1. Lifestyle Diseases
Obesity, Type II Diabetes, CVD, Cancer

2. If I knew I was going
to live this long,
I would have taken
better care of myself.
~Mickey Mantle
(died of liver cancer at age 64)

3. #1 Cause of Preventable Death
TOBACCO
CVD -cardiovascular disease
CLRD -chronic lower
respiratory disease
Cancer –
lung, mouth, lips, nasal cavity
(nose) and sinuses, larynx (voice
box), pharynx (throat), esophagus
(swallowing tube), stomach,
pancreas, kidney, bladder, uterus,
cervix, colon/rectum, ovary, and
acute myeloid leukemia

4. A New Epidemic!
Sedentary
Death
Syndrome
(SeDS)

5. Sedentary Death Syndrome
Inactivity
Poor Diet
Obesity
Diabetes (Type II)
CVD
Cancer
Also osteoarthritis
And osteoporosis

6. Lifestyle Disease
• Any non-infectious disease that is
caused or promoted by your behavior
and choices you make
• Obesity, type II diabetes, cardiovascular disease
(CVD, such as high blood pressure, heart attack,
and stroke), multiple forms of cancer,
osteoarthritis, osteoporosis, chronic back pain

7. Risk Factor
• Risk is the probability, the chance, that
something (usually negative) will happen
• A risk factor (in relation to diseases) is
anything that increases your chance of
developing a disease or condition
– High fat diet, cholesterol
– Smoking
– Stress
– Lack of exercise
– UV radiation

8. Leading Causes of US Deaths (2010)
1. Heart disease: 599,413
2. Cancer: 567,628
3. Chronic lower respiratory diseases: 137,353
4. Stroke (cerebrovascular diseases): 128,842
5. Accidents (unintentional injuries): 118,021
6. Alzheimer's disease: 79,003
7. Diabetes: 68,705
8. Influenza and Pneumonia: 53,692
9. Nephritis, nephrotic syndrome, nephrosis: 48,935
10. Intentional self-harm (suicide): 36,909
www.cdc.gov/nchs/FASTATS/lcod.htm

10. Obesity
• BMI (body mass index)
– (705 x weight in pounds)/(height in inches)2
• Exceptions because of percent lean body
mass, but a good general rule
– Percent body fat correlates well with the lifestyle
diseases; BMI is often a good surrogate measure
of that

11. Obesity
BMI Disease Risk Category
<18.5
18.5-21.99
22.0-24.99
25.0-29.99
30.0-34.99
35.0-39.99
>40.0
Increased
Low
Very low
Increased
High
Very high
Extremely high
Underweight
Acceptable
Acceptable
Overweight
Obesity I
Obesity II
Obesity III

12. • BMI tables are for ADULTS only though
• Use table on page 205 to view appropriate teen
weights
• Again, these are guidelines to help people
know the correct ranges
• Trend of increased obesity is causing increasing
health problems and health care costs
(http://www.cdc.gov/obesity/data/trends.html)
Obesity

13. • For children and adolescents (aged 2–19
years), the BMI value is plotted on the CDC
growth charts to determine the corresponding
BMI-for-age percentile.
• Overweight is defined as a BMI at or above
the 85th percentile and lower than the 95th
percentile.
• Obesity is defined as a BMI at or above the
95th percentile for children of the same age
and sex.

15. WHO stats on obesity
• 65% of world population live in countries where
overweight and obesity kills more people than
being underweight
• 2010: 43% of children <5 are overweight
• Child obesity in US has tripled in past 30 years
• In 2008:
– >1/3 of US children/teens are overweight or obese
– 1.5 billion adults >20 years overweight or obese

16. Obesity
So what?
Adverse metabolic effects on…
• Blood pressure
• Cholesterol
• Triglycerides
• Insulin resistance

17. Obesity
• Respiratory difficulties
• Chronic musculoskeletal problems
• Skin problems
• Infertility

18. • CVD problems
– High blood pressure; high cholesterol
– Heart disease; heart attack
– Stroke
• Insulin resistance and Type II diabetes
• Certain cancers (especially hormone-
related and large bowel cancers)
– Breast, colon, prostate, endometrium,
kidney, gall bladder
• Gall bladder disease
Obesity

19. Diabetes
• Chronic disease affecting how the body uses
glucose for energy
• Glucose—the basic sugar that fuels all bodily
functions
• Insulin—the hormone that helps glucose
move from the blood stream and into cells
• Pancreas—the organ that produces insulin

