James O. Hill, Ph.D. : Obesity, The Big Picture

8/12/2019 James O. Hill, Ph.D. : Obesity, The Big Picture

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Obesity: The Big Picture

James O. Hill, Ph.D.Anschutz Professor

University of Colorado

Anschutz Health and Wellness Center


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Obesity Issues 2014

Where are we today? Who is getting fat?

The biology of obesity

Transformational weight loss

Food vs Physical Activity

Metabolic Flexibility and Obesity Evaluating Research

Physical activity and brain function

The new science of sedentarianism

Strategic movement through the workday

Small steps and nudges Impact of food taxes

Role of the Food and Beverage Industry


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Trends in overweight, obesity and extreme obesity, ages 20-74 years

0%

5%

10%

15%

20%

25%

30%

35%

40%

1960-62 1971-74 1976-80 1988-94 1999-00 2001-02 2003-04 2005-06 2007-08 2009-10

Overweight

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.

Extremely Obese


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0%

5%

10%

15%

20%

25%

1963-65 1971-74 1976-80 1988-94 1999-00 2001-02 2003-04 2005-06 2007-08 2009-10 2011-2012

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.

Age 12-19

Age 6-11

Age 2-5

Trends in child and adolescent overweight


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Causes of Obesity

Energy intake

Energy expenditureEnergy expenditure

Energy intake

WEIGHT GAIN


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Who is becoming obese?


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Contributors to Obesity

Biology Behavior

Environment


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Biology: The Energy Balance System

EnergyIntake

EnergyExpenditure

EnergyStores

Active

Regulation/Integration

InheritedFactors EnvironmentalFactors

Efficiency

Adaptive thermogenesis

Food preferences

Food environment

Physical activity

environment


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Socioecological Models


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Decrease

Energy

Intake

Body weight increases

Body weight does not change

Body weight decreases

Usual physical activity

Metabolic RateFood Intake

What happens to body weight when food intake isdecreased?

Wh t h t b d i ht h h i l ti it i


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Increase

Physical

Activity

Body weight increases

Body weight does not change

Body weight decreases

Usual physical activity

Metabolic RateFood Intake

What happens to body weight when physical activity isincreased?


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Addressing the Environment


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Biology: Influenced by Environment andBehavior

Drive to eateat whenever food is available Like sugar, fat, salt Happy being sedentarylittle need for physical activity


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Biology Desire to Eat Pref for sweet/fat No Drive to be active

FoodAvailableGood tasting

Energy dense

Inexpensive

Large portions

Physical ActivityLittle need for physical activity in daily living

Attractiveness of sedentary Entertainment

Car for Transportation

Economics

Consume More

More for lessGreater Productivity

DecreasedEnergyExpenditure

IncreasedEnergy

Intake

ObesitySocioculturalForces

Challenges in reducing obesity


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How do we begin to study the

problem?


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Foreyt, John, and Ken Goodrick. "The ultimate triumph of obesity."The Lancet346.8968 (1995): 134-135.

Last American becomes obese in 2230


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Promoting Cognitive Skills

Making conscious efforts to overcomebiological and environment influencestoward obesity

Biology

Environment

Behavior


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Hill 5-Point Plan to Reduce Obesity

Prioritize prevention over treatment Increase physical activity of the population

Promote Smart Eatingusing small changes Use small changes to change environment Teach Cognitive Skills

Big Challenge: We have to give people a reason to want to change


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Energy Gap forprevention of weightgain

Energy Gap formaintenance forweight loss

BodyWeight

Time

What will it take to reduce obesity? The energy gap


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Energy

Gap

-10% (10 kg) = 190-200 kcal/day

-15% (15kg) = 280-300 kcal/day

Energy

Gap

Obesity

How much behavior change is needed for

successful weight loss maintenance?

