obesity: an emerging threat · obesity: an emerging threat m.g.rajanandh, dept. of pharmacy...

OBESITY: AN EMERGING THREAT

M.G.Rajanandh, Dept. of Pharmacy Practice, SRM College of Pharmacy, SRM University.

Obesity Diet and Physical ActivityPennington Biomedical Research Center

Division of Education

2009

Obesity in the United States

• Approximately 66% (or two thirds) of U.S. adults are overweight or obese.

• Healthy People 2010: reduce the prevalence of obesity among adults to less than 15%.

• The obesity rate increased from the late 1970’s to 2003 from 15 to nearly 33 percent.

CDC

2009

Obesity in the U.S.

• Body mass index (BMI) weight (kg)/ height squared (m2).

• BMI is significantly correlated with total body fat content.

With a BMI of: You are considered:Below 18.5 Underweight

18.5 - 24.9 Healthy Weight25.0 - 29.9 Overweight

30 or higher Obese

BMI tables: http://www.nhlbisupport.com/bmi

NIDDK

http://www.nhlbisupport.com/bmi

2009

Obesity in the U.S.

• Obesity is further divided into three separate classes, with Class III obesity being the most extreme of the three.

Obesity class BMI (kg/m2)Class I 30.0- 34.9Class II 35.0-39.9Class III

(Extreme Obesity)≥ 40.0

With a BMI of: You are considered:

Below 18.5 Underweight

18.5 - 24.9 Healthy Weight

25.0 - 29.9 Overweight30 or higher Obese

CDC

2009

Obesity in the United States

• In the United States, some minority groups are more affected than others. Income and education are also related to obesity prevalence.

• Some states have significantly higher rates of obesity than others.

NIDDK, Women’s Health

Percent of Obese (BMI > 30) in U.S. Adults

http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/

2009

Obesity in the U.S.

Being overweight/obese substantially raises one’s risk of morbidity from:

Higher body weights are also associated with increases in all-cause mortality.

– Hypertension– Dyslipidemia– Type 2 Diabetes– Coronary Heart Disease– Stroke

– Gallbladder Disease– Osteoarthritis– Sleep apnea– Certain cancers

(endometrial, breast, prostate, colon)

J La State Med Soc. 2005; 156: S42-S49.

2009

Obesity in the U.S.Obesity is also associated with:

– High blood cholesterol

– Complications of pregnancy

– Menstrual irregularities

– Hirsutism (presence of excess body and facial hair)

– Stress incontinence ( urine leakage caused by weak pelvic-floor muscles)

– Psychological disorders such as depression

– Increased surgical risk

NIDDK

2009

What Causes Obesity?

• Energy imbalance over a long period of time.

• Energy in > Energy out.• Excess calories and lack of

physical activity. Energy balance is like a scale. When calories consumed are greater than calories used, weight gain is the resultCDC

2009

Calories Used• Eating, digestion, sleeping, breathing, and movement.• Excess calories. • Physical activity.

Food/beverages consumed

Necessary physiological functionsPhysical activity

(consumed)Calories in

Calories used(expended)

Energy Balance

CDC

OverweightThe Right Approach

• If your BMI is between 25 and 30 and you are otherwise healthy– Try to avoid gaining any additional weight– Look into healthy ways of losing weight and increasing physical activity

2009

OverweightThe Right Approach

1. BMI is 30 or above, or2. BMI is between 25 and 30 and:

1. You have other health conditions3. Waist measures > 35 inches (women) or

> 40 inches (men)and:

1. You have other health conditions

Talk to your doctor about losing weight if you fall into any one of the three scenarios:

NIDDK

2009

Weight Loss & MaintenanceStrategies to Consider

Physical Activity&

Diet Therapy

2009

Why Treat Overweight and Obesity?

blood pressure serum triglycerides total serum cholesterol low-density lipoprotein cholesterol blood glucose levels

Because there is strong evidence that weight loss reduces risk factors for diabetes and cardiovascular disease, such as:

NHLBI

2009

Weight Loss Programs

• Healthy eating plans that reduces caloric intake• Regular physical activity and/or exercise instruction• Tips on healthy behavior • Slow and steady weight loss of about ¾ to 2 pounds a week • Medical care if needed• A plan to keep the weight off after you have lost it

Any safe and effective weight-loss program should include these components:

NIDDK

2009

Weight Loss

The key to any successful weight loss is making changes in your eating and physical activity

habits that you can keep for the rest of your life.

