obesity: from hunting and gathering to tv and take out by scott lear, phd
TRANSCRIPT
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OBESITY: FROM HUNTING AND GATHERING TO TV AND TAKE
OUTScott Lear, PhD
Pfizer/Heart & Stroke Foundation Chair in Cardiovascular Prevention Research at St. Paul’s Hospital
Professor, Faculty of Health Sciences, Simon Fraser UniversityMember, Division of Cardiology, Providence Health Care
Principal Investigator, Heart and Lung Institute, Providence Health Care
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Obesity: Definition “Excess body fat accumulation that may
impair health” Usually measured by body mass index (BMI)
Adults: A person’s body weight in kilograms divided by
their height in meters squared (kg/m2) Overweight: BMI 25.0-29.9 kg/m2
Obese: BMI > 30.0 kg/m2
Other measures include waist circumference, waist to hip ratio
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BMI and Cardiovascular Disease Mortality
0.6
1.0
1.4
1.8
2.2
2.6
3.0 Men (n=84 376)
Women (n=217 857)
<18.5 18.5-20-4
20.5- 21.9
22- 23.4
23.5- 24.9
25- 26.4
26.5- 27.9
28- 29.9
30- 31.9
32- 34.9
³35
BMI
Rel
ativ
e ris
k of
dea
th
Never-smokers, no history of heart disease
Calle EE et al. NEJM 1999; 341:1097-105
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ObesityInsulin
Resistance
Type IIDiabetes
Dyslipidemia
Hypertension
CardiovascularDisease
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Health Risks Associated with Obesity
•Type 2 diabetes•Gallbladder diseases•Dyslipidemia•Metabolic syndrome•Breathlessness•Sleep apnea
•Cardiovascular disease•Hypertension•Osteoarthritis•Hyperuricemia, gout•Cancer•Psychosocial issues
•Reproductive hormone abnormalities•Polycystic ovary syndrome•Impaired fertility•Low back pain•Fetal defects
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Is this man obese?
Weight = 106.8 kg (235 lbs)
Height = 1.878 m (6’ 2”)
Body mass index (BMI) = 30.3 kg/m2
This man is clinically obese!?!?
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Body Mass Index and Mortality
Pischon T et al. NEJM 2008; 359:2105.
All-cause mortality based on 359 387 Europeans.
BMI with lowest risk:Men = 25.3 kg/m2, women = 24.3 kg/m2
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BMI and Mortality- Is there a relationship?
Flegal et al. JAMA 2013:309;71.
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BMI and Mortality in Older Adults
Winter et al. Am J Clin Nut 2014:99;875.
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Waist to Hip Ratio Increases Risk of MI Despite Low BMI
Yusuf S et al. Lancet 2005;366:1640.
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Visceral Adipose Tissue
Subcutaneous Adipose Tissue
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Fat loss occurs when energy in < energy out.
The Energy Balance
Energy In
Energy Out
Weight Management
MetabolismPhysical activity
Food
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Meta-analysis of Weight Loss
Miller WC, et al. Int J Obesity 1997;21:941-947.
Variable (studies)
Diet Only Exercise Only Diet and Exercise
Weight Loss, kg 10.7 +0.5 (269)
2.9 +0.4 (90)
11.0 +0.6 (134)
Fat Loss, kg 7.8 +0.7 (48)
3.3 +0.5 (40)
9.0 +1.0 (33)
BMI Decrease 4.0 +0.4 (53)
0.8 +0.1 (27)
4.2 +0.4 (43)
Weight Loss at One Year, kg
6.6 +0.5 (91)
6.1 +2.1 (7)
8.6 +0.8 (54)
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Caloric Costs of Common Activities
Activity Kilocalories at 1 hr/5 times/week
Time to Expend 1 kg Fat (7700 kcal)
Walking Briskly 3 mph
1050 Over 7 weeks
Stationary Bicycling 1500 Over 5 weeks
Resistance Training 900 Over 8 weeks
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All Calories are Not Created Equal
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A Model of Connections
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Perceptions of Causes and Responsibility of Obesity
Tompson et al. Obesity in the United States: Public Perceptions. Assoc. Press- NORC 2012.
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PURE Vancouver Communities
UrbanSemi-Urban
Semi-Rural
Analysis based on 2681 participants.
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Measures of Obesity by Region
Urban Semi-urban Semi-rural25
25.5
26
26.5
27
27.5
28
Bod
y M
ass
Inde
x (k
g/m
2)
Urban Semi-urban Sub-urban79
80
81
82
83
84
85
86
87
88
Wai
st c
ircum
fere
nce
(cm
)
p<0.001
p<0.001
Lear SA, et al. Unpublished data from PURE Study.
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Assessing the Environment
1 segment
1 se
gment
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Green spaces/parks/public squares (free)
Bowling centres
Outdoor skating rinks (free)
Golf courses and country clubs
Skiing facilities
Bicycle Lanes (optional)
One per segment, where present.
Do capture some examples of different bike lane demarcation.
Small area – record waypoint in middle Large area – record waypoints at edges Look for other features of interest on park grounds, and record additional waypoints where present.
Photograph all park facilities/features.
