2 More than 60% of US Adults Are Overweight Obese (BMI ≥ 30)Overweight (BMI )Flegal K, et al. JAMA 2002;288: Hedley AA, et al. JAMA 2004;291:
3 Assessing Obesity: What Is BMI? Calculated as weight(kg)/height(m2)Evaluates weight relative to heightReplaced % ideal body weight as the primary criterion for assessing obesityCorrelates significantly with body fat, morbidity, and mortalityCategoryBMIUnderweight< 18.5Normal*18.5 – 24.9Overweight25.0 – 29.9Obesity≥ 30.0Class I30.0 – 34.9Class II35.0 – 39.9Class III≥ 40.0The BMI, easily calculated by office staff, should be an essential part of thepatient work-upBMIIs calculated as weight divided by height squaredEvaluates weight relative to heightHas replaced % ideal body weight as the primary criterion for assessing obesityCorrelates significantly with % of total body fat, morbidity, and mortalityConversion tables are available so calculations are done for youToday, calculating the BMI in all patients is considered to be state-of-the-art medicineToday, there are successful, proven approaches for controlling obesityKnowing the BMI is the first step to categorizing the patient’s overweight and obese statusRepeated calculations lead to understanding the patient’s trends for risks associated with obesityWaist circumference is an additional measure of the level of risk associated with obesityClassification for BMI - see file 1NIH Natl Heart, Lung, and Blood Inst. Obes Res. 1998;6(suppl 2):51S.Willett WC et al. N Engl J Med. 1999;341:427.
4 Prevalence of Obesity by Age MenWomenFlegal et al. JAMA 2002;288:
5 Obesity Trends by Gender and Ethnicity MenWomenFlegal K, et al. JAMA 2002;288:
6 Prevalence of Obesity by Education and Income 23.0023.5024.0024.5025.0025.5026.0026.5027.0027.50Average BMI198619881990199219941996199820002002YearLowestHighestAverage BMI22232425262728198619881990199219941996199820002002YearNo High SchoolHigh SchoolSome CollegeCollegeFlegal et al. JAMA 2002;288:
7 Prevalence of Extreme Obesity (BMI ≥ 40) by Gender and Ethnicity MenWomenHedley 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 Obesity and Coronary Heart Disease (CHD) Morbidity mortalityMorbidity mortalityMorbidity mortalityHypertensionDiabetesDyslipidemia40% are obese80% are obese50% – 70% are obeseOBESITY
10 Trends in Cardiovascular Risk Factors in Obese Individuals (BMI ≥ 30 kg/m2 ) High Blood PressureSmokingHigh CholesterolDiabetesGregg EW, et al. JAMA 2005;293:
11 Obesity Is Caused by Long-Term Positive Energy Balance FatstoresEnergyexpenditureEnergyintake
12 Regulation of Body Weight Genes confer the potential for obesityEnvironment determines whether and to what extent the potential is realized
13 Weight Classification of Adoptees Relationship Between Adoptee Weight and Weight of Biological or Adoptive Parents27212625242322Biological ParentsAdoptive ParentsBMI of Parents (kg/m2)FathersMothersThin Median Overweight ObeseThin Median Overweight ObeseWeight Classification of AdopteesStunkard et al. N Engl J Med 1986;314:193.
15 Components of Daily Energy Expenditure Thermic effect of feedingResting energy expenditureEnergy expenditure of physical activity8%17%8%32%75%60%Sedentary person(1800 kcal/d)Physically active person(2200 kcal/d)
16 Decreased Energy Expenditures and Weight GainLow RMRMiddle RMRHigh RMR123451015202530Cumulative Incidence of a10-kg Body Weigh Gain (%)Time (years)RMR = resting metabolic rateRavussin E, et al. N Engl J Med. 1988;318:
22 Prevalence of Obesity by Hours of TV per Day NHES Youth Aged 12 to 17 in andNLSY Youth Aged 10 to 15 in 1990510152025303540TV hours per day (youth report)Prevalence (%)NHESNLSY 19900 - 11 - 22 - 33 - 44 - 5> 5
23 Daily Physical Education % of Children withDaily Physical EducationAmerican Academy of Pediatrics.
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 statusPersons who seek weight loss report greater distressPatients at greatest risk of depression:WomenExtreme 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) BDI-II ScoreFabricatore AF. Obes Surg 2005; 15:
29 Prejudice Against the Obese Six-year old children labeled silhouettesof an overweight child as:LazyDirtyStupidUglyCheatsLiesStaffieri. J Per Social Psychol 1967;7:101.
30 Prejudice Against the Obese 196120011Healthy*2HealthyCrutchesFace*Mean Rank3WheelchairCrutches*HandHand4FaceWheelchair*Obese5Obese*6Latner, JD, Stunkard, AJ. Obes Res 2003;11:454.
31 Discrimination Against the Obese Discrimination has been reported in:Student SelectionEmployee SelectionEmployee Pay and PromotionTenant SelectionMarriageRoehling MV. Personnel Psychology 1999; 52:
32 Discrimination in the Workplace Discrimination against obese does not violate federal law in the USTitle VII in US protects people from discrimination based on race, color, religion, sex, or national originObesity is not a protected characteristic
33 Social Stigma and Obesity: “I’d Rather Go Blind”Patients who lost 45 kg or morePreferred to be normal weight with a major handicap (deaf, dyslexic, diabetic, legally blind, bad acne, heart disease, leg amputated) than to be morbidly obeseRather be normal weight than a morbidly obese multi-millionaireRand CS. Macgregor AM. Int J Obesity 1991; 15:577.
34 ConclusionThe epidemic of obesity is the result of a complex interplay of genetic, environment, cultural, and economic factorsGreater efforts are needed to change the environment that lies at the heart of the epidemicObese individuals should not be blamed for their condition, but instead be treated with respect, fairness, and compassion