Transcript Health Wellness and Disease Prevention

HEALTH
WELLNESS
PREVENTION
A.M. Donna Gordon, MD, MPH, FACP
Dr. Gordon graduated cum laude from the University of
the West Indies, Trinidad with a Bachelor of Science
degree in Chemistry and Biochemistry. Dr. Gordon
practices in Washington, D.C.
HEALTH, WELLNESS,
PREVENTION
• Primary Prevention: Promoting
Health; Preventing disease
• Secondary Prevention:
Preventing complications of
disease
DISCLOSURES
• Distributor with Wellness International
• I am not receiving any financial benefits
for this lecture
• I will discuss a few off-label use of
supplements
HEALTH, WELLNESS,
PREVENTION
Outline
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Why Prevention / Preventable conditions
The New Disease – Obesity & Adiposopathy
Consequences of Obesity
Perspective on Obesity
Approach to weight loss / weight management
Medical Benefits to Weight Loss
Foods, Supplements and Vitamins
WHY PREVENTION
Some preventable conditions:
• Hypertension
• Diabetes mellitus
• Hyperlipidemia
• Heart disease
• Stroke
• Chronic obstructive pulmonary disease
• Cancer
OUTCOME OF UNHEALTHY
LIFESTYLE CHOICES
Approx. 50% of deaths in the US relate to
unhealthy lifestyle choices:
•Hypertension - 1 in every 3 adults
•Diabetes - 8.3% of the population
•Heart Disease - leading cause of death in the
US; 1 death every 33 seconds
•Obesity - 1 in every 4 adults in the US
•Cancer - 2nd leading cause of death in the US; 1
of every 4 deaths
LEADING CAUSES OF DEATH IN CARICOM
COUNTRIES BY GENDER 2004 (Carec)
MALES
1.Heart Disease
2. Cancers
3. Injuries & Violence
4. Stroke
5. Diabetes
6. HIV & AIDS
7. Hypertension
8.Influenza/Pneumonia
FEMALES
1. Heart Disease
2.Cancers
3. Diabetes
4. Stroke
5. Hypertension
6. HIV & AIDS
7. Influenza/Pneumonia
Leading causes of death: Caribbean,
World, High Income Countries
Caribbean
World
High income countries
Cause of death
%
Cause of death
%
Cause of death
%
1.
Heart disease
15.7
Heart disease
12.8
Heart disease
15.6
2.
Cancer
14.6
Stroke
10.8
Stroke
8.7
3.
Stroke
10
Respiratory infections
6.1
Trachea, bronchus, lung
cancer
5.9
4.
Diabetes
10
Pulmonary disease
5.8
Alzheimer’s disease
4.1
5.
HIV/AIDS
6
Diarrheal diseases
4.3
Respiratory infections
3.8
6.
Hypertensive diseases
6
HIV/AIDS
3.1
Pulmonary disease
3.5
7.
Accidents
4
Trachea, bronchus, lung
cancer
2.4
Colon and rectum
cancer
3.3
8.
Homicide
3
Tuberculosis
2.4
Diabetes
2.6
9.
Respiratory infections
2
Diabetes
2.2
Hypertensive diseases
2.3
10.
