john peters, ph.d.: why are we (still) fat?

8/12/2019 John Peters, Ph.D.: Why are We (Still) Fat?

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Why are we (still) fat?John C. Peters, Ph.D.

Chief Strategy Officer Anschutz Health and Wellness Center

Professor of Medicine


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82 Putative Causes(From the Downey Obesity Report, February 28th, 2013)

1. agricultural policies2. air conditioning3. air pollution4. antibiotic usage at early age5. arcea nut chewing6. assortative mating7. being a single mother8. birth by C-section9. built environment10. chemical toxins

11. child maltreatment12. competitive food sales in schools13. consumption of pastries and chocolate (inBurkina Faso)14. decline in occupational physical activity15. delayed prenatal care16. delayed satiety17. depression18. driving children to school19. eating away from home

20. economic development21. endocrine disruptors22. entering into a romantic relationship23. epigenetic factors24. family conflict25. first-born in family26. food addiction27. food deserts28. food insecurity

29. food marketing to children30. food overproduction31. friends32. genetics33. gestational diabetes34. global food system35. grilled foods36. gut microbioata37. having children, for women38. heavy alcohol consumption

39. home labor saving devices40. hunger-response to food cues41. international trade policies (globalization)42. high fructose corn syrup43. lack of family meals44. lack of nutritional education45. lack of self-control46. large portion sizes47. living in the suburbs48. living in crime-prone areas

49. low levels of physical activity50. low socioeconomic status51. market economy52. marrying in later life53. maternal employment54. maternal obesity55. maternal over-nutrition during pregnancy56. maternal smoking57. meat consumption

58. menopause59. mental disabilities60. no or short term breastfeeding61. non-parental childcare62. overeating63. participation in Supplemental NutritionAssistance Program (formerly Food StampProgram)64. perception of neighborhood safety65. physical disabilities

66. prenatal maternal exposure to naturaldisasters67. poor emotional coping68. sleep deficits69. skipping breakfast70. snacking71. smoking cessation72. stair design73. stress74. sugar-sweetened beverages

75. trans fats76. transportation policies77. television set in bedrooms78. television viewing79. thyroid dysfunction80. vending machines81. virus82. weight gain inducing drugs


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Multi-factoral causesPortion sizeHigh energy densityHigh glycemic indexSoft drinks/

junkfoodIn schoolsAdded sugarEasy food accessLow costVarietyConvenienceGreat tasteAds/marketing

SedentaryworkplacesSedentary schoolsActivity unfriendly

community design

AutomobilesDrive-throughconveniencesElevators/escalatorsRemote controls

SedentaryentertainmentLabor saving devicesTelevision/computer

WEIGHT

GAIN

Energy intake

Energy expenditure


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Obesity: Evolutionary Biology, theEnvironment, Society and You


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The Evolutionary Biology: Why

we are the way we are? Humans are hard wired to like sugar, fat and salt

Humans evolved under conditions in whichphysical activity pulls appetite

Humans are energy misers

The biology is not brokenit is doing exactlywhat it was designed to do


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Put this biology into the currentenvironment:

Energy dense, high calorie food is everywhereand, it is

inexpensive

We no longer need to be physically active to survive

Cultural values and practices developed in a differentsurvival contextthey now contribute to the problem


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Godzilla Meets Bambi

Sugar

Fat

Salt

RestEnjoy

Market more fresh produce

Sidewalks, brighter stairwells

Restrictions on bad food

Reduced health premiums

T-shirts, water bottles

AND?

BIOLOGY

U n

h e a l t h y P r e

f e r e n c e s


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Humans are biased toward action, notthought (thought is expensive)
http://customerinnovations.files.wordpress.com/2008/09/brain-a-b-c1.png


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The Biology of Choicewe choosefor the moment

NOW

20 Years


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The marketplace plays to the biology


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The Evolutionary Biology: Whywe are the way we are?

Humans are hard wired to like sugar, fat and salt

Humans evolved under conditions in whichphysical activity pulls appetite

Humans are energy misers

The biology is not brokenit is doing exactlywhat it was designed to do

We built the environment toserve the biology


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Eat too much

Our biology applies constantpressure to:


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____________________________________ ______


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And, move too little

Leisure time physical activity has not declined

Physical activity at work has declined

Physical activity at home has declined


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Body Weight

EnergyIntake

Our biology works best at high level ofphysical activity (energy flux)

Physical ActivityThreshold forOptimal WeightRegulation

Unregulated

Zone Regulated

Zone

Adapted from Mayer et. al., 1956

Increase in physical activity

Adapted from Mayer et al, AJCN, 1956


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USA Amishtoday

-603 kcalday

-436 kcalday

Amish Men Amish Women US Men US Women

From Bassett et.al., Med. And Sci. in Sports and Exer., 2004

9%0% 32% 35%Obesity rate


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The Evolving Work Force

0.0

10.0

20.0

30.0

40.050.0

60.0

70.0

80.0

90.0

1960 1970 1980 1990 2000 2010

Year

%

Service Jobs

Goods ProducingJobs

AgriculturalJobs

Church TS et al. PLoS 2011


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1,150

1,250

1,350

1,450

1,550

1960 1970 1980 1990 2000 2010

Year

O c c u p a t i o n

R e

l a t e d D a

i l y

E n e r g y

E x p e n

d i t u r e

( c a

l o r i e s

)

Men

Women

Daily Occupational Caloric Expenditure

Church TS, et al. (2011) PLoS One 6: e19657.


