Transcript Obesity Rates Are Projected to Double Over the Next 30 Years

The Obesity/Diabetes Epidemic:
Adiposopathy & ObesityThe New Disease!
Dx & (Rx) of Insulin Resistance & early
DM (Part 2)
Stan Schwartz MD, FACP, FACE
Private Practice, Ardmore
Obesity Program
Cardiometabolic Diabetes Center and Affiliate,
Main Line Health System
Emeritus, Clinical Associate Professor
University of Pennsylvania
Outline
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Epidemiology and Economics of obesity/diabetes
Perspectives on Obesity
Consequences of Obesity, Prediabetes, Obesity
Obesity/ Diabetes Risk Factors,
Obesity/ Diabetes Onset can be Prevented or Delayed –
Early Risk Identification and Intervention.
• Medical Benefits to Weight Loss
• Treatment-CDC’s diabetes prevention program and
other Evidence-Based Interventions– Basics,
– Next Lecture in Series
Perspectives on Obesity
• Moral problem?
NOT- Must not blame an individual for issues they
cannot have complete control over- ie: Their genes!
IT’s A DISEASE AFTER ALL
• Psychological problem? Aesthetic problem?
• culture based- self perception/esteem
• Medical problem!- Recognized a Disease
• Public health problem! = Increased Societal Cost
Cultural Defintions Change Over Time
Perspectives on Obesity
• Moral problem?
NOT- Must not blame an individual for issues they
cannot have complete control over- ie: Their genes!
IT’s A DISEASE AFTER ALL
• Psychological problem? Aesthetic problem?
• culture based- self perception/esteem
• Medical problem!- Recognized a Disease
• Public health problem! = Increased Societal Cost
Components of Total Daily Energy Expenditure
Thermic effect of feeding
Energy expenditure of physical activity
Resting energy expenditure
8%
17%
8%
75%
Avg. Sedentary person
(1800 kcal/d)
32%
60%
Avg. Physically active person
(2200 kcal/d)
Obesity Is Caused by Long-Term
Positive Energy Balance
Fat
stores
Energy
intake
Energy
expenditure
Cumulative Effect of Small Daily Errors in
Energy Balance on Body Fat Mass
Lb/yr
Leads to ‘100 cal/ day = 1 lb/m’ rule
And patients are NOT ‘pigging out’
Regulation of Body Weight
• Genes confer the potential for
obesity.
• Environment determines whether
and to what extent the potential is
realized.
Thrifty Genes Contribute to Morbid Obesity
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Genetic factors account for 80 percent of a person’s tendency to develop obesity.
These “thrifty genes” are designed to protect us from starvation by allowing us to
store large amounts of energy in the form of fat when food is abundant.
This is the first time in human history that food has been so abundant.
The age-old advantage of thrifty genes has
been influenced by our unique environment to cause disease.
Kaplan L. Body Weight Regulation and Obesity. Journal of Gastrointestinal Surgery
2003;7(4):443-451.
Genetic Approach of Obesity
Environment
Genes
Polygenic
GAD2
Monogenic
dominant
MC4-R
Monogenic
recessive
Leptin
Leptin-R
POMC
PC-1
Regulation of Body Weight
• Genes confer the potential for
obesity.
• Environment determines whether
and to what extent the potential is
realized.- Diet/ Exercise
The “Toxic Environment”
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supersized
High-Calorie Food is…
– Highly palatable
– Inexpensive
– Heavily advertised
– Near-ubiquitous
Brownell KD & Horgen KB. Food Fight. New York: McGraw-Hill; 2003.