Obesity, Diabetes, and Diet

1
Obesity, Diabetes, and Diet

• Colonel James E. Turner 65
• Professor of Biology/Chemistry

2
Obesity In the US

• Obesity is a disease that affects nearly
  one-third of the adult American population
  (approximately 60 million).
• The number of overweight and obese Americans has
  continued to increase since 1960, a trend that is
  not slowing down.
• Today, 64.5 percent of adult Americans (about 127
  million) are categorized as being overweight or
  obese.
• Each year, obesity causes at least 300,000 excess
  deaths in the U.S., and healthcare costs of
  American adults with obesity amount to
  approximately 100 billion.

3
Secondary Causes of Low HDL

• Smoking
• Obesity (visceral fat)
• Very-low-fat diet
• Hypertriglyceridemia
• Drugs
• Beta-blockers
• Androgenic steroids
• Androgenic progestins

4
Weight and HDL

• Inverse correlation between body weight and HDL
  is consistently observed in both men and women.
• For every 3 kg (7 lb) of weight loss, HDL levels
  increase 1 mg/dL.

Dattilo AM, Kris-Etherton PM. Am J Clin Nutr
199256320328
5
Obesity is the Second Leading Cause of
Unnecessary Deaths.

• Despite its toll taken in death and disability,
  obesity does not receive the attention it
  deserves from government, the health care
  profession or the insurance industry.
• Research is severely limited by a shortage of
  funds.
• Inadequate insurance coverage limits access to
  treatment.
• Discrimination and mistreatment of persons with
  obesity is widespread and often considered
  socially acceptable.

6
Did You Know?

• Obesity is a chronic disease with a strong
  familial component.
• Obesity increases one's risk of developing
  conditions such as high blood pressure, diabetes
  (type 2), heart disease, stroke, gallbladder
  disease and cancer of the breast, prostate and
  colon.
• Health insurance providers rarely pay for
  treatment of obesity despite its serious effects
  on health.
• The tendency toward obesity is fostered by our
  environment lack of physical activity combined
  with high-calorie, low-cost foods.
• If maintained, even weight losses as small as 10
  percent of body weight can improve one's health.
  
• The National Institutes of Health annually spends
  less than 1.0 percent of its budget on obesity
  research.
• Persons with obesity are victims of employment
  and other discrimination, and are penalized for
  their condition despite many federal and state
  laws and policies.

7
What Is Obesity?

• Obesity having a very high amount of body fat in
  relation to lean body mass
• Body Mass Index (BMI) of 30 or higher.
• Being obese (more than 20 percent over your ideal
  weight) is not healthy
• Being obese and being overweight are not the same
  condition.
• A BMI of 30 or more is considered obese and a BMI
  between 25 to 29.9 is considered overweight.
•  

8
How Do We Measure Obesity?

• Body Mass Index (BMI) a measure of an adults
  weight in relation to his or her height,
  specifically the adults weight in kilograms
  divided by the square of his or her height in
  meters.
• Calculate your BMI
• Weight (lbs)   height (in)2   x 704.5 BMI

9
BMI and Obesity

• Healthy weight 18.5 to 24.9
• Overweight 25 to 29.9
• Obesity (Class 1) 30 to 34.9
• Obesity (class 2) 35 to 39.9
• Severe obesity (class3) 40

10
Obesity Risk Factors

• Fat tends to settle in certain regions, depending
  on gender.
• Women gain fat predominantly in the stomach, hips
  and thighs, while
• Men tend to gain fat in the belly and waist.

11
Obesity Risk Factors

• Risk by Age
• Risk by Gender.
• Risk by Economic Group.
• Ethnic Groups.
• US Regions
• Dietary Habits
• Night-Eating Syndrome
• Binge Eating and Eating Disorders
• Restrained Eating
• Infrequent Eating
• Specific Groups at Risk
• Anyone with Sedentary Lifestyles
• Ex-Smokers
• Shift-Workers
• People with Disabilities

12
Weight Wellness Profile

• Your Profile

13
Have We Reached 2010 Goals For Obesity?
14
Obesity in Adults 20 and Older
Age-adjusted percent
1988-94
1999-2000
2010 target
Total
Mexican American
Black, Not Hispanic
White, Not Hispanic
15
Childhood Obesity

• About 15.5 percent of adolescents (ages 12 to 19)
  and 15.3 percent of children (ages 6 to 11) are
  obese.
• The increase in obesity among American youth over
  the past two decades is dramatic.

