1. http://www.cdc.gov Sex Differences in Overweight & Obesity

2. http://www.cdc.gov Age Differences in Overweight & Obesity

3. http://www.cdc.gov Race Differences in Overweight & Obesity

4. Leptin TNF-α IL-6 MCP-1 PAI-1 Adipisn Adiponectin Resistin Angiotensin ENDOCRINE ADIPOCYTE

5. Insulin Glucagon Growth Hormone Thyroid Stimulating Hormone IL-6 Leptin Angiotensin II Glucagon Like Peptide-1 Gastrin RECEPTORS FOUND ON ADIPOCYTE TNF-α Β 1,β 2,β 3, α 1, α 2 Glucocorticoid Thyroid Hormone Androgen Estrogen Vit D

6. Leptin Insulin Insulin Glucocorticoids Glucocorticoids TNFα TNFα Estrogens Estrogens CCAAT/enhancer-binding protein α CCAAT/enhancer-binding protein α β3 β3 Androgens Androgens FFA FFA Growth Hormone Growth Hormone Peroxisome proliferator- activity receptor γ agonists Peroxisome proliferator- activity receptor γ agonists ↑ Satiety ↑ Energy Expenditure ↑glucose uptake ↑ glucose metabolism ↑ Insulin ↑ Glucose Production Hypothalamic-pituitary –adrenal axis Hypothalamic -pituitary-thyroid axis Hypothalamic-pituitary -gonadal axis

7. MPC-1 ↑ TNFα ↑ IL-6 ↑Insulin Resistance Inhibits Adipocyte growth Macrophage & Monocyte Chemoattractant Protein -1

8. TNFα ↑Insulin Resistance ↑ FFA Production ↑ Cholesterol Synthesis ↑ Insulin Resistance ↓ Glucose Uptake ↓ FFA Storage ↑Insulin Resistance ↑Macrophage Infiltration

9. IL-6 ↑ Insulin Resistance ↑ Hyperlipidemia ↑Insulin Resistance ↑ Glucose Production ↑Insulin Resistance IL-6 deficiency in CNS alerting energy homeostasis ↓ energy expenditure ↑Macrophage Infiltration

10. PAI-1 TNFα TNFα

11. Adiponectin Insulin Sensitivity Insulin Sensitivity Insulin Resistance Insulin Resistance ↓Triglyceride Production ↑ FFA Oxidation ↑ NO production ↑anti-inflammatory activities ↑ anti-adhesion activities ↓Glucose Production ↓ FFA Synthesis

12. Adipisn ↑ Insulin Secretion ↑ FFA Uptake ↑ Triglyceride Synthesis ↓ Lipolysis ↑ Glucose Transport ↑ Triglyceride Synthesis ↓ Lipolysis ↓ FFA release ↑Acylation Stimulating Protein (ASP)

13. Resistin ↑insulin resistance ↑ Insulin Resistance

14. Renin Angiotensin System (RAS) ↑ Fluid Reabsorption ↑Adipogenesis ACE Inhibitor Vasoconstriction ↓ lipolysis ↑ lipogenesis ↑ Insulin Resistance ↑ gluconeogenesis ↑ glycogenolysis

15. Steroidogenic Enzymes Sex SteroidsGlucocorticoids Androgens → Estrogens Androstenedione → Testosterone Estrone → Estrodiol Insulin Sensitivity Visceral Adipose Deposition

17. Subcuteanous Fat Deposit Visceral Fat Deposit

18. BODY MASS INDEX (BMI) MEN >27.8 kg/m 2 WOMEN >27.3 kg/m 2

19. Waist to Hip Ratio Upper Body Obesity Lower Body Obesity Men >0.85 Women >0.84 Men >0.85 Women >0.84 Men <0.80 Women <0.76 Men <0.80 Women <0.76