20. • Whether no insulin, too little insulin, or cells
not responding appropriately to insulin,
• Sugar builds up in the blood and causes
damage to eyes, kidneys, nerves, circulatory
system, heart
– Blindness
– Kidney failure
– Circulatory problems
– Limb amputations
– Heart attacks and stroke
Diabetes

21. • 5-10% of diabetics
• Body does not produce insulin
• Must have insulin (injections or pump) to
maintain health
• Must always monitor sugar intake and blood
sugar level
• Thought to be an autoimmune disease
• Genetic predisposition?
Type I Diabetes
(NOT a lifestyle disease)

22. • 90-95% of diabetics
• Body produces too little insulin, or produces
enough but cells don’t respond
appropriately
• Used to only appear in adults, but now also
in children and teens
• Major correlation to obesity and inactivity
Type II Diabetes

23. • Risk Factors
– High-fat, high-calorie diet
– High cholesterol
– Overweight or obese
• Management
– Weight management
– Monitored diet
– Exercise/physical activity
– Insulin (sometimes)
Type II Diabetes

24. Diabetes
• In 2010, 7th
leading cause of death
• Increases risk for heart disease and stroke
(>75% of diabetics die from heart disease or
stroke)
• Diabetes costs the US ~$174 annually!
($116 billion is direct medical cost)

25. Diabetes
• #1 reason for…
– Adult blindness
– Kidney failure
– Limb amputation
• Also linked to…
– A form of dementia
– Some forms of cancer
– Some forms of lung disease

26. Diabetes Complications

27. Diabetes
• Survey results released by the American
Diabetes Association (November, 2009)
– Less than half of the respondents chose diabetes
when asked whether diabetes, breast cancer or
AIDS causes the most deaths.
– Diabetes kills more than breast cancer and AIDS
combined.

28. Number (in Millions) of
Civilian/Noninstitutionalized Persons with
Diagnosed Diabetes, United States, 1980–2006

29. CDC 2010 Report on Diabetes
10/22/2010 press release:
• Currently, ~1 in 10 US adults have diabetes
• By 2050, expected to be 1 in 3!

30. Metabolic Syndrome
Increased risk for…
• Atherosclerosis and CHD
• Stroke
• Type II Diabetes
Biggest risks factors for having it are…
• Abdominal fat (waist circumference)
• Insulin resistance (from diet, stress, genetics)
(Also, lack of exercise, genetics, and age)

31. Metabolic Syndrome
Three or more of the following:
• Blood pressure equal to or higher than 130/85 mmHg
• Fasting blood sugar equal to or higher than 100 mg/dL
• Large waist circumference (length around the waist):
– Men - 40 inches or more
– Women - 35 inches or more
• Low HDL cholesterol:
– Men - under 40 mg/dL
– Women - under 50 mg/dL
• Triglycerides equal to or higher than 150 mg/dL

32. Cardiovascular Disease
• Hypertension (high blood pressure)
is a major risk factor for CVD
– Control with weight management, medication,
exercise, proper nutrition, and avoiding tobacco
• Arrythmias—irregular heartbeats
– One type, ventricular fibrillation, can cause
sudden cardiac arrest (heart stops beating)

33. • Atherosclerosis—plaque builds up in arteries
– Can restrict blood flow or completely block (clot)
• Angina—pain in heart when not enough oxygen
(restricted blood flow)
• Blood clot:
– If in artery feeding heart (coronary) Heart attack
– If in artery feeding brain (carotid) Stroke
Cardiovascular Disease

34. • Heart Attack—damage to the heart muscle
because of reduced or blocked blood supply
– Usually because of atherosclerosis
– Ventricular fibrillation follows often
• Congestive Heart Failure—gradual weakening
of heart until can’t perform its job
– High blood pressure, atherosclerosis, heart valve
defect, or illegal drug use (raising heart rate)
Cardiovascular Disease

35. • Stroke
– blood flow to brain is blocked, or
– blood vessels in brain burst (cerebral hemorrhage)
– High BP is leading cause of stroke
– All the same causes as other CVDs
Cardiovascular Disease
http://video.about.com/heartdisease/Heart-Attack.htm
http://www.medicinenet.com/heart_disease_pictures_slideshow/article.htm

