Growing Obesity in the U.S.

FCS 208

Summer 2007

Etiology of ObesityBody Composition is determined by a complex set

of genetic and behavioral factors (ACSM 2000).

Although the contributing variables are many, the fundamental determinant of body weight/body composition is caloric balance

Kcal InKcal In Kcal OutKcal Out

Body WeightBody Weight

The Energy Balance Equation

What does being overweight mean?

Does it mean being “overweight”, or…..

Does it mean being “overfat”, or…..

Does it mean being under “fat-free”

Fat-free = everything except body fatFat-free is most related to lean body mass or muscle

It is desirable to have more fat-free and less body fat

Weight on the bathroom scale does not tell you

much!!

It does tell how much of you there is.

It does not tell how much fat or muscle you have!!

For Greater, Long-Term Health

• Focus on building more muscle and lean body mass and less on losing weight.

• Diets often lead to a loss of lean body mass, therefore any weight loss leaves the body with a higher percentage of body fat.– This is a worse condition than before the diet

was begun!

Building or Retaining Lean Body Mass

• Building or retaining lean body mass (muscle) requires strength training or weight bearing exercise (work).

Evaluating Body WeightBody Mass Index

Obesity Defined by Body Mass Index(Quetelet Index)

Calculator at NIH website:http://www.nhlbisupport.com/bmi/bmicalc.htm

– used to assess body weight relative to height

BMI = weight (kg) / height (m)2

- - - OR - - -

BMI = wt (pounds) x 703 / ht (inches)2

Growing Obesity in the U.S.

• Go to the CDC website: http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm and click on a PowerPoint slide presentation format below the 2005 map for a presentation on the increasing obesity in American adults since 1985 - 2005.

% of adults in a state who have a BMI > 30 (obese), or ~ 30 lbs. overweight for 5'4" person

Obesity Incidence – Adults

• Obesity increase in the US: 1985 – 2005

• Obesity Incidence – 2003 - 2004 NHANES data– Overweight (BMI 25-29) – 34.1 %– Obese (BMI >30) – 32.2 %

• http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight/overwght_adult_03.htm

19961991

2003

Obesity Trends* Among U.S. AdultsBRFSS, 1991, 1996, 2003

(*BMI 30, or about 30 lbs overweight for 5’4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity in the US – 2005BMI > 30, or ~ 30 lbs. overweight for 5'4" person

Trends in Overweight* Prevalence (%), Adults 18 and Older, US, 1992-2005

1992 1995

1998

Less than 50% 50 to 55% More than 55% State did not participate in survey

*Body mass index of 25.0 kg/m2or greater. Source: Behavioral Risk Factor Surveillance System, CD-ROM (1984-1995, 1998) and Public Use Data Tape (2004, 2005), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 1997, 2000, 2005, 2006.

2005

The Evidence is In

• Americans are becoming more overweight and obese each year.

Health consequences

• Hypertension (high blood pressure)

• Diabetes mellitus• http://www.cdc.gov/diabetes/statistics/maps/index.

htm

• Coronary heart disease (CHD)

Source: Mokdad et al., Diabetes Care 2000;23:1278-83; J Am Med Assoc 2001;286:10.

Diabetes Trends* Among Adults in the U.S.,

(Includes Gestational Diabetes) BRFSS, 1990,1995 and 2001BRFSS, 1990,1995 and 20011990 1995

2001

No Data <4% 4%-6% 6%-8% 8%-10% >10%

CHD Incidence: (P.D.A.Y. Study)Pathological Determinants of Atherosclerosis in Youth • 15 - 19 y.o. (atherosclerotic lesions)

– All aortas and ½ right coronary arteries

• Children– Fatty streaks in arteries at age 6 y.o.

• From ages 15 - 34 y.o.– Rapid increase in prevalence and extent of

fatty streaks & fibrous plaques

• http://www.nih.gov/news/pr/jan97/nhlbi-27.htm

Economic Cost of Healthcare

• National Coalition on Healthcare– http://www.nchc.org/facts/cost.shtml

• $2 trillion or $6700 person in 2005• 16% of GDP (value of all goods and services

produced in the US• 4X the annual expenditure for Defense

– Projected cost• $2.9 trillion (2009) and $4 trillion (2015)• 20% of GDP in one decade (2015)

What is the Answer?

but, is obesity the problem?

or

Is obesity a symptom of the problem?

• What is the problem?

• How did we get to this point?

