Obesity: A World Health Concern By Grace Glennon, Carnisha Gilder, Cheyanne Barclay, Esha Fletcher

What is Obesity? Obesity is defined as a weight higher than what is considered healthy for a specific height. It is classified most often by: Body Mass Index (BMI) Waist Circumference (WC) WC: over 40 inches (88 cm) for men or 35 inches (88 cm) for women is considered an independent risk factor for chronic disease BMI: over 30 is obese

as dr leahey showed us in class….

The Obesity Epidemic The second highest cause of preventable mortality in the U.S 35% of the adult population is obese 1 in 6 children and adolescents ages 6 to 19 are considered to be obese.

The Obesity Epidemic Linked to increased incidence of heart disease/stroke type-two diabetes cancer mortality The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 health care costs for obese individuals have been estimated to be $1,429 higher than those of a normal weight http://www.cdc.gov/obesity/data/adult.html

Components to the Problem Genetics Socioeconomic status Lifestyle choices Poor dietary habits Lack of physical activity Smoking Depression Age and Menopause We each focused on one of these topics in order to understand different influences on obesity- Cheyanne will wrap up by presenting her research on one way to combat the problem through worksite wellness programs

Diabetes & Socioeconomic Status

Research Question & Review Question: How does socioeconomic status in individuals with obesity correlate to Type II Diabetes? Hypothesis: Obese individuals living at a lower socioeconomic status are at a higher risk for type II diabetes due to access to money, health care, medication knowledge and the ability to buy nutritious food Inability to afford insulin, knowing how and when to take insulin and knowing correct diet to be on as a diabetic Grocery stores vs corner stores and access to these stores- distance and transportation

Diabetes Related to Socioeconomic Status Self-management education or training focuses on self-care behaviors, such as healthy eating, being active, adhering to medications, learning coping skills, and monitoring blood glucose Lack of awareness about diabetes, combined with insufficient access to healthcare and essential medications, can lead to complications such as blindness, amputation and kidney failure High school dropouts are roughly 60% more likely to have diagnosed diabetes and twice as likely to have actual diabetes as men who have attended college Higher education lowers the risk of diabetes, with a more consistent and larger impact on actual diabetes than on diagnosed diabetes. Education may increase patients' ability to adopt and adhere to complex new diabetes treatments Many people with type 2 diabetes can control their blood glucose by following a healthy meal plan and a program of regular physical activity, losing excess weight, and taking medications. Medications for each individual with diabetes will often change during the course of the disease. Insulin also is commonly used to control blood glucose in people with type 2 diabetes Treatments often require careful patient self-management on a daily basis - for example, patients must monitor their blood glucose levels, balance insulin injection doses with food intake and physical activity, and consult regularly with health care providers

Death rates per 100,000 correlation and socioeconomic status- see correlation between education and death rates…lower the education, higher the death rate- Diabetes

Tread remains the same, the higher economic status the less diabetes based on these treads

Diabetes Diabetes has remained one of the top 10 leading causes of death in the United States since the 1980s Diabetes was the seventh leading cause of death in the United States in 2010 based on the 69,071 death certificates in which diabetes was listed as the underlying cause of death. In 2010, diabetes was mentioned as a cause of death in a total of 234,051 certificates Diabetes is a leading cause of blindness, amputation and kidney failure Direct Medical Cost in 2012- $176 billion Indirect Medical Cost in 2012- $69 billion (disability, work loss, premature death) Average medical expenditures among people with diagnosed diabetes were 2.3 times higher than people without diabetes

Socioeconomic Status Social Classes Upper Class: $150,000+ Middle Class: Upper Middle Class- $100,000 Middle Middle Class: $32,500-$60,000 Lower Middle Class: $23,500- $32,000 Lower Class: $18,000- $23,500 In the U.S., low socioeconomic position means poor education, lack of amenities, unemployment, and job insecurity, poor working conditions, and unsafe neighborhoods, with their consequent impact on family life Research studies have found that a higher level of educational attainment is a strong predictor of access to economic and healthcare resources Individuals with diabetes experience barriers in accessing cost-effective diabetes prevention, early detection, diagnosis, treatment and care 15% of US population lives below the poverty line Studies show that 65% of individuals with Diabetes are between Lower Class & Lower Middle Class

Smoking and Obesity

The Facts Smoking accounts for more than 480,000 deaths per year Over 16 million suffer from smoking related diseases The 2003 Framingham Heart Study found that obese smokers lost 13 years of life when compared to normal weight non-smokers Weight gain after smoking cessation is one of the primary reason smokers give for not quitting, especially women. we all know the obesity statistics, but I wanted to share the smoking statistics and the combination of the two

Lifestyle Factors and Smoking Lower physical activity level Higher alcohol consumption Higher intake of fat (regardless of overall calorie intake)

