2. השמנת יתר חמד " ע 26.1.06 פרופ ' ארדון רובינשטין

3. BMI-Associated Disease Risk Classification BMI (kg/m 2 )Risk Underweight<18.5Increased Normal18.5-24.9Normal Overweight25.0-29.9Increased ObeseI30.0-34.9High II35.0-39.9Very High III>40Extremely high Additional risks: Large waist circumference (men>40 in; women >35 in) 5 kg or more weight gain since age 18-20 y Poor aerobic fitness Specific races and ethnic groups

4. Body Fat (%) Body Mass Index (kg/m 2 ) Women Men Relationship Between BMI and Percent Body Fat in Men and Women

5. Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Nonalcoholic fatty liver disease steatosissteatohepatitiscirrhosis Coronary heart disease Diabetes Diabetes Dyslipidemia Dyslipidemia Hypertension Hypertension Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome Osteoarthritis Skin Gall bladder disease Cancer breast, uterus, cervix colon, esophagus, pancreas kidney, prostate Phlebitis venous stasis Gout Medical Complications of Obesity Idiopathic intracranial hypertension Stroke Severe pancreatitis Cataracts

6. Age-Adjusted Prevalence of Overweight and Obesity in Men Percent _

7. Age-Adjusted Prevalence of Overweight and Obesity in Women Percent _

8. Obesity Trends* Among U.S. Adults: BRFSS, 1988 (*BMI > 30, or ~ 30 lbs overweight for 5’4” woman)

9. Obesity Trends* Among U.S. Adults: BRFSS, 1994 (*BMI > 30, or ~ 30 lbs overweight for 5’4” woman)

10. Obesity Trends Among* U.S. Adults: BRFSS, 2000

11. % Distribution of BMI >30 kg/m 2 by Age in 695 Men & 1020 Women in Israel, 2000 25-34 35-44 45-54 55-65 years 25-34 35-44 45-54 55-65 years

12. Obesity BMI>30 in Israel, 2000 : comparison with Obesity BMI>30 in Israel, 2000 : comparison with countries: WHO Monica 1987-92, Obes Res 1999 % Prevalence

13. Obesity (BMI>30) among females by ethnicity & years of education (%)First National Health & Nutrition Survey (MABAT) 1999-2000

14. Diabetes (%) among Jews & Arabs aged 25-64 by sex & years of education First National Health & Nutrition Survey (MABAT),1999-2000 males females Jews Arabs

15. NHANES III Prevalence of Hypertension* According to BMI Percent

16. Prevalence of Hypertension* According to BMI by Sex Percent BMI Levels _

17. Obesity and Diabetes Risk BMI Levels Incidence of New Cases per 1,000 Person-Years

18. Relationship Between BMI and Risk of Type 2 Diabetes Age-Adjusted Relative Risk Body Mass index (kg/m 2 ) Men <22<2323 - 23.9 24 - 24.9 25 - 26.9 27 - 28.9 29 - 30.9 31 - 32.9 33 - 34.9 35+ 1.0 2.9 1.0 4.3 1.0 5.0 1.5 8.1 2.2 15.8 4.4 27.6 40.3 54.0 93.2 6.7 11.6 21.3 42.1 Women

19. Metabolic Syndrome Abdominal obesity Hyperinsulinemia High fasting plasma glucose Impaired glucose tolerance Hypertriglyceridemia Low HDL-cholesterol Hypertension

20. Clinical Identification of the Metabolic Syndrome*: NCEP-ATP III *Diagnosis is established when >3 of these risk factors are present Risk FactorDefining Level Abdominal obesity (Waist circumference) Men>102 cm (>40 in) Women>88 cm (>35 in) TG>150 mg/dL HDL-C Men<40 mg/dL Women<50 mg/dL Blood pressure>130 / >85 mm Hg Fasting glucose>110 (>100**) mg/dL ** 2003 New ADA IFG criteria (Diabetes Care)

21. Metabolic Syndrome: Impact on Mortality Mortality Rate (%) Without metabolic syndrome With metabolic syndrome *P < 0.001.

22. Metabolic Syndrome: Impact on Cardiovascular Health Prevalence (%) Without metabolic syndrome With metabolic syndrome *P < 0.001.

23. 26 -Year Incidence of Coronary Heart Disease in Men Incidence/1,000 BMI Levels

24. Relationship Between BMI and Cardiovascular Disease Mortality Relative Risk of Death Body Mass index <18.5 Men 18.5 – 20.4 20.5 – 21.9 22.0 – 23.4 23.5 – 24.9 25.0 – 26.4 26.5 – 27.9 28.0 – 29.9 30.0 – 31.9 32.0 – 34.9 35.0 – 39.9 >40.0 LeanOverweightObese Women

25. Relationship of BMI to Excess Mortality Mortality Ratio Body Mass Index (kg/[m 2 ]) 300 Age at Issue 20-29 250 200 150 100 50 15 0 30-39 202530 Low Risk 4035 High Risk Moderate Risk

26. Direct Cost * of Chronic Diseases in the United States Direct Cost ($ Billions) Type 2 Diabetes *Adjusted to 1995 dollars. ObesityCoronary Heart Disease Hyper- tension Stroke $18.1 $18.4 $38.7 $51.6 $53.2

27. Effect of Obesity on Expected Lifetime Medical Care Costs* in Men Costs ($)* Body Mass Index (kg/m 2 ) 32.527.537.5 55-64 45-54 *Total cost of CHD, type 2 DM, hypertension, hypercholesterolemia, stroke Age (y) 35-44 22.5

28. Economic Effect of Obesity to Business: 3- Year Costs to First Chicago NBD *BMI >27.8 kg/m 2 in men; >27.3 kg/m 2 in women. AbsenteeismHealthcare Lean $4,496 $6,822 $683 $1,546 Obese*