20. Increased Risk, Relative to Normal Weight and waist circumference Obesity BMI Men 102 cm Class Women 88 cm Underweight<18.5 Normal18.5-29.9 Overweight35.0-29.9IncreasedHigh Obesity I30-34.5HighVery High Obesity II35.0-39.3Very HighVery High Extreme Obesity>40.0Extremely HighExtremely High

21. PERCENT BODY FAT FOR HEATLH CategoryMenWomen Minimal<5%8% Below Ave6-15%15-23% Above Ave16-25%24-32% At Risk>25%>32% CategoryMenWomen Minimal<5%8% Below Ave6-15%15-23% Above Ave16-25%24-32% At Risk>25%>32% Lohman, Advances in Body Composition Assessment, Human Kinetics, 1992.

22. Wallace, J et al Am J of Human Biology 6:699-709, 1994. * * *

23. Obesity Trends* Among U.S. Adults BRFSS, 1985 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

24. Obesity Trends* Among U.S. Adults BRFSS, 1986 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

25. Obesity Trends* Among U.S. Adults BRFSS, 1987 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

26. Obesity Trends* Among U.S. Adults BRFSS, 1988 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

27. Obesity Trends* Among U.S. Adults BRFSS, 1989 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

28. Obesity Trends* Among U.S. Adults BRFSS, 1990 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

29. Obesity Trends* Among U.S. Adults BRFSS, 1991 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

30. Obesity Trends* Among U.S. Adults BRFSS, 1992 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

31. Obesity Trends* Among U.S. Adults BRFSS, 1993 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

32. Obesity Trends* Among U.S. Adults BRFSS, 1994 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

33. Obesity Trends* Among U.S. Adults BRFSS, 1995 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

34. Obesity Trends* Among U.S. Adults BRFSS, 1996 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

35. Obesity Trends* Among U.S. Adults BRFSS, 1997 No Data <10% 10%–14% 15%–19% ≥20 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

36. Obesity Trends* Among U.S. Adults BRFSS, 1998 No Data <10% 10%–14% 15%–19% ≥20 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

37. Obesity Trends* Among U.S. Adults BRFSS, 1999 No Data <10% 10%–14% 15%–19% ≥20 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

38. Obesity Trends* Among U.S. Adults BRFSS, 2000 No Data <10% 10%–14% 15%–19% ≥20 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

39. Obesity Trends* Among U.S. Adults BRFSS, 2001 No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

40. Source: Behavioral Risk Factor Surveillance System, CDC (*BMI  30, or ~ 30 lbs overweight for 5’4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman) Obesity Trends* Among U.S. Adults BRFSS, 2002

41. Obesity* Trends Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

42. Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

43. Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

44. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

45. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

46. Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

47. 1996 Obesity Trends* Among U.S. Adults BRFSS, 1985, 1996, 2006 (*BMI 30, or about 30 lbs overweight for 5’4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% 198 5 200 6

48. Salans, L.B., et al. Journal of Clinical Investigation 50:1005-1011, 1971. OVEREATING STUDIES (individual subjects)

49. Salans, L.B., et al. Journal of Clinical Investigation 50:1005-1011, 1971. OVEREATING STUDIES (individual subjects)

50. OVEREATING STUDIES (individual subjects) Salans, L.B., et al. Journal of Clinical Investigation 50:1005-1011, 1971.

51. OVEREATING STUDIES (individual subjects) Salans, L.B., et al. Journal of Clinical Investigation 50:1005-1011, 1971.

52. OVEREATING STUDIES (individual subjects) Salans, L.B., et al. Journal of Clinical Investigation 50:1005-1011, 1971.

53. OVEREATING STUDIES (individual subjects) Salans, L.B., et al. Journal of Clinical Investigation 50:1005-1011, 1971.

54. TNF α IL-6 Angiotensin Vasoconstriction ↓ NO Adiponectin ↓ Fibrinolysis PAI-1 Insulin Resistance Insulin Resistance Resistin Inflammation Insulin Resistance