Weighty Matters: Public Health Aspects of the Obesity Epidemic Martin T Donohoe
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Transcript of Weighty Matters: Public Health Aspects of the Obesity Epidemic Martin T Donohoe
Weighty Matters:Public Health Aspects of
the Obesity Epidemic
Martin T Donohoe
Average height and weight of Average height and weight of AmericansAmericans
Men: 5’9”, 191 lbsMen: 5’9”, 191 lbs
Women: 5’4”, 164 lbsWomen: 5’4”, 164 lbs
DefinitionsDefinitions
BMI (Body Mass Index) =BMI (Body Mass Index) =
weight (kg)/height squared (meters weight (kg)/height squared (meters squared)squared)
Overweight: BMI Overweight: BMI ≥ 25≥ 25 Obese: BMI Obese: BMI ≥ 30≥ 30 Waist to height ratio and waist-hip Waist to height ratio and waist-hip
ratio other measuresratio other measures The latter is more effective in The latter is more effective in
determining heart disease riskdetermining heart disease risk
ObesityObesity
1950: ¼ of Americans 1950: ¼ of Americans overweight (BMI overweight (BMI > 25)> 25)
2010: 68% overweight, 34% 2010: 68% overweight, 34% obese (BMI > 30)obese (BMI > 30)
20-25% of American children 20-25% of American children are overweight or obeseare overweight or obese 80% of obese children become obese 80% of obese children become obese
adultsadults
Sex Differences in Overweight Sex Differences in Overweight and Obesityand Obesity
Combined overweight and Combined overweight and obese:obese:Men 72%Men 72%Women 64%Women 64%
Obese:Obese:Men 32%Men 32%Women 36%Women 36%
ObesityObesity
Worldwide over 1 billion adults Worldwide over 1 billion adults are overweight and 300 million are overweight and 300 million are obeseare obese
20% of US dogs obese (obese 20% of US dogs obese (obese masters tend to have obese pets)masters tend to have obese pets)
Causes of and Contributors Causes of and Contributors to Obesityto Obesity
Poor dietPoor diet Inadequate exerciseInadequate exercise Inadequate/irregular sleepInadequate/irregular sleep Car culture – less Car culture – less
walking/bicyclingwalking/bicycling Excessive television watchingExcessive television watching
Causes of and Contributors Causes of and Contributors to Obesityto Obesity
Genetic factors (estimates range from 1% to Genetic factors (estimates range from 1% to 75% of cases)75% of cases) E.g., FTO (fat mass and obesity associated gene)E.g., FTO (fat mass and obesity associated gene)
Hormones and neurochemicals (including Hormones and neurochemicals (including phthalates, BPA)phthalates, BPA)
Snacking on high glycemic foods during late Snacking on high glycemic foods during late pregnancypregnancy
Viruses and bacteriaViruses and bacteria Sugar substitutes:Sugar substitutes:
May increase appetite for sweet foods and May increase appetite for sweet foods and promote overeatingpromote overeating
Causes of and Contributors Causes of and Contributors to Obesityto Obesity
Medications: e.g., OCPs, Medications: e.g., OCPs, antidepressants, antipsychotics, antidepressants, antipsychotics, etc.etc.
High birth weight (more common High birth weight (more common in mothers who gain excessive in mothers who gain excessive weight during pregnancy)weight during pregnancy)
Shorter or no breastfeedingShorter or no breastfeeding Menopause (attenuated by Menopause (attenuated by
exercise)exercise)
Causes of and Causes of and Contributors to ObesityContributors to Obesity
Childhood ability to delay Childhood ability to delay gratificationgratification
Parents frequently fail to recognize Parents frequently fail to recognize childhood overweight and obesitychildhood overweight and obesity
Energy in > energy outEnergy in > energy out Perception: many overweight and Perception: many overweight and
obest individuals think there is obest individuals think there is nothing wrong with their weightnothing wrong with their weight
ObesityObesity
More common among lower income More common among lower income individuals, rural Americans, individuals, rural Americans, Hispanics, and African-AmericansHispanics, and African-Americans Cultural explanations, food Cultural explanations, food
insecurity, fast food restaurants; insecurity, fast food restaurants; neighborhood safetyneighborhood safety
More prevalent in adults with sensory, More prevalent in adults with sensory, physical and mental health conditionsphysical and mental health conditions Healthy diet may help prevent Healthy diet may help prevent
depression and anxietydepression and anxiety
Obesity PreventionObesity Prevention
Ideal diet: 45-65% of calories from Ideal diet: 45-65% of calories from CHOs, 20-35% from fat, and 10-35% CHOs, 20-35% from fat, and 10-35% from proteinfrom protein
Ideal exercise = 1 hour per dayIdeal exercise = 1 hour per day 30% of Americans get regular exercise, 30% of Americans get regular exercise,
40% get none40% get none Exercise associated with education, Exercise associated with education,
income, being married (single status income, being married (single status associated with strengthening exercises, associated with strengthening exercises, primarily in men), West Coast, suburbsprimarily in men), West Coast, suburbs
ObesityObesity
Responsible for 300,000 US Responsible for 300,000 US deaths/yeardeaths/yearvs. 450,000/year from smoking vs. 450,000/year from smoking (400,000 direct, 50,000 (400,000 direct, 50,000 environmental tobacco smoke)environmental tobacco smoke)
Decreases in life expectancy and Decreases in life expectancy and increase in early mortality increase in early mortality similar to that seen with similar to that seen with smokingsmoking
Obesity vs. SmokingObesity vs. Smoking
Smoking causes greater health Smoking causes greater health burden from premature deaths than burden from premature deaths than from disability and activity from disability and activity limitationslimitations
Obesity causes greater burden from Obesity causes greater burden from disability and activity limitations disability and activity limitations than from premature deathsthan from premature deaths
Sequelae of ObesitySequelae of Obesity
Heart diseaseHeart disease Certain cancers (e.g., breast, uterine, Certain cancers (e.g., breast, uterine,
cervical, colon, esophageal, renal)cervical, colon, esophageal, renal) 24% of all cancers (higher 24% of all cancers (higher
percentages in women than in men) percentages in women than in men) due to diet, physical activity, and due to diet, physical activity, and body fatbody fat
100,000 cancers/yr attributable to 100,000 cancers/yr attributable to obesityobesity
Sequelae of ObesitySequelae of Obesity
Type II Diabetes: 1998 – 4.9%; Type II Diabetes: 1998 – 4.9%; 2000 – 6.5%; 2010 – 8%2000 – 6.5%; 2010 – 8% Epidemic of type II diabetes in Epidemic of type II diabetes in
childrenchildren HyperlipidemiaHyperlipidemia GallstonesGallstones Sleep apneaSleep apnea Pseudotumor cerebriPseudotumor cerebri
Sequelae of ObesitySequelae of Obesity
Venous thromboembolismVenous thromboembolism GERDGERD Worsening of asthmaWorsening of asthma Urinary incontinenceUrinary incontinence
Sequelae of ObesitySequelae of Obesity
Increased predisposition to food Increased predisposition to food allergies, higher IgE levelsallergies, higher IgE levels
