1. Growing Obesity in the U.S.
FCS 208
Summer 2007

2. Etiology of Obesity
Body 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
Body Weight
Kcal In
Kcal Out

3. The Energy Balance Equation

4. 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 fat
Fat-free is most related to lean body mass or muscle
It is desirable to have more fat-free and less body fat

5. 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!!

6. 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!

7. Building or Retaining Lean Body Mass
Building or retaining lean body mass (muscle) requires strength training or weight bearing exercise (work).

8. Evaluating Body Weight Body Mass Index
Obesity Defined by Body Mass Index
(Quetelet Index)
Calculator at NIH website:
– used to assess body weight relative to height
BMI = weight (kg) / height (m)2 OR
BMI = wt (pounds) x 703 / ht (inches)2

9. Growing Obesity in the U.S.
Go to the CDC website: and click on a PowerPoint slide presentation format below the 2005 map for a presentation on the increasing obesity in American adults since
% of adults in a state who have a BMI > 30 (obese), or ~ 30 lbs. overweight for 5'4" person

10. Obesity Incidence – Adults
Obesity increase in the US: 1985 – 2005
Obesity Incidence – NHANES data
Overweight (BMI 25-29) – 34.1 %
Obese (BMI >30) – 32.2 %

11. Obesity Trends* Among U.S. Adults BRFSS, 1991, 1996, 2003
(*BMI 30, or about 30 lbs overweight for 5’4” person)
1996
1991
2003
No Data <10% %–14% %–19% %–24% ≥25%

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

13. Trends in Overweight* Prevalence (%), Adults 18 and Older, US, 1992-2005
1995
1998
2005
This slide highlights the obesity epidemic as mentioned in the previous slide. In 2005, over 50% of the adults in all states, including District of Columbia, were overweight or obese, compared to just 12 states in 1992.
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 ( , 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.

14. The Evidence is In
Americans are becoming more overweight and obese each year.

15. Health consequences Hypertension (high blood pressure)
Diabetes mellitus
Coronary heart disease (CHD)

16. Diabetes Trends. Among Adults in the U. S
Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS, 1990,1995 and 2001
1990
1995
2001
No Data <4% %-6% %-8% %-10% >10%
Source: Mokdad et al., Diabetes Care 2000;23: ; J Am Med Assoc 2001;286:10.

17. CHD Incidence: (P.D.A.Y. Study) Pathological Determinants of Atherosclerosis in Youth
y.o. (atherosclerotic lesions)
All aortas and ½ right coronary arteries
Children
Fatty streaks in arteries at age 6 y.o.
From ages y.o.
Rapid increase in prevalence and extent of fatty streaks & fibrous plaques

18. Economic Cost of Healthcare
National Coalition on Healthcare
$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)

19. What is the Answer?

20. 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?

21. Judge throws out McDonald’s suit
MSNBC – Business with CNBC
Judge throws out McDonald’s suit
Plaintiffs failed to show fast food chain deceived consumers
The Associated Press
September 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 Supersize
fries, drinks
Effort to offer customers 'a balanced lifestyle'
The Associated Press
Updated: 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.

22. 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?

23. 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

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

25. “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.

26. State Fair early 1960’s
What is different than today?

27. Going to Elementary School - late 1950’s
Notice the children, see any differences? How do children go to school today?

28. 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

29. Kcal In vs. Kcal Out Article 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 ; 77:
Modern conveniences reduce energy expenditure and lead to weight gain

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

31. Childhood Obesity CDC – Childhood Overweight
Overweight children more likely to develop high blood pressure, high blood cholesterol, Type 2 diabetes, and become an obese adult

32. 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

33. 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?

34. Many of our health behaviors are learned early in life
Where did you learn your health behaviors?

35. What are the Common Risk Factors for Obesity?
Lack of Physical Activity and poor Nutrition
Lifelong Health
Physical Nutrition
Activity

37. Despite our level of education, are we a literate society?
Health Literate?
Nutrition Literate?
Exercise Literate?
Wellness Literate?
Disease Literate?

38. 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?

39. Much needs to be done in addressing current disease trends?
Children's Health
Should schools teach about heart disease?
Kids need to know how to keep themselves healthy, group says
The Associated Press
Updated: 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' bones
Study: Teens' fitness habits key to preventing osteoporosis
The Associated Press
Updated: 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.
Weekly
September 17, 2004 / 53(36);
Participation in High School Physical Education United States,
Physical 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 ) (3).
Cardiovascular Health
Overweight kids face greater heart attack risk
Change 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.

40. 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

41. 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
Click to watch in steaming video to start

42. 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

43. 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

44. Parent Support Vital

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

46. PE 4 Life Building 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.

47. 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
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.

48. PE 4 Life
Several valuable child overweight and obesity resources under Research heading at:

49. American Academy of Pediatrics
Published a Policy Statement on the Prevention of Pediatric Overweight and Obesity

50. Nutrition Information and Health?

51. 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?