Is Obesity the DESTINY

“EVerything is determined ,the beginning as well as the end by the forces over which we have no control, we all dance to a mysterious tune, intoned in the distance by an invisible piper”: 

“ EVerything is determined ,the beginning as well as the end by the forces over which we have no control, we all dance to a mysterious tune, intoned in the distance by an invisible piper” Albert Einstein

PowerPoint Presentation: 

Is Obesity a DESTINY Which we can not change ? at least for now !! Dr S P Sondhi 19 th March 2010

Who is to be blamed ??: 

Who is to be blamed ??

Obesity : Inability to Maintain the Balance .: 

Obesity : Inability to Maintain the Balance . Adipose tissue Energy Intake Energy Expenditure

Lifetime Food Intake: 

Lifetime Food Intake *kcal in millions Water 45,300 kg Fat 2300 kg 21 kcal* Cholesterol 8000 kg 31 kcal* Protein 1900 kg 7 kcal*

PowerPoint Presentation: 

½ of this PARATHA extra

“Predetermined future”: 

“Predetermined future”

PowerPoint Presentation: 

1680 painting by Juan Miranda of a girl presumed to be having Prader Willi syndrome

Prader Willi Syndrome :: 

Prader Willi Syndrome : Prevalence 1 : 25000 Autosomal dominent Deletion chromosome 15 Mental retardation, obesity, small hands and feet hyprephagia

PowerPoint Presentation: 

More than 100 genes are involved in determining the body weight These genes act through CNS ( hypothalamus & brain stem ) to control food intake and energy expenditure

Ob mice: 

Ob mice Ob mice becomes fat because they lack a single gene ob. This gene normally active in fat cells produces a protein that travels through the blood stream to the brain and tells it “ I am full ”

PowerPoint Presentation: 

Freidmen named it Leptin after the Greek word for thin. The same genes were discovered in man ( Nature Dec 1994 ) It has complex actions which we are still discovering If the fat mass falls Leptin also falls and the urge to eat goes up. After an eating binge leptin level goes up which is a signal to eat less.

Jeffrey Freidman: 

Jeffrey Freidman Two children in England were very obese 2 yr old was 64 lbs and 8 yr old was 189 lbs . Both have been treated with leptin successfully

F T O genes ( fat mass and obesity ): 

F T O genes ( fat mass and obesity ) Invented by genome wide association study 1.31 odds ratio for obesity 1.2 for overweight

Energy expenditure genes :: 

Energy expenditure genes : In most of the obesity in rodents eg in defects in leptin obesity results from not only increased feeding but decreased energy expenditure. Betaless ( deletion of B1B2B3 ) when fed with dense diet became Obese when their counterparts ( with “N” genes ) on the same diet did not.

PowerPoint Presentation: 

“However the day is not far off when we will, by scoring alleles of perhaps 15 – 20 such genes, be able to predict individual risk of Obesity.” Dr Leibiel editorial NEJM Dec 2008

Nature Vs Nurture !: 

Nature Vs Nurture ! Monozygotic twins have 100% same genes The most powerful way to prove a genetic causation of obesity has come from monozygotic twins reared apart ( two brother separated in kumbh ka mela ! )

Adoption studies :: 

Adoption studies : 5000 Danish adoption registry BMI of adoptees and their biological siblings had a strong correlation “ these findings suggest that adult body size, shape, and composition are highly heritable in both men and women.” Stunkard et al 1986

PowerPoint Presentation: 

Maes et al ( 1997 )reported a 69% heritability in a study from Virginia. Stunkerd et al (1990 )from Sweden suggested a heritability of 0.70 for men and 0.66 for women Price and Gottesman ( 1991 ) fond it to be 0.60 in a UK study. Allison et al (1996 ) In a meta analysis of Finnish, Japanese & American twins found the same result.

PowerPoint Presentation: 

Does obesity has a fetal origin ?

