1. Evolution of the Obesity Epidemic
Information from Time Magazine, National Geographic Magazine, and other sources

2. Exercise and Body Composition
Two major factors that lead to obesity:
Over-nutrition – consuming too much
Under-expenditure – expending too little energy

3. Over-nourishment Increased caloric consumption Increased portion sizes
Eating as entertainment

4. Exercise and Body Composition
Decreased daily energy expenditure
Transportation
Manual Labor
Entertainment

5. Role of Genetics About 2/3rds of tendency for obesity is genetic
Factors include
Low RMR 15%
High RQ (low fat oxidation) 5%
Low spontaneous physical activity (fidgeting) 10%
Other???
(Ravuzzin, ACSM, 2008)

6. Ancient History Humans started by living in a world of scarcity.
To survive they developed the habit of eating everything that tasted good whenever they could find it.

7. Ancient History That's the way it was during 99.9% of human evolution.
For most of the 7 million years of human existence, life has been "nasty, brutish, and short"
Thomas Hobbes

8. Ancient History
Life expectancy was under 30 years - mainly due to accidents, infection, childbirth, and predation.

9. Ancient History
Early diet consisted of fruits, shoots, nuts, tubers, and vegetation - all low in calories - took constant work and eating whatever we found just to stay alive.
Fruits were highly desirable so we learned to seek fructose and glucose.

10. Evolution
It was some 2.5 million years ago that our ancestors developed a taste for meat.
As a result, the human brain became markedly bigger and more complex at the same time.
We also increased in physical size.

11. Evolution
Because it's packed with nutrients and calories, meat gave early humans a respite from constant feeding.
Our ancestors ate a diet composed of lean meats, vegetables, and fruits and worked out almost nonstop.

12. Agriculture 150,000 to 100,000 years ago.
Provided steady source of food.
No longer hunter/gatherers.
Farming became major source of food.

13. Agriculture
Nutritionally the shift away from wild meat, fruits and vegetables to a diet of mostly cultivated grains robbed humans of many of the essential amino acids.
Still physical exertion was common.

14. Progress?

16. Environment
Our bodies evolved in an environment where food was scare and movement was required
We now find ourselves in an environment where food is abundant and movement is optional – recent development

18. Then and Now
In 1700, the average Briton consumed 7.5 pounds of sugar per year.
In the US, we currently consume 150 pounds of sweetener per year.

19. Overconsumption
We each ate 1775 pounds of food in 2000, up from 1497 in 1970.
Although it appears we are eating more vegetables, almost 1/3 of these vegetables were iceberg lettuce, French fries, and potato chips.

20. Now
Rapid change in environment last 50 years compared to previous 50,000 years.
Removal of physical activity combined with abundance of food.

21. Now
Daily imbalance is on average small: an extra can of soda per day (150 kcal) can add 15.6 pounds per year

22. Factors Related to Obesity
Food producers and the "Fast Food“ industry - if they’re successful, we all eat more

23. Childhood Obesity
The growth of the fast food industry and increasing portion sizes make it easy for children to overeat

24. Supersize Me

28. Childhood Obesity
“A large fast food meal (double cheeseburger, French fries, soft drink, desert) could contain 2200 kcal, which… would require a full marathon to burn off”
Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public health crisis, common sense cure. Lancet 2002;360:

29. Childhood Obesity
On days that children and youth eat fast food – they consume an extra 126 kcals/day (P<0.0001)
Bowman S, Gortmaker SL, Ebbeling CB, Pereira MA, Ludwig DS. Effects of fast food consumption on energy intake and diet quality among children in a national household survey. Pediatrics, in press.

30. Twenty Worst Foods in America

31. Childhood Obesity
Sugar-sweetened beverages contribute to childhood obesity incidence

32. Childhood Obesity
“For each additional serving of sugar sweetened beverage consumed, both BMI (0.243 kg/m2; P=0.03), and incidence of obesity (odds ratio 1.60; P=0.02) increased.”
Ludwig DS, Peterson KE, Gortmaker SL. Lancet 2001, 357:505-8

33. Childhood Obesity
Television and video/film production and distribution industry - if they’re successful we all watch more

35. Now Advertisers constantly telling us to "eat this now".
Obesity increases as industrialization increases.

36. A Widening Problem
In a historical first, there are now as many overnourished people as undernourished around the world.

37. Why are we fatter?
Here's the recipe for obesity on such a global scale:
Take technology—cars, washing machines, elevators—that reduces physical exertion.
Increase calorie consumption, courtesy of increasing prosperity.  

38. A Widening Problem Add television, computers and video games.
Stir in the intensive marketing of candy and fast food, and you have the makings of an epidemic.

39. A Widening Problem
In countries where the food supply has been unstable, people are getting fat despite far less abundance than in the United States.

