Obesity

Jessica Phelan

ObesityDefining ObesityOverweight and obesity are terms for ranges of weight that are greater than what is generally considered healthy for a given heightResults when body fat accumulates over time as a result of chronic energy imbalanceIdentifies ranges of weight that are shown to increase likelihood of certain diseasesMeasuring Obesity in AdultsDetermined by using weight and height to calculate body mass index (BMI)An adult with a BMI of 30 or higher is considered obeseOther methods of measuring are skinfold tests, waist circumference, calculation of waist-to-hip circumference ratios, ultrasound computed tomography, and MRIs-It is important to remember that although BMI correlates with the amount of body fat it does not directly measure body fat, athletes for example may appear to be obese according to BMI but truly are not

3Defining and Measuring Obesity in Children and TeensWeight status in youth is determined using an age- and sex- specific percentile for BMI rather than the BMI categories used for adultsFor children and teens obesity is defined as a BMI at or above the 95th percentile for children of the same age and sex-youth is age- and sex- specific percentiles because childrens body composition varies as they age and it also varies between boys and girls

4Stature-for-age and weight-for-age percentiles

http://www.cdc.gov/growthcharts/data/set1clinical/cj41c022.pdfBody mass index-for-age percentiles

http://www.cdc.gov/growthcharts/data/set1clinical/cj41c024.pdfCauses and ConsequencesA variety of factors can contribute to obesityBehavior, environment, and genetic factors may have an effect in causing someone to become obeseRisk Factors for Health Topics Associated with ObesityHigh blood pressure- hypertensionHigh LDL cholesterol- bad cholesterolLow HDL cholesterol- good cholesterolHigh triglyceridesHigh blood glucose (sugar)Family history of premature heart diseasePhysical inactivityCigarette smokingBehavior and its effect on obesityCaloric Balance Equation: obesity results form an energy imbalanceCalorie: unit of energy supplied by food

-caloric balance equation- eating too many calories and not getting enough physical activity-weight management is al about balance, balancing the calories consumed with the number of calories your body uses or burns off

9Caloric balance statusMaintaining weight= in caloric balanceLoosing weight= in caloric deficitGaining weight= in caloric excess

Behavior consists of choices on eating and physical activity-Caloric excess means you are eating more calories than your body is using and you will store these extra calories as fat and you will gain weight

10Environment and its effect on obesityPeople make choices based on their environment or communityThe Surgeon Generals Call to Action to Prevent and Decrease Overweight and Obesity 2001 identified action steps for locations that can affect obesity-a person may choose not to walk to the store or to work because of a lack of sidewalks-communities homes and workplaces can all influence health decisions-The Surgeon Generals Call to Action to Prevent and Decrease Overweight and Obesity 2001 identified home, schools, work, and the community as places that can influence it-at home things that create a sedentary lifestyle such as watching TV and lack of physical activity schedule in regular routines-at schools the breakfast and lunch programs nutrition, availability of sugary and high fat foods such as chips and sodas in vending machines, physical education programs-work- lack of physical activity in work site-community- food outlets such as grocery stores carry a variety of nutritious food, location of minimarts

11Genetics and ObesityGenes can directly cause obesity in some disordersMultiple genes may increase susceptibility for obesity They do not always predict future health-disorders such as Bardet-Biedl syndrome and Prader-Willi syndrome are both genetic disorders that casue obesity-multiple genes may increase susceptibility for obesity in ways that it requires a specific food supply or limit physical activity which futher puts the individual at risk for obesity-James Hill and Frederick Throwbridge concluded in their paper Childhood obesity : future directions and research priorities saying despite obesity having strong genetic determinants the genetic composition of the population does not change rapidly. Therefore, the large increase in obesity must reflect major changes in non-genetic factors12Other factors that contribute to obesityDiseases such as hypothyroidism Cushings disease and polycystic ovary syndromeDrugs such as steroids and some antidepressantsLack of sleepHypothyroidism: the thyroid gland fails to produce enough thyroid hormone and it often results in lowered metabolic rate and loss of vigor

Cushings: hormonal disorder caused by prolonged exposure of the body's tissues to high levels of hormone cortisol, upper body obesity rounded face and increased fat around the neck and the thinning of arms and legs are commons symptoms

Polycystic ovary syndrome: high levels of androgens (male hormone)

Drugs: slow rate at which the body burns calories, stimulate appetite, or cause the body to hold extra water

