Transcript Document

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. Adults
BRFSS, 1990
(*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
No Data
Source: Mokdad AH.
<10%
10%-14%
15-19%
20%
Obesity Trends* Among U.S. Adults
BRFSS, 1991
(*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
No Data
Source: Mokdad AH.
<10%
10%-14%
15-19%
20%
Obesity Trends* Among U.S. Adults
BRFSS, 1991
(*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
No Data
Source: Mokdad AH.
<10%
10%-14%
15-19%
20%
Obesity Trends* Among U.S. Adults
BRFSS, 1992
(*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
No Data
Source: Mokdad AH.
<10%
10%-14%
15-19%
20%
Obesity Trends* Among U.S. Adults
BRFSS, 1993
(*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
No Data
Source: Mokdad AH.
<10%
10%-14%
15-19%
20%
Obesity Trends* Among U.S. Adults
BRFSS, 1994
(*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
No Data
Source: Mokdad AH.
<10%
10%-14%
15-19%
20%
Obesity Trends* Among U.S. Adults
BRFSS, 1995
(*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
No Data
Source: Mokdad AH.
<10%
10%-14%
15-19%
20%
Obesity Trends* Among U.S. Adults
BRFSS, 1996
(*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
No Data
Source: Mokdad AH.
<10%
10%-14%
15-19%
20%
Obesity Trends* Among U.S. Adults
BRFSS, 1997
(*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
No Data
Source: Mokdad AH.
<10%
10%-14%
15-19%
20%
Obesity Trends* Among U.S. Adults
BRFSS, 1998
(*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
No Data
Source: Mokdad AH.
<10%
10%-14%
15-19%
20%
Obesity Trends* Among U.S. Adults
BRFSS, 1999
(*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
No Data
<10%
10%-14%
Source: Mokdad A H, et al. J Am Med Assoc 2000;284:13
15-19%
20%
Obesity Trends* Among U.S. Adults
BRFSS, 2000
(*BMI  30, or ~ 30 lbs overweight for 5’4” woman)
No Data
<10%
10%-14%
Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10
15-19%
20%
Obese Adults – UK %
25
20
15
Male
Female
10
5
0
1980
Adapted from Erens & Primatesta 1999
1997
2004
Increasing prevalence of overweight and
obesity in English children
Prevalence (%)
20
Boys overweight
Boys obese
Girls overweight
Girls obese
15
10
5
0
1974
1984
1994
Adapted from Chinn & Rona. BMJ 2001; 322: 24-26
Rise in Childhood Obesity - UK
25
20
15
Overweight
Obese
10
5
0
1989
1998
Bundred et al, BMJ Feb 2001
Prevalence of overweight and obesity in
UK children and adolescents
Prevalence (%)
35
Overweight (BMI>85th centile)
Obese (BMI>95th centile)
30
25
20
15
10
5
0
6
7
8
9
10
11
Age (years)
12
13
14
15
Adapted from Reilly & Dorosty . Lancet 1999; 354: 1874-1875
WHO classification of obesity
BMI = weight(kg)/height(m)2
WHO Classification
BMI
Risk of Comorbidity
Underweight
Below 18.5
Low
Healthy weight
18.5-24.9
Average
Overweight (grade 1 obesity)
25.0-29.9
Mild increase
Obese (grade 2 obesity)
30.0-39.0
Moderate/severe
Morbid/severe obesity(grade 3) 40.0 and above
Very severe
World Health Organisation. Obesity: Preventing and Managing the Global Epidemic. Geneva: WHO,
1997 [3]
Fat or Fit?

