obesity: the current landscape

7/30/2019 Obesity: The Current Landscape

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Obesity: The Current

Landscape

James O. Hill, Ph.D.Anschutz Professor

Executive Director

Anschutz Health and Wellness Center

University of Colorado


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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


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How Fat are We?


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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; obesitydefines as BMI>=30; Extreme obesity defines as BMI>=40.

Trends in overweight, obesity and

extreme obesity, ages 20-74 years


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Age 12-19

Age 6-11

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.

Trends in child and adolescent

overweight


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What Causes Obesity?

Name the top 3 causes of obesity


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Potential Causes of Obesity

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,

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,
http://www.ncbi.nlm.nih.gov/pubmed/23336994http://www.ncbi.nlm.nih.gov/pubmed/21285941http://www.ncbi.nlm.nih.gov/pubmed/22505764http://www.ncbi.nlm.nih.gov/pubmed/22907693http://www.ncbi.nlm.nih.gov/pubmed/22555788http://www.ncbi.nlm.nih.gov/pubmed/23056005http://www.ncbi.nlm.nih.gov/pubmed/22245381http://www.ncbi.nlm.nih.gov/pubmed/22623615http://www.ncbi.nlm.nih.gov/pubmed/23128770http://www.ncbi.nlm.nih.gov/pubmed/12006126http://www.ncbi.nlm.nih.gov/pubmed/23414663http://www.ncbi.nlm.nih.gov/pubmed/20194985http://www.ncbi.nlm.nih.gov/pubmed/22407248http://www.ncbi.nlm.nih.gov/pubmed/22407248http://www.ncbi.nlm.nih.gov/pubmed/21647427http://www.ncbi.nlm.nih.gov/pubmed/22643478http://www.ncbi.nlm.nih.gov/pubmed/20150577http://www.ncbi.nlm.nih.gov/pubmed/22098801http://www.ncbi.nlm.nih.gov/pubmed/23171217http://www.ncbi.nlm.nih.gov/pubmed/22734914http://www.ncbi.nlm.nih.gov/pubmed/23412985http://www.ncbi.nlm.nih.gov/pubmed/22329821http://www.ncbi.nlm.nih.gov/pubmed/19360012http://www.ncbi.nlm.nih.gov/pubmed/23166398http://www.ncbi.nlm.nih.gov/pubmed/21684646http://www.plosone.org/article/info:doi/10.1371/journal.pone.0013907http://www.ncbi.nlm.nih.gov/pubmed/21907742http://www.nlm.nih.gov/medlineplus/podcast/transcript062512.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/23364918http://www.ftc.gov/os/2012/12/121221foodmarketingreport.pdfhttp://dopaminehegemony.blogspot.com/2012/05/us-obesity-epidemic-caused-by.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/22749656http://www.ncbi.nlm.nih.gov/pubmed/23390806http://www.ncbi.nlm.nih.gov/pubmed/22726771http://www.ncbi.nlm.nih.gov/pubmed/21872749http://www.ncbi.nlm.nih.gov/pubmed/21872749http://www.ncbi.nlm.nih.gov/pubmed/22726771http://www.ncbi.nlm.nih.gov/pubmed/23390806http://www.ncbi.nlm.nih.gov/pubmed/22749656http://dopaminehegemony.blogspot.com/2012/05/us-obesity-epidemic-caused-by.htmlhttp://www.ftc.gov/os/2012/12/121221foodmarketingreport.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/23364918http://www.nlm.nih.gov/medlineplus/podcast/transcript062512.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/21907742http://www.plosone.org/article/info:doi/10.1371/journal.pone.0013907http://www.plosone.org/article/info:doi/10.1371/journal.pone.0013907http://www.plosone.org/article/info:doi/10.1371/journal.pone.0013907http://www.ncbi.nlm.nih.gov/pubmed/21684646http://www.ncbi.nlm.nih.gov/pubmed/23166398http://www.ncbi.nlm.nih.gov/pubmed/19360012http://www.ncbi.nlm.nih.gov/pubmed/22329821http://www.ncbi.nlm.nih.gov/pubmed/23412985http://www.ncbi.nlm.nih.gov/pubmed/22734914http://www.ncbi.nlm.nih.gov/pubmed/23171217http://www.ncbi.nlm.nih.gov/pubmed/22098801http://www.ncbi.nlm.nih.gov/pubmed/20150577http://www.ncbi.nlm.nih.gov/pubmed/22643478http://www.ncbi.nlm.nih.gov/pubmed/21647427http://www.ncbi.nlm.nih.gov/pubmed/22407248http://www.ncbi.nlm.nih.gov/pubmed/22407248http://www.ncbi.nlm.nih.gov/pubmed/20194985http://www.ncbi.nlm.nih.gov/pubmed/23414663http://www.ncbi.nlm.nih.gov/pubmed/12006126http://www.ncbi.nlm.nih.gov/pubmed/23128770http://www.ncbi.nlm.nih.gov/pubmed/22623615http://www.ncbi.nlm.nih.gov/pubmed/22623615http://www.ncbi.nlm.nih.gov/pubmed/22623615http://www.ncbi.nlm.nih.gov/pubmed/22245381http://www.ncbi.nlm.nih.gov/pubmed/23056005http://www.ncbi.nlm.nih.gov/pubmed/23056005http://www.ncbi.nlm.nih.gov/pubmed/23056005http://www.ncbi.nlm.nih.gov/pubmed/22555788http://www.ncbi.nlm.nih.gov/pubmed/22555788http://www.ncbi.nlm.nih.gov/pubmed/22555788http://www.ncbi.nlm.nih.gov/pubmed/22907693http://www.ncbi.nlm.nih.gov/pubmed/22505764http://www.ncbi.nlm.nih.gov/pubmed/21285941http://www.ncbi.nlm.nih.gov/pubmed/23336994