NIDDK

Physical Activity

2009

Physical InactivityIn the U.S.

• Many studies show that Americans are too sedentary.• Due to

– Increased use of technology.– Increased use of automobiles.

CDC

According to the Behavioral Risk Factor Surveillance System, in 2000 more than 26 percent of adults reported no leisure time physical activity.

2009

Physical InactivityIn the U.S.

• Physical inactivity contributes to premature deaths.• Rates differ by race and ethnicity.

– Hispanic women - most inactive– Hon-Hispanic women – second– Asian and Pacific islander women – third and, lastly, – White non-Hispanic women - fourth.

Women’s Health

2009

Physical Activity

• Contributes to weight loss.• Helpful for the prevention of overweight and obesity.• Helps maintain weight loss.

CDC

2009

Physical Activity

– Occupational work• Carpentry, construction, waiting tables, farming

– Household chores• Washing floors or windows, gardening, or yard work

– Leisure time activities• Walking, skating, biking, swimming, playing Frisbee,

dancing, softball, tennis, football, aerobics

CDC

2009

Physical Activity

• Physical activity decreases the risk for:– Colon cancer– Diabetes– High blood pressure

• Physical activity also helps to:– Control weight– Contribute to healthy bones, muscles, and joints– Reduce falls among the elderly– Relieve the pain of arthritis.

Regular physical activity is good for overall health.

CDC

2009

How Much Physical Activity a Day?

To reduce the risk of chronic diseases in adulthood: Engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week.

To help manage weight and prevent gradual, unhealthy weight gain in adulthood: Engage in approximately 60 minutes of moderate- to vigorous-intensity activity on most days of the week while not exceeding caloric intake requirements.

To sustain weight loss in adulthood:

The 2005 Dietary Guidelines for Americans recommend the following for adults:

Dietary Guidelines for Americans

2009

• Any activity helps. • Moderate physical activity brings

health benefits.• Make it personal.• Start slowly (10 minute walk/day).

How Much Physical Activity a Day?

2009

Increasing Physical Activity

You can increase your physical activity by taking small steps to change what you do everyday.If you normally… Then try this instead!

Park as close as possible to the store Park farther awayLet the dog out back Take the dog for a walk

Take the elevator Take the stairsHave lunch delivered Walk to pick up lunch

Relax while the kids play Get involved in their activity

Women’s Health

2009

How Many Calorie Am I Burning?

Activity 100 lb 150 lb 200 lbBicycling, 6 mph 160 240 312Bicycling, 12 mph 270 410 534Jogging, 7 mph 610 920 1,230Jumping rope 500 750 1,000Running, 5.5 mph 440 660 962Running, 10 mph 850 1,280 1,664Swimming, 25 yds/min 185 275 358Swimming, 50 yds/min 325 500 650Tennis singles 265 400 535Walking, 2 mph 160 240 312Walking, 3 mph 210 320 416Walking, 4.5 mph 295 440 572

American Heart Association

Calories burned/hour of activity

2009

How Many Calories Do I Need?

• To maintain - use your current weight.• To lose - use the average healthy weight recommended for your height.

ACS

2009

Calculating Ideal Body Weight

A 5’9 man’s ideal body weight would be:First 5’0 = 106 lb standard weight for men Plus 9 additional inches 9 (6 lbs)= 54 lbs 106 + 54= 160 pounds (± 10%)= 144 to 176 144 to 176 pounds is this man’s idea weight

A 5’4 woman’s ideal body weight would be:First 5’0= 100 lb standard weight for women Plus 4 additional inches 4(5 lbs)= 20 100 + 20= 120 pounds (± 10%)= 108 to 132 108 to 132 pounds is this woman’s ideal weight

For men:Use 106 pounds of body weight for the first 5 feet of their height. Add 6 pounds for each additional inch.

For women:Use 100 pounds of body weight for the first 5 feet of their height. Add 5 pounds for each additional inch.

