1. ~ My health journey began as a desperate attempt to win my own battle against obesity, and to avoid, for myself and for my siblings, the degenerative diseases that prematurely claimed tire lives of our parents.~ Marilu Henner

2. OBESITY, A NEW EPIDEMIC Presenter: Carlos A. Aguilar November 2 nd, 2009

3. Obesity, a new epidemic  Introduction  Main topics Definition Causes and consequences Statistics and trends Management  Conclusion

4. Introduction  Prevalence in U.S. men and women of 31.1% and 33.2%,  Medical expenses 9.1% of total U.S. medical expenditures in 1998 and reached $78.5 billion  “Obesogenic” society: Increased food intake non healthful foods and physical inactivity

5. Definition  Overweight and obesity are both labels for ranges of weight that are greater than what is generally considered healthy for a given height  Obesity: Body Mass Index (BMI) of 30 or higher  Overweight: BMI 25>30

6. Body mass index (Kg/m 2 ) HeightWeightRangeConsidered 5' 9" 124 lbs or lessBelow 18.5Underweight 125 lbs to 168 lbs18.5 to 24.9Healthy weight 169 lbs to 202 lbs25.0 to 29.9Overweight 203 lbs or more30 or higherObese Formula= weight (lb) / [height (in)]2 x 703 Example: [124/(69*69)]x703=18.30

7. Causes  Behavior Caloric balance equation  Environment Sedentary behaviors vs. physical activity Diet low in fat, calories, and added sugars High fruits and vegetables intake Food and beverage portion sizes  Genetic factors Genes do not always predict future health

8. Health Consequences  Coronary heart disease  Type 2 diabetes  Cancers Colon, breast, esophageal, uterine, ovarian, kidney, and pancreatic  High blood pressure  Dyslipidemia  Stroke  Liver and Gallbladder disease  Sleep apnea and respiratory problems  Osteoarthritis  abnormal menses, infertility

9. 1999 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2008 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2008 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: CDC Behavioral Risk Factor Surveillance System.

10. Childhood obesity Age (years) 1976– 1980 2003– 2006 2-55%12.4% 6-116.5%17% 12-195%17.6% Source: NANHES Surveys 1976–1980 and 2003–2006

11. Management  Previous approaches to weight reduction  Patterns of food intake (binge eating)  Physical activity  Readiness for weight reduction

12. Goals  A reduction in weight as small as 5 to 10% may be sufficient  Reduced-calorie diets with daily intakes that are: Very low <800 Kcal Low 800-1500 Kcal Moderate about 500 Kcal less than typical daily intake

13. Physical activity  Walking with pedometer use  Joining a gym  Home-centered program with aerobic and resistance training  Set realistic goals  Record food intake and energy expenditure  Weigh at least weekly

14. Pharmacotherapy  Diethylpropion minimal effect, insomnia  Phentermine insomnia, systemic and pulm. HTN  Sibutramine mild increase in BP/HR  Orlistat (OTC Ali) oily spotting, flatus with discharge, and fecal urgency Daily multivitamin required

15. Conclusions  Prevalence has significantly increased over the last years  Behavioral, genetic and environmental factors involved  Multiple health consequences  Management directed by caloric restriction, exercise and pharmacotherapy

17. Bibliography  BRFSS, Behavioral Risk Factor Surveillance System http: //www.cdc.gov/brfss/  Mokdad AH, et al. The spread of the obesity epidemic in the United States, 1991—1998 JAMA 1999; 282:16:1519–22.  Mokdad AH, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001; 286:10:1519–22.  Mokdad AH, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003: 289:1: 76–9  CDC. State-Specific Prevalence of Obesity Among Adults — United States, 2007; MMWR 2008; 57(36);765-8  Eckel R. Nonsurgical Management of Obesity in Adults. N Engl J Med 2008;358:1941-50.