36. • Heredity (genetic component)
• Gender
– Men greater risk CVD and heart attack earlier
in life
– Women less likely to survive a heart attack
• Age
– CVD risk increases with age
– Most who die of CVD are 65 or older
CVD Risk Factors—Can’t Control

37. CVD Risk Factors—Can Control
• Tobacco use
• High blood pressure (BP)
• High cholesterol (LDL, not HDL)
• Physical inactivity
• Excess weight (raises BP and cholesterol)
• Abdominal fat (apple-shaped, not pear-shaped)
• Excess stress (raises BP)
• Alcohol and drug use (raises BP, arrythmias)
• Type II Diabetes

38. CVD and Diabetes Risk Factors
You CAN Control
• Diet and Exercise
– Reduce fat and cholesterol
– Maintain healthy blood pressure
– Maintain recommended weight for height
– at least 20-60 minutes vigorous activity 3-5 days
per week
• Do not use tobacco products

39. Blood Pressure
• Normal blood pressure
– Adult: < 120/80 mmHg
• Hypertension (high blood pressure)
– Adult: >140/90
– Teens: >95%ile for age, height, gender
– Teens at >90%ile are 3x more likely to have
hypertension as adults

40. Cholesterol
• Total cholesterol (adult):
–<200 mg/dL = desirable
–>240 mg/dL = 2x risk of heart disease

41. Cholesterol—HDL is Good
• HDL—
– <40 mg/dL men = increased risk heart disease
– <50 mg/dL women = increased risk heart disease
– >60 mg/dL = protection against heart disease
• To raise HDL:
– Maintain appropriate weight for height
• Healthy diet (low in fat, especially trans-fats)
• 30-60 minutes physical activity more days than not
– Avoid tobacco products
(*Estrogen also raises HDL)

42. Cholesterol—LDL is Bad
• Higher LDL =  risk heart attack and stroke
• LDL build up in arteries (atherosclerosis)
• LDL—
– <100 mg/dL is Optimal
– 160-189 mg/dL is High
– >190 mg/dL is Very High
• To lower LDL:
– Maintain appropriate weight for height
• Healthy diet (low in fat, especially trans-fats)
• 30-60 minutes physical activity more days than not
– Avoid tobacco products

43. Fats
• Unsaturated = good
– Necessary for growth and normal body function
– Liquid at room temperature
– Olives; olive and canola oils; nuts; avocados;
soybeans, corn, sunflower, and sesame oils; fish
and fish oils
• Saturated = not good
– Raises LDL
– Solid at room temperature
– Butter, shortening, animal fats, tropical oils (palm
kernel, coconut oils), whole dairy foods, meat

44. Fats (cont.)
• Trans-fats = Really bad!
– Man-made saturated fats (by hydrogenating
vegetable oils)
–Raise LDL and lower HDL (double
whammy!)
– In packaged baked goods (cookies, crackers)
– In fried foods

45. Did you know...
• That working off a bottle of soda or fruit juice
takes 50 minutes of running?
• That a calorie of HFCS (sweetener in sodas
and other foods) causes more weight gain
than a calorie of cane sugar?
• That aspartame (Nutrisweet, Equal) has
almost 100 side effects, including slow, steady
weight gain?!

46. Sugar v. HFCS
• High-fructose corn syrup (HFCS) has been
used as natural sweetener since 1970s
– Enzyme to make invented in 1957
– Commercially available in 1970s
– Since 1977, sugar is much more expensive
– HFCS tastes as sweet as sugar
• Recent study shows that calorie for calorie,
HFCS causes more weight gain
(published in March 2010)
www.themoneytimes.com/featured/20100326/high-fructose-corn-syrup-worse-sugar-id-10105392.html

47. Exercise Guidelines for Teens
• Aerobic Exercise—1 hour physical activity/day
– Most of hour at moderate to vigorous level (50%
to 85% training intensity)
• Strength Training—at least 3 days/week
• Flexibility Training—3 to 7 days/week
• Benefits:
Maintain healthy weight
Less risk of disease
More lean body mass (less fat)
Increased BMR
Less injuries
Age well
Endorphins

48. Smoking (aside from causing cancers)
• Tar
– Thickens mucous so cilia can’t remove well
– Bronchitis, Emphysema, COLD
– Makes it harder for lungs to get oxygen
• Nicotine
– Increases heart rate, increases BP
– So heart needs more oxygen
– Triggers formation of blood clots
• CO
– Binds to RBCs so oxygen cannot—less oxygen to
heart and rest of body

