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![Page 1: Obesity Interventions That Work The Molten Moment Tracy Flood MD, PhD Director of the Statewide Obesity Surveillance System University of Wisconsin Madison.](https://reader038.fdocuments.net/reader038/viewer/2022110319/56649c745503460f949265ca/html5/thumbnails/1.jpg)
Obesity Interventions That
WorkThe Molten Moment
Tracy Flood MD, PhDDirector of the Statewide Obesity Surveillance System
University of Wisconsin Madison
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About Me
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About Us
The Socio Ecological Model
Individual
Social, Organizational
Community, Public PolicyBuilt environment
Cellular
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Question:How do we decrease obesity?
Clinic1 v 1 Populations
vs.
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Why?UnhealthyWeight Gain
Obesity
“Toxic” Obesity =
Metabolic Syndrome(MetS)
Cardiovascular Dz(CVD)= Death
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GoalProvide how-to-steps
on how to move the needle on obesity &
prevent premature death from cardiovascular disease.
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OutlineWHY should we care? Metabolic Syndrome, CVD, etc!
Ok, we care. Let’s take action!
Let’s Design an intervention that works (review the lit reviews)
WHEN = Molten Moment WHERE = Clinic vs. Community WHAT WORKS?*
*Informed by Biology The Story of the Fat Cell
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When do we act?
The Molten
Moment
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Cold, Solid HOT, Malleable
The Molten Moment
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The Molten Moment
Where do you strikeFor the biggest impact?
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The Molten Moment
Where do you strikeFor the biggest impact?
birth 15 25+ 10 20
Age:
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The Molten
Moment
Design anIntervention
?
Where do we act?
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Pick an Obesity Intervention
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Pick an Obesity InterventionIndividual
Organizational(ex. Schools, worksites)
Policy & Built environment
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Will the Intervention work?1000+ Studies
35 Systematic Reviews & Meta-analyses & What Works for Health
= Evidence-based Interventions
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Will the Intervention work?Define “What Works”
ChangeKey*Behaviors
Obesity
CVD
MetS
*Will define key behaviors for each case
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The Molten
Moment
Design anIntervention
?
The Story of The Fat
Cell
What Works?
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The Story of The Fat Cell
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U.S. Prevalence of Overweight & Obesity
0-2 yrs 2-5 yrs 6-11 yrs 12-19 yrs 20-39 yrs 40-59 yrs 60+ yrs0
0.10.20.30.40.50.60.70.80.9
1
OverweightObesePediatric Definition Adult Definition
%
Little Cell, Big Problem
Data from NHANES 2011-12 Ogden, Carroll, Kit, Flegal 2014
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Defining Obesity
ADULTSCHILDREN
Obese BMI ≥ 95th percentile
Overweight BMI 85th – 94th percentile
>
Obese
Over-weight
Normalweight
30
25
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The Story of The Fat Cell
Glucose spike
Stem Cells can become Fat Cells(Arner Spalding 2010; Spalding, Arner 2008)
Fat Cell
OB
OW
NW
BMI
insulinGlucose Fat
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Let’s Begin!
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Pick an Obesity Intervention
Obese 15 yo girl who isotherwise healthy
Normal weight 35 yowith an obese preschooler
Obese 55 yo man with Metabolic Syndrome
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Pick an Obesity Intervention
Obese 55 yo man with Metabolic Syndrome
Diet + Exercise
GoodAdvice
Rx
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Results of Intervention
Advice Alone
Diet AloneExercise Alone
Diet+Exercise Orlistat
Sibutramine
Very Low Cal Diet
Average weight loss of subjects completing a minimum 1-year weight-management intervention; based on review of 80 studies (N=26,455; 18,199 completers [69%]). (Franz et al, 2007)
13 lbs
Note: Built environment & surgery not included
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160 lb
weight5’6”
BMI
190 lb 30
25
OB
OW
NW
13 lbs
Results of Intervention
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Meta-Analysis & Reviews
CVD improves, With minimal weight loss?
