definition of obesity: a condition characterized by excess body fat (webster’s dictionary) obesity...
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Definition of obesity:
A condition characterized by excess body fat (Webster’s Dictionary)
Obesity is a chronic disease; patient and practitioner must understand that successful treatment requires a lifelong effort. (NIH The Practical Guide: Identification, Evaluation, and Treatment of Overweigt and Obesity in Adults)
CHICAGO SUN TIMESWednesday December 3, 2003
CHICAGO SCHOOLKIDS TWICE AS LIKELY TO BE OBESEAn ‘astonishing’ 23% of public school pupils under 7 are overweight vs. 10% nationally
Overweight teen 15 – 17 years old is 20 times more likely to be obese at 24 years old than lean teen.
Obesity Trends* Among U.S. AdultsBRFSS, 1987
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Obesity Trends* Among U.S. AdultsBRFSS, 1991
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1993
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1995
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Obesity Trends* Among U.S. AdultsBRFSS, 1998
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Obesity Trends* Among U.S. AdultsBRFSS, 2001
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. AdultsBRFSS, 2004
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Obesity Trends* Among U.S. AdultsBRFSS, 2006
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. AdultsBRFSS, 2010
MexAm Black White0
5
10
15
20
25
MexAm Black White0
5
10
15
20
25
Per
cen
t
Per
cen
t
Prevalence of Overweight Among Children in the United States, National Health & Nutrition Examination Surveys, 1971 - 2002
1971 – 74 1976 – 80 1988 – 94 1999 – 04
Freedman et al. Obesity 14:301,2006 Ogden et al. JAMA 295:1549, 2006
Girls Boys
20
22
24
26
28
30
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
Mea
n B
od
y M
ass
Ind
ex
Mean BMI (self-reported, age-adj) by Ethnicity & Sex
BRFSS - US
BMHMWMBFHFWFTOTAL
Physical Consequences of Childhood & Adolescent Overweight & Obesity
• Sleep apnea
• Pickwickian syndrome
• Slipped capital epiphyses
• Tibial torsion
• Flat feet
• Increased risk of sprains and fractures
• Idiopathic intracranial hypertension
• Cholelithiasis
• Gastro-esophageal reflux
• Menstrual abnormalities
• Polycystic ovary syndrome
• Hypercorticism
• Left ventricular hypertrophy
Breathing Problems
Bone/Skeletal Problems
Vascular Problems
Digestive Problems
Hormonal Problems
Heart Problems
Toba c c o
Die t/Ina c tiv ity
Alc ohol
M ic robia l Age nt
Tox ic Age nts
M otor Ve hic le s
Fire a rm s
Se x ua l Be ha v ior
Il lic it Drugs
0 5 1 0 1 5 2 0
P er centage (of all deaths)
2000
Toba c c o
Die t/Ina c tiv ity
Alc ohol
M ic robia l Age nt
Tox ic Age nts
M otor Ve hic le s
Fire a rm s
Se x ua l Be ha v ior
Il lic it Drugs
0 5 1 0 1 5 2 0
P er centage (of all deaths)
1990
Actual Causes of Death in the US, 1990 & 2000
www.cdc.gov, 2004JAMA 2004;291:1238-45, erratum 2005;293:293-4.
Type 2 DiabetesObes ity CHD Hypertens ion Stroke0
10
20
30
40
50
60
Direct Cost ($
Billions)
Direct Cost of Chronic Diseases in the United States
53.251.6
38.7
18.4 18.1
* Adjusted to 1995 dollarsWolf & Colditz Obesity Res 1998;6:97-106 Hodgson & Cohen Med Care 1999;37:994-1012
Energy Intake
Energy
Expenditure
Body Fat Stores
Obesity is Caused by Long-Term Positive Energy Balance
+ 12 calories per day = 1 pound excess weight per year
+ 25 calories per day = 2 pounds excess weight per year
+ 125 calories per day = 10 pounds excess weight per year
Restaurant Portion Sizes – 1985 & Today
Bagel 3” diam. 140 kcal 6” diam. 350 kcal
Turkey Sandwich 320 kcal 820 kcal
Coffee (whole milk & sugar) 8 oz. 45 kcal (whole milk & flavored syrup) 16 oz. 350 kcal
Blueberry Muffin 1.5 oz. 210 kcal 4 oz. 500 kcal
Spaghetti & Meatballs 1 c. 500 kcal 2 c. 1025 kcal
Soda 8 oz. 100 kcal 20 oz. 250 kcal
Calories Burned in 30 minutes – 165 pound person
TV/computer/sitting in class 65
Sleeping 40
Walking 95
Basketball – playing in game 300
Basketball – shooting baskets 165
Swimming laps 300
Running, jogging 250
One pound of body fat contains 3500 calories – if you eat 500 calories more each day than you burn off you will gain one pound in a week.
Energy In must equal Energy Out to stay the same weight.
Westside Chicago Elementary School
6th Grade 8th Grade
Servings of chips 4 3
% of calories 25% 20%
Servings of soda 3 2.5
% of calories 16% 15%
Servings of milk 1 1
Servings of fruit/veg 1.5 1
What about candy? Calories
King Size Reese’s Peanut Butter Cup 420
King Size Baby Ruth 480
Twizzlers - large bag 490
Now ‘N Later (regular pack) 280
Laffy Taffy (10 pcs) 380
What about candy? Calories Hours Walking
King Size Reese’s Peanut Butter Cup 420 2hr 10min
King Size Baby Ruth 480 2hr 30min
Twizzlers - large bag 490 2hr 35min
Now ‘N Later (regular pack) 280 1hr 30min
Laffy Taffy (10 pcs) 380 2hr
Doesn’t matter where the calories come from – fat or sugar – any extra over what you burn will turn to body fat
The New York TimesMonday, May 25, 2005
USDA, Economic Research Service 2009
Sugar
USDA, Economic Research Service 2009
Vegetable
Fruit
USDA, Economic Research Service 2009
Whole
Lower Fat/Skim
Total
Regular
Diet
1977-78 1989-91 1994-96
Energy Intake (kcal)
Soft drinks 144 157 193
Fruit drinks 139 152 189
French fries 188 247 256
Hamburgers 389 392 486
Portion Size (oz)
Soft drinks 13.1 16.8 19.9
Fruit drinks 11.3 12.6 15.1
French fries 3.1 3.5 3.6
Hamburgers 5.7 5.9 7.0
Trends in Portion Sizes & Energy Intake for Americans, 2 years and older
NFS & NHANES
Nielsen, S. J. et al. JAMA 2003;289:450-453.
Relationship between Body Fatness &Restaurant Food Consumption in Adults
Convenience sample, Boston, n=73
McCrory et al. Obes Res 1999;7:564-71.
Our Toxic Environment
• >5000 fast food franchises in schools
• 70% more meals eaten away from home
• Growing number of high calorie beverages
• Soft drink contracts with schools (?)
• Increased use of corn sweeteners• 10,000 junk food ads each year
• Junk food advertising - $45/person
• Healthy food advertising - $1.50/person
• Increased TV & video games,
• Reduced emphasis on physical activity
Healthy Tips
• Avoid fad diets and quick weight loss schemes
• Drink plenty of water or other low calorie beverages
• Never skip meals
• Get up and go! 30 minutes of activity per day