13The Dangers of ObesityHealth ConsequencesEconomic ConsequencesHealth ConsequencesCoronary heart diseaseType II diabetesEndometrial, breast, and colon cancersHypertensionDyslipidemia (ex: high total cholesterol)StrokeLiver and gallbladder diseaseSleep apnea and respiratory problemsOsteoarthritisGynecological problems: abnormal menses &infertilityResearch has shown that as weight increases to levels classified as overweight and obese the risks of many diseases also increases15Additional Risks for ChildrenObese children are at greater risk of social and psychological problemsObese children are more likely to become obese adultsIf children are overweight or obese, then obesity in adulthood is likely to be more severeThese problems in children can be things such as discrimination and poor self esteem, which can potentially continue into adulthood16Economic ConsequencesDirect medical costs such as preventive, diagnostic, and treatment services related to obesityIndirect medical costs that are related to morbidity and mortality costsIn 2008 the medical costs of obesity in the US totaled at around $147 billionMorbidity costs are the value of income lost from decreased productivity, restricted activity, absenteeism, and bed days

Mortality costs are the value of future income lost by premature death17Psychological and Social EffectsEmotional suffering Feelings of unattractivenessStereotypes: gluttonous and/or lazyFace prejudice and discrimination in may settingsFeelings of rejection, shame, and depressionTreatmentVaries depending on level of obesity, health condition, and readiness to lose weightDiet, exercise, behavior modification, sometimes weight loss drugs, and in extreme cases bariatric surgery Men over 40 and women older than 50 should speak with a health care provider before beginning a vigorous physical activity program

Data and StatisticsPrevalence of Obesity in the US33.9% of US adults age 20 and over18.1% of adolescents age 12-19 19.6% of children age 6-1110.4% of children age 2-5Data on prevalence is pulled from National Health and Nutrition Examination Survey (NHANES)

21Racial and ethnic disparities in adult obesity31.9% among non-Hispanic white men37.3% among non-Hispanic black men35.9% among Mexican-American men

33.0% among non-Hispanic white women49.6% among non-Hispanic black women45.1% among Mexican-American womenHealth and Human Services:

In men obesity prevalence is generally similar at all income levels; however, among non-Hispanic black and Mexican-American men those with higher income are more likely to be obese than those with low income

Higher income women are less likely to be obese than low income women, but most obese women are not low income

There was no significant trend between obesity and education among men; however, among women those with college degrees are less likely to be obese compared to less educated women22Percent of Obese in US Adults (BMI>30)

In the past 20 years there has been an increase in obesity. As seen on the map, in 2010 no state had a prevalence of obesity less than 20%. 36 states had a prevalence of 25% or more, 12 of these states had a prevalence of 30% or more

No state met the Healthy People 2010 goal to lower obesity prevalence to 15%

23Percent of Obese in US Adults 1985

Percent of Obese in 1990

Percent of Obese in 1995

Percent of Obese in 2000

Percent of Obese in 2005

Percent of Obese in 2010

The data in the maps were collected through the CDCs Behavioral Risk Factor Surveillance System, on self-reported weight and height. State health departments use standard procedures to gather data through monthly phone interviews with US adults. 29County Level Estimates of Obesity2008 Age-Adjusted Estimates of the Percentage of Adults Who are Obese in VA

Translational ResearchThe CDCs Division of Nutrition, Physical Activity, and Obesity (DNPAO) has a state-based nutrition and physical activity programs to prevent obesity and other chronic diseases: currently funds 25 states to address obesityU.S. Department of Health and Human Services awarded $119 million to states to support efforts to reduce obesity, improve nutrition, and decrease smoking

31DNPAO Examples of Translational ResearchImproving Retail Access for Fruits and VegetablesGoal is to increase the consumption of fruits and vegetables by improving access to retail venues that sell or increase availability of high-quality fruits and vegetables in underserved communitiesNew York Taste n Take program provides a weekly bag of fresh produce to low income housing in several cities in New York. In 2008 10,00 pounds distributed and in 2010 over 69,00032DNPAO Examples of Translational ResearchEnhanced School-Based Physical EducationAims to increase physical activity by enhancing school-based physical educationGeorgia School Fitness Assessment was conducted by the Georgia Student Health and Physical Education partnershipConduct an assessment and provides feedback to students and parents through computer softwareScores are evaluated against objective criterion based standards that indicated the level of fitness necessary for good health. Fitness-gram Software generates the report and provides objective results, feedback, and positive reinforcement. Teachers also will receive training to understand obesity in children in GA33Surveillance SystemsBehavioral Risk Factor Surveillance SystemNational Health and Nutrition Examination SurveyYouth Risk Behavior Surveillance SystemNational Health Interview SurveyPediatric and Pregnancy Nutrition Surveillance SystemsNational Collaborative on Childhood Obesity Research

Obesity ResourcesCDChttp://www.cdc.gov/obesity/index.htmlNIHhttp://health.nih.gov/topic/Obesity/FoodNutritionandMetabolismNational Heart, Lung, and Blood Institutehttp://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/index.htmNational Institute of Environmental Health Scienceshttp://www.niehs.nih.gov/research/supported/programs/obe/index.cfm