1. SUPERSIZED NATION By Jennifer Ericksen August 24, 2007

2. Obesity & Overweight as an Independent Risk Factor Outline Obesity trends/statistics Body mass index (BMI) Associated risks/disease CHA detection project findings A little can do a lot…examples Future strategies Questions/comments

5. 1998 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2006 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2006 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

6. U.S. Economic Consequences Totals: $51.5 $78.5 $26.8 $47.5

7. What does it mean to be overweight or obese? Above healthy weight range Determined by body mass index (BMI) Result of energy imbalance Increased risk of various health problems

8. Body Mass Index (BMI) Calculated using weight and height Weight (kg) / [height (m)]2 or Weight (lb) / [height (in)]2 x 703 Indicator of body fatness Inexpensive and easy-to-perform Used for screening, not diagnosing Age and sex specific for children

9. BMI Interpretation BMIWeight Status Below 18.5Underweight 18.5 – 24.9Normal 25.0 – 29.9Overweight 30.0 and AboveObese

10. So What’s the BIG Deal? Hypertension Osteoarthritis Dyslipidemia Type II diabetes Coronary heart disease Stroke Gallbladder disease Sleep apnea & respiratory problems Certain cancers Endometrial Breast Colon Increased risk of developing:

11. Coronary Heart Disease Uncontrollable risks: Age, gender, genetics Modifiable risks: Smoking, high cholesterol & blood pressure, physical inactivity, obesity & overweight, diabetes mellitus, stress “The Metabolic Syndrome”

12. The Metabolic Syndrome Over 50 million Americans Characterized by: Elevated waist circumference Elevated triglycerides Reduced HDL Elevated blood pressure Elevated fasting glucose

13. There Still Exists a Controversy Does excess weight have additional impact on cardiovascular outcomes beyond its effects on other risk factors? Should patients control their weight if their blood pressure and cholesterol levels are not high?

14. Chicago Heart Association Detection Project (CHA) 17643 men & women Aged 31 to 64 years No CHD or diabetes at baseline Main outcomes (after age 65): Hospitalization/mortality from CHD, cardiovascular disease, or diabetes

15. CHA Study Objective To assess relationship of midlife BMI with morbidity & mortality in older age among individuals with and without other major risk factors at baseline

16. Copyright restrictions may apply. Yan, L. L. et al. JAMA 2006;295:190-198. Risk of Mortality and Hospitalization From Coronary Heart Disease in Older Age, by Midlife Risk and Body Mass Index Category

17. Copyright restrictions may apply. Yan, L. L. et al. JAMA 2006;295:190-198. Risk of Mortality and Hospitalization From Cardiovascular Disease in Older Age, by Midlife Risk and Body Mass Index Category

18. Copyright restrictions may apply. Yan, L. L. et al. JAMA 2006;295:190-198. Risk of Diabetes Listed on Death Certificates or Hospitalization Records in Older Age, by Midlife Risk and Body Mass Index Category

19. CHA Study Conclusion For individuals with no cardiovascular risk factors as well as for those with 1 or more risk factors, those who are obese in middle age have a higher risk of hospitalization and mortality from CHD, cardiovascular disease, and diabetes in older age than those who are normal weight

20. A Little Can Mean a Lot Examples of benefits from weight loss…

21. It’s Not Rocket Science… Obesity is preventable & controllable Only 43% of obese persons are actually advised to lose weight during routine checkups As if we didn’t already know… Something needs to be done

22. Where Do We Go From Here? NIH Research Strategy to Fight Obesity Behavioral & environmental Lifestyle modifications Pharmacologic, surgical, other medical Decipher link between obesity & other diseases (DMII, CHD, cancer) Special populations Children, ethnicity, sex, age Disseminating research results to public & health professionals

23. The Ericksen Solution: No Food Until You Earn It

24. “ Progress is made by lazy men looking for easier ways to do things”

25. References Centers for Disease Control (CDC) website National Institute of Health (NIH) website: Yan, et al. Midliefe Body Mass Index and Hospitalization and Mortality in Older Age. JAMA. 2006; 295: 190-198