The role of the health care professional in the obesity epidemic

Transcription

1 The role of the health care professional in the obesity epidemic Donal O Shea November 27 th 2012 Department of Endocrinology, St Vincents University & St Columcilles Hospitals

2 Outline of talk Scale of the problem Effect of obesity on adult immune system Childhood obesity and immune system Role of the health care professional

3 Obesity is associated with Diabetes Cancer Sleep Apnoea Osteoarthritis Fatty liver disease Psoriasis Dementia Cardiovascular Disease Death from H1N1 (Swine Flu)

4 Childhood Obesity in Ireland 25% 3 year olds overweight/obese 25% 9 years olds overweight/obese Growing up in Ireland 2009

5 Childhood Obesity in Ireland 25% 25% 3 year olds overweight/obese 9 years olds overweight/obese low self image, concept and self esteem Growing up in Ireland 2009

6 Median BMI for each 5-year rise in age of onset of overweight

7 Young Scientist 2012

8 Weight (kg) 75 Age v Weight Age

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10 Study cohort subjects (2961 male) mean age 11.4 ± 4.0 years at baseline mean length of follow-up 23.1 ± 3.3 years 5554 subjects normal weight as children 812 (15%) were obese as adults 774 subjects overweight or obese as children 500 (65%) were obese as adults 147 subjects obese as children 121 (82%) were obese as adults Juonala et al, NEJM 2011

11 This

12 Becomes this BMI 51 BMI 52

13 Becomes this (82% chance) BMI 51 BMI 52

14 TOXIC ENVIRONMENT

15 TOXIC ENVIRONMENT

16 5 times more girls drive themselves to secondary school than cycle 16

17 American Diabetes Association

18 2012 Philadelphia

19 Lead by example?

20 Lead by example you must

21 Need environment conducive to exercise

22 Percentage increase in BMI categories since 1986 source: Behavioral Risk Factor Surveillance Survey; results adjusted for changes in population demographics to be comparable to 2005 demographics Sturm, R. Public Health 07

23 BMI range 50 to 55 BMI 51 BMI 52

24 Outline of talk Scale of the problem Effect of obesity on adult immune system Childhood obesity and immune system Role of the health care professional

25 Because obesity is associated with Diabetes Cancer Sleep Apnoea Osteoarthritis Fatty liver disease Psoriasis Dementia Cardiovascular Disease Death from H1N1 (Swine Flu)

26 Focus our work on the immune system in obesity

27 Blood Film

28 Natural Killer Cell Key cell in attacking viruses and cancer cells Involved in a range of autoimmune conditions

29 NK cells (% total lymphocytes) % NK Decrease in circulating natural killer cells in obesity * 15 *** obese n = 110, p = lea n 0 Lean NK Obese NK Natural Killer Cells in Obesity: Impaired Function and Increased Susceptibility to the Effects of Cigarette Smoke Donal O Shea 1, Tom J. Cawood 2, Cliona O Farrelly 3, Lydia Lynch 4,5 * 1 Department of Endocrinology, St. Vincent s University Hospital, Dublin, Ireland, 2 Department of Endocrinology, Christchurch Hospital, Christchurch, New Zealand, 3 School of Biochemistry and Immunology and School of Medicine, Trinity College Dublin, Dublin, Ireland, 4 Oncology and Hematology, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, Massachusetts, United States of America, 5 Obesity and Immunology, Education and Research Centre, St. Vincent s University Hospital, Dublin, Ireland

30 Moved on to the inkt cell A key cell in the innate immune system T cells Cytokine NK cells Represents 0.2% - 1.2% of circulating T cells Cytotoxicity DCs Interacts with other immune cells to determine the downstream immune response: Pro-inflammatory Anti-inflammatory Cytotoxic Chemokines Macrophages B cells

31 NKT cells (% T cells) inkt (% T cells) inkt cells are reduced in human obesity 0.90 *** Lean Obese Obese Lean

32 Outline of talk Scale of the problem Effect of obesity on adult immune system Childhood obesity and immune system Role of the health care professional

33 What about overweight kids? Childhood obesity and immune system

34 Age & Pubertal Staging

35 BMI

36 Systolic BP

37 Fasting Blood Glucose

38 Fasting Insulin Levels

39 Summary in Children Early signs that immune system under pressure: Type 2 diabetes rates in kids due to quadruple Type 1 diabetes rates in kids due to treble

40 Outline of talk Scale of the problem Effect of obesity on adult immune system Childhood obesity and immune system Role of the health care professional

41 The role of the health professional Highlight the problem every chance

42 The role of the health professional Highlight the problem every chance Be angry

43 The role of the health professional Highlight the problem every chance Be angry (professionally)

44 The role of the health professional Highlight the problem every chance Be angry (professionally) Weigh and advise patients every visit

45 The role of the health professional Highlight the problem every chance Be angry (professionally) Weigh and advise patients every visit Look for local solutions

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