Obesity – a man’s problem Dr Ian W Campbell General Practitioner and Assoc. Specialist, UHN...
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Transcript of Obesity – a man’s problem Dr Ian W Campbell General Practitioner and Assoc. Specialist, UHN...
Obesity – a man’s problem
Dr Ian W Campbell General Practitioner and Assoc. Specialist, UHN
National Obesity Forum
Prevalence of Obesity
Workplaces and Inactivity
Past 50 years - shift from manual to sedentary employment
Obesity Trends* Among U.S. AdultsBRFSS, 1990
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% 20%
Source: Mokdad AH.
Obesity Trends* Among U.S. AdultsBRFSS, 1991
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% 20%
Source: Mokdad AH.
Obesity Trends* Among U.S. AdultsBRFSS, 1991
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% 20%
Source: Mokdad AH.
Obesity Trends* Among U.S. AdultsBRFSS, 1992
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% 20%
Source: Mokdad AH.
Obesity Trends* Among U.S. AdultsBRFSS, 1993
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% 20%
Source: Mokdad AH.
Obesity Trends* Among U.S. AdultsBRFSS, 1994
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% 20%
Source: Mokdad AH.
Obesity Trends* Among U.S. AdultsBRFSS, 1995
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% 20%
Source: Mokdad AH.
Obesity Trends* Among U.S. AdultsBRFSS, 1996
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% 20%
Source: Mokdad AH.
Obesity Trends* Among U.S. AdultsBRFSS, 1997
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% 20%
Source: Mokdad AH.
Obesity Trends* Among U.S. AdultsBRFSS, 1998
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
No Data <10% 10%-14% 15-19% 20%
Source: Mokdad AH.
Obesity Trends* Among U.S. AdultsBRFSS, 1999
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 2000;284:13
No Data <10% 10%-14% 15-19% 20%
Obesity Trends* Among U.S. AdultsBRFSS, 2000
(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)
Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10
No Data <10% 10%-14% 15-19% 20%
Obese Adults – UK %
0
5
10
15
20
25
1980 1997 2004
MaleFemale
Adapted from Erens & Primatesta 1999
Increasing prevalence of overweight and obesity in English children
0
5
10
15
20
1974 1984 1994
Boys overweight Boys obese
Girls overweight Girls obesePrevalence (%)
Adapted from Chinn & Rona. BMJ 2001; 322: 24-26
Rise in Childhood Obesity - UK
0
5
10
15
20
25
1989 1998
OverweightObese
Bundred et al, BMJ Feb 2001
Prevalence of overweight and obesity in UK children and adolescents
0
5
10
15
20
25
30
35
6 7 8 9 10 11 12 13 14 15
Overweight (BMI>85th centile)
Obese (BMI>95th centile)
Adapted from Reilly & Dorosty . Lancet 1999; 354: 1874-1875
Prevalence (%)
Age (years)
WHO classification of obesityBMI = weight(kg)/height(m)2
WHO ClassificationWHO Classification BMIBMI Risk of ComorbidityRisk of Comorbidity
UnderweightUnderweight Below 18.5Below 18.5 LowLow
Healthy weightHealthy weight 18.5-24.918.5-24.9 AverageAverage
Overweight (grade 1 obesity)Overweight (grade 1 obesity) 25.0-29.925.0-29.9 Mild increaseMild increase
Obese (grade 2 obesity)Obese (grade 2 obesity) 30.0-39.030.0-39.0 Moderate/severeModerate/severe
Morbid/severe obesity(grade 3)Morbid/severe obesity(grade 3) 40.0 and above40.0 and above Very severeVery severe
World Health Organisation. Obesity: Preventing and Managing the Global Epidemic. Geneva: WHO, 1997 [3]
Fat or Fit?
Jonah LomuJonah Lomu Height 196cmHeight 196cm Weight 118kgWeight 118kg BMI 31BMI 31 Waist?Waist? Body fat mass?Body fat mass?
Women
>88 cm (80cm) = Increased risk
Men
>102 cm (90cm) = Increased risk
Lean MEJ et al. Lancet; 1998; 351:853-6
Body fat distributionApple shaped obesity
cm
Cause of Obesity
Genes Obesity
Environment
Obesity trends, diet and physical activity over 40 years
Prentice and Jebb, 1995, BMJ - UK data.Prentice and Jebb, 1995, BMJ - UK data.
19501950 19601960 19701970 19801980 19901990
Data normalised as % ofData normalised as % ofmean for whole periodmean for whole period
00
100100
200200
19501950 19601960 19701970 19801980 19901990
Data normalised as % ofData normalised as % ofmean for whole periodmean for whole period
00
100100
200200% obese% obese % obese% obese
FatFatintakeintake
EnergyEnergyintakeintake
Cars perCars perhouseholdhousehold
TV hrTV hrper wkper wk
Effects of Obesity
Daniel Lambert
1770-18091770-1809 52 st, 11 lb (336kg)52 st, 11 lb (336kg) ““his corpulencehis corpulence never never
caused him any pain. caused him any pain. He never snored, He never snored, rarely retired before 1 rarely retired before 1 a.m., never slept more a.m., never slept more than 8 hours and was than 8 hours and was very partial to the very partial to the female sexfemale sex””
The metabolic syndrome Waist circumferenceWaist circumference
M 102cm, F 88cmM 102cm, F 88cm
TriglyceridesTriglycerides >> 1.69 mmol 1.69 mmol
HDLHDL M < 1.0 mmolM < 1.0 mmol F < 1.3 mmol F < 1.3 mmol
Blood pressureBlood pressure >> 130/85 mmHg 130/85 mmHg
Fasting glucoseFasting glucose >> 6.1 mmol 6.1 mmol
ATP III: The metabolic syndrome, JAMA 2001;285:2486-2497
Physical Effects of Obesity
CardiovascularRespiratory disease
Gall bladder disease
Hormonal abnormalities
Hyperuricaemia and gout
Stroke
Diabetes
Osteoarthritis
Cancer
Relative risk of non-fatal MI and fatal CHD (Combined) vs BMI, in women with no previous CHD
<21 21-22.9 23-24.9 25-28.9 >290
1
2
3
4
RelativeRisk
MI = myocardial infarction; CHD = coronary heart disease.
