This document discusses obesity, overweight, and their health risks. It defines obesity as a BMI of 30 or higher, or excessive body fat. Obesity is estimated to exceed smoking as a leading cause of preventable death. While genetics play a role, lifestyle factors like diet and exercise are the primary determinants of weight gain. Maintaining a healthy weight through a balanced diet and regular physical activity can help prevent obesity-related diseases like heart disease, diabetes, and some cancers. Treatment involves lifestyle modifications like diet, exercise and behavior therapy, while very severe obesity may also be treated with medications or surgery in some cases.

1. OBESITY and OVERWEIGHT PED 488 1

2. OVERWEIGHT and OBESITY An excess of body fat frequently resulting in a significant impairment of health Having a very high amount of body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or higher. Estimated to be the biggest health challenge in the future Will exceed that of smoking as a cause of death Exercise is most effective in preventing and controlling body weight and/or body fat 2

3. CAUSE of DEATHS

4. Diseases associated excess body fat Coronary Heart Disease Hypertension Diabetes Hyperlipidemia Cancer Gallbladder Disease Menstrual Irregularities Reproductive Hormone Dysfunction 4

5. Associated Risk Factors Predictive of CVD/CHD (especially central or visceral adiposity) Metabolic Syndrome Certain Cancers Hypertension Osteoarthritis 5

6. Obesity Trends Among U.S. Adults between 1985 and 2006 Data shown in maps were collected through CDC’s Behavioral Risk Factor Surveillance System (BRFSS). http://www.cdc.gov/NCCDPHP/dnpa/obesity/trend/maps/index.htm 6

7. US Ranks Last in Preventable Deaths, Health Affairs, 2008 7

8. Process of Excess Body Fat Storage of extra energy adipose cells unlimited storage capacities. No spot reduction Useful for times when food is not available Food available year-round food stores occur in excess Obesity occurs when adipose cells increase excessively size (hypertrophy) number (hyperplasia) Both size and number 8

9. Theories for Fat Gain Caloric Balance you eat more calories than you expend, you gain fat Biochemical Imbalance Hormone and other substance alteration is associated with obesity Set Point Theory body desires to have a specific amount of body always return to its own target percentage Excess Fat Intake 9

12. Determining Obesity Measure of “Body Build” or structure of the body Muscularity Linearity Fatness Body Mass Index (BMI) = weight (kg) / height (m2) Body size is determined by height and weight Body fat percentage Skinfolds, underwater weighing, bioelectrical impedance, etc. 12

13. Calculation of Ideal Body Weight Range Women: 100 lbs for first 5 feet. plus 5 lbs for each additional inch Men: 106 lbs for first 5 ft. 6lbs for each additional inch Assumes Medium Frame add/subtract 10% 110% overwt. 120% obese Hamwi 1974 13

14. BMI - Values Disease Risk Relative to Normal Weight and Waist Circumference BMI (kg/m2) <18.5 18.5 - 24.9 25.0 - 29.9 30.0 - 34.9 35.0 - 39.9 >40 Obesity Class I II III Men (<102 cm) <40 in Women (<88 cm) <35 in -- -- Increased High Very High Extremely High Men (>102 cm) >40 in Women (>88 cm) >35 in -- -- High Very High Very High Extremely High Underweight Normal Overweight Obesity Extreme obesity Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. Obes Res 1998;6(suppl 2). 14

15. OBESITY & MORTALITY Mortality Ratio High Moderate Low Very Low Body Mass Index 15

17. Defining Obesity as % Body Fat American Council on Exercise 17

18. Children Based on BMI for age and gender Overweight at or above 95th percentile At risk for Overweight 85th to 95th percentile Source: Expert Committee on Clinical Guidelines for Overweight Adolescent Preventative Services.(Pediatrics 1998;102(3). pediatrics.aappublications.org/cgi/content/full/102/3/e29 18

