EPIDEMIOLOGY OF OBESITY

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EPIDEMIOLOGY OF OBESITY
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Epidemiology

• The study of the spread of diseases within and
  between populations.

http//www.medterms.com/script/main/art.asp?articl
ekey3277
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Obesity Trends Among U.S. AdultsBRFSS, 1989
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 2001
No Data lt10 1014
1519 2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Weight-Associated Mortality
2.5
Men, age lt 65
Women, age lt 65
2.0
Men, age gt 65
Relative Mortality
1.5
1.0
Very Low
Very High
Moderate
Low
Moderate
High
25
30
40
35
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Body Mass Index (kg/m2)
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Prevalence of Morbid Obesity
Sturm, R. Arch Intern Med 20031632146-2148.
Sturm, R. Arch Intern Med 20031632146-2148.
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Today in the developed world, the incidence of
obesity is rising
Philip Campbell, Editor, and Ritu Dhand,
Associate Editor, Nature. Nature 404 (6778)631
April 6, 2000
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Mokdad AH, Bowman BA, Ford ES, et al. Prevalence
of obesity, diabetes, and obesity related health
risk factors, 2001. JAMA 20032897679.
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Obesity Trends in Selected Countries
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Obesity in Minorities

• Non-Hispanic Black Women 77.3
• Hispanic Women 71.9
• Non-Hispanic White Women 57.3
• Non-Hispanic Black Men 60.7
• Hispanic Men 74.7
• Non-Hispanic White Men 67.4

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Prevalence of Obesity

• Nearly one-third of U.S. adults are obese (BMI gt
  30)
• All adults 61.3 million (30.5 )
• Women 34.7 million (33.4 )
• Men 26.6 million (27.5 )

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What is severe obesity?

• 100 lbs over ideal body weight for men (80lbs for
  women)
• OR BMI gt 40
• OR Twice ideal body weight
• OR obesity complicated by other medical
  conditions eg. diabetes, high blood pressure

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What does BMI stand for
BODY Mass Index
Formula for BMI Weight (kg)/ Height(m2)
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Prevalence of Overweight

• Nearly two-thirds of U.S. adults are overweight
  (BMI gt 25).
• 129.6 million (64.5 of population)
• Women 64.5 million (61.9 )
• Men 65.1 million (67.2 )

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BMI/Body Fat correlation is influenced by age,
gender, and race
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Pediatric Epidemiology
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Obese Children

• 25 of children are overweight
• Incidence has doubled in 20 years

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Obese Children

• About 15.3 percent of children, ages 6 to 11
  years are obese

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Obese Children

• There is an epidemic increase in overweight
  children
• More than 3 fold increase in obese children
  (5-15.5)
• Obese children are 30 heavier than in 1990
  250,000 with BMIgt40

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Obese Children

• Prevalence of obese children, ages 6 to 11 years,
  at the 95th percentile of Body Mass Index (BMI)

• 1999 to 2000 15.3
• 1988 to 1994 11.0
• 1976 to 1980 7.0

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Obese Adolescents

• Obese adolescents are likely to be obese adults

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Obese Adolescents

• Daily enrollment in high school physical
• education has dropped from 49 in 1991 to 29 in
  1999

USA Today Nov 29, 2000
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Obese Adolescents
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Obese Adolescents

• About 15.5 percent of adolescents, ages 12 to 19
  years are obese

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Obese Adolescents

• Prevalence of obese adolescents, ages 12 to 19
  years, at the 95th percentile of Body Mass Index
  (BMI)

• 1999 to 2000 15.5
• 1988 to 1994 11.0
• 1976 to 1980 5.0

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Why Are We Concerned?

• Prevalence of obesity in children and adolescents
  has increased from 5 in 1980 to 11-13 in 1999

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An Epidemic Increase of Overweight Children

• More than 3 fold increase in obese children
  (5-15.5)
• Obese children are 30 heavier than in 1990
  250,000 with BMIgt40
• Obese adolescents likely to be obese adults

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Youth of America-Fat and Getting Fatter

• 25 of children
• are overweight
• Incidence has doubled in 20 years
• USA TodayNov 29,2000

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• Increased obesity rates in children track a
  national decline in walking and bicycling

According to a USDOT survey, the number of trips
the average American took on foot declined by 42
percent between 1974 and 1995
Source CDC (1999)
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Teen obesity and family environment
Parents have a strong influence over whether or
not their children will become overweight or
obese, and it's not just their genes that they
pass on.
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  BMI decreases the preschool years, then
increases into adulthood. The percentile curves
show this pattern of growth.

• BMI for Children and Teens (BMI-for-age)BMI is
  Used Differently with Children Than it is With
  AdultsIn children and teens, body mass index is
  used to assess underweight, overweight, and risk
  for overweight.
•   Underweight BMI-for-age lt 5th percentile   
  At risk of overweight BMI-for-age 85th
  percentileto lt 95th percentile    Overweight

http//www.locateadoc.com/articles.cfm/1660/1238
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Obese adolescents likely to be obese adults
Probability of obesity in young adults relates to
the presence of overweight at various times
during childhood Whitaker et al. NEJM
1997337869-873
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Example Let's look at the BMI for a boy as he
grows. While his BMI changes, he remains a t
the 95th percentile BMI-for-age. We see how the
boy's BMI declines during his preschool years and
increases as he gets older.
http//www.locateadoc.com/articles.cfm/1660/1238
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Short Break

• We will now take a short break. You have five
  minutes to do what you need to do such as get a
  drink or use the restroom. Also feel free to ask
  questions during this break time and your HOPS
  Weight Loss Counselor will be glad to answer them.

