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Obesity
Overweight and obesity are both chronic conditions that are the result of an energy imbalance over a period of time.
The cause of this energy imbalance can be due to a combination of several different factors and varies from one person to another. Individual behaviors, environmental factors, and genetics all contribute to the complexity of the obesity epidemic.
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CDC
Energy Imbalance
What is it?
Weight Gain Calories Consumed > Calories Used Weight Loss Calories Consumed < Calories Used No Weight Change Calories Consumed = Calories Used
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CDC
Energy Imbalance
Effects in the Body
Excess energy is stored in fat cells, which enlarge or multiply. Enlargement of fat cells is known as hypertrophy, whereas multiplication of fat cells is known as hyperplasia. With time, excesses in energy storage lead to obesity.
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J La State Med Soc .2005; 156 (1): S42-49.
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Weight Classifications
A Review
Body mass index (BMI) is a mathematical ratio which is calculated With a BMI of: as weight (kg)/ height squared (m2). It is used to describe an individuals Below 18.5 relative weight for height, and is 18.5 - 24.9 significantly correlated with total 25.0 - 29.9 body fat content. BMI is intended for those 20 years of age and older. 30 or higher
You are considered: Underweight Healthy Weight
Overweight
Obese
You can find tables on the web that have done the math and metric conversions for you.
http://www.pbrc.edu/Division_of_Education/Tools/BMI_Calculator.asp
or
http://www.nhlbisupport.com/bmi
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CDC
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Mortality
Weight, Fat Distribution, and Activity
The following factors have been shown to increase mortality in individuals: Excess body weight Regional fat distribution Weight gain patterns Sedentary Lifestyle
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Mortality
Excess Body Weight
Mortality associated with excess body weight increases as the degree of obesity and overweight increases. It is estimated that 280,000 to 325,000 deaths a year can be attributed to obesity in the United States, more than 80% of these deaths occur among individuals with a BMI greater than 30 kg/m2.
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Mortality
Regional Fat Distribution
Regional fat distribution can contribute to mortality. This was first noted in the beginning of the 20th century. Obese individuals with an android (or apple) distribution of body fat are at a greater risk for diabetes and heart disease than were those with a gynoid distribution (pear). Android fat distribution results in higher free fatty acid levels, higher glucose and insulin levels and reduced HDL levels. It also results in higher blood pressure and inflammatory markers.
Android Gynoid
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Mortality
Weight Gain
In addition to overweight and central fatness, the amount of weight gain after ages 18 to 20 also predicts mortality.
The Nurses Health Study and the Health Professionals Follow-up Study showed that a marked increase in mortality from heart disease is associated with increasing degrees of weight gain.
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Mortality
Sedentary Lifestyle
Sedentary lifestyle is another important component in the relationship of excess mortality to obesity. A sedentary lifestyle increases the risk of death at all levels of BMI. Unfit men in the BMI range of less than 25 kg/m2 had a significantly higher risk than men with a high level of cardiovascular fitness. Obese men with a high level of fitness had risks of death that were not different from fit men with normal body fat.
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Morbidity
Associated with Obesity
Overweight affects several diseases, although its degree of contribution varies from one disease to another. Additionally, the risk of developing a disease often differs by ethnic group, and by gender within a given ethnic group.
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Morbidity
Associated with Obesity
Individuals who are obese are at a greater risk of developing:
Obstructive sleep apnea Osteoarthritis Cardiovascular disorders Gastrointestinal disorders Metabolic disorders
Endometrial, prostate and breast cancers Complications of pregnancy Menstrual irregularities Psychological disorders
CDC
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Cardiovascular Disorders
Associated with Obesity
Obese individuals are at a greater risk of developing these cardiovascular disorders:
Hypertension
Hypertension (HTN) is the term for high blood pressure. Hypertension is identified when a blood pressure is sustained at 140/90 mmHg. High blood pressure is referred to as the silent killer, since there are usually no symptoms with HTN. Some individuals find out that they have high blood pressure when they have trouble with their heart, brain, or kidneys.
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NHLBI
Hypertension
The Dangers
Failure to find and treat HTN is serious, as untreated HTN can cause:
The heart to get larger, which may lead to heart failure. Small bulges (aneurysms) to form in blood vessels. Blood vessels in the kidney to narrow, which may lead to kidney failure. Arteries in the body to harden faster, especially those in the heart, brain, kidneys, and legs. This can cause a heart attack, stroke, kidney failure, or can lead to amputation of part of the extremities. Blood vessels in the eye to burst or bleed. This may cause vision changes and can result in blindness.
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NHLBI
Hypertension
Blood pressure is often increased in overweight individuals. Estimates suggest that control of overweight would eliminate 48% of the hypertension in Caucasians and 28% in African Americans. Overweight and hypertension interact with cardiac function, leading to thickening of the ventricular wall and larger heart volume, and thus to a greater likelihood of cardiac failure.
