Why is There an Obesity Epidemic? - Infomed is There an Obesity Epidemic? Richard Kahn, PhD. Outline...

Why is There an Obesity Epidemic?

Why is There an Obesity Epidemic?

Richard Kahn, PhDRichard Kahn, PhD

OutlineOutline

• Defining the problem

• How did it happen?

• What can we do about it?

Prevalence of Obesity in US Adults1960-2000


0

5

10

15

20

25

30

35

1960 1970 1980

Perc

ent

Men

Women

20001990

Diabetes 56:2673-2676, 2007

Trends In Overweight ChildrenTrends In Overweight Children

0

2

4

6

8

10

12

14

16

18

66-70’ 71-74’ 76-80’ 88-94’ 99-00’

Year

%O

verw

eigh

t

6-23 mo.2-5 Years6-11 Years12-19 Years

Ogden et al. JAMA 288:1728-1732, 2002

Prevalence of Obesity in US Adults by Ethnicity, 1980-2000

Prevalence of Obesity in US Adults by Ethnicity, 1980-2000

0

5

10

15

20

25

30

35

40

45

1980 1990 2000

Perc

ent

50

Hispanic Americans

African Americans

European Americans

Diabetes 56:2673-2676, 2007

Obesity Trends* Among U.S. AdultsBRFSS, 1985

No Data <10% 10%–14%

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


No Data <10% 10%–14%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19% ≥20



No Data <10% 10%–14% 15%–19% ≥20%


Obesity* Trends Among U.S. AdultsBRFSS, 2003


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

Source: Behavioral Risk Factor Surveillance System, CDC.


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

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

OutlineOutline




ObesityEnergy Intake

Exceeds

Energy Expenditure

Socio-cultural Factors

Genetic Factors Physiological Factors

Environmental Factors

Regulation of Body Weight is Impressive!!

Regulation of Body Weight is Impressive!!

• Average intake = 2,500 cal/dayor 912,500/yr

• 1 pound = 3,500 cal (or <10 cal/day)

• We eat 261 pounds/year

…But only gain ~ 1 – 2 lbs/yr

Signals Controlling Energy HomeostasisSignals Controlling Energy Homeostasis

Brain

Catabolic: (e.g., PVN)Reduce food intakeReduce body fat

Anabolic: (e.g., LHA)Increase food intakeIncrease body fat

+ -

αMSH

NPY/AgRP

ARC

CRHOxytocin

MCHOrexin

HYPOTHALAMUS

Brain CapillaryPancreas

Stomach

Liver

Fat

Learning habits, stress,reward/hedonics, circadianrhythms, social situation

Energy Intakeand Expenditure

CCK, GLP-1, APOA-IV,Glucagon, EnterostatinGhrelin,PYY

GhrelinIncretins

Leptin FFAs

Glucose FFAs

Insulin

Cause Of ObesityCause Of Obesity

• Physical activity• Cost per calorie• Consumption pattern• Calories consumed• Source of calories

ONLY BECAUSE OF NET EXCESS CALORIES(intake exceeds output)

Adults Reporting No Physical ActivityAdults Reporting No Physical ActivityPe

rcen

t

Age

0

10

20

30

40

50

60

70

18-24 25-44 45-64 65-74 > 75

Healthy People 2010. US Government

Decline in Physical Activity in Adolescent Girls

Decline in Physical Activity in Adolescent Girls

0

5

10

15

20

25

30

35

1(age 9-10)

3 (age 11-12)

5 (age 13-14)

7 (age 15-16)

WhitesBlacks

MET

–tim

es /

wee

k

9(age 17-18)

Study Year

Kimm SY et al. NEJM 347:703-715, 2002

100

75

50

25

0

% o

f dai

ly e

nerg

y ex

pend

iture

Exercise

NEATThermogenesis

RMR

Standing and

ambulating

526 minutes

Standing and

ambulating

373 minutes

Sitting 407 minutes

Sitting 571 minutes

352 + 65Kcal/day

LeanLean

ObeseObese

Ravussin, Science 307:530-331, 2005

Posture allocation (min)