16
Childhood Obesity

• Prevalence of Obese Children (Ages 6 to 11) at
  the 95th percentile of Body Mass Index (BMI)
• 1999 to 2000 - 15.3 increase
• 1988 to 1994 - 11
• 1976 to 1980 - 7
• Prevalence of Obese Adolescents (Ages 12 to 19)
  at the95th percentile of Body Mass Index (BMI)
• 1999 to 20001 - 15.5 increase
• 1988 to 1994 - 11
• 1976 to 1980 - 5

17
Is Obesity an Epidemic?

• Obesity epidemic increases dramatically in the
  United StatesCDC director calls for national
  prevention effort
• According to the findings, the obesity epidemic
  spread rapidly during the 1990s across all
  states, regions, and demographic groups in the
  United States.
• Obesity (defined as being over 30 percent above
  ideal body weight) in the population increased
  from 12 percent in 1991 to 17.9 percent in 1998.
  The highest increase occurred among the youngest
  ages (18- to 29-year-olds), people with some
  college education, and people of Hispanic
  ethnicity.
• By region, the largest increases were seen in the
  South with a 67 increase in the number of obese
  people. Georgia had the largest increase--101.
  The findings also show that a major contributor
  to obesity -- physical inactivity-- has not
  changed substantially between 1991 and 1998.
• According to surveys conducted in 1977-78 and
  1994-96, reported daily caloric intakes increased
  from 2239 Kcal to 2455 Kcal (calories) in men,
  and from 1534 Kcal to 1646 Kcal in women.

18
Obesity Trends Among U.S. AdultsBRFSS, 1991,
1996, 2004
(BMI ?30, or about 30 lbs overweight for 54
person)
1996
2004
No Data 1519 2024 25
19
Is Obesity An Epidemic?

• Eating more frequently is encouraged by
  innumerable environmental changes
• More food and foods with higher caloric content,
• The growth of the fast food industry,
• The increased numbers and marketing of snack
  foods, school vending machines,
• Increased time for socializing, and a custom of
  socializing with food and drink.

20
Is An Obesity Epidemic Just Hype?

• The controversy
• Is excess fat by itself a health risk?
• Do you do yourself harm by dramatically cutting
  calories and losing weight?
• The latest study had another surprising finding
  People who are modestly overweight but not obese
  have a lower risk of death than people of normal
  weight. Indeed, the fewer deaths from being
  modestly overweight partially canceled out the
  deaths from obesity.

21
A Balancing Act Intake vs Output
When a person's caloric intake exceeds his or her
energy expenditure, the body stores the extra
calories in the fat cells present in adipose
tissue. These adipose cells function as energy
reservoirs, and they enlarge or contract
depending on how people use this energy. If
people do not balance energy input and output by
adopting healthy eating habits and regular
exercise, then fat builds up, and they may become
overweight.
22
How Is Food Consumption Controlled?

• Obesity results when the body consumes more
  calories than it uses.
• Research points to several different factors that
  may influence weight gain. About 90 of people
  who diet gain every pound back that they lose
  regardless of their weight-loss method.
• Some evidence suggests that every person has an
  inherited weight range that varies by only about
  10 either up or down from some set point. (For
  instance, a man whose "genetically-determined"
  weight is 200 pounds would tend to swing from 180
  to 220 pounds, but would be unlikely to lose or
  gain more than this.)
• Genetic factors that influence fat metabolism and
  regulate certain hormones and proteins that
  affect appetite may play some part in 70 to 80
  of obesity cases.