Yes !!: 

Yes !! Specially low birth weight babies are more closely related to truncal fat deposition in later life.( permanent metabolic changes induced by fetal nutrition “ metabolic Inprinting ” ) Law et al 1992 Faster rate of growth in childhood and early puberty is associated with adult fatness. Parson et al 2001 The findings suggest that to be borne small and then to catch up in late childhood confers a higher risk of central obesity

Is maternal starvation to be blamed for obesity in children ?: 

Is maternal starvation to be blamed for obesity in children ? Second world war Dutch famine “hunger winter” 1944 – 45

PowerPoint Presentation: 

People borne following the famine were studied at the age of 19 years Those children who were affected by the famine during 1 st and 2 nd trimester of fetal life were twice as likely to be Obese. Ravelli et al 1976 “Early pregnancy is a critical period for the development of hypothalamus and the nutritional deprivation at that time resets the regulation of appetite and growth for life”

Does breast feeding protects against Obesity ?: 

Does breast feeding protects against Obesity ? A large study of 15000 children in US found that those who were mostly breast fed were less likely to be Obese than their counterparts Gillman et al 2001 Breast feeding may increase self control in infant

PowerPoint Presentation: 

Can we change His DESTINY ?

Treating Obesity how have we fared so far ??: 

Treating Obesity how have we fared so far ??

PowerPoint Presentation: 

We thought that we will make him run and he will loose weight ! How wrong

Physical Activity Alone Results in Minimal Weight Loss: 

Physical Activity Alone Results in Minimal Weight Loss Wing. Med Sci Sports Exerc 1999;31(suppl):S547. * P <0.05 vs control group Duration of each study ranged from 4 to 12 months. Stefanick 1998 Stefanick 1998a Anderssen 1995 Hammer 1989 Verity 1989 R ö nnemaa 1988 Wood 1988 Wood 1983 Weight loss (kg) Control Group Exercise Group * * * *

Energy expenditure :: 

Energy expenditure :

Why don’t you loose enough weight with exercise ? : 

Why don’t you loose enough weight with exercise ? General rule of thumb is that 1 kg of body fat yields approx 7500 kcal when oxidized. A 75 kg person require approx 100 kcal to walk a mile. One would have to walk 75 miles to expend the energy contained in 1 kg of fat. So if one wants to loose 10 kg he will have to walk 750 miles. Many obese can not even walk 1 mile continuously !!!

PowerPoint Presentation: 

Next option :

PowerPoint Presentation: 

ATKIN’S DIET : FIRST INTRODUCED IN 1973 RE INTRODUCED IN 1992 & LATER IN 2002 10 MILLION COPIES SOLD SO FAR LOW CARBOHYDRATE , HIGH PROTEIN HIGH FAT DIET

PowerPoint Presentation: 

Weight loss with ATKIN’ diet and low fat diet:

PowerPoint Presentation: 

We tried to play GOD by trying some medicines in treating Obesity

Drugs to bring down weight :: 

Drugs to bring down weight : Fenfluramine Banned Riminobant Banned Sibutramine Banned Orlistat 120 mgTDS

PowerPoint Presentation: 

Cochrane analysis ( 2009 )pooled data on Orlistat suggested that in trials longer than 1 year, it reduced weight by 2.9 Kg 30 – 40% participants left midway through the studies

Is any anti obesity drug on the horizon ?: 

Is any anti obesity drug on the horizon ? Qnexa ( combination of weight loss warhorse Phenteramine and antiepileptic Topiramate ) was disapproved by FDA in July 2010 because it increased heart rate by 1 / minute Naltrexone + Bupropion in 1 year phase III trial increased LDL Lorcaserin a selective serotonin 2c receptor agonist proved to be slightly less effective than Orlistat in a phase III trial on 1600 patients with 50% dropout at 1 year NEJM 2010 Liraglutide a GLP1 analogue 2 year wt loss was 5.3 kg Vs 2.3 kg in Orlistat group with a drop in BP ( OD s/c injection )

Our problems are self made, therefore they may be solved by man. No problem of human destiny is beyond human beings: 

Our problems are self made, therefore they may be solved by man. No problem of human destiny is beyond human beings John F Kennedy

People who are changing the Destiny: 

People who are changing the Destiny

PowerPoint Presentation: 

& HAPPY HOLI sondhisp@gmail.com