Obesity – a man’s problem Dr Ian W Campbell General Practitioner and Assoc. Specialist, UHN National Obesity Forum

Prevalence of Obesity

Workplaces and Inactivity Past 50 years - shift from manual to sedentary employment

Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) No Data <10% 10%-14% 15-19%  20% Source: Mokdad AH.

Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) No Data <10% 10%-14% 15-19%  20% Source: Mokdad AH.

Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) No Data <10% 10%-14% 15-19%  20% Source: Mokdad AH.

Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) No Data <10% 10%-14% 15-19%  20% Source: Mokdad AH.

Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) No Data <10% 10%-14% 15-19%  20% Source: Mokdad AH.

Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) No Data <10% 10%-14% 15-19%  20% Source: Mokdad AH.

Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) No Data <10% 10%-14% 15-19%  20% Source: Mokdad AH.

Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) No Data <10% 10%-14% 15-19%  20% Source: Mokdad AH.

Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) No Data <10% 10%-14% 15-19%  20% Source: Mokdad AH.

Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) No Data <10% 10%-14% 15-19%  20% Source: Mokdad AH.

Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 2000;284:13 No Data <10% 10%-14% 15-19%  20%

Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI  30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10 No Data <10% 10%-14% 15-19%  20%

Obese Adults – UK % Adapted from Erens & Primatesta 1999

Increasing prevalence of overweight and obesity in English children Boys overweightBoys obese Girls overweightGirls obese Prevalence (%) Adapted from Chinn & Rona. BMJ 2001; 322: 24-26

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

Prevalence of overweight and obesity in UK children and adolescents Overweight (BMI>85th centile) Obese (BMI>95th centile) Adapted from Reilly & Dorosty. Lancet 1999; 354: Prevalence (%) Age (years)

WHO classification of obesity BMI = weight(kg)/height(m)2 WHO Classification BMI Risk of Comorbidity Underweight Below 18.5 Low Healthy weight Average Overweight (grade 1 obesity) Mild increase Obese (grade 2 obesity) Moderate/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]

Fat or Fit? Jonah Lomu Height 196cm Weight 118kg BMI 31 Waist? Body fat mass?

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

Cause of Obesity

Genes Obesity Environment

Obesity trends, diet and physical activity over 40 years Prentice and Jebb, 1995, BMJ - UK data Data normalised as % of mean for whole period Data normalised as % of mean for whole period % obese Fatintake Energyintake Cars per household TV hr per wk

Effects of Obesity

Daniel Lambert st, 11 lb (336kg) “his corpulence never caused him any pain. He never snored, rarely retired before 1 a.m., never slept more than 8 hours and was very partial to the female sex”

The metabolic syndrome Waist circumference  M 102cm, F 88cm Triglycerides  > 1.69 mmol HDL  M < 1.0 mmol  F < 1.3 mmol Blood pressure  > 130/85 mmHg Fasting glucose  > 6.1 mmol ATP III: The metabolic syndrome, JAMA 2001;285:

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

Relative risk of non-fatal MI and fatal CHD (Combined) vs BMI, in women with no previous CHD < > Relative Risk MI = myocardial infarction; CHD = coronary heart disease. Adapted from Willett et al. JAMA. 1995;273: (Nurses Health Study). BMI Obesity and cardiovascular disease n = 115,

32 Obesity is a Risk Factor for Type 2 Diabetes in Men Adapted from Chan JM et al. Diabetes Care 1994; 17: Multivariate adjusted relative risk of type 2 diabetes <  Body mass index (kg/m 2 )

The Costs of Obesity Direct  UK £500 million  co-morbidities, GP and nurse time, prescriptions, hospitals Indirect  UK £ 2.1 billion  disability, unemployment, early retirement  18 m sick days, lost years working life, deaths, die 9 years early Intangible

Genetic, hormonal environmental, socio-economic, cultural behavioural Blaming patient is inappropriate and does not produce positive outcomes Medical management of obesity Lifestyle modifications Nutrition/diet Physical activity Behaviour modification Pharmacotherapy Surgery Treatment options 3 Multiple causes 2 Serious health consequences Major risk factor for common causes of death Legitimate, chronic disease Clinical guidelines. National Heart, Lung, and Blood Institute Web site. Available at: nhlbi.nih.gov/guidelines/obesity/ob_home.htm. Accessed March, Weighing the Options; 1995: Beales et al. PharmacoEconomics. 1994;5(suppl 1):18-32.

Working with commercial weight loss groups: Weight Watchers meetings compared with self-help/brief counselling programme Heshka et al 2003, JAMA, 289:14: Mean weight lossWeight Watchers (n=150) Self help 1 year 2 years 3kg0.1kg

Men and their trousers 50% of men wear their trousers too tight  only 10% admit to it 40% identified their own image  20% women identified their man’s image 45% of men thought they were overweight 30% hated their stomach most of all Prof Steven Gray, NTU, 1999

No nonsense approach to waist loss – for men A personal web-bases waist loss programme Enables men to make healthy choices Teaches techniques to change habits of a lifetime Sustainable, realistic and gradual modification Enjoyable

CHD risk increases when waist size is greater than 90cm/35”. Consider losing waist if the belly exceeds 35”. At the very least not to increase over this amount. Encourage waist loss if greater than 102cm/40”. Healthy Less than 90 cm or 35 inches Increased Health Risk 90 to 102 cm or inches Greater Health Risk More than 102cm or 40 inches Importance of waist size Waist size & health risk

Weight loss of 5-10 kg (5- 10cm or 2-4inches from around your waist) brings improvements to blood pressure, cholesterol levels, glucose tolerance and a reduced incidence of type 2 diabetes. Sustained intentional weight loss of 5-10 kg (5-10 cm waist reduction)  Chance of dying from heart problems by 9%  Risk of dying from any disease by 20%  Risk of dying from cancer by 37%  >40% fall in obesity related deaths  Deaths due to diabetes by 44%  10mmHg systolic and diastolic BP  50% fall in fasting glucose Lipids10% dec. total cholesterol 15% dec. in LDL 30% dec. in triglycerides 8% inc. in HDL The benefits of waist loss

Small movements add up TV remote control – can result in: 20 less short walks per day 20 x 20m = 400m 400m x 365 days=146 km 5 km/hr = 25 hrs 220 kcal/hour x25hrs = 6000 kcal = 1 kg of fat in one year

Small measures add up The humble digestive biscuit Over one year: 1 biscuit = 80 kcal 365 days = kcal = 4kg fat gain

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