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Obesity
KATE GILMORE
ERIK HALEY
CHRONIC DISEASES
SPRING 2013
Obesity- What is it and how defined?
 Defined as the accumulation of excess body fat
 A person’s Body Mass Index (BMI) is used to
approximate how much body fat an individual has. The
BMI is calculated from the person’s height and weight.
BMI = Weight (kg)/ Height(m)2
 An adult is normally considered overweight if BMI > 25
and obese if BMI > 30.
 In children and adolescents, obesity is generally defined
as having an age- and gender-specific BMI at ≥95th
percentile)
Prevalence
 In 2009-2010, over a third of adults in the US were
obese (35.7%). In the same year, 16.9% of children
were obese.
 The prevalence of obesity has not noticeably changed
between 2007-2010.
 http://www.cdc.gov/nchs/data/databriefs/db82.htm
Obesity By Sex and Age
Childhood Obesity by Age and Sex
Obesity Trends Over Last 40 Years
 Top = Extreme Obesity, Middle= Obesity, Bottom =
Overweight
Obesity Trends over Last Decade by Sex
Childhood Obesity Trends over Last Decade
Prevalence by Race and Socioeconomic Status
 Non-Hispanic blacks have the highest rates of obesity
(49.5%), followed by Hispanics (39.1%) and then NonHispanic whites (34.3%).
 Higher income black and Hispanic men are more likely
to be obese, while higher income women are less likely to
be obese
 While there was no correlation between education and
obesity for men, women with college degrees are less
likely to be obese.
 Source: http://www.cdc.gov/obesity/data/adult.html
Geographic Differences in Obesity
Morbidity & Risk for Chronic Disease
 Obesity directly and indirectly impacts multiple
organ system
 Therefore many severe, chronic health conditions are
correlated with obesity, including:
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heart disease
stroke
type 2 diabetes
certain types of cancer including colon, endometrial, and
postmenopausal breast cancer
Obesity-Related Mortality
 Studies have shown that obesity is associated with
greater “all-cause and CVD-specific mortality”, but have
not found the same association for just being overweight.
(McGee 2005).
 Over 300,000 people a year die due to illnesses related to
obesity.
 Age may be a modifier in obesity-related mortality.
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In adults older than 70 yrs, there is no association.
However in children, overweight status also appears to be associated
with overall increased CVD mortality in adulthood.
Screening for Obesity- Current
Recommendations
 The U.S. Preventive Services Task Force (USPSTF)
recommends screening for obesity in all adults based on
BMI
 For adults with BMI greater than or equal to 30 kg/m2,
the USPSTF recommends “intensive multicomponent
behavioral interventions” (2012)
 The USPSTF recommends that clinicians screen children
aged 6 years and older for obesity and “offer them or
refer them to comprehensive, intensive behavioral
interventions to promote improvement in weight status.”
(2010)
International Context
 Worldwide obesity has more than doubled since 1980.
 In 2008, more than 1.4 billion adults, 20 and older, were overweight.
Of these over 200 million men and nearly 300 million women were
obese.
 65% of the world's population live in countries where overweight and
obesity kills more people than underweight.
 More than 40 million children under the age of five were overweight in
2010.http://www.who.int/mediacentre/factsheets/fs311/en/index.htm
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 Global Database on Body Mass Index: (WHO) Of note both the obese
and pre-obese distribution maps
http://apps.who.int/bmi/index.jsp
International Context
 All around the world, many countries face a “double burden” where
under-nutrition and obesity may exist within the same country,
community, or even household.
 Children in low- and middle-income countries are more vulnerable
to inadequate pre-natal, infant and young child nutrition
 They are also exposed to high-fat, high-sugar, high-salt, energy-
dense, micronutrient-poor foods, which tend to be lower in cost.
 These dietary patterns, in addition to low levels of physical activity,
result in increases in childhood obesity and under-nutrition.
Obesity & Genetics
Does genetics contribute to obesity risk?
 Genes seem to play a role in how our bodies capture, store, and release
energy from food
 According to the "thrifty genotype" hypothesis, the same genes that
helped our ancestors survive occasional famines are now being
challenged by environments in which food is plentiful year round.
 There have been some genes that have been found to be “associated”
with higher frequencies of obesity though the identification of these
genes is difficult and these have only been founded through association
studies
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http://www.cdc.gov/features/obesity/
Obesity & Genetics
 Genetics may also play a role in the following:
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the drive to overeat (poor regulation of appetite and satiety)
the tendency to be sedentary (physically inactive)
a diminished ability to use dietary fats as fuel
an enlarged, easily stimulated capacity to store body fat.
 More about genetics and obesity:
http://www.cdc.gov/features/obesity/
Modifiable Risk Factors
 Excessive caloric consumption/ weight gain
 Type of diet (carbohydrates, proteins, fiber, balanced
diet)
 Physical activity/energy expenditure
 Television viewing
 (behavior associated with including poor diet/food
consumption, viewing of tv ads etc)
Treatment for Overweight and Obesity
Conditions
 Weight loss/Reduction of excess body fat
 Dietary Modification/ Reduction of excess caloric
intake
 Physical activity/ Increase energy expenditure
 Behavioral therapies including tracking food
consumption and physical activity, setting goals,
social support networks
Treatment for Severe Obesity
 Clinical therapies are recommended for a select group of
high-risk individuals with severe obesity
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Pharmacological: FDA-approved drugs to treat obesity related weight
loss including appetite suppressants and drugs that block the
digestion and absorption of fat
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Surgical: surgically changes the structure of the gastrointestinal tract
designing it to reduce caloric intake. This can be done to change food
intake or limit the absorption of nutrients
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Associated with substantial weight loss and reduction in
comorbidities and all-cause mortality, however there are medical
complications and risks. Additionally, weight loss maintenance is
still an issue.