Weakened immune systems; Weakened immune systems; lower CD4 response to HAART lower CD4 response to HAART in HIV+ patientsin HIV+ patients
Higher rates of infection/sepsis Higher rates of infection/sepsis after traumaafter trauma
Psoriatic arthritisPsoriatic arthritis
Sequelae of ObesitySequelae of Obesity
Weaker bonesWeaker bones Lower levels of vitamin DLower levels of vitamin D Loss of brain tissue, dementiaLoss of brain tissue, dementia Multiple sclerosisMultiple sclerosis Depression and suicideDepression and suicide
Sequelae of ObesitySequelae of Obesity
Erectile dysfunction in menErectile dysfunction in men But not sexual dysfunction in womenBut not sexual dysfunction in women
Decreased fertility, lower sperm Decreased fertility, lower sperm quantity and qualityquantity and quality
EndometriosisEndometriosis Increased risk of diabetes, obesity, and Increased risk of diabetes, obesity, and
multiple birth defects (including multiple birth defects (including congenital heart disease) among congenital heart disease) among offspringoffspring
Sequelae of ObesitySequelae of Obesity
Earlier menarche (4 months)Earlier menarche (4 months) Associated with increased risk of Associated with increased risk of
breast cancerbreast cancer Associated with high risk sexual Associated with high risk sexual
behavior in adolescent girls (as is behavior in adolescent girls (as is underweight)underweight)
Less use of contraceptionLess use of contraception Oral contraceptives less effectiveOral contraceptives less effective
Sequelae of ObesitySequelae of Obesity
Less likely to breast feedLess likely to breast feed Higher rates of unintended Higher rates of unintended
pregnancy and abortionpregnancy and abortion Associated with fetal and infant Associated with fetal and infant
deathdeath Childhood exposure to intimate Childhood exposure to intimate
partner violence against mother partner violence against mother associated with adult obesityassociated with adult obesity
Sequelae of ObesitySequelae of Obesity
Decreases in social and physical Decreases in social and physical functioningfunctioning
Decrease in some health-related Decrease in some health-related quality of life (QOL) measuresquality of life (QOL) measures Obesity in adolescents confers Obesity in adolescents confers
same risk for premature death in same risk for premature death in adulthood as smoking adulthood as smoking > ½ ppd> ½ ppd
Severely obese children and Severely obese children and adolescents have QOL similar to adolescents have QOL similar to those with cancerthose with cancer
Sequelae of ObesitySequelae of Obesity
Barrier to preventive care? Barrier to preventive care? e.g., probably mammograms and e.g., probably mammograms and
Pap smears (despite higher rates of Pap smears (despite higher rates of breast and cervical cancer)breast and cervical cancer)
20% more likely to have false-20% more likely to have false-positive mammogramspositive mammograms
Reluctance to being weighed a Reluctance to being weighed a common barriercommon barrier
Sequelae of ObesitySequelae of Obesity
Marginalization, discrimination, Marginalization, discrimination, bullyingbullying
Lower life expectancyLower life expectancy Worse school performanceWorse school performance More strongly associated with More strongly associated with
chronic medical conditions and chronic medical conditions and reduced health-related quality of reduced health-related quality of life than smoking, heavy drinking life than smoking, heavy drinking or povertyor poverty
Economic Consequences of Economic Consequences of ObesityObesity
Obesity-attributable national Obesity-attributable national expenditures $127 billion/yr expenditures $127 billion/yr (health care) + $49 billion (health care) + $49 billion (lost productivity due to (lost productivity due to excess mortality) + $43 billion excess mortality) + $43 billion (lost productivity caused by (lost productivity caused by disability) = $319 billion (U.S. disability) = $319 billion (U.S. and Canada, 2009)and Canada, 2009)
Excess U.S. Medical CostsExcess U.S. Medical Costs
35% of total healthcare expenditures
Obese individuals spend an additional $1429/yr than their normal-weight counterparts
Costs will rise as population ages
Economic Consequences of Economic Consequences of ObesityObesity
Half of costs covered by Medicare, Half of costs covered by Medicare, which now classifies obesity as a which now classifies obesity as a diseasedisease
Increased costs of care due to:Increased costs of care due to: Prescription drugsPrescription drugs More complications from surgeryMore complications from surgery Increased lengths of stayIncreased lengths of stay Increased use of health care Increased use of health care
services during pregnancyservices during pregnancy
Economic Consequences of Economic Consequences of ObesityObesity
Costs to business:Costs to business: Lost productivityLost productivity AbsencesAbsences UnderperformanceUnderperformance Higher insurance premiumsHigher insurance premiums
Obesity contributes to increasing Obesity contributes to increasing carbon emissions and global carbon emissions and global warmingwarming
Military Consequences of Military Consequences of ObesityObesity
1/20 U.S. would-be military 1/20 U.S. would-be military enlistees rejected because of a enlistees rejected because of a criminal recordcriminal record
1/3 rejected because of physical 1/3 rejected because of physical unfitnessunfitness
Nutritional Changes and Nutritional Changes and ObesityObesity
AgricultureAgriculture 10,000 years ago10,000 years ago Benefits: community, local food Benefits: community, local food
productionproduction Adverse consequences: class-based, Adverse consequences: class-based,
hierarchical societies; large-scale hierarchical societies; large-scale warfare; sedentary lifestyles; warfare; sedentary lifestyles; dramatically decreased crop and game dramatically decreased crop and game diversity; corporate control of diversity; corporate control of agriculture and povertyagriculture and poverty
Nutritional Changes and Nutritional Changes and ObesityObesity
Increases in portion sizeIncreases in portion size Spread of fast food franchises since Spread of fast food franchises since
the mid-20the mid-20thth Century Century Use of artificial sweeteners and trans Use of artificial sweeteners and trans
fatty acids in processed foodsfatty acids in processed foods High levels of consumption of sugar- High levels of consumption of sugar-
and caffeine-containing sodasand caffeine-containing sodas In part a consequence of increased salt In part a consequence of increased salt
intakeintake
Fast Foods and Fast Foods and SupersizingSupersizing
Portion sizes and restaurant dinner Portion sizes and restaurant dinner plates have increased over last half plates have increased over last half centurycentury
Americans spend about one-half of their Americans spend about one-half of their food budgets and consume about one-food budgets and consume about one-third of their calories outside the homethird of their calories outside the home
Fast food spending increased 18-fold Fast food spending increased 18-fold since 1970since 1970 $184 billion industry$184 billion industry over $100 billion per year in U.S.over $100 billion per year in U.S.
