OBESITY AND PREVENTION Nutrition 500 WEIGHT LOSS RECIDIVISM 1-5-06 Division of Metabolism,...

OBESITY AND PREVENTION

Nutrition 500

WEIGHT LOSS RECIDIVISM1-5-06

Division of Metabolism, Endocrinology and NutritionJohn Brunzell, MD

Build and Blood Pressure Study 1959

Build Study 1979American Cancer Society Study 1979

Manson, JAMA 1987;257:353

Mortality

Ratio

% of Average Weight

Men2.5

2.0

1.5

1.0

0.5

080 90 100 110 120 130 140 150 160

Mortality Increases With Body Weight

48 yo

Medical Complications of Obesity

Phlebitisvenous stasis

Coronary heart disease

Pulmonary diseaseabnormal functionobstructive sleep apneahypoventilation syndrome

Gall bladder disease

Gynecologic abnormalitiesabnormal mensesinfertilitypolycystic ovarian syndrome

Gout

Stroke

Diabetes

Osteoarthritis

Cancerbreast, uterus, cervixcolon, esophagus, pancreaskidney, prostate

Nonalcoholic fatty liver diseasesteatosissteatohepatitiscirrhosis Hypertension

Dyslipidemia

Cataracts

Skin Infections

Idiopathic intracranial hypertension

Pancreatitis

NAASO

NEJM 1999p427

Women

Men

Middle aged

Medical Complications of “Central” Obesity

Coronary heart disease

Gynecologic abnormalitiespolycystic ovarian syndrome

Gout

Stroke

Diabetes

Nonalcoholic fatty liver diseasesteatosissteatohepatitis

HypertensionDyslipidemia

Modified from NAASO

Current and projected obesity prevalence rates from 1960 to 2025

Kopelman. Nature 404, 635 - 643 (2000)

SMOKING AND BMI: NHANES 88-91

Flegal et al. NEJM 1995, p1165

24

26

28

30

32

-5 0 5 10 15

Years

BM

I

Female Quit

Male Quit

Female Never

Male Never

Female Still

Male Still

KG8.55.3

3.81.5

3.01.8

3

In conditions of plenty,

body weight is 60-80%

genetically determined

D. Cummings

MonozygoticTwins

Dizygotic Twins

Adopted Children’s Weight Correlates WithWeight of Their Biological, Not Adoptive, Parents

Stunkard et al, NEJM 1986;314:193

BMI of

Parents

(kg/m2)

Thin Median Overweight ObeseThin Median Overweight Obese

Biological Parents Adoptive Parents27

21

26

25

24

23

22

Weight Category of Children

Fathers

Mothers

Genetic Leptin Deficiency Causes Obesity in ob/ob mice

Farooqi et al, Farooqi et al, JCI 110:1093, JCI 110:1093, 20022002

Leptin Deficiency also CausesLeptin Deficiency also Causes Obesity in HumansObesity in Humans

Weight Regain After Behavior Modification

Diet Program: 16 studies

0

20

40

60

80

100

0 1 2 3 4 5

Duration of Follow-Up (years)

% Weight Regain

Safer. So. Med. J. 84:1470, 1991

Diabetes Prevention Program

Regaining weight, final results not in

24 Hour Energy Expenditure

BEFORE AND AFTER WEIGHT LOSS

24 Hour Non-resting Energy Expenditure

Adam Drewnowski and reduced obese individuals

“Sweet and Fat Tooth”

Physiol Behavior 1985, 35:617-622

Usualweight

Weightloss

Weightgain

“Adipostatic” Body Weight Regulation

Counter regulationR. Schwartz, 1982

Usualweight

Weightloss

Weightgain

“Adipostatic” Body Weight Regulation

Counter regulation

Counter regulationR. Schwartz 1982

Body weight is regulated

within a narrow,

individualized range.

body fat stores

leptin/insulin

Adiposity Negative FeedbackAdiposity Negative Feedback

-

energy balance

body fat stores

Food intakeEnergy expenditure

-

Circulatingsignals

Adiposity Negative FeedbackAdiposity Negative Feedback

Copyright ©2005 American Society for Clinical Investigation

Rosenbaum, M. et al. J. Clin. Invest. 2005;115:3579-3586

Schematic of protocol



Effects of weight loss and leptin administration on circulating leptin concentrations



Energy expenditure and skeletal muscle

Body Weight Ballpark:

5-10% Volitional Control

Body

Weight

(lbs)

Time0

100

200

300

0

100

200

300

20 year old male

170 lb.

60 year old male

210 lb.1 lb. per year = 3500 kcal/365 days...or…

~10 kcal/day

Prevalence of Overweight Children and

Adolescents in the United States Is Increasing

0

5

10

15

1963–70 1971–74 1976–80 1988–94 1999

Prevalence of Overweight (%)

Troiano. Arch Pediatr Adol Med 1995;149:1085NHANES 1999: www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight99.htm

Children, 6–11 y

Adolescents, 12–17 y

OBESITY AND PREVENTIONNutrition 500

Dietary fat and fructose?

Sedentary lifestyle?

Venus of

Willendorf

(24,000 BCE)

Miss America:An Undernourished Role Model?

Rubinstein and Caballero JAMA. 2000;283:1569-1569

MORTALITY IN MEN 60-69 YEARS OLD

1979

The Metabolic Syndrome

Hypertension

Type 2 Diabetes

Dyslipidemia

VisceralObesity

Increased PAI-1

InsulinInsulinResistanceResistance

Free Fatty Acids

Atherosclerosis

Oligogenic Metabolic Disorders

Metabolic Syndrome

Familial Combined

Hyperlipidemia

Type 2

Diabetes

PREMATURE CORONARY DISEASE

Metabolic Syndrome

Familial Combined

Hyperlipidemia

Type 2

Diabetes

15-20% 20-30%

OBESITY AND PREVENTION Nutrition 500 WEIGHT LOSS RECIDIVISM 1-5-06 Division of Metabolism,...

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