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Obesity: The Current Landscape

Obesity: The Current Landscape. James O. Hill, Ph.D. Anschutz Professor Executive Director Anschutz Health and Wellness Center University of Colorado. Obesity Issues 2013. Why are we so fat? Why do we care? What can we do about it?. Role of the environment National Security Issue

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Obesity: The Current Landscape

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  1. Obesity: The Current Landscape James O. Hill, Ph.D.Anschutz Professor Executive Director Anschutz Health and Wellness Center University of Colorado

  2. Obesity Issues 2013 • Why are we so fat? • Why do we care? • What can we do about it? • Role of the environment • National Security Issue • Role of Industry • Kids • What should we be talking about The Obesity Solution

  3. How Fat are We?

  4. Trends in overweight, obesity and extreme obesity, ages 20-74 years Overweight Obese Extremely Obese Note: Age-adjusted by the direct method to the year 2000 US Bureau of the Census using age groups 20-39, 40-59 and 60-74 years. Pregnant females excluded. Overweight defined as 24,=BMI; obesity defines as BMI>=30; Extreme obesity defines as BMI>=40.

  5. Trends in child and adolescent overweight Age 6-11 Age 12-19 Age 2-5 Note: Overweight is defined as BMI>=gender and weight-specific 95th percentile from the 2000 CDC Growth Charts. Source: National Health Examination Surveys II (ages 6-11) and III (ages 12-17), National Examination Surveys, I, II, III and 1999-204, NCHS, CDC.

  6. What Causes Obesity? • Name the top 3 causes of obesity

  7. Potential Causes of Obesity 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, • 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,

  8. Potential Causes of Obesity 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, • 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

  9. Potential Causes of Obesity • 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.

  10. Which of these factors have been changed to impact obesity?

  11. How do we begin to study the problem?

  12. The Energy Balance System Inherited Factors Environmental Factors Energy Stores • Efficiency • Adaptive thermogenesis • Food preferences • Food environment • Physical activity • environment Energy Intake Energy Expenditure Active Regulation/Integration

  13. What happens to body weight when food intake is decreased? Body weight increases Decrease Energy Intake Body weight does not change Body weight decreases Usual physical activity Metabolic Rate Food Intake

  14. What happens to body weight when physical activity is increased? Body weight increases Increase Physical Activity Body weight does not change Body weight decreases Usual physical activity Metabolic Rate Food Intake

  15. Body Weight The obesity epidemic arose from gradual weight gain over time Active Regulation EOut EIn

  16. Which is more important – food or phsical activity?

  17. Women

  18. Why are we gaining weight? Occupations and Obesity TS Church, PLoSOne 2011;6(5):e19657.

  19. Walking: Old Order Amish vs. Current Population ~603 kcal/day ~436 Kcal/day Amish Men US Men US Women Amish Women

  20. Energy Intake Energy Expenditure

  21. Our biology works best at high Physical Activity Threshold for Optimal Weight Regulation Obesity Energy Intake Body Weight “Unregulated” Zone “Regulated” Zone

  22. Metabolic Changes with Decreased Physical Activity Muscles Insulin Sensitivity Nutrient Metabolism Fat Cells Appetite Brain function

  23. Hypothetical Model for the Cause of the Obesity Epidemic of the Late 20th Century Body Weight Energy Intake Total Energy expenditure Energy Expenditure in Physical Activity 1920 1950 1980 2013

  24. Role of the Environment?

  25. Addressing the Environment

  26. How do we reduce obsity?

  27. The Energy Balance System Energy Stores Energy Intake Energy Expenditure Active Regulation/Integration

  28. How much behavior change is needed for successful weight loss maintenance? Obesity Energy Gap -10% (10 kg) = 190-200 kcal/day -15% (15kg) = 280-300 kcal/day Energy Gap Example for 100 kg person

  29. Comparison of weight loss diets with different compositions of fat, protein and carbohydrates (n=811) Sacks FS. et al. NEJM 2009;360(9) 859-873.

  30. Characteristics of Successful LosersNational Weight Control Registry • Eating a Reduced Calorie-Reduced Fat Diet • Engaging in a high level of physical activity • Limiting TV Viewing • High level of dietary restraint • Frequent self-weighing • Maintaining dietary consistency • Eating breakfast

  31. Energy Gap for Prevention of Weight Gain (<100 kcal/day) Energy Gap Energy Gap Obese Body Weight Energy Gap Overweight Healthy Weight

  32. The birth of small changes

  33. Addressing Obesity Biology Behavior Environment

  34. Biology, Behavior & Environment Physical Activity Little need for physical activity in daily living Attractiveness of sedentary Entertainment Car for Transportation Biology Healthy Environment Reason to push back • Desire to Eat • Pref for sweet/fat • No Drive to be active Decreased Energy Expenditure Different Value Equation Economics Obesity • Consume More • More for less • Greater Productivity Increased Energy Intake Food Available Good tasting Energy dense Inexpensive Large portions Make better choices Social Environment of Wellness Social Systems

  35. What’s Missing: the Why 20 years NOW

  36. Role for the private sector?

  37. How Academia Works Ideas basic and clinical research Development of Science-based programs Programs evaluated in controlled settings Implement Programs In the population Goal: Use science to improve people’s lives

  38. Industry Involvement in Implementation Ideas basic and clinical research Development of Science-based programs Programs evaluated in controlled settings Implement Programs In the population

  39. Diabetes Prevention Program (DPP) 2002

  40. Diabetes Prevention Program (DPP) Ideas May be possible to prevent diabetes in those at risk basic and clinical research Lifestyles factors and glycemic control Development of Science-based programs Small scale testing of impact of lifestyle Programs evaluated in controlled settings DPP Implement Programs In the population ??

  41. Menu Labeling Ideas Knowing calorie content could reduce intake basic and clinical research Very little clinical research Development of Science-based programs No real testing Very little evaluation in controlled settings Programs evaluated in controlled settings Policy to force implementation Implement Programs In the population

  42. Health & Wellness Clinical Education Research Colorado Center for Health & Wellness Center

  43. Addressing a Complex Issue Develop and Test Potential Solutions Create new “thinking space” for creating solutions Implement Science-Based, Scalable Programs and Initiatives Community Engagement Private Sector Partnerships

  44. Enjoy the next 3 days

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