23
How Is Food Consumption Controlled?

• Eating patterns are regulated by feeding and
  satiety centers located in the hypothalamus and
  pituitary glands of the brain that respond to
  signals indicating high fat stores and hunger.
• A number of molecules are produced in fat tissue
  and the gut that further control this process by
  stimulating or suppressing appetite.
• In some cases, genetic factors may produce
  imbalances in these chemicals
• Insulin
• Leptin.
• Resistin
• Intestinal Chemicals
• Other Chemicals

24
Body Fat Control

• Leptin - expressed predominantly by fat cells
  (adipocytes), which fits with the idea that body
  weight is sensed as the total mass of fat in the
  body a lipostat
• Strong positive correlation of serum leptin
  concentrations with percentage of body fat

25
Appetite Control

• The Yin and Yang personalities of ghrelin and
  obestatin. Both hormones derive from the same
  precursor protein and are predominantly secreted
  by the stomach and released into the blood. Each
  acts on a different receptor (GPR39 and GHS-R, as
  shown) and has an opposite effect on food intake,
  body weight, and gastrointestinal motility.

26
Obesity Treatment

• Over-the-Counter Drugs and Herbal Remedies
• A 2001 study reported that 7 of American adults
  use nonprescription weight-loss products. People
  must be cautious when using any weight-loss
  medications, including over-the counter diet
  pills and herbal or so-called natural remedies.
  Buying unverified products over the Internet can
  be particularly dangerous.
• Perhaps the best alternative advice for people
  who are overweight is to drink tea.

27
Obesity Treatment

• The growing prevalence of obesity has stimulated
  the search for drugs to treat this condition.
  Various therapeutic strategies have been
  explored, including
• Serotonin and noradrenaline reuptake inhibitors
  (anorectic agents)
• Lipase inhibitors
• ß 3-adrenoreceptor agonists
• Leptin agonists
• Melanocortin-3 agonists

Rimonabant has been developed from the knowledge
that cannabis smokers often experience extreme
hunger pangs, which cannabis smokers refer to as
'the munchies'. (Source ABPI) Blocking cannaboid
receptors should work?
28
Obesity Treatment

• Drugs
• Orlistat (Xenical) - prevents enzymes in the
  gastrointestinal tract from breaking down dietary
  fats into smaller molecules that can be absorbed
  by the body (lipase inhibitors)
• Sibutramine (Meridia) appetite supressant
• Psychostimulants
• Phentermine and Other Sympathomimetics
• Amphetamines loss of appetite.
• Investigative Agents
• Ciliary Neurotrophic Factor
• Zonisamide. Zonisamide (Zonegran)

29
Obesity Treatment

• Bariatric surgeries produce weight loss through
  one of two approaches
• Restrictive Banding Procedure. These procedures
  restrict the amount of food by closing off parts
  of the stomach with bands.
• Malabsorptive Bypass Procedures. This approach
  restricts the amount of food and also reduces
  absorption by using a by-pass of parts of the
  intestine.
• The malabsorptive procedures are more successful
  in achieving weight loss than the banding
  approach, but they carry a greater risk for
  nutritional deficiencies.

30
Problems With Bypass Surgery?

• It's estimated that 140,000 people had this
  procedure in 2004, with the number expected to
  grow even higher this year. And for the majority
  of patients, this surgery is a lifesaver, but not
  for all.
• A recent study by researchers at the University
  of Washington found that 1 in 50 people die
  within one month of having gastric bypass
  surgery, and that figure jumps nearly fivefold if
  the surgeon is inexperienced.

31
Obesity Treatments

• Liposuction
• Liposuction is a surgical procedure intended to
  remove fat deposits and shape the body. Fat is
  removed from under the skin with the use of a
  vacuum-suction canula (a hollow pen-like
  instrument) or using an ultrasonic probe that
  emulfsies (breaks up into small pieces) the fat
  and then removes it with suction.
• Liposuction is a procedure for shaping the body
  and is not recommended for weight loss.
• Liposuction may be performed on the abdomen,
  hips, thighs, calves, arms, buttocks, back, neck,
  or face

32
Obesity Treatment

• One model that has arisen is known as Health at
  Every Size. Rather than focusing on calorie
  counting, this approach encourages obese
  individuals to actually back off from monitoring
  how much food they eat and, instead, train
  themselves to pay more attention to internal body
  cues that signal hunger and fullness.

