James O. Hill, Ph.D. : Obesity, The Big Picture
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8/12/2019 James O. Hill, Ph.D. : Obesity, The Big Picture
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Obesity: The Big Picture
James O. Hill, Ph.D.Anschutz Professor
University of Colorado
Anschutz Health and Wellness Center
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Obesity Issues 2014
Where are we today? Who is getting fat?
The biology of obesity
Transformational weight loss
Food vs Physical Activity
Metabolic Flexibility and Obesity Evaluating Research
Physical activity and brain function
The new science of sedentarianism
Strategic movement through the workday
Small steps and nudges Impact of food taxes
Role of the Food and Beverage Industry
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Trends in overweight, obesity and extreme obesity, ages 20-74 years
0%
5%
10%
15%
20%
25%
30%
35%
40%
1960-62 1971-74 1976-80 1988-94 1999-00 2001-02 2003-04 2005-06 2007-08 2009-10
Overweight
Obese
Note: Age-adjusted by the direct method to the year 2000 US Bureau of the Census using age groups 20-39, 40-59 and 60-74 years.Pregnant females excluded. Overweight defined as 24,=BMI; obesity defines as BMI>=30; Extreme obesity defines as BMI>=40.
Extremely Obese
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0%
5%
10%
15%
20%
25%
1963-65 1971-74 1976-80 1988-94 1999-00 2001-02 2003-04 2005-06 2007-08 2009-10 2011-2012
Note: Overweight is defined as BMI>=gender and weight-specific 95th percentile from the 2000 CDC Growth Charts. Source:National Health Examination Surveys II (ages 6-11) and III (ages 12-17), National Examination Surveys, I, II, III and 1999-204, NCHS,CDC.
Age 12-19
Age 6-11
Age 2-5
Trends in child and adolescent overweight
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Causes of Obesity
Energy intake
Energy expenditureEnergy expenditure
Energy intake
WEIGHT GAIN
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Who is becoming obese?
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Contributors to Obesity
Biology Behavior
Environment
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Biology: The Energy Balance System
EnergyIntake
EnergyExpenditure
EnergyStores
Active
Regulation/Integration
InheritedFactors EnvironmentalFactors
Efficiency
Adaptive thermogenesis
Food preferences
Food environment
Physical activity
environment
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Socioecological Models
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Decrease
Energy
Intake
Body weight increases
Body weight does not change
Body weight decreases
Usual physical activity
Metabolic RateFood Intake
What happens to body weight when food intake isdecreased?
Wh t h t b d i ht h h i l ti it i
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Increase
Physical
Activity
Body weight increases
Body weight does not change
Body weight decreases
Usual physical activity
Metabolic RateFood Intake
What happens to body weight when physical activity isincreased?
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Addressing the Environment
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Biology: Influenced by Environment andBehavior
Drive to eateat whenever food is available Like sugar, fat, salt Happy being sedentarylittle need for physical activity
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Biology Desire to Eat Pref for sweet/fat No Drive to be active
FoodAvailableGood tasting
Energy dense
Inexpensive
Large portions
Physical ActivityLittle need for physical activity in daily living
Attractiveness of sedentary Entertainment
Car for Transportation
Economics
Consume More
More for lessGreater Productivity
DecreasedEnergyExpenditure
IncreasedEnergy
Intake
ObesitySocioculturalForces
Challenges in reducing obesity
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How do we begin to study the
problem?
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Foreyt, John, and Ken Goodrick. "The ultimate triumph of obesity."The Lancet346.8968 (1995): 134-135.
Last American becomes obese in 2230
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Promoting Cognitive Skills
Making conscious efforts to overcomebiological and environment influencestoward obesity
Biology
Environment
Behavior
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Hill 5-Point Plan to Reduce Obesity
Prioritize prevention over treatment Increase physical activity of the population
Promote Smart Eatingusing small changes Use small changes to change environment Teach Cognitive Skills
Big Challenge: We have to give people a reason to want to change
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Energy Gap forprevention of weightgain
Energy Gap formaintenance forweight loss
BodyWeight
Time
What will it take to reduce obesity? The energy gap
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Energy
Gap
-10% (10 kg) = 190-200 kcal/day
-15% (15kg) = 280-300 kcal/day
Energy
Gap
Obesity
How much behavior change is needed for
successful weight loss maintenance?
