The Problem: The Problem: Obesity in Obesity in AmericaAmerica

Frank J. Domino, M.D.Frank J. Domino, M.D.

Barbara Olendzki, RD, MPHBarbara Olendzki, RD, MPH

World Wide Rates of World Wide Rates of overweight and obesity, overweight and obesity,

2000-20042000-2004US 66.3%UK 63.0% Mexico 62.3% Canada 57.5% Greece 57.1% New Zealand 56.2% Germany 49.2%Italy 42.6%

Consequences of ObesityConsequences of Obesity 66% of Americans are overweight*66% of Americans are overweight* 22% of Americans are obese 22% of Americans are obese

Deaths from Obesity:Deaths from Obesity: 300,000 premature deaths associated 300,000 premature deaths associated

with obesity with obesity annuallyannually (CDC) (CDC) 25,000/month, 5,769/week, 821/day, 34/hour.25,000/month, 5,769/week, 821/day, 34/hour.

450,000 from tobacco-related disease450,000 from tobacco-related disease 10.4 million people with type II diabetes10.4 million people with type II diabetes 4747 million with metabolic syndrome million with metabolic syndrome

**CDC 2006CDC 2006

Is treating obesity a way Is treating obesity a way to save the economy?to save the economy?

•2003: 9.1 % of U.S. health expenditures* •Estimated annual medical spending due to overweight and obesity (BMI >25) to be as much as $92.6 billion in 2002 dollars*

•2006: 10% of U.S. expenditures**•$147 billion in 2006 dollars**•(Afghan war ~ 28 Billion per year over 8 Yrs)

*Finkelstein EA; Health Affairs Web Exclusive. 2003; W3:219-226. **Finkelstein EA; Health Affairs 28, no. 5 (2009): w822-w831

Obesity Trends* Among U.S. Obesity Trends* Among U.S. AdultsAdults

BRFSS, 1985BRFSS, 1985

No Data <10% 10%–14%

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

Obesity Trends* Among U.S. Obesity Trends* Among U.S. AdultsAdults

BRFSS, 2007BRFSS, 2007(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 2009BRFSS, 2009

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

1999

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2009

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

2009

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

(*BMI 30)

Hispanic

State-specific Prevalence of Obesity* Among State-specific Prevalence of Obesity* Among U.S. Adults, by Race/Ethnicity, 2006-2008U.S. Adults, by Race/Ethnicity, 2006-2008

White non-Hispanic

Black non-Hispanic

SummarySummary

Non-Hispanic blacks, Hispanics, & Non-Hispanic blacks, Hispanics, & non-Hispanic whites non-Hispanic whites

For For non-Hispanic blacks non-Hispanic blacks − Overall prevalence of obesity—Overall prevalence of obesity—35.735.7%%− Midwest and SouthMidwest and South− Prevalence ranged from 23.0% (New Prevalence ranged from 23.0% (New

Hampshire) to 45.1% (Maine) Hampshire) to 45.1% (Maine) − 40 states had a prevalence of 40 states had a prevalence of ≥ 30%≥ 30%− 5 states (Alabama, Maine, 5 states (Alabama, Maine,

Mississippi, Ohio, and Oregon) had a Mississippi, Ohio, and Oregon) had a prevalence of prevalence of ≥ 40% ≥ 40%

Summary Summary

For For Hispanics Hispanics − Overall prevalence of obesity—Overall prevalence of obesity—28.7%28.7%− Lower prevalence was observed in the Northeast Lower prevalence was observed in the Northeast − Prevalence ranged from 21.0% (Maryland) to 36.7% Prevalence ranged from 21.0% (Maryland) to 36.7%

(Tennessee) (Tennessee) − 11 states had a prevalence of 11 states had a prevalence of ≥ 30%≥ 30%

For For non-Hispanic whites non-Hispanic whites − Overall prevalence of obesity—23.7%Overall prevalence of obesity—23.7%− Higher prevalence in the Higher prevalence in the Midwest and SouthMidwest and South− Prevalence ranged from 9.0% (DC) to 30.2% (West Prevalence ranged from 9.0% (DC) to 30.2% (West

Virginia) Virginia) − Only one state (Only one state (West VirginiaWest Virginia) had a prevalence of ) had a prevalence of ≥ ≥

30%30%− 5 states (California, Colorado, Connecticut, Hawaii, 5 states (California, Colorado, Connecticut, Hawaii,

and New Mexico) and DC had a prevalence of and New Mexico) and DC had a prevalence of <20% <20%

What else has changed?What else has changed?