33
Diabetes Mellitus What is It?

• A condition where the body is no longer able to
  control the glucose levels in the blood stream
• 16 mill. cases in the United States
• 5-10 of those cases are type I
• Half of these cases are under age 20
• Types I and II

34
Type 1 vs Type 2 Diabetes

• Type 1 autoimmune disease of the pancreas
  destruction of the beta cells that secrete
  insulin
• Type 2 inability of cells to take in glucose
  little to no response to insulin

35
Current Population Trend

• Diabetes is the growing heath problem in the
  United States and has risen about six fold since
  1950.
• Its now affecting about 17 million Americans and
  one third of those Americans (5.9 million) dont
  even now they have the disease.
• Today, not only are adults being diagnosed with
  this disease, but its also affecting todays
  youth.

36
Regulation of Glycogen Metabolism

• Muscle glycogen is fuel for muscle contraction
• Liver glycogen is mostly converted to glucose for
  bloodstream transport to other tissues
• Both mobilization and synthesis of glycogen are
  regulated by hormones
• Insulin, glucagon and epinephrine regulate
  mammalian glycogen metabolism

37
Five Phases of Glucose Homeostasis

• Graph illustrates glucose utilization after 100g
  glucose consumption then 40 day fast

38
Hormones Regulate Glycogen Metabolism

• Insulin is produced by b-cells of the pancreas
  (high levels are associated with the fed state)
• Insulin increases rate of glucose transport into
  muscle, adipose tissue via
• Insulin stimulates glycogen synthesis in the liver

39
Regulation of Glucose Transport by the Hormone
Insulin
The binding of insulin to cell-surface receptors
stimulates intracellular vesicles containing
membrane-imbedded GLUT4 transporters to fuse with
the plasma membrane. This delivers GLUT4
transporters to the muscle or adipose cell
surface, thereby increasing the capacity of the
cell to transport glucose.
Basal levels of glucose transport are maintained
by GLUT1 and GLUT3 forms of the glucose
transporter (in most tissues).
40
Glucagon

• Secreted by the a cells of the pancreas in
  response to low blood glucose (elevated glucagon
  is associated with the fasted state)
• Stimulates glycogen degradation and slows down
  glycolysis to restore blood glucose to
  steady-state levels
• Only liver cells are rich in glucagon receptors
  and therefore respond to this hormone

41
Negative Feedback

• Homeostasis of blood glucose levels
• Blood glucose levels increase after a meal ?
  Insulin is secreted
• Insulin causes tissues to take up glucose ? blood
  glucose levels decline
• Rate of insulin secretion declines too ? rate of
  blood glucose uptake decreases

42
Low Blood Glucose Levels

• Nervous system malfunctions
• Fats and proteins are broken down causing
  ketoacidosis
• pH drops
• Ketones enter the blood stream
• Amino acids are broken down and used to
  synthesize glucose by the liver

43
High Blood Glucose Levels

• Kidneys produce large volumes of urine
• Urine is high in glucose molecules
• Frequent urination can lead to dehydration

44
Pathophysiology

• Diabetes mellitus is characterized by glucose
  concentrations in the blood that are high enough
  to overwhelm the reabsorption capabilities of the
  kidneys
• Glycosuriaglucose in urine
• Polyuriaexcessive urine production
• Other metabolic products are present in abnormal
  concentrations

45
Causes

• Researchers are uncertain of causes
• Possibilities
• Genetic abnormalities
• Pathological conditions
• Injuries
• Immune disorders
• Hormonal imbalances
• Secretion of too little insulin
• Insufficient numbers of insulin receptors
• Defective receptors

46
Without Insulin

• Cells cannot absorb glucose
• After meals, blood concentrations become so
  elevated that the kidneys cannot reclaim all the
  glucose
• High urinary concentrations of glucose limit
  ability to conserve water
• High urinary concentrations of glucose cause
  frequent urination and possible dehydration

