Obesity Presentation Assignment: Pathophysiology, Risk Assessment and Prevalence

Obesity Presentation Assignment: Pathophysiology, Risk Assessment and Prevalence

Note: This is an individual assignment. Based on the feedback offered by the provider, identify the best approach for teaching. Prepare a presentation to accompany the teaching plan and present the information to your community. Select one of the following options for delivery of the presentation:

1. PowerPoint presentation – no more than 30 minutes
2. Pamphlet presentation – 1 to 2 pages
3. Poster presentation

Appropriate community settings include:

1. Public health clinic
2. Community health center
3. Long-term care facility
4. Transitional care facility
5. Home health center
6. University/School health center
7. Church community
8. Adult/Child care center

Before presenting information to the community, seek approval from an agency administrator or representative.

Upon receiving approval from the agency, include the “Community Teaching Experience Form” as part of your assignment submission.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

Select one of the following alterations of cardiovascular disorders: peripheral arterial disease, myocardial infarction, coronary artery disease, congestive heart failure, or dysrhythmia. Think about how hypertension or dyslipidemia can lead to the alteration you selected.

Post a description of the pathophysiology of cardiovascular disorders, including how the factor you selected might impact the pathophysiology. Then, explain how hypertension or dyslipidemia can lead to the alteration you selected for patients with the factor you identified.

ORDER Obesity Presentation Assignment

Obesity: Pathophysiology, Risk Assessment, and Prevalence – PowerPoint PPT Presentation

Title: Obesity: Pathophysiology, Risk Assessment, and Prevalence

1
Obesity Pathophysiology, Risk Assessment, and
Prevalence
2
Obesity

• Excessive amount of body fat
• Women with gt 35 body fat
• Men with gt 25 body fat
• Increased risk for health problems
• Are usually overweight, but can have healthy BMI
  and high fat
• Measurements using calipers

3
Desirable Body Fat

• Men 8-25
• Women 20-35

4
Regional Distribution

• The regional distribution of body fat affects
  risk factors for the heart disease and type 2
  diabetes

5
Body Fat Distribution Gynecoid

• Lower-body obesity–Pear shape
• Encouraged by estrogen and progesterone
• Less health risk than upper-body obesity
• After menopause, upper-body obesity appears

6
Body Fat Distribution Android

• Upper-body obesity–apple shape
• Associated with more heart disease, HTN, Type II
  Diabetes
• Abdominal fat is released right into the liver
• Encouraged by testosterone and excessive alcohol
  intake
• Defined as waist measurement of gt 40 for men and
  gt35 for women

7
Body Fat Distribution
8
Weight Management

• Balancing energy intake and energy expenditure is
  the basis of weight management throughout life

9
Set Point Theory

• Body tends to preserve a given weight
• Energy expenditure increases and decreases with
  weight loss and gain
• Effect may be temporary, e.g. energy needs drop
  during calorie restriction and normalize when
  energy balance is achieved

10
Components of Energy Expenditure

• Resting energy expenditure expressed as RMR
• Energy expended in voluntary activity
• Thermic effect of food (TEF) or diet-induced
  thermogenesis (DIT)
• Related to energy value of food consumed and
  adaptive response to overeating
• TEF may decline as day progresses (Romon, AJCN,
  1993)

11
Resting Metabolic Rate

• Increases with increased muscle mass
• Declines with age
• Declines during restriction of energy intake (up
  to 15)
• Explains 60-70 of total energy expenditure. Obesity Presentation Assignment: Pathophysiology, Risk Assessment and Prevalence

12
Voluntary Energy Expenditure (activity
thermogenesis)

• The most variable component of energy expenditure
• Accounts for 15-30 of total
• Most of us will require increasing voluntary
  energy expenditure as we age to offset declining
  fat free mass and RMR in order to maintain weight

13
Role of Brain Neurotransmitters

• Neurotransmitters govern the bodys response to
  starvation and dietary intake
• Decreases in serotonin and increases in
  neuropeptide Y are associated with an increase in
  carbohydrate appetite
• Neuropeptide Y increases during deprivation may
  account for increase in appetite after dieting
• Cravings for sweet high-fat foods among obese and
  bulimic patients may involve the endorphin system

14
Hormonal Regulation of Body Weight

• Norepinephrine and dopaminereleased by
  sympathetic nervous system in response to dietary
  intake
• Fasting and semistarvation lead to decreased
  levels of these neurotransmittersmore
  epinephrine is made and substrate is mobilized.