Fast Foods and Fast Foods and SupersizingSupersizing
U.S. food industry produces 3800 U.S. food industry produces 3800 cal/person/daycal/person/day Average caloric need only 2500 Average caloric need only 2500
calories/person/daycalories/person/day Fast foods 10% of total caloric Fast foods 10% of total caloric
intakeintake On any given day, 8% of On any given day, 8% of
Americans eat at McDonaldsAmericans eat at McDonalds
Fast Foods and Fast Foods and SupersizingSupersizing
Typical American eats 30 pounds of Typical American eats 30 pounds of French fries per yearFrench fries per year
McDonalds’ fries in 1955: 2.4 oz. / McDonalds’ fries in 1955: 2.4 oz. / 210 calories210 calories Today 7 oz. / 610 caloriesToday 7 oz. / 610 calories
1916: typical bottle of Coca Cola = 1916: typical bottle of Coca Cola = 6.5 oz. / 79 calories6.5 oz. / 79 calories Today 16 oz. / 194 caloriesToday 16 oz. / 194 calories
Fast Foods and Fast Foods and SupersizingSupersizing
Some mega-sized fast food burgers Some mega-sized fast food burgers on the market today contain > 1000 on the market today contain > 1000 caloriescalories
Even Even Joy of CookingJoy of Cooking recipes have recipes have shown increases of 33% in caloric shown increases of 33% in caloric density and portion size since 1940sdensity and portion size since 1940s
Fast food companies “leanwashing” Fast food companies “leanwashing” themselvesthemselves
Fast Foods and the Inner Fast Foods and the Inner Cities / Poor CommunitiesCities / Poor Communities
Fast food outlets target poor Fast food outlets target poor inner city communitiesinner city communities
Meals inexpensive and Meals inexpensive and convenientconvenient Helps consumers working two Helps consumers working two
jobs, raising children solo or jobs, raising children solo or lacking inadequate kitchen lacking inadequate kitchen facilitiesfacilities
Fast Foods and ChildrenFast Foods and Children
Fast food industry directly targets Fast food industry directly targets childrenchildren Produces 20% of Saturday Produces 20% of Saturday
morning televisionmorning television Offers prizes and inducements Offers prizes and inducements
based on characters which appeal based on characters which appeal to youngsters, often in collusion to youngsters, often in collusion with motion picture industrywith motion picture industry
Fast Foods and ChildrenFast Foods and Children
Fast food restaurants clustered Fast food restaurants clustered around schoolsaround schools Students in proximate schools eat Students in proximate schools eat
fewer servings of fruits and fewer servings of fruits and vegetables, consume more soda, vegetables, consume more soda, and are more likely to be and are more likely to be overweightoverweight
Fast food diet linked to Alzheimer’s Fast food diet linked to Alzheimer’s DiseaseDisease
Fast Foods and HospitalsFast Foods and Hospitals
Some US hospitals have regional and Some US hospitals have regional and national fast food franchises located national fast food franchises located on the grounds of their main medical on the grounds of their main medical centerscenters42% of 234 academic-affiliated 42% of 234 academic-affiliated
hospitals surveyed in 2006hospitals surveyed in 2006Sends the wrong message to Sends the wrong message to
patients and their families about patients and their families about optimal nutritionoptimal nutrition
Sodas and Artificial Sodas and Artificial SweetenersSweeteners
High fructose corn syrup - High fructose corn syrup - artificial sweetener added to artificial sweetener added to many products, including sodas many products, including sodas and fruit drinksand fruit drinks1,000+% increase in 1,000+% increase in
consumption over last few consumption over last few decadesdecades
Sodas and Artificial Sodas and Artificial SweetenersSweeteners
Consumption of fast and junk Consumption of fast and junk foods begins early in lifefoods begins early in life3-10% of US infants and 3-10% of US infants and
toddlers eat candy dailytoddlers eat candy dailyChildhood candy consumption Childhood candy consumption
linked to violence in adulthoodlinked to violence in adulthood4-23 consume sweetened soda 4-23 consume sweetened soda
beveragesbeverages
SodasSodas
Soft drinks account for 20-24% of calories Soft drinks account for 20-24% of calories for 2- to 19-year-oldsfor 2- to 19-year-olds associated with tooth decay and decreased associated with tooth decay and decreased
consumption of fruits and vegetablesconsumption of fruits and vegetables associated with goutassociated with gout
Majority of adults drink soda dailyMajority of adults drink soda daily Per capita soda consumption has more than Per capita soda consumption has more than
doubled since 1970, from 24 gallons per year doubled since 1970, from 24 gallons per year to 53 gallons per yearto 53 gallons per year
““Big Gulp” and “Super Big Gulp”Big Gulp” and “Super Big Gulp”
Sodas and CaffeineSodas and Caffeine
70% of soft drinks consumed in US contain 70% of soft drinks consumed in US contain caffeinecaffeine
Evidence suggests that the mood-altering Evidence suggests that the mood-altering and physical dependence-producing effects and physical dependence-producing effects of caffeine (a central nervous system of caffeine (a central nervous system stimulant) have contributed to high rates stimulant) have contributed to high rates of consumption of caffeinated soft drinksof consumption of caffeinated soft drinks
High fructose corn syrup-containing High fructose corn syrup-containing products also frequently contaminated products also frequently contaminated with mercurywith mercury
Sodas and CaffeineSodas and Caffeine
Soda’s addictive properties Soda’s addictive properties put imbibers at risk of put imbibers at risk of caffeine-withdrawal caffeine-withdrawal symptoms such as headachesymptoms such as headache
Other caffeinated beverages: Other caffeinated beverages: e.g., Red Bulle.g., Red Bull
The National School Lunch The National School Lunch ProgramProgram
NSLP gives schools more than $6 NSLP gives schools more than $6 billion/yr to offer low-cost meals to billion/yr to offer low-cost meals to 31 million schoolchildren at over 31 million schoolchildren at over 100,000 schools and childcare 100,000 schools and childcare centerscenters
Kids eat free if their parents earn Kids eat free if their parents earn less than 130% of the poverty line; less than 130% of the poverty line; small charge if parents earn up to small charge if parents earn up to 180% of the poverty line180% of the poverty line
The National School Lunch The National School Lunch ProgramProgram
Began in 1946Began in 1946
Reimburses schools $2.28/mealReimburses schools $2.28/meal Cost = almost $10 billion per yearCost = almost $10 billion per year
Administered by USDAAdministered by USDA
The National School Lunch The National School Lunch ProgramProgram
Conflicting missions of providing healthy Conflicting missions of providing healthy meals to children, regardless of income, meals to children, regardless of income, subsidizing agribusiness, and shoring up subsidizing agribusiness, and shoring up demand for beef and milkdemand for beef and milk
Meals emphasize meat and dairy products Meals emphasize meat and dairy products at the expense of fruit and vegetables, at the expense of fruit and vegetables, contain high levels of fat, and fail to meet contain high levels of fat, and fail to meet government’s own, inadequate, nutritional government’s own, inadequate, nutritional standards, which are out of date with standards, which are out of date with current science and have not been updated current science and have not been updated since the 1970ssince the 1970s
The National School Lunch The National School Lunch ProgramProgram
81% of schools serve lunches exceeding 81% of schools serve lunches exceeding 30% fat content, less than 45% serve 30% fat content, less than 45% serve cooked vegetables other than potatoes cooked vegetables other than potatoes (usually French-fried), 42% don’t serve (usually French-fried), 42% don’t serve daily fruits and vegetables, and less than daily fruits and vegetables, and less than 10% serve legumes10% serve legumes
Overemphasis on milk products may Overemphasis on milk products may increase long-term the risk for breast increase long-term the risk for breast cancer, particularly if the milk comes from cancer, particularly if the milk comes from cattle treated with rBGHcattle treated with rBGH
Does not help to establish good nutritional Does not help to establish good nutritional habitshabits
The National School Lunch The National School Lunch ProgramProgram
Dramatic changes in NSLP Dramatic changes in NSLP unlikely to occur given political unlikely to occur given political clout wielded (and campaign clout wielded (and campaign dollars donated) by beef and dairy dollars donated) by beef and dairy industriesindustries
