Introduction to the Multifactorial Chronic Disease Overweight and Obesity

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Introduction to the Multifactorial Chronic
DiseaseOverweight and Obesity

• Class 1
• Exercise, Diet, and Weight Management
• Instructor Samantha Rubin, MS, RD, CDE

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Overweight and Obesity

• Overweight an excess amount of total body
  weight, including muscle, water and fat
• Obesity excessive body fat.
• Often defined using Body Mass Index.

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BMI

• Body Mass Index
• First published in 1836 by Quetelet
• Weight/Ht squared
• Weight in kg
• Height in m2
• lt19 underweight, 19 - 25 normal
• gt25 - lt30 is overweight,
• gt30 is obesity, gt40 severe obesity

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Obesity Facts

• 59 million people are obese in the US
• 64 are considered overweight or obese (BMI gt 25)
• Second leading cause of unnecessary deaths
• More damaging to health than smoking, high levels
  of alcohol drinking, and poverty (Rand
  Organization study)
• Causes gt 300,000 deaths in the US yearly
• One of the most expensive diseases
• Carries annual healthcare costs of 100 billion.

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Obesity Facts- Incidence

• Prevalence of obesity has increased by more than
  75 since 1980.
• Prevalence of overweight in children and
  adolescents has more than doubled since 1976
  approximately 13 seriously overweight
• Now as many obese in world as malnourished 500
  million overweight, 250 million obese adults
• By year 2030, 100 of adults in US will be
  overweight if current rate of gain continues.
• Healthy People 2010, reduce prevalence of obesity
  among US adults to less than 15.

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Obesity Facts- Health Consequences

• Causes many serious medical conditions
• Affects all major body systems- heart, lungs,
  muscles, bones
• Associated with gt 30 medical conditions strongly
  related to 15 of these
• Small weight gains are associated with
  significant additional complications.
• Even small weight losses are associated with
  significant health improvements.

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Obesity Facts- Diabetes

• Well established relationship between excess body
  weight and type 2 Diabetes.
• 2/3s of adult men/women in US diagnosed with
  type 2 diabetes have a BMI gt 27.
• In 2000, 33 increase in people in the age of
  30-39 years of age diagnosed with type 2
  Diabetes.
• 4-5 year olds have been diagnosed
• Metabolic Syndrome- 50 million Americans have
  insulin resistance

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Obesity Facts- Treatment Efforts

• 29 of men and 44 of women in the US describe
  themselves as trying to lose weight only 20
  report restricting caloric intake and increasing
  physical activity simultaneously.
• 85 of Americans do not receive advice about how
  to lose weight from a health professional.
• Americans spend 35 billion annually on weight
  loss products and services.
• In 1999, 321 million was spent in the US on
  prescription medications to treat obesity.

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Risk factors and Diseases that May Influence
Obesity Therapy

• Presence of CAD
• Presence of obesity related diseases that
  increase CHD
• HTN (SBP gt 140 or DBP gt 90 or taking antiHTN
  meds)
• high LDL gt 160 mg/dl or low HDL lt 35 mg/dl
• impaired FPG (110-125 mg/dl) or type 2 DM
• Presence of additional RFs for CHD
• family history
• age (gt 45 men, gt women (or postmenopausal)
• History of lifestyle associated RFs
• cigarette smoking
• weight gain of 5 kg or more since the age of
  18-20 years
• sedentary lifestyle (lt 30 min/day of moderate
  activity 5 days/week)
• Presence of additional obesity-related diseases
  that may benefit from weight loss.

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Suggested Weight Loss Treatment Options Based On
BMI and Risk Factors

BMI Category Treatment
25.0-26.9 27.0-29.9
30.0-34.9 35.0-39.9 gt 40.0 Diet,
Exercise, with RF with RF
yes yes yes
Behavior therapy Pharmacotherapy
with obesity yes
yes yes
related dz
Surgery
with
obesity yes
related dz See evidence-based algorithm for the
Treatment of Obesity.
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Conclusions

• Overweight and obesity- very big problem
• Major impact on health (physical and
  psychological) and quality of life
• Incidence rising
• Huge annual healthcare costs
• People spending large amounts of money on the
  wrong things
• Weight loss and prevention of weight gain must
  become major components of clinical practices
• Major need for us!