Obesity Compared to other Diseases in US

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1 Fatima Cody Stanford, MD, MPH Obesity Medicine & Nutrition Massachusetts General Hospital Harvard Medical School Harvard Kennedy School of Government Obesity Compared to other Diseases in US 1 CDC.gov All numbers from 2010 or 2011 summary data 1

2 Number in Millions 5/13/2015 Obesity Prevalence in Adults and Children in the United States Number of individuals with obesity, Females Males Adults aged 20 and over Children and Adolescents 2-19 SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey,

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15 Obesity Impact on Global GDP 15

16 Body Mass Index Calculation Metric measurements: Weight (kg) Height (m) 2 English measurements: Weight (lb) X 703 Height (in) 2 How is Obesity defined in Children and Adolescents? Weight Status Category Underweight Healthy Weight Overweight Obesity BMI Percentile Range < 5 th Percentile 5 th Percentile - <85 th Percentile 85 th Percentile- <95 th Percentile 95 th Percentile 16

17 How is Obesity defined in Adults? Weight Status Category Body Mass Index (BMI) Underweight < 18.5 Normal Weight Overweight Class I Obesity Class II Obesity Class III Obesity 40 17

18 Energy Balance (Simple) All Calories are NOT created EQUAL 18

19 Obesity: A Multi-factorial Disorder Genetics Environment Development Behavior Medical Complications of Obesity 19

20 Regulation of Food Intake Regulation of Food Intake Nature Reviews Genetics 10, (July 2009) 20

21 Central Nervous System regulates weight Diet Food quality is most important No one diet is superior to another Find what works for you Consider to track foods on a Smartphone application 21

22 Goal Organization Moderate Aerobic Maintain health Prevent weight gain For weight loss To prevent weight regain Physical Activity Guidelines US dept of Health and Human Services (2008) American College of Sports Medicine (ACSM) American College of Sports Medicine (ACSM) 150 min/wk min/wk >250 min/wk Vigorous Aerobic OR 75 min/wk NA NA Resistance Training AND on 2 or more days NA NA Role of resistance exercises in weight loss and prevention of weight regain is controversial. Weight loss from exercise is modest (~ average of 1-3 lbs of additional weight loss). 22

23 Sleep Sleep quality is most important Duration varies for individuals Most prefer 7-8 hours of sleep Take note if you: Snore Wake up gasping for breath Someone notes that you stop breathing in the middle of the night Daytime sleepiness Morning Headache Weight Promoting Drugs Drugs prescribed for other issues may cause weight gain Common culprits: Anti-psychotics Anti-depressants Sleep agents Insulin Long term steroid use Nerve agents 23

24 Circadian Rhythm Disturbances Night shift workers have circadian rhythm disturbances Body prefers to be awake during daytime hours A shift to daytime hours may lead to weight loss Thermoregulation Persons regulate temperature differently Body temperature influences energy expenditure 24

25 57 year old woman BMI: 40 BMI: 30 Behavioral BMI: 28 Phentermine/Topiramate 55 year old woman BMI: 36 BMI: 33 Phentermine BMI: 30 BMI: 29 BMI: 32 Behavioral BMI: 27 Topiramate? 25

26 31 year old woman BMI: 36 BMI: 24 Phentermine/ Topiramate 45 year old woman BMI: 33.5 CPAP+ Metformin BMI:

27 37 year old woman BMI: 36 BMI: 36 BMI: 29.5 Phentermine+ Topiramate Conclusion Obesity is multifactorial disease process Different reasons why a person may struggle with weight Strategies should target individual to determine the best strategy that will help one to achieve a healthy weight Be patient! 27

28 Thank you for your time! Fatima Cody Stanford, MD, MPH Obesity Medicine & Nutrition Massachusetts General Hospital Harvard Medical School Harvard Kennedy School of Government 28

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