Former lobbyists in key positions Former lobbyists in key positions in the Department of Agriculturein the Department of Agriculture
Pouring Contracts and Soda Pouring Contracts and Soda ConsumptionConsumption
““Pouring rights” contracts with Pouring rights” contracts with soda manufacturerssoda manufacturers Signed by cash-strapped school Signed by cash-strapped school
districts to gain additional income to districts to gain additional income to compensate for cuts in educational compensate for cuts in educational and athletic programsand athletic programs
2002: 240 U.S. school districts had 2002: 240 U.S. school districts had exclusive contractsexclusive contracts
Conflicts with schools’ responsibility Conflicts with schools’ responsibility to teach proper nutritionto teach proper nutrition
Pouring Contracts and Soda Pouring Contracts and Soda ConsumptionConsumption
In return for the placement of In return for the placement of soda machines on campus and soda machines on campus and exclusive marketing rights to the exclusive marketing rights to the districts’ children, companies districts’ children, companies sponsor sports and other sponsor sports and other extracurricular activitiesextracurricular activities Rooftop adsRooftop ads T-shirt suspension and free T-shirt suspension and free
speechspeech
Pouring Contracts and Soda Pouring Contracts and Soda ConsumptionConsumption
Some school districts have banned the sale Some school districts have banned the sale and marketing of soda (e.g., Los Angeles)and marketing of soda (e.g., Los Angeles) 63% of US schools limited carbonated soft 63% of US schools limited carbonated soft
drinks in 2008, compared to 38% in 2006drinks in 2008, compared to 38% in 2006 Federal law now requires school districts Federal law now requires school districts
to have nutritional wellness policies in to have nutritional wellness policies in placeplace These will be strengthened over the These will be strengthened over the
coming few years, and should help to coming few years, and should help to curb pouring contractscurb pouring contracts
Pouring Contracts and Soda Pouring Contracts and Soda ConsumptionConsumption
2006: Coca-Cola, Pepsi, and other soft drink 2006: Coca-Cola, Pepsi, and other soft drink manufacturers announced new voluntary manufacturers announced new voluntary policies to remove soda and other sugary policies to remove soda and other sugary drinks from schools nationwidedrinks from schools nationwide Led to decreases in numbers of drinks boughtLed to decreases in numbers of drinks bought ?effect on calories?effect on calories
Nevertheless, soft drink advertising still Nevertheless, soft drink advertising still reaches students through television and reaches students through television and magazine advertisements and via Channel magazine advertisements and via Channel OneOne
ExerciseExercise
IOM recommends exercise one IOM recommends exercise one hour of exercise per day, double hour of exercise per day, double the 1996 recommendation by the 1996 recommendation by the Surgeon Generalthe Surgeon General
70% of American adults are not 70% of American adults are not active in their leisure time; 40% active in their leisure time; 40% are not active at allare not active at all
Exercise and SchoolExercise and School 1/3 of children do not participate in the 1/3 of children do not participate in the
minimum recommended level of physical minimum recommended level of physical activityactivity
Number of children taking part in Number of children taking part in physical education courses has dropped physical education courses has dropped significantly, in part due to school significantly, in part due to school funding cutsfunding cuts
Daily physical education associated with Daily physical education associated with better school attendance, more positive better school attendance, more positive attitudes about school, and better attitudes about school, and better academic performanceacademic performance
Exercise and Poor Exercise and Poor CommunitiesCommunities
Neighborhoods with high levels Neighborhoods with high levels of minorities and individuals of of minorities and individuals of low socioeconomic status have low socioeconomic status have paucity of facilities that enable paucity of facilities that enable and promote physical activity, and promote physical activity, such as parks and gymnasiasuch as parks and gymnasia
Exercise and Poor Exercise and Poor CommunitiesCommunities
Healthy weight status associated Healthy weight status associated with amount of local park spacewith amount of local park space
Perception of one’s Perception of one’s neighborhood as less safe is also neighborhood as less safe is also associated with an increased associated with an increased risk of overweight in childrenrisk of overweight in childrenFear of exercising outdoorsFear of exercising outdoors
TelevisionTelevision Television, the internet, and video gamesTelevision, the internet, and video games
Average American watches over 4 Average American watches over 4 hrs/dayhrs/day
Average youth spends 67% more time Average youth spends 67% more time watching TV per year than he/she spends watching TV per year than he/she spends in the classroomin the classroom 32% of children aged 2-7 have TVs in 32% of children aged 2-7 have TVs in
their rooms (65% of children aged 8-18)their rooms (65% of children aged 8-18) Diminishes parental control over Diminishes parental control over
viewing time and contentviewing time and content
Television and Television and OvereatingOvereating
Increases in television viewing Increases in television viewing are associated with increased are associated with increased calorie intake among youthcalorie intake among youthEspecially of calorie-dense Especially of calorie-dense
low-nutrient foods of the type low-nutrient foods of the type promoted on TVpromoted on TV
MarketingMarketing
Businesses spend estimated $13 Businesses spend estimated $13 billion annually marketing food and billion annually marketing food and drinks in the USdrinks in the US Much TV advertisingMuch TV advertising
American children exposed to American children exposed to 40,000 food ads/yr40,000 food ads/yr 72% for candy, cereal, and fast food72% for candy, cereal, and fast food Numbers increasingNumbers increasing
MarketingMarketing
Convenience/fast foods and sweets Convenience/fast foods and sweets over 80% of foods advertised during over 80% of foods advertised during children’s programmingchildren’s programming
African-American-oriented television African-American-oriented television airs far more junk food ads targeted airs far more junk food ads targeted at kids than general-oriented at kids than general-oriented networksnetworks
MarketingMarketing
Neither FTC nor FCC has authority Neither FTC nor FCC has authority to limit advertising, despite the fact to limit advertising, despite the fact that children are vulnerable to that children are vulnerable to exploitive advertising messages and exploitive advertising messages and unable to discern truth from fiction unable to discern truth from fiction in adsin ads
2007: Kelloggs to restrict food 2007: Kelloggs to restrict food marketing to childrenmarketing to children
TelevisionTelevision
Overweight and obese characters under-Overweight and obese characters under-representedrepresented Men 25%; Women 10%Men 25%; Women 10% Obese and overweight characters less Obese and overweight characters less
likely to be considered attractive, to likely to be considered attractive, to interact with romantic partners, or to interact with romantic partners, or to display physical affectiondisplay physical affection
Perpetuates stereotypesPerpetuates stereotypes Weight loss shows: e.g., Biggest Loser Weight loss shows: e.g., Biggest Loser
- ?Helpful?- ?Helpful?
StigmatizationStigmatization
Reality: the overweight and obese Reality: the overweight and obese suffer from stigmatizationsuffer from stigmatization Overweight and obese women get Overweight and obese women get
fewer promotions and face more fewer promotions and face more job discriminationjob discrimination
Not true for heavyset menNot true for heavyset men
The Food Industry and The Food Industry and Medical GroupsMedical Groups
Medical groups have taken money from food Medical groups have taken money from food companies (troubling conflict of interest):companies (troubling conflict of interest): American Dietetic Association:American Dietetic Association:
Published “Straight Facts about Beverage Choices,” Published “Straight Facts about Beverage Choices,” supported by grant from National Soft Drink supported by grant from National Soft Drink AssociationAssociation
