Downey Fact Sheet 1 – About Obesity

September 27th, 2009 No comments »

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Obesity is a global epidemic and a major health concern because of its premature mortality and extensive comorbidities. Obesity is a common, complex, multifactorial disease with a high degree of heritability. Between 25 and 40% of person with obesity have a parent who is obese. There are several significant facts to bear in mind when discussing obesity:

By Julie Snider for the Downey Obesity Report

By Julie Snider for the Downey Obesity Report

Every individual inherits a certain number of fat cells or adipose tissue. Obesity requires (a) a large number of fat cells or (b) a large volume in each fat cell or (c) both. Adipose tissue continues throughout the lifespan. Weight loss, including surgically-induced weight loss, does not remove fat cells. This is why weight regain is so common. Individuals with obesity have significantly more fat cells than the non-obese, 23-65 billion compared to 37-237 billion for persons with obesity . Early onset obesity is associated with increase adipose cell number while adult obesity is associated with normal cell number. There are two phases of life in which growth of adipose cells are likely to develop: very early, within the first few years of life and between the ages of 9-13 years of age. Those who become very obese early in life are the ones who have nearly normal cell size but have the greatest increase in cell number; whereas those with onset of obesity between 9-13 have more change in cell size than cell number. Salans LB, Cushman SW, Weisman RE, Studies of human adipose tissue. Adipose cell size and number in non0bese and obese patients. J. Clin Invest. 1973 Apr’ 52(4): 929-41)

Extremely obese individuals may have four times the number of fat cells as lean counterparts. http://www.jpp.krakow.pl/journal/archive/1205_s6/pdf/5_1205_s6_article.pdf

Human food intake and energy expenditure are controlled by complex, redundant and distributed neural systems that reflect fundamental biological reaction to food supply and energy balance. The hypothalamus and caudal brainstem play a critical role. The limbic system is important for processing information regarding previous experience with food, reward and emotion. The predisposition to store considerable amounts of energy as fat for later use is now a major health risk. Brain, appetite and obesity – PubMed Results

Extensive research over the past 10 years has shown that appetite is regulated by a complex system of central and peripheral signals which interact in order to modulate the individual response to nutrient ingestion. Satiety signals include cholecystokinin, glucagon-like peptide and peptide YY which originate from the gastrointestinal tract during a meal and through the vagus nerve reach the caudal brainstem. Here the signals move to the arcuate nucleus where satiety signals are integrated with adiposity signals, namely leptin and insulin, and with several other inputs create a neural circuit which controls the individual’s response to a meal, i.e. keep eating or stop. Neuro-hormonal control of food intake: basic mecha…[J Physiol Pharmacol. 2005] – PubMed Result

Adipose tissue, rather than some inert, jello-like, substance is an active hormonal tissue, secreting many hormones which are involved in creating signals from the gut to the brain, indicating hunger or satiety. These hormones include insulin, leptin, ghrelin, PYY-33-6, adiponctin, resistin and visfatin as well as cytokines and chemokines, such as tumor necrosis factor-alpha, interleukin-6 and others. These can lead to a chronic sub-inflammatory state which plays a critical role in the development of insulin resistance, type 2 diabetes, increased risk of cardiovascular disease associated with obesity. Adipokines: the missing link between insulin resis…[Diabetes Metab. 2008] – PubMed Result

Downey Fact Sheet 2 – Quick Facts

September 27th, 2009 No comments »
The Downey Obesity Report

The Downey Obesity Report

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ADULT OBESITY

The adult obesity rates have risen dramatically from 1960 to today; rates of overweight (BMI >30) have doubled, rates of obesity (BMI 30-39.9) have nearly tripled and rates of extreme or morbid obesity (BMI >40) have nearly increased seven fold.

ADULT (age 20-74) Prevalence 1

Overweight (BMI 25-30) Percentage

1960-1962 31.5%

2005-2006 33%

Obese (BMI>30)

1960-1962 13.4%

2005-2006 35.1%

Extreme or Morbid Obese( BMI>40)

1960-1962 0.9%

2005-2006 6.2%

The rates of obesity only tell half the story. During this period, the total US population has also increased. Therefore, the raw numbers of Americans affected have also increased. Looking at the numbers of people affected, the overweight population has doubled, the obese population has increased 5 fold and the population with extreme or morbid obesity as increased by a factor of nearly 12!