Effect of Exercise on Energy Expenditure

Effect of Exercise on Energy Expenditure

0

5

10

15

20

25

LowNEAT

HighNEAT

ExerciseNEAT

Wee

kly

Act

ivity

EE

(kca

l x 1

03 )

Intermediate NEAT

+30 min/dBrisk Walk

5d/wk

+60 min/dBrisk Walk

5d/wk

+35 miRun/wk

Diabetes 56:2655-2667, 2007


• Physical activity

• Cost per calorie

• Consumption pattern

• Calories consumed

• Source of calories


Price of FoodPrice of Food

Food away from home 56

All food 59

Soft Drinks 20

Eggs 45

Poultry 50

Dairy 56

Fish 77

Fresh Fruit/Veg 118

Food at home 61

All items 57

Fats & Oils 35

Sugar/sweets 46

Red Meats 52

Cereal/bakery 75

Total Fruit/Veg 89

Retail prices - % change 1985 - 2000

Putnam et al, Food Review 25:2-15, 2002

Per Capita Consumption of Carbonated Soft DrinksPer Capita Consumption

of Carbonated Soft Drinks

05

101520253035404550

US Mexico UK China India

Gal

lons

2004 Pepsico Annual Report

Annual Per Capita Consumption of Snack Chips

Annual Per Capita Consumption of Snack Chips

0

5

10

15

20

US UK Mexico China India

Poun

ds p

er c

apita

2004 Pepsico Annual Report

Patterns of Food ConsumptionPatterns of Food Consumption

• 1970 - $6 billion on fast food• 2001 - $110 billion

• 1980 - Teenagers consumed 2 x more milk than soda• 2000 - Teenagers consumed 2 x more soda than milk

• 1975 – 33% of moms w/young children were employed• 2002 – 67% were employed

Source: “Fast Food Nation”

• We spend more on fast food then on movies, books, magazines, newspapers and recorded music –COMBINED!!

• Every month ~ 90% of children 3-9 years of age visit a fast food restaurant

• On any given day, 25% of adults visit a fast food restaurant

Patterns of Food ConsumptionPatterns of Food Consumption

Annual Per Capita Availability of Energy- Adjusted and Unadjusted

for Waste

Annual Per Capita Availability of Energy- Adjusted and Unadjusted

for Waste

1500

2000

2500

3000

3500

4000

450019

50

1960

1975

Kca

l/day

1955

1980

1985

1991

1965

1970

1996

2001

UnadjustedAdjusted

Diabetes 56:2673-2676, 2007

Age-Adjusted Mean Energy Intake (kcal/day) Among White and Black

Men and Women

Age-Adjusted Mean Energy Intake (kcal/day) Among White and Black

Men and Women

0

500

1000

1500

2000

2500

3000

1971-74 1976-80 1988-94

Kca

l/day

1999-02

White MenBlack MenBlack WomenWhite Women

Diabetes 56:2673-2676, 2007

Trends in Energy Intake atFast Food Restaurants

Trends in Energy Intake atFast Food Restaurants

Calories Portion SizeFood 77-78’ 94-96’ % Increase 77-78’ 94-96 % Increase

French Fries 171 284 +66 60 94 +57

Hamburgers 419 497 +19 170 206 +18

Cheeseburgers 406 537 +32 169 209 +24

Nielsen SJ, Popkin BM, JAMA 289:450-453, 2003

Cumulative Energy Intake Related to Food Density

Cumulative Energy Intake Related to Food Density

0

500

1000

1500

2000

2500

3000

3500

4000

B L D S B L D S

LowHigh

Ener

gy c

onsu

med

(kca

l)

Day 1 Day 2

MealsBell et al. Am J Clin Nutr 67:412-20, 1998

Relationship Between Portion Size & Energy IntakeRelationship Between Portion Size & Energy Intake

Pasta entrée

Accompaniments (tomatoes w/pesto, roll & butter)

Optional items (side dishes, desserts, beverages)

Entire meal

507 cal

457 cal

2636 cal

612 cal

298 cal

3300 cal

100% Portion(1766 cal)