2009

How Many Calories Do I Need?

• USDA’s MyPyramid site: http://www.mypyramid.gov/• Determines calorie needs and calculates the servings

needed from food groups.• The American Cancer Society (ACS) site:

http://www.cancer.org/docroot/PED/content/PED_6_1x_Calorie_Calculator.asp

• The ACS site indicates the number of calories that are needed per day to maintain your current weight.

http://www.mypyramid.gov/



On the Path to Increased Physical Activity

2009

Before Beginning an Exercise Program

• Are a man older than age 40 or a woman older than age 50

• Have had a heart attack• Have a family history of heart-related

problems before age 55• Have heart, lung, liver or kidney disease• Feel pain in your chest, joints, or muscles

during physical activity• Have high blood pressure, high cholesterol,

diabetes, arthritis, osteoporosis, or asthma

• Have had joint replacement surgery• Smoke• Are overweight or obese• Tale medication to manage a chronic

condition• Have an untreated joint or muscle

injury, or persistent symptoms after a joint or muscle injury

• Are pregnant• Unsure of your health status.

You should check with your doctor before beginning an exercise program if you:

Mayo Clinic

Health Benefits of Physical Activity

Health benefits of physical activity. CMAJ. 2006; 174(6): 801-809.

2009

Physical ActivityPrimary Effects on Diabetes Mellitus

• Aerobic and resistance types of exercise decrease the incidence of type 2 diabetes.

• A modest weight loss through diet and exercise reduces the incidence of diabetes.

CMAJ. 2006;174(6): 801-809.

2009

Physical ActivitySecondary Effects on Diabetes Mellitus

• Exercise helps in the management of diabetes.

• Aerobic and resistance training help in the control of diabetes

CMAJ. 2006;174(6): 801-809.

2009

Physical ActivityPrimary Effects on Cancer

• Routine activity reduces the incidence cancers.

• Activity results in a 30-40% reduction in the relative risk of colon cancer and breast cancer.

Moderate physical activity is believed to exhibit a greater protective effect than activities of less intensity.

CMAJ. 2006;174(6): 801-809.

2009

Physical ActivitySecondary Effects on Cancer

• Regular physical activity - important.

• Increased self-reported physical activity = decreased reoccurrence of cancer and a decreased risk of death from cancer.

• Reduced cancer-related death.

CMAJ. 2006;174(6): 801-809.

2009

Physical ActivityPrimary Effects on Osteoporosis

• Many studies have been conducted.

• According to findings, routine physical activity, especially weight-bearing and impact exercise, prevents bone loss associated with aging.

CMAJ. 2006;174(6): 801-809.

2009

Physical ActivitySecondary Effects on Osteoporosis

• Regular physical activity can lead to stronger bones.

• Bone responds to physical stress at any age; even in the elderly.

CMAJ. 2006;174(6): 801-809.

Osteoporosis

Eating for Weight Loss

2009

The Critical Role of Healthy Eating

• Good nutrition leads to a healthier life.• Many do not eat based on MyPyramid recommendations.

CDC

2009

U.S. Eating Habits

68

70

72

74

76

78

80

82

Men Women Total

Percentage of adultsreporting that theyconsumed fewer than5 servings of fruits andvegetables/day, 2000

81%

73%

77%

CDC. Behavioral Risk Factor Surveillance System

In 2000, the larger majority of U.S. adults reported that theydid not consume 5 or mservings of fruits and vegetables/day.

2009

Dietary Guidelines for Americans, 2005

Tips for Healthy Eating

1. Make half your grains whole2. Vary your veggies3. Focus on fruit4. Get your calcium rich foods5. Go lean with protein6. Find your balance between food and physical activity

MyPyramid, which is the newest Food Guide Pyramid, recommends the following for a healthy lifestyle:

MyPyramid: http://mypyramid.gov/

http://mypyramid.gov/

2009

A Healthy Diet

• Emphasizes fruits, vegetables, whole grains, fat-free or low-fat milk, & milk products; • Includes lean meats, poultry, fish, beans, eggs, and nuts• Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.