Respiratory diseases
2
Traffic accidents
2.1
Breast cancer
1.9
PREVENTABLE CONDITIONS
• In Latin America and the Caribbean,
chronic diseases are now the leading
cause of premature mortality, accounting
for nearly half of deaths of persons under
70 years, and for two out of three deaths
overall
• The Caribbean is the Region of the
Americas worst affected by the epidemic
of chronic disease (PAHO – 2007-2008)
PREVENTABLE CONDITIONS
IN THE CARIBBEAN
• Chronic diseases contribute to almost 50
per cent of disability-adjusted life years
lost in the Region
• In English-speaking Caribbean for 2003–
2005, the estimated mortality due to CVD
and diabetes was almost 250 per 100 000
population compared to 70 per 100 000
for communicable diseases
PREVENTABLE CONDITIONS
IN THE CARIBBEAN
• NCDs in Grenada accounted for an
estimated 81% majority of all mortality in
2008
• In 2008, the most prevalent NCDs were
cardiovascular diseases (34%). Cancers,
diabetes and non-communicable variants
of respiratory diseases contributed 21%,
9% & 3% to total mortality respectively
WHY PREVENTION
Unhealthy lifestyle
• Lack of physical exercise or sedentary
lifestyle - twice the risk for heart disease;
increased risk for DM; increased risk for
tumors of the breast, colon and kidney
• Poor diet: Diets rich in saturated fats and
cholesterol - high risk for CVD
• Tobacco - twice the risk for heart attack
compared to non smokers; increased risk for
cancers
WHY PREVENTION
Unhealthy lifestyle
•Alcohol abuse – liver disease; poor
nutrition, cancer
•Use of illicit drugs – impaired
judgment, heart attacks, psychoses
•High speed driving – death and
dismemberment
WHY PREVENTION
Health Care Costs in the US-2011 (AHA)
Direct Costs:
• DM
- $55.2 billion / year
• Hypertension - $42.7 billion /year
• Hyperlipidemia - $38.9 billion /year
• CVD
- $116.3 billion
• CVD (dir+indir) - $240.2 billion
• Cancer
- $88.7 billion
WHY PREVENTION
Health Care Costs in the Caribbean
• Follow-up studies conducted
by the
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CCHD (Caribbean Commission on
Health and Development) in 2005
revealed the burdensome economic costs
of hypertension and diabetes in the
Caribbean. When taken together, the
burden of these two diseases ranged
between a low of 1.36% of GDP for the
Bahamas to a high of 8% of GDP for
Trinidad and Tobago
WHY PREVENTION
The Burden of NCDs in the
Caribbean
• NCD deaths are 5 times of deaths from
other diseases
• NCD deaths are 10 times of deaths
from HIV/AIDS
• NCDs account for 65% burden of
diseases
PREVENTABLE CONDITION
• Obesity is a leading cause of preventable death
in the United States, causing an estimated
200,000 deaths per year
• 1 in 4 adults are obese in the United States
• According to WHO 2013 Fact Sheet on
"Obesity and Overweight,” obesity rates
worldwide have almost doubled since 1980
• In the global population, 2012 was the first
time overweight and obesity caused more
deaths than malnutrition
ADIPOSOPATHY & OBESITY
Being overweight/obese can seriously affect
health and longevity:
• Elevated blood pressure / hypertension
• Elevated serum cholesterol /Dyslipidemia
• Non-insulin dependent diabetes mellitus
• Coronary heart disease / Stroke
• Gall bladder disease
• Gout
• Some types of cancer
• Osteoarthritis of the weight-bearing joints
• Pulmonary disease / Sleep Apnea
ADIPOSOPATHY & OBESITY
• Obesity also confers an increased risk
of disease related to air pollution
• A new study suggests overweight or
obese individuals breathe in up to 50
percent more air each day than those
of a healthy weight, which makes the
overweight or obese more vulnerable
to air contaminants
ADIPOSOPATHY & OBESITY
• Decreasing body weight down to normal
weight values, should seriously reduce
their risk of chronic diseases resulting
from indoor and outdoor air pollutants