Multi-component Individualized programs
Worksite WellnessPrograms
Zoning for Active Living(Mixed use, good streetscape)
Behaviors:Physical Act/Active TransportBalanced Diet
Obesity
CVD
MetS
Weight(~4-8 lbs) prevent wt
Ref What Works for Health
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The Story of The Fat Cell
Glucose spike
Stressed fat cells = Metabolic Syndrome(Arner Spalding 2010; Spalding, Arner 2008)
insulin
FATFAT FAT
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The Story of The Fat Cell
Origins of Metabolic Syndrome(Arner Spalding 2010; Spalding, Arner 2008)
Fatty LiverTG
TG
HDLTG
TG (Fat)Used for fuel if active
FAFAFA
Result:Higher TG
Lower HDLHDL is the good cholesterolScavenges Xtra TG then is destroyed
FA
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The Story of The Fat Cell
FAT
FAT
High TG, Low HDLHypertensionDiabetes=Metabolic Syndrome
Insulin Resistance
FAT
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Insulin Resistance
= Metabolic Syndrome
Body Type& Risk
The Story of The Fat Cell
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The Story of The Fat Cell
Metabolic HealthGood Poor
BMI
Obese
Normalweight
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The Story of The Fat Cell
Obese 55 yo man with Metabolic Syndrome
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The Story of The Fat Cell
Glucose spike
Relief with 7-10% Weight Loss(Arner Spalding 2010; Spalding, Arner 2008)
insulin
FATFAT FAT
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The Story of The Fat Cell
Rebellion with >10% Weight Loss(Arner Spalding 2010; Spalding, Arner 2008)
5’6”
BMI
30
25
OB
OW
NW
I’m HUNGRY!!
I’m HUNGRY!!
FEED me!!
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The Story of The Fat Cell
EAT MORE!BURN LESS!
I’m HUNGRY
!!
I’m HUNGRY
!!FEED me!!
Rebellion with >10% Weight Loss(Martins, Robertson, Morgan 2008)
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lebeauleblog.wordpress.com
30 min of moderate exercise x 5 days a week to maintain
60-90 min of moderate exercise x 7 d/wk to maintain weight loss
I’m HUNGRY
!!
I’m HUNGRY
!!FEED me!!
(Martins, Robertson, Morgan 2008)
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The Molten Moment
Behavior Change
Modest Weight
CVD Risk Decreases
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The Molten Moment
Behavior Change Possible
CVD Risk Decreases
birth 15 25+ 10 20
Age:
![Page 40: Obesity Interventions That Work The Molten Moment Tracy Flood MD, PhD Director of the Statewide Obesity Surveillance System University of Wisconsin Madison.](https://reader038.fdocuments.net/reader038/viewer/2022110319/56649c745503460f949265ca/html5/thumbnails/40.jpg)
Pick an Obesity Intervention
Obese 15 yo girl who isotherwise healthy
Normal weight 35 yowith an obese preschooler
Obese 55 yo man with Metabolic Syndrome
![Page 41: Obesity Interventions That Work The Molten Moment Tracy Flood MD, PhD Director of the Statewide Obesity Surveillance System University of Wisconsin Madison.](https://reader038.fdocuments.net/reader038/viewer/2022110319/56649c745503460f949265ca/html5/thumbnails/41.jpg)
Pick an Obesity Intervention
Obese 15 yo girl who isotherwise healthy
Schoolbased
BehavTherapy
Neighbor-hood
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Results of InterventionAdult Obesity
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Meta-Analysis & Reviews
What Works For HealthN=13 meta-analysis &Systematic reviews
Individualized Behav programs
Multi-Component School-based
Access to Places for PA(Mixed use, streetscape, Rec Facilities)
Behaviors:Physical ActSedentary Behav (SB)Sugar-Sweetened Beverage
Obesity
CVD
MetS
Weight gain
Clinic-based counseling (SB)
Enhance/Expand Physical Ed
Safe Routes to School & Walking Schoolbus
Physically Active Classrooms & Structured Recess
Competitive Pricing in Schools
TV Monitoring Devices (SB)
But will she remain obese
for life?
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The Story of The Fat Cell
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The Story of The Fat Cell
CVD Risk: Sun et al., 2008Trajectory: Ventura, Loken, & Birch, 2009
Very High Risk of Future CVD
Finished w/ Linear Growth
Increased BMI = Increased Risk of CVD
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Note: Subjects with BMI 25th to 75th percentile (CDC charts) were the referent group. Adapted from Bjorge, Engeland, Tverdal, & Smith (2008).