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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

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,
http://www.medicaldaily.com/articles/11639/20120821/grill-barbecue-summer-diabetes-obesity-insulin-resistance.htmhttp://www.ncbi.nlm.nih.gov/pubmed/23401286http://www.huffingtonpost.com/glenn-d-braunstein-md/postpartum-weight-loss_b_2051100.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/23327878http://www.ncbi.nlm.nih.gov/pubmed/?term=45+year+trends+in+women%27s+use+of+time+and+household+management+energyhttp://www.ncbi.nlm.nih.gov/pubmed/23313402http://www.iatp.org/blog/201204/exporting-obesity-the-role-of-tradehttp://www.ncbi.nlm.nih.gov/pubmed/20086073http://www.webmd.com/parenting/news/20110502/family-meals-help-cut-risk-of-childhood-obesityhttp://www.ama-assn.org/amednews/2012/05/21/gvsf0525.htmhttp://www.americanscientist.org/science/pub/kids-who-lack-self-control-more-prone-to-obesity-laterhttp://www.ncbi.nlm.nih.gov/pubmed/22877767http://www.nytimes.com/2003/09/04/garden/as-suburbs-grow-so-do-waistlines.html?pagewanted=all&src=pmhttp://www.ncbi.nlm.nih.gov/pubmed/18479521http://www.ncbi.nlm.nih.gov/pubmed/23419502http://www.ncbi.nlm.nih.gov/pubmed/23283503http://www.ncbi.nlm.nih.gov/pubmed/23279746http://www.ncbi.nlm.nih.gov/pubmed/22795874http://www.ncbi.nlm.nih.gov/pubmed/22790446http://www.ncbi.nlm.nih.gov/pubmed/23262935http://www.ncbi.nlm.nih.gov/pubmed/21587200http://www.ncbi.nlm.nih.gov/pubmed/22184058http://www.ncbi.nlm.nih.gov/pubmed/20592131http://www.webmd.com/menopause/guide/menopause-weight-gain-and-exercise-tipshttp://www.ncbi.nlm.nih.gov/pubmed/23200634http://www.downeyobesityreport.com/2012/11/breastfeeding-and-obesity/http://www.ncbi.nlm.nih.gov/pubmed/23140878http://www.ncbi.nlm.nih.gov/pubmed/23295637http://www.ncbi.nlm.nih.gov/pubmed/23439902http://www.ncbi.nlm.nih.gov/pubmed/23439902http://www.ncbi.nlm.nih.gov/pubmed/23439902http://www.ncbi.nlm.nih.gov/pubmed/23377729http://www.ncbi.nlm.nih.gov/pubmed/23121746http://www.ncbi.nlm.nih.gov/pubmed/22289861http://www.ncbi.nlm.nih.gov/pubmed/21184967http://articles.washingtonpost.com/2011-08-02/lifestyle/35271238_1_sleep-deprived-subjects-michael-breus-sleep-deprived-peoplehttp://www.ncbi.nlm.nih.gov/pubmed/15883552http://www.yalemedicalgroup.org/caprio_042810http://www.yalemedicalgroup.org/caprio_042810http://www.ncbi.nlm.nih.gov/pubmed/15883552http://articles.washingtonpost.com/2011-08-02/lifestyle/35271238_1_sleep-deprived-subjects-michael-breus-sleep-deprived-peoplehttp://www.ncbi.nlm.nih.gov/pubmed/21184967http://www.ncbi.nlm.nih.gov/pubmed/22289861http://www.ncbi.nlm.nih.gov/pubmed/23121746http://www.ncbi.nlm.nih.gov/pubmed/23377729http://www.ncbi.nlm.nih.gov/pubmed/23439902http://www.ncbi.nlm.nih.gov/pubmed/23439902http://www.ncbi.nlm.nih.gov/pubmed/23295637http://www.ncbi.nlm.nih.gov/pubmed/23140878http://www.ncbi.nlm.nih.gov/pubmed/23140878http://www.ncbi.nlm.nih.gov/pubmed/23140878http://www.downeyobesityreport.com/2012/11/breastfeeding-and-obesity/http://www.ncbi.nlm.nih.gov/pubmed/23200634http://www.webmd.com/menopause/guide/menopause-weight-gain-and-exercise-tipshttp://www.ncbi.nlm.nih.gov/pubmed/20592131http://www.ncbi.nlm.nih.gov/pubmed/22184058http://www.ncbi.nlm.nih.gov/pubmed/21587200http://www.ncbi.nlm.nih.gov/pubmed/21587200http://www.ncbi.nlm.nih.gov/pubmed/21587200http://www.ncbi.nlm.nih.gov/pubmed/23262935http://www.ncbi.nlm.nih.gov/pubmed/22790446http://www.ncbi.nlm.nih.gov/pubmed/22795874http://www.ncbi.nlm.nih.gov/pubmed/23279746http://www.ncbi.nlm.nih.gov/pubmed/23283503http://www.ncbi.nlm.nih.gov/pubmed/23419502http://www.ncbi.nlm.nih.gov/pubmed/18479521http://www.ncbi.nlm.nih.gov/pubmed/18479521http://www.ncbi.nlm.nih.gov/pubmed/18479521http://www.nytimes.com/2003/09/04/garden/as-suburbs-grow-so-do-waistlines.html?pagewanted=all&src=pmhttp://www.ncbi.nlm.nih.gov/pubmed/22877767http://www.americanscientist.org/science/pub/kids-who-lack-self-control-more-prone-to-obesity-laterhttp://www.americanscientist.org/science/pub/kids-who-lack-self-control-more-prone-to-obesity-laterhttp://www.americanscientist.org/science/pub/kids-who-lack-self-control-more-prone-to-obesity-laterhttp://www.ama-assn.org/amednews/2012/05/21/gvsf0525.htmhttp://www.webmd.com/parenting/news/20110502/family-meals-help-cut-risk-of-childhood-obesityhttp://www.ncbi.nlm.nih.gov/pubmed/20086073http://www.iatp.org/blog/201204/exporting-obesity-the-role-of-tradehttp://www.ncbi.nlm.nih.gov/pubmed/23313402http://www.ncbi.nlm.nih.gov/pubmed/23313402http://www.ncbi.nlm.nih.gov/pubmed/23313402http://www.ncbi.nlm.nih.gov/pubmed/?term=45+year+trends+in+women%27s+use+of+time+and+household+management+energyhttp://www.ncbi.nlm.nih.gov/pubmed/23327878http://www.huffingtonpost.com/glenn-d-braunstein-md/postpartum-weight-loss_b_2051100.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/23401286http://www.ncbi.nlm.nih.gov/pubmed/23401286http://www.medicaldaily.com/articles/11639/20120821/grill-barbecue-summer-diabetes-obesity-insulin-resistance.htm


