Taking account of research around the relationship between genetics and our new ‘food environment’, Dr Robyn Toomath (endocrinologist and Clinical Director Wellington Hospital) argues that we are in the middle of an obesity epidemic which impacts widely on public health. She advocates for new approaches to obesity based not on blame or impossible personal goals, but on outcomes. She argues it is the responsibility of all to become informed and active (personally and politically), in working for change to present health policies and gives examples of what can be done. http://dosomething.org.nz

1. Why Do We Need To Do Something About Obesity?

3. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

4. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

5. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

6. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

11. Prevalence of overweight and obesity in adults 1977 to 2003 Ministry of Health 2004e

12. The Effects of Obesity

15. Table 1 Health risks associated with increasing Body Mass Index (BMI) Overweight/obesity plus hypertension is associated with increased risk of ischaemic stroke Obesity is a contributing factor to cardiac failure in >10% of patients 70% of obese women with hypertension have left ventricular hypertrophy Dyslipidaemia progressively develops as BMI increases from 21 kg m −2 with rise in small particle low-density lipoprotein 3.6× risk of CAD for each unit change in BMI Coronary artery disease (CAD) and stroke 85% of hypertension is associated with a BMI >25 kg m −2 66% of hypertension is linked to excess weight 5× risk in obesity Hypertension 90% of type 2 diabetics have a body mass index (BMI) of >23 kg m −2 Type 2 diabetes 30% of middle-aged people in developed countries have features of metabolic syndrome Metabolic syndrome

16. Table 1 Health risks associated with increasing Body Mass Index (BMI) 4 Obesity Related Morbidity. Obesity Reviews 8 (s1), 13-17. 3× risk of gall bladder disease in women with a BMI of >32 kg m −2 ; 7× risk if BMI of >45 kg m −2 Overweight and obesity associated with non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH). 40% of NASH patients are obese; 20% have dyslipidaemia Liver and gall bladder disease Frequent association in the elderly with increasing body weight – risk of disability attributable to OA equal to heart disease and greater to any other medical disorder of the elderly Osteoarthritis (OA) Impotency and infertility are frequently associated with obesity in men 6% of primary infertility in women is attributable to obesity Reproductive function 10% of all cancer deaths among non-smokers are related to obesity (30% of endometrial cancers) Cancers Neck circumference of >43 cm in men and >40.5 cm in women is associated with obstructive sleep apnoea, daytime somnolence and development of pulmonary hypertension Respiratory effects

17. Top 20 causes of death, by risk factor, NZ 1997

20. Who would want to be obese?

21. What Causes Obesity?

22. The body-mass index of twins who have been reared apart AJ Stunkard, JR Harris, NL Pedersen, and GE McClearn Next Pr evious Number 21 May 24, 1990 Volume 322:1483-1487

27. How Does the Genotype Link to Phenotype?

32. 1998 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2007 (*BMI  30, or about 30 lbs. overweight for 5’4” person) 2007 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

36. “ Genetic epidemiological studies and multiple genome-wide linkage analyses have established that the causes of common obesity are complex involving a Westernized lifestyle in the presence of genetic predisposition” Dahlman I and Arner P. Review. Int J Obes (2007) 31, 1629-1641.

37. Genes and the Environment BMI 1977 2006 * * * Genetically thin Genetically fat

38. How should we tackle the problem? Personal endeavour or environmental engineering?