1. Weight Problems

2. Overweight Adults – UK % Erens & Primatesta 1999

3. Obese Adults – UK % Erens & Primatesta 1999

4. Rise in Childhood Obesity - UK Bundred et al, BMJ Feb 2001

5. WHO classification of obesity BMI = weight(kg)/height(m)2 WHO Classification BMI Risk of Death Underweight Below 18.5 Low Healthy weight 18.5-24.9Average Overweight (grade 1 obesity) 25.0-29.9 Mild increase Obese (grade 2 obesity) 30.0-39.0Moderate/severe Morbid/severe obesity(grade 3) 40.0 and above Very severe World Health Organisation. Obesity: Preventing and Managing the Global Epidemic. Geneva: WHO, 1997 [3]

6. Three people have the following heights: 1.65m; 1.73 m; 1.85m They each have a BMI of 30. Calculate their body masses.

7. 1.65m = 81.7 kg 1.73m = 89.8 kg 1.83m = 100.5 kg

8. Women >88 cm (80cm) = Increased risk Men >102 cm (90cm) = Increased risk Lean MEJ et al. Lancet; 1998; 351:853-6 Body fat distribution Apple shaped obesity cm

9. Waist Measurement or BMI?

11. Causes of Obesity Energy Expenditure Energy Intake nutritional, activity levels, endocrine, genetic, drugs

12. The Costs of Obesity £4.6 billion pa, UK (2007) £4.6 billion pa, UK (2007) Direct Direct  Death, health service expend, drug prescription charges, hospital costs, Indirect Indirect  Disability, unemployment, early retirement  18 million sick days, 40 000 lost years working life, obese die 9 years earlier Intangible Intangible  Loss self esteem, relationships, pain

13. Physical Effects of Obesity Cardiovascular Respiratory disease Gall bladder disease Hormonal abnormalities gout Stroke Diabetes Osteoarthritis Cancer

14. Benefits of 10% Weight Loss Mortality >20% fall in total mortality >30% fall in diabetes related deaths >40% fall in obesity related deaths Blood pressure fall of 10mmHg systolic and diastolic pressure Diabetes 50% fall in fasting glucose Lipids 10% dec. total cholesterol 15% dec. in LDL 30% dec. in triglycerides 8% inc. in HDL Jung 1997

15. Obesity in practice GP average has 2000 patients 800 overweight adults BMI > 25 320 obese adults BMI > 30 16 morbidly obese adults BMI > 40 30% increase appointments and prescriptions in last 10 years 95% will see GP in 5 years 130 will die of the disease each year

16. Men and their trousers 50% of men wear their trousers too tight  only 10% admit to it 45% of men thought they were overweight 30% hated their stomach most of all Prof Steven Gray, NTU, 1999

17. Men and weight loss Men are reluctant to seek medical advice to lose weight, until after they have developed a medical problem Less than one fifth GP or hospital obesity clinic patients are male Women are the driving force behind men’s health

18. Is this man too big for his trousers…?

20. What about this man..?

21. Or this one..?

22. The perfect male..?

23. …and the perfect female??

24. WHO April 2001 “Obesity cannot be prevented or managed solely by governments (or health professionals). The food industry, the media, communities and individuals need to work together so that the environment is less conducive to weight gain” “Obesity cannot be prevented or managed solely by governments (or health professionals). The food industry, the media, communities and individuals need to work together so that the environment is less conducive to weight gain”

25. Copy this table, and make a list of practical things each group could do to tackle obesity: Government Food Industry MediaIndividual

26. LDL and HDL formation Identify stages 1-5

28. Atherosclerosis Red cells Cholesterol Plaque Platelet Collagen fibre

34. Risk of CHD increases if: Blood cholesterol > 5 mmol dm-3 Blood cholesterol > 5 mmol dm-3 Blood LDLs > 3 mmol dm-3 Blood LDLs > 3 mmol dm-3 Blood HDL< 1 mmol dm-3 Blood HDL< 1 mmol dm-3 Ratio of HDL:LDL should be 4:1 or better Ratio of HDL:LDL should be 4:1 or better

36. Worked examples

37. What is meant by the ‘prevalence’ of a disease? (1) Prevalence means Prevalence means “The number of people in a population with that disease.” “The number of people in a population with that disease.”

38. Q. “What is the prevalence of obesity in England in 2007” (2) (answer from data in table or graph) (answer from data in table or graph) In England in 2007, 17% of men and 21% of women were estimated as being obese (BMI > 30) In England in 2007, 17% of men and 21% of women were estimated as being obese (BMI > 30)

39. Q. “What are the main ‘risk factors’ for CHD?” (4) Diet rich in saturated fatty acids Diet rich in saturated fatty acids Lack of exercise (low PAL) Lack of exercise (low PAL) BMI > 30 ( obese) BMI > 30 ( obese) Heredity Heredity Hypertension ( high BP) Hypertension ( high BP)

40. Q. “How does a high salt diet lead to hypertension?” (4) Salt in the blood lowers water potential Salt in the blood lowers water potential Water is drawn into blood from tissues by osmosis Water is drawn into blood from tissues by osmosis Blood volume increases Blood volume increases Heart needs to work harder to pressurise this volume of blood Heart needs to work harder to pressurise this volume of blood

41. What happens when Energy Intake is lower than expenditure…?

43. Anorexic or fashion victim?

44. True ‘Starvation’ – a disease called MARASMUS. What symptoms can you see? Very thin (skeletal) Papery skin Weak and Miserable

46. Still world-wide malnutrition…WHY?

47. Kwashiorkor

49. Give three recognisable signs of kwashiorkor.

50. Prep – A4 essay for next week: Explain the term ‘malnutrition’ Explain the term ‘malnutrition’ You must include the 4 PEM diseases: You must include the 4 PEM diseases: Anorexia, Obesity, Marasmus, Kwashiorkor Anorexia, Obesity, Marasmus, Kwashiorkor