47
Without insulin

• Chronic dehydration can cause neural function and
  muscle weakness
• Satiety center of brain responds with an
  exaggerated appetite
• Endocrine tissues respond with more glucose
• Ketoacidosis results

48
Diabetic Coma

• Causeloss of NA, K, and ketone bodies through
  excessive urination
• S/Slabored breathing, gasping for air, fruity
  smelling breath, nausea, vomiting, thirst,
  flushed skin, confusion, unconsciousness
• Careearly detection of ketoacidosis, injection
  of insulin

49
Insulin Shock

• Causetoo much insulin in the body results in
  hypoglycemia
• S/Stingling sensations, physical weakness,
  headaches, abdominal pain, rapid HR, tremors,
  drowsiness
• Careadhere to a carefully planned diet with a
  snack before activity, keep a sugar source
  available

50
Symptoms of Diabetes

• Type 2 diabetes is often without symptoms in its
  early stages. Thats the reason there are 40 of
  people with Type 2 diabetes are unaware of their
  disease. When there are symptoms, they may occur
  gradually. If present, they usually are
• feeling tired and weak
• passing large volumes of urine, especially during
  the night
• having frequent infections
• having blurred eyesight
• Weight-loss
• Excessive hunger and thirst

51
Facts on Type 2

• Type 2 diabetes is a disease that generally
  develops over a period of years.
• People who will eventually develop this disease
  are insulin resistant several years before their
  blood sugars become abnormal.
• Their bodies try to make up for the higher
  insulin needs created by insulin resistance by
  producing more insulin.

52
Regulation of Glucose Transport by the Hormone
Insulin
The binding of insulin to cell-surface receptors
stimulates intracellular vesicles containing
membrane-imbedded GLUT4 transporters to fuse with
the plasma membrane. This delivers GLUT4
transporters to the muscle or adipose cell
surface, thereby increasing the capacity of the
cell to transport glucose.
Basal levels of glucose transport are maintained
by GLUT1 and GLUT3 forms of the glucose
transporter (in most tissues).
53
Facts on Type 2

• But in Type 2 diabetes, the body ends up
  producing abnormally high levels of insulin over
  the years eventually begins to have a negative
  effect.
• The pancreas gradually begins to lose its ability
  to produce the extra insulin needed to overcome
  insulin resistance. As body insulin levels fall,
  blood sugars begin to rise.

54
Who gets Type 2 Diabetes?

• Most people are lead to believe that theyre to
  blame for the disease. However, this disease can
  also be inherited by genes as well. Not everyone
  that eats a lot of sugar and is overweight have
  the disease. But there are higher risks for
  people developing type 2 diabetes. Here are some
  facts on how it is people obtain this disease

55

• People who are overweight
• Have a parent or sibling with diabetes
• Are 40 years of age
• Have high blood pressure
• Are African America, Latino, or Native American
• Had diabetes during pregnancy
• Have the stress of an illness or injury
• Had a baby that weighed more than 9 pounds at
  birth.

56
Pharmacology

• Insulin is the main drug
• Insulin is a protein hormone and must be injected

57
RISK FACTORS!

• If left untreated this, Diabetes can cause many
  life threatening complications
• Blindness
• Chronic Renal Failure kidney failure
• Atherosclerosis heart attacks and stroke
• Diabetic Neuropathy numbness and pain to hands
  and feet
• Foot Ulcers
• Autonomic Neuropathy diarrhea, rapid heart beat,
  and low blood pressure

58
Risk Factors!

• Coma or death may occur as a result in Diabetic
  Ketoacidosis (caused by infection)
• People who smoke are a much higher risk at heart
  attacks, stroke, infections, and problems with
  poor circulation

59
How to take care of yourself

• Once youve been diagnosed with Type 2, there are
  many changes and things you have to do in order
  to keep your blood sugar level steady and
  healthy. Those ways are meal planning, weight
  loss, and exercise.