The 2005 Dietary Guidelines for Americans defines a healthy diet as one that:



2009

• 1. Adequate Nutrients Within Calorie Needs– Consume a variety of nutrient-dense foods (whole grains, fruits and

vegetables, lean meats, low-fat dairy) and beverages within and among the basic food groups while choosing foods that limit the intake of saturated fats and trans fats, cholesterol, added sugars, salt, and alcohol.

– Meet recommended intakes within energy needs by adopting a balanced eating pattern, such as the USDA Food Guide or the Dietary Approaches to Stop Hypertension (DASH) Eating Plan.


Key Recommendations for the General Population



2009



• 2. Weight Management– To maintain body weight in a healthy range, balance calories

from foods and beverages with calories expended.

– To prevent gradual weight gain over time, make small decreases in food and beverage calories and increase physical activity.



2009



• 3. Physical activity– Engage in regular physical activity and reduce sedentary

activities to promote health, psychological well-being, and a healthy body weight.

– Achieve physical fitness by including cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises for muscle strength and endurance.



2009


Key Recommendations for the General Population• 4. Food Groups to Encourage

– Consume a sufficient amount of fruits and vegetables while staying within energy needs.

– Choose a variety of fruits and vegetables each day. Select from all five vegetable subgroups (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week.

– Consume 3 or more ounce-equivalents of whole-grain products per day, with the rest of the recommended grains coming from enriched or whole-grain products. At least half the grains should come from whole grains.

– Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.



2009


Key Recommendations for the General Population• 5. Fats

– Keep total fat intake between 20 - 35 percent of calories (With most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils).

– Limit intake of fats and oils high in saturated and/or trans fatty acids, and choose products low in such fats and oils.

– Consume less than 10 percent of calories from saturated fatty acids – Consume less than 300 mg/day of cholesterol– Keep trans fatty acid consumption as low as possible – When selecting and preparing meat, poultry, dry beans, and milk or milk

products, make choices that are lean, low-fat, or fat-free.



2009



• 6. Carbohydrates– Choose fiber-rich fruits, vegetables, and whole grains often. – Choose and prepare foods and beverages with little added sugars or caloric sweeteners.– Reduce the incidence of dental caries by practicing good oral hygiene and consuming

sugar- and starch-containing foods and beverages less frequently.

• 7. Sodium and Potassium– Consume less than 2,300 mg (approximately 1 teaspoon of salt) of sodium per day. – Choose and prepare foods with little salt. At the same time, consume potassium-rich

foods, such as fruits and vegetables.



2009


Key Recommendations for the General Population• 8. Alcoholic Beverages

– Those who choose to drink alcoholic beverages should do so sensibly and in moderation (≤ 1 drink for women/day and ≤ 2 drinks for men/day).

– Alcoholic beverages should be avoided by individuals engaging in activities that require attention, skill, or coordination, such as driving or operating machinery.

– Alcoholic beverages should not be consumed by some individuals, including: those who cannot restrict their alcohol intake, women of childbearing age who may become pregnant, pregnant and lactating women, children and adolescents, individuals taking medications that can interact with alcohol, and those with specific medical conditions.



2009


Key Recommendations for the General Population• 9. Food Safety

– To avoid microbial food borne illness: • Clean hands, food contact surfaces, fruits, and vegetables.

Meat and poultry should not be washed or rinsed. • Separate raw, cooked, and ready-to-eat foods while shopping,

preparing, or storing foods. • Cook foods to a safe temperature to kill microorganisms. • Chill (refrigerate) perishable food promptly and defrost foods properly. • Avoid raw (unpasteurized) milk or any products made from unpasteurized milk, raw

or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, unpasteurized juices, and raw sprouts.



Weight loss:

Goals for WeightManagement of Weight Lost

2009

Calorie DeficitNeeded For Weight Loss

• A calorie deficit of no more than 500 kcal/day. • This can be achievable through the combination of diet + exercise.• An example of how to create a calorie deficit of 500 kcal/day through diet + exercise would

be: eating 250 kcal less per day, along with burning 250 calories through exercise

ACS

2009

Calorie DeficitNeeded For Weight Loss

• Eating 250 kcal less per day:• Leave out mayonnaise in a sandwich• Leave out dessert• Switch from soft drinks to water• Reduce portion sizes

• burning 250 calories through exercise:• Walk for 30 minutes• Swimming 25 yards• Bicycling for 30 minutes

A caloric deficit of 500 can be done by:

2009

Exercise + DietingCalorie Deficit

• Initially physical activity, in combination with dieting, is an important component of weight loss.

