Global Epidemiology Of Obesity

1. Global Epidemiology Of Obesity <ul><li>Dr. Sumeet Shah </li></ul><ul><li>Consultant Laparoscopic and Bariatric Surgeon…
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  • 1. Global Epidemiology Of Obesity <ul><li>Dr. Sumeet Shah </li></ul><ul><li>Consultant Laparoscopic and Bariatric Surgeon </li></ul><ul><li>Sir Ganga Ram Hospital </li></ul><ul><li>New Delhi </li></ul>
  • 2. The human phenotype is changing rapidly Increased body size and fatter body composition Response to environments that make low demands on energy expenditure, together with greater energy-density diets This change is occurring within one to three generations, around the world Not entirely an urban phenomenon, but more pronounced in big cities
  • 3. The Obesity Pandemic <ul><li>~1 billion malnourished worldwide </li></ul><ul><li>>1 billion overweight worldwide </li></ul><ul><li>>350 million obese worldwide </li></ul><ul><li>2.5 million obesity-deaths annually </li></ul><ul><li>2000: 170 million diabetics worldwide </li></ul><ul><li>2020: Doubled </li></ul>Source: International obesity task force & WHO
  • 4. Obesity Trends* Among U.S. Adults BRFSS, 1990 *BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person No Data <10% 10%–14%
  • 5. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
  • 6. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  • 7. Obesity rates: Current and projected 0 10 20 30 40 50 1960 1970 1980 1990 2000 2010 2020 2030 USA England Mauritius Australia Brazil Population percentage with BMI > 30kg/m 2
  • 8. The Demographic Transition
  • 12. South Atlantic Ocean South Pacific Ocean North Atlantic Ocean Indian Ocean Arctic Ocean Arctic Ocean Arctic Ocean North Pacific Ocean Brazil South Africa Tanzania Kenya Egypt Mali China India Ghana Kyrgyzstan Bolivia Madagascar Namibia Zimbabwe Malawi Cameroon C. A. R. Côte D’Ivoire Turkey Vietnam Kazakhstan Uzbekistan Uganda Peru Colombia Dominican Republic Guatemala Haiti Niger Nigeria Senegal Zambia Benin Chad Guinea Yemen Nepal Bang. Togo Patterns of Overweight and Obesity among Women of Child-bearing Age from the DHS (BMI>25, Ages 20-49 , Age-Standardized, Weighted) 10-20% 31-40% 21-30% 41-50% > 51% <10% Burkina Faso Mozambique Comoros Eritrea Jordan Mexico
  • 14. Prevalence of Obese Preschool Children In Selected Countries and Territories
  • 17. Less Active Lifestyles
  • 18. Childhood Obesity <ul><li>28% of Delhi’s children in the 14-18 age group are overweight or obese. </li></ul><ul><li>13% of Delhi’s school children – positive for C-reactive protein </li></ul><ul><li>Women & Child Development Ministry </li></ul><ul><li>Diabetes Foundation of India </li></ul>
  • 20. Prevalence of obesity - India <ul><li>Overweight – females – 47.5% </li></ul><ul><li>males - 32% </li></ul><ul><li>Obese – females – 14% </li></ul><ul><li>males – 3% </li></ul><ul><li>Abdominal adiposity – females – 35% </li></ul><ul><li>males – 49% </li></ul><ul><li> </li></ul>
  • 21. The “Nutrition Transition” <ul><li>Changes in age structure of the population, diet and physical activity patterns that result in </li></ul><ul><ul><li>Emergence of obesity as a common problem, with its predictable co-morbidities </li></ul></ul><ul><ul><li>Change in nature and extent of cancer burden </li></ul></ul><ul><ul><li>Increases in other chronic diseases depending on the nature of dietary and lifestyle shifts </li></ul></ul><ul><ul><li>with or without solution of existing problems of under- and mal-nutrition </li></ul></ul>
  • 22. Driving Forces behind the Nutrition Transition <ul><li>Increases in life expectancy and declines in mortality: larger proportion of adults and growing number of elderly </li></ul><ul><li>Urbanization </li></ul><ul><li>Economic and technical development </li></ul><ul><li>Changes in physical activity and diet </li></ul><ul><ul><li>Sedentary occupations and leisure-time activities </li></ul></ul><ul><ul><li>Urban environments that restrain physical activity </li></ul></ul><ul><ul><li>Dietary change: increases in dietary fat, sugar, animal products, ?total dietary energy, + declines in dietary quality </li></ul></ul>
  • 23. Predictable Sequence of the Developing Epidemic of Nutrition-Related Non-Communicable Diseases (NR-NCDs) Obesity and overweight are the first manifestation Within a generation, the prevalence of Type 2 diabetes mellitus and/or hypertension and stroke rise Within two generations, premature CHD emerges as a major cause of premature death, disability and health care costs Within two generations, the nature of the cancer burden shifts to domination by diet- and physical-activity related cancers
  • 24. Deaths, by broad cause group and WHO Region, 2000 Injuries Noncommunicable conditions Communicable diseases, maternal and perinatal conditions and nutritional deficiencies AFR EMR EUR SEAR WPR AMR 25 50 75 % Source: WHO, World Health Report 2001