Hypertension
Prevalence in the Overweight
35 30
27.0 22.1 27.7
32.7
Prevalence of HTN
25 20 15 10 5 0
14.9
15.2
BMI < 25 BMI > 25 & < 27 BMI > 27 & <30
Males
Females
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Stroke
Normally, blood containing oxygen and nutrients is delivered to the brain, and carbon dioxide and cellular wastes are removed. A stroke occurs when the blood supply to part of the brain is suddenly interrupted by a blocked vessel or when a blood vessel in the brain bursts. Once their supply of oxygen and nutrients from the blood is cut off to the brain cells, they die.
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NINDS
Stroke
The symptoms of a stroke include:
Sudden numbness or weakness, especially on one side of the body Sudden confusion or trouble speaking or understanding speech Sudden trouble seeing in one or both eyes Sudden trouble with walking, dizziness, or loss of balance or coordination Sudden severe headache with no known cause
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NINDS
Stroke
There are two forms of stroke: ischemic and hemorrhagic. Ischemic stroke occurs when an artery to the brain is blocked. Overweight and obesity increase the risk for ischemic stroke in men and women. With increasing BMI, the risk of ischemic stroke increases progressively and is doubled in those with a BMI greater than 30 kg/m2 when compared to those having a BMI of less than 25 kg/m2. Hemorrhagic strokes occur when a blood vessel in the brain erupts. Overweight and obesity do not increase the risk for hemorrhagic strokes.
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NHLBI
Coronary Arteries
Blood Flow
When the heart muscle is not receiving the amount of oxygen that it needs, one of two things can happen:
Angina This is the chest pain or discomfort that occurs when the heart is not getting enough blood. Heart attack This is what happens when a blood clot develops at the site of the plaque in a coronary artery. The result is a sudden blockage, which may block all or most of the blood supply to the heart muscle. Because cells in the heart muscle begin to die when they are not receiving adequate amount of oxygen, permanent damage to the heart muscle can occur if blood flow is not quickly restored.
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NHLBI
Over time, CAD can weaken the heart muscle and contribute to: Heart Failure Arrhythmias
NHLBI
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Gastrointestinal Disorders
Associated with Obesity
Obese individuals are at greater risk of developing these gastrointestinal disorders:
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Colon Cancer
Colorectal cancer is a term used to refer to cancer that develops in the colon or the rectum.
The colon (a.k.a. the large intestine) is about 5 feet long and its role in the digestive system is to continue to absorb water and mineral nutrients from food. Once this process of absorption is complete, waste matter (feces) remains. The rectum is the final 6 inches of the digestive system. Feces are passed from the large intestine to the rectum, to exit the body through the anus.
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Colon Cancer
Colorectal cancer is the second leading cause of cancer-related deaths in the U.S. It is estimated to cause about 55,170 deaths during 2006.
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Colon Cancer
Findings Relating to Obesity
Colon cancer has been shown to occur more frequently in people who are obese than in people who are of a healthy weight.
An increased risk of colon cancer has been consistently reported for men with high BMIs.
Women with high BMI are not at increased risk of colon cancer.
There is evidence that abdominal obesity may be important in colon cancer risk.
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NCI
Gallbladder Disease
Cholelithiasis is the primary hepatobiliary pathology associated with overweight. Cholelithiasis is a condition characterized by the presence or formation of gallstones in the gallbladder or bile ducts. Normally, a balance of bile salts, lecithin and cholesterol keep gallstones from forming. However, if there are abnormally high levels of bile salts or, more commonly, cholesterol, then stones can form.
NIH
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Gallstones
Findings Related to Obesity
Obesity appears to be associated with the development of gallstones. More cholesterol is produced at higher body fat levels. Approximately 20 mg of additional cholesterol is synthesized for each kg of extra body fat. High cholesterol concentrations relative to bile acids and phospholipids in bile increase the likelihood of precipitation of cholesterol gallstones in the gallbladder.
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Gallstones
Findings Related to Obesity
In the Nurses Health Study, when compared to those having a BMI of 24 or less, Women with a BMI > 30 kg/m2 had a 2-fold increased risk for symptomatic gallstones. Women with a BMI > 45 kg/m2 had a 7-fold increased risk for symptomatic gallstones. The relative increased risk of symptomatic gallstone development with increasing BMI appears to be less for men than for women.
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Gallstones
Findings Related to Obesity
Ironically, weight loss leads to an increased risk of gallstones-- because of the increased flux of cholesterol through the biliary system.
Diets with moderate levels of fat that trigger gallbladder contraction and subsequent emptying of the cholesterol content may reduce the risk of gallstone formation.
Bile acid supplementation can be used to lower ones risk for gallstone formation.
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Metabolic Disorders
Associated with Obesity
Obese individuals are at greater risk of developing these metabolic disorders:
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Diabetes Mellitus
Type 2 diabetes mellitus (DM) is strongly associated with overweight and obesity in both genders and in all ethnic groups. The risk for Type 2 DM increases with the degree and duration of overweight in individuals. The risk for Type 2 DM also increases in individuals with a more central distribution of body fat (abdominal).
