Obesity and food; Is a calorie a calorie. Overlege Dr.Med Bård Kulseng Regionalt senter for behandling av sykelig overvekt St. Olavs Hospital og NTNU

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1 Obesity and food; Is a calorie a calorie Overlege Dr.Med Bård Kulseng Regionalt senter for behandling av sykelig overvekt St. Olavs Hospital og NTNU

2 BMI = KMI = kg/m² BMI WHO KLASSIFIKASJON < 18,5 Undervekt 18,5-25 Normalvekt Overvekt >30 Fedme Fedme grad Fedme grad 2 > 40 Fedme grad 3 Sykelig fedme = BMI > 40 BMI > 35 + komorbiditet Super-obese = BMI > 60 (50)

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5 20-69 år, prevalens BMI>30 HUNT 1: HUNT 2: HUNT 3: % 10-15% 15-20% 20-25% 25-30% >30%

6 Livsstil Slåttonn på Klefsås,

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8 Fattigdom/matmangel

9 Changes in the incidence and disease panorama. Do we have a health care system that is adapted to new challenges?

10 Complications of childhood obesity The Lancet Volume 360, Issue

11 Complications to obesity increases early mortality CMAJ October 4; 183(14): e1059 e1066.

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14 Increased food energy supply is more than sufficient to explain the epidemic of obesity

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18 Figure 2. Adjusted association of sugar availability (kcal/person/day) with diabetes prevalence (% adults years old). Basu S, Yoffe P, Hills N, Lustig RH (2013) The Relationship of Sugar to Population-Level Diabetes Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data. PLoS ONE 8(2): e doi: /journal.pone

19 Obesity is a natural reaction to the food environment we live in Obesity is controlled by the hedonic and homeostatic systems Hedonic hunger is a physiological response to food, involving the brain s reward centres. The result is that we eat not according to energy needs, but purely for pleasure Feelings of hunger; is released in the presence of high-fat, high-sugar foods even when the body does not need calories The job of the homeostatic system is to defend those stored calories and a progressively higher body weight

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21 Body fat content is under homeostatic control.

22 Leptin acts as part of a feedback loop to maintain constant stores of fat Nature 395, (22 October 1998)

23 OR Leptin Resistance Modified from Nature 395, (22 October 1998)

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31 0.18 kg sukker /dag

32 Reported changes in food intake (g) between the Continuing Survey of Food Intake by Individuals and * intake significantly different from the intake at P<.05. Chanmugam et al. J Am Diet Assoc 103:867, 2003

33 Fructose is not glucose Fructose does not suppress ghrelin (hunger hormone) Acute fructose do not stimulate insulin Hepatic fructose metabolism is different Chronic fructose exposure promotes the Metabolic Syndrome

34 High Fructose Corn Syrop is % Fructose Sucerose is 50 % Fructose

35 Metabolism of Glucose

36 Metabolism of fructose

37 Energy Balance is not Physics but Physiology Controlled by Hedonic and Homeostatic Systems Adiposcyte Gut microbiota

38 Why is exercise important in obesity? Because it burns calories Because it improves skeletal muscle insulin sensitivity Because it reduses stress, and cortisol release Because it makes the Kreps cycle run faster, and detoxifies fructose,impruving hepatic insulin sensitivity

39 Inter-individual differences in response to exercise FFM: 0.89±2.12kg FFM: 0.47±1.51kg, P<0.05 hunger and EI hunger and EI RMR (14.2±242.4) RMR (60.2±298.3) Participants ex for 12 weeks, 5 times /week (all ex sessions were supervised). Each session was individually designed to expend 500kcal at approximatly 70% max HR. King et al, 2008 (IJO)

40 The Maintenance of Energy Balance Is Compromised after Weight Loss Figure 1 Changes among metabolic tissues, hormones and brain reward systems in maintaining an energy balance in a weight-reduced state. CCK, cholecystokinin; CR, cognitive restraint; GLP-1, glucagon-like peptide-1; NE, norepinephrine; PAEE, physi... Canadian Journal of Diabetes Volume 37, Issue

41 Conclusion Obesity lead to disease and premature death The quality of the food we eat is important to your health. Proteins, fats and carbohydrates are good for health. It's all about quality and quantity. We need to change your diet to lower glucose index, increased fiber and reduced fructose and sugar A calorie is not a calorie, but the biochemical processes that food lead to Obesity, gluttony and sloth may be the result of neuroendocrine responses to the food we eat

42 Thank you Sievenpiper J L, and de Souza R J Am J Clin Nutr 2013;98: by American Society for Nutrition