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Obesity Interventions That Work The Molten Moment Tracy Flood MD, PhD Director of the Statewide Obesity Surveillance System University of Wisconsin Madison.

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Presentation on theme: "Obesity Interventions That Work The Molten Moment Tracy Flood MD, PhD Director of the Statewide Obesity Surveillance System University of Wisconsin Madison."— Presentation transcript:

1 Obesity Interventions That Work The Molten Moment Tracy Flood MD, PhD Director of the Statewide Obesity Surveillance System University of Wisconsin Madison

2 About Me

3 About Us The Socio Ecological Model Cellular

4 Question: How do we decrease obesity? Clinic 1 v 1 Populations vs.

5 Why? Unhealthy Weight Gain Obesity “Toxic” Obesity = Metabolic Syndrome (MetS) Cardiovascular Dz (CVD) = Death

6 Goal Provide how-to-steps on how to move the needle on obesity & prevent premature death from cardiovascular disease.

7 Outline WHY should we care? Metabolic Syndrome, CVD, etc! Ok, we care. Let’s take action! Let’s Design an intervention that works (review the lit reviews) WHEN = Molten Moment WHERE = Clinic vs. Community WHAT WORKS?* *Informed by Biology The Story of the Fat Cell

8 When do we act? The Molten Moment

9 Cold, Solid HOT, Malleable The Molten Moment

10 Where do you strike For the biggest impact?

11 The Molten Moment Where do you strike For the biggest impact? birth Age:

12 The Molten Moment Design an Intervention Design an Intervention ? Where do we act?

13 Pick an Obesity Intervention

14 Individual Organizational (ex. Schools, worksites) Policy & Built environment

15 Will the Intervention work? Studies 35 Systematic Reviews & Meta-analyses & What Works for Health = Evidence-based Interventions

16 Will the Intervention work? Define “What Works” Change Key* Behaviors  Obesity  CVD  MetS *Will define key behaviors for each case

17 The Molten Moment Design an Intervention ? The Story of The Fat Cell What Works?

18 The Story of The Fat Cell

19 U.S. Prevalence of Overweight & Obesity Pediatric Definition Adult Definition % Little Cell, Big Problem Data from NHANES Ogden, Carroll, Kit, Flegal 2014

20 Defining Obesity ADULTS CHILDREN Obese BMI ≥ 95 th percentile Overweight BMI 85 th – 94 th percentile > Obese Over- weigh t Normal weight 30 25

21 The Story of The Fat Cell G l u c o s e s p i k e Stem Cells can become Fat Cells (Arner Spalding 2010; Spalding, Arner 2008 ) Fat Cell OB OW NW BMI insulin Glucose  Fat

22 Let’s Begin!

23 Pick an Obesity Intervention Obese 15 yo girl who is otherwise healthy Normal weight 35 yo with an obese preschooler Obese 55 yo man with Metabolic Syndrome

24 Pick an Obesity Intervention Obese 55 yo man with Metabolic Syndrome Diet + Exercise Good Advice Rx

25 Results of Intervention Advice Alone Diet Alone Exercise Alone Diet+Exercise Orlistat Sibutramine Very Low Cal Diet Average weight loss of subjects completing a minimum 1-year weight-management intervention; based on review of 80 studies (N=26,455; 18,199 completers [69%]). (Franz et al, 2007) 13 lbs Note: Built environment & surgery not included

26 160 lb weight 5’6” BMI 190 lb30 25 OB OW NW 13 lbs Results of Intervention

27 Meta-Analysis & Reviews CVD improves, With minimal weight loss? CVD improves, With minimal weight loss? Multi-component Individualized programs Worksite Wellness Programs Zoning for Active Living (Mixed use, good streetscape) Behaviors:  Physical Act/ Active Transport Balanced Diet  Obesity  CVD  MetS  Weight (~4-8 lbs) prevent wt  Ref What Works for Health

28 The Story of The Fat Cell G l u c o s e s p i k e Stressed fat cells = Metabolic Syndrome (Arner Spalding 2010; Spalding, Arner 2008 ) insulin FAT

29 The Story of The Fat Cell Origins of Metabolic Syndrome (Arner Spalding 2010; Spalding, Arner 2008 ) Fatty Liver  TG HDL  TG  TG (Fat) Used for fuel if active FA Result: Higher TG Lower HDL HDL is the good cholesterol Scavenges Xtra TG then is destroyed FA

30 The Story of The Fat Cell  FAT High TG, Low HDL Hypertension Diabetes =Metabolic Syndrome Insulin Resistance  FAT

31 Insulin Resistance = Metabolic Syndrome Body Type & Risk The Story of The Fat Cell

32 Metabolic Health GoodPoor BMI Obese Normal weight

33 The Story of The Fat Cell Obese 55 yo man with Metabolic Syndrome

34 The Story of The Fat Cell Glucose spike Relief with 7-10% Weight Loss (Arner Spalding 2010; Spalding, Arner 2008 ) insulin FAT

35 The Story of The Fat Cell Rebellion with >10% Weight Loss (Arner Spalding 2010; Spalding, Arner 2008 ) 5’6” BMI OB OW NW I’m HUNGRY!! FEED me!!