Accepted money from Mars and Coca Cola for annual Accepted money from Mars and Coca Cola for annual meetingmeeting
AAFP’s magazine, “Family Doctor: Your AAFP’s magazine, “Family Doctor: Your Essential Guide to Health and Well Being,” Essential Guide to Health and Well Being,” marinated in ads from junk food companies, marinated in ads from junk food companies, including McDonalds, Kraft (maker of Oreo including McDonalds, Kraft (maker of Oreo cookies), and Dr. Peppercookies), and Dr. Pepper
The Food Industry and The Food Industry and Medical GroupsMedical Groups
Cadbury Schweppes (makers of Dr. Cadbury Schweppes (makers of Dr. Pepper and chocolate candies) donated Pepper and chocolate candies) donated a few million dollars to the American a few million dollars to the American Diabetes Association (ADA) in exchange Diabetes Association (ADA) in exchange for getting to use ADA label on its diet for getting to use ADA label on its diet drinksdrinks
AHA has accepted money from similar AHA has accepted money from similar companies, and allows its label on companies, and allows its label on certified “heart-healthy” productscertified “heart-healthy” products
The Food Industry and The Food Industry and Medical GroupsMedical Groups
AAFP partnership with Coca-Cola to AAFP partnership with Coca-Cola to support its family doctor websitesupport its family doctor websiteCompany’s Guatemala bottling Company’s Guatemala bottling plants excoriated by human rights plants excoriated by human rights groups for labor rights violations, groups for labor rights violations, including rape, murder, and including rape, murder, and attempted murderattempted murder
Its bottled water operations in India Its bottled water operations in India are depleting local water tablesare depleting local water tables
The Food Industry and The Food Industry and Medical GroupsMedical Groups
Yale School of Medicine Yale School of Medicine fellowship in obesity studies fellowship in obesity studies sponsored by PepsiCosponsored by PepsiCo
Coca-Cola and PepsiCo both Coca-Cola and PepsiCo both produce bottled waterproduce bottled water
Coke: Dasani (tap water), othersCoke: Dasani (tap water), othersPepsiCo: Aquafina (tap water)PepsiCo: Aquafina (tap water)
Food Producers and Food Producers and ObesityObesity
Sugar producers, the packaged food Sugar producers, the packaged food industry, and producers of high industry, and producers of high fructose corn syrup sweetener:fructose corn syrup sweetener: Contribute generously to politiciansContribute generously to politicians Top executives among President George Top executives among President George
W Bush’s biggest fundraisersW Bush’s biggest fundraisers Have exercised political influence to Have exercised political influence to
weaken food standards and labeling laws weaken food standards and labeling laws in the US and to pressure the WHO to in the US and to pressure the WHO to weaken its anti-obesity guidelinesweaken its anti-obesity guidelines
US Agricultural US Agricultural SubsidiesSubsidies
US agricultural subsidies have caused US agricultural subsidies have caused real (inflation-adjusted) price of fats and real (inflation-adjusted) price of fats and oils to decrease by 10%, of sugars and oils to decrease by 10%, of sugars and sweets to decrease by 15%, of sweets to decrease by 15%, of carbonated drinks to decrease by 34%, carbonated drinks to decrease by 34%, and of fresh fruits and vegetables to and of fresh fruits and vegetables to increase by 50% since the 1960sincrease by 50% since the 1960s Less than 1/10 of Americans meet Less than 1/10 of Americans meet
guidelines for fruit and vegetable guidelines for fruit and vegetable intakeintake
Consolidation and Consolidation and Industrialization of US Industrialization of US
AgricultureAgriculture 6.8 million farms in 1935 (vs. < 2 million 6.8 million farms in 1935 (vs. < 2 million
today)today) The average farmer now feeds 129 The average farmer now feeds 129
Americans (vs. 19 in 1940)Americans (vs. 19 in 1940) Americans spend less than 10% of their Americans spend less than 10% of their
incomes on food, down from 18% in 1966incomes on food, down from 18% in 1966 Subsidies mean one dollar can buy 1,200 Subsidies mean one dollar can buy 1,200
calories of potato chips or 875 calories of calories of potato chips or 875 calories of soda or 250 calories of vegetables or 170 soda or 250 calories of vegetables or 170 calories of fresh fruitcalories of fresh fruit
The Obesity EconomyThe Obesity Economy
Plus-size apparel market worth Plus-size apparel market worth $17 billion$17 billion20% of women’s clothing sales 20% of women’s clothing sales
(up from 11% in 2001)(up from 11% in 2001) Half of all U.S. women wear size Half of all U.S. women wear size
14 or larger14 or larger1985: average size was 8.701985: average size was 8.70
The Obesity EconomyThe Obesity Economy
XXXL sized clothes; oversized XXXL sized clothes; oversized autos, furniture, and coffins, and autos, furniture, and coffins, and specialized medical equipment specialized medical equipment such as lifts, special chairs and such as lifts, special chairs and toiletstoilets
SWA requires obese to buy extra SWA requires obese to buy extra seatseat Other airlines consideringOther airlines considering
Obesity WorldwideObesity Worldwide
America’s weight problem is occurring in the America’s weight problem is occurring in the midst of a global epidemic of overweight and midst of a global epidemic of overweight and obesityobesity Obese = 1.1 billion = UnderfedObese = 1.1 billion = Underfed
Migration from countries with lower rates of Migration from countries with lower rates of cancer and more healthy diets (e.g., many SE cancer and more healthy diets (e.g., many SE Asian nations) adopt American diet within a Asian nations) adopt American diet within a generationgeneration Become more overweight/obese and suffer higher Become more overweight/obese and suffer higher
rates of cancer and obesity-related illnessesrates of cancer and obesity-related illnesses Cultural export of fast food outlets / supersizingCultural export of fast food outlets / supersizing
Underweight and Underweight and Pathological Eating Pathological Eating
BehaviorsBehaviors Abnormal self-imageAbnormal self-image Prevalence of eating disorders has Prevalence of eating disorders has
risen in US and developing countriesrisen in US and developing countries Consequence (in part) of media’s depiction Consequence (in part) of media’s depiction
of “ideal” (excessively thin) womanof “ideal” (excessively thin) woman 66% of women and 52% of men report 66% of women and 52% of men report
feelings of dissatisfaction or feelings of dissatisfaction or inadequacy regarding their body inadequacy regarding their body weightweight
Underweight and Underweight and Pathological Eating Pathological Eating
BehaviorsBehaviors 60% of girls in grade 9-12 trying to 60% of girls in grade 9-12 trying to
lose weightlose weight 24% of boys24% of boys
#1 wish of girls aged 11 to 17 is to #1 wish of girls aged 11 to 17 is to lose weightlose weight
Women more likely to judge Women more likely to judge themselves overweight when they are themselves overweight when they are notnot Men the oppositeMen the opposite
Underweight and Underweight and Pathological Eating Pathological Eating
BehaviorsBehaviors Women who desire to lose weight Women who desire to lose weight
more likely to do so in the hopes of more likely to do so in the hopes of improving their appearanceimproving their appearance Men more likely to be concerned Men more likely to be concerned
about future health and fitnessabout future health and fitness Body image distress classified as a Body image distress classified as a
psychological disorder (body psychological disorder (body dysmorphic disorder)dysmorphic disorder)
Underweight and Underweight and Pathological Eating Pathological Eating
BehaviorsBehaviors Five to 10 percent of females Five to 10 percent of females
(and 1-2% of males) have some (and 1-2% of males) have some form of eating disorderform of eating disorderAdolescent girls:Adolescent girls:
anorexia nervosa (0.5%)anorexia nervosa (0.5%)bulimia (1-2%)bulimia (1-2%)
Underweight and Underweight and Pathological Eating Pathological Eating
BehaviorsBehaviors Male and female high school athletes at Male and female high school athletes at
high risk for risky weight-control behaviorshigh risk for risky weight-control behaviors E.g., restricting food intake, vomiting, over-E.g., restricting food intake, vomiting, over-
exercising, using diet pills, inappropriately exercising, using diet pills, inappropriately taking prescribed stimulants or insulin, and taking prescribed stimulants or insulin, and using nicotineusing nicotine
