Transcript 2013 Obesity Epidemic, Part 3

The Obesity/Diabetes Epidemic:
Perspectives, Consequences,
Prevention, Treatment
Part 3
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
Genetic Approach of Obesity
Environment
Genes
Polygenic
GAD2
Monogenic
dominant
MC4-R
Monogenic
recessive
Leptin
Leptin-R
POMC
PC-1
Gene Variants and Binge Eating
as Predictors of Co-morbidities
and Outcome of Treatment in Severe Obesity
• Melanocortin-4 receptor gene (MC4R) variants are
associated with obesity and binge-eating disorder (BED).
• 300 patients (233 women, 67 men) with a mean BMI of
43.5 and a mean age of 42
• Laparoscopic Adjustable Gastric Banding
• 36-month follow-up
• All MC4R patients had BED, compared to 18 percent
in noncarriers.
• MC4R patients showed less weight loss and
five times more gastric complications.
Potoczna, et al. J Gastro Surg 2004:8(9).
Relationship Between Adoptee Weight and Weight of
Biological Parents +, but with Adoptive Parents- none
27
Biological Parents
Adoptive Parents
BMI of Parents (kg/m2)
26
25
24
23
Fathers
22
Mothers
21
Thin
Median Overweight Obese
Thin
Median Overweight Obese
Weight Classification of Adoptees
Stunkard AJ, Sorensen TI, Hanis C,et al. N Engl J Med 1986;314:193.
The “Toxic Environment”
•
supersized
High-Calorie Food is…
– Highly palatable
– Inexpensive
– Heavily advertised
– Near-ubiquitous
Brownell KD & Horgen KB. Food Fight. New York: McGraw-Hill; 2003.
Increasing Caloric Intake Over time
in USA
Energy
Intake
(kcal)
NHANES 1
(1971-74)
NHANES 2
(1976-80)
NHANES 3
(1988-94)
NHANES 4
(1999-2002)
All
1968 ± 20 1942 ± 16
2172 ± 18
2205 ± 16
Men
2420 ± 30 2409 ± 26
2627 ± 27
2616 ± 22
Women
1537 ± 17 1503 ± 13
1741 ± 14
1820 ± 20
Kant AK. Am J Clin Nutr. 2006:84:1215-23.
Health Benefits of Modest
Weight Loss (5-10%)
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Decreased cardiovascular risk
Decreased blood glucose and insulin levels
Decreased blood pressure
Decreased LDL and triglycerides, increased HDL
Decrease in severity of sleep apnea
Reduced symptoms of degenerative joint disease
Improvement in gynecologic conditions
Multiple cardiovascular risk factors and other complications
can be improved.
Source: The Practical Guide to the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults..
The “Toxic Environment”
• Physical
Activity is…
– To be
avoided
– Nearly
unnecessary
– Limited by
infrastructure
Brownell KD & Horgen KB. Food Fight. New York: McGraw-Hill; 2003.
Burning a lot less energy (per
half hour) in 2004
Calories Burned 2004
Calories Burned 1984
Lift (2 mins)
3
Take Stairs
19
Order take away
1
Cook Meal
70
Load Dishwasher 23
Wash Up
80
Watch TV
35
Play Cards
52
Go to car wash
35
Wash Car
104
Play Video Game 53
Play Basketball 280
Ride Lawn Mower 88
Mow Lawn
193
Average Steps/Day
Men
Women % Obese
Colorado
6733
6384
16.0
U.S.
5940
5276
22.8
Tennessee
4547
4730
25.0
Childhood Obesity
http://www.committed-to-kids.com
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
Medical Complications of Obesity
Pulmonary disease
abnormal function
obstructive sleep apnea
hypoventilation syndrome
Nonalcoholic fatty liver disease
steatosis
steatohepatitis
cirrhosis
Gall bladder disease
Gynecologic abnormalities
abnormal menses
infertility
polycystic ovarian syndrome
Osteoarthritis
Idiopathic intracranial hypertension
Stroke
Cataracts
Coronary heart disease
Diabetes
Dyslipidemia
Hypertension
Severe pancreatitis
Cancer
breast, uterus, cervix
colon, esophagus, pancreas
kidney, prostate
Skin
Gout
Phlebitis
venous stasis