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Why are we fat? John C. Peters, Ph.D. Chief Strategy Officer Anschutz Health and Wellness Center Professor of Medicine.

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Presentation on theme: "Why are we fat? John C. Peters, Ph.D. Chief Strategy Officer Anschutz Health and Wellness Center Professor of Medicine."— Presentation transcript:

1 Why are we fat? John C. Peters, Ph.D. Chief Strategy Officer Anschutz Health and Wellness Center Professor of Medicine

2 82 Putative Causes (From the Downey Obesity Report, February 28th, 2013) 1. agricultural policies 2. air conditioning 3. air pollution 4. antibiotic usage at early age 5. arcea nut chewing 6. assortative mating 7. being a single mother 8. birth by C-section 9. built environment 10. chemical toxins 11. child maltreatment 12. competitive food sales in schools 13. consumption of pastries and chocolate (in Burkina Faso) 14. decline in occupational physical activity 15. delayed prenatal care 16. delayed satiety 17. depression 18. driving children to school 19. eating away from home 20. economic development 21. endocrine disruptors 22. entering into a romantic relationship 23. epigenetic factors 24. family conflict 25. first-born in family 26. food addiction 27. food deserts 28. food insecurity 29. food marketing to children 30. food overproduction 31. friends 32. genetics 33. gestational diabetes 34. global food system 35. grilled foods 36. gut microbioata 37. having children, for women 38. heavy alcohol consumption 39. home labor saving devices 40. hunger-response to food cues 41. international trade policies (globalization) 42. high fructose corn syrup 43. lack of family meals 44. lack of nutritional education 45. lack of self-control 46. large portion sizes 47. living in the suburbs 48. living in crime-prone areas 49. low levels of physical activity 50. low socioeconomic status 51. market economy 52. marrying in later life 53. maternal employment 54. maternal obesity 55. maternal over-nutrition during pregnancy 56. maternal smoking 57. meat consumption 58. menopause 59. mental disabilities 60. no or short term breastfeeding 61. non-parental childcare 62. overeating 63. participation in Supplemental Nutrition Assistance Program (formerly Food Stamp Program) 64. perception of neighborhood safety 65. physical disabilities 66. prenatal maternal exposure to natural disasters 67. poor emotional coping 68. sleep deficits 69. skipping breakfast 70. snacking 71. smoking cessation 72. stair design 73. stress 74. sugar-sweetened beverages 75. trans fats 76. transportation policies 77. television set in bedrooms 78. television viewing 79. thyroid dysfunction 80. vending machines 81. virus 82. weight gain inducing drugs

3 Multi-factoral causes  Portion size  High energy density  High glycemic index  Soft drinks/ ” junk food  In schools  Added sugar  Easy food access  Low cost  Variety  Convenience  Great taste  Ads/marketing  Sedentary workplaces  Sedentary schools  Activity “ unfriendly ” community design  Automobiles  Drive-through conveniences  Elevators/escalators  Remote controls  Sedentary entertainment  Labor saving devices  Television/computer WEIGHT GAIN Energy intake Energy expenditure

4 Obesity: Evolutionary Biology, the Environment, Society and You

5 The Take Away… Why we are the way we are…survival We have built the environment to serve the biology Obesity is a normal response to the environment To overcome the biology we will have to rely on cognition—individual and social We must find a better “why” for people and society to change The “why” must be important for “survival” in the modern world

6 The Evolutionary Biology: Why we are the way we are? Humans are hard wired to like sugar, fat and salt Humans evolved under conditions in which physical activity “pulls” appetite Humans are “energy misers” The biology is not broken…it is doing exactly what it was designed to do We built the environment to serve the biology

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11 S. French J Nutr 2003 Even price has limits…

12 What about physical activity?

13 A high flux improves regulation of energy balance (and protects against weight gain) Adapted from Mayer et al, AJCN, 1956

14 USA Amish…today -603 kcal day -436 kcal day Amish Men Amish Women US Men US Women From Bassett, Med. And Sci. in Sports and Exer., 2004 9%0%32%35% Obesity rate

15 We don’t get enough physical activity Leisure time physical activity has not declined Physical activity at work has declined Physical activity at home has declined