Public recreational courts (free) e.g. tennis, basketball courts; skateboard parks; paved/turf sports areas
Fitness and recreational sports centres ($)
Supermarket and grocery stores
Beer, wine and liquor stores
Specialty food stores
Full-service restaurants
Limited-service restaurants
Drinking places (alcoholic beverages)
Convenience stores/general store
Meat or fish/seafood stores/market stores
Fruit and vegetable stores/market stores
Baked goods stores
Confectionary or nut stores
Nutrition related:
Physical Activity related:
Environment Features
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Built Environment Features by Region
Urban Semi-urban Semi-rural
Sport fields 113 163 83
Grocery stores 41 37 9
Convenience stores 93 127 29
Fruit & veg. stores 15 6 3
Full-service restaurants 411 295 40
Fast food restaurants 380 275 64
Community centres 20 21 3
Places of worship 128 118 25
Lear SA, et al. Unpublished data from PURE Study.
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Mapping Environment Features
Beer by Sachan; Apple & Fast Food by Creative Stall; Cutlery by Pham Thi Dieu Linh
Pub / Liquor Store
Restaurant
Fast Food
Market / Grocery
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Combine Participants and Environment Features
Beer by Sachan; Apple & Fast Food by Creative Stall; Cutlery by Pham Thi Dieu Linh
Participant A
500 metres500 metresRestaurant Density = 3Fast Food Density = 1Pub Density = 1
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Associations with Obesity Defined by Waist to Hip Ratio
Predictor Variable Odds Ratio 95% CI
Fast Food (500m) 1.05*** 1.02 – 1.08
Bars/Pubs (500m) 1.12** 1.02 – 1.23
Markets (500m) 0.83*** 0.75 – 0.91
Restaurants (500m) 0.98* 0.96 – 0.99
Adjusted for age, sex, socioeconomic status, population density.
6339 participants from three cities in Canada
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Device Ownership and Prevalence of Obesity/Diabetes
0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3HIC UMIC LMIC LIC
0
5
10
15
20
25
30
35
Country Income Level and Device Ownerhsip
Prev
alen
ce (%
)
*****
Prevalence of obesity (blue bars) and diabetes (red bars) by cumulative device ownership (television, car and computer).HIC = high income countries; UMIC = upper middle income countries; LMIC = lower middle income countries; LIC = lower income countries* p<0.01 for trend, ** p<0.001 for trend
*
Lear SA, et al. CMAJ 2014:186:258
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So what can we do?
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Look AHEAD Trial- Type 2 Diabetes
reduction in risk factors andadvanced kidney disease
Look AHEAD. NEJM 2013; 369:145.
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Out of Sight (and Reach) Out of Mind (Mouth)
Wansink B, et al. Int J Obesity 2006:30;871-875.
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Clean Your Plate?? Participants
assigned to either regular soup in bowl or refilling bowl.
Those eating from refilling bowl ate 73% more calories.
Assessment of being full and perceived caloric consumption no different. Wansink B, et al. Obesity Res 2005:13;93-100.
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Start Your Day Off with a Meal Nearly 3000 people (79% women) who lost
>30 lbs for > 1 year from U.S. National Weight Loss Registry.
Wyat HR, et al. Obesity Res 2002:10;78-82.
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Early Bird Loses More Weight Observational
study of 510 people in weight loss clinics.
‘early eaters’ compared to ‘late eaters’
Early eaters lost 5 lbs more.
Garaulet, et al. Int J Obesity 2013;1-8.
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We are sitting ourselves to death!!
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Sitting, even if active, can be deadly...
Women Men
Patel AV, et al. Am J Epidemiol 2010:172;419-429.
Total Physical Activity (MET-hours/week)
blue <3, red 3-5, green >5 hours sitting per day
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Time to Stand Up for Our Health!
Dunstan D W et al. Diabetes Care 2012;35:976-983
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Time to Stand Up for Our Health!
Dunstan D W et al. Diabetes Care 2012;35:976-983.
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Take Home Message Obesity increases the risk for
cardiovascular disease. It’s a complex situation with no easy
solutions. Weight loss is possible but very
challenging: Better to concentrate on healthy lifestyle
behaviours and not weight Preventing weight gain or maintaining weight may
be best option
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Resources Canadian Obesity Network
http://www.obesitynetwork.ca/
http://www.obesitynetwork.ca/resources
Weight Watchershttps://www.weightwatchers.com/ca/en
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Objectives Describe obesity as a risk factor for
IHD Describe the impact of obesity on IHD Describe the long-term outcomes
related to obesity Describe current evidence on
interventions to minimize poor outcomes
List useful resources available to support nurses in discussing to patients about weight
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We don't need everything to address specifically with PTCA etc... but the more we can bring it back somewhat to heart disease the better. We know that obesity is a cardiac risk factor..so the more we can understand obesity the better we can help understand our patients and help our patients. As far as our objective #4, I think this is refering to the interventions to reduce obesity and therefore minimize cardiac risk factors. You could simply discuss what you said that outcomes after interventions is poor. You don't have to address anything that you don't feel well versed in. I think even stating that we have to help people with their weight loss issue before they become obese...in order for them to have any chance.