יתר השמנת

ע" חמד

26.1.06

פרופ' ארדון רובינשטין

BMI-Associated Disease RiskClassification

BMI (kg/m2)

Risk

Underweight<18.5Increased

Normal18.5-24.9Normal

Overweight25.0-29.9Increased

ObeseI30.0-34.9High

II35.0-39.9Very High

III>40Extremely highAdditional risks:• Large waist circumference (men>40 in; women >35 in)• 5 kg or more weight gain since age 18-20 y• Poor aerobic fitness• Specific races and ethnic groups

0

10

20

30

40

50

60

70

Bod

y F

at

(%)

Body Mass Index (kg/m2)

Women

Men

Relationship Between BMI and Percent Body Fat in Men and

Women

Pulmonary diseasePulmonary diseaseabnormal functionabnormal functionobstructive sleep apneaobstructive sleep apneahypoventilation syndromehypoventilation syndrome

Nonalcoholic fatty liver Nonalcoholic fatty liver diseasediseasesteatosissteatosissteatohepatitissteatohepatitiscirrhosiscirrhosis

Coronary heart diseaseCoronary heart disease

DiabetesDiabetes

DyslipidemiaDyslipidemia

HypertensionHypertension

Gynecologic abnormalitiesGynecologic abnormalitiesabnormal mensesabnormal mensesinfertilityinfertilitypolycystic ovarian syndromepolycystic ovarian syndrome

OsteoarthritisOsteoarthritis

SkinSkin

Gall bladder diseaseGall bladder disease

CancerCancerbreast, uterus, cervixbreast, uterus, cervixcolon, esophagus, pancreascolon, esophagus, pancreaskidney, prostatekidney, prostate

PhlebitisPhlebitisvenous stasisvenous stasis

GoutGout

Medical Complications of Obesity

Idiopathic intracranial Idiopathic intracranial hypertensionhypertension

StrokeStroke

Severe pancreatitisSevere pancreatitis

CataractsCataracts

37.8

10.4

41.1

11.8

39.1

12.2

39.4

19.9

0

10

20

30

40

50

BMI 25-29.9 BMI >30

NHES (1960–62) NHANES I (1971–74)

NHANES II (1976–80) NHANES III (1988–94)

Age-Adjusted Prevalence ofOverweight and Obesity in

Men

Perc

en

t

_

Age-Adjusted Prevalence of Overweight and Obesity in

Women

23.6

15.1

23.6

16.1

24.3

16.3

24.7 24.9

0

10

20

30

40

50

BMI 25-29.9 BMI > 30

NHES (1960–62) NHANES I (1971–74)

NHANES II (1976–80) NHANES III (1988–94)

Per

cen

t

_

Obesity Trends* Among U.S. Adults: BRFSS, 1988

(*BMI > 30, or ~ 30 lbs overweight for 5’4” woman)

Obesity Trends* Among U.S. Adults: BRFSS, 1994

(*BMI > 30, or ~ 30 lbs overweight for 5’4” woman)

Obesity Trends Among* U.S. Adults: BRFSS, 2000

10.812.5

19.1 20.3 19.7

33.2

23.9

41.2

0

10

20

30

40

50

Men

Women

% Distribution of BMI >30 kg/m% Distribution of BMI >30 kg/m22 by Ageby Agein 695 Men & 1020 Women in Israel, 2000in 695 Men & 1020 Women in Israel, 2000

25-34 35-4425-34 35-44 45-54 55-65 years 45-54 55-65 years

0

5

10

15

20

25

30

Austral China Czech Fin Germ Isr Spain Swed UK USA Yugos

MenWomen

Obesity BMI>30 in Israel, 2000 : comparison Obesity BMI>30 in Israel, 2000 : comparison withwithcountries: WHO Monica 1987-92, Obes Res countries: WHO Monica 1987-92, Obes Res 19991999

%

%

Pre

vale

nce

Pre

vale

nce

Obesity (BMI>30) among females by ethnicity & Obesity (BMI>30) among females by ethnicity &

years of education (%)First National Health & years of education (%)First National Health &

Nutrition Survey (MABAT) 1999-2000Nutrition Survey (MABAT) 1999-2000

26.924.4

16.1 14.8

65.9

21.9

1013.7

0

10

20

30

40

50

60

70

80

0-8 8-11 12 >12

Jews Arab

Diabetes (%) among Jews & Arabs aged 25-64 by sex & years of education

12.0

7.45.4 5.8

18.4

6.1 4.8 0.90

5

10

15

20

<=8 9-11 12 >12(academic)

Years of education

Perc

ent

First National Health & Nutrition Survey First National Health & Nutrition Survey (MABAT),1999-2000(MABAT),1999-2000

males

females

11.515.2

5.1 3.7

18.6

0.0 4.7 4.7

0

5

10

15

20

<=8 9-11 12 >12(academic)