Humans have a Humans have a genotypegenotype that permits energy that permits energy intake > expenditureintake > expenditure

Political decisions & industrialization of Political decisions & industrialization of farms farms growth of grain for livestock, rather than growth of grain for livestock, rather than humanshumans

11stst in recorded history cost of in recorded history cost of meat < vegetablesmeat < vegetables. . ↑↑ portion sizes, portion sizes, ↑ ↑ fat intakes, sweetened fat intakes, sweetened

beveragesbeverages Lack of physical activityLack of physical activity: : ↓ Manual Labor, ↓ Manual Labor,

Computer/Screen time, increased automation Computer/Screen time, increased automation allows for less activity @ homeallows for less activity @ home

““What’s for Take Out?” What’s for Take Out?” 1.2 vs > 5.0 per week1.2 vs > 5.0 per week

140 calories 3-inch diameter

Calorie Difference: 210 calories

350 calories 6-inch diameter

BAGELBAGEL

20 Years Ago Today

5 days/wk X 50 weeks=15.6 lb.

If you rake the leaves for 50 minutes you will burn the extra 210 calories.*

Calorie Difference: 257 calories

590 calories

CHEESEBURGER

20 Years Ago Today

333 calories

If you lift weights for 1 hour and 30 minutes,you will burn approximately 257 calories.*

610 Calories6.9 ouncesDifference: 400 Calories

FRENCH FRIES

20 Years Ago Today

210 Calories

2.4 ounces

You need to walk for 1 hour and 10 minutes to burn approximately 400 extra calories

Frank J. Domino, M.D.Frank J. Domino, M.D.

Jill Grimes, M.D.Jill Grimes, M.D.

Barbara Olendzki, RD, MPHBarbara Olendzki, RD, MPH

Barriers to nutritional Barriers to nutritional counselingcounseling

Confusion over current guidelinesConfusion over current guidelinesLack of time & compensation Lack of time & compensation Effectiveness of interventions Effectiveness of interventions Confusion: nutrition as it relates to Confusion: nutrition as it relates to disease disease

GOAL: 5 Brief Concepts to GOAL: 5 Brief Concepts to RecommendRecommend

“ “Successful Losers”Successful Losers”

The National Weight Control RegistryThe National Weight Control Registry

>5000 successful losers>5000 successful losers

Members lost an average of 66 lbs (range=30-Members lost an average of 66 lbs (range=30-300 lbs) x 5.5 years (= 1 lb/month x 5 years)300 lbs) x 5.5 years (= 1 lb/month x 5 years)

78% eat breakfast every day. 78% eat breakfast every day. 75% weigh them self at least once a week. 75% weigh them self at least once a week. 62% watch < 10 hours of TV per week. 62% watch < 10 hours of TV per week. 90% exercise, about 1 hour per day.90% exercise, about 1 hour per day.

http://www.nwcr.wshttp://www.nwcr.ws

What about the average person?What about the average person?Daily PracticesDaily Practices

Survey 2004 US > 18 Yrs. Survey 2004 US > 18 Yrs. “Successful Weight Loss Maintainers”“Successful Weight Loss Maintainers”

1.1. Eat Fast Food Eat Fast Food < 2/Week< 2/Week

2.2. >> 5 Fruits & Vegetables/day ** AND 5 Fruits & Vegetables/day ** AND

3.3. 150 Minutes physical activity (25 150 Minutes physical activity (25 Min/Day)Min/Day)

What else can your Patients Do?What else can your Patients Do? 3200 Japanese, 30-69 Yrs Survey 2003-63200 Japanese, 30-69 Yrs Survey 2003-6 BMI, Eating “until full” & speed of eatingBMI, Eating “until full” & speed of eating

Odds of Being OverweightOdds of Being OverweightMaleMale FemaleFemale

Eating Till Full Eating Till Full 2.002.00 1.841.84 Eating Quickly Eating Quickly 1.841.84 2.092.09 Full & QuicklyFull & Quickly 3.133.13 3.213.21

Triple the odds !!!Triple the odds !!!BMJ 2008: 337: BMJ 2008: 337:

a2002a2002Eat Slowly and question if still wants moreEat Slowly and question if still wants more