Systematic Review Aim Smoking is often related to a lower BMI In recent years, research has started to look at central adiposity in smokers Hypothesis: Smokers have a higher waist circumference than nonsmokers, putting them at risk for the same chronic diseases as obese individuals. central adiposity/obesity is associated with the same health risks as obesity. So even if BMI is seemingly normal or lower in smokers, a high central adiposity measured by WC leads to the same health problems as overall obesity (PLUS the smoking health problems) So, i reviewed the literature with the aim to show that there is a higher WC in smokers despite BMI which can then be used as a cessation message to smokers, especially women who may use it for weight management

Results BMI: Lower BMI in smokers, especially females, compared to non-smokers Almost all studies showed that former smokers had the highest BMIs Most of the studies were conducted in europe and china- probably due to the high prevelance of smoking my results so far have shown pretty expected results with BMI

Results Waist Circumference (WC) Many studies showed a higher WC in smokers compared to nonsmokers, some did not overall evidence was inconclusive Although this review did not show strong relationship btw smoking and higher WC, A review published in the American Journal of Clinical Nutrition by Chiolero (Consequences of smoking for body weight, body fat distribution, and insulin resistance.) found Seven cross-sectional studies indicating that waist-to-hip-ratio or waist circumference was higher in smokers than nonsmokers19. Possible mechanisms of action include changes in sex hormones or cortisol levels. The lack of information on waist-to-hip-ratio in the current review and only using pubMed may be the reason for the lack of these findings.

Health Consequences of Obesity + Consequences of Smoking Results High correlation between the number of cigarettes smoked and a higher WC and BMI Health Consequences of Obesity + Consequences of Smoking so, smokers in general, but mainly heavy smokers (>20 cigs/day) associated with higher WC than non smokers and light smokers Therefore, smoking really does contribute to the obesity problem even if BMI looks seemingly normal- same health consequences as obesity PLUS health problems of smoking

Menopause,Depression,and Obesity

Purpose The purpose of this systematic review was to analyze the association between menopause, depression, and obesity amongst middle aged women.

Question ? Is there an association between menopause and depression, and does depression increase the prevalence of obesity in women?

Hypothesis If middle aged women are menopausal and or depressive, then they are more likely to become obese over time.

Why women? Why middle aged Women? More women are obese than men Women gain approximately 1lb per year from ages 45-55. Middle aged women are menopausal Prevalence of depression increases with age Women are more likely to be depressed than men Dr. Leahy

Menopause Ages 40-58 Natural Process Marks the end of menstruation and production of eggs Drop in estradiol and progesterone

Menopausal Symptoms Hot Flashes Sexual Dysfunction Mood Swings Depression

Menopause and Obesity Ho et al 2010 Increase in abdominal fat accumulation Small decrease in lean mass Increase in total fat mass Approximately 5% increase in total body fat mass

Depression Will affect 1 in 4 women in their lifetime Common mental disorder Characterized by sadness and loss of pleasure Linked to obesity

Depression

Depression NHANES

Depression and Obesity Pan et al (2012) Bidirectional association between depression and obesity

Results Menopause has the potential to increase the prevalence of obesity Bidirectional association between depression and obesity Correlation between menopause, depression and obesity.

Obesity Prevention in the workplace Many adults spend the majority of their waking hours in the workplace, where a social support system is already established. The workplace is an ideal setting for obesity prevention and weight loss programs, as they benefit both the employees and the employers.

Obesity Prevention in the Workplace Obese employees have been found to require about twice as many days off from work as their more lean coworkers. Chronic diseases associated with obesity raise healthcare costs for employers. Because of this, many worksites are investing time and money into obesity prevention and weight loss programs.

Study Purpose The purpose of this systematic review is to determine not only if these programs are successful at combating overweight and obesity in the workplace, but also if they produce a return on investment for employers.

Results Seven of the eleven studies reviewed showed statistically significant changes in health status of those in the intervention group. Of the 5 studies that reviewed cost-effectiveness of the intervention, only two found significant cost savings initially; however, they all mentioned that longer term cost benefits were likely.

Take Home Message Obesity is a multifactorial condition that is affected by all of these components. This current health concern needs to be addressed Possible avenues for interventions: Worksite health Revamping government assistance programs Educating medical staff

References http://www.cdc.gov/obesity/adult/defining.html http://www.mayoclinic.org/diseases-conditions/obesity/basics/risk-factors/con-20014834 http://www.cdc.gov/obesity/data/prevalence-maps.html http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848262/ http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf http://www.nber.org/bah/summer07/w12905.html http://www.investopedia.com/financial-edge/0912/which-income-class-are-you.aspx

Discussion Questions Given what the research shows about smoking and central obesity, how can we disseminate this knowledge, especially to those people who use smoking for weight management Is it feasible for physicians to educate middle aged women about menopause and the possible weight gain associated with it? In an ideal world, what would be your proposal to stop the increasing rates of obesity? Given the detrimental effects obesity has on health, do you think it is ethical to place heavy taxes on unhealthy foods such as soda to discourage people from purchasing them. If there is no intervention for obesity, where do you see this epidemic heading in the future? Is the workplace an appropriate setting for an obesity prevention program? What are some issues that could arise?