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Assessment of the Obesity Epidemic. More than 60% of US Adults Are Overweight Flegal K, et al. JAMA 2002;288:1723-1727. Hedley AA, et al. JAMA 2004;291:2847-2850.

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Presentation on theme: "Assessment of the Obesity Epidemic. More than 60% of US Adults Are Overweight Flegal K, et al. JAMA 2002;288:1723-1727. Hedley AA, et al. JAMA 2004;291:2847-2850."— Presentation transcript:

1 Assessment of the Obesity Epidemic

2 More than 60% of US Adults Are Overweight Flegal K, et al. JAMA 2002;288: Hedley AA, et al. JAMA 2004;291: Obese (BMI 30) Overweight (BMI )

3 Assessing Obesity: What Is BMI? BMI –Calculated as weight(kg)/height(m 2 ) –Evaluates weight relative to height –Replaced % ideal body weight as the primary criterion for assessing obesity –Correlates significantly with body fat, morbidity, and mortality NIH Natl Heart, Lung, and Blood Inst. Obes Res. 1998;6(suppl 2):51S. Willett WC et al. N Engl J Med. 1999;341:427. CategoryBMI Underweight < 18.5 Normal*18.5 – 24.9 Overweight 25.0 – 29.9 Obesity 30.0 Class I30.0 – 34.9 Class II35.0 – 39.9 Class III 40.0

4 Flegal et al. JAMA 2002;288: Prevalence of Obesity by Age MenWomen

5 Obesity Trends by Gender and Ethnicity MenWomen Flegal K, et al. JAMA 2002;288:

6 Flegal et al. JAMA 2002;288: Education Income Average BMI Year Lowest Income Highest Income Prevalence of Obesity by Education and Income

7 Prevalence of Extreme Obesity (BMI 40) by Gender and Ethnicity MenWomen Hedley AA, et al. JAMA 2004;291:

8 Prevalence of Overweight in Children and Adolescents Flegal K, et al. JAMA 2002;288: Hedley AA, et al. JAMA 2004;291:

9 Coronary Heart Disease Morbidity mortality HypertensionDiabetesDyslipidemia 40% are obese 80% are obese50% – 70% are obese OBESITY Obesity and Coronary Heart Disease (CHD)

10 Trends in Cardiovascular Risk Factors in Obese Individuals (BMI 30 kg/m 2 ) Smoking High Cholesterol High Blood Pressure Gregg EW, et al. JAMA 2005;293: Diabetes

11 Obesity Is Caused by Long-Term Positive Energy Balance Fat stores Energy intake Energy expenditure

12 Regulation of Body Weight Genes confer the potential for obesity Environment determines whether and to what extent the potential is realized

13 Relationship Between Adoptee Weight and Weight of Biological or Adoptive Parents Stunkard et al. N Engl J Med 1986;314:193. Weight Classification of Adoptees BMI of Parents (kg/m 2 ) Thin Median Overweight Obese Biological Parents Adoptive Parents Fathers Mothers

14 Heritability of Body Weight

15 Sedentary person (1800 kcal/d) Physically active person (2200 kcal/d) 60% Components of Daily Energy Expenditure 32% 75% 8% 17% 8% Thermic effect of feeding Resting energy expenditure Energy expenditure of physical activity

16 Decreased Energy Expenditures and Weight Gain Cumulative Incidence of a 10-kg Body Weigh Gain (%) Time (years) Low RMR Middle RMR High RMR Ravussin E, et al. N Engl J Med. 1988;318: RMR = resting metabolic rate

17 Barsh GS, Schwartz MW. Nat Rev Genet. 2002;3:

18 Gene-Environment Interaction in the Pathogenesis of Obesity Pima Indians in Maycoba, Mexico Pima Indians in Arizona Ravussin E et. al. Diabetes Care 17:1067, p < Body Mass Index (kg/m 2)

19 The Toxic Environment Food is… Highly accessible Inexpensive Advertised heavily High fat, high sugar Delicious

20 16 oz32 oz44 oz52 oz64 oz 1 oz 12 calories

21 Nielsen & Popkin, JAMA Food Portion Size Trends Salty Snacks DessertsSoft Drinks Fruit Drinks French Fries Ham- burgers Cheese- burgers PizzaMexican Food Food Intake per Eating Occasion, oz

22 TV hours per day (youth report) Prevalence (%) NHES NLSY > 5 Prevalence of Obesity by Hours of TV per Day NHES Youth Aged 12 to 17 in and NLSY Youth Aged 10 to 15 in 1990

23 American Academy of Pediatrics. % of Children with Daily Physical Education

24 Responding To The Obesity Epidemic Create a child-healthy environment Banish junk food from schools Reduce food ads directed at children Increase opportunities for physical activity

25 Psychological Factors and Obesity Moral problem? Psychological problem? Aesthetic problem? Social and medical problem?

26 Psychosocial Status of Obese Individuals Most obese individuals have normal psychological status Persons who seek weight loss report greater distress Patients at greatest risk of depression: –Women –Extreme obesity (BMI 40 kg/m2) –Binge eating disorder (BED) Friedman & Brownell. Psych Bull 1995;117:3-20.

27 Risk of Major Depression with Extreme Obesity Onyike, et al. Amer J Epidemiology 2003;158:

28 Bodily Pain and Depression in Obese Individuals (N = 306) Fabricatore AF. Obes Surg 2005; 15: BDI-II Score Bodily Pain:

29 Prejudice Against the Obese Six-year old children labeled silhouettes of an overweight child as: Staffieri. J Per Social Psychol 1967;7:101. Lazy Dirty Stupid Ugly Cheats Lies

30 Prejudice Against the Obese Mean Rank Healthy Healthy* Crutches Crutches* Wheelchair Wheelchair* Hand Face Face* Obese Obese* Latner, JD, Stunkard, AJ. Obes Res 2003;11:454.

31 Discrimination Against the Obese Discrimination has been reported in: –Student Selection –Employee Selection –Employee Pay and Promotion –Tenant Selection –Marriage Roehling MV. Personnel Psychology 1999; 52:

32 Discrimination in the Workplace Discrimination against obese does not violate federal law in the US Title VII in US protects people from discrimination based on race, color, religion, sex, or national origin Obesity is not a protected characteristic

33 Patients who lost 45 kg or more Preferred to be normal weight with a major handicap (deaf, dyslexic, diabetic, legally blind, bad acne, heart disease, leg amputated) than to be morbidly obese Rather be normal weight than a morbidly obese multi-millionaire Social Stigma and Obesity: Id Rather Go Blind Rand CS. Macgregor AM. Int J Obesity 1991; 15:577.

34 Conclusion The epidemic of obesity is the result of a complex interplay of genetic, environment, cultural, and economic factors Greater efforts are needed to change the environment that lies at the heart of the epidemic Obese individuals should not be blamed for their condition, but instead be treated with respect, fairness, and compassion

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