Weight Problems

Overweight Adults UK %
70 60 50 40 30 20 10 0 1980
Erens & Primatesta 1999

Male Female

1997

Obese Adults UK %
20 18 16 14 12 10 8 6 4 2 0 1980
Erens & Primatesta 1999

Male Female

1997

Rise in Childhood Obesity - UK

25 20 15 10 5 0 1989 1998 Overweight Obese

Bundred et al, BMJ Feb 2001

WHO classification of obesity

BMI = weight(kg)/height(m)2
WHO Classification Underweight Healthy weight Overweight (grade 1 obesity) Obese (grade 2 obesity) BMI Below 18.5 18.5-24.9 25.0-29.9 30.0-39.0 Risk of Death Low Average Mild increase Moderate/severe Very severe

Morbid/severe obesity(grade 3) 40.0 and above

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

Three people have the following heights: 1.65m; 1.73 m; 1.85m

They each have a BMI of 30. Calculate their body masses.

1.65m = 81.7 kg 1.73m = 89.8 kg 1.83m = 100.5 kg

Body fat distribution Apple shaped obesity

Women

cm

Men
>102 cm (90cm) = Increased risk

>88 cm (80cm) = Increased risk

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

Waist Measurement or BMI?

Causes of Obesity

Energy Intake

Energy Expenditure

nutritional, activity levels, endocrine, genetic, drugs

The Costs of Obesity

4.6 billion pa, UK (2007) Direct Death, health service expend, drug prescription charges, hospital costs, Indirect Disability, unemployment, early retirement 18 million sick days, 40 000 lost years working life, obese die 9 years earlier Intangible Loss self esteem, relationships, pain

Physical Effects of Obesity

Stroke Respiratory disease

Cardiovascular

Gall bladder disease

Diabetes Osteoarthritis

Hormonal abnormalities

Cancer

gout

Benefits of 10% Weight Loss

Mortality Blood pressure Diabetes Lipids
>20% fall in total mortality >30% fall in diabetes related deaths >40% fall in obesity related deaths fall of 10mmHg systolic and diastolic pressure 50% fall in fasting glucose 10% dec. total cholesterol 15% dec. in LDL 30% dec. in triglycerides 8% inc. in HDL

Jung 1997

Obesity in practice

GP average has 2000 patients 800 overweight adults BMI > 25 320 obese adults BMI > 30 16 morbidly obese adults BMI > 40 30% increase appointments and prescriptions in last 10 years 95% will see GP in 5 years 130 will die of the disease each year

Men and their trousers

50% of men wear their trousers too tight only 10% admit to it 45% of men thought they were overweight 30% hated their stomach most of all
Prof Steven Gray, NTU, 1999

Men and weight loss

Men are reluctant to seek medical advice to lose weight, until after they have developed a medical problem Less than one fifth GP or hospital obesity clinic patients are male Women are the driving force behind mens health

Is this man too big for his trousers?

What about this man..?

Or this one..?

Fat bloke my arse

The perfect male..?

and the perfect female??

WHO April 2001

Obesity cannot be prevented or managed solely by governments (or health professionals). The food industry, the media, communities and individuals need to work together so that the environment is less conducive to weight gain

Copy this table, and make a list of practical things each group could do to tackle obesity:
Government Food Industry Media Individual

LDL and HDL formation

Identify stages 1-5

Atherosclerosis
Collagen fibre Platelet Plaque Red cells Cholesterol

Risk of CHD increases if:

Blood cholesterol Blood LDLs Blood HDL

> 5 mmol dm-3 > 3 mmol dm-3 < 1 mmol dm-3

Ratio of HDL:LDL should be 4:1 or better

Worked examples

What is meant by the prevalence of a disease? (1)

Prevalence means The number of people in a population with that disease.

Q. What is the prevalence of obesity in England in 2007 (2)

(answer from data in table or graph) In England in 2007, 17% of men and 21% of women were estimated as being obese (BMI > 30)

Q. What are the main risk factors for CHD? (4)

Diet rich in saturated fatty acids Lack of exercise (low PAL) BMI > 30 ( obese) Heredity Hypertension ( high BP)

Q. How does a high salt diet lead to hypertension? (4)

Salt in the blood lowers water potential Water is drawn into blood from tissues by osmosis Blood volume increases Heart needs to work harder to pressurise this volume of blood

What happens when Energy Intake is lower than expenditure?

Anorexic or fashion victim?

True Starvation a disease called MARASMUS.

What symptoms can you see? Very thin (skeletal) Papery skin Weak and Miserable

Still world-wide malnutritionWHY?

Kwashiorkor

Give three recognisable signs of kwashiorkor.

Prep A4 essay for next week:

Explain the term malnutrition You must include the 4 PEM diseases: Anorexia, Obesity, Marasmus, Kwashiorkor