36 The Story of The Fat Cell EAT MORE! BURN LESS! I’m HUNGRY !! FEED me!! Rebellion with >10% Weight Loss (Martins, Robertson, Morgan 2008)

37 lebeauleblog.wordpress.com 30 min of moderate exercise x 5 days a week to maintain min of moderate exercise x 7 d/wk to maintain weight loss I’m HUNGRY !! FEED me!! (Martins, Robertson, Morgan 2008)

38 The Molten Moment Behavior Change Modest  Weight  CVD Risk Decreases

39 The Molten Moment Behavior Change Possible CVD Risk Decreases birth Age:

40 Pick an Obesity Intervention Obese 15 yo girl who is otherwise healthy Normal weight 35 yo with an obese preschooler Obese 55 yo man with Metabolic Syndrome

41 Pick an Obesity Intervention Obese 15 yo girl who is otherwise healthy School based Behav Therapy Neighbor- hood

42 Results of Intervention Adult Obesity

43 Meta-Analysis & Reviews What Works For Health N=13 meta-analysis & Systematic reviews Individualized Behav programs Multi-Component School-based Access to Places for PA (Mixed use, streetscape, Rec Facilities) Behaviors:  Physical Act  Sedentary Behav (SB)  Sugar-Sweetened Beverage  Obesity  CVD  MetS  Weight gain Clinic-based counseling (  SB) Enhance/Expand Physical Ed Safe Routes to School & Walking Schoolbus Physically Active Classrooms & Structured Recess Competitive Pricing in Schools TV Monitoring Devices (  SB) But will she remain obese for life? But will she remain obese for life?

44 The Story of The Fat Cell

45 CVD Risk: Sun et al., 2008 Trajectory: Ventura, Loken, & Birch, 2009 Very High Risk of Future CVD Finished w/ Linear Growth Increased BMI = Increased Risk of CVD

46 Note: Subjects with BMI 25 th to 75 th percentile (CDC charts) were the referent group. Adapted from Bjorge, Engeland, Tverdal, & Smith (2008). Figure. Mortality in adulthood (<55 y/o) of OW/OB adolescents (males and females) compared to normal weight peers. Mortality risk in adulthood for OW/OB adolescents If OW/OB teen  Normal Weight by adulthood Risk Factors & Atherosclerosis associated with adiposity DECREASE (Oren et al., 2003; Weiss et al., 2009) But our patient has a 92% chance of remaining obese at the age of 40. (Nader, 2008)

47 The Story of The Fat Cell The Immortal Cell… sort of (Arner Spalding 2010; Spalding, Arner 2008 )

48 The Molten Moment birth Age: Behavior Change Possible Decrease CVD Risk Behavior Change Possible Altered growth trajectory

49 Pick an Obesity Intervention Obese 15 yo girl who is otherwise healthy Normal weight 35 yo with an obese preschooler Obese 55 yo man with Metabolic Syndrome

50 Pick an Obesity Intervention Normal weight 35 yo with an obese preschooler Early childcare based Behav Therapy Neighbor- hood

51 Results of Intervention

52 Meta-Analysis & Reviews What Works For Health N=13 meta-analysis & Systematic reviews Nutrition & PA Interventions in Preschool & Early Childcare Access to Places for PA (Mixed use, streetscape, Rec Facilities) Behaviors:  Sugar-Sweetened Beverage  Obesity  CVD  MetS Allow me to Explain Allow me to Explain  Sedentary Behavior  Sleep Provision of Health Food & Removal of Unhealthy Food Intervention to reduce SB

53 The Story of The Fat Cell

54 I’m Learning about the world! Sugar-sweetened beverages Skipping Meals Sedentary Behavior Fat Cell of a Preschooler Sleep

55 Behavioral Plasticity Preschoolers mimic parents’: Fruit & Vegetable consumption Portion sizes Snacking frequency TV Physical activity Grocery shopping Preschoolers mimic parents’: Fruit & Vegetable consumption Portion sizes Snacking frequency TV Physical activity Grocery shopping “When mothers improve their diets in order to control their weight, their child (1-3 y/o) improves their diet as well, even if that was not the original intent ” (Klohe-Lehman, et al., 2007)

56 Synthesis of Evidence

57 Synthesis: Behavior (Wahi, et al., 2011) Meta-Analysis. RCT to reduce SB. 13 studies in review

58 Synthesis: BMI Change 6-12 yo OB OW NW OB OW NW OB OW NW ns (Waters, et al., 2011) Cochrane review of 55 studies. Meta-analysis on 37 studies, 27,946 children.

59 Synthesis: Success Danielsson et al., 2012 (0.5 SD BMI) Kraschnewski et al., 2010 Intervention Success Rates defined as enough BMI change to reduce CVD risk

60 BMI Percentile Chart Behavior BMI Change Success

61 High Risk Borderline Risk Thinnest Weight Successful Community Interventions Moldable Habits

62 The Molten Moment birth Age: Behavior Change Possible Decrease CVD Risk Behavior Change Possible Alter growth trajectory Behavior Change Possible  Obesity MOLTEN MOMENT Prevention of Obesity

63 New Goal Provide how-to-steps on how to move the needle on obesity & prevent premature death from cardiovascular disease. behavior &

64 Summary Obesity is associated with MetS, CVD, & Death Small changes at any time =  CVD Small changes at the Molten Moment =  Obesity The 1v1 AND Population Interventions work We must all work together, doing what we can

65 FOR MORE INFORMATION: What Works for Health County Health Rankings.org

66 Thank You! Questions/Comments? For M


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