Years of education

Perc

ent

JewsJews

ArabsArabs

NHANES III Prevalence of Hypertension* According to BMI

14.9 15.2

22.127.727

32.7

41.937.8

0

10

20

30

40

50

Men Women

BMI <25 BMI 25-<27 BMI 27-<30 BMI > 30

Perc

en

t

Prevalence of Hypertension* According to BMI by Sex

Perc

en

t

14.9

22.127

41.9

15.2

27.732.7

37.8

0

10

20

30

40

50

<25 25-<27 27-<30 >30

Men Women

BMI Levels

_

Obesity and Diabetes Risk

0

20

40

60

80

100

<20 20-25 25-30 30-35 35-40 >40

BMI Levels

Incid

en

ce o

f N

ew

Cases

per

1,0

00 P

ers

on

-Years

0

25

50

75

100

Relationship Between BMI and Risk of Type 2 Diabetes

Age-A

dju

sted R

ela

tive R

isk

Body Mass index (kg/m2)

MenMen

>22 >23 23-

23.9

24-

24.9

25-

26.9

27-

28.9

29-

30.9

31-

32.9

33-

34.9

35+

1.0

2.91.0

4.31.0

5.01.5

8.12.2

15.8

4.4

27.6

40.3

54.0

93.2

6.711.6

21.3

42.1

WomenWomen

Metabolic Syndrome

•Abdominal obesity

•Hyperinsulinemia

•High fasting plasma glucose

•Impaired glucose tolerance

•Hypertriglyceridemia

•Low HDL-cholesterol

•Hypertension

Clinical Identification of the Metabolic Syndrome*: NCEP-ATP III

*Diagnosis is established when >3 of these risk factors are present

Risk FactorDefining Level

Abdominal obesity

(Waist circumference)

Men>102 cm (>40 in)

Women>88 cm (>35 in)

TG>150 mg/dL

HDL-C

Men<40 mg/dL

Women<50 mg/dL

Blood pressure>130 / >85 mm Hg

Fasting glucose>110 )<100(** mg/dL

** 2003 New ADA IFG criteria (Diabetes Care)

Metabolic Syndrome :Impact on Mortality

0

5

10

15

20

25

All- cause Mortality Cardiovascular Mortality

Mort

alit

y R

ate

(%

) Without metabolic syndromeWith metabolic syndrome

*P < 0.001.

Metabolic Syndrome: Impact on Cardiovascular Health

0

5

10

15

20

25

CHD MI Stroke

Pre

vale

nce

(%

)

Without metabolic syndromeWith metabolic syndrome

*P < 0.001.

26- Year Incidence of Coronary Heart Disease in Men

177

255

350333366

440

0

100

200

300

400

500

600

<25 25-<30 30+

<50 years 50+ years

Incid

en

ce/

1,0

00

BMI Levels

0.6

1.0

1.4

1.8

2.2

2.6

3.0

Relationship Between BMI and Cardiovascular Disease Mortality

Rela

tive R

isk

of

Death

Body Mass index

<18.5

MenMen

18.5–

20.4

20.5–

21.9

22.0–

23.4

23.5–

24.9

25.0–

26.4

26.5–

27.9

28.0–

29.9

30.0–

31.9

32.0–

34.9

35.0–

39.9

>40.0

Lean Overweight

Obese

WomenWomen

Relationship of BMI to Excess Mortality

Mort

ality

Rati

o

Body Mass Index (kg/[m2])

300Age at Issue

20-29250

200

150

100

50

150

30-39

20 25 30

Low

Risk

4035

High

Risk

Moderate

Risk

0

10

20

30

40

50

60

Direct Cost * of Chronic Diseases in the United States

Dir

ect

Cost

($ B

illio

ns)

Type 2Diabete

s

*Adjusted to 1995 dollars.

Obesity CoronaryHeart

Disease

Hyper-tension

Stroke

$18.1$18.4

$38.7

$51.6$53.2

0

10000

20000

30000

40000

Effect of Obesity on Expected Lifetime Medical Care Costs* in

Men

Costs

($)*

Body Mass Index (kg/m2)

32.5 27.537.5

55-6445-54

*Total cost of CHD, type 2 DM, hypertension, hypercholesterolemia, stroke

Age (y)

35-4422.5

$0

$2,000

$4,000

$6,000

$8,000

$0

$400

$800

$1,200

$1,600

Economic Effect of Obesity to Business: 3-Year Costs to First Chicago NBD

*BMI >27.8 kg/m2 in men; >27.3 kg/m2 in women.

AbsenteeismHealthcare

LeanLean

$4,496

$6,822

$683

$1,546

ObeseObese**