2. The human phenotype is changing rapidly Increased body size and fatter body composition Response to environments that make low demands on energy expenditure, together with greater energy-density diets This change is occurring within one to three generations, around the world Not entirely an urban phenomenon, but more pronounced in big cities

4. Obesity Trends* Among U.S. Adults BRFSS, 1990 *BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person No Data <10% 10%–14% http://www.cdc.gov/nccdphp/dnpa/obesity/

5. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

6. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

7. Obesity rates: Current and projected 0 10 20 30 40 50 1960 1970 1980 1990 2000 2010 2020 2030 USA England Mauritius Australia Brazil Population percentage with BMI > 30kg/m 2

8. The Demographic Transition

12. South Atlantic Ocean South Pacific Ocean North Atlantic Ocean Indian Ocean Arctic Ocean Arctic Ocean Arctic Ocean North Pacific Ocean Brazil South Africa Tanzania Kenya Egypt Mali China India Ghana Kyrgyzstan Bolivia Madagascar Namibia Zimbabwe Malawi Cameroon C. A. R. Côte D’Ivoire Turkey Vietnam Kazakhstan Uzbekistan Uganda Peru Colombia Dominican Republic Guatemala Haiti Niger Nigeria Senegal Zambia Benin Chad Guinea Yemen Nepal Bang. Togo Patterns of Overweight and Obesity among Women of Child-bearing Age from the DHS (BMI>25, Ages 20-49 , Age-Standardized, Weighted) 10-20% 31-40% 21-30% 41-50% > 51% <10% Burkina Faso Mozambique Comoros Eritrea Jordan Mexico

14. Prevalence of Obese Preschool Children In Selected Countries and Territories

17. Less Active Lifestyles

23. Predictable Sequence of the Developing Epidemic of Nutrition-Related Non-Communicable Diseases (NR-NCDs) Obesity and overweight are the first manifestation Within a generation, the prevalence of Type 2 diabetes mellitus and/or hypertension and stroke rise Within two generations, premature CHD emerges as a major cause of premature death, disability and health care costs Within two generations, the nature of the cancer burden shifts to domination by diet- and physical-activity related cancers

24. Deaths, by broad cause group and WHO Region, 2000 Injuries Noncommunicable conditions Communicable diseases, maternal and perinatal conditions and nutritional deficiencies AFR EMR EUR SEAR WPR AMR 25 50 75 % Source: WHO, World Health Report 2001

33. Health risks overweight Abdominal obesity Dyslipidemia Insulin resistance Hypertension Proinflammatory state Prothrombotic state Cardio-vascular disease Diabetes Mellitus Metabolic disorders as a common denominator for the various components Nutrition may play an important role in the development Overweight subjects are at increased risk of developing metabolic disorders

36. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004 Oct 13;292(14):1724-37 Buchwald H , Avidor Y , Braunwald E , Jensen MD , Pories W , Fahrbach K , Schoelles K . Department of Surgery, University of Minnesota, Minneapolis 55455, USA. buchw001@umn.edu CONTEXT : About 5% of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery. OBJECTIVE: To determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea). DATA SOURCES AND STUDY SELECTION: Electronic literature search of MEDLINE, Current Contents, and the Cochrane Library databases plus manual reference checks of all articles on bariatric surgery published in the English language between 1990 and 2003. Two levels of screening were used on 2738 citations. DATA EXTRACTION: A total of 136 fully extracted studies, which included 91 overlapping patient populations (kin studies), were included for a total of 22,094 patients. Nineteen percent of the patients were men and 72.6% were women, with a mean age of 39 years (range, 16-64 years). Sex was not reported for 1537 patients (8%). The baseline mean body mass index for 16 944 patients was 46.9 (range, 32.3-68.8). DATA SYNTHESIS: A random effects model was used in the meta-analysis. The mean (95% confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%) for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding; 61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and 70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative mortality (< or =30 days) in the extracted studies was 0.1% for the purely restrictive procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion or duodenal switch. Diabetes was completely resolved in 76.8% of patients and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more of patients. Hypertension was resolved in 61.7% of patients and resolved or improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients and was resolved or improved in 83.6% of patients. CONCLUSIONS: Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement

37. Number of weight loss operations performed in the United States JAMA. 2005;294:1909-1917.