EPIDEMIOLOGY & DISCRIMINATION ---------------IN OBESITY------------------

R. ARMOUR FORSE AND DEVI MUKKAI KRISHNAMURTY

ASMBS

33 % of the world’s population of 7.08 billion— 2.36 billion people—are overweight or obese.

In 2008, more than 1.4 billion adults were overweight and of these more than 200 million men and nearly 300 million women were obese

Obesity is associated with markedly reduced life expectancy.

Leading cause of preventable deaths in the United States.

Hypertension, hyperlipidemia, coronary artery disease ,abnormal glucose tolerance or diabetes, sleep apnea, nonalcoholic fatty liver disease

Esophageal, pancreatic, renal cell, postmenopausal breast, endometrial, cervical, and prostate cancers.

NATIONAL INSTITUE OF HEALTH 2015

Stroke,osteoartheritis,Obesity Hypoventilation Syndrome,infertility,Gallstone

DEFINITION OF OBESITY

WHO: If the amount of body fat exceeds normal

physiological values, a person is obese The physiologically normal amount of body fat

depends on age and, on sex with high variation among individuals

Newborns:10–15 % first year : 25 % 10 years:15% During sexual maturation girls experience an increase in their body fat again25% Adulthood :slowly increased in both sexes

Densitometry, hydrometry, dual energy X-ray absorptiometry (DXA), computed tomography (CT), or magnetic resonance imaging (MRI).

Skinfold thickness measurements, bioelectrical impedance, BMI and waist circumference, and the more recently described body adiposity index (BAI) : 1.5

(hip circumference /height ) - 18

Patients with a waist/hip ratio of less than one tend to have more of a peripheral fat distribution ratio often referred to as being a “pear” distribution. This fat distribution has low health risk.

Greater than one are referred to as having an “apple” or central fat distribution and these patients are considered to have a high health risk.

In children (2–19 years of age), overweight is defined as a BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile on the (CDC) growth charts .

Obesity is defined as a BMI-for- age greater than or equal to the 95th percentile on the CDC growth charts

LIMITATIONS OF BMI USAGE

There is a wide variation of body adiposity in the same BMI range.

Adiposity has been shown to vary among men and women (with women having more adiposity for the same BMI group)

Adiposity increases with age. In the same BMI range, Asians and

African-Americans have more prevalence of diseases such as hypertension and diabetes.

The Nurses ‘Health Study tracked patterns of weight gain and diabetes development in 78000 U.S women to see if there were any differences by ethnic group.

All women were healthy.after 20 years they found that at the same BMI ,Asians had more than double the risk of development of DM than Whites,Hispanic and Blacks.

Increases in weight over time were more harmful in Asians than the others.

For every 5 kg Asians gained during adulthood,they had 84% in their risk of type 2 DM.

Several other studies have found that at the same BMI ,Asians have higher risk of hypertention and cardiovascular disease than their white European counterparts,and a higher risk of dying early from cardiovascular disease.

Wen CP,David Cheng TY,et al.Are Asians at greater mortality risks for being overweight than caucasians?Public Health Nutr,2009,12:497

WHY?

Asians have 3-5 %higher total body fat. (Deurenberg P,et al.,Asians are different from Caucasians and from each

other in their body mass index/body fat percent relationship.Obes Rev,2002,3:141-6)

South Asians have high levels of body fat and more prone to developing abdominal obesity which may account for their very high risk of DM and cardiovascular disease.

(Misra A,Khrana L.the metabolic syndrome in south Asians:epidemiology determinants and prevention.Metab Sunde Relat Disord .2009;7:497-514)

Blacks have lower body fat and higher leanmuscle mass than whites,at the same BMI,may be at lower risk of obesity-related diseases.(Rush EC,Goedecke JH,et al.BMI,fat and muscle differences in urban women of five ethnicities from two countries.Int J Obes.2007;31:1232-9)

While genetic differences may be at the root of these different body fat patterns in Asians and other ethnic groups,environmental factors seem to be a much stronger force.

During chinese famine of 1954-1964,raises the risk of Dm in adulthood,especially when individuals live in nutritionally rich environments later in life.

(Li Y,Jaddoe VW.et al.Exposure to the chinese famine in early life and the risk of metabolic syndrome in adulthood.Diabetes Care .2011;34:1014-8)

SHOULD BMI OR WAIST CIRCUMFERENCE CUT POINTS BE ETHNICITY SPECIFIC?

At 2004 WHO weighed the evidence on Asians higher risk of weight-related diseases at lower BMIs

Several groups have begun to set lower cutoff points for BMI and abdominal obesity metrics among asians.(international diabetes federation.The IDF consensus,Brussels,2006)

China and japan define overweight as a BMI of 24 or higher and obesity a BMI of 28 or higher.

India define overweight as a BMI of 23 or higher and obesity a BMI of 27 or higher.

GLOBAL BURDEN OF OBESITY

It is estimated that if recent trends continue, by 2030 up to 57.8 % of the world’s adult population

Big problem in developing country

RACIAL, ETHNIC, AND INCOME DISPARITIES

OBESITY AND INCOME LEVEL

Slightly higher at higher income levels especially among non-Hispanic black and Mexican- American men

OBESITY AND LEVEL OF EDUCATION

Among men, there is no significant trend between education level and obesity prevalence.

Among women, obesity prevalence increases as education decreases. Women with college degrees tend to be less obese than lesser educated.

DISCRIMINATION IN OBESITY

Obese individuals are vulnerable to negative societal attitudes, stigma, and

prejudice.

There is a clear need for increased public awareness and education about the complex etiology of obesity and the significant obstacles present in efforts to achieve sustainable weight loss.

Thank you