AH Mokdad, CDC M Shields, Statistics Canada, 2005

Gotye, et al, 2013

YEAR   2003 2005 2007 2008 2009

Total 18 years of age or over

49.4 50.0 50.8 51.1 51.6

Males 57.3 58.1 58.7 58.6 59.2

Females 41.3 41.8 42.9 43.5 43.9

Canadian Community Health Survey 2009

Pulmonary Disease

•  Abnormal function

•  Obstructive sleep apnea

• Pulmonary HTN

•  Hypoventilation syndrome

Nonalcoholic Fatty Liver Disease

•  Steatosis

•  Steatohepatitis

•  Cirrhosis

Gall Bladder Disease

Gynecologic Abnormalities

•  Abnormal menses

•  Infertility

•  Polycystic ovarian syndrome

Idiopathic Intracranial Hypertension

Stroke Cataracts

Coronary Heart Disease

CHF

Hypertension Dyslipidemia

Diabetes Severe Pancreatitis

Cancer

Breast, uterus, cervix, colon, esophagus, pancreas, kidney, prostate

Phlebitis

•  Venous stasis

Gout Peripheral Vascular Disease

Osteoarthritis

Adverse cardiometabolic effects of products of adipocytes

Adipose tissue

↑ IL-6

↓ Adiponectin

↑ Leptin

↑ TNFα

↑ Adipsin (Complement D)

↑ Plasminogen activator inhibitor-1

(PAI-1)

↑ Resistin

↑ FFA

↑ Insulin

↑ Agiotensinogen

↑ Lipoprotein lipase

↑ Lactate

Inflammation

Type 2 diabetes

Hypertension

Atherogenic dyslipidaemia

Thrombosis Atherosclerosis

Lyon 2003; Trayhurn et al 2004; Eckel et al 2005

5

39 35

4.5

19 11

22 12

0 0 5

10 15 20 25 30 35 40 45

10

Identical Twins Fraternal Twins Borjeson, Acta Pediatrca Scand, 1976

Heritability refers to the proportion of the variance in a trait in the population that can be attributed to genes. Calculations are based on Stunkard et al, JAMA,256:1, 1986

Exercise 15%

Thermogenesis 15%

Basal Metabolic

Rate 70%

Duration and Intensity of Exercise

Food Intake Cold Stress Thermogenic Drugs

Fat Free mass Age Gender Hormones Drugs Protein Turnover

calories

0

2000

REE = Resting energy expenditure

En

ergy

Exp

end

itu

re (%

RE

E)

Liver, Brain, Kidneys, Gut, Heart

Tissue energy expenditure

Tissue weight

Weigh

t (% B

ody W

eight)

80

60

40

20

0 Skeletal Muscle

Adipose Tissue,

Lean Person

Adipose Tissue, Obese Person

Owen O.. Mayo Clin Proc 1988;63:503-510.

NeuropeptideY Agouti-related protein galanin

Orexin-A dynorphin

Melanocyte stimulating hormone Propiomelanocortin Glucagon-like-peptide-1

Cocaine/amphetamine regulated transcript NE 5-HT

Glucose

CCK, GLP-1, Apo-A-IV Vagal afferents

Insulin Ghrelin

Leptin

Cortisol + -

-

+

Gastrointestinal tract

Adipose tissue

Food Intake

Adrenal glands

External factors Emotions Food characteristics Lifestyle behaviors Environmental cues

Adapted from Dr. R. Johns

Steiger, A. et al,2012, Obesity 20, 1212-1217

Johns et al, 1999: Obesity (23) 1335-1346

Coffee with cream and sugar 45 calories

Grande Mocha Latte with whip cream 440 calories

395 calorie difference

Hiking uphill continuously for 35 minutes

0 12 25 125

0 4 8 12

Excess intake (kcal/d)

Rosenbaum M et al. N Engl J Med. 1997;337:396-408.

Energy intake

(kcal/y)

Change in body fat (lb/y)

12 lbs per year

Adapted from Dr. R. Ross

750 205

Wing. Med Sci Sports Exerc 1999;31(suppl):S547.

*P<0.05 vs control group Duration of each study ranged from 4 to 12 months.

Stefanick 1998

Stefanick 1998a

Anderssen 1995

Hammer 1989

Verity 1989

Rönnemaa 1988

Wood 1988

Wood 1983

Weight loss (kg)

Control Group Exercise Group

* *

* *

Diet Only

Loss

of F

at-F

ree

Mas

s (%

Tot

al W

eigh

t Los

s)

Diet Plus Physical Activity

Men Women

*P<0.05

Reprinted with permission from Int J Obes Relat Metab Disord, Ballor and Poehlman;18:35. Copyright 1994 Macmillan Publishers Ltd.

Lean <16.7%

Rel

ativ

e R

isk

of C

VD

Mor

talit

y

Body Fat Category (% Weight as Fat) Lee et al. Am J Clin Nutr 1999;69:373.

Normal 16.7%-24.9%

Obese >25%

Aerobically fit Unfit

250 kcal of carrots

1250 kcal of cookies

0

20

40

60

80

100

120

Fruits & Vegetables

Sugars Pop Fats and Oils

Percentage Increase

USDA 2008 data

12-02-28 8:37 PMDistance To McDonald’s – The Contiguous United States, September 2010

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Lau DCW et al, Can Med Assoc J 2007;176 (8 suppl):S1-S13

•  The waist circumference is measured by locating the upper hip bone and the top of the right iliac crest and placing a measuring tape in a horizontal plane around the abdomen at the level of the iliac crest

•  Before reading the tape measure, the tape should be snug but not compressing the skin and should be parallel to the floor

•  The measurement is made at the end of normal expiration

A4_1

Alberti KGMM et al. Lancet 2005;366:1059-1062. | Grundy SM et al. Circulation 2005;112:2735-2752.

Padwal, et al, CMAJ 2011

Weng et al Lancet 2011; 378: 1244–53

Almost a 50% reduction!

Diabetes Prevention Program Research Group. N Engl J Med 2002;346:393-403.

Year

Chan

ge

in

Wei

ght

(kg)

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 -8 -6 -4 -2 0 2 4

Chan

ge

in P

hys

ical

Act

ivity

(MET-

hr/

wk)

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 0

2

4

6

8

Placebo

Metformin Lifestyle

Med

icat

ion

Adher

ence

(%

)

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 60

65

70

75

80

85

Lifestyle

Metformin

Placebo

Metformin

Placebo

Absolute Changes in HbA1c of Individual Studies of Structured Exercise Training vs No Intervention

Umpierre, D. et al. JAMA 2011;305:1790-1799