O.T. - Fatties overtaking America

[Inkana7]

Originally Posted by Bob's your Information Minister

Actually I never roll out of bed. I live in my bed. I've grown so large I can't get out of it without heavy equipment. It takes a specially-constructed system of pulleys and weights just to lift my neck forward so I can eat. That picture of me at the Chiefs game was faked with photoshop. I wanted people to think I had actually been outside, but alas you have discovered my cunning ruse.

I don't appreciate your ruse, ma'am.

[Bronco_Beerslug]

Originally Posted by TexanBob

They already do with increased medical costs. But how far do you want to take this? Should gays be taxed because of their higher rates of HIV/AIDS infections? Should we tax cell phone users because of all the auto accidents they cause? How about we tax junkies for the damage they do through drug abuse?

Somehow, this concept of bankrupting people into better health has a flaw in it somewhere. Most people who earn less money tend to choose *less* healthy alternatives for food, not better choices.

Most people who smoke earn less money also, so they are paying for some of their costs to society in tobacco taxes, that works for me too.

If you can figure out to make car cell phone users pay higher auto insurance costs (so I don't have to) I'm for that too.

[RkyMtnThunder]

Originally Posted by TexanBob

They already do with increased medical costs. But how far do you want to take this? Should gays be taxed because of their higher rates of HIV/AIDS infections? Should we tax cell phone users because of all the auto accidents they cause? How about we tax junkies for the damage they do through drug abuse?

Somehow, this concept of bankrupting people into better health has a flaw in it somewhere. Most people who earn less money tend to choose *less* healthy alternatives for food, not better choices.

GREAT IDEA! Honestly

But you have to legalize in order to tax it!

New can of worms.....

[Los Broncos]

Im big sexy

[NaptownChief]

Originally Posted by Bronco_Beerslug

Whats wrong with having people pay for the problems and costs they cause?

You keep talking like this and they will kick you out of the Democratic party.

[RkyMtnThunder]

Originally Posted by Lynchmob72

Im big sexy

now now now, dont be listening to everything momma tells you!



(j/k)

[Bob's your Information Minister]

This is why America is fat.

http://www.junkfoodblog.com/2006/07/...-pancakes.html

[RhymesayersDU]

Originally Posted by Inkana7

I don't appreciate your ruse, ma'am.

"My ruse?"
"Yes, your cunning attempt to trick me."


My favorite scene in that whole movie, easy.

"I'm never renting here again!"
"You won't be missed."
"Screw you!"
"YOU'RE NOT ALLOWED TO RENT HERE ANYMORE! (YEAH!) .... Screw me?"

[jutang]

As obvious as a problem obesity is for America is really is a touchy subject and incredibly tough to treat. Also defining who is obese is more complicated than just using a single measure ala BMI.

However, the BMI is still one of the best measures for obesity and a great screening tool for health care workers to identify who is at risk and who isn't. I would be careful to state that the "BMI is completely worthless." While there is bunch of literature out there, here is a recent article from the Mayo Clinic's academic journal published in Oct 2006.

I apologize for the length of this article, I don't think the link would have been publicly available and I am not versed enough on pubmed

[RhymesayersDU]

Oh, and fatties should join us in this thread:

http://www.orangemane.com/BB/showthread.php?t=54902

[jutang]

Results: Mayo Clinic Proceedings

(C) 2006 Mayo Foundation for Medical Education and Research

Volume 81(10) Supplement, October 2006, pp S5-S10

Extreme Obesity: A New Medical Crisis in the United States
[Supplement on Bariatric Surgery in Extreme Obesity: Supplement Article]

Hensrud, Donald D. MD, MPH; Klein, Samuel MD
From the Division of Preventive, Occupational, and Aerospace Medicine and
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic
College of Medicine, Rochester, Minn (D.D.H.); and Center for Human Nutrition,
Washington University School of Medicine, St Louis, Mo (S.K.).
Address correspondence to Donald D. Hensrud, MD, MPH, Division of Preventive,
Occupational, and Aerospace Medicine, Mayo Clinic College of Medicine, 200 First
St SW, Rochester, MN 55905 (e-mail: hensrud.donald@mayo.edu).

