OBESITY

Age-adjusted Prevalence of Obesity Among U.S.

Adults Aged 18 Years or Older

Obesity (BMI ≥30 kg/m2)

1994 2000 2009

No Data <14.0% 14.0%–17.9% 18.0%–21.9% 22.0%–25.9 ≥ 26%

CDC’s Division of Diabetes Translation. National Diabetes Surveillance

System available at http://www.cdc.gov/diabetes/statistics
U.S. Adults by State and Territory, BRFSS,
2011
¶
Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be
compared to
prevalence estimates before 2011.

*Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥
30%.
U.S. Adults by State and Territory, BRFSS,
2012
¶
Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be
compared to prevalence estimates before 2011.

*Sample size <50 or the relative standard error (dividing the standard error by the
prevalence) ≥ 30%.
U.S. Adults by State and Territory, BRFSS,
2013
¶
Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be
compared to prevalence estimates before 2011.

*Sample size <50 or the relative standard error (dividing the standard error by the
prevalence) ≥ 30%.
U.S. Adults by State and Territory, BRFSS,
2014
¶
Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be
compared to prevalence estimates before 2011.

*Sample size <50 or the relative standard error (dividing the standard error by the
prevalence) ≥ 30%.
 Prevalence of Self-Reported Obesity Among Non-Hispanic White Adults,
by State, BRFSS, 2011-2013

Data not reported* 15%–<20% 20%–<25% 25%–<30% 30%–<35%

≥35%
* Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%.
Prevalence of Self-Reported Obesity Among Non-Hispanic Black Adults,
by State, BRFSS, 2011-2014

Data not reported* 15%–<20% 20%–<25% 25%–<30% 30%–<35%

≥35%
* Sample size <50 or the relative standard error (dividing the standard error by the
prevalence) ≥ 30%.
 Prevalence of Self-Reported Obesity Among Hispanic Adults,
by State, BRFSS, 2011-2013

Data not reported* 15%–<20% 20%–<25% 25%–<30% 30%–<35%

≥35%
* Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%.
Obesity
“Obesity is a chronic disease associated with, if
not the principal cause of, much disease,
disability, and discrimination.” Murdy and Ehram

Many times seen as a social or moral problem

and stigmatize its treatment

Clinical Exercise Physiology, 2 nd ed., Ch. 12

 A Difference in
Approaches

Weight-Normative Vs.
Weight-Inclusive
Weight-Normative
Principles and practices of health care and health
improvement that prioritize weight as a main
determinant of health

Assumptions
 Weight and disease are related in a linear fashion: weight

↑, disease ↑
 Emphasizes personal responsibility for maintenance of
“healthy weights”
Weight-Inclusive
Everybody is capable of achieving health and
well-being independent of weight

Assumptions
 BMI does not reflect health status or moral character
 Weight not a focal point for medical treatment or
intervention
 Other factors influence weight loss and regain (access to
food, genetics, poor nutritional advice)
Body Composition
Obesity
Definition- a severe excess of fat in proportion to
lean body mass
Evaluation of Obesity

BMI = weight (kg) ÷

height (cm) ÷ height
(cm) × 10,000

or

BMI = weight (lbs.) ÷

height (in.) ÷ height (in.)
× 703

What are some pros and

cons?
Classification

Disease Risk To Normal

Weight and Waist Circumference
BMI (kg/m2) Men, ≤ 102 cm Men, ≥ 102 cm
Women, ≤ 88 cm Women, ≥ 88 cm

Underweight < 18.5 ------- ------

Normal 18.5 – 24.9 ------- ------
Overweight 25 – 29.9 Increased High
Obesity, Class
I 30 – 34.9 High Very High
II 35 – 39.9 Very high Very High
III ≥ 40 Extremely high Extremely High

ACSM’s Guidelines, P. 63
Terms
 Morbidity:

 Prevalence: Number of individuals in poor health during a given time period

 Incidence: the number of newly appearing cases of the disease per unit time

 Mortality:

 Number of deaths in some population, scaled to size of the population, per unit time

 Co-morbidity: coexisting diseases

 Review paper defining comorbidity

Obesity and All-Cause Mortality Among Black Adults and White Adults
Am J Epidemiol. 2012;176(5):431–442
Obesity and All-Cause Mortality Among Black Adults and White Adults
Am J Epidemiol. 2012;176(5):431–442
Pennington Biomedical Research Center,
Louisiana State University System,
Baton Rouge, Louisiana, USA

14,343 participants

• 5,506 white women

• 3,524 African American women,
• 4,076 white men
• 1,237 African American men
• 18-89 years of age

1994 – 2009

Obesity (2013) 21, 1070-1075.

NHANES III
Risk of multiple comorbidities rises with
obesity, regardless of gender or race
Adipose Tissue
Visceral Adipose Tissue
Brown Fat
Skinfold Measurements
Estimates Used in Gyms
Body Mass Index
Only an indicator of health
Bioelectrical Impedance
Analysis Weight (kg)
BMI =
Height (m2)

Waist-to-Hip Ratio
Only an indicator of health
Underwater Weighing Bod Pod
DEXA
Magnetic Resonance Imaging
(MRI)
So, how does excess
adipose tissue lead to
health problems?
White Adipose Tissue: Structure

• Large in size

• Single,
unilocular lipid
droplet
Endocrine Function
Cytokines
Cytokines - are small cell-signaling protein used
extensively in intercellular communication.

