2Etiology 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 balanceBody WeightKcal InKcal Out
4What 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 muscleIt is desirable to have more fat-free and less body fat
5Weight 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!!
6For 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!
7Building or Retaining Lean Body Mass Building or retaining lean body mass (muscle) requires strength training or weight bearing exercise (work).
8Evaluating Body Weight Body Mass Index Obesity Defined by Body Mass Index(Quetelet Index)Calculator at NIH website:– used to assess body weight relative to heightBMI = weight (kg) / height (m)2ORBMI = wt (pounds) x 703 / ht (inches)2
9Growing 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
11Obesity Trends* Among U.S. Adults BRFSS, 1991, 1996, 2003 (*BMI 30, or about 30 lbs overweight for 5’4” person)199619912003No Data <10% %–14% %–19% %–24% ≥25%
12BMI > 30, or ~ 30 lbs. overweight for 5'4" person Obesity in the US – 2005BMI > 30, or ~ 30 lbs. overweight for 5'4" person
13Trends in Overweight* Prevalence (%), Adults 18 and Older, US, 1992-2005 199519982005This 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.
14The Evidence is InAmericans are becoming more overweight and obese each year.
16Diabetes Trends. Among Adults in the U. S Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS, 1990,1995 and 2001199019952001No Data <4% %-6% %-8% %-10% >10%Source: Mokdad et al., Diabetes Care 2000;23: ; J Am Med Assoc 2001;286:10.
17CHD Incidence: (P.D.A.Y. Study) Pathological Determinants of Atherosclerosis in Youth y.o. (atherosclerotic lesions)All aortas and ½ right coronary arteriesChildrenFatty streaks in arteries at age 6 y.o.From ages y.o.Rapid increase in prevalence and extent of fatty streaks & fibrous plaques
18Economic Cost of Healthcare National Coalition on Healthcare$2 trillion or $6700 person in 200516% of GDP (value of all goods and services produced in the US4X the annual expenditure for DefenseProjected cost$2.9 trillion (2009) and $4 trillion (2015)20% of GDP in one decade (2015)
20but, is obesity the problem? orIs obesity a symptom of the problem?What is the problem?How did we get to this point?Who is responsible?
21Judge throws out McDonald’s suit MSNBC – Business with CNBCJudge throws out McDonald’s suitPlaintiffs failed to show fast food chain deceived consumersThe Associated PressSeptember 4, 2003New 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, 2004CHICAGO - 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 begunphasing 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.
22Who determines what McD serves? Does McDonald’s determine what they sell?orDo the customers determine what McDonald's sells?Who determines what you eat at restaurants, campus dining, or buy at the grocery store?
23What is different today than yesterday? The following pictures show changes over time.State Fair – 2003State Fair – early 1960’sChildren going to school in the late 1950’s
24Fried What! Almost anything batter dipped & deep-fat fried, Illinois State Fair, 2003
25“Uptown” NormalHave 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.
26State Fair early 1960’sWhat is different than today?
27Going to Elementary School - late 1950’s Notice the children, see any differences? How do children go to school today?
28What has changed? Why has it changed? Many changesReadily available, cheap foodModern conveniencesDesk jobsBusy lifeOther factorsTechnology and prosperity have changed the activity levels of children and adults in developed countries
29Kcal 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
30Dr. 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
31Childhood Obesity CDC – Childhood Overweight Overweight children more likely to develop high blood pressure, high blood cholesterol, Type 2 diabetes, and become an obese adult
32The DebateA current debate is what to call overweight and obese childrenJune 11, 2007Experts advise docs to be blunt, call kids ‘obese’. Fuzzy terms used for tact don’t properly define weight issue, group explains
33Another 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?
34Many of our health behaviors are learned early in life Where did you learn your health behaviors?
35What are the Common Risk Factors for Obesity? Lack of Physical Activity and poor NutritionLifelong HealthPhysical NutritionActivity
37Despite our level of education, are we a literate society? Health Literate?Nutrition Literate?Exercise Literate?Wellness Literate?Disease Literate?
38How best to change life-long behaviors? Best age for intervention?Adulthood?Children?If childhood, how do we reach children?Pre-KSchools (K-12)Through parentsShould the focus be Prevention or Treatment?What are the future economic costs of today’s actions and decisions?
39Much needs to be done in addressing current disease trends? Children's HealthShould 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, 2004DALLAS - 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 FitnessExercise better than calcium for girls' bonesStudy: Teens' fitness habits key to preventing osteoporosisThe Associated PressUpdated: 3:07 p.m. ET June 10, 2004STATE COLLEGE, Pa. - Got exercise? A recent study indicates that exercise is more important than calcium in developing strong bones in girls and young women.WeeklySeptember 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 HealthOverweight kids face greater heart attack riskChange eating habits for cardiovascular health, group saysUpdated: 7:03 p.m. ET Sept. 29, 2004LONDON - 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.
40How 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 PEStated at Madison Jr. High School in Naperville, IL with Mr. Phil Lawler, PE teacher
41The “New PE”Watch the following short video on one step in the right directionLearning to be FitFit for Life, PBS Video April 3, 2002Click to watch in steaming video to start
42How 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 wellnessHow to train children in developing their own physical activity program for life-long healthNutrition educationTrain students to develop their own wellness plan
43How can students be reached? Students need to learn how to design:Cardiovascular, strength training, and flexibility activities for physical fitnessDiets for nutrition and healthCustomized wellness programs for lifelong healthTeachers are needed who can teach these principles to children, andParents need to assume greater responsibility in training their children in wellness principles and in demonstrating a healthy lifestyle
45PE 4 LifeOne not-for-profit organization working to improve the health of American children is PE 4 Life
46PE 4 Life Building Healthy Student Bodies – One at a Time™ Cause: Quality, daily physical education programs in all US schoolsMission: 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.
47PE 4 LifeMr. Phil Lawler has become their Director of Outreach and Training. Here is his testimony before a Congressional Committee in Washington DC on May 10, 2007The 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.
48PE 4 LifeSeveral valuable child overweight and obesity resources under Research heading at:
49American Academy of Pediatrics Published a Policy Statement on the Prevention of Pediatric Overweight and Obesity
51TodayWe Have MoreInformation sourcesFoodConveniencesExercise equipmentGood intentionsHealth knowledgeBut does not translate into greater health and well-beingWhat will it take to get Americans moving, eating less and choosing healthier foods?