60
Meal Planning

• With type 2 Diabetes you have to eat healthy in
  order to keep your sugar levels well maintained.
  That means
• Fruits and vegetables (apples, bananas, broccoli,
  spinach, etc.)
• Whole grain, cereals ,and bread. (Wheat, barley,
  rice and bran.)
• Dairy products (yogurt, skim milk, cream)
• Meat fish, poultry, eggs, dried beans

61
Weight-loss

• Obesity increases insulin resistance and can
  lead to many other cardiovascular health
  problems.
• However the diabetic that carries the disease
  and loses weight, will see a decrease in blood
  glucose levels and a decrease in taking oral
  medication

62
Exercise

• Exercise can take glucose out of the blood and
  for energy during or after exercise, which lowers
  the glucose level.
• Helps delay large blood vessel clots, which lead
  to Cardiovascular heart Disease
• All people with diabetes should exercise to
  control their blood sugar level

63
Global Trends in Diabetes Is It Am Epidemic?

• The global incidence of type 2 diabetes is
  expected to double to over 300 million by 2025.
• Many of those affected will be young adults.
• How do we halt this epidemic?
• However, a recent study surveyed more than 700
  extremely fat children, more than half of whom
  had a family history of Type II diabetes. In
  other words, the studys cohort represented the
  tiny slice of the childhood population most at
  risk for developing the illness. And how many
  cases did the researchers uncover in this
  highest-risk group? 50? 100? 200? Answer exactly
  one.

64
Projected Increase in Total Heart Disease Deaths
Related to Increased Diabetes Prevalence
Heart Disease Deaths (thousands)
Proportion due to diabetes
65
What is the Link Between CVD, Obesity and
Diabetes?
Hypertension Obesity Hyperinsulinemia Diabetes Hyp
ertriglyceridemia Small, dense LDL Low
HDL Hypercoagulability
InsulinResistance
Atherosclerosis
66
CHD, Obesity, and Diabetes The Metabolic
Syndrome

• The metabolic syndrome is characterized by a
  group of metabolic risk factors in one
  person. They include
• Abdominal obesity (excessive fat tissue in and
  around the abdomen)
• Atherogenic dyslipidemia (blood fat disorders
   high triglycerides, low HDL cholesterol and
  high LDL cholesterol that foster plaque
  buildups in artery walls)
• Elevated blood pressure
• Insulin resistance or glucose intolerance (the
  body cant properly use insulin or blood sugar)
• Prothrombotic state (e.g., high fibrinogen or
  plasminogen activator inhibitor1 in the blood)
• Proinflammatory state (e.g., elevated C-reactive
  protein in the blood)

67
CHD, Obesity, and Diabetes The Metabolic
Syndrome

• People with the metabolic syndrome are at
  increased risk of coronary heart disease and
  other diseases related to plaque buildups in
  artery walls (e.g., stroke and peripheral
  vascular disease) and type 2 diabetes. The
  metabolic syndrome has become increasingly common
  in the United States. Its estimated that over 50
  million Americans have it.

68
Diagnosis of the Metabolic Syndrome

• The American Heart Association and the National
  Heart, Lung, and Blood Institute recommend that
  the metabolic syndrome be identified as the
  presence of three or more of these components
• Elevated waist circumferenceMen  Equal to or
  greater than 40 inches (102 cm)Women  Equal to
  or greater than 35 inches (88 cm)
• Elevated triglyceridesEqual to or greater than
  150 mg/dL
• Reduced HDL (good) cholesterolMen  Less than
  40 mg/dLWomen  Less than 50 mg/dL
• Elevated blood pressureEqual to or greater than
  130/85 mm Hg
• Elevated fasting glucoseEqual to or greater
  than 100 mg/dL

69
Prevention???

• Researchers attribute obesity to Type 2 Diabetes
• Maintain a healthy body weight
• Eat a healthy diet
• (fruits, vegetables, bread, milk)
• Exercise at least 30 minutes for 4-5 days a week.
• (swimming, walking, basketball, running)