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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.
http://www.nejm.org/doi/full/10.1056/NEJM199511023331801http://www.ncbi.nlm.nih.gov/pubmed/19434031http://www.ncbi.nlm.nih.gov/pubmed/19156597http://www.ncbi.nlm.nih.gov/pubmed/23321486http://thelede.blogs.nytimes.com/2007/08/27/trans-fats-and-americas-obesity-problem/http://www.ncbi.nlm.nih.gov/pubmed/21610130http://www.ncbi.nlm.nih.gov/pubmed/19420181http://www.ncbi.nlm.nih.gov/pubmed/22958789http://www.ncbi.nlm.nih.gov/pubmed/23399772http://www.cspinet.org/new/200405111.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/22771001http://www.ncbi.nlm.nih.gov/pubmed/22166172http://www.ncbi.nlm.nih.gov/pubmed/22166172http://www.ncbi.nlm.nih.gov/pubmed/22771001http://www.cspinet.org/new/200405111.htmlhttp://www.ncbi.nlm.nih.gov/pubmed/23399772http://www.ncbi.nlm.nih.gov/pubmed/22958789http://www.ncbi.nlm.nih.gov/pubmed/19420181http://www.ncbi.nlm.nih.gov/pubmed/21610130http://thelede.blogs.nytimes.com/2007/08/27/trans-fats-and-americas-obesity-problem/http://www.ncbi.nlm.nih.gov/pubmed/23321486http://www.ncbi.nlm.nih.gov/pubmed/23321486http://www.ncbi.nlm.nih.gov/pubmed/23321486http://www.ncbi.nlm.nih.gov/pubmed/19156597http://www.ncbi.nlm.nih.gov/pubmed/19434031http://www.nejm.org/doi/full/10.1056/NEJM199511023331801


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Which of these factors have been

changed to impact obesity?