----------------------------------------------

Outline

Abstract

DEFINITION AND CLASSIFICATION

PREVALENCE TRENDS

ETIOLOGY

COMORBIDITIES

MORTALITY

DISCRIMINATION AND QUALITY OF LIFE

ECONOMICS

EPIDEMIOLOGY OF BARIATRIC SURGERY

SUMMARY

REFERENCES

Abstract

The prevalence of obesity has markedly increased in the past few decades, and this disorder is responsible for more health care expenditures than any other medical condition. The greater the body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters), the greater the risk of comorbidities, including diabetes mellitus, hypertension, obstructive sleep apnea, many cancers, dyslipidemia, cardiovascular disease, and overall
mortality. Class III (extreme) obesity, defined as a BMI of 40 kg/m2 or greater,has also increased such that it now affects almost 1 in 20 Americans. The prevalence of extreme obesity is greater among women than among men and greater among blacks than among non-Hispanic whites or Hispanics. The effect of extreme obesity on mortality is greater among young than among older adults, greater among men than among women, and greater among whites than among blacks. The current permissive environment that promotes increased dietary energy intake and decreased energy expenditure through reduced daily physical activity coupled with genetic susceptibility is an important pathogenic factor. The number of bariatric surgical procedures performed annually is relatively small but increasing.

[jutang]

BMI = body mass index; BRFSS = Behavioral Risk Factor Surveillance System;
NHANES = National Health and Nutrition Examination Survey

Until very recently in the history of human existence, obtaining enough food or survival was a major challenge, and regular physical activity was unavoidable. Technological advances and the built environment have resulted in a progressive increase in average body weight and body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters). Moreover, the prevalence of extreme obesity, defined as a BMI of 40 kg/m2 or greater, has markedly increased in the United States and throughout the world. This article focuses on the prevalence trends, etiology, and consequences of extreme obesity among US adults. Trends in bariatric surgery are also discussed.

DEFINITION AND CLASSIFICATION

Obesity is defined as an excess of body fat. Surrogate measures are used to
identify obesity because measuring body fat directly is impractical. Currently,
BMI is the standard used to classify obesity. Although BMI correlates directly
with body fat mass and health outcomes, it is not a perfect tool. An individual
with a high BMI and a large proportion of lean tissue (ie, muscle) could be
classified as being obese yet have a low percentage of body weight as fat.

The current classification of obesity is shown in Table 1. Overweight is defined as a BMI of 25.0 to 29.9 kg/m2 and obesity as a BMI of 30 or greater. Obesity is further divided into categories of class I (BMI, 30.0-34.9), class II (BMI, 35.0-39.9), and class III or extreme obesity (BMI, >=40).1 As BMI increases above the normal range, health risks increase, slowly at lower BMIs and more steeply with greater degrees of obesity. The term medically complicated obesity refers to a subset of obese individuals who also have health complications due to their obesity, for example, a patient with a BMI of 36 kg/m2 who has type 2 diabetes mellitus, hypertension, or obstructive sleep apnea. Increased waist circumference, reflective of abdominal subcutaneous and visceral fat, is associated with increased risk of metabolic risk factors for coronary heart disease. However, the importance of waist circumference measurements in determining health risks decreases with increasing BMI. In patients with BMI values of 35 kg/m2 or greater, waist circumference does not add to the level of risk determined by assessment of BMI alone.1

[jutang]

PREVALENCE TRENDS

Awareness of obesity has existed since the Stone Age,2 and there are numerous references to obesity in Hippocratic writings.3 Throughout history, obesity has occurred most commonly in the upper socioeconomic strata, but increased weight in the past did not usually approach the level currently categorized as extreme obesity. Until the last 45 years, population data sets that could estimate the prevalence of extreme obesity in the United States did not exist.