Adapted from Willett et al. JAMA. 1995;273:461-465 (Nurses Health Study).
BMI
Obesity and cardiovascular disease
n = 115,818
1.00 1.19
1.46
2.06
3.56
32
Obesity is a Risk Factor for Type 2 Diabetes in Men
Adapted from Chan JM et al. Diabetes Care 1994; 17: 961-9
Multivariate adjustedrelative risk of type 2 diabetes
0
10
20
30
40
50
<23 23-23.9
24-24.9
25-26.9
27-28.9
29-30.9
31-32.9
33-34.9
35
1.0 1.0 1.52.2
4.46.7
11.6
21.3
42.1
Body mass index (kg/m2)
The Costs of Obesity
DirectDirect UK £500 millionUK £500 million co-morbidities, GP and nurse co-morbidities, GP and nurse
time, prescriptions, hospitalstime, prescriptions, hospitals IndirectIndirect
UK £ 2.1 billionUK £ 2.1 billion disability, unemployment, early disability, unemployment, early
retirementretirement 18 m sick days, 40 000 lost years 18 m sick days, 40 000 lost years
working life, 30 000 deaths, die working life, 30 000 deaths, die 9 years early9 years early
Intangible Intangible
• Genetic, hormonal environmental, socio-economic, cultural behavioural
• Blaming patient is inappropriate and does not produce positive outcomes
Medical management of obesity
• Lifestyle modifications• Nutrition/diet• Physical activity• Behaviour modification
• Pharmacotherapy• Surgery
Treatment options3
Multiple causes2
• Serious health consequences
• Major risk factor for common causes of death
Legitimate, chronic disease1
1. 1. Clinical guidelines. National Heart, Lung, and Blood Institute Web site. Available at:http://www. nhlbi.nih.gov/guidelines/obesity/ob_home.htm. Accessed March, 2001.2. Weighing the Options; 1995:52. 3. Beales et al. PharmacoEconomics. 1994;5(suppl 1):18-32.
Working with commercial weight loss groups:
Weight Watchers meetings compared with self-help/brief counselling programme
Heshka et al 2003, JAMA, 289:14:1792-8
Mean weight loss Weight Watchers (n=150)
Self help (n=159)
@ 1 year 5kg 0.6kg
@ 2 years 3kg 0.1kg
Men and their trousers
50% of men wear their trousers 50% of men wear their trousers too tighttoo tight only 10% admit to it only 10% admit to it
40% identified their own image40% identified their own image 20% women identified their 20% women identified their
man’s imageman’s image 45% of men thought they were 45% of men thought they were
overweightoverweight 30% hated their stomach most 30% hated their stomach most
of allof all
Prof Steven Gray, NTU, 1999Prof Steven Gray, NTU, 1999
No nonsense approach to waist loss – for men
A personal web-bases waist loss programme
Enables men to make healthy choices
Teaches techniques to change habits of a lifetime
Sustainable, realistic and gradual modification
Enjoyable
www.fatmanslim.com
CHD risk increases when waist size is greater than 90cm/35”.
Consider losing waist if the belly exceeds 35”. At the very least not to increase over this amount.
Encourage waist loss if greater than 102cm/40”.
Healthy Less than 90 cm or 35 inches
Increased Health Risk
90 to 102 cm or 35 - 40 inches
Greater Health Risk
More than 102cm or 40 inches
www.fatmanslim.com Importance of waist size
Waist size & health risk
Weight loss of 5-10 kg (5-10cm or 2-4inches from around your waist) brings improvements to blood pressure, cholesterol levels, glucose tolerance and a reduced incidence of type 2 diabetes.
Sustained intentional weight loss of 5-10 kg (5-10 cm waist reduction)
Chance of dying from heart problems by 9%
Risk of dying from any disease by 20%
Risk of dying from cancer by 37%
>40% fall in obesity related deaths
Deaths due to diabetes by 44%
10mmHg systolic and diastolic BP
50% fall in fasting glucose
Lipids 10% dec. total cholesterol15% dec. in LDL30% dec. in triglycerides8% inc. in HDL
www.fatmanslim.com
The benefits of waist loss
www.fatmanslim.com
Small movements add up
TV remote control – can result in:
20 less short walks per day
20 x 20m = 400m
400m x 365 days=146 km
5 km/hr = 25 hrs
220 kcal/hour x25hrs = 6000 kcal
= 1 kg of fat in one year
www.fatmanslim.com
Small measures add up
The humble digestive biscuit
Over one year:
1 biscuit = 80 kcal365 days = 29200 kcal
= 4kg fat gain
fatmanslim.com
Foretelling the future……..
If you want a job done well…………
Do it yourself…………..