15
Hormones and Weight

• Hypothyroidism may diminish adaptive
  thermogenesis
• Insulin resistance may impair adaptive
  thermogenesis
• Leptin is secreted in proportion to percent
  adipose tissue and may regulate (decrease)
  appetite

16
Hunger vs. Satiety

• Satietypostprandial state when excess food is
  being stored
• Hungerpostabsorptive state when stores are being
  mobilized
• Short-term regulation affected

17
Hunger vs. Satietycontd

• Feedback mechanism with signal from adipose mass
  when weight loss occurseating is the natural
  result
• Not always identified in the elderly
• This occurs mostly in young people
• Long-term regulation affected

18
Nature vs Nurture

• Identical twins raised apart have similar weights
• Genetics account for 40-70 of weight
  differences
• Genes affect metabolic rate, fuel use, brain
  chemistry, body shape
• Thrifty metabolism gene allows for more fat
  storage to protect against famine

19
Nature vs Nurture

• Obesity tends to run in families
• If both parents are normal weight 10 chance of
  obesity in offspring
• If one parent is obese 40 chance
• If both parents obese 80 chance
• Is it genetics or learned eating behavior? Obesity Presentation Assignment: Pathophysiology, Risk Assessment and Prevalence

20
Nurture vs Nature

• Environmental factors influence weight
• Learned eating habits
• Activity factor (or lack of)
• Poverty and obesity
• Female obesity is rooted in childhood obesity
• Male obesity appears after age 30

21
Nurture vs Nature

• Overeating learned early in childhood
• Bottle vs breast
• Urging children to eat more, clean their plates
• Use of food as a reward

22
Food Love
Shelly Thorene Photography
23
Nature and Nurture

• Obesity is nurture allowing nature to express
  itself
• Location of fat is influenced by genetics
• A child of obese parents must always be concerned
  about his weight

24
Nature and Nurture

• The influence of environment is apparent in the
  fact that the prevalence of obesity has increased
  dramatically in the US in the past 40 years

25
Causes of Obesity
26
Causes of Excessive Energy Intake

• Active large portion sizes, frequent meals and
  snacks
• Passive excessive intake of energy-dense foods
  containing hidden calories
• Variety of options the greater the variety of
  foods offered, the greater the intake
• Sensory-specific satiety as foods are consumed
  they become less appealing

27
Low Energy Expenditure

• There is a mismatch between our thrifty metabolic
  genetic heritage and the sedentary American
  lifestyle

28
Obesity is a Growing Problem

• 127 million adults in the U.S. are overweight, 60
  million obese, and 9 million severely obese.
• 66 percent of U.S. adults are overweight (BMI25)
• 32 percent are obese (BMI30)
• 17 of children and adolescents ages 2-19 are
  overweight

29
Obesity Trends Among U.S. Adults BRFSS
30
Prevalence of Obesity in Ohio
31
Obesity A Major Health Issue

• Obesity is the No. 2 preventable cause of death
  and disability (smoking is 1)
• Obesity is associated with increased risk of
  heart disease, stroke, gallbladder disease,
  cancer, osteoarthritis, sleep apnea
• Obesity-related health problems cost 75 billion
  annually (2003 data)
• The public pays about 39 billion a year — or
  about 175 per person — for obesity through
  Medicare and Medicaid programs

32
Health Problems Associated with Excess Body Fat

• Surgical risk
• Lung (pulmonary) disease
• Sleep apnea
• HTN
• CVD
• Bone and joint disorders (gout, osteoarthritis)

• Type 2 diabetes
• Gallstones
• Cancers (breast, colon, pancreas, gallbladder)
• Infertility
• Pregnancy- difficult delivery
• Reduced agility
• Early death