Two large-scale national data sets have tracked the prevalence of obesity in the United States, the National Health and Nutrition Examination Survey (NHANES) and the Behavioral Risk Factor Surveillance System (BRFSS).4 The NHANES obtains measured data on height and weight in a representative sample of the US noninstitutionalized civilian population. The BRFSS is a multistage survey that obtains self-reported data on height and weight from individuals in each state with use of random-digit dialing. Because data from the BRFSS are obtained by self-report, it likely underestimates the true prevalence of obesity. Moreover, underreporting increases with the magnitude of overweight.5 Nonetheless, the BRFSS is useful for following national trends over time.

According to the BRFSS, the prevalence of extreme obesity has been increasing twice as fast as obesity in general.6 Data from the BRFSS have been summarized for the period from 1990 to 2000.7 During this decade, the overall prevalence of extreme obesity increased almost 3-fold, from 0.8% to 2.2%, and this increase was seen in both sexes, all racial/ethnic groups, all age groups, and all education levels. The prevalence of extreme obesity was greater among blacks than among non-Hispanic whites or Hispanics, greater among persons who did not complete high school, greater among shorter than among taller persons, and approximately 2-fold greater among women than among men. The largest proportional increase among age groups was seen in 18- to 29-year-olds. The higher the BMI at baseline, the greater the increase in BMI, ie, the heaviest people gained the most weight.

The NHANES has tracked BMI data since NHANES I was conducted in 1960-1962, at which time the prevalence of obesity was 13.4%.8 From NHANES II in 1976-1980 to NHANES III in 1988-1994, the prevalence of obesity increased from 15.0% to 23.3%. The latest data from the NHANES showed that in 2003-2004, 66.3% of adult (>=20 years) Americans were overweight or obese, and 32.2% were obese.9 Compared to the period 1999-2000, the prevalence of obesity in 2003-2004 was stable among women (33.4% and 33.2%, respectively) but increased among men (from 27.5% to
31.1%).

The NHANES found a 2.9% prevalence of extreme obesity in 1988-1994, 4.7% in 1999-2000, and 4.8% in 2003-2004.8,9 Although the overall prevalence of extreme obesity was stable between 1999-2000 and 2003-2004 and affects almost 1 in 20 Americans overall, it appeared to be increasing in the 20- to 39-year age group (5.4% in 2003-2004 compared with 4.5% in 1999). In 2003-2004, the prevalence of extreme obesity was greater among women (6.9%) than among men (2.8%), greater among blacks (10.5%) than among non-Hispanic whites (4.3%) or Hispanics (4.5%), and highest among black women (14.7%).

[jutang]

ETIOLOGY

Obesity develops when energy intake exceeds energy expenditure over a long period. Despite the seeming simplicity of the energy balance equation, the factors that influence energy balance are numerous, varied, and complex. These factors involve genetic, metabolic, environmental, behavioral, cultural, and socioeconomic influences.10 Ultimately, all factors that contribute to obesity influence energy intake or energy expenditure.

Certain genetic syndromes are associated with extreme obesity, including leptin deficiency, Prader-Willi syndrome, and Laurence-Moon-Biedl syndrome. These genetic defects are rare and are not responsible for most cases of obesity and extreme obesity. Clearly, our genetic makeup has not changed during the past few decades as the prevalence of obesity has increased dramatically. However, genetic alleles may have developed throughout evolution that promote food consumption and weight gain, which could increase survival during periods of food scarcity or famine. A prevailing view is that the current increase in obesity is the result of a permissive environment that has allowed greater expression of genetic predisposition.

Numerous metabolic factors influence energy regulation, perhaps in a feedback model. These factors include hormones, peptides, nutrients, uncoupling proteins, and neural regulatory substances from the gut, liver, brain, and even fat cells.11 The scientific understanding of these factors and the complexity of how they interrelate are in their infancy. Similarly, how these factors influence the development of extreme obesity and specifically how the feedback model
unravels in this situation are even less well understood. Genetic factors probably play a role in some of these regulatory processes.