• Who is responsible?

MSNBC – Business with CNBC

Judge throws out McDonald’s suitPlaintiffs failed to show fast food chain deceived consumersThe Associated PressSeptember 4, 2003

New York, NY. – For a second time this year, a federal judge threw out a lawsuit Thursday that alleged McDonald’s misled consumers into believing its food was nutritious and part of a healthy diet.

“If a person knows or should know that eating copious orders of supersized McDonald’s products is unhealthy and may result in weight gain…..it is not the place of the law to protect them from their own excesses,” U.S. District Court Judge Robert Sweet wrote at the time.

He said, consumers “cannot blame McDonald’s if they, nonetheless, choose to satiate their appetite with overindulgence of supersized McDonald’s products.”

McDonald’s phasing out Supersizefries, drinksEffort to offer customers 'a balanced lifestyle'

The Associated PressUpdated: 10:56 a.m. ET March 3, 2004

CHICAGO - Hold the fries — at least the super-sized version.

In a sign of the times, McDonald’s is getting rid of the extra-large portions that had become one of its signatures. The burger giant said it has begun

phasing out Supersize fries and drinks in its more than 13,000 U.S. restaurants and will stop selling them altogether by year’s end, except in promotions.

Who determines what McD serves?

• Does McDonald’s determine what they sell?or

• Do the customers determine what McDonald's sells?

• Who determines what you eat at restaurants, campus dining, or buy at the grocery store?

What is different today than yesterday?

• The following pictures show changes over time.

– State Fair – 2003– State Fair – early 1960’s

– Children going to school in the late 1950’s

Fried What! Almost anything batter dipped & deep-fat fried, Illinois State Fair, 2003

“Uptown” Normal

• Have you tried the “Fried Twinkies” at the new Chicago-style hot dog restaurant on Beaufort St?– They are very popular!

• You do not have to go to the State Fair to get your Fried Treats anymore.

State Fair early 1960’s

What is different than today?

Going to Elementary School - late 1950’s

Notice the children, see any differences? How do children go to school today?

What has changed? Why has it changed?

• Many changes– Readily available, cheap food– Modern conveniences– Desk jobs– Busy life – Other factors

Technology and prosperity have changed the activity levels of children and adults in developed countries

Kcal In vs. Kcal OutArticle by: Steven N Blair & Milton Z Nichaman,

The public health problem of increasing prevalence rates of obesity and what should be done about it.

Mayo Clin Proc. 2002; 77: 109-113

• http://www.mayoclinicproceedings.com/pdf%2F7702%2F7702e%2Epdf

Modern conveniences reduce energy expenditure and lead to weight gain

Dr. Steven N. Blair of the Cooper Institute, Dallas TX

• http://www.cooperinst.org/index.cfm

• Steven Blair stated that the evidence shows that the reduction in energy expenditure is more responsible for the weight gain of Americans than increased caloric intake.

• Since this 2002 article the incidence of overweight and obesity has continued to increase in adults and children

Childhood Obesity

• CDC – Childhood Overweight– http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/

index.htm

• Overweight children more likely to develop high blood pressure, high blood cholesterol, Type 2 diabetes, and become an obese adult

The Debate

• A current debate is what to call overweight and obese children– June 11, 2007

• Experts advise docs to be blunt, call kids ‘obese’. Fuzzy terms used for tact don’t properly define weight issue, group explains– http://www.msnbc.msn.com/id/19194146/

Another Debate

• What should be done about childhood obesity?

• How can childhood obesity be slowed and reversed?

• How can children be educated and trained in a healthy lifestyle?

Many of our health behaviors are learned early in life

Where did you learn your health behaviors?

What are the Common Risk Factors for Obesity?

• Lack of Physical Activity and poor Nutrition

Lifelong Health

Physical Nutrition

Activity

Physical Activity Fundamental To Preventing Disease

J une 20, 2002

Regular physical activity, fitness, and exercise are critically important for the health and well being of people of all ages. Research has demonstrated that virtually all individuals can benefit from regular physical activity, whether they participate in vigorous exercise or some type of moderate health-enhancing physical activity. Even among frail and very old adults, mobility and functioning can be improved through physical activity.1 Therefore, physical fitness should be a priority for Americans of all ages.

Despite our level of education, are we a literate society?

– Health Literate?– Nutrition Literate?– Exercise Literate?– Wellness Literate?– Disease Literate?

How best to change life-long behaviors?