40. A Widening Problem The implication?
Newly industrialized nations in Asia, Africa, the Caribbean, and Latin America may develop even higher rates of obesity-related health problems than in the U.S.

41. A Widening Problem
>24%
20-24
15-19
10-14
0-9
No data

42. A Widening Problem
North America States with the highest obesity rates—Mississippi and Alabama—are in the South. The more affluent and outdoorsy western states of Colorado and Utah have the lowest rates.   South America As Latin America becomes more developed, supermarkets stocked with processed foods have become the norm, rising from 20 percent of food retail during the 1980s to 60 percent in  

43. A Widening Problem
Europe Candy, fast food, and sweetened cereals account for more than half the food ads in ten European Union nations. In the U.K. snack food consumption rose nearly 25 percent in five years.   Africa In some parts of Africa obesity afflicts more children than malnutrition. In Tunisia the urban population is shifting from traditional healthy whole grain breads to white bread.  

44. A Widening Problem
Asia In Shanghai, roads once filled with pedestrians and cyclists are now congested with cars. KFC opened a drive-through restaurant in Beijing in 2002, with more to come.   Oceania Pacific Islanders have always valued hefty physiques. Now their shift away from local foods to a high-fat, Western diet has made them among the world's fattest people

45. Now
The Puget Sound ferries in Washington have increased the width of their seats from 18 to 20 inches to allow squeeze-in room for bigger bottoms.

46. Now
In Colorado, an ambulance company has retrofitted its vehicles with a winch and a plus-size compartment to handle patients weighing up to half a ton (1000 lbs).

47. Now
An Indiana manufacturer of caskets now offers a double-oversize model - 38 inches wide, compared with a standard 24 inches.

48. Discrimination
In one study at Michigan State University, undergraduates said they would be more inclined to marry an embezzler or cocaine user than an obese person.

49. Discrimination

50. The Stigma of Childhood Obesity Can be devastating…
An obese child’s quality of life is similar to the life of a child diagnosed with cancer, which has been determined as the lowest quality of life score.1

51. The Stigma of Childhood Obesity can be devastating…
Adolescents who are teased about their weight are 2 to 3 times more likely to have suicidal ideation and attempts compared to adolescents who are not teased about their weight. 2

52. The Stigma of Childhood Obesity Can be devastating…
Obese children and adolescents are 4 times more likely to experience impaired school function when compared with healthy children and adolescents. 1
Obese children and adolescents have been found to miss an average of 4.2 days of school during the month. 1

53. It starts early…
Low self esteem is not a characteristic in inner city obese African American children or obese preschool children. 3
Levels of self esteem of preschool children do not differ between non obese and obese children, but upon entering school this feelings change substantially. 3

54. Negatively affects school aged children and adolescents…
4-11 year old children describe obese peers has “ugly”, “selfish”, “lazy” “stupid”, “dishonest”, “socially isolated” and subjects of teasing compared to their average weight peers who were described as “clever”, “healthy”, “attractive”, “kind”, “happy”, “socially popular” and a “desirable playmate”. 4
Overweight adolescents are more likely to be isolated and peripheral to social networks then their normal weight peers. 5

55. Negatively affects school aged children and adolescents…
Social marginalization is more pronounced in white non Hispanic adolescent girls. 5
90% of 9-11 year old overweight children believe that teasing and harassment from their peers would end if they could lose weight and 69% felt that if they were thinner they would have more friends. 6

56. It is also seen in homes, schools and clinical settings…
30.0% of adolescent girls and 24.7% of adolescent boys report being teased about their weight by their peers. 2
28.7% of adolescent girls and 16.1% of adolescent boys report being teased about their weight by someone in their families. 2
14.6% of adolescent girls and 9.6% of adolescent boys report being teased about their weight by both their peers and family members.2

57. It is also seen in homes, schools and clinical settings…
Parents communicate to their children negative stereotypes about obese children. 7
Parents of overweight children are criticized and feel that they are guilty and to blame for their child’s obesity. 6
On implicit and explicit measures, health professionals labeled obese people as “lazy”, “stupid” or “worthless”. 8

58. Who do we think we are or strive to be?
Perception vs Reality
Who do we think we are or strive to be? vs
Who we actually are?

59. Mr and Ms America?

60. Mr. And Ms. America

61. Conan the Governor

63. Jack Nicholson

64. Jack Nicholson

65. Denise Richards

67. What this leads to is body disatisfaction

68. Eating Disorders

69. Progress?
By contrast, among people who still live in conditions most like those of our distant Stone Age ancestors - Maku or Yanomami of Brazil - there is virtually no obesity at all.

71. Tsunami of Health Care

72. Tsunami of Health Care Cardiovascular Disease Diabetes Mellitus
Glucose Intolerance
Overweight and Obesity
Sedentary Lifestyle