Brochu P, Bouchard M, et al. Physiological Daily Inhalation Rates for Health
Risk Assessment in Overweight/Obese Children, Adults, and Elderly. Risk
Analysis. 2013
OBESITY STATISTICS
• The adult prevalence rate of obesity
(% population;WHO;2008):
• #1: American Samoa –
74.6%
• #11: St Kitts Nevis –
40.7%
• #13: Bahamas –
34.7%
• #14: Barbados –
34.7%
• #18: USA –
33.0%
OBESITY STATISTICS
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#23: Mexico –
32.1%
#31: Trinidad&Tobago – 29.3%
#52: Antigua&Barbuda – 25.6%
#61: Dominica –
24.9%
#67: Jamaica –
24.1%
#78: Grenada –
22.5%
#87: St. Lucia –
21.4%
OBESITY STATISTICS - 2015
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Bahamas ------ 36.6%
U.S. ------------ 35.0%
Barbados ------ 33.2%
Trinidad & Tobago: -------- 32.3%
Antigua & Barbuda --------- 31.0%
OBESITY STATISTICS
• World Health Organization: countries
with the highest percent of
overweight adults (people age 15
and over):
• #9: United States ------------- 74.1%
• #11: Dominica ----------------- 71.0%
• #12: Barbados ----------------- 69.7%
• #20: Trinidad and Tobago --- 67.9%
ADIPOSOPATHY & OBESITY –
COSTS – U.S:
• In 2008 , the direct medical costs for
treating obesity and obesity-related health
problems was estimated at $147 billion
• Days of work lost – 52 million
• Days of restricted activity – 229 million
• Bed days – 87 million
• Psychosocial costs are additional
OBESITY GUIDELINES
Obesity 2 :
2013 AHA/ACC/TOS Guideline
• Based on 5-year evidence-based reviews
• 5 key recommendations operationalized via an
algorithm
• Promotes addressing weight management as a
pathway to better health
• Use BMI as an initial screen
• Use Waist Circumference as an indicator of
risk
DEFINITION
BMI
• BMI of 25-29.9 ---------Overweight
• BMI of 30-39.9 ----------Obese
• BMI of >40 --------------Morbidly Obese
Waist Circumference (WC)
Women > 35 inches
Men > 40 inches
PERSPECTIVE ON OBESITY
• Moral problem?
NOT- Must not blame an individual for issues they
cannot have complete control over- i.e.: 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 Definitions Change Over Time
Obesity Is Caused by Long-Term
Positive Energy Balance
Fat
stores
Energy
intake
Energy
expenditure
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 TO
OBESITY
Environment
Genes
Polygenic
GAD2
Monogenic
dominant
MC4-R
Monogenic
recessive
Leptin
Leptin-R
POMC
PC-1
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.
The “Toxic Environment”
g
REGULATION OF BODY WEIGHT
• Genes confer the potential for
obesity.
• Environment determines whether
and to what extent the potential is
realized.- Diet / Exercise
RECOMMENDATIONS
Obesity 2 Guidelines
• Lifestyle Modification
• Pharmacotherapy
• Bariatric Surgery
ATTITUDE TOWARDS
EXERCISE
Ex.er.cise (ek’ser siz),
n:1. The art of converting big meals and
fattening snacks into back strains and
pulled muscles by lifting heavy things that
don’t need to be moved, or running when
no one is chasing you.
We can now prove that large
numbers of Americans are
dying from sitting on their
behinds.
Dr. Bruce Dan
CARNIVAL PREPARATION
AROUND THE SAVANNAH
CARNIVAL PREPARATION
AROUND THE SAVANNAH
TRINIDAD CARNIVAL
TRINIDAD CARNIVAL
GUIDELINES FOR BETTER HEALTH:
Exercise
Recommendations by CDC and NIH:
• 30 minutes of moderate-intensity physical
activity for most days of the week
• Intermittent activity also confers substantial
benefits
• Any activity - just becoming physically active
i.e. moving from fairly sedentary to active can
decrease disease risk dramatically (Marcus
and Bock, 1998)
GUIDELINES FOR BETTER HEALTH:
Exercise
Physical Activity:
• Lowers blood pressure
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Increases high-density lipoprotein (HDL) cholesterol
Facilitates weight loss
Improves diabetes management
Reduces the risk of heart disease and stroke
Reduces the risk of cancers: breast, colon etc.
