
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. Adults
BRFSS, 1996
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. Adults
BRFSS, 1997
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. Adults
BRFSS, 1998
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Obesity Trends* Among U.S. Adults
BRFSS, 1999
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19%
20%
Source: Mokdad A H, et al. J Am Med Assoc 2000;284:13
Obesity Trends* Among U.S. Adults
BRFSS, 2000
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19%
20%
Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10
Prevalence
61% of U.S. adults obese (1999)
Obesity has nearly doubled from 15 to 27%
in 1999
In 2000 38.8 million Americans were obese
(19.6 men and 19.2 women)
Prevalence
In Europe prevalence of obesity is 10-25%
in most countries
Britain is one of the fastest growing obesity
populations (17% men and 20% women)
Also on rise in countries such as China,
Singapore and Thailand
Childhood Obesity
Three times as many American children are
obese than 20 years ago
Childhood obesity on rise globally
– 1991-1997 China (6.4-7.7%)
– 1975-1999 Brazil (4%-144%)
– Russia demonstrated a 50% decrease
Childhood Obesity Risk
Factors
Weight Gain occurs if the amount of calories
consumed is more than those expended.
Genetics
Family history of obesity
Psychological factors
Social and cultural factors
Medical Illnesses
Medications
Alcohol consumption
Smoking Cessation
Race
Several studies have found that Black
women have a lower resting metabolic rate
when compared to white women
New Research
Low grade inflammation theory
Measured by levels of C-Reactive protein in
the blood
Produced in response to inflammation
Obesity Virus
Researchers at the University of Wisconsin
have been able to bring on obesity in
animals by inoculation with adenovirus
Population at Risk
1) Racial-ethnic Minorities
Mexican American and Black adults more
overweight than whites
American Indians (80% for men and 67% in
Arizona)
Population at Risk
2) Women
For all racial and ethnic groups combined
women of lower socio-economic status are
50% more likely to be obese
Population at Risk
Black women 64.5%
Hispanic women 56.8%
White women 43%
Population at Risk
4) Children & Adolescents
In 1999 13% of children aged 6-11 years
and 14% aged 19-199 were overweight
Population at Risk
5) Elderly
Obesity among the elderly (those over 50)
has nearly doubled from 1982-1999 (14.4-
26.7%)
Importance Of Culture
Many obesity related diseases are found in
higher rates in minorities
Diabetes, hypertension, cancer
Importance Of Culture
Studies have demonstrated that minorities
are less preoccupied with their body image
Larger bodies are more socially accepted in
this community
This can have a negative consequence:
Weight gain leading to obesity
Other Concerns
Low Self-Esteem & Discrimination
Low self-esteem most evidenced in children
and adolescents
Study done in the 1960’s to assess
children’s perception of obesity
Other Concerns
Discrimination of obese persons is common
Especially common in the workplace
Other Concerns
Obese persons had lower wages
Were considered lazy and possessing
negative personality traits
Discrimination also found in the health care
arena
Overweight patients were less likely to
receive important preventative health care
services
Economic Costs
Total costs due to obesity:
$99 Billion in 1995
$117 billion in 2000
Solutions
HEALTHY PEOPLE GOALS 2010
Reduce the proportion of children and
adolescents who are overweight or obese
From 11% to 5% in children 6-11 years
From 11% to 5% in adolescents 12-19
Solutions
Increase the proportion of adults who are at
a healthy weight from 42% to 60%
Reduce the proportion of adults who engage
in no leisure-time physical activities from
40% to 20%
Solutions
Increase the proportion of adults who
engage regularly in moderate physical
activity for at least 30 minutes per day from
30 % to 15%
Obesity: Risk Factors
Genetics
Family history of obesity
Psychological factors
Social and cultural factors
Medical Illnesses
Medications
Alcohol consumption
Smoking Cessation
Obesity: Causes
Causes
Biology
Lack of Physical Activity
Eating Patterns
Obesity: Consequences
Diabetes Peripheral Vascular
Disease (PVD)
Hypertension
Hyperlipidemia
Myocardial
Degenerative Joint
infarction
disease
Cerebrovascular Gallbladder Disease
attack (CVA)
Obesity: Consequences
Obese persons had lower wages
Were considered lazy and possessing
negative personality traits
Discrimination also found in the health care
arena
Overweight patients were less likely to
receive important preventative health care
services
Weight Issues vs. Health
White Americans believe thinness to
be a desirable health goal, whereas
other groups such as Haitians, consider
thin people to be in poor health.
– Hispanic older women believe weight
gain is inevitable, only young people
should be concerned about their weight.
Why Most Commercial
Weight Loss Programs Do
Not Work
Negative Impact
Temporary
Perfect- Orientation
Project Mentality
Do not Address Cause
Types of Weight Loss
Diets
Low Carbohydrate aka High Protein
Low Fat aka High Carbohydrate
Very Low Calorie aka Modified Fast
Novelty Diets
Weight Loss Programs
Consequences of Dieting
Decrease in rate of weight loss
Loss of lean tissue with fat loss
Decrease in metabolism, 10-40%
Decrease in Protein turnover
Preoccupation with food
Increase in irritability, moodiness
Tires easier, less physical activity
Apathy, depression
Re-feeding after Weight
Loss intake
Increase in pre-dieting food
Preference for high fat foods
Regain in weight, but greater increase in % BF
Metabolism slow to return to normal
Regain Weight quicker with each diet
Increase in abdominal fat deposits
Less likely to return to pre-diet physical activity
Decrease in self-efficacy/esteem
Recognizing an Unsound
Weight Control Diet
Promotes Quick Weight Loss
Limits Food Selection
Testimonials or Famous People/Places
Expensive Supplements or Products
No Attempt to Permanently change eating or
physical activity
Critical of Scientific Community‘
They know more, or something new
Characteristics of a
Sound Weight Control
Diet
Nutritionally adequate yet low in calories
Fit into current lifestyle
Foods that are liked
Slow rate of weight loss
Followed for life
Healthy Eating
Recommendations
for Weight Management
PLAN meals through the day
Eat a VARIETY of foods (at each meal)
Center meals around CARBOHYDRATE foods
(real foods with no mother)
Watch the FAT (always) and
Sugar (at any one time)
Don’t worry about the PROTEIN
CARBOHYDRATE (CHO)
Percentage of calories can vary
Individualize based on:
– Individual eating habits
– Blood glucose and lipid goals
Glucose in the Body
Blood sugar of 80-100mg/dl
= 5 grams = 20 Calories
Liver glycogen (20% of reserve)
= 75 gm = 300 Calories
Muscle glycogen (80% of reserve)
= 300 gm = 1200 Calories
FAT
< 10% of kcal/day from saturated fat
Percentage of calories from total fat can
vary
Dietary cholesterol < 300 mg/day
Research: amount of MUFA/PUFA
versus amount of CHO (?)
SODIUM
Persons with hypertension < 2,400 mg/day
To choose low sodium in food:
– Single serving of food: sodium < 400 mg
– Entrees or convenience meals: sodium < 800 mg
Buy fresh or low sodium foods and salt at the table
Solutions
Solutions will be found in prevention
policies aimed at
promoting healthy lifestyles
Increased physical activity
Behavior changes which emphasize long
term weight management rather than short
term weight reduction