• However, after around 6 months, physical activity will not lead to substantially greater weight losses when combined with dieting.

• The benefit of sustained physical activity thereafter is mainly through its role in the prevention of weight gain.

• In addition, it has a benefit in reducing cardiovascular and diabetes risks beyond that produced by weight gain alone.

NHLBI

2009

Goals for Weight LossAnd Management

• The initial goal of weight loss therapy is to reduce body weight by approximately 10 percent from baseline. Once this goal is achieved, then further weight loss can be attempted, if necessary.

• A reasonable time line for a 10 percent reduction in body weight is 6 months.

• Experience reveals that lost weight is usually regained unless a weight maintenance program, consisting of diet therapy, physical activity and behavior therapy, is continued indefinitely.

NHLBI

2009


• For overweight individuals with BMIs in the typical range of 27 to 35 kg/m2, a decrease of 300 to 500 kcal/day will result in weight losses of about ½ to 1 lb per week.

• A 10 percent weight loss could be achieved within 6 months.• For more severely obese individuals (BMI > 35), deficits of up to 500 to 1,000 kcal/day

will lead to weight losses of about 1 to 2 lb per week.• A 10 percent weight loss could be achieved within 6 months.

NHLBI

2009


• After 6 months of weight loss treatment, the individual should be assessed.• If no further weight loss is needed, then the current weight should be maintained.• Sustained physical activity is particularly important in the prevention of weight regain.• If further weight loss is desired, another attempt at weight reduction can be made.

2009

Pennington Biomedical Research Center

• Division of EducationPhillip Brantley, PhD, DirectorPennington Biomedical Research CenterClaude Bouchard, PhD, Executive Director

• Heli J Roy, PhD, RD, Associate Professor

• Beth Kalicki

About Our Company• The Pennington Biomedical Research Center is a world-renowned nutrition research center.•• Mission:• To promote healthier lives through research and education in nutrition and preventive medicine. •• The Pennington Center has several research areas, including:•• Clinical Obesity Research• Experimental Obesity• Functional Foods• Health and Performance Enhancement• Nutrition and Chronic Diseases• Nutrition and the Brain• Dementia, Alzheimer’s and healthy aging• Diet, exercise, weight loss and weight loss maintenance•• The research fostered in these areas can have a profound impact on healthy living and on the prevention of common chronic diseases, such as

heart disease, cancer, diabetes, hypertension and osteoporosis. •• The Division of Education provides education and information to the scientific community and the public about research findings, training

programs and research areas, and coordinates educational events for the public on various health issues.•• We invite people of all ages and backgrounds to participate in the exciting research studies being conducted at the Pennington Center in

Baton Rouge, Louisiana. If you would like to take part, visit the clinical trials web page at www.pbrc.edu or call (225) 763-3000.2009

PREVALENCE OF OBESITY IN DELHI SCHOOL CHILDRENFROM DIFFERENT SOCIO -ECONOMIC GROUPS

0

200

400

600

800

1000

1200

1400

Private Boys Girls Govt.

TotalNon-obeseObese /Overwt.

23.928.7

1.5

24.4

Tandon and colleagues, 2004

Obesity in Children and Young Adults

17 16

21

17

0

5

10

15

20

25 MalesFemales

Obesity Abdominal Obesity

Misra and colleagues, International Journal of Obesity, 2004

Childhood Obesity is the Important Determinant for Diabetes in Children

Snapshot

•Youth-onset Type 2 diabetes is a real concern in many countries

•Our data show that increase fat over chest and abdomen is a extremely important determinant of youth-onset diabetes

Type 2 Diabetes Mellitus in Children, Adolescents and Young Adult Asian Indians (CAYA-2DM Trial):

A Multicenter Collaborative studyObjective

To study the anthropometric, biochemical and immunological profiles of children, adolescents and young adults with type 2 diabetes mellitus and compare them with age-matched healthy controls

