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

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

The Energy Balance Equation

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

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!!

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!

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

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

Growing Obesity in the U.S. Go to the CDC website: http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm and click on a PowerPoint slide presentation format below the 2005 map for a presentation on the increasing obesity in American adults since 1985 - 2005. % of adults in a state who have a BMI > 30 (obese), or ~ 30 lbs. overweight for 5'4" person

Obesity Incidence – Adults Obesity increase in the US: 1985 – 2005 Obesity Incidence – 2003 - 2004 NHANES data Overweight (BMI 25-29) – 34.1 % Obese (BMI >30) – 32.2 % http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight/overwght_adult_03.htm

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% 10%–14% 15%–19% 20%–24% ≥25%

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

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 (1984-1995, 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.

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

Health consequences Hypertension (high blood pressure) Diabetes mellitus http://www.cdc.gov/diabetes/statistics/maps/index.htm Coronary heart disease (CHD)

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% 4%-6% 6%-8% 8%-10% >10% Source: Mokdad et al., Diabetes Care 2000;23:1278-83; J Am Med Assoc 2001;286:10.

CHD Incidence: (P.D.A.Y. Study) Pathological Determinants of Atherosclerosis in Youth 15 - 19 y.o. (atherosclerotic lesions) All aortas and ½ right coronary arteries Children Fatty streaks in arteries at age 6 y.o. From ages 15 - 34 y.o. Rapid increase in prevalence and extent of fatty streaks & fibrous plaques http://www.nih.gov/news/pr/jan97/nhlbi-27.htm

Economic Cost of Healthcare National Coalition on Healthcare http://www.nchc.org/facts/cost.shtml $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)

What is the Answer?

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?

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.

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?

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

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

“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.

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

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

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

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. 2002; 77: 109-113 http://www.mayoclinicproceedings.com/pdf%2F7702%2F7702e%2Epdf Modern conveniences reduce energy expenditure and lead to weight gain

Dr. Steven N. Blair of the Cooper Institute, Dallas TX http://www.cooperinst.org/index.cfm 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

Childhood Obesity CDC – Childhood Overweight http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/index.htm Overweight children more likely to develop high blood pressure, high blood cholesterol, Type 2 diabetes, and become an obese adult

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 http://www.msnbc.msn.com/id/19194146/

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?

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

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

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

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?

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);844-847 Participation in High School Physical Education -- - United States, 1991--2003 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. 22-10) (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.

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

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 http://www.pbs.org/newshour/bb/education/jan-june02/pe_3-22.html# Click to watch in steaming video to start

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

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

Parent Support Vital

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

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. http://www.pe4life.org/about.php

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 http://www.pe4life.org/articles/PE4life_Testimony_051007.pdf 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.

PE 4 Life Several valuable child overweight and obesity resources under Research heading at: http://www.pe4life.org/research.php

American Academy of Pediatrics Published a Policy Statement on the Prevention of Pediatric Overweight and Obesity http://aappolicy.aappublications.org/cgi/reprint/pediatrics;112/2/424.pdf

Nutrition Information and Health?

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?