  • 25. Current Situation in the World’s Largest Countries <ul><li>China (1.26 billion) </li></ul><ul><li>Fast-growing economy (8.5%/year GDP growth) </li></ul><ul><ul><li>% of population in poverty down from 20% in 1980s to <10% </li></ul></ul><ul><ul><li> % of deaths due to NR-NCDs: 41.6% in 1995, 52.0% by 2020 </li></ul></ul><ul><li>India (1 billion) </li></ul><ul><li>Real economic growth 3%/yr GDP </li></ul><ul><li>% of population in poverty down from 55% in 1970 to 26% </li></ul><ul><li>% of deaths due to NR-NCDs: 31.6% in 1995; 43.3% by 2020 </li></ul>
  • 26. Costs of Undernutrition and NR-NCDs in the World’s Largest Countries <ul><li>China: Costs of undernutrition and NR-NCDs currently equal; NR-NCDs will dominate by 2025 </li></ul><ul><li>India: Costs of undernutrition still predominate, but NR-NCDs will contribute as much cost by the year 2025 </li></ul>
  • 27. Nature of the Transition in the World’s Largest Countries <ul><li>China: dramatic rises in hypertension, stroke </li></ul><ul><li>India: major rise in incidence of adult-onset diabetes </li></ul><ul><li>Reasons for contrasting experience? </li></ul><ul><ul><li>?genetic backgrounds? </li></ul></ul><ul><ul><li>Nature of dietary shift (oils and meats in China, sugars and dairy products in India) </li></ul></ul>
  • 28. <ul><li>Increase in prevalence in China over last 20 years was 400% compared to 20% in Australia </li></ul><ul><li>Asia Pacific Cohort Studies Collaboration </li></ul>
  • 33. Health risks overweight Abdominal obesity Dyslipidemia Insulin resistance Hypertension Proinflammatory state Prothrombotic state Cardio-vascular disease Diabetes Mellitus Metabolic disorders as a common denominator for the various components Nutrition may play an important role in the development Overweight subjects are at increased risk of developing metabolic disorders
  • 34. Why is obesity an even bigger problem for developing countries? <ul><li>More limited resources </li></ul><ul><li>Late recognition of the problem </li></ul><ul><li>Cultural factors favoring overweight, favoring overeating, favoring sedentary lifestyles, and/or stigmatizing thinness in some areas </li></ul>
  • 35. In Summary……. <ul><li>Nearly a million Overweight/ Obese population in the country </li></ul><ul><li>Rising prevalence amongst children and young adults </li></ul><ul><li>Much higher incidence of abdominal adiposity and metabolic syndrome </li></ul><ul><li>Diabetes capital of the world </li></ul>
  • 36. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004 Oct 13;292(14):1724-37 Buchwald H , Avidor Y , Braunwald E , Jensen MD , Pories W , Fahrbach K , Schoelles K . Department of Surgery, University of Minnesota, Minneapolis 55455, USA. CONTEXT : About 5% of the US population is morbidly obese. This disease remains largely refractory to diet and drug therapy, but generally responds well to bariatric surgery. OBJECTIVE: To determine the impact of bariatric surgery on weight loss, operative mortality outcome, and 4 obesity comorbidities (diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea). DATA SOURCES AND STUDY SELECTION: Electronic literature search of MEDLINE, Current Contents, and the Cochrane Library databases plus manual reference checks of all articles on bariatric surgery published in the English language between 1990 and 2003. Two levels of screening were used on 2738 citations. DATA EXTRACTION: A total of 136 fully extracted studies, which included 91 overlapping patient populations (kin studies), were included for a total of 22,094 patients. Nineteen percent of the patients were men and 72.6% were women, with a mean age of 39 years (range, 16-64 years). Sex was not reported for 1537 patients (8%). The baseline mean body mass index for 16 944 patients was 46.9 (range, 32.3-68.8). DATA SYNTHESIS: A random effects model was used in the meta-analysis. The mean (95% confidence interval) percentage of excess weight loss was 61.2% (58.1%-64.4%) for all patients; 47.5% (40.7%-54.2%) for patients who underwent gastric banding; 61.6% (56.7%-66.5%), gastric bypass; 68.2% (61.5%-74.8%), gastroplasty; and 70.1% (66.3%-73.9%), biliopancreatic diversion or duodenal switch. Operative mortality (< or =30 days) in the extracted studies was 0.1% for the purely restrictive procedures, 0.5% for gastric bypass, and 1.1% for biliopancreatic diversion or duodenal switch. Diabetes was completely resolved in 76.8% of patients and resolved or improved in 86.0%. Hyperlipidemia improved in 70% or more of patients. Hypertension was resolved in 61.7% of patients and resolved or improved in 78.5%. Obstructive sleep apnea was resolved in 85.7% of patients and was resolved or improved in 83.6% of patients. CONCLUSIONS: Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement
  • 37. Number of weight loss operations performed in the United States JAMA. 2005;294:1909-1917.
  • 38. <ul><li>Thank You </li></ul><ul><li>Thank You </li></ul>
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