1. Exercise and Body Composition The Health Cost of Obesity and Overweight

2. Health Risks of Not Maintaining a Healthy Weight u Overweight and obesity are associated with an increased risk for developing various medical conditions including: u cardiovascular disease, u certain cancers (endometrial, colon, postmenopausal breast, kidney, and esophageal) 5, u high blood pressure, u arthritis-related disabilities u and type 2 diabetes. 7 u U.S. Department of Health and Human Services

4. Consequences of Childhood and Adolescent Obesity u Growth u Psychosocial u Hyperlipidemia u Hepatic stenosis u Abnormal glucose metabolism u Persistence into adulthood u Growth u Psychosocial u Hyperlipidemia u Hepatic stenosis u Abnormal glucose metabolism u Persistence into adulthood u Hypertension u Sleep apnea u Pseudotumor u PCOD u Cholelithiasis u Orthopedic u Hypertension u Sleep apnea u Pseudotumor u PCOD u Cholelithiasis u Orthopedic CommonCommonUncommonUncommon

5. Consequences of Adult Obesity u Psychosocial u Cardiovascular u Hyperlipidemia u Diabetes mellitus u Hypertension u Respiratory u Cardiac u Psychosocial u Cardiovascular u Hyperlipidemia u Diabetes mellitus u Hypertension u Respiratory u Cardiac u Medical u Polycystic ovary disease u Gall bladder disease u Osteoarthritis u Cancer u Pregnancy and postpartum complications u Mortality u Medical u Polycystic ovary disease u Gall bladder disease u Osteoarthritis u Cancer u Pregnancy and postpartum complications u Mortality

6. Medical Conditions u 88 to 97% of all cases of Type II (non- insulin dependent) diabetes, u 57 to 70% of coronary heart disease cases, u 11% of breast cancers, u and 10% of colon cancers that are diagnosed are related to obesity.

7. Medical Conditions u 1/3 of all cases of hypertension and 70% of gallstone cases are related to being obese. u Unhealthy weight is also associated with osteoarthritis and gout, along with a number of other disabling conditions. u (SUA, 1997)

8. Exercise and Body Composition u Other less understood risks of obesity include: u difficulties in surgical anesthesia and delivery u gallbladder disease, u infertility, u osteoarthritis, u etc...

9. Physical Activity and a Nutritious Diet are Key to Maintaining Energy Balance and a Healthy Weight u Regular physical activity along with a nutritious diet is key to maintaining a healthy weight. u In order to maintain a healthy weight, there must be a balance between calories consumed and calories expended through metabolic and physical activity. u U.S. Department of Health and Human Services

10. Physical Activity and a Nutritious Diet are Key to Maintaining Energy Balance and a Healthy Weight u Although overweight and obesity are caused by many factors, in most individuals, weight gain results from a combination of excess calorie consumption and inadequate physical activity. u U.S. Department of Health and Human Services

11. Maintaining Energy Balance and a Healthy Weight  Even though a large portion of a person ’ s total caloric requirement is used for basal metabolism and processing food, an individual ’ s various physical activities may account for as much as 15 to 40 percent of the calories he or she burns each day. u While vigorous exercise uses calories at a higher rate, any physical activity will burn calories. u U.S. Department of Health and Human Services

12. Maintaining Energy Balance and a Healthy Weight u For example, a 140-pound person can burn 175 calories in 30 minutes of moderate bicycling, and 322 calories in 30 minutes of moderate jogging. u The same person can also burn 105 calories by vacuuming or raking leaves for the same amount of time. u U.S. Department of Health and Human Services

13. Health Risks of Not Maintaining a Healthy Weight u Epidemiological studies show an increase in mortality associated with overweight and obesity. u Approximately 300,000 deaths (predicted to be 360,000 in 2004) a year in this country are currently associated with overweight/obesity and related comorbidities. 29 u U.S. Department of Health and Human Services

14. Health Risks of Not Maintaining a Healthy Weight u It is also important for individuals who are currently at a healthy weight to strive to maintain it since both modest and large weight gains are associated with significantly increased risk of disease. u U.S. Department of Health and Human Services

15. Health Risks of Not Maintaining a Healthy Weight u For example, a weight gain of 11 to 18 pounds increases a person’s risk for developing type 2 diabetes to twice that of individuals who have not gained weight, while those who gain 44 pounds or more have four times the risk of type 2 diabetes. 30 u U.S. Department of Health and Human Services

16. Health Risks of Not Maintaining a Healthy Weight u Recent research studies have shown that a gain of 10 to 20 pounds resulted in an increased risk of coronary heart disease (which can result in nonfatal heart attacks and death) of 1.25 times in women 31 and 1.6 times in men. 32