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How do we begin to study the

problem?


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The Energy Balance System

Energy

Intake

Energy

Expenditure

Energy

Stores

Active

Regulation/Integration

Inherited

Factors EnvironmentalFactorsEfficiency

Adaptive thermogenesis

Food preferences

Food environment

Physical activity

environment


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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

decreased?

Wh t h t b d i ht h h 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 physic

activity is increased?


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EIn EOut

Body

Weight

Active Regulation

The obesity

epidemic

arose from

gradualweight gain

over time


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130

135

140

145

150

155

160

1000

1100

1200

1300

1400

1500

1600

1700

1800

1900

2000

1971-74 1976-80 1988-94 1994-2000

Energy Intake (kcal/day) Body Wt (lbs)


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TS Church, PLoS One 2011;6(5):e19657.

Why are we gaining weight? Occupations and Obesity

W lki Old O d A i h C


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18000

14000

5940 5276

Steps per Day

US Men US Women

Walking: Old Order Amish vs. Current

Population

Amish Men Amish Women

~603

kcal/day

~436

Kcal/day


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Energy

Intake

Energy Expenditure


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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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Metabolic Changes with Decreased Physical Activity

Muscles

Insulin Sensitivity

Nutrient Metabolism

Fat Cells

Appetite

Brain function


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Hypothetical Model for the Cause of the

Obesity Epidemic of the Late 20th Century

Total Energy expenditur

EnergyExpenditure in

Physical Activity

Body Weight

Energy Inta

198019501920 2013


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Role of the Environment?


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Addressing the Environment


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How do we reduce obsity?


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The Energy Balance System

Energy

Intake

Energy

Expenditure

Energy

Stores

Active

Regulation/Integration

H h b h i h i d d f


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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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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.


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Characteristics of Successful Losers

National Weight Control Registry

1.Eating a Reduced Calorie-Reduced FatDiet

2.Engaging in a high level of physical activity

3.Limiting TV Viewing4.High level of dietary restraint

5.Frequent self-weighing

6.Maintaining dietary consistency

7.Eating breakfast

E G f P ti f W i ht G i


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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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The birth of small changes


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Biology Behavior

Environment

Addressing Obesity

Bi l B h i & E i t


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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 Activity

Little need for physical activity in daily livingAttractiveness of sedentary Entertainment

Car for Transportation

Economics

Consume More

More for less

Greater Productivity

Decreased

Energy

Expenditure

Increased

Energy

Intake

Obesity

Social Systems

Reason to push back

Different Value Equation

Social Environment of Wellness

Healthy

Environment

Make betterchoices

Biology, Behavior & Environment


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20 years

NOW

Whats Missing: the Why


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Role for the private sector?


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Ideas

basic and

clinical research

Programs evaluated in

controlled settings

Development of

Science-based programs

Implement ProgramsIn the population

How Academia Works

Goal: Use science to improve peoples lives


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Ideas

basic and

clinical research


controlled settings

Development of



Industry Involvement in Implementation

a etes revent on rogram


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a etes revent on rogram(DPP) 2002
http://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=An%20external%20file%20that%20holds%20a%20picture,%20illustration,%20etc.Object%20name%20is%20nihms-5217-0001.jpg%20[Object%20name%20is%20nihms-5217-0001.jpg]&p=PMC3&id=1370926_nihms-5217-0001.jpg


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Ideas

basic and

clinical research


controlled settings

Development of



Diabetes Prevention Program (DPP)

Lifestyles factors and glycemic control

May be possible to prevent diabetes in those at risk

Small scale testingof impact of lifestyle

DPP

??


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Ideas

basic and

clinical research


controlled settings

Development of



Menu Labeling

Knowing calorie content could reduce intake

Very little clinical research

No real testing

Very little evaluation in

controlled settings

Policy toforce implementation

Colorado Center for Health & Wellness


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Colorado Center for Health & Wellness

Center

Health &

Wellness

Clinical

Education

Research


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Addressing a Complex Issue

Private Sector PartnershiCommunity

Engagement

Create new thinking space

for creating solutions

Develop and TestPotential Solutions

Implement

Science-Based,Scalable Programs

and Initiatives


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obesity: the current landscape

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