49. Cancer
• Uncontrolled cell growth
Tumor—abnormal mass of tissue that has no
natural role in the body
• Benign—noncancerous
• Malignant—cancerous; can spread
– Metastatsis—the spread of cancer from its origin
to other parts of the body

50. Warning Signs
C—change in bowel habits
A—a sore that doesn’t heal
U—unusual bleeding or discharge
T—thickening or a lump somewhere in/on body
I—indigestion or difficulty swallowing
O—obvious change wart or mole
N—nagging cough or hoarsness

51. Categories
1. Lymphomas—immune (lymphatic) system
2. Leukemias—blood forming organs
3. Carcinomas—glands, body linings
– Skin, digestive tract, lungs
1. Sarcomas—connective tissue
– Bones, ligaments, muscle

52. • 5-10% of cancers are hereditary
• Many cancers have an external cause
– Carcinogen—any substance that causes cancer
– Promoter—any substance that along with another
substance or substances causes cancer or
enhances cancer cell growth
• ~60% of cancers could be prevented through
healthy lifestyle choices

53. Risk Factors
• Genetic predisposition
• Environmental exposures
– TOBACCO (major cause of cancer in US)
– Diet
– Obesity
– Radiation
– Certain viruses
– Chemical exposures (occupational or community)

54. Tobacco Use
• At least 43 carcinogens in tobacco and smoke
• First hand and second hand smoke associated
with lung cancer and other diseases

55. Diet
• High fat and low fiber diets increase risk of
colon, breast, and prostate cancers
• Certain nutrients, such as antioxidants found
in fruits and vegetable, help to protect the
body from cancer

56. Early detection is KEY!

57. Self-examination
• Breast cancer
• Testicular cancer
• Skin cancer
Medical Examination
• Pap smear (cervical cancer)
• Prostate exam (prostate cancer)
• Colonoscopy
• Mammogram
Biopsy—removal of a small piece of tissue for
examination

58. Treatment
• Surgery
• Radiation therapy
• Chemotherapy
–Traditional (various chemicals)
–Immunotherapy (use chemicals and immune
response)
–Hormone therapy (use hormone treatments)

59. • Remission—state of time when the cancer is
under control and symptoms disappear
• Cured—cancer free

60. • Breast
– Most common, non-skin cancer in women
– Average woman has a 1 in 8 risk of being
diagnosed with breast cancer during lifetime
– Second leading cause cancer death in women
– Incidence and mortality decreasing slightly this
decade
– Early detection (BSE) is very important to survival
Female Reproductive Cancers

61. Female Reproductive Cancers
• Cervical
– Incidence and mortality declining
– Early detection is easy (Pap smear)
– Protection (vaccine)
• Ovarian
– Lowest incidence of female reproductive (~3%)
– Highest mortality (~5th
leading cause of cancer
death for women)
– Lack of early symptoms

62. Male Reproductive Cancers
• Testicular—Young age
– Rare in general, but
– Most common cancer in males aged 15-35
– Often curable if caught and treated early
(SELF-EXAMS are key!!!)
• Prostate—Old age
– Most common, non-skin cancer in men
– Average man has a 1 in 6 risk of being diagnosed
during lifetime; only 1 in 34 will die
– Second leading cause cancer death in men

63. Lung Cancer
• Most common, non-skin cancer
• #1 cause of cancer death
– 29% of all cancer deaths
– More than breast, prostate, and colon combined!
(even though more women diagnosed with breast cancer
and more men diagnosed with prostate—think about early
symptoms and detection)
• 1 in 13 chance of diagnosis for men; 1 in 16
chance for women
• Smoking increases risk significantly
– Male smokers 23x more likely to get lung cancer
– Female smokers 13x more likely

64. Colorectal Cancer
• Third most common cancer
• Third leading cause cancer death
• Risk increases with age
• Slight decrease in incidence and mortality

65. Leukemias
• One of most common childhood cancers
• 4 types: CLL, CML, ALL, AML
• ALL and AML more common in children
• Most ALL and AML can be cured
• Chemotherapy and/or bone marrow
transplant

66. Lymphomas
• Hodgkin’s and Non-Hodgkin’s (NHL)
• NHL like ALL
• Most common cancer in teens
• Early symptoms:
– Swelling of lymph nodes
• Chemotherapy and radiation
• Good prognosis with full treatment

67. Skin Cancer
• Not related to the sedentary lifestyle, but
another lifestyle disease that plagues our
country