Long Term Weight Loss/Maintenance
 Key to reducing morbidity and mortality related to
obesity
 National Weight Loss Registry strategies:
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Engaging in high-level physical activity (60 min/day)- some
studies indicate even more may be necessary
Eating low calorie/low fat diets
Eating breakfast
Monitoring weight regularly
Consistent diet/patterns
Addressing small regains immediately/early
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http://www.nwcr.ws/Research/default.htm
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Prevention- Global Strategies
 Main goal of prevention strategies is to prevent
unhealthy weight gain
 WHO Global Strategy on Diet, Physical Activity, and
Health (2004) and 2008-2013 Action plan for the global
strategy for the prevention and control of noncommunicable diseases provides recommendations to
member states on:
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Increase the knowledge and skills of the population related to diet,
physical activity, and weight;
Reduce population exposure to an obesity-promoting environment
http://www.who.int/dietphysicalactivity/en/index.html
Current Prevention Efforts in the U.S.
 Accelerating Progress in Obesity Prevention: Solving the
Weight of the Nation- Institute of Medicine (2012)
 The IOM evaluated prior obesity prevention strategies and
identified recommendations to meet the following goals and
accelerate progress
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Integrate physical activity every day in every way
Market what matters for a healthy life
Make healthy foods and beverages available everywhere
Activate employers and health care professionals
Strengthen schools as the heart of health
Info graphic:
http://www.iom.edu/Reports/2012/Accelerating-Progress-in-ObesityPrevention/Infographic.aspx
Current Prevention Efforts in the U.S.
 CDC initiatives and grants:
http://www.cdc.gov/obesity/stateprograms/cdc.html
 Childhood Obesity Demonstration Project
The aim of the project is to identify effective health care
and community strategies to help combat childhood
obesity.
 Communities Putting Prevention to Work
CPPW is a locally driven initiative supporting 50
communities to tackle obesity and tobacco use.
Prevention Efforts Programs
Government Launched Let’s Move! –launched by Michelle Obama (2010)
http://www.letsmove.gov/
Foundation/Non-ProfitHealthy Kids, Healthy Communities:
http://www.healthykidshealthycommunities.org/
Advocacy/CampaignCampaign to End Obesity
http://www.obesitycampaign.org/
Financial/Economic Impact of Obesity
 In 1999, it was estimated that $78.5 billion in direct medical costs could be
attributed to overweight and obesity related conditions.
 Medical costs associated with obesity are estimated at $147 billion
 If all obesity related illness and disability included at $190.2 billion
 21% of of medical spending is on obesity-related illness
 Obesity accounts for nearly $4.3 billion in annual losses to companies due to
obesity-related job absenteeism.
 In 2008, the medical costs for people who are obese were $1,429 higher than those
of normal weight.
Data Sources:
http://www.iom.edu/Reports/2012/Accelerating-Progress-in-Obesity-Prevention.aspx
http://www.cdc.gov/obesity/data/adult.html
Current Research Efforts
National Institutes of Health (current studies in active recruitment
or underway): http://www.clinicaltrials.gov/
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Change in Cognitive Function in Obese Patients After Bariatric Surgery - an Observational Study
Obesity and Financial Incentives
Course of Obesity and Extreme Obesity in Adolescents
Use of Electronic Health Records for Addressing Overweight and Obesity in Primary Care
Does Treating Obstructive Sleep Apnea in Obese Canadian Youth Improve Blood Sugar Control?
Economic Aspects of Extreme Obesity in Adolescent
Sleep and Obesity in Teenagers
Evaluating the Transferability of a Successful, Hospital-based, Childhood Obesity Clinic to Primary
Care: a Pilot Study
Identification and Characterization of Youth With Extreme Obesity
Mitochondrial Function in Pediatric Obesity
A Child Care-based Obesity Prevention Intervention
Expiratory Airflow Limitation in Subjects With Obesity
Parents As The Agent Of Change For Childhood Obesity (PAAC)
Virtual Environments For Supporting Obesity Treatment
Parents as the Agent of Change for Childhood Obesity
Community Based Obesity Prevention Among Black Women
Healthy Children, Strong Families: American Indian Communities Preventing Obesity
Internet Obesity Treatment Enhanced With Motivational Interviewing
Observational Study of Early Metabolic and Vascular Changes in Obesity
Microarray Analysis in Syndromic Obesity
Ongoing and Future Research Needs
 Translational Research
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How to facilitate wide scale implementation of interventions in communities
 Communication Strategies Research
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Research to identify effective communication strategies for relaying
information about physical activity, diet, and obesity to the public
 Research related to demographic-level disparity in obesity levels for
 Research on morbidly obese populations (as this group increases)
 Effective and appropriate timing for weight loss strategies in children
and adolescents
 Maintenance of weight loss
 Better evidenced based approaches for effective, sustainable public
health approaches to weight loss
 Enhanced research in cost and cost-effectiveness of various approaches
to preventing and addressing obesity and obesity-related conditions
Additional References and Links
 http://www.surgeongeneral.gov/news/testimony/ob
esity07162003.html
 http://www.cdc.gov/nchs/data/databriefs/db82.h
tm
 http://www.cdc.gov/obesity/data/adult.html
 http://www.cdc.gov/nchs/data/databriefs/db82.h
tm