Data reported by the Centers for Disease Control and Prevention suggest that mean energy intake increased by 168 kcal/d in American men and 335 kcal/d in American women between 1971 and 2000.12 However, variances in methodology and bias from self-reporting could affect the validity of these estimates. Dietary factors that have been identified as contributing to increased energy intake and obesity include larger portion size, increased intake of refined carbohydrates
including soft drinks, greater variety of foods consumed (except vegetables and fruits), eating away from home, and increased intake of fast food, salty snack foods, and pizza.13-16 Other factors such as smoking cessation and pregnancy may also contribute to an individual's susceptibility to gain weight. However, such factors generally are associated with modest amounts of weight gain and are unlikely to contribute to the development of extreme obesity.

Low levels of physical activity, including both exercise and nonexercise activity, are associated with an increased risk of obesity.17 A sedentary lifestyle probably contributes to the high prevalence of obesity in the United States. More than 60% of the US population does not perform regular physical activity, and approximately 25% are completely sedentary.18 Total daily physical
activity appears to have declined in recent years,19 and this decline may have contributed to the increase in obesity.20,21 A detailed study of physical activity found that obese subjects were sedentary (sitting) 2 1/2 hours more per day than were lean subjects, which translates into a decreased energy expenditure of about 350 kcal/d attributable to this behavior alone.22

The built environment is probably a strong contributor to decreased energy expenditure. During the past few decades, technological innovations such as elevators, escalators, computers, remote controls, and other labor-saving devices have produced a small but cumulative decrease in energy expenditure. The amount of time spent watching television has correlated positively with obesity
in both children and adults and with the risk of type 2 diabetes mellitus in adults.23,24 Although the relative contributions of environmental factors responsible for decreasing physical activity and increasing energy intake have not been fully elucidated, their collective effect appears to be powerful and pervasive in facilitating the development of obesity.

Why some people stop gaining weight after a moderate increase in BMI and others go on to develop extreme obesity is unknown. In fact, gaining weight tends to promote resistance to further weight gain. A major determinant of resting metabolic rate is the amount of lean tissue. As people gain weight, approximately 20% to 35% of excess weight is lean tissue to help support fat tissue.
Therefore, as weight increases, resting metabolic rate increases, ie, increasing obesity is associated with increasing metabolic rate. For example, a 40-year-old woman who is 67 inches tall and has extreme obesity (BMI, 45 kg/m2) has a calculated resting metabolic rate of 2030 kcal/d. In comparison, a person of the same age and height but of normal weight (BMI, 23 kg/m2) has a calculated resting metabolic rate of only 1420 kcal/d. This means that for an obese
individual to continue to gain weight, energy intake must be high enough to overcome the greater resting metabolic rate.

MORTALITY

Obesity increases the risk of premature mortality. An estimated 112,000 to
365,000 deaths yearly in the United States are due to obesity.35-38 differences among these estimates are due to variations in the methods and assumptions used in each study, including adjustment for confounding factors, age of the data, and use of self-reported or measured values for BMI.35 As the degree of obesity increases, mortality increases.25 Compared to persons with a BMI of 23.5 to 24.9 kg/m2, women with extreme obesity have a 2-fold higher risk of all-cause mortality, and men have a more than 2-fold higher risk.39 Extreme obesity has been estimated to shorten life by 5 to 20 years, depending on sex, age, and racial/ethnic group.40 Although life expectancy continues to increase in the US population,41 some investigators suggest that the increase in life expectancy will soon cease because of the rising prevalence of obesity and that for the first time in history, children may not live as long as their parents. The relative effect of obesity on mortality is greater in whites than in blacks, greater in men than in women, and greater in young than in older adults. Extremely obese white men aged 20 to 30 years are estimated to lose 13 years of life compared with their normal BMI counterparts, and extremely obese white women in this age group lose 8 years.40 The elevated risk of mortality is primarily due to the increased incidence of cardiovascular disease and cancer associated with higher degrees of obesity.39 An estimated 14% of all cancer deaths in men and 20% of those in women are due to obesity.43 The relative increased risk of obesity-associated mortality diminishes with age, and most population-based studies have not found a statistically significant increase in besity-associated mortality in adults who are older than 75 years.44