Number of Americans Overweight in 1960: 56.5 million

Number of Americans Overweight in 2006: 94.5 million

Number of Americans Obese in 1960: 24 million

Number of Americans Obese in 2006:
40 million

Number of American with extreme or morbid obesity in 1960:
1.6 million

Number of Americans with extreme or morbid obesity in 2006: 18.6 million

Since 1960-61 to 2006, the number of American adults who became obese or extremely obese*: 61.1 million

Average number per year: 1.3 million

Average number per month: 110,779

Average number per day: 3,693

Average number per hour: 153

Average increase per minute: 2.5

Since 1960-61 to 2006, the number of American adults who became  extremely obese*: 11 million

Average number per year: 240,217

Average number per month: 20,018

Average number per day: 667

Average number per hour: 27

Adolescents Obesity age 12-19 3

Percent overweight/obese 2005-2006 18%

Young adult Obesity
Ages 18-29

Percent obese 1971-1974 8%

Percent obese 2005 24%

Childhood 2

Ages 6-11 15%

Ages 2-5 11%

Year at which each group will reach 80% obesity 4

All 2072

Men 2077

Women
2058

African American Women 2035

African American Men 2079

Mexican American Women 2073

Mexican American Men 20 91

White Women 2082

White Men
2073

Adipose Tissue (Fat Cells) 5

Age at which typical body has acquired its full number of fat cells: 13

Number of fat cells in average American Adult: 23-65 billion

Number of fat cells in persons with morbid obesity: 37-237 billion

Number of fat cells lost in weight-loss efforts: 0

By Julie Snider for the Downey Obesity Report

By Julie Snider for the Downey Obesity Report

 

Daily Calories Needed and Available 6

Recommended calories per day by typical American adult:

Men 2,400 to 2,800

Women 2,000 to 2,200

Mean (meaning half were above and half below) adult daily calorie intake per day 7 :

Men

1971 2,450

2001-2004 2,593

Women

1971 1,542

2001-2004 1,886

Percent increase in food available for consumption per person from
1970 to 2003: 16%

Amount of food available for each person increase from
1.67 pounds in 1970 to 1.95 pounds in 2003

Daily caloric intake has grown by 523 calories from 1970 to 2003. Leading the way were fats, oils, grains, vegetables and sugars and sweeteners.

U.S. Government Biomedical Research 8

2008 Budget of National Institutes of Health $29.6 billion

NIH Spending 2008 on selected diseases:

Cancer
$5.6 billion

HIV/AIDS funding $2.9 billion

Cardiovascular Disease
$2.0 billion

Heart Disease $1.2 billion

Obesity
$664 million

U. S. Government Infrastructure on Combating Obesity

Name of coordinator of U.S. global anti-obesity efforts:

(Trick question: no such position exists)

Name of White House coordinator of federal anti-obesity efforts:

(Another trick question: no such position exists)

Name of coordinator of Department of Health and Human Services***anti-obesity efforts:

(No such position exists)

*Calculations were made by taking the CDC prevalence figures for 1960-1962 and 2005-2006and multiplying them against US census data for 1960 and census data for 2006,respectively. See Census Bureau Home Page

**Available in this context means the total US calories available for consumption, less spoilage and waste. See ERS/USDA Data – Food Availability (Per Capita) Data System)

*** Department of Health and Human Services includes the National Institutes of Health, the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, the Food and Drug Administration, Office of the Surgeon General, the Agency for Healthcare Research and Quality among others.)

Notes

1. N C H S – Health E Stats – Prevalence of overweight, obesity and exreme obesity among adults: United States, trends 1960-62 through 2005-2006

2. FASTSTATS – Overweight Prevalence

3. http://www.cdc.gov/nchs/data/hus/hus08.pdf

4. Studies of human adipose tissue. Adipose cell size…[J Clin Invest. 1973] – PubMed Result

5. Will all Americans become overweight or obese? est…[Obesity (Silver Spring). 2008] – PubMed Result. In this estimate, by 2030, 86.3% of adults will be overweight or obese and 51% obese; black women at a level of 96.9% will be the most effected, followed by Mexican-American men (91.1%). By 2048, all American adults would be overweight or obese but black women would reach that milestone by 2034. In children, the authors estimate, rates will nearly double by 2030.