Figure. Mortality in adulthood (<55 y/o) of OW/OB adolescents (males and females) compared to normal weight peers.
Mortality risk in adulthood for OW/OB adolescents
If OW/OB teen Normal Weight by adulthoodRisk Factors & Atherosclerosis associated with adiposity
DECREASE (Oren et al., 2003; Weiss et al., 2009)
But our patient has a 92% chanceof remaining obese at the age of 40.
(Nader, 2008)
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The Story of The Fat Cell
The Immortal Cell… sort of(Arner Spalding 2010; Spalding, Arner 2008)
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The Molten Moment
birth 15 25+ 10 20
Age:
Behavior Change Possible
Decrease CVD Risk
Behavior Change Possible
Altered growth trajectory
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Pick an Obesity Intervention
Obese 15 yo girl who isotherwise healthy
Normal weight 35 yowith an obese preschooler
Obese 55 yo man with Metabolic Syndrome
![Page 50: Obesity Interventions That Work The Molten Moment Tracy Flood MD, PhD Director of the Statewide Obesity Surveillance System University of Wisconsin Madison.](https://reader038.fdocuments.net/reader038/viewer/2022110319/56649c745503460f949265ca/html5/thumbnails/50.jpg)
Pick an Obesity Intervention
Normal weight 35 yowith an obese preschooler
Early childcare
based
BehavTherapy
Neighbor-hood
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Results of Intervention
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Meta-Analysis & Reviews
What Works For HealthN=13 meta-analysis &Systematic reviews
Nutrition & PA Interventions in Preschool & Early Childcare
Access to Places for PA(Mixed use, streetscape, Rec Facilities)
Behaviors:Sugar-Sweetened Beverage
Obesity
CVD
MetSAllow me to
Explain
Sedentary BehaviorSleep
Provision of Health Food &Removal of Unhealthy Food
Intervention to reduce SB
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The Story of The Fat Cell
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The Story of The Fat CellI’m
Learning about the
world!
Sugar-sweetened beverages
Skipping Meals
Sedentary Behavior
Fat Cell of a PreschoolerSleep
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Behavioral PlasticityPreschoolers mimic parents’:
Fruit & Vegetable consumptionPortion sizesSnacking frequencyTVPhysical activityGrocery shopping
“When mothers improve their diets in order to control their weight, their child (1-3 y/o) improves their diet as well, even if that was not the original intent” (Klohe-Lehman, et al., 2007)
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Synthesis of Evidence
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Synthesis: Behavior
Preschooler Teenager0
1
2
3
4
5
Hours Less of Weekly Sedentary Behavior After Intervention
(Wahi, et al., 2011) Meta-Analysis. RCT to reduce SB. 13 studies in review
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Synthesis: BMI Change
6-12 yo
OB
OW
NW
OB
OW
NW
OB
OW
NW
0-5 yrs 6-12 yrs 13-18 yrs
-0.3
-0.25
-0.2
-0.15
-0.1
-0.05
0
Cochrane Meta-AnalysisBMI Change After Community-based Intervention by
Age (in kg/m2)
ns
(Waters, et al., 2011)Cochrane review of 55 studies. Meta-analysis on 37 studies, 27,946 children.
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Synthesis: Success
20% 16%
90%
Danielsson et al., 2012 (0.5 SD BMI) Kraschnewski et al., 2010
Intervention Success Rates defined as enough BMI change to reduce CVD risk
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BMI Percentile Chart
Beha
vior
BMI C
hang
eSu
cces
s
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High RiskBorderline
RiskThinnest Weight
Successful Community Interventions
Moldable Habits
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The Molten Moment
birth 15 25+ 10 20
Age:
Behavior Change Possible
Decrease CVD Risk
Behavior Change Possible
Alter growth trajectory
Behavior Change Possible
Obesity
MOLTEN MOMENTPrevention of Obesity
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New GoalProvide how-to-steps
on how to move the needle on obesity &
prevent premature death from cardiovascular disease.
behavior &
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Summary• Obesity is associated with MetS, CVD, & Death
• Small changes at any time = CVD• Small changes at the Molten Moment = Obesity• The 1v1 AND Population Interventions work We must all work together, doing what we can
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FOR MORE INFORMATION: What Works for Health County Health Rankings.org