Obesity: from epidemiology to treatment Entwicklung der Adipositas und Epidemiology, definition and des Diabetes in Europa diagnosis of obesities Hermann Toplak, Präsident ÖDG &EASO Hermann Toplak, President EASO Medizinische Universität Graz Medical University of Graz, Austria
Genes in a new environment
Our modern lifestyle with the old genes...
Prevalence of Obesity and Diabetes (in US Adults 1991 & 2001) Obesity Diabetes Mokdad AH et al. JAMA 2003;289:76 79.
http://www.iotf.org/database/trendseuropeanadultsthroughtimev3.htm
Share of obese persons in the EU, by education level, 2014 (%) 20 19.9 16.0 15 11.5 10 5 0 Low education level Medium education level High education level Geographical information The European Union (EU) includes Belgium, Bulgaria, the Czech Republic, Denmark, Germany, Estonia, Ireland, Greece,
2015 Communications: Milan Declaration
Milan Declaration calls to action: To address this situation, obesity should become a top priority, with increased commitment for concerted, coordinated and specific actions. A comprehensive, sustainable and pro-active strategy to deal with the challenges posed by the obesity epidemic is urgently needed. Encouraging the development and implementation of programmes for prevention, early diagnosis and treatment is mandatory. It is clearly imperative that obesity, as a disease and as a gateway to NCDs, is targeted as an area for immediate action and priority for research, innovation and action. In 1999 EASO issued a Milan Declaration in which we called for recognition, support and national action in this field. In the intervening years great progress has been made but more needs to be done and we must act now.
Milan Declaration Statement I It is clear that weight management must now play a major role in reducing morbidity and mortality of populations in Europe and world-wide. EASO resolves to provide leadership, guidance and support to governments, as part of its mission of facilitating and engaging in actions that reduce the burden of unhealthy excess weight in Europe through prevention and management, but a wider effort is needed. EASO therefore calls on governments, health agencies and all relevant stakeholders to: Recognise that individuals and communities who are obese require understanding, respect and support.
Milan Declaration Statement III Prioritise obesity as a national health action, by developing, supporting and implementing national strategies for action on obesity. These strategies must prioritise medical education (undergraduate and HCPs) and public information campaigns. Prioritise the identification of critical unmet needs in obesity research, clinical care, education and training and other areas that have yet to be adequately addressed. Support national and European research that will inform and develop new and effective prevention and management strategies, thus delivering real societal benefit.
BMI and BMI are not equal... Waist circumference is adding information 189 cm, 93 kg = BMI 26 190 cm, 94 kg = BMI 26 Waist circumference Testosteron > < Waist circumference Testosteron Title time and place of presentation Page #
All cause mortality in Denmark Unadjusted --- Adjusted Bigaard et al. Obesity 2003
Body fat (%) Body fat (%) Correlation between BMI & body fat percentage r = 0.78 P < 0.00001 n = 1,915 r = 0.87 P < 0.00001 n = 4,208 BMI (kg/m 2 ) Men Women Gómez-Ambrosi et al. Int J Obesity 2012 BMI (kg/m 2 )
Lean BMI-based classification Overweight Obese >18.0-24.9 kg/m 2 >25.0-29.9 kg/m 2 >30.0 kg/m 2 Gómez-Ambrosi et al. Int J Obesity 2012 % Body fat-based classification 0.2% 1.0% 29% 80%
Body fat (%) Correlation between BMI & body fat percentage Body fat (%) NOOB: Non-Obese-BMI/Obese BF% OBOB: Obese-BMI/Obese BF% MEN WOMEN NOOB NOOB n = 371 OBOB n = 1208 n = 445 OBOB n = 371 n = 96 r = 0.78 P < 0.00001 n = 1,915 n = 560 r = 0.84 P < 0.00001 n = 4,208 BMI (kg/m 2 ) BMI (kg/m 2 ) BMI BF% NOOB 27.8 31.5 OBOB 32.8 kg/m 2 31.0 % BMI BF% NOOB 26.8 40.9 OBOB 32.8 kg/m 2 41.4 % Gómez-Ambrosi et al. Int J Obes 2012
Body fat (%) Body fat (%) MEN WOMEN n = 371 n = 1208 n = 445 n = 371 n = 96 r = 0.78 P < 0.00001 n = 1,915 n = 560 r = 0.84 P < 0.00001 n = 4,208 BMI (kg/m 2 ) Non-obese subjects by the BMI criterion but obese by BF% exhibit: Gómez-Ambrosi et al. Int J Obesity 2012 BMI (kg/m 2 ) Waist circumference Blood pressure Glucose, insulin, triglycerides, total cholesterol and LDL-chol. levels Fibrinogen and CRP concentrations HDL-cholesterol levels
Increased risk in Non-Obese BMI-high BF NOOB: Non-Obese-BMI/Obese BF% OBOB: Obese-BMI/Obese BF% 500 400 Fibrinogen Fibrinogen * * 500 400 Fibrinogen Fibrinogen mg/dl 300 200 mg/dl 300 200 100 100 logcrp (mg/l) 0 1.6 1.2 0.8 0.4 0.0-0.4 Lean NOOB OBOB C-reactive protein C-reactive protein Lean NOOB OBOB * * * * 1.2 logcrp (mg/l) 0 1.6 0.8 0.4 0.0-0.4 C-reactive protein C-reactive protein -0.8 Lean NOOB OBOB *P<0.05 vs Lean; P<0.05 vs NOOB -0.8 Lean NOOB OBOB Gómez-Ambrosi et al. Int J Obes 2012
kg/m 2 Men 30 25 20 15 BMI Body fat % 50 P = 0.091 P = 0.008 P = 0.139 40 30 20 10 cm 110 100 90 80 70 Waist 10 NG PreDiab/T2D 0 NG PreDiab/T2D 60 NG PreDiab/T2D Women 30 BMI Body fat 60 P = 0.216 P < 0.0001 P < 0. 0001 110 100 Waist kg/m 2 20 10 % 40 20 cm 90 80 70 60 0 NG PreDiab/T2D Gómez-Ambrosi et al. Obesity 2011 0 NG PreDiab/T2D 50 NG PreDiab/T2D
BMI, Body fat, Fat free mass and mortality Bigaard et al. Obesity Research 2004
Commentary to NCD 11 will be published 2017 When speaking about a disease seems to be useful using BMI cutoffs above 30 kg/m 2 otherwise we declare half of the population as diseased It will be important to have obesity as a single entity, not in the nutrition part, as it is also lack of exercise and others So a main category obesity following nutrition will be necessary in ICD (with subcategories) Dimension Etiology (multifactorial or attributable to a major cause like iatrogenic, endocrinologically induced, tumor-induced, genetically determined, other ) Dimension Extent (Classes I-VI: 30, 35, 40, 45, 50 and 55) Manuscript by EASO expected within the next months in Obesity Facts
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