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