Subjects:• 31 patients; 59 age-matched healthy controls

Anthropometric Profile:• Body mass index, waist circumference, waist-hip

ratio, skinfold thickness at 8 sites• Percentage body fat by two-point bioelectrical

impedance

CAYA-2DM TrialMethods

Variable(s) Cases (n=31) Controls (n=59)

Pulse rate 81.6±10.3 83.2±10.2

Systolic BP (mmHg)

121.5±12.3 114.7±12.2***

Diastolic BP (mmHg)

76.6±11.1 75.1±11.0

BMI (kg/m2) 24.7±5.3 20.8±5.3**

Waist Circumference (cm)

83.0±15.4 70.9±15.2***

Waist Hip Ratio 0.89±0.07 0.80±0.07***

*:p<0.05; **: p<0.01; ***: p<0.001

CAYA-2DM TrialComparative Clinical Profile

CAYA-2DM TrialComparison of Cases and Controls

Variable(s) Cases (n=31) Controls (n=59)Skinfold thickness (mm)

Biceps 13.8±6.3 8.7±6.3**Triceps 21.2±8.8 15.6±8.7*Subscapular 29.0±10.7 17.5±10.7***Suprailiac 29.7±12.4 18.9±12.3**Thigh 31.7±13.2 25.5±13.0Calf 19.5±7.3 17.3±7.2

Percent body fat 33.1±9.7 23.9±9.6****:p<0.05; **: p<0.01; ***: p<0.001

CAYA-2DM TrialComparison of Cases and Controls

Variable(s) Cases (n=31) Controls (n=59)Overweight (BMI>25 kg/m2) 42.9 8.5**High %BF (>25% M, >30% F) 59.3 19.0**

High WC (>102 cm M, > 88 F) 21.4 5.1*

High W-HR (>0.95 M,> 0.80 F) 46.4 10.36**

Hypercholesterolemia (>200 mg/dL) 21.4 5.1*

Hypertriglyceridemia (>150 mg/dL) 39.3 5.1**

Low HDL-C (< 40 M, < 50 F) 46.4 23.7*

High LDL-C (>130 mg/dL) 7.1 5.1

*:p<0.05; **: p<0.01; ***: p<0.001

Generalized (high BMI) as well as abdominal obesity (high W-HR) are the most important

predictors for early onset of IGT and T2DM in Asian Indians.

CAYA-2DM TrialConclusions

How to Predict Diabetes in Children

Parameter Risk

Abdominal obesity & family history of diabetes

68 times

CAYA-2DM TrialWeight Percentiles of Cases:

Birth and Current

0

10

20

30

40

50

60

70

80

90

100

Birthweight Present weight

Perc

entil

es

Figure 3: BMI in subjects with IGT/IFG/DM (red line) and lowestquartile for 120 minute plasma glucose (green line).

Age (years)

30282624222018 1614121086420

Mea

n Z

Sco

re

.4

.3

.2

.1

-.0

-.1

-.2

-.3

IGT/IFG/DM

low 120 min glucose

Cohort mean

Adiposity rebound

age (years) High normal BP IGT/IFG/DM Obesity

(BMI ≥30kg/m2)

2 and 3

24.5

20.2

20.5

4 and 5 24.1

18.5

18.8

6 23.5

13.1

14.3

7 17.0

13.4

9.8

8 17.6

10.2

4.9

9 15.5

13.0

1.5

Total 19.7

13.7

10.7

p value for linear trend

0.008

0.009 0.000

ISSUES• Increasing obesity• Contributory factors:

- calorie dense food- consumption of processed foods- limited physical activity- sedentary interests: computers, TV,

video games• THE SEED FOR ADULT OBESITY IS

SOWN EARLY - CHILDHOOD

INTERVENTIONS

• Catch them young - school age children must be targeted

• Increase awareness: media; school teachers; governmental and NGO effort

• Minimise advertising pressure for “junk foods”

• School play grounds; “Games periods”• Health food in school canteens

obesity: an emerging threat · obesity: an emerging threat m.g.rajanandh, dept. of pharmacy...

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