Some adolescents dehydrate by restricting Some adolescents dehydrate by restricting fluid intake, spitting, wearing rubber suits, fluid intake, spitting, wearing rubber suits, taking daily steam baths and/or saunas, taking daily steam baths and/or saunas, and using diuretics or laxativesand using diuretics or laxatives
Consequences of Abnormal Consequences of Abnormal Weight Loss BehaviorsWeight Loss Behaviors
Delayed maturationDelayed maturation Impaired growthImpaired growth Menstrual irregularities / amenorrheaMenstrual irregularities / amenorrhea InfectionsInfections Eating disordersEating disorders DepressionDepression
Alternatively, such behaviors can be a Alternatively, such behaviors can be a sign of depression or verbal, physical, or sign of depression or verbal, physical, or sexual abusesexual abuse
The Role of the MediaThe Role of the Media
Media images contribute to Media images contribute to misguided perception of the “ideal” misguided perception of the “ideal” bodybody Models today weigh 23% less than Models today weigh 23% less than
average women; 1986: 8%average women; 1986: 8% Dimensions of the average fashion Dimensions of the average fashion
model: 5’9”, 110lbsmodel: 5’9”, 110lbs Dimensions of average American Dimensions of average American
woman: 5’4”, 163 lbswoman: 5’4”, 163 lbs
The Role of the MediaThe Role of the Media
Waist-to-height ratio:Waist-to-height ratio: Barbie Doll 25%Barbie Doll 25% Ken Doll 36%Ken Doll 36% Female college swimmers 42%Female college swimmers 42% Male college swimmers 43%Male college swimmers 43% General healthy cutoff 50%General healthy cutoff 50%
Modeling Schools for Modeling Schools for TeensTeens
Create unrealistic expectationsCreate unrealistic expectations Only a very “select” few models achieve Only a very “select” few models achieve
financial successfinancial success Of these, beginners earn $1500 per Of these, beginners earn $1500 per
day, those in the top tier $25,000 per day, those in the top tier $25,000 per day, and supermodels $100,000 or even day, and supermodels $100,000 or even more per day)more per day)
Some major fashion cities (e.g., Milan) Some major fashion cities (e.g., Milan) now require minimum BMI of 18 (not now require minimum BMI of 18 (not NYC)NYC)
Food Insecurity and Food Insecurity and HungerHunger
Worldwide, hunger-related causes Worldwide, hunger-related causes kill as many people in 2 days as died kill as many people in 2 days as died in the atomic bombing of Hiroshimain the atomic bombing of Hiroshima
US faces increasing mal-distribution US faces increasing mal-distribution of wealth and significant levels of of wealth and significant levels of poverty and hungerpoverty and hunger Twenty-five percent of children live in Twenty-five percent of children live in
poverty, and 4 million go hungry each poverty, and 4 million go hungry each dayday
Food Insecurity and Food Insecurity and HungerHunger
USDA: 12% of US households suffer USDA: 12% of US households suffer from food insecurity (limited or from food insecurity (limited or uncertain availability of nutritionally uncertain availability of nutritionally adequate and safe foods or limited or adequate and safe foods or limited or uncertain ability to acquire acceptable uncertain ability to acquire acceptable food in socially acceptable ways)food in socially acceptable ways)
Another 4% face outright hunger (the Another 4% face outright hunger (the uneasy or painful sensation caused by uneasy or painful sensation caused by the recurrent lack of access to food)the recurrent lack of access to food)
WasteWaste
Meanwhile, American Meanwhile, American households waste over $43 households waste over $43 billion worth of food per yearbillion worth of food per year1,400 calories per day (40% 1,400 calories per day (40% of food supply) wastedof food supply) wasted
3 times as much as in 19853 times as much as in 1985
Gluttony and Eating Gluttony and Eating ContestsContests
International Federation of International Federation of Competitive Eating sponsors more Competitive Eating sponsors more than 150 annual gorgefeststhan 150 annual gorgefests Chicken wings, oysters, jalapenos, etc.Chicken wings, oysters, jalapenos, etc. Official newsletter: “The Gurgitator”Official newsletter: “The Gurgitator” Nathan’s Annual Fourth of July Hot Dog Nathan’s Annual Fourth of July Hot Dog
Eating ContestEating Contest The World Cup of food boltingThe World Cup of food bolting Past winners have consumed over 50 wieners Past winners have consumed over 50 wieners
and buns in just twelve minutesand buns in just twelve minutes
Treatments for ObesityTreatments for Obesity
Decrease caloric intake (especially Decrease caloric intake (especially simple carbohydrates and trans-fatty simple carbohydrates and trans-fatty acids)acids)
Eat slowlyEat slowly Drink two glasses of water before Drink two glasses of water before
eatingeating Exercise moreExercise more Get adequate sleepGet adequate sleep Behavioral modificationBehavioral modification
Treatments for ObesityTreatments for Obesity
Enlist familial and social support Enlist familial and social support networknetwork
Economic incentives (?Economic incentives (?sustainability)sustainability)
Rule out contributing factors Rule out contributing factors (e.g., hypothyroidism)(e.g., hypothyroidism)
Treat associated conditions / Treat associated conditions / sequelaesequelae
Treatments for ObesityTreatments for Obesity
Adults should receive 45% to 65% of calories Adults should receive 45% to 65% of calories from carbohydrates, 20%-35% from fat, and from carbohydrates, 20%-35% from fat, and 10%-35% from protein10%-35% from protein
2/3 of women and 1/3 of men with BMI > 27 2/3 of women and 1/3 of men with BMI > 27 have attempted weight losshave attempted weight loss Most who initially succeed regain lost weight Most who initially succeed regain lost weight
within 5 yrswithin 5 yrs With the exception of one trial involving With the exception of one trial involving
Weight Watchers, evidence to support major Weight Watchers, evidence to support major commercial and self-help weight loss commercial and self-help weight loss programs is sub-optimalprograms is sub-optimal
Treatments for ObesityTreatments for Obesity
In some countries, insurance In some countries, insurance companies cover obesity treatmentcompanies cover obesity treatment Most in the U.S. do not, although they Most in the U.S. do not, although they
do cover myriad expensive health do cover myriad expensive health consequences of obesityconsequences of obesity
Americans spend an estimated $30 Americans spend an estimated $30 billion each year on diet pills, diet billion each year on diet pills, diet foods, exercise videos, health club foods, exercise videos, health club dues, and other weight loss toolsdues, and other weight loss tools
Treatments for ObesityTreatments for Obesity
Weight loss drugs are a billion Weight loss drugs are a billion dollar per year business in the USdollar per year business in the US
Nearly 5 million US adults used Nearly 5 million US adults used prescription weight loss pills prescription weight loss pills between 1996 and 1998between 1996 and 1998 However, ¼ of users were not overweightHowever, ¼ of users were not overweight Use especially common among womenUse especially common among women [Slentrol – 1[Slentrol – 1stst FDA-approved weight loss FDA-approved weight loss
drug for dogs]drug for dogs]
Treatments for ObesityTreatments for Obesity
Drug therapy may be appropriate Drug therapy may be appropriate for patients with a BMI > 30 or a for patients with a BMI > 30 or a BMI > 27 with additional risk BMI > 27 with additional risk factorsfactors
Sibutramine and orlistat reduce Sibutramine and orlistat reduce weight 10% when combined with weight 10% when combined with diet and exercisediet and exercise
Treatments for ObesityTreatments for Obesity
Orlistat (Xenical) = inhibits Orlistat (Xenical) = inhibits intestinal lipasesintestinal lipases Average weight loss 2.89 kg over Average weight loss 2.89 kg over
one yearone year Side effects include GI discomfort, Side effects include GI discomfort,
fecal urgency, liver failure, fecal urgency, liver failure, oxalate-induced kidney injury, and oxalate-induced kidney injury, and pancreatitispancreatitis
Treatments for ObesityTreatments for Obesity
Sibutramine (Meridia) = SSRI/NARISibutramine (Meridia) = SSRI/NARI Average weight loss 4.2 kg over Average weight loss 4.2 kg over
one yearone year Can increase heart rate and blood Can increase heart rate and blood
pressurepressure 2010: Withdrawn from market due 2010: Withdrawn from market due
to increased risk of stroke and MIto increased risk of stroke and MI
Treatments for ObesityTreatments for Obesity
