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OBESITY AND THE REGULATION OF BODY WEIGHT

OBESITY AND THE REGULATION OF BODY WEIGHT. OBESITY: A Huge Public Health Problem. Definition of obesity: BMI>30. BMI = weight (kg)/ height 2 (m). 30% of the US population are obese Another 35% are overweight The incidence of obesity and overweight is increasing

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OBESITY AND THE REGULATION OF BODY WEIGHT

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  1. OBESITY AND THE REGULATION OF BODY WEIGHT

  2. OBESITY: A Huge Public Health Problem Definition of obesity: BMI>30 BMI = weight (kg)/ height2 (m) • 30% of the US population are obese • Another 35% are overweight • The incidence of obesity and overweight is increasing • Obesity is becoming more common in children • Obesity is also increasing in other parts of the world

  3. What’s my BMI?

  4. What’s my BMI? About 30.5 (based on height of 1.87 m and weight of 107 kg)

  5. Obesity Trends* Among U.S. AdultsBRFSS, 1985 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% www.cdc.gov

  6. Obesity Trends* Among U.S. AdultsBRFSS, 1986 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

  7. Obesity Trends* Among U.S. AdultsBRFSS, 1987 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

  8. Obesity Trends* Among U.S. AdultsBRFSS, 1988 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

  9. Obesity Trends* Among U.S. AdultsBRFSS, 1989 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

  10. Obesity Trends* Among U.S. AdultsBRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

  11. Obesity Trends* Among U.S. AdultsBRFSS, 1991 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  12. Obesity Trends* Among U.S. AdultsBRFSS, 1992 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  13. Obesity Trends* Among U.S. AdultsBRFSS, 1993 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  14. Obesity Trends* Among U.S. AdultsBRFSS, 1994 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  15. Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  16. Obesity Trends* Among U.S. AdultsBRFSS, 1996 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  17. Obesity Trends* Among U.S. AdultsBRFSS, 1997 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

  18. Obesity Trends* Among U.S. AdultsBRFSS, 1998 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

  19. Obesity Trends* Among U.S. AdultsBRFSS, 1999 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

  20. Obesity Trends* Among U.S. AdultsBRFSS, 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

  21. Obesity Trends* Among U.S. AdultsBRFSS, 2001 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  22. Obesity Trends* Among U.S. AdultsBRFSS, 2002 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  23. Obesity Trends* Among U.S. AdultsBRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  24. Obesity Trends* Among U.S. AdultsBRFSS, 2004 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  25. Obesity Trends* Among U.S. AdultsBRFSS, 2005 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  26. Obesity Trends* Among U.S. AdultsBRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  27. Obesity Trends* Among U.S. AdultsBRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  28. www.cdc.gov/nccdphp/dnpa/obesity/trend/index.htm

  29. % From: Handbook of Obesity: Etiology and Pathophysiology, 2nd edition, G.A. Bray and C. Bouchard, editors, Marcel Dekker, NY,2004

  30. Obesity is a risk factor for: • Type II diabetes • Hypertension • Atheroschlerosis • Some types of cancer • Asthma • Gall bladder problems • Gastroesophageal reflux • Sleep apnea • Fertility problems • Osteoarthritis

  31. Prevalence of type II diabetes by BMI From: Handbook of obesity, Marcel Dekker Inc, 2004

  32. 1990 1995 2001 Diabetes Trends* Among Adults in the U.S.,(Includes Gestational Diabetes)BRFSS, 1990,1995 and 2001 Source: Mokdad et al., Diabetes Care 2000;23:1278-83; J Am Med Assoc 2001;286:10.

  33. From: Handbook of Obesity: Etiology and Pathophysiology, 2nd edition, G.A. Bray and C. Bouchard, editors, Marcel Dekker, NY,2004

  34. Risk of premature death 15 20 25 30 35 BMI

  35. From: Ludwig, D.S. New England Journal Of Medicine 357:2325-27, 2007.

  36. Risk factors for the development of obesity • Genetics • twin concordance rates are very high (80%) • obesity is higher in certain ethnic groups • (Pacific Islanders, native American’s, African Americans) • animals can be bred for fatness • there are inbred strains of mice and rats that are spontaneously obese • whole genome wide studies have replicated in a large number of studies, an association of a SNP in the FTO gene with obesity • Environment • Animals on a high fat diet gain weight • Human who live in other cultures gain weight when they move to the US or other places with a Western diet • Sleep duration affects BMI

  37. Wildtype (C57BL/6J) Ob/Ob

  38. Risk factors for the development of obesity • Genetics • twin concordance rates are very high (80%) • obesity is higher in certain ethnic groups • (Pacific Islanders, native American’s, African Americans) • animals can be bred for fatness • there are inbred strains of mice and rats that are spontaneously obese • whole genome wide studies have replicated in a large number of studies, an association of a SNP in the FTO gene with obesity • Environment • Animals on a high fat diet gain weight • Human who live in other cultures gain weight when they move to the US or other places with a Western diet • Sleep duration affects BMI

  39. Association of a SNP in the FTO gene with obesity From: Frayling, TM et al Science 316:889, 2007

  40. Short sleep duration increases BMI From: Taheri et al, PLoS Med 3:e62, 2004

  41. Sleep and Obesity • Elevations of BMI are observed in subjects who sleep fewer than • 6 h per night • Experimental acute sleep curtailment increases hunger and appetite • especially for energy rich foods • -Mice in which circadian rhythms are disrupted become obese • More than 33% of adolescents get less sleep than recommended

  42. WHY IS OBESITY INCREASING? • 1) Genetics? Unlikely. It takes thousands of years to • change the gene pool that drastically. • 2) Changes in environment? • Diet: more carbohydrates and less fat, also • different types of fat • Exercise: more sedentary lifestyles • 3) Gene environment interactions? Susceptibility genes • that are only expressed in conjunction with certain diets

  43. Koh-Banerjee et al, Am J Clin Nutr, 2003 Not all fats are created equal: • Amount of transfat in diet is significantly related • to waist circumference gain • Total amount of fat in diet is not

  44. Also called “partially hydrogenated” oil • Performed to increase shelf life and increase flavor stability • Present in most processed foods • Makes fat solid at room temperature

  45. Okie, S. New York to Trans Fats: You're Out! NEJM: 356:2017-2021, 2007

  46. Consumption of trans fats increases the risk of heart disease Mozaffarian et al NEJM 354:1601-1613, 2007

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