“Cytokine" encompasses a large and diverse

family of regulators produced throughout the
body.
Adipokines

 Previously known as adipocytokines

 Protein molecules secreted specifically from adipocytes

 Can act in

 Autocrine – self regulating

 Paracrine – regulation of nearby tissue

 Endocrine function – regulation of whole body

 Over 60 currently known

Adipokine Function

Function Primary Adipokine(s)

Appetite and energy balance Leptin

Angiogenesis Vascular endothelial growth factor

Lipid metabolism Apolipoprotein E

Blood pressure regulation Angiotensinogen

Vascular hemostasis PAI-1

Insulin sensitivity Adiponectin, IL-6, TNF-α

Inflammation and immunity IL-1β, TNF-α, MCP-1

Adipogenesis Chemerin
Fat Cell Function

Ouchi, 2011
 Pathological Changes Associated with
Overweight and Obesity

Environment Genes

Activity Food Intake

Excess Fat Stores

Disease due to
Disease due to
increased fat
“sick” fat cells
mass

Diabetes NAFLD CVD Stigma Osteoarthritis

GB
Cancer Sleep Apnea
Disease
Obesity
Definition- a severe excess of fat in proportion to
lean body mass

“Eat less, run more”

Is it this easy?
Hunger, Satiation, Satiety, and
Appetite
Hunger Satiation
“I need to eat” “I’m full”

Satiety
Time Between 2 States
Hunger, Satiation, Satiety, and
Appetite
Psychological desire to eat food, which may or
may not be a result of hunger.
Leptin
Hormone Primarily synthesized in WAT

Leptin signals

satiety

 Direct positive correlation between WAT and

serum leptin

 Primary effect is on energy intake

Leptin: Miracle Drug?
Ghrelin
Hormone produced by cells in stomach
and duodenum
Triggers the CNS to release neuropeptide
Y (NPY), which stimulates food intake

These inhibit food intake

Ghrelin
Ghrelin increases with weight loss in
“normal weight” women
Ghrelin is lower in obese women
 Proposed: body in energy excess, so no need to stimulate
hunger

Weight loss in obese women leads to

increased ghrelin
 Possible weight cycling
Adiponectin

Synthesized primarily in adipocytes

Indirectly correlated w/ obesity

Improves:
Insulin sensitivity

Vascular function

Inflammatory response

Appetite and energy balance control

Location, Location,
Location!
Visceral Fat
Visceral lies deep with in body cavity
 Surrounds organs
 Associated with insulin resistance
 Higher risk factor than subcutaneous

Measured by MRI

Practical measure is sagittal

diameter

Waist circumference
Epicardial Fat, Cardiac Dimensions, and Low-Grade Inflammation
in Young Adult Monozygotic Twins Discordant for Obesity
Epicardial Fat, Cardiac Dimensions, and Low-Grade Inflammation
in Young Adult Monozygotic Twins Discordant for Obesity

Monozygotic Twins

Lean Obese
Visceral Adipose Tissue
Epicardial adipose tissue
Genetics
“In conclusion, subjects who share the same
genes seem to have similar cardiac dimensions.
However, acquired obesity increases epicardial
fat independent of genetic factors. The close
relation between epicardial fat and low-grade
inflammation is likely to contribute to the
development of cardiovascular disease in
obesity.”
Metabolic Responses to
Reduced Daily Steps
in Healthy Non-exercising Men

What happens if you reduce steps per day in a young healthy

population?

The purpose of this study was to reduce daily steps and assess
metabolic changes.

JAMA, March 19, 2008—Vol 299, No. 11

Methods
Excluded participants who walked less than
3,500 steps

Excluded participants who exercised more than 2

hours per week

Male

27.1 years (5.7)

22.9 BMI (4)

Results

7% increase in intra-abdominal fat

 Results

Insulin Area Under the

Curve – example this
graph is not from study
Insulin
Why is Obesity a
Health Issue?
U.S. Adults by State and Territory, BRFSS,
2014
¶
Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be
compared to prevalence estimates before 2011.

*Sample size <50 or the relative standard error (dividing the standard error by the
prevalence) ≥ 30%.
Metabolically Healthy Obese (MHO) Metabolically Obese Normal Weight
• Insulin Sensitive (MONW)
• Normal Lipid Levels • Insulin Resistant
• Normal Blood Pressure • Dyslipidemia
• Low levels of inflammatory markers • Hypertensive
• Elevated inflammatory markers
Take Home
Obesity as a risk factor for mortality is a
complicated issue

BMI alone is not a valid way to classify

individual risk

Visceral adipose tissue is the key in determining

metabolic health

Everyone should be taken on a case by case basis