Naltrexon SR/Bupropion SR (ContraveNaltrexon SR/Bupropion SR (Contrave Weight loss of 5-10% (vs. 1-6% placebo)Weight loss of 5-10% (vs. 1-6% placebo) Side effects: N, HA, elevated BP and HRSide effects: N, HA, elevated BP and HR FDA requiring more phase 3 trialsFDA requiring more phase 3 trials
Fenfluramine and dexfenfluramine Fenfluramine and dexfenfluramine taken off market in 1997taken off market in 1997 Numerous reports of cardiac Numerous reports of cardiac
valvulopathyvalvulopathy Alli, Meridia, Acomplia, othersAlli, Meridia, Acomplia, others
Treatments for ObesityTreatments for Obesity
Non-prescription supplements can be Non-prescription supplements can be dangerousdangerous Unregulated with respect to purity, Unregulated with respect to purity,
composition, and effectivenesscomposition, and effectiveness Especially avoid compounds Especially avoid compounds
containing ephedracontaining ephedraBanned by FDA, but still found in a Banned by FDA, but still found in a number of preparations sold in the number of preparations sold in the US and purchased abroadUS and purchased abroad
Treatments for ObesityTreatments for Obesity
Future pharmaceutical Future pharmaceutical treatments will likely be directed treatments will likely be directed against hormones involved in against hormones involved in the regulation of satiety, such as the regulation of satiety, such as leptin and ghrelin, and may leptin and ghrelin, and may include vaccinesinclude vaccines
Treatments for ObesityTreatments for Obesity
BMI > 40 (or BMI > 35 with DM2 or BMI > 40 (or BMI > 35 with DM2 or OSA) may be eligible for bariatric OSA) may be eligible for bariatric surgerysurgery
Procedures include Roux-en-Y Procedures include Roux-en-Y gastric bypass (best outcomes), gastric bypass (best outcomes), stapled gastroplasty, and adjustable stapled gastroplasty, and adjustable gastric bandinggastric bandingDesigned to reduce stomach size Designed to reduce stomach size
and control caloric intakeand control caloric intake
Treatments for ObesityTreatments for Obesity >200,000 procedures performed annually>200,000 procedures performed annually
Only 0.6% of eligible adults underwent a Only 0.6% of eligible adults underwent a procedureprocedure
Substantial health benefits commonSubstantial health benefits common Average weight loss after one year/three Average weight loss after one year/three
years: 62%/71% with Roux-en-Y gastric years: 62%/71% with Roux-en-Y gastric bypass, 43%/55% with gastric bandingbypass, 43%/55% with gastric banding
Excess weight loss of up to 70% and Excess weight loss of up to 70% and resolution of diabetes in 77% of patientsresolution of diabetes in 77% of patients
Up to 45% lower risk of deathUp to 45% lower risk of death Improvements in memory functionImprovements in memory function
Treatments for ObesityTreatments for Obesity
Perioperative mortality 0.3%Perioperative mortality 0.3% Complication rates almost 20-Complication rates almost 20-
30% over a 180-day period30% over a 180-day period
LiposuctionLiposuction
Public Health Measures to Public Health Measures to Reduce ObesityReduce Obesity
DHHS’s Healthy People 2010 DHHS’s Healthy People 2010 objective: reduce prevalence of objective: reduce prevalence of obesity to 15%obesity to 15%
<1/2 of obese US adults visiting <1/2 of obese US adults visiting a primary care physician a primary care physician counseled about weight losscounseled about weight loss Those counseled twice as likely Those counseled twice as likely
to attempt weight lossto attempt weight loss
Public Health Measures to Public Health Measures to Reduce ObesityReduce Obesity
Need for improved health care Need for improved health care provider education in nutrition and provider education in nutrition and increased use of nutritionists in increased use of nutritionists in primary care settingsprimary care settings Would likely be cost-savingWould likely be cost-saving
School- and community-based health School- and community-based health education campaigns tailored to education campaigns tailored to cultural background, gender, and cultural background, gender, and age groupage group
Public Health Measures to Public Health Measures to Reduce ObesityReduce Obesity
Media health messages to Media health messages to correct misperceptions correct misperceptions regarding weight and promote regarding weight and promote healthy behaviorshealthy behaviors
Enhanced public school health Enhanced public school health curriculacurricula
Public Health Measures Public Health Measures to Reduce Obesityto Reduce Obesity
Obesity report cardsObesity report cards 20 states20 states 23% of US elementary schools23% of US elementary schools
Lincoln University in PA requires Lincoln University in PA requires students with BMI students with BMI > 30 to pass a physical > 30 to pass a physical fitness test to graduatefitness test to graduate
Public Health Measures to Public Health Measures to Reduce ObesityReduce Obesity
More healthful school and hospital More healthful school and hospital cafeteria meal choicescafeteria meal choices
No fast foods, soda pop machines, or No fast foods, soda pop machines, or exclusivity contracts in schoolsexclusivity contracts in schools Enhanced state funding for public Enhanced state funding for public
educationeducation Provision of healthier menu options in Provision of healthier menu options in
federally-sponsored school lunches federally-sponsored school lunches increases student participation in NSLPincreases student participation in NSLP
Public Health Measures to Public Health Measures to Reduce ObesityReduce Obesity
Use of local produce from Use of local produce from community-supported agriculture, community-supported agriculture, especially organics, would especially organics, would decrease adverse consequences of decrease adverse consequences of pesticides on the environment and pesticides on the environment and amount of harmful greenhouse amount of harmful greenhouse gasses produced in transportation gasses produced in transportation of food over long distancesof food over long distances
Public Health Measures to Public Health Measures to Reduce ObesityReduce Obesity
School wellness policy provision School wellness policy provision included in the Child Nutrition and included in the Child Nutrition and Women, Infants and Children Women, Infants and Children Reauthorization Act of 2004 mandates Reauthorization Act of 2004 mandates that schools participating in federal that schools participating in federal nutrition programs create wellness nutrition programs create wellness policies on how to improve students’ policies on how to improve students’ nutrition and health as well as set nutrition and health as well as set guidelines for all foods sold in schools guidelines for all foods sold in schools by 2006by 2006
Public Health Measures to Public Health Measures to Reduce ObesityReduce Obesity
Child Health Nutrition Promotion Child Health Nutrition Promotion and School Lunch Protection Act, and School Lunch Protection Act, introduced in both the US Senate introduced in both the US Senate and House of Representatives, calls and House of Representatives, calls for updating decades-old federal for updating decades-old federal nutrition standards for snack foods nutrition standards for snack foods sold in cafeterias, stores, and sold in cafeterias, stores, and vending machines on school groundsvending machines on school grounds
Public Health Measures to Public Health Measures to Reduce ObesityReduce Obesity
Pedestrian mallsPedestrian malls Recreational centers, parks, and Recreational centers, parks, and
workplace gymsworkplace gyms Requiring physical education at Requiring physical education at
schoolschool Providing insurance coverage for Providing insurance coverage for
membership in athletic clubs and membership in athletic clubs and insurance discounts for participation insurance discounts for participation in exercise programsin exercise programs
Public Health Measures to Public Health Measures to Reduce ObesityReduce Obesity
Alabama: $25/month health Alabama: $25/month health insurance surcharge on state workers insurance surcharge on state workers whose BMI exceeds 35 and who fail whose BMI exceeds 35 and who fail to enroll in a free wellness program to enroll in a free wellness program and “show progress”and “show progress”
State workers, however, pay lower State workers, however, pay lower rates for lower BP, FBS, cholesterol, rates for lower BP, FBS, cholesterol, and weight, or if they see a doctor to and weight, or if they see a doctor to address health problems or address health problems or participate in an exercise classparticipate in an exercise class
Public Health Measures Public Health Measures to Reduce Obesityto Reduce Obesity
Comprehensive employee Comprehensive employee wellness programs yield average wellness programs yield average reduction in healthcare reduction in healthcare expenditures of 26%expenditures of 26%