150% Portion(2647 cal) Difference %

1671 cal 2390 cal +43

+21

-35

+25

Diliberti N et al. Obes Res. 12:562-568, 2004

Meal Component

Relationship between Portion Size & Energy Intake

Relationship between Portion Size & Energy Intake

Survey Question 100% Portion 150% Portion

Was the entrée portion appropriate for you?(1 = way too small, 7 = way to large)

Compare what you ate today vs. normally(1 = less than normal, 7 = more than normal)

Did the entrée give you value for your money(1 = poor value, 7 = great value)

How would you rate this entrée?(1 = off-putting, 7 = delicious)

4.4

4.7

5.1

6.1

4.6

5.0

5.6

6.1

*

Diliberti N et al. Obesity Res 12:562-568, 2004

Trends in Energy Intake(portion size in oz.)

Trends in Energy Intake(portion size in oz.)

Food 77-81’ 87-91’ 94-96’

Salty Snacks 1.0 1.4 1.5 Home

0.8 1.1 1.3 Restaurant

1.2 1.3 1.9 Fast Food

Soft Drinks 12.2 14.7 17.0

10.8 13.6 15.7

10.9 14.0 17.7

Fruit Drinks 11.3 12.4 14.7

9.7 9.5 14.4

10.4 11.8 15.4

Desserts 4.2 4.2 4.4 NS

4.0 4.3 4.5 NS

3.9 4.7 5.2

Nielson & Popkin JAMA 289;450-453, 2003

Weight and soft drink consumption in womenWeight and soft drink consumption in women

80

78

76

74

72

70

68

661991 1995 1999

Year

Wei

ght (

kg)

<1 Drink/wk >1 Drink/d >1 Drink/d<1 Drink/d

>1Drink/d <1 Drink/wk >1 Drink/d<1 Drink/wk

1991 1995 1999

Schulze MB et al. JAMA 292:927-934, 2004

Average Consumption of Added SugarsAverage Consumption of Added Sugars

Item 70-74’ 80-84’ 90-94’ 00’ Diff.Annual Per Capita Intake (lbs)

Total Sweeteners

Refined cane/beet

High fructose corn

Glucose

Dextrose

Honey

124

101

2

16

5

1

122

75

27

16

3

1

141

64

53

19

4

1

149

66

63

16

3

1

20%

-35%

3150%

1%

-36%

0%

USDA.gov



0

5

10

15

20

25

30

35

1960 1970 1980

Perc

ent

Men

Women

20001990

Diabetes 56:2673-2676, 2007

Trends In Overweight ChildrenTrends In Overweight Children

0

2

4

6

8

10

12

14

16

18

66-70’ 71-74’ 76-80’ 88-94’ 99-00’

Year

%O

verw

eigh

t

6-23 mo.2-5 Years6-11 Years12-19 Years

Ogden et al. JAMA 288:1728-1732, 2002

OutlineOutline




Mor

talit

y R

R in

70-8

2 Yr

Old

Adu

lts0.5

1.0

1.5

2.0

2.5

MEAN +SD

Rel

ativ

e M

orta

lity

from

CA

D in

Mid

dle

Age

d M

en

0.5

1.0

1.5

2.0

2.5

“Little” “Intermediate “RelativelyMuch”

Drivers(high sit time)

Conductors(low sit time)

Rel

ativ

e In

cide

nce

of M

I

0.5

1.01.52.02.5

Rel

ativ

e R

isk

in

Adu

lt W

omen

0.5

1.5

2.5

3.5 CVDMortality Fatal MI

Low Mid High Low Mid High

1st 2nd 3rd1.48+0.01 1.68+0.01 1.94+0.02

NON-EXERCISE PHYSICAL ACTIVITY PHYSICAL ACTIVITY LEVEL TERTILES

DAILY SITTING TIME

Effect of Exercise on CVD

Diabetes 56:2655-2666, 2007

Can we make these changes??Can we make these changes??

• Tax “bad” food ; subsidize “good” food

• Tax high BMI

• Offer incentives for exercise

• Make public awareness a priority

Thanks!Thanks!

Why is There an Obesity Epidemic? - Infomed is There an Obesity Epidemic? Richard Kahn, PhD. Outline...

Documents

Transcript of Why is There an Obesity Epidemic? - Infomed is There an Obesity Epidemic? Richard Kahn, PhD. Outline...