1. Why Obesity is a Chronic Disease
Dr. Sean Wharton, MD, FRCPC, PharmD
Wharton Medical Clinic
Adjunct Professor – McMaster University
Diplomate American Board of Obesity Medicine

2. Global Obesity Map 2014
The Lancet, 2016

3. Prevalence and current landscapeX2
6 million
Worldwide obesity has more
than DOUBLED since 19801
Canadians are living with obesity3,4
>50%
of the world’s adult population was living with overweight/obesity in 20142
Note to facilitator:
This slide is animated. Upon first click, the Canadian obesity prevalence rates appear. Upon second click, the adult and children obesity prevalence rates appear.
Obesity has reached epidemic proportions globally, with at least 2.8 million people dying each year as a result of being overweight or obese.1 Worldwide obesity rates have more than doubled since 1980 and in 2014, more than 1.9 billion adults (18 years of age and older, were overweight. Of these, over 600 million were obese. 39% of adults aged 18 years and over were overweight in 2014, and 13% were obese. Most of the world's population live in countries where overweight and obesity kills more people than underweight. 42 million children under the age of 5 were overweight or obese in
In Canada, over 1 in 4 Canadian adults (estimates range from 24.3%-25.4%) are obese, according to measured height and weight data from Of children and youth aged 6 to 17, 8.6% are obese. Generally actual measurements of height and weight result in higher estimates of obesity than data obtained from self-reports.3
References:
WHO facts on obesity. Available at: 10 facts on obesity.
WHO Obesity and overweight fact sheet. Available at:
Public Health Agency of Canada Obesity in Canada. A joint report from the Public Health Agency of Canada and the Canadian Institute for Health Information. Available at:
1 in 4
Canadian adults
2.8 million
people die/year from overweight or obesity2
1 in 10
Canadian children
1. WHO Obesity and overweight fact sheet. Available at: 2. WHO facts on obesity. Available at: 10 facts on obesity. 3. Canadian Obesity Network Obesity in Canada. Available at: CON. 4. Public Health Agency of Canada Obesity in Canada. A joint report from the Public Health Agency of Canada and the Canadian Institute for Health Information. Available at:

4. Twells, LK., CMAJ Open, 2014;2(1), E18-E26.

5. The Jamie Bogart Story Behavioral modification and December 2005
527lbs, BMI 72.1
“Feel more normal and not have
Children staring at me”
PMHX
Chronic renal failure
Sleep Apnea
Arthritis – Hip
Behavioral modification and
Meal Replacement – Jan 2006
Surgery – in the US

6. Jamie Bogart Meal Replacement 527lbs to 400lbs
Surgery - Waited & Waited & Waited
Cellulitis – Hospital - ICU
Died of Sepsis and Renal Failure – Age 42 (2006)
Approval for surgery – 3 days after his death

7. Obesity is a Chronic, Progressive, Relapsing Medical Disease (pathological condition)
2011 National Obesity Summit Workshop

8. Medical Complications of Increased Weight
Pulmonary disease
abnormal function
obstructive sleep apnea
hypoventilation syndrome
Stroke
Cataracts
Nonalcoholic fatty liver disease
steatosis
steatohepatitis
cirrhosis
Coronary heart disease
Diabetes
Dyslipidemia
Hypertension
Gall bladder disease
Severe pancreatitis
Gynecologic abnormalities
abnormal menses
infertility
polycystic ovarian syndrome
urinary incontinence
Cancer
breast, uterus, cervix
colon, esophagus, pancreas
kidney, prostate
Medical complication of obesity
Osteoarthritis
Phlebitis/DVT (Blood Clots)
venous stasis
Skin
fungal/bacterial infections
Gout

9. Weight Gain is Natural
Weight Loss is Unnatural

10. Hyperphagia contributes to elevated obesity rates: Humans are eating more, portion size effects80 70 60 50 40 30 10 20
Breakfast
Lunch
Dinner
Snacks
Day 1
Day 2
Day 3
Day 4
Study day and meals
Mean cumulative EI (MJ/d)
Men increase energy intake by 17%, women by 10% when presented with large portions versus standard portion
meals; no compensation observed for
increased intake over 4 days
CDC, Centre for Disease Control; EI, energy intake
Kelly MT et al. Br J Nutr 2009;102:470–477; CDC. The new (Ab)normal. available at:

11. BIOLOGY
DEFEND YOUR
SET POINT
(highest weight)

12. Scar Tissue (Gliosis) in the Hypothalamus – leading to chronic obesity
Thaler et al. Diabetes Vol 62, 2013

13. Short Term Weight Changes May Not Lead To Long Term Hypothalamic Changes

14. Defended Fat Mass Lifestyle Interventions Years of Exposure
Weight stabilizing
alternatives
Healthy
Diet
Physical
Activity
Stable eating patterns
More and
better sleep
Stress
reduction
Abnormal
dietary constituents
Disturbed
Circadian rhythm
Weight gaining medications
Unhealthy
muscle
Sleep
deprivation
Stress
Years of Exposure

15. Treatment time (months)
Differences in pattern of weight loss Weight loss trajectories of 7,121 patients over 7.5 years 50 40 30 20 10
-10
-20
-30
-40 15 45 60 75 90
Treatment time (months)
% WL
Weight gain (0.8%)
Weight stable (33.3%)
Minimal WL (36.9%)
WL regain (6.8%)
Large WL (2.3%)
Slow WL (15.9%)
Moderate WL (4.0%)
–21% WL
–2.3% WL
Patients who attended a physician-lead multi-disciplinary clinical lifestyle weight management that predominantly focused on education and diet counselling management. WL, weight loss
Kuk J, Wharton S. Obes Sci Pract 2016;2:215–23