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
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Jonah Lomu
Height 196cm
Weight 118kg
BMI 31
Waist?
Body fat mass?
Body fat distribution
Apple shaped obesity
Women
cm
>88 cm (80cm) = Increased risk
Men
>102 cm (90cm) = Increased risk
Lean MEJ et al. Lancet; 1998; 351:853-6
Cause of Obesity
Environment
Genes
Obesity
Obesity trends, diet and physical
activity over 40 years
Prentice and Jebb, 1995, BMJ - UK data.
Data normalised as % of
mean for whole period
Data normalised as % of
mean for whole period
200
% obese
200
% obese
TV hr
per wk
Fat
intake
100
Cars per
household
100
Energy
intake
0
0
1950 1960
1970
1980
1990
1950 1960
1970
1980
1990
Effects of Obesity
Daniel Lambert

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1770-1809
52 st, 11 lb (336kg)
“his corpulence never
caused him any pain.
He never snored,
rarely retired before 1
a.m., never slept more
than 8 hours and was
very partial to the
female sex”
The metabolic syndrome

Waist circumference


Triglycerides



M < 1.0 mmol
F < 1.3 mmol
Blood pressure


> 1.69 mmol
HDL


M 102cm, F 88cm
> 130/85 mmHg
Fasting glucose

> 6.1 mmol
ATP III: The metabolic syndrome, JAMA
2001;285:2486-2497
Physical Effects of Obesity
Stroke
Respiratory disease
Gall bladder disease
Cardiovascular
Diabetes
Osteoarthritis
Hormonal abnormalities
Hyperuricaemia and gout
Cancer
Obesity and cardiovascular disease
Relative risk of non-fatal MI and fatal CHD
(Combined) vs BMI, in women with no previous CHD
4
3.56
3
Relative
Risk
2
1
0
2.06
1.00
1.19
1.46
n = 115,818
<21
21-22.9
23-24.9
BMI
25-28.9
MI = myocardial infarction; CHD = coronary heart disease.
Adapted from Willett et al. JAMA. 1995;273:461-465 (Nurses Health Study).
>29
Obesity is a Risk Factor for
Type 2 Diabetes in Men
Multivariate adjusted
relative risk of type 2 diabetes
50
42.1
40
30
21.3
20
10
1.0
1.0
<23
2323.9
1.5
2.2
4.4
6.7
11.6
0
2424.9
2526.9
2728.9
2930.9
Body mass index (kg/m2)
3132.9
3334.9
35
Adapted from Chan JM et al.
32
Diabetes Care 1994; 17: 961-9
The Costs of Obesity
Direct
 UK £500 million
 co-morbidities, GP and nurse
time, prescriptions, hospitals
 Indirect
 UK £ 2.1 billion
 disability, unemployment,
early retirement
 18 m sick days, 40 000 lost
years working life, 30 000
deaths, die 9 years early
 Intangible
Medical management of obesity
Legitimate, chronic disease1
• Serious health
consequences
• Major risk factor for
common causes of death
Multiple causes2
• Genetic, hormonal environmental,
socio-economic, cultural behavioural
• Blaming patient is inappropriate and
does not produce positive outcomes
Treatment options3
• Lifestyle modifications
• Nutrition/diet
• Physical activity
• Behaviour modification
• Pharmacotherapy
• Surgery
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
Mean weight loss
Weight Watchers
(n=150)
Self help (n=159)
@ 1 year
5kg
0.6kg
@ 2 years
3kg
0.1kg
Heshka et al 2003, JAMA, 289:14:1792-8
Men and their trousers
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50% of men wear their trousers
too tight
 only 10% admit to it
40% identified their own image
 20% women identified their
man’s image
45% of men thought they were
overweight
30% hated their stomach most
of all
Prof Steven Gray, NTU, 1999
www.fatmanslim.com
No nonsense approach to
waist loss – for men
A personal web-bases waist
loss programme
Enables
men
healthy choices
to
make
Teaches
techniques
to
change habits of a lifetime
Sustainable, realistic
gradual modification
Enjoyable
and
www.fatmanslim.com
Importance of waist size
Waist size & health risk
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
The benefits of waist loss
Sustained intentional weight loss of 5-10
kg (5-10 cm waist reduction)
Weight loss of 5-10 kg (510cm or 2-4inches from
around your waist) brings
improvements
to
blood
pressure, cholesterol levels,
glucose tolerance and a
reduced incidence of type 2
diabetes.
 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 cholesterol
15% dec. in LDL
30% dec. in triglycerides
8% inc. in HDL
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 kcal
365 days = 29200 kcal
= 4kg fat gain
fatmanslim.com
Foretelling the future……..
If you want a job done well…………
Do it yourself…………..