Obesity: A World Health Concern

By Grace Glennon, Carnisha Gilder, Cheyanne Barclay, Esha Fletcher

What is Obesity?

● Obesity is defined as a weight higher than what is considered healthy for a specific height.

● It is classified most often by:o Body Mass Index (BMI)o Waist Circumference (WC)

The Obesity Epidemic

The second highest cause of preventable mortality in the U.S

● 35% of the adult population is obese

● 1 in 6 children and adolescents ages 6 to 19 are considered to be obese.

The Obesity Epidemic● Linked to increased incidence of

o heart disease/strokeo type-two diabeteso cancero mortality

● The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008

● health care costs for obese individuals have been estimated to be $1,429 higher than those of a normal weight

Components to the Problem● Genetics● Socioeconomic status● Lifestyle choices

o Poor dietary habitso Lack of physical activityo Smoking

● Depression● Age and Menopause

Diabetes & Socioeconomic Status

Research Question & ReviewQuestion: How does socioeconomic status in

individuals with obesity correlate to Type II Diabetes?

Hypothesis: Obese individuals living at a lower socioeconomic status are at a higher risk for type II diabetes due to access to money, health care, medication knowledge and the ability to buy nutritious food

Diabetes Related to Socioeconomic Status

Self-management education or training focuses on self-care behaviors, such as healthy eating, being active, adhering to medications, learning coping skills, and monitoring blood glucose

Lack of awareness about diabetes, combined with insufficient access to healthcare and essential medications, can lead to complications such as blindness, amputation and kidney failure

High school dropouts are roughly 60% more likely to have diagnosed diabetes and twice as likely to have actual diabetes as men who have attended college

Higher education lowers the risk of diabetes, with a more consistent and larger impact on actual diabetes than on diagnosed diabetes.

Education may increase patients' ability to adopt and adhere to complex new diabetes treatments

Diabetes● Diabetes has remained one of the top 10 leading causes of death in the United

States since the 1980s

● Diabetes was the seventh leading cause of death in the United States in 2010 based on the 69,071 death certificates in which diabetes was listed as the underlying cause of death. In 2010, diabetes was mentioned as a cause of death in a total of 234,051 certificates

● Diabetes is a leading cause of blindness, amputation and kidney failure

● Direct Medical Cost in 2012- $176 billion

● Indirect Medical Cost in 2012- $69 billion (disability, work loss, premature death)

Socioeconomic Status● Social Classes

o Upper Class: $150,000+o Middle Class: Upper Middle Class- $100,000 Middle Middle Class: $32,500-

$60,000 Lower Middle Class: $23,500- $32,000o Lower Class: $18,000- $23,500

● In the U.S., low socioeconomic position means poor education, lack of amenities, unemployment, and job insecurity, poor working conditions, and unsafe neighborhoods, with their consequent impact on family life

● Research studies have found that a higher level of educational attainment is a strong predictor of access to economic and healthcare resources

● Individuals with diabetes experience barriers in accessing cost-effective diabetes prevention, early detection, diagnosis, treatment and care

Smoking and Obesity

The Facts● Smoking accounts for more than 480,000 deaths per year

● Over 16 million suffer from smoking related diseases

● The 2003 Framingham Heart Study found that obese smokers lost 13 years of life when compared to normal weight non-smokers

● Weight gain after smoking cessation is one of the primary reason smokers give for not quitting, especially women.

Lifestyle Factors and Smoking

Lower physical activity level

Higher alcohol consumption

Higher intake of fat (regardless of overall calorie intake)

Systematic Review Aim

● Smoking is often related to a lower BMI● In recent years, research has started to look at

central adiposity in smokers

Hypothesis: Smokers have a higher waist circumference than nonsmokers, putting them at

risk for the same chronic diseases as obese individuals.

Results

● BMI: o Lower BMI in smokers, especially females,

compared to non-smokerso Almost all studies showed that former

smokers had the highest BMIs

Results

● Waist Circumference (WC)o Many studies showed a higher WC in

smokers compared to nonsmokers, some did not

o overall evidence was inconclusive

Results

High correlation between the number of cigarettes smoked and a higher WC and

BMI

Health Consequences of Obesity + Consequences of Smoking

Menopause,Depression,and Obesity

Purpose The purpose of this systematic review was

to analyze the association between menopause, depression, and obesity amongst middle aged women.

Question ?

Is there an association between menopause and depression, and does depression increase the prevalence of obesity in women?

Hypothesis

If middle aged women are menopausal and or depressive, then they are more likely to become obese over time.

Why women? Why middle aged Women?

● More women are obese than men● Women gain approximately 1lb per year from

ages 45-55. ● Middle aged women are menopausal● Prevalence of depression increases with age● Women are more likely to be depressed than

men

Menopause ● Ages 40-58● Natural Process● Marks the end of menstruation and

production of eggs● Drop in estradiol and progesterone

Menopausal Symptoms

● Hot Flashes● Sexual Dysfunction● Mood Swings● Depression

Menopause and Obesity

● Ho et al 2010● Increase in abdominal fat accumulation● Small decrease in lean mass● Increase in total fat mass ● Approximately 5% increase in total body

fat mass

Depression

● Will affect 1 in 4 women in their lifetime● Common mental disorder● Characterized by sadness and loss of

pleasure● Linked to obesity

Depression

Depression

Depression and Obesity

● Pan et al (2012)● Bidirectional association between

depression and obesity

Results

● Menopause has the potential to increase the prevalence of obesity

● Bidirectional association between depression and obesity

● Correlation between menopause, depression and obesity.

Obesity Prevention in the workplace

● Many adults spend the majority of their waking hours in the workplace, where a social support system is already established.

● The workplace is an ideal setting for obesity prevention and weight loss programs, as they benefit both the employees and the employers.

Obesity Prevention in the Workplace

● Obese employees have been found to require about twice as many days off from work as their more lean coworkers.

● Chronic diseases associated with obesity raise healthcare costs for employers.

● Because of this, many worksites are investing time and money into obesity prevention and weight loss programs.

Study Purpose

● The purpose of this systematic review is to determine not only if these programs are successful at combating overweight and obesity in the workplace, but also if they produce a return on investment for employers.

Results

● Seven of the eleven studies reviewed showed statistically significant changes in health status of those in the intervention group.

● Of the 5 studies that reviewed cost-effectiveness of the intervention, only two found significant cost savings initially; however, they all mentioned that longer term cost benefits were likely.

Take Home Message Obesity is a multifactorial condition that is affected by all of

these components. This current health concern needs to be addressed

Possible avenues for interventions:◦ Worksite health◦ Revamping government assistance programs◦ Educating medical staff

References http://www.cdc.gov/obesity/adult/defining.html http://www.mayoclinic.org/diseases-conditions/obesity/basics/risk-factors/con-20014

834 http://www.cdc.gov/obesity/data/prevalence-maps.html http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848262/ http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-

web.pdf http://www.nber.org/bah/summer07/w12905.html http://www.investopedia.com/financial-edge/0912/which-income-class-are-

you.aspx

Discussion Questions1. Given what the research shows about smoking and central obesity, how can we

disseminate this knowledge, especially to those people who use smoking for weight management

2. Is it feasible for physicians to educate middle aged women about menopause and the possible weight gain associated with it?

3. In an ideal world, what would be your proposal to stop the increasing rates of obesity?

4. Given the detrimental effects obesity has on health, do you think it is ethical to place heavy taxes on unhealthy foods such as soda to discourage people from purchasing them.

5. If there is no intervention for obesity, where do you see this epidemic heading in the future?

6. Is the workplace an appropriate setting for an obesity prevention program? What are some issues that could arise?