Obesity – a man’s problem

Dr Ian W Campbell General Practitioner and Assoc. Specialist, UHN

National Obesity Forum

Prevalence of Obesity

Workplaces and Inactivity

Past 50 years - shift from manual to sedentary employment

Obesity Trends* Among U.S. AdultsBRFSS, 1990

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

No Data <10% 10%-14% 15-19% 20%

Source: Mokdad AH.

Obesity Trends* Among U.S. AdultsBRFSS, 1991

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

No Data <10% 10%-14% 15-19% 20%

Source: Mokdad AH.

Obesity Trends* Among U.S. AdultsBRFSS, 1991

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

No Data <10% 10%-14% 15-19% 20%

Source: Mokdad AH.

Obesity Trends* Among U.S. AdultsBRFSS, 1992

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

No Data <10% 10%-14% 15-19% 20%

Source: Mokdad AH.

Obesity Trends* Among U.S. AdultsBRFSS, 1993

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

No Data <10% 10%-14% 15-19% 20%

Source: Mokdad AH.

Obesity Trends* Among U.S. AdultsBRFSS, 1994

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

No Data <10% 10%-14% 15-19% 20%

Source: Mokdad AH.

Obesity Trends* Among U.S. AdultsBRFSS, 1995

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

No Data <10% 10%-14% 15-19% 20%

Source: Mokdad AH.

Obesity Trends* Among U.S. AdultsBRFSS, 1996

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

No Data <10% 10%-14% 15-19% 20%

Source: Mokdad AH.

Obesity Trends* Among U.S. AdultsBRFSS, 1997

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

No Data <10% 10%-14% 15-19% 20%

Source: Mokdad AH.

Obesity Trends* Among U.S. AdultsBRFSS, 1998

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

No Data <10% 10%-14% 15-19% 20%

Source: Mokdad AH.

Obesity Trends* Among U.S. AdultsBRFSS, 1999

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 2000;284:13

No Data <10% 10%-14% 15-19% 20%

Obesity Trends* Among U.S. AdultsBRFSS, 2000

(*BMI 30, or ~ 30 lbs overweight for 5’4” woman)

Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10

No Data <10% 10%-14% 15-19% 20%

Obese Adults – UK %

0

5

10

15

20

25

1980 1997 2004

MaleFemale

Adapted from Erens & Primatesta 1999

Increasing prevalence of overweight and obesity in English children

0

5

10

15

20

1974 1984 1994

Boys overweight Boys obese

Girls overweight Girls obesePrevalence (%)

Adapted from Chinn & Rona. BMJ 2001; 322: 24-26

Rise in Childhood Obesity - UK

0

5

10

15

20

25

1989 1998

OverweightObese

Bundred et al, BMJ Feb 2001

Prevalence of overweight and obesity in UK children and adolescents

0

5

10

15

20

25

30

35

6 7 8 9 10 11 12 13 14 15

Overweight (BMI>85th centile)

Obese (BMI>95th centile)

Adapted from Reilly & Dorosty . Lancet 1999; 354: 1874-1875

Prevalence (%)

Age (years)

WHO classification of obesityBMI = weight(kg)/height(m)2

WHO ClassificationWHO Classification BMIBMI Risk of ComorbidityRisk of Comorbidity

UnderweightUnderweight Below 18.5Below 18.5 LowLow

Healthy weightHealthy weight 18.5-24.918.5-24.9 AverageAverage

Overweight (grade 1 obesity)Overweight (grade 1 obesity) 25.0-29.925.0-29.9 Mild increaseMild increase

Obese (grade 2 obesity)Obese (grade 2 obesity) 30.0-39.030.0-39.0 Moderate/severeModerate/severe

Morbid/severe obesity(grade 3)Morbid/severe obesity(grade 3) 40.0 and above40.0 and above Very severeVery severe

World Health Organisation. Obesity: Preventing and Managing the Global Epidemic. Geneva: WHO, 1997 [3]

Fat or Fit?

Jonah LomuJonah Lomu Height 196cmHeight 196cm Weight 118kgWeight 118kg BMI 31BMI 31 Waist?Waist? Body fat mass?Body fat mass?

Women

>88 cm (80cm) = Increased risk

Men

>102 cm (90cm) = Increased risk

Lean MEJ et al. Lancet; 1998; 351:853-6

Body fat distributionApple shaped obesity

cm

Cause of Obesity

Genes Obesity

Environment

Obesity trends, diet and physical activity over 40 years

Prentice and Jebb, 1995, BMJ - UK data.Prentice and Jebb, 1995, BMJ - UK data.

19501950 19601960 19701970 19801980 19901990

Data normalised as % ofData normalised as % ofmean for whole periodmean for whole period

00

100100

200200

19501950 19601960 19701970 19801980 19901990

Data normalised as % ofData normalised as % ofmean for whole periodmean for whole period

00

100100

200200% obese% obese % obese% obese

FatFatintakeintake

EnergyEnergyintakeintake

Cars perCars perhouseholdhousehold

TV hrTV hrper wkper wk

Effects of Obesity

Daniel Lambert

1770-18091770-1809 52 st, 11 lb (336kg)52 st, 11 lb (336kg) ““his corpulencehis corpulence never never

caused him any pain. caused him any pain. He never snored, He never snored, rarely retired before 1 rarely retired before 1 a.m., never slept more a.m., never slept more than 8 hours and was than 8 hours and was very partial to the very partial to the female sexfemale sex””

