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Obesity, Diabetes, and Diet

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Title: 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 States CDC 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. Adults BRFSS, 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
Insulin Resistance
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 circumference Men  Equal to or
    greater than 40 inches (102 cm) Women  Equal to
    or greater than 35 inches (88 cm)
  • Elevated triglycerides Equal to or greater than
    150 mg/dL
  • Reduced HDL (good) cholesterol Men  Less than
    40 mg/dL Women  Less than 50 mg/dL
  • Elevated blood pressure Equal to or greater than
    130/85 mm Hg
  • Elevated fasting glucose Equal 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)
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