19. Overweight Overweight At risk At risk 19

20. Source: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overwght99.htm 20

22. Cardiovascular Diseaes

23. Dyslipidemia

24. Type 2 Diabetes

25. Sleep Apnea

26. Osteoarthritis

27. Infertility

28. Other

29. Progressive gain since adolescence

30. Hx of Obesity

31. Bulimia Nervosa

32. Binge Eating Disorder

33. Depression/Anxiety/Stress

34. Relevant medical conditions

35. Overall Disease Burden

36. Quality of Life

37. Physical Inactivity

38. Waist-Hip

39. > 1.0 in

40. >0.8 in

41. Waist Circumference

42. >40 in

44. The etiology of overweight and obesity is a combination of genetic and life-style factors. The life-style factors will contribute to overweight and obesity provided the genetic predisposition exists. Genetics Exercise Eating Habits 23

45. Trends in Health Education…what is missing

46. Physical Activity and Obesity Minimal weight loss in the absence of caloric restriction Best predictor of weight loss maintenance Include both programmed and lifestyle Utilize self monitoring tools – for example pedometers Is recommended for health benefits whether or not it directly results in wt. loss Decreases visceral inflammation Increases Insulin Sensitivity Reduces Mortality regardless of BMI 25

47. Exercise in OBESITY Sedentary Free Eaters Sedentary Pair Weighted Exercise Calories per Day Oscai et al J Lipid Research 13:588-592, 1972.

48. Exercise in OBESITY Body Weight (g) Percent Fat (%)

49. Exercise in OBESITY Fat Cell Number Fat Cell Size

50. Lifestyle Management Most effective treatments require a gradual long-term approach Sensible diet, moderate physical activity, behavioral counseling In isolation these approaches do not lead to significant weight loss 10% wt. loss is associated with a decrease in obesity related health consequences 29

51. A Multilevel, Transdisciplinary, Ecological Model of Factors that Influence What Children Eat . L Kolbe & M Story, 2007 Push—Pull Factors 30

52. Estimating Energy Needs Level of Activity and Cal/kg Goal: Low Moderate High Lose Wt. 15kcal/kg 20kcal/kg 25kcal/kg Maintain Wt. 20kcal/kg 25kcal/kg 30kcal/kg GROUPCALORIES/lb. Men/Active Women 15 Women/Sedentary Men/>55 13 Sedentary women/obese adults 10 31

53. M: 662 – (9.53 X Age) + PA{(15.91 X W in kg) + (539.6 X Ht in m)} F: 354 – (6.91 X Age) + PA {(9.36 X Wt in kg) + 726 X Ht in m)} PA Values for Different Activity Levels SedLow ActiveActiveVery Active M 1.00 1.11 1.25 1.48 F 1.00 1.12 1.27 1.45 32 Energy Expenditure Rate (Formula based on Physical Activity)

54. Pharmacological Approaches Should only be considered with high BMI and/or comorbidities Need to consider cost, side effects, and rebound weight gain Noradrenergic Agents Appetite Suppression Serotonergic Agents Appetite Suppression Mixed Noradrenergic/Serotonergic LIPASE INHIBITORS Reduction of Nutrient Absorption 33

56. Laparoscopic

57. Adjustable Gastric Binding

58. Bilio Pancreatic Diversion

59. Distal BypassGASTRIC BYPASS 34

61. Laparoscopic

62. Adjustable Gastric Binding

63. Bilio Pancreatic Diversion

64. Distal Bypass35

65. Obesity Resources for Practitioners Partnership for healthy Weight Management http://www.consumer.gov/weightloss Weight Information Network http://win.niddk.nih.gov/publications/choosing.htmThe Practical Guide: Identification, Evaluation, and treatment of Overweight and Obesity in Adults http://www.nhlbi.nih.gov/about/oei/index.htm North American Association for the Study of Obesity http://www/nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf North American Obesity Association http://www.naaso.orghttp://www.obesity.org 36