6. http://www.usdaplate.com/

7. http://www.ers.usda.gov/AmberWaves/November05/pdf/FindingsDHNovember2005.pdf

8. NIH Research Portfolio Online Reporting Tool (RePORT) – Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC)

By Julie Snider for the Downey Obesity Report

By Julie Snider for the Downey Obesity Report

Downey Fact Sheet 3 – Costs

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New analysis indicates costs attributed to obesity are estimated to be $147 billion per year. Annual Medical Spending Attributable To Obesity: P…[Health Aff (Millwood). 2009] – PubMed Result In 1998 the medical costs of obesity were estimated to be $78.5 billion, approximately half financed by Medicare or Medicaid.National Medical Spending Attributable To Overweight And Obesity: How Much, And Who’s Paying? — Finkelstein et al., 10.1377/hlthaff.w3.219 — Health Affairs.

Total health care expenditures of obese adults increased by more than 80% from 2001 to 2006.

During this time, the proportion of health care expenditures for obese adults increased from 28.1% of total health expenditures to 35.3%.

The mean annual health care expenditure for obese adults increased from $3,458 in 2001 to $5,148 in 2006. AHRQ News and Numbers: Health Care Spending for Obese U.S. Adults Rose More Than 80 Percent From 2001 to 2006

Total health care costs attributable to obesity/overweight are projected to double every decade, accounting for 16-18% of total US health care costs. Will all Americans become overweight or obese? Will all Americans become overweight or obese? est…[Obesity (Silver Spring). 2008] – PubMed Result compared to about 9% at present.

Elevated BMI levels in children is associated with $14.1 billion in additional prescription drug, emergency room and outpatient visit costs annually, indicating that the economic consequences of childhood obesity are probably much greater than previously indicated. The Impact of Obesity on Health Service Utilizatio…[Obesity (Silver Spring). 2009] – PubMed Result.

Downey Fact Sheet 4 – The Global Obesity Epidemic

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Increasing rates of obesity are not unique to the United States. Rates of obesity are increasing around the globe.

By Julie Snider for the Downey Obesity Report

By Julie Snider for the Downey Obesity Report

The World Health Organization projects at, as of 2005, 1.6 billion adults were overweight and at least 400 million were obese. Approximately 2.3 billion adults will be overweight and 700 million will be obese by 2015. WHO | Obesity and overweight

The Global Prevalence of Obesity is tracked by the International Obesity Task Force, a wealth of data is available at ..:: IOTF.ORG – International Obesity Taskforce ::..

The prevalence of obesity among children is increasing worldwide. Worldwide trends in childhood overweight and obesi…[Int J Pediatr Obes. 2006] – PubMed Result

The increasing trends worldwide appear to affect the children from higher, not lower, socioeconomic status Obesity among pre-adolescent and adolescents of a …[Asia Pac J Clin Nutr. 2004] – PubMed Result

Prevalence is also increasing in Europe The epidemic of obesity in children and adolescent…[Cent Eur J Public Health. 2006] – PubMed Result

In India, undernutrition and obesity are co-occuring. Patterns, distribution, and determinants of under-…[Am J Clin Nutr. 2006] – PubMed Result

The cause appears to reflect dramatic changes in diet in urban areas and in reductions in physical activity The nutrition transition and obesity in the develo…[J Nutr. 2001] – PubMed Result. Some of the effects may be due to changes in income levels. Rapid income growth adversely affects diet quality…[Soc Sci Med. 2004] – PubMed Result. See also, Poverty and obesity: the role of energy density an…[Am J Clin Nutr. 2004] – PubMed Result and The real contribution of added sugars and fats to …[Epidemiol Rev. 2007] – PubMed Result

As one would expect, the worldwide incidence of diabetes is also increasing Global Prevalence of Diabetes — Diabetes Care

Downey Fact Sheet 5 – Measuring Obesity – The Body Mass Index

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How do we know if one is overweight or obese?