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Trends in Housework EnergyExpenditure (1965-2005)

Archer et al. 45-year Trends in Household Management. In Press. PLOS One

4653

35533324

2769 2877 2806

1013

14521923 1977 2086 2034

0

1000

2000

3000

4000

5000

1965 1975 1985 1995 2005 2010

K c a

l s / w e

e k

Women

Men

PLOS ONE | www.plosone.org 7 February 2013 | Volume 8 | Issue 2 | e56620


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Source: Ng S.W. & Popkin B.M. Obesity Reviews ( 2012). Modernization, Time Use

and Physical Activity: A shift away from movement across the globe.

0

5

10

15

20

25

30

35

40

45

0

50

100

150

200

250

1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030

A v e r a g e

h o u r s p e r w e e k

b e i n g S e

d e n t a r y

A v e r a g e M E T - h

o u r s p e r w e e

k

Year

Active Leisure PA

Travel PA

Domestic PA

Occupational PA

Sedentary Time (hrs/wk)

1965: 235

MET-hr/wk

2009: 160MET-hr/wk

by 2020: 142MET-hr/wk

by 2030: 126MET-hr/wk

US Adults Met-hours Per Week of All Physical Activity, and Hours/Week of Time inSedentary Behavior: Measured for 1965-2009 and Forecasted for 2010-2030

Obes Rev. 2012 August ; 13(8): 659 680.


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Source: Ng S.W. & Popkin B.M. Obesity Reviews (2012 ). Modernization, Time

Use and Physical Activity: A shift away from movement across the globe .

0

10

20

30

40

50

60

0

50

100

150

200

250

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030

A v e r a g e


b e i n g S e

d e n t a r y


o u r s p e r w e e

k

Year

Active Leisure PA

Travel PA

Domestic PA

Occupational PASedentary Time (hrs/wk)

by 2030: 140MET-hr/week2005: 173

MET-hr/week

by 2020: 153MET-hr/week

1961: 216

MET-hr/week

UK Adults Met-hours per Week of Physical Activity and Hours/Week of Time inSedentary Behavior: Measured for 1961-2005 and Forecasted for 2006-2030

Obes Rev. 2012 August ; 13(8): 659 680.


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0

5

10

15

20

25

30

100

150

200

250

300

350

400

450

1991 1994 1997 2000 2003 2006 2009 2012 2015 2018 2021 2024 2027 2030

A v e r a g e

h o u r s p e r w e e

k b r i n g s e

d e n t a r y

A v e r a g e M E T - h o

u r s p e r w e e

k

Year

Active Leisure PA

Travel PA

Domestic PA

Occupational PA

Sedentary Time (hrs/week)


2009: 213 MET-hr/week


1991: 399MET-hr/week

Source: Ng S.W. & Popkin B.M. Obesity Reviews (2012 ). Modernization, Time


Chinese Adults Met-hours per Week of Physical Activity & Hours/Week of Time inSedentary Behavior: Measured for 1991-2009 and Forecasted for 2010-2030

Obes Rev. 2012 August ; 13(8): 659 680.


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Source: Ng S.W. & Popkin B.M. Obesity Reviews (2012 ). Modernization , Time


0

5

10

15

20

25

30

35

100

150

200

250

2002 2006 2010 2014 2018 2022 2026 2030

A v e r a g e


b e i n g S e

d e n t a r y


o u r s p e r w e e

k

Year

Active leisure

Travel

Domestic

Occupational

Sedentary time


2008: 214MET-hr/week

by 2020: 180

MET-hr/week

Brazilian Adults Met-hours per Week Of Physical Activity & Hours/Week Of TimeIn Sedentary Behavior: Measured For 2002-2008 And Forecasted For 2009-2030

Obes Rev. 2012 August ; 13(8): 659 680.


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18

19

20

21

100

150

200

250

2000 2005 2010 2015 2020 2025 2030

A v e r a g e


b e i n g S e

d e n t a r y


o u r s p e r w e e

k

Year

Active Leisure PA

Travel PA

Domestic PA

Occupational PASedentary Time (hrs/week)


2005: 239

MET-hr/week by 2020: 225MET-hr/week

Indian Adults Met-hours per Week of Physical Activity & Hours/Week of Time inSedentary Behavior: Measured for 2000-2005 and Forecasted for 2006-2030

Source: Ng S.W. & Popkin B.M. Obesity Reviews (2012 ). Modernization , Time

Use and Physical Activity: A shift away from movement across the globe . Obes Rev. 2012 August ; 13(8): 659 680.


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We sit too muchand, its lethal Over a lifetime, the unhealthful effects of sitting add up.