Several state insurance plans impose a $25/month surcharge on smokers
Others give up to 20% premium reductions to those who meet certain health guidelines
Public Health Measures Public Health Measures to Reduce Obesityto Reduce Obesity
Enhanced health insurance Enhanced health insurance coverage for obesity prevention and coverage for obesity prevention and treatmenttreatment Adjusted premiums based on Adjusted premiums based on
weight in several statesweight in several states
Health and life insurance companies Health and life insurance companies own 1.9 billion of stock in the 5 own 1.9 billion of stock in the 5 leading fast food companies (2010)leading fast food companies (2010)
Public Health Measures Public Health Measures to Reduce Obesityto Reduce Obesity
Airline’s requiring obese passengers Airline’s requiring obese passengers on full flights to rebook or purchase on full flights to rebook or purchase two seatstwo seats
Child abuse/child custody statutesChild abuse/child custody statutes
Purge governmental bodies of those Purge governmental bodies of those with industry connectionswith industry connections
Public Health Measures Public Health Measures to Reduce Obesityto Reduce Obesity
Laws to prohibit weight discrimination Laws to prohibit weight discrimination (MI only state, others considering)(MI only state, others considering) Have broad popular supportHave broad popular support Some doctors refuse to treat obese patients Some doctors refuse to treat obese patients
(higher risk of surgical complications, etc.)(higher risk of surgical complications, etc.) Fat Acceptance/CelebrationFat Acceptance/Celebration
Fat StudiesFat Studies National Association to Advance Fat National Association to Advance Fat
AcceptanceAcceptance
Public Health Measures to Public Health Measures to Reduce ObesityReduce Obesity
Provision of nutrition information on Provision of nutrition information on restaurant menusrestaurant menus Consumers strongly supportConsumers strongly support Required in NYC (upheld by federal Required in NYC (upheld by federal
appeals court in 2009)appeals court in 2009) Consumers underestimate calorie Consumers underestimate calorie
content of restaurant food by 28-48%content of restaurant food by 28-48% Effective in decreasing calorie Effective in decreasing calorie
consumptionconsumption Required by Obama Health PlanRequired by Obama Health Plan
Public Health Measures to Public Health Measures to Reduce ObesityReduce Obesity
As of January 1, 2006, all As of January 1, 2006, all conventional food items must conventional food items must include information re the amount of include information re the amount of trans fatty acids they containtrans fatty acids they contain FDA: will prevent from 600 to FDA: will prevent from 600 to
1200 cases of coronary heart 1200 cases of coronary heart disease and 250 to 500 deaths disease and 250 to 500 deaths each yeareach year
Public Health Measures to Public Health Measures to Reduce ObesityReduce Obesity
CA, NYC, Philadelphia have banned use of CA, NYC, Philadelphia have banned use of artificial trans-fatty acids in restaurantsartificial trans-fatty acids in restaurants 2008: McDonalds eliminating trans fatty acid 2008: McDonalds eliminating trans fatty acid
cooking oilscooking oils Less than 2% of NYC restaurants using trans Less than 2% of NYC restaurants using trans
fats (2009)fats (2009) Some claim that these compounds add Some claim that these compounds add
flavor and texture to fried foods, but flavor and texture to fried foods, but suitable, less dangerous cooking oil suitable, less dangerous cooking oil substitutes are availablesubstitutes are available
Public Health Measures to Public Health Measures to Reduce ObesityReduce Obesity
Prohibit distribution of toys and Prohibit distribution of toys and promotional games and presence of promotional games and presence of play equipment and video games at play equipment and video games at fast food outletsfast food outlets
Require fast food restaurants to Require fast food restaurants to locate minimum distance from locate minimum distance from schools and playgroundsschools and playgrounds
Limit per capita number of fast food Limit per capita number of fast food outlets in a communityoutlets in a community
Public Health Measures to Public Health Measures to Reduce ObesityReduce Obesity
Limit proximity of fast food Limit proximity of fast food outlets to each otheroutlets to each other
Charge fee to fast food outlets Charge fee to fast food outlets and use proceeds to mitigate the and use proceeds to mitigate the impact of poor nutritional impact of poor nutritional content content
Prohibit drive-through serviceProhibit drive-through service
Public Health Measures to Public Health Measures to Reduce ObesityReduce Obesity
Majority of Americans believe the Majority of Americans believe the government should be involved in government should be involved in fighting obesity, particularly by fighting obesity, particularly by regulating marketing of “junk foods” regulating marketing of “junk foods” to kidsto kids
40 states tax non-nutritious foods 40 states tax non-nutritious foods (e.g., soft drinks and candy)(e.g., soft drinks and candy) 11cent/oz tax could reduce consumption of sugared cent/oz tax could reduce consumption of sugared
beverages by more than 10%beverages by more than 10% Taxes recommended by IOMTaxes recommended by IOM
Public Health Measures to Public Health Measures to Reduce ObesityReduce Obesity
Lawsuits against purveyors of Lawsuits against purveyors of junk foods to reclaim health care junk foods to reclaim health care costscosts
Some states considering class Some states considering class action suitsaction suits
ConclusionsConclusions
Epidemic of obesity in US Epidemic of obesity in US and worldwideand worldwide
Serious health and economic Serious health and economic consequencesconsequences
Multi-tiered approach Multi-tiered approach necessary to combatnecessary to combat
Covered in Other Slide Covered in Other Slide ShowsShows
Ideals of beauty and body Ideals of beauty and body modificationmodification
Cosmetic surgeryCosmetic surgery Female genital cuttingFemale genital cutting Ethical and policy issuesEthical and policy issues
ReferencesReferences Donohoe MT. Weighty matters: public health aspects of the obesity Donohoe MT. Weighty matters: public health aspects of the obesity
epidemic. Part I – Causes and health and economic consequences of epidemic. Part I – Causes and health and economic consequences of obesity. Medscape Ob/Gyn and Women’s Health 2007 (posted 12/12/07). obesity. Medscape Ob/Gyn and Women’s Health 2007 (posted 12/12/07). Available at Available at http://www.medscape.com/viewarticle/566056
Donohoe MT. Weighty matters: public health aspects of the obesity Donohoe MT. Weighty matters: public health aspects of the obesity epidemic. Part II – Economic Consequences of Obesity, the “Obesity epidemic. Part II – Economic Consequences of Obesity, the “Obesity Economy,” and the Role of Nutrition, Exercise, and Television. Medscape Economy,” and the Role of Nutrition, Exercise, and Television. Medscape Ob/Gyn and Women’s Health 2008 (posted 1/04/08). Available at Ob/Gyn and Women’s Health 2008 (posted 1/04/08). Available at http://www.medscape.com/viewarticle/566349?src=mp
Donohoe MT. Weighty matters: public health aspects of the obesity Donohoe MT. Weighty matters: public health aspects of the obesity epidemic. Part III – A look at food and beverage industries. Medscape epidemic. Part III – A look at food and beverage industries. Medscape Ob/Gyn and Women’s Health 2008 (posted 3/25/08). Available at Ob/Gyn and Women’s Health 2008 (posted 3/25/08). Available at http://www.medscape.com/viewarticle/568110_print
Donohoe MT. Weighty matters: public health aspects of the obesity Donohoe MT. Weighty matters: public health aspects of the obesity epidemic. Part IV – Obesity worldwide, pathological underweight, and epidemic. Part IV – Obesity worldwide, pathological underweight, and gluttony. Medscape Ob/Gyn and Women’s Health 2008 (Posted 3/19/08). gluttony. Medscape Ob/Gyn and Women’s Health 2008 (Posted 3/19/08). Available at Available at http://www.medscape.com/viewarticle/571497_print
Donohoe MT. Weighty matters: public health aspects of the obesity Donohoe MT. Weighty matters: public health aspects of the obesity epidemic. Part V – Treatments and public health approaches to combating epidemic. Part V – Treatments and public health approaches to combating the problem. Medscape Ob/Gyn and Women’s Health 2008 (posted the problem. Medscape Ob/Gyn and Women’s Health 2008 (posted 4/10/08). Available at 4/10/08). Available at http://www.medscape.com/viewarticle/571139_print..
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