Example for 100 kg person
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Body
WeightEnergy
Gap
Energy
Gap
EnergyGap
Healthy Weight
Overweight
Obese
Energy Gap for Prevention of Weight Gain
(
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TRANSFORMATION
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When it comes to weight, which is more important:Food vs Physical Activity
Eat a bacon cheeseburger and consume 720 kcal in 5 min Takes 2.6 hours of walking at moderate intensity to burn it off
I worked 8 hours today to make $500 I spent $500 in 15 min on concert tickets
When it comes to net worth, which is more important:Income vs Spending
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Body Weight
EnergyIntake
Our biology works best at high
Physical Activity
Threshold forOptimal Weight
Regulation
UnregulatedZone
Regulated Zone
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Energy
Intake
Energy Expenditure
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Smart Eating
Portion Size Energy Density Liquid Calories
Healthy Defaults
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Messages
Eat Less and Move More Eat Smarter and Move More
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The birth of small changes
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Source: D.M. Bravata et.al., JAMA 298: 2296-2304, 2007
Pedometers To Increase Activity
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A better approach: Healthy Defaults
Disney parks Kids meals come with low fat milk and fruit
Starbucks Drinks made with low fat milk
Portion sizes/energy density Would anyone notice a 5% reduction?
School drop offs Buses and cars drop kids off 500 steps from
school
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0
100
200
300
400
500
600
700
Calories
7-Eleven Soft Drinks
Super Big
Gulp
Gulp Big Gulp Double
Gulp
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333 kcal
590 kcal
The Cheeseburger
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Why Change Anything?
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Program partners: Primary funder:
Developing Skills
PI: James O. Hill, Ph.D.
http://www.ucdenver.edu/academics/colleges/medicalschool/centers/HealthandWellnessCenter/Pages/Home.aspx -
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The 5thGear Card
10% Discountat King Sooperson KingSoopers brandfoods.
Show your cardfor discountsand to earnpoints at other
partners Redeem yourpoints for prizesat www.5thGearKids.org
http://www.5thgearkids.org/http://www.5thgearkids.org/ -
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Sustaining Behavior Change
RegulateBehaviorControl/LimitChoices
Educate toallow people to
make betterchoices
FOOD
TaxesPricingExposure
Zoning RestrictionsMenu LabelingPortion ControlRestrictions on bad foodsRegulations for school foods
PHYSICAL ACTIVITY
Increase active transportReduce sedentary behaviorImprove physical activity programsMandate physical activity inschools
Where is the middle ground?
Public-Private Partnerships
We will need policy but what and when?
Parents must take thelead in reducingchildrens TV watching
and provide alternatives
Are children prey for fastfood companies?
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Biology Desire to Eat Pref for sweet/fat No Drive to be active
FoodAvailableGood tasting
Energy dense
Inexpensive
Large portions
Physical ActivityLittle need for physical activity in daily living
Attractiveness of sedentary Entertainment
Car for Transportation
Economics
Consume More
More for lessGreater Productivity
DecreasedEnergyExpenditure
IncreasedEnergyIntake
ObesitySocioculturalForces
Reason to push back
Different Value Equation
Social Environment of Wellness
Make betterchoices
Challenges in reducing obesity
Energy BalanceSkills
Health & Wellness Center
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Health & Wellness Center
Integration andinteraction
Health &Wellness
Clinical
Education
Research
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Addressing a Complex Issue
PrivateSectorPartnershipsCommunity
Engagement
Create new thinking spacefor creating solutions
Develop and TestPotential Solutions Implement
Science-Based,Scalable Programsand Initiatives
Model schoolsModel worksites
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HEALTH VS WELLNESS
PreventionAccumulating Wellness
Pulmonary GIDermatologicalOrthopedic GenitourinaryPsychological Asthma
DiabetesCardiovascular DiseaseCognitive ImpairmentRenal DiseaseCancer
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CU Wellness Score
DietQuality
Quality ofLife Sleep
Stress
MetabolicFitness
PhysicalFitness
Your WellnessScore:62 (out of 100)
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Thank You!