1. INTERVENTION IS PREVENTION: For A Healthier Community Bronx County Medical Society 10 th Annual National Doctors Recognition Day March 20, 2013 Julie J Ramos, MD, MS Cardiologist/Nutritionist Montefiore-Einstein Center for Heart and Vascular Care

2. CAN YOUR PATIENT PINCH AN INCH??

3. Where Is The Weight? Where fat ends up influenced by factors such as: Subcutaneous fat vs. Visceral fat

4. VISCERAL FAT Insulin resistance Increase risk of CVD Promotes low-level chronic inflammation (TNF & IL-6)

5. IDEAL BODY WEIGHT

7. Percent of Obese NYC Residents (BMI > 30), by Borough NYCDOH 2003

8. Diabetes Prevalence in NYC By Borough, 2002 Healthy People 2010 Goal: 2.5% NYCDOH 2003

9. Metabolic Effects of Excess Weight Abnormal Lipids Insulin Resistance Diabetes Hypertension Heart Failure

10. INSULIN RESISTANCE

11. SPECTRUM OF INSULIN RESISTANCE Polycystic Ovary Disease Dyslipidemia Metabolic Syndrome

12. LIVER STORAGE ENERGY FAT MOUTH TO GUT PROCESS

13. FAT BEGETS MORE FAT: With the Help of Insulin

14. METABOLIC SYNDROME Blood pressure > 130/85 mmHg Fasting Blood Sugar > 100 mg/dL Waist Circumference : –Men - 40 inches or more –Women - 35 inches or more Low HDL cholesterol: –Men - < 40 mg/dL –Women - < 50 mg/dL Triglycerides > 150 mg/dL

15. Jordan et al., Prev Chronic Diseases 2012;9

16. METABOLIC SYNDROME SEQUELAE Diabetes Coronary Artery Disease Liver Disease (fatty liver) Stroke Peripheral Vascular Disease

17. WHAT CAN WE DO?

18. AHA/ACC Prevention of CVD Guidelines- Update 2011 30 min/day of moderate exercise -or- 15 min/day of vigorous exercise (Class I; Level of Evidence B) Mosca et al, JACC Vol. 57, No. 12, 2011

19. Minimum of 60 to 90 min of at least moderate-intensity physical activity almost everyday (Class I; Level of Evidence B). Mosca et al, JACC Vol. 57, No. 12, 2011 PHYSICAL ACTIVITY REQUIRED FOR WEIGHT LOSS

20. Let’s Talk Metabolism Muscle uses glucose to function. Body Fat produces factors that prevent weight loss.

21. Exercise Increases Insulin Response in Glucose Transport to Muscle

22. EXERCISE WORKS

23. STRRIDE-AT/RT Study; Bateman et al., Am J Cardiol 2011;108:838-844

24. FOOD

25. American Diet: 1/3 Junk Food and Soft Drinks! Diseaseproof.com

26. Heart Healthy Diet Starts with unprocessed foods Limit unhealthy fats and cholesterol. Choose low-fat protein sources. Eat more vegetables and fruits. Low sodium diet.

27. Mediterranean Bliss

28. The Mediterranean Diet

29. Lunch 1 cup pasta with spinach and beans 1 cup mixed greens with Parmigiano cheese 1 cup grapes Ice tea or water

30. Healthy Eating Works

31. Dietary Intervention and Metabolic Syndrome Healthy Diet-Increased whole grain, fish, and berries Whole Grain Enriched Diet-Added Whole grain Refined Flour Diet (aka, American Diet)

32. The Sysdimet Study Lankinen et al., PLoS ONE 6(8): e22646; Aug 2011

33. FINAL WORDS SOCIAL Issues Intersect With The HEALTH and WELL Being of Our Community

34. Community Issue of Availability BRONX UES

35. Lets Do Less of This!

36. Let’s Do More of This!