33
NHANES III Prevalence of Hypertension According
to BMI
Percent
Defined as mean systolic blood pressure ?140 mm
Hg, mean diastolic ?90 mm Hg, or currently
taking antihypertensive medication.
Brown C et al. Body Mass Index and the
Prevalence of Hypertension and Dyslipidemia.
Obes Res. 20008605-619.
34
Obesity and Diabetes Risk
Incidence of New Cases per 1,000 Person-Years
BMI Levels
Knowler WC et al. Am J Epidemiol
1981113144-156.
35
Weight Gain and Diabetes Risk
Weight Change Since Age 21
Relative Risk
Body Mass Index at Age 21
Adapted from Chan JM et al. Diabetes Care
199417960-969.
36
Metabolic Syndrome Criteria

• Three or more of the following abnormalities
• Waist circumference gt102 cm (40 inches) in men
  and gt 88 cm (35 inches) in women
• Serum triglycerides of at least 150 mg/dL
• High density lipoprotein level lt40 mg/dL in men
  and lt50 mg/dL in women
• Blood pressure gt135/85 mm/hg
• Serum glucose gt110 mg/dl
• Includes 47 million US residents (27.7 of the
  population
• Obesity Presentation Assignment: Pathophysiology, Risk Assessment and Prevalence

ATP III Guidelines. National Cholesterol
Education Program, 2001
37
Polycystic Ovary Syndrome (PCOS)

• Endocrine disorder characterized by
  hyperandrogenism and insulin resistance
• Associated with android obesity
• Affects 5-10 of reproductive age women
• Erratic menstrual periods, chronic anovulations
  resulting in multiple ovarian cysts
  infertility, acne, hirsutism and alopecia
• Increased risk of heart disease, type 2 diabetes,
  reproductive cancers

38
Management of PCOS

• Symptom oriented, as etiology is unclear
• Individualized diet and exercise plan to promote
  weight loss and normalize insulin levels
• Medications to alleviate symptoms

39
26 -Year Incidence of Coronary Heart Disease in
Men
Incidence/1,000
BMI Levels
Adapted from Hubert HB et al. Circulation
198367968-977. Metropolitan Relative Weight of
110 is a BMI of approximately 25.
40
26 -Year Incidence of Coronary Heart Disease in
Women
Incidence/1,000
BMI Levels
Adapted from Hubert HB et al. Circulation
198367968-977. Metropolitan Relative Weight
of 110 is a BMI of approximately 25.
41
Hypertension
60
50
40
Percentage
30
20
10
20
25
30
35
40
BMI
Relationship between BMI and crude percentage of
women reporting medical problems, surgical
procedures, symptoms, and health care utilization.
Brown WJ et al. Int J Obes 199822520-528.
42
Diabetes
15
10
Percentage
5
0
20
25
30
35
40
BMI
Relationship between BMI and crude percentage of
women reporting medical problems, surgical
procedures, symptoms, and health care utilization.
Brown WJ et al. Int J Obes 199822520-528.
43
Cholescystectomy
25
20
Percentage
15
10
5
20
25
30
35
40
BMI
Relationship between BMI and crude percentage of
women reporting medical problems, surgical
procedures, symptoms, and health care utilization.
Brown WJ et al. Int J Obes 199822520-528.
44
Back Pain
35
30
Percentage
25
20
15
20
25
30
35
40
BMI
Relationship between BMI and crude percentage of
women reporting medical problems, surgical
procedures, symptoms, and health care utilization.
Brown WJ et al. Int J Obes 199822520-528.
45
Body Mass Index and Mortality Risk
(Adapted from Bray GA. Gray DS, Obesity, part 1
Pathogenesis. West J Med 149429, 1988 and Lew
EA, Garfinkle L Variations in mortality by
weight among 750,000 men and women. J Clin
Epidemiol 32563, 1979.)
46
BMI and Health
Below 18.5 Underweight
18.5 24.9 Normal
25.0 29.9 Overweight Monitor for risk
30.0 and Above Obese Increased health risk
40.0 and above Severely obese Major health risk. Obesity Presentation Assignment: Pathophysiology, Risk Assessment and Prevalence.