The Epidemic of Obesity Louis J. Aronne, MD, FACP Clinical Professor of Medicine Weill Medical College of Cornell University Clinical Associate Professor of Medicine, Columbia University College of Physicians and Surgeons Director, Comprehensive Weight Control Program, New York Presbyterian Hospital
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The Epidemic of Obesity
Louis J. Aronne, MD, FACPClinical Professor of Medicine
Weill Medical College of Cornell University
Clinical Associate Professor of Medicine, Columbia University College of Physicians and Surgeons
Director, Comprehensive Weight Control Program, New York Presbyterian Hospital
I am a consultant, speaker, advisor, or receive research support
U.S. Obesity Prevalence, 1960- 2008More Than 2/3 of Adults are Overweight or Obese
Overweight (BMI = 25-29.9)
NHLBI. Obes Res. 1998;6(suppl 2):51S-209S.Flegal, et al. Int J Obes. 1998;22:39-47.www.cdc.gov/nchs/data/hestat/obesity_adult_07_08/obesity_adult_07_08.htm
31.5% 33.6%
13.4%
34.3%
0.9%
6.0%
Obese(BMI = >
30)
Extremely Obese (BMI = 40)
5
U.S. Obesity Prevalence, 1960- 2008More Than 2/3 of Adults are Overweight or Obese
Overweight (BMI = 25-29.9)
NHLBI. Obes Res. 1998;6(suppl 2):51S-209S.Flegal, et al. Int J Obes. 1998;22:39-47.www.cdc.gov/nchs/data/hestat/obesity_adult_07_08/obesity_adult_07_08.htm
45.8%
73.9%
31.5% 33.6%
13.4%
34.3%
0.9%
6.0%
Obese(BMI = >
30)
Extremely Obese (BMI = 40)
31.5% 33.6%
Number and Percentage of U.S. Population with Diagnosed Diabetes, 1958-2009
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available athttp://www.cdc.gov/diabetes/statistics
Sturm R. Pub Hlth. 2007 Jul;121:492-496.
The Biggest Increases are in Clinically Severe Obesity, US 1987-2005
BMI >30 Increased 24%
BMI >50Increased 75%In 5 years
BMI >40 Increased 52%
7
1972 – 2011 Football Linemen Are 68 Lbs Heavier
XLV2011316.3
Chad CliftonT, 6-5, 320
Chad CliftonT, 6-5, 320
What’s Causing the Epidemic of Obesity? Contributors to the Obesity Epidemic
The usual suspects• Too much fattening food• Not enough physical activity
Some new ideas• Sleep debt• Endocrine disruptors• Pharmaceutical Iatrogenesis• Reduction in variability of ambient temperature• Microorganisms• Epigenetics-heritable changes in gene expression like DNA
methylation, chromatin folding• Increasing maternal age• Greater fecundity among people with higher adiposity• Assortive mating• Intrauterine and intergenerational effects
Crit Rev Food SciNutr. 2009 November ; 49(10): 868–913
Crit Rev Food SciNutr. 2009 November ; 49(10): 868–91
Every One Trends UP !
Endocrine Disruptor in Breast Milk Obesity Prevalence
Pt Visits with Antipsychotics Mother’s Age at 1st Birth
Excess Adipose Tissue Attracts and Activates Macrophages, Leading to Chronic Inflammation and Adipocyte Insulin Resistance
Xu H, et al. J. Clin. Invest. 2003;112(12):1821-1830
• When adiposity reaches a certain threshold, factors derived from adipocytes induce macrophage activation and infiltration.
• Activated macrophages secrete cytokines that impair adipocyte insulin sensitivity and stimulate further activation and infiltration of peripheral monocytes and macrophages into fat.
• Preadipocytes can also secrete chemokines under the stimulation of TNF-, which contributes to macrophage infiltration and eventually causes systemic insulin resistance.
More than 70 illnesses are caused by excess body weight
Source: Center for Disease Control, NHANES III
Obese Patients are at substantial risk to develop Type II DiabetesWhich increases with BMI
Relationship between obesity and risk of developing Type II Diabetes
%
8
48
The Growing Burden of Obesity: Over the Next 20 Years In the US and UK, the
Increase in Obesity Will Add
• 6–8 million cases of diabetes• 5–7 million cases of cardiovascular diseases, • More than half a million new cancers • Negative effects on longevity, disability-free life-
years, quality-of-life, and productivity • By 2030, these increases in health-care costs by
$48–66 billion a year in the USA and by 1-2 billion a year in the UK.
Yang, YC et al Lancet 2011; 378: 815–25
The Cost of Obesity • 27% of the growth in health-care
expenditure between 1987 and 2001 is attributable to the increase in obesity and increased spending on obesity-related diseases.
• A loss of 1.7–3 million productive person- years in working US adults, representing an economic cost as high as $390–580 billion over the next 20 years.
Thorpe KL et al. Health Aff (Millwood) 2004; W4 (suppl): 480–
86.Wang Y et al Obesit (Sil er Spring) 2008 16 2323 30
Do the 4 M’s of Obesity’s Comorbidities Improve with
Weight Loss?
•
Metabolic
•
Mechanical
•
Mental
•
Monetary
The 4 M’s: Dr. Arya Sharma
There are other comorbidities besides metabolic
Do the 4 M’s of Obesity’s Comorbidities Improve with
Weight Loss?
•
Metabolic ‐
Yes
•
Mechanical ‐
Yes
•
Mental –
Usually, depends
•
Monetary – Possibly, depends
The 4 M’s: Dr. Arya Sharma
There are other comorbidities besides metabolic
What-if scenarios Yang CY et al , Lancet, Aug 2011