DISCRIMINATION AND QUALITY OF LIFE

Obesity is associated with social discrimination, even among medical professionals.45,46 Obese persons are less likely to be hired, receive equal wages, or be promoted compared with their normal-weight counterparts.45 Education and health care are other areas in which discrimination is recognized. For example, obese persons are less likely to receive appropriate preventive care, including screening tests for cervical and breast cancer.47 Extremely obese individuals report reduced quality of life.48 This may be due to obesity-related medical complications or challenges in everyday activities such as buckling seat belts; fitting into seats in airplanes, theaters, and buses; maintaining good hygiene; urinating accurately (men); and even cutting toenails.49 After bariatric surgery-induced weight loss, extremely obese patients perceive a marked improvement in their quality of life and a decrease in discrimination.50-52

[jutang]

ECONOMICS

Obese adults have 36%- to 39%-higher health care costs than normal-weight
persons.53,54 Obesity is associated with more health care costs than any other medical condition or factor, including smoking.53 An estimated 5% to 7% of total annual medical expenditures in the United States, or $75 billion annually in direct costs and up to $139 billion in total costs, are due to obesity.55 Obesity is associated with increased costs to businesses, partly because of absenteeism and health-related lost productive time.56-58

Annual health care expenditures increase in a stepwise fashion with increasing
classes of obesity. One study estimated that women with extreme obesity have adjusted mean annual health care expenditures of $3506 compared with $2127 for normal-weight women.59 Consistent with these figures, another study estimated that adults with extreme obesity have health care expenditures that are 81% greater than those of normal-weight adults and are responsible for $11 billion in direct health care costs.60 The increased expenditures are due to higher office, emergency department, and inpatient expenses as well as prescription medication costs. Among the employed US population, only 3% are extremely obese, yet they account for 21% of the health care costs associated with obesity.61

EPIDEMIOLOGY OF BARIATRIC SURGERY

From 1996 to 2002, population-adjusted rates of bariatric surgical procedures
increased 7-fold, from 3.5 to 24.0 per 100,000 population.62 The greatest increase was seen in gastric bypass procedures, which increased 9-fold in the
1990s.63 In terms of absolute numbers, bariatric procedures increased from 13,386 in 1998 to 71.733 in 2002, and this trend shows no signs of slowing.64
The American Society for Bariatric Surgery estimates that 170,000 procedures
were performed in 2005.65 Despite this rapid increase in the number of operations performed, only 0.6% of the estimated 11.5 million extremely obese
adults eligible for bariatric surgery in 2002 underwent a bariatric procedure.64

The fastest growth in bariatric procedures occurred in those older than 65
years, and women accounted for 84% of all surgeries in 2002. From 1990 to 2000, hospital stay decreased from 6.0 to 4.1 days, and in-hospital mortality
increased slightly from 0.2% to 0.5% in 2000.63 The article by McGlinch et al 66 elsewhere in this supplement discusses mortality from bariatric surgery in
greater detail. Bariatric surgery has been estimated to cost almost $20,000 per procedure,64 and hospital charges of nearly $30,000 have been reported.62 Almost 4% of bariatric surgeries are revision procedures, which are more costly than primary operations.

SUMMARY

The increasing prevalence of obesity and extreme obesity is a major public
health problem. The risk of comorbidities of obesity, including mortality,
increase with increasing BMI. Health care costs associated with obesity are
greater than those associated with any other medical condition. The number of bariatric surgical procedures being performed each year is small but increasing. The continued increase in the prevalence of extreme obesity warrants greater attention. More research on the pathogenesis and pathophysiology of extreme obesity, assessment of the most effective and safe treatment options, and greater health care coverage of appropriate therapies are needed.