The metabolic syndrome Waist circumferenceWaist circumference

M 102cm, F 88cmM 102cm, F 88cm

TriglyceridesTriglycerides >> 1.69 mmol 1.69 mmol

HDLHDL M < 1.0 mmolM < 1.0 mmol F < 1.3 mmol F < 1.3 mmol

Blood pressureBlood pressure >> 130/85 mmHg 130/85 mmHg

Fasting glucoseFasting glucose >> 6.1 mmol 6.1 mmol

ATP III: The metabolic syndrome, JAMA 2001;285:2486-2497

Physical Effects of Obesity

CardiovascularRespiratory disease

Gall bladder disease

Hormonal abnormalities

Hyperuricaemia and gout

Stroke

Diabetes

Osteoarthritis

Cancer

Relative risk of non-fatal MI and fatal CHD (Combined) vs BMI, in women with no previous CHD

<21 21-22.9 23-24.9 25-28.9 >290

1

2

3

4

RelativeRisk

MI = myocardial infarction; CHD = coronary heart disease.

Adapted from Willett et al. JAMA. 1995;273:461-465 (Nurses Health Study).

BMI

Obesity and cardiovascular disease

n = 115,818

1.00 1.19

1.46

2.06

3.56

32

Obesity is a Risk Factor for Type 2 Diabetes in Men

Adapted from Chan JM et al. Diabetes Care 1994; 17: 961-9

Multivariate adjustedrelative risk of type 2 diabetes

0

10

20

30

40

50

<23 23-23.9

24-24.9

25-26.9

27-28.9

29-30.9

31-32.9

33-34.9

35

1.0 1.0 1.52.2

4.46.7

11.6

21.3

42.1

Body mass index (kg/m2)

The Costs of Obesity

DirectDirect UK £500 millionUK £500 million co-morbidities, GP and nurse co-morbidities, GP and nurse

time, prescriptions, hospitalstime, prescriptions, hospitals IndirectIndirect

UK £ 2.1 billionUK £ 2.1 billion disability, unemployment, early disability, unemployment, early

retirementretirement 18 m sick days, 40 000 lost years 18 m sick days, 40 000 lost years

working life, 30 000 deaths, die working life, 30 000 deaths, die 9 years early9 years early

Intangible Intangible

• Genetic, hormonal environmental, socio-economic, cultural behavioural

• Blaming patient is inappropriate and does not produce positive outcomes

Medical management of obesity

• Lifestyle modifications• Nutrition/diet• Physical activity• Behaviour modification

• Pharmacotherapy• Surgery

Treatment options3

Multiple causes2

• Serious health consequences

• Major risk factor for common causes of death

Legitimate, chronic disease1

1. 1. Clinical guidelines. National Heart, Lung, and Blood Institute Web site. Available at:http://www. nhlbi.nih.gov/guidelines/obesity/ob_home.htm. Accessed March, 2001.2. Weighing the Options; 1995:52. 3. Beales et al. PharmacoEconomics. 1994;5(suppl 1):18-32.

Working with commercial weight loss groups:

Weight Watchers meetings compared with self-help/brief counselling programme

Heshka et al 2003, JAMA, 289:14:1792-8

Mean weight loss Weight Watchers (n=150)

Self help (n=159)

@ 1 year 5kg 0.6kg

@ 2 years 3kg 0.1kg

Men and their trousers

50% of men wear their trousers 50% of men wear their trousers too tighttoo tight only 10% admit to it only 10% admit to it

40% identified their own image40% identified their own image 20% women identified their 20% women identified their

man’s imageman’s image 45% of men thought they were 45% of men thought they were

overweightoverweight 30% hated their stomach most 30% hated their stomach most

of allof all

Prof Steven Gray, NTU, 1999Prof Steven Gray, NTU, 1999

No nonsense approach to waist loss – for men

A personal web-bases waist loss programme

Enables men to make healthy choices

Teaches techniques to change habits of a lifetime

Sustainable, realistic and gradual modification

Enjoyable

www.fatmanslim.com

CHD risk increases when waist size is greater than 90cm/35”.

Consider losing waist if the belly exceeds 35”. At the very least not to increase over this amount.

Encourage waist loss if greater than 102cm/40”.

Healthy Less than 90 cm or 35 inches

Increased Health Risk

90 to 102 cm or 35 - 40 inches

Greater Health Risk

More than 102cm or 40 inches

www.fatmanslim.com Importance of waist size

Waist size & health risk

Weight loss of 5-10 kg (5-10cm or 2-4inches from around your waist) brings improvements to blood pressure, cholesterol levels, glucose tolerance and a reduced incidence of type 2 diabetes.

Sustained intentional weight loss of 5-10 kg (5-10 cm waist reduction)

Chance of dying from heart problems by 9%

Risk of dying from any disease by 20%

Risk of dying from cancer by 37%

>40% fall in obesity related deaths

Deaths due to diabetes by 44%

10mmHg systolic and diastolic BP

50% fall in fasting glucose

Lipids 10% dec. total cholesterol15% dec. in LDL30% dec. in triglycerides8% inc. in HDL

www.fatmanslim.com

The benefits of waist loss

www.fatmanslim.com

Small movements add up

TV remote control – can result in:

20 less short walks per day

20 x 20m = 400m

400m x 365 days=146 km

5 km/hr = 25 hrs

220 kcal/hour x25hrs = 6000 kcal

= 1 kg of fat in one year

www.fatmanslim.com

Small measures add up

The humble digestive biscuit

Over one year:

1 biscuit = 80 kcal365 days = 29200 kcal

= 4kg fat gain

fatmanslim.com

Foretelling the future……..

If you want a job done well…………

Do it yourself…………..