Example for 100 kg person


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Body

WeightEnergy

Gap

Energy

Gap

EnergyGap

Healthy Weight

Overweight

Obese

Energy Gap for Prevention of Weight Gain

(


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TRANSFORMATION


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When it comes to weight, which is more important:Food vs Physical Activity

Eat a bacon cheeseburger and consume 720 kcal in 5 min Takes 2.6 hours of walking at moderate intensity to burn it off

I worked 8 hours today to make $500 I spent $500 in 15 min on concert tickets

When it comes to net worth, which is more important:Income vs Spending


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Body Weight

EnergyIntake

Our biology works best at high

Physical Activity

Threshold forOptimal Weight

Regulation

UnregulatedZone

Regulated Zone


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Energy

Intake

Energy Expenditure


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Smart Eating

Portion Size Energy Density Liquid Calories

Healthy Defaults


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Messages

Eat Less and Move More Eat Smarter and Move More


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The birth of small changes


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Source: D.M. Bravata et.al., JAMA 298: 2296-2304, 2007

Pedometers To Increase Activity


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A better approach: Healthy Defaults

Disney parks Kids meals come with low fat milk and fruit

Starbucks Drinks made with low fat milk

Portion sizes/energy density Would anyone notice a 5% reduction?

School drop offs Buses and cars drop kids off 500 steps from

school


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0

100

200

300

400

500

600

700

Calories

7-Eleven Soft Drinks

Super Big

Gulp

Gulp Big Gulp Double

Gulp


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333 kcal

590 kcal

The Cheeseburger


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Why Change Anything?


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Program partners: Primary funder:

Developing Skills

PI: James O. Hill, Ph.D.
http://www.ucdenver.edu/academics/colleges/medicalschool/centers/HealthandWellnessCenter/Pages/Home.aspx


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The 5thGear Card

10% Discountat King Sooperson KingSoopers brandfoods.

Show your cardfor discountsand to earnpoints at other

partners Redeem yourpoints for prizesat www.5thGearKids.org
http://www.5thgearkids.org/http://www.5thgearkids.org/


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Sustaining Behavior Change

RegulateBehaviorControl/LimitChoices

Educate toallow people to

make betterchoices

FOOD

TaxesPricingExposure

Zoning RestrictionsMenu LabelingPortion ControlRestrictions on bad foodsRegulations for school foods

PHYSICAL ACTIVITY

Increase active transportReduce sedentary behaviorImprove physical activity programsMandate physical activity inschools

Where is the middle ground?

Public-Private Partnerships

We will need policy but what and when?

Parents must take thelead in reducingchildrens TV watching

and provide alternatives

Are children prey for fastfood companies?


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Biology Desire to Eat Pref for sweet/fat No Drive to be active

FoodAvailableGood tasting

Energy dense

Inexpensive

Large portions

Physical ActivityLittle need for physical activity in daily living

Attractiveness of sedentary Entertainment

Car for Transportation

Economics

Consume More

More for lessGreater Productivity

DecreasedEnergyExpenditure

IncreasedEnergyIntake

ObesitySocioculturalForces

Reason to push back

Different Value Equation

Social Environment of Wellness

Make betterchoices

Challenges in reducing obesity

Energy BalanceSkills

Health & Wellness Center


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Health & Wellness Center

Integration andinteraction

Health &Wellness

Clinical

Education

Research


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Addressing a Complex Issue

PrivateSectorPartnershipsCommunity

Engagement

Create new thinking spacefor creating solutions

Develop and TestPotential Solutions Implement

Science-Based,Scalable Programsand Initiatives

Model schoolsModel worksites


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HEALTH VS WELLNESS

PreventionAccumulating Wellness

Pulmonary GIDermatologicalOrthopedic GenitourinaryPsychological Asthma

DiabetesCardiovascular DiseaseCognitive ImpairmentRenal DiseaseCancer


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CU Wellness Score

DietQuality

Quality ofLife Sleep

Stress

MetabolicFitness

PhysicalFitness

Your WellnessScore:62 (out of 100)


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Thank You!

James O. Hill, Ph.D. : Obesity, The Big Picture

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