1. Obesity Pandemic Athanassios Petrotos, M.D. Surgical Specialists of Greenwich Greenwich Hospital

2. “Global epidemic” 25% of all Americans 25% of all Americans 10-20% in other parts of the globe 10-20% in other parts of the globe Steadily increasing occurrence Steadily increasing occurrence

3. Definition Body Mass Index = weight/height² in kg/m² Body Mass Index = weight/height² in kg/m² Obesity is defined as a BMI>30kg/m² Obesity is defined as a BMI>30kg/m² Overweight is defined as a BMI>25kg/m² Overweight is defined as a BMI>25kg/m² Morbid Obesity is defined as a BMI>40kg/m² Morbid Obesity is defined as a BMI>40kg/m²

4. Table 1 Weight Category ‘71-’74 ‘76-’80 ‘88-’94 Overweight 32% 32% 32% Obese 10% 10% 14% Severely Obese 3% 3% 5% Morbid Obesity 1% 2% 3% --------------------------------------------------------------- Total population 46% 47% 54%

5. Current estimates U.S.A. 66% overweight 32% obese 5% morbidly obese Worldwide More than 300 million people are obese, with 2 billion documented as overweight, approximating the number of starving individuals worlwide

6. The youth 4% in children (6-11) 6% in teenagers(12-17) 10% in girls 11.4% in boys

7. The youth 40% in Native Americans 30% in African Americans 30% in Hispanics 25% in Caucasians 20% in Asian Americans

8. Etiology Exact cause is unknown Exact cause is unknown Multiple factors Multiple factors Genetic Genetic Dietary Dietary Environmental Environmental Modernization of the society Modernization of the society

9. Etiology Energy Imbalance Energy Imbalance Axis Brain-Gut-Adipose tissue Axis Brain-Gut-Adipose tissue Hormones: Leptin Hormones: Leptin Insulin Insulin Ghrelin Ghrelin Appetite-regulating neuropeptides Appetite-regulating neuropeptides

10. LEPTIN,INSULIN,GHRELIN LEPTIN :Secreted by adipocytes. Reduces food intake. LEPTIN :Secreted by adipocytes. Reduces food intake. INSULIN: Inhibits eating through its action in the hypothalamus but…Increase eating by decreasing the blood glucose levels. INSULIN: Inhibits eating through its action in the hypothalamus but…Increase eating by decreasing the blood glucose levels. GHRELIN: Secreted by the stomach and proximal small intestine. Regulates meal initiation and satiety. GHRELIN: Secreted by the stomach and proximal small intestine. Regulates meal initiation and satiety.

11. DIETARY FACTORS Energy-dense, micronutrient poor foods Energy-dense, micronutrient poor foods Sugar-sweetened beverages Sugar-sweetened beverages Portion Size Portion Size Palatability Palatability Fiber Fiber Breastfeeding Breastfeeding Eating disorders Eating disorders

12. Obesity Comorbidities Hypertension Hypertension Dyslipidemia Dyslipidemia Diabetes Diabetes Cardiac and Peripheral Vascular Disease Cardiac and Peripheral Vascular Disease Asthma Asthma Sleep Apnea Sleep Apnea Obesity-Hypoventilation Syndrome Obesity-Hypoventilation Syndrome

13. Obesity Comorbidities Back and Disk Disease Back and Disk Disease Peripheral Osteoarthritis Peripheral Osteoarthritis Cholelithiasis Cholelithiasis Gastroesophageal Reflux Disease Gastroesophageal Reflux Disease Liver Disease Liver Disease Pseudotumor Cerebri and Carpal Tunnel Syndrome Pseudotumor Cerebri and Carpal Tunnel Syndrome Intertriginous Dermatitis Intertriginous Dermatitis

14. Obesity Comorbidities Stress Incontinence Stress Incontinence Female and Male Reproductive Disorders Female and Male Reproductive Disorders Depression Depression

15. Obesity and Cancer Esophagus Esophagus Stomach Stomach Liver Liver Pancreas Pancreas Colon and rectum Colon and rectum Breast Breast Uterus Uterus Prostate Prostate

16. Social Implications of Obesity Stigmatization Stigmatization Depression Depression Self-Confidence Self-Confidence Is Obesity an addiction? Is Obesity an addiction?

17. Summary Global phenomenon Global phenomenon Multifactorial Multifactorial All ages All ages Significant comorbidities Significant comorbidities