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MENS EPIDEMOLOGY
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This Chart will show Men's BMI vs. age
http//www.halls.md/body-mass-index/womens.htm
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Obesity and overweight
Globally, there are more than 1 billion
overweight adults, at least 300 million of them
obese. Obesity and overweight pose a major risk
for chronic diseases,
http//www.who.int/dietphysicalactivity/publicatio
ns/facts/obesity/e
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Women Epidemiology
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BMI/Body Fat correlation is influenced by
age,gender,and race. This is showing Women,s BMI
vs. age
http//www.halls.md/body-mass-index/womens.htm
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Obesity and Mortality
If this trend continues, obesity will become the
leading cause of death by 2005, killing 500,000
people per year. CDC 3/04
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Obesity

• Obesity is a condition in which the natural
  energy reserve, stored in the fatty tissue of
  humans and other mammals, is increased to a point
  where it is a risk factor for certain health
  conditions or increased mortality

Source Wikipedia
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EPIDEMIOLOGY

• ADULTS

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Obesity Trends in Developing Countries
EPI slide31 ver.1 as of 12/17/2006
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Personal Physician Counseling and You

• Your Personal Physical Health
• Your Unique Situation
• Your Medical Conditions
• Your Psychological Make-Up

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Private Consultation

• We strongly encourage you to set up a personal
  consultation with one of our HOPS Doctors.
• So if you do not fully understand all of these
  different options, medical or surgical options
  and would like a personal consultation with one
  of our HOPS Doctors, we can further explain these
  procedures to you. Please discuss with one of
  your HOPS Weight Loss Counselors on how to set up
  an appointment with us.
• The cost of private consultation probably will
  not be covered by your health insurance company,
  Medicare, and or Medicaid. We will issue you a
  receipt and a bill and would expect you to submit
  the bill to your insurance and collect
  reimbursement on your own. The cost of
  consultation is 250 per hour and there is a
  minimum of two hours consultation time
  recommended. Payment is expected in advance of
  the consultation.
• If you would like a trial of Xenical along with
  HOPS Weight loss program the cost of private
  consultation probably will not be covered by your
  health insurance company, Medicare, and or
  Medicaid. We will issue you a receipt and a bill
  and would expect you to submit the bill to your
  insurance and collect reimbursement on your own.
  The cost of a FULL DETAILED HISTORY AND PHYSICAL
  is ONLY 250. Payment is expected in advance of
  the consultation.

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Private Consultation With HOPS Weight Loss
Counselors

• We strongly encourage you to set up a personal
  consultation with one of our HOPS Weight Loss
  Counselors
• So if you do not fully understand all of these
  different CONCEPTS, and would like a personal
  consultation with one of our HOPS Weight Loss
  Counselors we can further explain these concepts
  to you. Please discuss with one of your HOPS
  Weight Loss Counselors on how to set up an
  appointment with us.
• The cost of private consultation probably will
  not be covered by your health insurance company,
  Medicare, and or Medicaid. We will issue you a
  receipt and a bill and would expect you to submit
  the bill to your insurance and collect
  reimbursement on your own. The cost of
  consultation is 25 per hour and there is a
  minimum of two hours consultation time
  recommended. Payment is expected in advance of
  the consultation.

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Pathogenesis of Obesity

• Overweight and Obesity result from an energy
  imbalance
• Too many calories and not enough physical
  activity.

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Food expenditures
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Pathogenesis of Obesity
Overweight and obesity result from an energy
imbalance Too many calories and not enough
physical activity. Body weight is the result of
genes, metabolism, behavior, environment,
culture, and socioeconomic status.
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Parent-Child Eating Styles

• Parents shape childrens eating style
• Foods available
• Parent feeding styles
• restriction of intake (restrict childs access to
  unhealthy foods)
• pressure to eat (pressure child to eat more food,
  typically healthy foods)
• Mothers report gt use of restrictive practices
• With increased mothers own weight/eating
  concerns
• With increased perception of daughters risk for
  weight problem
• Mothers report gt use of pressure to eat
• With increased perception of daughter as
  underweight

Francis, Appetite, 2001
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High-tech increases body weight
Cellular phones and remote controls deprive us
from walking!
20 times daily x 20 m 400 m
Walking distance lost/year400x365 146.000 m
146 km 25 h of walking
1 h of walking 113-226 kcal
Energy saved 2800-6000 kcal
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PATHOGENESIS
Necessary Calories Per Day
If you consume only the necessary calories
everyday then you will stay the same size.
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If you consume extra calories everyday then they
will gradually show up in your size.
Extra Calories Per Day
Necessary Calories Per Day
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If you consume less calories everyday then it
will gradually show in your size.
Calories Not Eaten Per Day (Calorie Deficit)
Total Calories to Maintain present weight
Necessary Calories Per Day
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Food expenditure

• In the US
• GDP spent on food 9.7
• Lowest in the world
• GDP spent on health care 16
• Highest in the world
• Food industry overview Plunkett Research, Feb
  2006
• Health affairs (Millwood) 200697 (1) 20-3

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(No Transcript)
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Pathogenesis of Obesity

• Behavior and environment play a large role
  causing people to be overweight and obese. These
  are the greatest areas for prevention and
  treatment actions.