17. Health Risks of Not Maintaining a Healthy Weight u In these studies, weight increases of 22 pounds in men and 44 pounds in women resulted in a increased coronary heart disease risk of 1.75 and 2.65, respectively. u U.S. Department of Health and Human Services

18. Health Risks of Not Maintaining a Healthy Weight u In one study among women with a BMI of 34 or greater, the risk of developing endometrial cancer was increased by more than 6 times. 33 u Overweight and obesity are also known to exacerbate many chronic conditions such as hypertension and elevated cholesterol. u U.S. Department of Health and Human Services

19. Health Risks of Not Maintaining a Healthy Weight u Overweight and obese individuals also may suffer from social stigmatization, discrimination, and poor body image. u U.S. Department of Health and Human Services

20. Health Risks of Not Maintaining a Healthy Weight u Although obesity-associated morbidities occur most frequently in adults, important consequences of excess weight as well as antecedents of adult disease occur in overweight children and adolescents. u Overweight children and adolescents are more likely to become overweight or obese adults. u U.S. Department of Health and Human Services

21. Health Risks of Not Maintaining a Healthy Weight u As the prevalence of overweight and obesity increases in children and adolescents, type 2 diabetes, high blood lipids, and hypertension as well as early maturation and orthopedic problems are occurring with increased frequency. u A common consequence of childhood overweight is psychosocial specifically discrimination. 34 u U.S. Department of Health and Human Services

22. Metabolic Syndrome Syndrome X

23. Metabolic Syndrome u Visceral adiposity u Elevated blood pressure u Insulin resistance u Low HDL/High Triglycerides u Systemic pro-inflammatory state

24. Metabolic Syndrome Identified by Three of the Following (NCEP): u Waist girth u > 102 cm (40 in) for men u > 88 cm (35 in) for women u Fasting glucose u > 110 mg/dl u Triglycerides u > 150 mg/dl

25. Metabolic Syndrome u Blood pressure u > 130/85 u Use of bp medications u HDL u < 40 mg/dl for men u < 50 mg/dl for women

26. Metabolic Syndrome u >87% of patients who experienced a fatal coronary event had exposure to > 1 risk factor.

27. Metabolic Syndrome u Received ICD-9 code (277.7) in 2001 u What physicians use to bill insurance company

28. Metabolic Syndrome u May be identified by elevated waist circumference and elevated triglycerides alone u Depprees

29. Metabolic Syndrome u From NHANES III (1988-1994) data, prevalence is 24% of population. u 86 million Americans will have by 2025

30. Metabolic Syndrome u 2600 American each day die from cardiovascular disease u That’s an equivalent death rate as a 9/11 everyday

31. Metabolic Syndrome u Perhaps it should be called physical inactivity syndrome u When PA or PF is considered, metabolic syndrome is not a great predictor of all- cause or CHD caused mortality. u Lakka, et al., MSSE 2002, 35:1279-1286

32. Improvement u Among the morbidly obese (150-200% overweight), moderate weight loss can mean a 20-75% reduction in risk factors for several chronic diseases.

33. Improvement u Significantly overweight patients who lost 10-20% of their body weight - and kept it off during a three-year follow-up period - reduced their risk factors for hypertension (by 70-75%, on average), Type II diabetes mellitus (40-60%), and cardiovascular disease (25-50%).

34. Radical Treatment u Gastric bypass is a major surgery that shrinks the stomach's capacity from win bottle to shot glass size and reconfigures the small intestine.

35. Gastric Bypass u Most patients lose about 2/3rds of their excess weight in a year after surgery. u Some patients can subvert the surgery by snacking continuously.

36. Gastric Bypass u The list of complications includes blood clots in the lung, pneumonia, infection, leakage from the reshaped intestinal tract, and - in one out of a hundred cases - death.

37. Gastric Bypass u Over 100,000 gastric bypass surgeries were conducted in the US in 2003.

38. Key Question u Is the problem obesity/overweight, or is it the sedentary lifestyle and poor nutrition associated with OB/OW that is the problem.

39. Answer u Mounting evidence indicates that the problem is the sedentary lifestyle and poor nutrition that causes the problem.

40. Recent Research u Demonstrates that being slightly overweight might be healthier than being slightly underweight.

41. Recent Research u Those who are overweight (and even obese) and yet have higher cardiovascular fitness (VO2) than leaner cohorts have lower risk for morbidity and mortality.

42. Key to Solving the Problem u Focus on the process of living rather than the product (symptoms) of death. u Increase physical activity and eat in a nutritionally sound way, and weight problems, disease, and death will be reduced