• Best age for intervention?– Adulthood?– Children?

• If childhood, how do we reach children?– Pre-K– Schools (K-12)– Through parents

• Should the focus be Prevention or Treatment?

• What are the future economic costs of today’s actions and decisions?

Children's Health

Should schools teach about heart disease?Kids need to know how to keep themselves healthy, group saysThe Associated PressUpdated: 5:26 p.m. ET Oct. 11, 2004

DALLAS - Schools should be more aggressive in teaching children about heart disease and the risks of bad diet and little exercise, the American Heart Association said Monday.

Diet and Fitness

Exercise better than calcium for girls' bonesStudy: Teens' fitness habits key to preventing osteoporosisThe Associated PressUpdated: 3:07 p.m. ET June 10, 2004

STATE COLLEGE, Pa. - Got exercise? A recent study indicates that exercise is more important than calcium in developing strong bones in girls and young women.

Cardiovascular Health

Overweight kids face greater heart attack riskChange eating habits for cardiovascular health, group says

Updated: 7:03 p.m. ET Sept. 29, 2004

LONDON - Overweight children are three to five times more likely to suffer a heart attack or stroke before they reach 65 than slimmer youngsters, an international charity said on Monday.

Weekly

September 17, 2004 / 53(36);844-847

Participation in High School Physical Education --- United States, 1991--2003Physical education (PE) can increase student participation in moderate to vigorous physical activity (1) and help high school students gain the knowledge, attitudes, and skills they need to engage in lifelong physical activity (2). Two national health objectives for 2010 are to 1) increase to >50% the proportion of adolescents who participate in daily school PE (objective no. 22-9) and 2) increase to >50% the proportion of adolescents who spend at least half of school PE class time being physically active (objective no. 22-10) (3).

Much needs to be done in addressing current disease trends?

How can children be reached?

The “New PE”

• Movement to teach principles needed for lifelong health and wellness vs. teaching the “rules and skills of games” of traditional PE

– Stated at Madison Jr. High School in Naperville, IL with Mr. Phil Lawler, PE teacher

The “New PE”

• Watch the following short video on one step in the right direction

• Learning to be Fit– Fit for Life, PBS Video April 3, 2002

• http://www.pbs.org/newshour/bb/education/jan-june02/pe_3-22.html#

• Click to watch in steaming video to start

How can children be reached?

• How to introduce the “New PE” concept into schools?– Teachers need to be trained to teach:

• The role of physical activity in health and wellness• How to train children in developing their own

physical activity program for life-long health• Nutrition education• Train students to develop their own wellness plan

How can students be reached?– Students need to learn how to design:

• Cardiovascular, strength training, and flexibility activities for physical fitness

• Diets for nutrition and health

• Customized wellness programs for lifelong health

– Teachers are needed who can teach these principles to children, and

– Parents need to assume greater responsibility in training their children in wellness principles and in demonstrating a healthy lifestyle

Parent Support Vital

PE 4 Life

• One not-for-profit organization working to improve the health of American children is PE 4 Life

PE 4 LifeBUILDING HEALTHY STUDENT BODIES – ONE AT

A TIME™

• Cause: Quality, daily physical education programs in all US schools

• Mission: PE4life inspires active, healthy living by advancing the development of quality, daily physical education programs for all children.

• Philosophy: Daily physical education provides a simple and inexpensive solution to reduce children's exposure to chronic diseases, while fostering lifelong fitness habits.– http://www.pe4life.org/about.php

PE 4 Life

• Mr. Phil Lawler has become their Director of Outreach and Training. Here is his testimony before a Congressional Committee in Washington DC on May 10, 2007– http://www.pe4life.org/articles/

PE4life_Testimony_051007.pdf

– The video of the Hearing is available under the what they’re saying heading on the PE 4 Life homepage, but it is the whole session and Mr. Lawler was the last presenter.

PE 4 Life

• Several valuable child overweight and obesity resources under Research heading at:

– http://www.pe4life.org/research.php

American Academy of Pediatrics

• Published a Policy Statement on the Prevention of Pediatric Overweight and Obesity

– http://aappolicy.aappublications.org/cgi/reprint/pediatrics;112/2/424.pdf

Nutrition Information and Health?

Today

• We Have More– Information sources– Food– Conveniences– Exercise equipment– Good intentions– Health knowledge

• But does not translate into greater health and well-being

• What will it take to get Americans moving, eating less and choosing healthier foods?