Prevention of

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Prevention of and
Obesity
Diabetes
E. Y. St. A. Morrison November 20, 2000
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OBESITY ?

• WT gt 120 ideal
• BMI gt 30 kg/m2
• Affecting ? 30 of our adult population

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DIABETES MELLITUS ?
i) FBS gt 7 (126) ii) FBS lt 7 (126) 2
hrpp 75 g glucose gt 11.1 (200) iii) IGT IFG
Glycosuria Affecting ? 15 - 20 of our adult
population
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WATCH

• BMI gt 25 Kg/m2
• IFG 6.1- 7.0

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WHY COMBINE THE APPROACHES
?
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OBESITY

• General
• Skin Fold Thickness
• Weight for Height (CFNI)
• Waist Circumference (Gut)
• Hip Circumference (Butt)
• Body Mass Index (BMI)
• Type
• Waist Hip Ratio

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METABOLIC PREDICTIONS OF WEIGHT GAIN

• Low metabolic rate
• Low levels of physical activity
• Low rates of fat oxidation
• Insulin sensitivity
• Low sympathetic nervous system activity
• Low plasma leptin concentrations

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Leptin hormone (protein) determined by ob
gene Regulation - insulin and glucocorticoids
? - fasting and ? receptor agonists
? Produced in - White and Brown
fat - Placenta - Fetal tissues -
heart, bone/cartilage - Hypothalamus Acts
via - Glucagon-like Peptide-1 - CRH
- Neuropeptide Y EFFECT COMPLEX NOT CLEAR
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BAD OBESITY
The single most important predisposing factor for
the development of Type 2 DM
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BAD OBESITY and TYPE 2 DM

• Which is PRIMARY DEFECT?
• Insulin Resistance
• Pancreatic Insufficiency
• All of the above

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BAD OBESITY
?

• Insulin Resistance/ Hyperinsulinemia
• Hypertriglyceridaemia
• Hypertension
• ? HDL

Syndrome X of REAVEN (1988) The deadly quartet
predicting risk of Cardiovascular Disease.
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BAD OBESITY

• Also associated with
• ? Activity of Renin-Angiotensin System
• ? Activity of Sympathetic Nervous System
• ? Secretion of Atrial Natriuretic Peptide
• ? Intravascular, cardiac and stroke volume
• All the above Genetic predisposition ? ? BP

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HYPER-
glycaemia tension insulinemia adiposity trigly
ceridemia uricaemia cholesterolaemia
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WEIGHT LOSS
Reduces complications even without attaining the
ideal weight
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SOME JAMAICAN DATA
In the 15 age group Prevalence
() Diabetes Mellitus (WHO criteria) 17.9 Hypert
ension (gt 140/90) 45.9 Obesity (gt 30
kg/m2) 36.6 Obese Diabetes 48.5
Source Jamaican All-Island Survey, 1993
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BMI WHR
BMI (kg/m2) WHR (normal lt 1) DM (
prevalence) gt 25 lt1 22.0
19-25 ? 1 24.9 gt 25 ? 1 46.0
Source Jamaican All-Island Survey, 1993
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THE APPROACH TO PREVENTION!?
Pharmacological Intervention - NO Lifestyle
Intervention - YES
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EDUCATION

Eating Exercise
In Schools the Community
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ADVICE

• Multiparity
• Smoking

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EDUCATION

• SCHOOLS
• Back on Curriculum
• PE gt 2/wk
• Use of the Public Transportation
• School Feeding Programme

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• COMMUNITY
• EDUCATION
• Fast Foods
• Physical Activity
• Public Transportation

• NEGOTIATION
• Stakeholder Industries
• e.g. sweet drinks
• fried foods
• sweet products

• INFLUENCE POLICY
• Governmental licences to operate
• Monitor the operation

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CHALLENGE
Knowledge ? Practice
Pragmatic gt Idealistic
Adaptable ? Relevant Flexible
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SOME FACTS

• World Population ? 6.2 b
• 1.2 b are gt 25 kg/m2
• 1.2 b are lt 19 kg/m2
• 91 in the USA ? Daily minimum of 5 servings of
  fruits/vegetables
• 99 of children in the USA do not get USDA
  recommended number of servings from each of the 5
  major food groups/day

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FACTS (contd)

• In the past 50 years, consumption of added sugars
  in the USA has increased by 45 lbs/person/year

• 80 of refined and processed sugars produced
  today go to the food and beverage industry, c.f.
  1950s when most went to home baking

• Consumption of soft drinks in the USA has
  increased 130 between 1978 and 1995. (In 1997
  that translated to soft drink consumption of 41
  gallons/person)

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FACTS (contd)

• NDNS in the UK found that
• girls 15-18 years
• consumed 4x more sweets in weight than leafy
  greens
• only 20 consumed any citrus within a week
• and children, on average, consumed 75 more sodas
  than milk

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FACTS (contd)

• Conclusion from the NDNS
• Many children are growing up with an unhealthy
  diet, eating too much salt, sugar and saturated
  fat, and not enough vegetables, and not receiving
  enough exercise.
• Peter Leighton
• Galileo Laboratories
• Santa Clara, CA, USA

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FOR THE HEALTHY SOCIETY

• Educate
• Influence

i) The Community ii) The Policymakers iii) The
Stakeholders