Obesity Obesity PandemicPandemic

Athanassios Petrotos, M.D.Athanassios Petrotos, M.D.

Surgical Specialists of Surgical Specialists of GreenwichGreenwich

Greenwich HospitalGreenwich Hospital

““Global epidemic”Global epidemic”

25% of all Americans25% of all Americans

10-20% in other parts of the globe10-20% in other parts of the globe

Steadily increasing occurrenceSteadily increasing occurrence

DefinitionDefinition

Body Mass Index = weight/height² in kg/m²Body Mass Index = weight/height² in kg/m²

Obesity is defined as a BMI>30kg/m²Obesity is defined as a BMI>30kg/m²

Overweight is defined as a BMI>25kg/m²Overweight is defined as a BMI>25kg/m²

Morbid Obesity is defined as a Morbid Obesity is defined as a BMI>40kg/m²BMI>40kg/m²

Table 1Table 1

Weight Category ‘71-’74 ‘76-’80 Weight Category ‘71-’74 ‘76-’80 ‘88-’94‘88-’94

Overweight 32% 32% 32%Overweight 32% 32% 32%Obese 10% 10% 14%Obese 10% 10% 14%Severely Obese 3% 3% 5%Severely Obese 3% 3% 5%Morbid Obesity 1% 2% 3% Morbid Obesity 1% 2% 3% ------------------------------------------------------------------------------------------------------------------------------Total population 46% 47% 54% Total population 46% 47% 54%

Current estimatesCurrent estimates

U.S.A.U.S.A.66% overweight66% overweight32% obese32% obese5% morbidly obese5% morbidly obeseWorldwideWorldwideMore than 300 million people are obese, More than 300 million people are obese,

with 2with 2billion documented as overweight, billion documented as overweight,

approximatingapproximatingthe number of starving individuals worlwide the number of starving individuals worlwide

The youth The youth

4% in children (6-11)4% in children (6-11)

6% in teenagers(12-17)6% in teenagers(12-17)

10% in girls10% in girls

11.4% in boys11.4% in boys

The youthThe youth

40% in Native Americans40% in Native Americans

30% in African Americans 30% in African Americans

30% in Hispanics30% in Hispanics

25% in Caucasians25% in Caucasians

20% in Asian Americans20% in Asian Americans

EtiologyEtiology

Exact cause is unknownExact cause is unknown Multiple factorsMultiple factors GeneticGenetic DietaryDietary EnvironmentalEnvironmental Modernization of the societyModernization of the society

EtiologyEtiology

Energy Imbalance Energy Imbalance

Axis Brain-Gut-Adipose tissueAxis Brain-Gut-Adipose tissue

Hormones: LeptinHormones: Leptin

InsulinInsulin

GhrelinGhrelin Appetite-regulating neuropeptidesAppetite-regulating neuropeptides

LEPTIN,INSULIN,GHRELLEPTIN,INSULIN,GHRELININ

LEPTINLEPTIN : :Secreted by adipocytes. Secreted by adipocytes. Reduces food intake.Reduces food intake.

INSULININSULIN: : Inhibits eating through Inhibits eating through its action in the hypothalamus but…its action in the hypothalamus but…Increase eating by decreasing the Increase eating by decreasing the blood glucose levels.blood glucose levels.

GHRELINGHRELIN:: Secreted by the stomach Secreted by the stomach and proximal small intestine. and proximal small intestine. Regulates meal initiation and satiety.Regulates meal initiation and satiety.

DIETARY FACTORSDIETARY FACTORS

Energy-dense, micronutrient poor Energy-dense, micronutrient poor foodsfoods

Sugar-sweetened beveragesSugar-sweetened beverages Portion SizePortion Size PalatabilityPalatability FiberFiber BreastfeedingBreastfeeding Eating disordersEating disorders

Obesity ComorbiditiesObesity Comorbidities

Hypertension Hypertension DyslipidemiaDyslipidemia DiabetesDiabetes Cardiac and Peripheral Vascular Cardiac and Peripheral Vascular

DiseaseDisease AsthmaAsthma Sleep ApneaSleep Apnea Obesity-Hypoventilation SyndromeObesity-Hypoventilation Syndrome

Obesity ComorbiditiesObesity Comorbidities

Back and Disk DiseaseBack and Disk Disease Peripheral OsteoarthritisPeripheral Osteoarthritis CholelithiasisCholelithiasis Gastroesophageal Reflux DiseaseGastroesophageal Reflux Disease Liver DiseaseLiver Disease Pseudotumor Cerebri and Carpal Pseudotumor Cerebri and Carpal

Tunnel SyndromeTunnel Syndrome Intertriginous Dermatitis Intertriginous Dermatitis

Obesity ComorbiditiesObesity Comorbidities

Stress IncontinenceStress Incontinence Female and Male Reproductive Female and Male Reproductive

DisordersDisorders DepressionDepression

Obesity and CancerObesity and Cancer

EsophagusEsophagus StomachStomach Liver Liver PancreasPancreas Colon and rectumColon and rectum BreastBreast UterusUterus ProstateProstate

Social Implications of Social Implications of ObesityObesity

StigmatizationStigmatization

DepressionDepression

Self-ConfidenceSelf-Confidence

Is Obesity an addiction?Is Obesity an addiction?

SummarySummary

Global phenomenonGlobal phenomenon

MultifactorialMultifactorial

All agesAll ages

Significant comorbiditiesSignificant comorbidities