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

Exercise and Body Exercise and Body CompositionComposition

The Health Cost of Obesity and Overweight

Health Risks of Not Health Risks of Not Maintaining a Healthy Maintaining a Healthy WeightWeight

Overweight and obesity are associated with an increased risk for developing various medical conditions including: cardiovascular disease, certain cancers (endometrial, colon,

postmenopausal breast, kidney, and esophageal)5,

high blood pressure, arthritis-related disabilities and type 2 diabetes.7

U.S. Department of Health and Human Services

Consequences of Childhood Consequences of Childhood and Adolescent Obesityand Adolescent ObesityConsequences of Childhood Consequences of Childhood and Adolescent Obesityand Adolescent Obesity

GrowthGrowth PsychosocialPsychosocial HyperlipidemiaHyperlipidemia Hepatic stenosisHepatic stenosis Abnormal glucose Abnormal glucose

metabolismmetabolism Persistence into Persistence into

adulthoodadulthood

GrowthGrowth PsychosocialPsychosocial HyperlipidemiaHyperlipidemia Hepatic stenosisHepatic stenosis Abnormal glucose Abnormal glucose

metabolismmetabolism Persistence into Persistence into

adulthoodadulthood

HypertensionHypertension Sleep apneaSleep apnea PseudotumorPseudotumor PCODPCOD CholelithiasisCholelithiasis OrthopedicOrthopedic

HypertensionHypertension Sleep apneaSleep apnea PseudotumorPseudotumor PCODPCOD CholelithiasisCholelithiasis OrthopedicOrthopedic

CommonCommonCommonCommon UncommonUncommonUncommonUncommon

Consequences of Adult ObesityConsequences of Adult ObesityConsequences of Adult ObesityConsequences of Adult Obesity

PsychosocialPsychosocial CardiovascularCardiovascular

HyperlipidemiaHyperlipidemia Diabetes Diabetes

mellitusmellitus HypertensionHypertension RespiratoryRespiratory CardiacCardiac

PsychosocialPsychosocial CardiovascularCardiovascular

HyperlipidemiaHyperlipidemia Diabetes Diabetes

mellitusmellitus HypertensionHypertension RespiratoryRespiratory CardiacCardiac

MedicalMedical Polycystic ovary diseasePolycystic ovary disease Gall bladder diseaseGall bladder disease OsteoarthritisOsteoarthritis CancerCancer

Pregnancy and Pregnancy and postpartum complicationspostpartum complications

MortalityMortality

MedicalMedical Polycystic ovary diseasePolycystic ovary disease Gall bladder diseaseGall bladder disease OsteoarthritisOsteoarthritis CancerCancer

Pregnancy and Pregnancy and postpartum complicationspostpartum complications

MortalityMortality

Medical ConditionsMedical Conditions 88 to 97% of all cases of Type II

(non-insulin dependent) diabetes, 57 to 70% of coronary heart

disease cases, 11% of breast cancers, and 10% of colon cancers that are

diagnosed are related to obesity.

Medical ConditionsMedical Conditions 1/3 of all cases of hypertension

and 70% of gallstone cases are related to being obese.

Unhealthy weight is also associated with osteoarthritis and gout, along with a number of other disabling conditions.

(SUA, 1997)

Exercise and Body Exercise and Body CompositionComposition

Other less understood risks of obesity include: difficulties in surgical anesthesia and

delivery gallbladder disease, infertility, osteoarthritis, etc...

Physical Activity and a Physical Activity and a Nutritious Diet are Key to Nutritious Diet are Key to Maintaining Energy Balance Maintaining Energy Balance and a Healthy Weightand a Healthy Weight

Regular physical activity along with a nutritious diet is key to maintaining a healthy weight.

In order to maintain a healthy weight,

there must be a balance between calories consumed and calories expended through metabolic and physical activity.


Physical Activity and a Physical Activity and a Nutritious Diet are Key to Nutritious Diet are Key to Maintaining Energy Balance Maintaining Energy Balance and a Healthy Weightand a Healthy Weight

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.


Maintaining Energy Balance Maintaining Energy Balance and a Healthy Weightand 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.

While vigorous exercise uses calories at a higher rate, any physical activity will burn calories.


Maintaining Energy Balance Maintaining Energy Balance and a Healthy Weightand a Healthy Weight

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.

The same person can also burn 105 calories by vacuuming or raking leaves for the same amount of time.



Epidemiological studies show an increase in mortality associated with overweight and obesity.

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



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.



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



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 women31 and 1.6 times in men.32


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.



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

Overweight and obesity are also known to exacerbate many chronic conditions such as hypertension and elevated cholesterol.



Overweight and obese individuals also may suffer from social stigmatization, discrimination, and poor body image.



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.

Overweight children and adolescents are more likely to become overweight or obese adults.



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.

A common consequence of childhood overweight is psychosocial specifically discrimination.34


Metabolic SyndromeMetabolic Syndrome

Syndrome X


Visceral adiposity Elevated blood pressure Insulin resistance Low HDL/High Triglycerides Systemic pro-inflammatory state


Identified by Three of the Following (NCEP):

Waist girth > 102 cm (40 in) for men > 88 cm (35 in) for women

Fasting glucose > 110 mg/dl

Triglycerides > 150 mg/dl


Blood pressure > 130/85 Use of bp medications

HDL < 40 mg/dl for men < 50 mg/dl for women


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


Received ICD-9 code (277.7) in 2001 What physicians use to bill insurance

company


May be identified by elevated waist circumference and elevated triglycerides alone Depprees


From NHANES III (1988-1994) data, prevalence is 24% of population.

86 million Americans will have by 2025


2600 American each day die from cardiovascular disease

That’s an equivalent death rate as a 9/11 everyday


Perhaps it should be called physical inactivity syndrome

When PA or PF is considered, metabolic syndrome is not a great predictor of all-cause or CHD caused mortality. Lakka, et al., MSSE 2002, 35:1279-

1286

ImprovementImprovement Among the morbidly obese (150-

200% overweight), moderate weight loss can mean a 20-75% reduction in risk factors for several chronic diseases.

ImprovementImprovement 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%).

Radical TreatmentRadical Treatment

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

Gastric BypassGastric Bypass

Most patients lose about 2/3rds of their excess weight in a year after surgery.

Some patients can subvert the surgery by snacking continuously.


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.


Over 100,000 gastric bypass surgeries were conducted in the US in 2003.

Key QuestionKey Question

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

AnswerAnswer

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

Recent ResearchRecent Research

Demonstrates that being slightly overweight might be healthier than being slightly underweight.

Recent ResearchRecent Research

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

Key to Solving the Key to Solving the ProblemProblem

Focus on the process of living rather than the product (symptoms) of death.

Increase physical activity and eat in a nutritionally sound way, and weight problems, disease, and death will be reduced

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

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