17 Physical Activity in the USA 2008 Age-Adjusted Estimates of the Percentage of Adults Who Are Physically Inactive

18 The Evolving Work Force Church TS et al. PLoS 2011

19 Daily Occupational Caloric Expenditure -140 daily kcals -120 daily kcals Church TS et al. PLoS 2011

20 Trends in Housework Energy Expenditure (1965-2005) Archer et al. 45-year Trends in Household Management. In Press. PLOS One

21 We sit too much… Hamilton et al, Curr. Cardiovasc. Risk Reports, 2008

22 …and, it’s lethal Over a lifetime, the unhealthful effects of sitting add up. Alpa Patel, an epidemiologist at the American Cancer Society, tracked the health of 123,000 Americans between 1992 and 2006. The men in the study who spent six hours or more per day of their leisure time sitting had an overall death rate that was about 20 percent higher than the men who sat for three hours or less. The death rate for women who sat for more than six hours a day was about 40 percent higher. Patel estimates that on average, people who sit too much shave a few years off of their lives. New York Times, April 14, 2011

23 Just say NO to screen time? One recent study compared adults who spent less than two hours a day in front of the TV or other screen-based entertainment with those who logged more than four hours a day of recreational screen time. Those with greater screen time had: –A nearly 50 percent increased risk of death from any cause –About a 125 percent increased risk of events associated with cardiovascular disease, such as chest pain (angina) or heart attack The increased risk was separate from other traditional risk factors for cardiovascular disease, such as smoking or high blood pressure. From J Levine,

24 We are deficient in non-exercise activity thermogenesis (NEAT) Hamilton et al, Diabetes, 2007

25 What are the consequences of poor diet, low activity and sitting? Poor physical and cardiorespiratory fitness Obesity Diabetes Cardiovascular disease Reduced quality of life

26 Attributable Fractions (%) for All-Cause Deaths 40,842 Men & 12,943 Women, ACLS Blair SN. Br J Sports Med 2009; 43:1-2.

27 Humans are biased toward action, not thought (thought is expensive)

28 The Biology of Choice…we choose for the moment NOW 20 Years

29 The marketplace plays to the biology

30 So What? What does all of this suggest about ways we might approach the problem differently?

31 Nutrition Reviews, 59, 2001 The Environment and YOU Behavior Settings

32 The Environment and YOU: Systems Foresight Diagram YOU are here

33 What is the real problem? Physical activity is not necessary. We are too rich. Food is cheap Physical activity is not necessary We have disposable income AND, there is no compelling reason to change… WHY?

34 Godzilla Meets Bambi Sugar Fat Salt Rest Enjoy Market more fresh produce Sidewalks, brighter stairwells Restrictions on “bad” food Reduced health premiums T-shirts, water bottles …AND? BIOLOGY Unhealthy Preferences

35 Drive motivation for behavior change by linking desired behaviors to meeting basic needs Physiological Safety and Security Belongingness and Love Esteem Self-actualization Transcendence Need to move the focus

36 Social motivation hierarchy Transcendence Well Society National defense, affordable housing, safe neighborhoods Collective purpose, American Values, National Pride Economic health, jobs, global competitiveness, education

37 Strategies for change Try to “structure” each behavior environment separately Continue to focus on individual motivation Leverage a collective motivation across society that is consistent with today’s priorities and values Plant the seeds to create demand for a healthier environment

38 NEW “THINKING” SPACE Demand for healthy choices (why?) Opportunities for healthy choices Leave people alone and let them choose Regulate, mandate, tax, control NEW “DOING” SPACE

39 It’s about creating demand…

40 Catalyzing demand: Where do we start? Schools & Home Commerce, the “ Environment ” Workplaces

41 We need it all… Individual inspiration, for those who are ready to change themselves Environmental structuring, where possible (e.g., schools, workplaces) Nudge—choice architecture, where possible Continued product and service innovation to make healthy behaviors more desirable, accessible, affordable and convenient (supply) A more important WHY for the average citizen—as a way to build demand

42 Summing Up Changing behavior of individuals or of communities is opposing biological preferences. We built the environment to serve the biology. To manage and work with the biology we need an equally strong cognitive motive that would matter to individuals and society as a whole The “WHY” should be important for “survival” in the modern world Sustainable solutions must provide short-term tangible rewards for individuals Sustainable solutions must provide rewards for the social collective, e.g., be integral to the economy…the “prosperity engine”. There is no “win-win” business model for healthy behaviors…yet

43 “We have changed our environment more quickly than we know how to change ourselves” Walter Lippmann (1915)

44 Thank You Thank You

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