Alpa Patel, an epidemiologist at the American CancerSociety, tracked the health of 123,000 Americansbetween 1992 and 2006. The m en in the study whospent six hours or more per day of their leisure timesitting had an overall death rate that w as abo ut 20percent h igher than the men who sat for three hours orless. The death rate for w o m e n who sat for more than

six hours a day was about 40 percent h igher . Patelestimates that on average, people who sit too muchshave a few years off of their lives.

New York Times, April 14, 2011


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Source: Lee, et.al., Lancet, 380: 2012

Inactivity and life expectancy


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So What?What does all of this suggest about

ways we might approach the problemdifferently?

Secondary leverage pointsl

The Environment and YOU


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Framework for determinants of physical activity andeating behavior

entertainmentindustry

health careindustry

transportationsystem

knowledge

cost

time

convenience

safety

accessibility

situation or context

physical and social

social trends

seasonality

homefood stores

health care providers

workplace

restaurants

religious, communityand non-governmentorganizations

vehicle of transport

neighborhood

health club

parks, recreation centers, senior centers

community activity providers

shopping malls

familyfood stores

local government

developers property owners

employer

school board,districts

non-government

organizations

nonprofit providers

community

shopping

mall

restaurants andfood outlets

recreationfacilit ies

architecture & building codes

government

food industryexercise,

physical activity& sports industry

recreationindustry

labor-savingdeviceindustry

informationindustry

education system

political advocacy/lobbying

Primary leverage pointsBehavioral settingsLifestyleEnablers o f choice

values

beliefs

life experience

social roles

educational

attainment

socioeconomicstatus

interpersonalrelationships

life stagehabits

self identities ethnicidentities

SocialCultural

source of information

local school

day care

physiology

pleasure

gene ticshier archyof ne eds

Psycho-biological Core

April 20, 2000Nutrition Reviews, 59, 2001

Behavior Settings


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We need to think about theproblem in a new way

Yes, we will need new policies andenvironmental interventionsbut, we still needpeople to comply

What is the motivational structure that works inthe modern world?

How do healthier behaviors become part of dailylife even if they take cognitive and physicaleffort?


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We need to work WITH thebiology

Our biology is first and foremostconcerned with survival

- What are key elements of survival in the

21 st century?


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Survival in the 21st

century: Food, shelter, safety

Where do the means come from to

acquire these?

What is needed to support these

systems?Economic growthprosperity


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What is the real problem?

Physical activity isnot necessary.

We are too rich.

Food is cheap

Physical activity isnot necessary

We havedisposable income

There is no compellingreason to change

WHY?We dont have a good enough reason to not be fat

Is focusing on health care costs the right


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Is focusing on health care costs the rightway to promote wellness?

(workplace example)

Most incentives for health care come via the health caresysteme.g., premiums, on -line exercises, emanatefrom HR and benefitsnot day to day business conduct.How present are these in your life daily?

Your Life(sleep, work, family, domestic,

travel, shopping, leisure, eating,exercise, etc.)

Health care slice ofdaily life?


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Drive motivation for behavior change by linkingdesired behaviors to meeting basic needs

Physiological

Safety and Security

Belongingness and Love

Esteem

Self-actualization

Transcendence

Need to movethe focus


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Social motivation hierarchy

TranscendenceWell Society

National defense, affordable housing,safe neighborhoods

Collective purpose,American Values,

National Pride

Economic health, jobs, globalcompetitiveness, education


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Strategies for change

Try to

structure

each behavior environment?- e.g., policies, regulations, choice architecture

Continue to focus on individual motivation?- change must come from within

Leverage a collective motivation across society that isconsistent with today

s priorities and values?

- what if healthful behavior was employmentexpectation?

- plant the seeds to create demand for a healthierenvironment?


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We need to think about theproblem in a new way

We need a better reason for people to behealthy that matters to them as individuals andto the nation as a wholewhats in it for ME andwhats in it for US ?

Work with the biologyrewards immediate andpart of daily life

Align individual and collective purpose

Align behavioral purpose and motivationalcontextwork, school

Not opt ineveryone is part of itnewbehavioral expectations become part of thewoodwork


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NEW THINKING SPACE

Demandfor healthychoices(why?)

Opportunitiesfor healthy

choices

Leavepeople

alone andlet themchoose

Regulate,mandate,

tax,control

NEW DOING SPACE


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Its about

creatingdemand


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Catalyzing demand: Where do we start?

Schools & Home

Commerce, the Environment

Workplaces


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We need it all

Individual inspiration, for those who areready to change themselves

Environmental structuring, wherepossible (e.g., schools, workplaces)

Nudge choice architecture, wherepossible

Continued product and serviceinnovation to make healthy behaviorsmore desirable, accessible, affordableand convenient (supply)

A more important WHY for the averagecitizen as a way to build demand


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The Take Away

Why we are the way we aresurvival

We have built the environment to serve the biology

Obesity is a normal response to the environment

To overcome the biology we will have to rely oncognition individual and social

We must find a better why for people and society tochange

The why must be important for survival in themodern world


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We have changed our environmentmore quickly than we know how to

change ourselves

Walter Lippmann (1915)


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Thank You

john peters, ph.d.: why are we (still) fat?

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