There are several methods, but the one most frequently used by researchers and physicians is the Body Mass Index or BMI. The BMI is a mathematical formula involving dividing one’s weight (in kilograms) by one’s height in meters squared. The resulting number is one’s BMI. Thanks to the Internet, there are now a lot of calculators to do the math for us. This is just one of them. Calculate your BMI – Standard BMI Calculator . As you can see from the formula, the BMI is not adjusted for age, gender or other health status. It is meant to be a proxy for excess adipose tissue in the body. It does a pretty good job of that when studying a whole population or a subgroup. At the personal level, it may not be as good an indicator of excess adipose tissue. Waist circumference is sometimes used as an additional assessment of risk because it measures central adiposity, which is more likely to predict the risk for co-morbid conditions. (Generally, one BMI unit is equal to about 5 pounds.)

More sophisticated tools are sometimes used including hydrostatic weighing and DEXA which uses bioelectrical impedance to determine body composition.

The other problem with the BMI has to do with the cut-off points. In other words, what is the range for normal, overweight, obese and morbid obesity. Much research goes into evaluating what are the appropriate cutoffs. The studies are not always very clear…except for the fact that, at some point, increasing weight by any measurement means increased risk for comorbid conditions (See Health Effects) of mortality (See Obesity A to Z). A discussion of the needs for changes in BMI usage in the elderly is reported at An evidence-based assessment of federal guidelines…[Arch Intern Med. 2001] – PubMed Result

BMI may tell us a lot about populations but you might be interested in how your weight compares with others your age, race or gender. See: Average height and weight charts, men and women .

For many years, Americans were familiar with the Metropolitan Life Insurance Weight tables Height & Weight Tables. These tables are often used with patients considering bariatric surgery. Many surgeons discuss weight loss not in terms of BMI units but in terms of Excess Weight or one’s current weight minus the Metropolitan Life ‘ideal weight.’ Excess Weight Loss or EWL, then, becomes the standard to look at weight loss following bariatric surgery.ASMBS – Rationale for Surgery

The search for an improved BMI continues but it is well validated and continues to be used worldwide.

Read more: Pathophysiology of obesity. [Proc Nutr Soc. 2000] – PubMed Result

BMI Calculator Go to Calculate your BMI – Standard BMI Calculator

Background on US BMI criteria: Criteria for definition of overweight in transition: background and recommendations for the United States — Kuczmarski and Flegal 72 (5): 1074 — American Journal of Clinical Nutrition

Comparisons of percentage body fat, body mass inde…[Am J Clin Nutr. 2009] – PubMed Result

How does your weight compare to others of same race, gender and age? See:Average height and weight charts, men and women

Downey Fact Sheet 6 – Morbid Obesity

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Fact Sheet Morbid Obesity

Over two-thirds of Americans are overweight or obese; one-third are obese. But the obesity crisis in the United States is really the crisis of morbid obesity. It is this group – persons with morbid obesity – who have the most comorbid conditions, the highest health care costs and the greatest likelihood of death.

Morbid obesity is defined as a Body Mass Index (BMI) of 40 or more (roughly 100 pounds over ideal weight). (The Body Mass Index is a formula in which the weight in kilograms is divided by height in meters squared. A BMI of 30 to 39.9 is regarded as obese; 25-29.9 overweight and 20-24.9 normal weight; a BMI below 20 is considered unhealthy.) The number of Americans with morbid or severe obesity, defined as 100 pounds or more overweight or a BMI of 40, is growing twice as fast as the number of Americans who are overweight or obese.

The prevalence of Americans with a BMI over 50 has increased by 75 percent from 2000 to 2005. This statistic confirms that the heaviest BMI groups have been increasing at the fastest rates for 20 years. (Increases in morbid obesity in the USA: 2000-2005. [Public Health. 2007] – PubMed Result)

Downey Fact Sheet 7 – Bariatric Surgery

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Most chronic diseases, if they have a treatment, can be better addressed at early stages before the disease process has established itself. The longer and more severe the disease, the less effective treatments there are. Obesity does not follow this model. For the most severe cases there is actually a very good and effective intervention ― bariatric surgery. Many studies support surgery as effective in resolving comorbid chronic diseases.