[Los Broncos]

Originally Posted by RkyMtnThunder

now now now, dont be listening to everything momma tells you!



(j/k)

Well i am

[Bob's your Information Minister]

BroncoBuff just told me he was 6-foot-7, 288 pounds. Now, aside from the fact that it seems like everyone I run into on the internet claims to be some kind of giant, does anyone else think Casey should try out for the Broncos? Do you have any quickness or speed, Casey?

[elsid13]

To much corn syrus in drinks, fast food and not enough movement and you get fat out of shape Americans

[BroncoBuff]

HIGH FRUCTOSE CORN SYRUP






blech!

[BroncoBuff]

Anybody who's still drinking sugar-pop or sugar-tea ... I strongly recommend changing to diet. If you don't know, it svcks at first, but after 3 weeks or so - BOOM! Suddenly it tastes great - better than sugar pop ever tasted. And you'll never want regular again.

It's a very weird phenomenon. Something about the aspartame molecule eventually "fooling" your taste buds. After maybe 3 weeks of complaining, "this is NOT sugar!" "this is NOT sugar!" "this is NOT sugar!" "this is NOT sugar!" "this is NOT sugar!" "this is NOT sugar!" "this is NOT sugar!" .... finally the taste buds just surrender.

[Bob's your Information Minister]

This is so wrong, but hilarious.

[mosca]

Just drink water. Even without all the sugar, all the other stuff in the soda's bad for you too. Americans just can't seem to drink anything unless it's sweet and "tastes good".

[broncocalijohn]

It is too easy to get lunch out at fast food. SubWay is one of the only fast foods that push healthy grub. I love Carls but I know they are using 28% fat meat. As my Sig says, I am dieting by eating a little less, but try not to drink regular sodas and work out with water. Also, BB had a great point. I went from 2% milk to 1% for about 3 months then switched to non fat. Havent used anything else in over 12 years. I am getting lighter and stronger but i know i need to keep this up to keep the fat off. Why kids are getting this way? No outside activity and their parents. If parents dont know a good diet for themselves, how can they prepare it for their child?

[Hotrod]

Originally Posted by BroncoBuff

Anybody who's still drinking sugar-pop or sugar-tea ... I strongly recommend changing to diet. If you don't know, it svcks at first, but after 3 weeks or so - BOOM! Suddenly it tastes great - better than sugar pop ever tasted. And you'll never want regular again.

It's a very weird phenomenon. Something about the aspartame molecule eventually "fooling" your taste buds. After maybe 3 weeks of complaining, "this is NOT sugar!" "this is NOT sugar!" "this is NOT sugar!" "this is NOT sugar!" "this is NOT sugar!" "this is NOT sugar!" "this is NOT sugar!" .... finally the taste buds just surrender.

Sorry but Jack and diet coke is simply Un-American son

[NYBronco]

Originally Posted by BroncoBuff

Anybody who's still drinking sugar-pop or sugar-tea ... I strongly recommend changing to diet. If you don't know, it svcks at first, but after 3 weeks or so - BOOM! Suddenly it tastes great - better than sugar pop ever tasted. And you'll never want regular again.

It's a very weird phenomenon. Something about the aspartame molecule eventually "fooling" your taste buds. After maybe 3 weeks of complaining, "this is NOT sugar!" "this is NOT sugar!" "this is NOT sugar!" "this is NOT sugar!" "this is NOT sugar!" "this is NOT sugar!" "this is NOT sugar!" .... finally the taste buds just surrender.

I used to drink whole milk when I was younger and switched to skim so long ago I don't even remember. But you are right the transition at first is a little difficult but once over the hump it's a piece of cake.

Now I eat my salads without any dressing on them at all. I used to use the low fat kind but now depend on the vegetables and lettuce for my flavorings. It seems the transistions are easier now because I know it's just a matter of time for me to adjust.