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15%
BMI < 25 BMI > 25 or BMI < 30 BMI > 30
55%
30%
Diabetes Mellitus
Findings Related to Obesity
The Nurses Health Study demonstrated the curvilinear relationship between increasing BMI and the risk of diabetes in women:
Women with a BMI below 22 kg/m2 had the lowest risk of DM At a BMI of 35 kg/m2, the relative risk of DM increased 40-fold or 4,000%
The Health Professionals Follow-up Study demonstrated a similar relationship between increasing BMI and the risk of diabetes in men:
Men with a BMI below 24 kg/m2 had the lowest risk of DM At a BMI of 35 kg/m2, the relative risk of DM increased 60-fold or 6,000%
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Diabetes Mellitus
Findings Relating to Weightloss
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Dyslipidemia
Dyslipidemia is defined as abnormal concentration of lipids or lipoproteins in the blood.
As BMI increases, there is an increased risk for heart disease. This is because a positive correlation between BMI and triglyceride (TG) levels has been demonstrated.
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Dyslipidemia
Findings Related to Obesity
An inverse relationship between HDL cholesterol and BMI has been noted. This relationship may be more important than the relationship between BMI & TG levels. Low level of HDL carries more relative risk for developing heart disease than do elevated triglyceride levels. Central fat distribution also plays an important role in lipid abnormalities. Excessive body fat in the abdominal region leads to increased circulating triglyceride levels.
HDL
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Liver Disease
Nonalcoholic fatty liver disease (NAFLD) is the term given to describe a collection of liver abnormalities that are associated with obesity.
In a cross-sectional analysis of liver biopsies of obese patients, it was found that the prevalence of steatosis, steatohepatitis, and cirrhosis were approximately 75%, 20%, and 2% respectively.
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Liver Disease
Fatty Liver
Steatosis is the term for fatty liver and it is not actually a disease, but rather a pathological finding.
Most cases of fatty liver are due to obesity. Other causes of fatty liver include:
Diabetes Certain drugs Intestinal bypass operations Starvation Protein malnutrition Alcoholism
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Liver Disease
Fatty Liver
A gradual weight reduction can help to reduce the enlargement of the liver due to fat, and it can normalize the associated liver test abnormalities. It is important to limit the amount of alcohol consumed in the diet. Alcohol can decrease the rate of metabolism and secretion of fat in the liver.
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The 300 billion cells of the liver control a process known as metabolism. During metabolism, the liver breaks down nutrients into usable products. These products are then delivered to the rest of the body through the bloodstream. The liver also metabolizes toxins into byproducts that can be safely eliminated.
The liver also produces many important substances, such as: albumin, bile, cholesterol, clotting factors, globin, and immune factors.
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Mayo Clinic
Other Disorders
Associated with Obesity
Obese individuals are at greater risk of developing these metabolic disorders:
Obstructive sleep apnea Osteoarthritis Endometrial, prostate, and breast cancers Complications of pregnancy Menstrual irregularities Psychological disorders
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Osteoarthritis
Osteoarthritis (OA) is the most common type of arthritis 40 million Americans currently have osteoarthritis. It is a degenerative disease which frequently leads to chronic pain and disability. For individuals over the age of 65, it is the most disabling disease. Currently, only the symptoms of OA can be treated; there is no cure.
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NSLS
Osteoarthritis
Findings Relating to Obesity
The incidence of OA is significantly increased in overweight individuals. OA that develops in the knees and ankles is probably directly related to the trauma associated with the degree of excess body weight.
Osteoarthritis in other non-weight bearing joints suggests that there must be some component of the overweight syndrome responsible for altering cartilage and bone metabolism, independent of the actual stresses of body weight on joints.
Areas of the body most commonly affected by OA
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NSLS
Cancer
Findings Relating to Obesity
Overweight and obesity are associated with an increased risk of: esophageal, gallbladder, pancreatic, cervical, breast, uterine, renal, and prostate cancers.
Obesity and physical inactivity may account for 25 to 30 percent of several major cancers, including--- colon, breast (postmenopausal), endometrial, kidney, and cancer of the esophagus.
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Endocrine Changes
There are various endocrine changes associated with overweight. Changes in the reproductive system are among the most common. Irregular menses and frequent anovular cycles are common. Rates of fertility may also be reduced.
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Endocrine Changes
Associated with Obesity
Common hormonal abnormalities associated with obesity
Increased cortisol production Insulin resistance Decreased sex hormone-binding globulin in women Decreased progesterone levels in women Decreased testosterone levels in men Decreased growth hormone production
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Psychological Disorders
Weight Loss
Intentional weight loss has been consistently associated with improved quality of life.
Severely obese patients who lost 43 kg through gastric bypass demonstrated improved quality of life scores to such an extent that their post-weight loss scores were equal to or even better than population norms.
In Conclusion
The following conditions have been found to be associated with obesity:
These diseases have been found to be associated with increased metabolic activity (secretion) of fat cells in obesity
Diabetes mellitus Hypertension Gallbladder Disease Liver Disease Cancer Coronary Artery Disease Cerebrovascular disease (stroke) Endocrine Changes
These diseases have been found to be associated with increased fat mass
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