(CDC 1996)
• Reduces anxiety and stress (DHHS, 1996)
• Improves mood and self esteem
• Improves work performance or family interactions
Jones et al, 1998)
GUIDELINES FOR BETTER HEALTH:
A safe and nutritionally adequate diet
• Eat breakfast
• Spice up your breakfast with fruit or
have a protein shake
• Use sparingly/eliminate butter/
margarine
• Use lite/low fat dairy products
• Use lean meats (chicken, turkey, beef
round, sirloin)
GUIDELINES FOR BETTER HEALTH:
A safe and nutritionally adequate diet
• Avoid fried foods, use oils sparingly
(try olive or canola oils)
• Use healthy snacks (fruit, veg) –
5/more servings daily
• Desserts/sweets – cut down on portion
size and frequency
• Reduce consumption of coffee/tea
/sodas / drugs with caffeine
• Ensure adequate water intake
GUIDELINES FOR BETTER HEALTH:
A safe and nutritionally adequate diet
• Low in calories
• Nutritionally sound (Nutrient rich) colorful fruits and vegetables have more
nutrients
• Adequate protein, vitamins and minerals
• Aim for 500-1000 calorie deficit per day
• Goal of 1-2 lbs. per week weight loss
HEALTHY FOODS
• Lignans: Whole grains - plant-based estrogen
• Saponins: Water/Fat Soluble Plant compounds
• Pomegranates: Slows down the growth of
estrogen-fueled breast cancers
• Lycopene: Antioxidant
• Cruciferous vegetables (bok choy, cabbage,
cauliflower): packed with phytochemicals
• Onions: Anti-oxidant; Anti-inflammatory; Antibiotic; Anti-allergic; Anti-viral
• Garlic: Allicin – prevents formation of nitrosamine
SUPPLEMENTS / VITAMINS
• WIN OMEGA 3
• BIOLEAN – a thermogenic agent that aids
metabolism
• LIPOTRIM – a weight loss product that targets
glucose control and appetite control
• PHYTOVITE - a fully loaded state of the art
MVI that improves overall health, boosts
immune system function and helps with hair,
skin and nails
WIN OMEGA 3 COMPLEX
• DART study: 29% reduction in all cause
mortality
• GISSI-Prevenzione Trial: 45% reduction in
sudden death & 20% reduction in all-cause
mortality
• Meta-analysis of 11 randomized controlled
trials (1966-1999): reduction in overall
mortality, mortality caused by MI, and sudden
death
WIN OMEGA 3 COMPLEX
• US Physicians’ Health Study surveyed 20,000
male physicians: Significant inverse
relationship between blood levels of omega 3
and risk of sudden death in men with no
history of CHD
• Von Schacky et al (1999): Increased regression
and decreased progression of coronary lesions
• U.S. Nurses’ Health Study (analyzing diets of
84,688 female nurses): Decreased risk of CHD
and CHD- related deaths
WIN OMEGA 3 COMPLEX
• Hypertension - Howe (1997): Dose response
hypotensive effect in patients with hypertension;
little or no effect in normotensive patients
• Rheumatoid Arthritis: Several studies found
that EPA dose of at least 3g/day significantly
reduced morning stiffness and # of tender,
swollen joints in patients.
• Depression/Bipolar d/o/ADHD: Significant
benefits
A COMPREHENSIVE APPROACH
• Discuss weight management with our patients
• Set realistic goals – a 10% reduction in weight
can significantly improve BP/DM/Sleep
Apnea; modest weight loss = dramatic health
benefits
• Dietary changes can begin the process
• Increased physical activity will sustain it
• Behavior modification
• Support metabolism with daily vitamins and
adequate water intake
A COMPREHENSIVE APPROACH
• Need a holistic approach that includes different
aspects of social life, such as: early intervention
school programs and faith-based organizations
• There must be a public health approach to obesity
involving strategies dealing with the weight status
of the population as a whole
• Environment-based strategies which will require a
range of integrated public policies encompassing
environmental, educational, economic, technical
and legislative measures
CONCLUSION
IF YOU DO NOT MAKE TIME
FOR HEALTHIER LIFESTYLE
CHOICES
YOU MUST MAKE TIME FOR
ILLNESS