By Julie Snider for the Downey Obesity Report

By Julie Snider for the Downey Obesity Report

In a recent study, bariatric surgery had a significant decrease in the prevalence of 26 of 106 specific diseases and conditions ― about one-fourth. The prevalence of type 2 diabetes, high cholesterol, osteoarthritis and intervertebral disc disorders dropped by about half, hypertension by about one-third and asthma by almost three-quarters within two to four months after surgery. Patients were able to maintain or further decrease the prevalence of these diseases and conditions for up to two years. The impact of morbid obesity and bariatric surgery…[J Occup Environ Med. 2009] – PubMed Result. Recent studies show support for surgery’s role in treating type 2 diabetes. Weight and type 2 diabetes after bariatric surgery…[Am J Med. 2009] – PubMed Result

Increasing technological improvements both in the surgical process and in the devices, such as the adjustable band, can improve outcomes and reduce adverse events (see Meta-analysis: surgical treatment of obesity. [Ann Intern Med. 2005] – PubMed Result)..

A recent study demonstrated bariatric surgery’s effectiveness in reducing the risk of cancer (see http://www.asbs.org/html/pdf/soard_featured_article.pdf). More importantly, the rapid resolution of diabetes following bariatric surgery and before significant weight loss is providing researchers with new avenues to investigate the basic science of obesity and diabetes.

The ability of bariatric surgery to effect a remission of type 2 diabetes was first reported in the 1970s. Subsequent research has increased the evidence for this effect.

One commentator has concluded, “The most effective way to induce a remission of type 2 diabetes at present is not pharmacologic, but surgical. Bariatric surgery, particularly when gastric banding is effectively applied, results in rapid and massive weight loss that reduces insulin resistance. Roux-en-Y procedures, however, may act via the entero-pancreatic (incretin) hormone axis, causing diabetes to remit even before weight loss. However bariatric surgery has adverse effects and complications, as it enforces a major alteration of lifestyle. Surgically reduced stomach volume restricts how much food the individual can ingest without significant discomfort. Long-established eating habits are necessarily changed.” (Saudek, CD, Can Diabetes Be Cured? Potential Biological and Mechanical Approaches, JAMA, April 15, 2009, 301:15:1588-1589)

Another paper estimated that as many as 14,310 diabetes-related deaths might be prevented by bariatric surgery over five years. (Purnell JA, Flum DR, Bariatric Surgery and Diabetes, Who Should be Offered the Option of Remission, JAMA, April 15, 2009, 301;15:1593-1595.)

Recent data shows a mortality rate as safe or safer than gallbladder surgery when performed in a Center of Excellence. (see Pratt, G.M., McLees, B., W.J. Pories. The ASMBS Bariatric Surgery Centers of Excellence Program: A Blueprint for Quality Improvement. Surgery for Obesity and Related Diseases, 2, 2006. pp. 497-503).

Bariatric Surgery Centers of Excellence have been established identify and track long term outcomes. See Surgical Review Corporation

Resources

September 27th, 2009 No comments »

Follow the debate on obesity as a disease at Obesity – ProCon.org

USDA MyPyramid MyPyramid.gov – United States Department of Agriculture – Home

Nutrition Fact Sheets from the American Dietetic Association Nutrition Fact Sheets

Diabetes Research Summaries from the American Diabetes Association Diabetes Research Summaries – Overweight, Obesity & Weight Loss – American Diabetes Association

Diet and Lifestyle Recommendations from the American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=851

Disease Management Association of America obesity resource page Welcome to the Obesity Resource Center

The Obesity Action Coalition’s mission is to assist persons trying to lose weight and facing discrimination in insurance and the workplace. OAC ­ Obesity Action Coalition

NCCOR | National Collaborative on Childhood Obesity Research

This is a fun site on the First Family’s food issues: Obama Foodorama

Here’s a toolkit for parents and caregivers of adolescents on eating and activity pattern changes BodyWorks – A Toolkit for Healthy Teens and Strong Families

This is the Head Start program to improve activity and eating in children I am Moving, I am Learning (IMIL)

We Can is a program of the National Institutes of Health focused on childhood obesity We Can! is an education program to prevent childhood overweight

The Campaign to End Obesity