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Disease X in 1985

Disease X in 1985. No Data <10% 10%–14%. Disease X in 1986. No Data <10% 10%–14%. Disease X in 1987. No Data <10% 10%–14%. Disease X in 1988. No Data <10% 10%–14%. Disease X in 1989.

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Disease X in 1985

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  1. Disease X in 1985 No Data <10% 10%–14%

  2. Disease X in 1986 No Data <10% 10%–14%

  3. Disease X in 1987 No Data <10% 10%–14%

  4. Disease X in 1988 No Data <10% 10%–14%

  5. Disease X in 1989 No Data <10% 10%–14%

  6. Disease X in 1990 No Data <10% 10%–14%

  7. Disease X in 1991 No Data <10% 10%–14% 15%–19%

  8. Disease X in 1992 No Data <10% 10%–14% 15%–19%

  9. Disease X in 1993 No Data <10% 10%–14% 15%–19%

  10. Disease X in 1994 No Data <10% 10%–14% 15%–19%

  11. Disease X in 1995 No Data <10% 10%–14% 15%–19%

  12. Disease X in 1996 No Data <10% 10%–14% 15%–19%

  13. Disease X in 1997 No Data <10% 10%–14 15%–19% ≥20%

  14. Disease X in 1998 No Data <10% 10%–14 15%–19% ≥20%

  15. Disease X in 1999 No Data <10% 10%–14 15%–19% ≥20%

  16. Disease X in 2000 No Data <10% 10%–14 15%–19% ≥20%

  17. Disease X in 2001 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  18. Disease X in 2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  19. Disease X in 2003 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  20. Disease X in 2004 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  21. Disease X in 2005 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

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

  23. OBESITY: AN EXPANDING EPIDEMIC Alcohol Medical Scholars Program

  24. Obesity • Major public health concern • Related to high calorie intake • Influenced by • Physiology • Environment • Genes Alcohol Medical Scholars Program

  25. Covered Topics Obesity • Definition and epidemiology • Comorbid illness • Mechanism of disease • Treatment Alcohol Medical Scholars Program

  26. Obesity Body mass index (BMI)=kg/m2 Alcohol Medical Scholars Program

  27. Who is obese? • 66% in United States overweight or obese • 32% obese • 5% extreme obesity • Mexican American 76% • Non-Hispanic Black 76% • Non-Hispanic White 64% Alcohol Medical Scholars Program

  28. Covered Topics Obesity • Definition and epidemiology • Comorbid illness • Mechanism of disease • Treatment Alcohol Medical Scholars Program

  29. So what? • 300,000 obesity-related deaths/year in US • 5x risk for diabetes • 5x risk for gallbladder disease • More depression and bipolar disorder • More deaths from heart disease Alcohol Medical Scholars Program

  30. Covered Topics Obesity • Definition and epidemiology • Comorbid illness • Mechanism of disease • Treatment Alcohol Medical Scholars Program

  31. Mechanisms of Obesity • Environment • Types of food available • Increased portion size • Sedentary lifestyle Alcohol Medical Scholars Program

  32. Mechanisms of Obesity • 50% of risk is genetic • Concordance: 60% dizygotic 75% monozygotic • Adoptee weight more like biological parents • Gene mutations • Leptin • Proopiomelanocortin (POMC) • Bred in or out of mice Alcohol Medical Scholars Program

  33. Mechanisms of Obesity: Feeding • Dopamine with food • Opioids will feeding Ghrelin Leptin Alcohol Medical Scholars Program

  34. ACTH Stress Eating and Opioids POMC β-endorphin • Stress consumption of comfort food • Opiates sugar intake Stress Reward Feeding α-MSH Alcohol Medical Scholars Program

  35. Emotional factors Stress, boredom Intrinsic factors Leptin Ghrelin Dopamine Extrinsic factors food-related cue & availability Signals that Control Feeding Hypothalamus Alcohol Medical Scholars Program

  36. Dopamine and Reward • Dopamine critical to reward • Pleasure dopamine • Drugs • Sex • Food • Too much pleasure dopamine • Drugs • Food Alcohol Medical Scholars Program

  37. Control Obese Dopamine and Obesity p < 0.002 • Obese • Control BMI p = 0.3 Dopamine Receptor Concentration Dopamine D2 receptor imaging Wang et al, Lancet 2001 Alcohol Medical Scholars Program

  38. Food Craving • When do we crave? • Chronic stress • Food deprivation • What do we crave? • Sweets • Carbohydrates Alcohol Medical Scholars Program

  39. Carbohydrates (mmmm…) • Dopamine • Opiates • Serotonin • Alcohol is carbohydrate rich • Is food • Is drug Alcohol Medical Scholars Program

  40. From Chocolate to Morphine • Sugar preferring rats • Increased cocaine • Increased morphine • Increased alcohol Alcohol Medical Scholars Program

  41. Drug Withdrawal and Sweets • Increased sweets consumption after • Smoking cessation • Alcohol abstinence • Opiate withdrawal • Cocaine withdrawal • No impairment in taste Alcohol Medical Scholars Program

  42. Weight Loss and Alcohol • Calorie restricted body wants calories • Prefers carbohydrates • Calorie deprived rats drink alcohol • Surgically treated obesity • Decreased calorie intake • Overcome size restriction by liquid calories • Standard drink = 100 calories Alcohol Medical Scholars Program

  43. Covered Topics Obesity • Definition and epidemiology • Comorbid illness • Mechanism of disease • Treatment Alcohol Medical Scholars Program

  44. Weight Loss Strategies • Improve health • Address behavioral change • Address neurobiological change? Alcohol Medical Scholars Program

  45. Treatment: Surgery • Roux-en-Y • Restrict stomach size / decrease absorption • 25% in body weight • Vertical banded gastroplasty • Restrict stomach size • 15% in body weight Alcohol Medical Scholars Program

  46. Treatment: Behavioral • Brief Intervention • Medical consequences • Impact of dietary change • Impact of exercise • Diet and exercise 5% in body weight Alcohol Medical Scholars Program

  47. Treatment: Behavioral • Overeaters Anonymous • Get peer network • Change attitudes • Cognitive behavioral therapy • Help patient change view of eating • Help change behavior to weight loss • Help recognize and avoid risk situations Alcohol Medical Scholars Program

  48. Treatment: Behavioral • Motivational interviewing • Emphasize change • Discuss resistance • Encourage acceptable change • Behavioral therapy alone 5% weight Alcohol Medical Scholars Program

  49. Treatment: Medications • Decrease appetite / increase metabolism • Sibutramine: inhibits monoamine reuptake • Rimonabant: cannabinoid receptor antagonist • Decrease absorption • Orlistat: fat absorption in gut • Decrease appetite • Naltrexone?: opioid antagonist • Medications 5% in body weight Alcohol Medical Scholars Program

  50. Conclusions • Obesity morbidity and mortality • Overlapping neuropathways with addiction • Treatments • Surgical • Behavioral • Pharmacological Alcohol Medical Scholars Program

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