Total helserisiko ved overvekt Overlege Bård Kulseng

Hippocrates (460–377 BC) ‘If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health’. ‘Corpulence is not only a disease in itself, but the harbinger of others’. He noted that life expectancy was far shorter in the obese compared to lean individuals.

Grenser for behandling: menn > 102 cm og kvinner > 88 cm) Intra-abdominal adiposity (IAA) is closely correlated with abdominal obesity 300 200 100 r = 0.80 60 80 120 Intra-abdominal adiposity Waist circumference (cm) IAA (cm2) Intra-abdominal adiposity is closely correlated with abdominal obesity Here we see an example of a CT scan in a patient with intra-abdominal adiposity, showing the accumulation of fat around the visceral organs. CT scanning is considered to represent the ‘gold standard’ for measurement of body fat distribution, but is too complex and costly for routine use for this purpose. Abdominal obesity, as measured by waist circumference, correlates closely with intra-abdominal adiposity measured using CT scanning. The data shown on this slide are from a population of 81 men and 70 women. Abdominal obesity, with diagnostic criteria based on waist circumference, is a requirement for the diagnosis of the metabolic syndrome according to the new guidelines from the International Diabetes Federation. This simple, straightforward and well-known measure should be adopted as part of standard clinical practice for diagnosing intra-abdominal adiposity which, in turn, signifies increased cardiovascular risk. Grenser for behandling: menn > 102 cm og kvinner > 88 cm) Despres JP, Lemieux I, Prud'homme D. Treatment of obesity: need to focus on high risk abdominally obese patients. Br Med J 2001;322:716–20. Pouliot MC, Despres JP, Lemieux S et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 1994;73:460–8. Després JP et al, 2001; Pouliot MC et al, 2004 3

BMI – WHO KLASSIFIKASJON BMI = KMI = kg/m² < 18,5 Undervekt 18,5 - 25 Normalvekt 25 - 30 Overvekt >30 Fedme 30 - 35 Fedme grad 1 35 - 40 Fedme grad 2 > 40 Fedme grad 3 Sykelig fedme = BMI > 40 BMI > 35 + komorbiditet Super-obese = BMI > 60 (50)

1985 (BMI ≥30) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

1995 (BMI ≥30) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

2009 (BMI ≥30) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Hva med Norge?

HUNT 1: 1984-1986 Kvinner, 30-69 år, prevalens BMI>30 5-10% 10-15% 15-20% 20-25% 25-30% >30%

HUNT 2: 1995-1997 Kvinner, 30-69 år, prevalens BMI>30 5-10% 10-15% 15-20% 20-25% 25-30% >30%

HUNT 3: 2006-2007 Kvinner, 30-69 år, prevalens BMI>30 5-10% 10-15% 15-20% 20-25% 25-30% >30%

HUNT 1: 1984-1986 Menn, 30-69 år, prevalens BMI>30 5-10% 10-15% 15-20% 20-25% 25-30% >30%

HUNT 2: 1995-1997 Menn, 30-69 år, prevalens BMI>30 5-10% 10-15% 15-20% 20-25% 25-30% >30%

HUNT 3: 2006-2007 Menn, 30-69 år, prevalens BMI>30 5-10% 10-15% 15-20% 20-25% 25-30% >30%

30-69 år, prevalens BMI>30 HUNT 1: 1984-1986 HUNT 2: 1995-1997 5-10% 10-15% 15-20% 20-25% 25-30% >30%

5-10% 10-15% 15-20% 20-25% 25-30% >30%

Nå har ca 1 av 4 fedme i Norge! Age 20+ H2: 18.6% H3: 23.5% Nå har ca 1 av 4 fedme i Norge! Age 20+ H2: 14.4% H3: 22.5%

PREMATUR DØD - BMI Sammenlignet med en normalvektig person har en 25år gammel mann med sykelig overvekt en 22% reduksjon i forventet gjenværende levetid, noe som svarer til ca 12 mistede livsår Buchwald H et al, JAMA, October 2004

Age-adjusted Percentage of U. S Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes Obesity (BMI ≥30 kg/m2) 1994 2000 2008 No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0% Diabetes 1994 2000 2008 No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

Prevalens av diabetes (%) i ulike BMI-kategorier NHANES 1988-1994 Must et al. The Disease Burden Associated With Overweight and Obesity. JAMA 1999.

HUNT 1 1984-86 n = 76 885 HUNT 2 1995-96 n = 65 599 HUNT 3 2006-07 n = 50 842 Diabetes Fedme Kvinner 3.2% 13% 19% 3.8% 24% Menn 2.6% 7.5% 3.3% 14% 5.0% 23% Fedme Diabetes

reseptregisteret

Hoveddiagnose eller bidiagnose med akutt hjerteinfarkt Tidsskr Nor Lægeforen 2008; 128: 17-23 © Tidsskrift for Den norske lægeforening

Neste generasjon pasienter

Påvirkning av fosteret ? Nedsatt fertilitet

Mothers with BMI > 30 before pregnancy spina bifida, neural-tube defects, heart problems, cleft palate or cleft lip abnormal rectum or anus development, hydrocephaly

Komplikasjoner til overvekt Emosjonelle og psykologiske problemer Sosiale effekter mobbing, arbeidsledighet, fattigdom og osv

2011 Bård Kulseng

Weight loss at one year (ITA) in the different treatment groups a, b, c b a a, b, c Columns with the same letter represent sig. differences in 1 year weight loss between treatment groups 2011 Bård Kulseng

Table 2. Resolution of comorbidities at 1 year after different weight loss programs Surgery Residential intermittent program Weight loss camp Hospital outpatient program All lifestyle interventions Asthma 6 (40%) 1 (20%) 3 (38%) 7 (33%) Arthritis 3 (33%) 4 (57%) 4 (80%) 11 (61%) DM2 4 (67%) 4 (33%) 1 (33%) 2 (50%) 7 (37%) Hypertension 16 (84%) 8 (31%) 7 (54%) 7 (44%) 22 (40%)* Sleep apnea 9 (69%) 4 (50%) 0 (0%) 1 (50%) 5 (42%) Number (percentage) of patients diagnosed with the comorbidities at baseline that experienced resolution of the condition at 1 year. Significant differences between surgery and lifestyle (all combined) groups: * P<0.01 2011 Bård Kulseng

BARIATRISK KIRURGI – LEVEUTSIKTER The New England Journal of Medicine, august 23, 2007; 2 studier som viser forlenget overlevelse etter bariatrisk kirurgi Sjöström L et al: SOS-studien 1987 – 2001 I kirurgigruppen betyr dette en reduksjon i justert hazard ratio for død på 29% Forskjellen synes særlig å gjelde AMI og cancer Adams TD et al: 1984 – 2002 (Utah, USA) 2,7% døde i kirurgigruppen og 4,1% i kontrollgruppen Sykdomsspesifikk mortalitet i kirurgigruppen red. med Coronarsykdom 56% Diabetes 92% Cancer 60% 2011 Bård Kulseng

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