Assessment of the Obesity Epidemic

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Assessment of the Obesity Epidemic
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More than 60 of US Adults Are Overweight
Flegal K, et al. JAMA 20022881723-1727.
Hedley AA, et al.
JAMA 20042912847-2850.
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Assessing Obesity What Is BMI?

• BMI
• Calculated as weight(kg)/height(m2)
• Evaluates weight relative to height
• Replaced ideal body weight as the primary
  criterion for assessing obesity
• Correlates significantly with body fat,
  morbidity, and mortality

NIH Natl Heart, Lung, and Blood Inst. Obes Res.
19986(suppl 2)51S. Willett WC et al. N Engl J
Med. 1999341427.
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Prevalence of Obesity by Age
Men
Women
Flegal et al. JAMA 20022881723-1727.
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Obesity Trends by Gender and Ethnicity
Men
Women
Flegal K, et al. JAMA 20022881723-1727.
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Prevalence of Obesity by Education and Income
Education
Flegal et al. JAMA 20022881723-1727.
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Prevalence of Extreme Obesity (BMI 40) by
Gender and Ethnicity
Men
Women
Hedley AA, et al. JAMA 20042912847-2850.
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Prevalence of Overweight in Children and
Adolescents
Flegal K, et al. JAMA 20022881723-1727.
Hedley AA, et al.
JAMA 20042912847-2850.
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Obesity and Coronary Heart Disease (CHD)
Coronary Heart Disease
Morbiditymortality
Morbiditymortality
Morbiditymortality
Hypertension
Diabetes
Dyslipidemia
80 are obese
50 70 are obese
40 are obese
OBESITY
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Trends in Cardiovascular Risk Factors in Obese
Individuals (BMI 30 kg/m2 )
High Blood Pressure
Smoking
High Cholesterol
Diabetes
Gregg EW, et al. JAMA 20052931868-1874.
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Obesity Is Caused by Long-Term Positive Energy
Balance

• Fat
• stores

Energy expenditure

Energy intake
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Regulation of Body Weight

• Genes confer the potential for obesity
• Environment determines whether and to what extent
  the potential is realized

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Relationship Between Adoptee Weight and Weight of
Biological or Adoptive Parents
Adoptive Parents
Biological Parents
BMI of Parents (kg/m2)
Thin Median Overweight Obese
Thin Median Overweight Obese
Weight Classification of Adoptees
Stunkard et al. N Engl J Med 1986314193.
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Heritability of Body Weight
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Components of Daily Energy Expenditure
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8
8
32
75
60
Sedentary person (1800 kcal/d)
Physically active person (2200 kcal/d)
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Decreased Energy Expenditures and Weight Gain
RMR resting metabolic rate
Ravussin E, et al. N Engl J Med. 1988318467-472.
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Barsh GS, Schwartz MW. Nat Rev Genet.
20023589-600.
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Gene-Environment Interaction in the Pathogenesis
of Obesity
Body Mass Index (kg/m2)
Ravussin E et. al. Diabetes Care 171067, 1994.
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The Toxic Environment

• Food is
• Highly accessible
• Inexpensive
• Advertised heavily
• High fat, high sugar
• Delicious

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16 oz
32 oz
44 oz
52 oz
64 oz
1 oz 12 calories
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Food Portion Size Trends
Nielsen Popkin, JAMA 2003.
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Prevalence of Obesity by Hours of TV per Day
NHES Youth Aged 12 to 17 in 1967-1970 and NLSY
Youth Aged 10 to 15 in 1990
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of Children with Daily Physical Education
American Academy of Pediatrics.
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Responding To The Obesity Epidemic

• Create a child-healthy environment
• Banish junk food from schools
• Reduce food ads directed at children
• Increase opportunities for physical activity

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Psychological Factors and Obesity
Moral problem? Psychological problem?
Aesthetic problem? Social and medical problem?
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Psychosocial Status of Obese Individuals

• Most obese individuals have normal psychological
  status
• Persons who seek weight loss report greater
  distress
• Patients at greatest risk of depression
• Women
• Extreme obesity (BMI 40 kg/m2)
• Binge eating disorder (BED)

Friedman Brownell. Psych Bull 19951173-20.
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Risk of Major Depression with Extreme Obesity
Onyike, et al. Amer J Epidemiology
20031581139-1147.
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Bodily Pain and Depression in Obese Individuals
(N 306)
Bodily Pain
BDI-II Score
Fabricatore AF. Obes Surg 2005 15304-309.
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Prejudice Against the Obese
Six-year old children labeled silhouettes of an
overweight child as

• Lazy
• Dirty
• Stupid

• Ugly
• Cheats
• Lies

Staffieri. J Per Social Psychol 19677101.
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Prejudice Against the Obese
1961
2001
1
Healthy
2
Healthy
Crutches
Face
3
Mean Rank
Wheelchair
Crutches
Hand
Hand
4
Wheelchair
Face
Obese
5
Obese
6
Latner, JD, Stunkard, AJ. Obes Res 200311454.
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Discrimination Against the Obese

• Discrimination has been reported in
• Student Selection
• Employee Selection
• Employee Pay and Promotion
• Tenant Selection
• Marriage

Roehling MV. Personnel Psychology 1999 52
969-1016.
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Discrimination in the Workplace

• Discrimination against obese does not violate
  federal law in the US
• Title VII in US protects people from
  discrimination based on race, color, religion,
  sex, or national origin
• Obesity is not a protected characteristic

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Social Stigma and Obesity Id Rather Go
Blind

• Patients who lost 45 kg or more
• Preferred to be normal weight with a major
  handicap (deaf, dyslexic, diabetic, legally
  blind, bad acne, heart disease, leg amputated)
  than to be morbidly obese
• Rather be normal weight than a morbidly obese
  multi-millionaire

Rand CS. Macgregor AM. Int J Obesity 1991 15577.
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Conclusion

• The epidemic of obesity is the result of a
  complex interplay of genetic, environment,
  cultural, and economic factors
• Greater efforts are needed to change the
  environment that lies at the heart of the
  epidemic
• Obese individuals should not be blamed for their
  condition, but instead be treated with respect,
  fairness, and compassion