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
BMI = KMI = kg/m² BMI WHO KLASSIFIKASJON < 18,5 Undervekt 18,5-25 Normalvekt 25-30 Overvekt >30 Fedme 30-35 Fedme grad 1 35-40 Fedme grad 2 > 40 Fedme grad 3 Sykelig fedme = BMI > 40 BMI > 35 + komorbiditet Super-obese = BMI > 60 (50)
20-69 år, prevalens BMI>30 HUNT 1: 1984-1986 HUNT 2: 1995-1997 HUNT 3: 2006-2007 5-10% 10-15% 15-20% 20-25% 25-30% >30%
Livsstil Slåttonn på Klefsås,
Fattigdom/matmangel
Changes in the incidence and disease panorama. Do we have a health care system that is adapted to new challenges?
Complications of childhood obesity The Lancet Volume 360, Issue 9331 2002 473-482
Complications to obesity increases early mortality CMAJ. 2011 October 4; 183(14): e1059 e1066.
Increased food energy supply is more than sufficient to explain the epidemic of obesity
Figure 2. Adjusted association of sugar availability (kcal/person/day) with diabetes prevalence (% adults 20 79 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): e57873. doi:10.1371/journal.pone.0057873 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0057873
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
Body fat content is under homeostatic control.
Leptin acts as part of a feedback loop to maintain constant stores of fat Nature 395, 763-770(22 October 1998)
OR Leptin Resistance Modified from Nature 395, 763-770(22 October 1998)
0.18 kg sukker /dag
Reported changes in food intake (g) between the Continuing Survey of Food Intake by Individuals 1989-1991 and 1994-1996. *1994-1996 intake significantly different from the 1989-1991 intake at P<.05. Chanmugam et al. J Am Diet Assoc 103:867, 2003
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
High Fructose Corn Syrop is 42-55 % Fructose Sucerose is 50 % Fructose
Metabolism of Glucose
Metabolism of fructose
Energy Balance is not Physics but Physiology Controlled by Hedonic and Homeostatic Systems Adiposcyte Gut microbiota
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
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)
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 2 2013 121-127
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
Thank you Sievenpiper J L, and de Souza R J Am J Clin Nutr 2013;98:261-263 2013 by American Society for Nutrition