The Obesity Epidemic: Trends, Causes, Effects and Ways to Reduce the Incidence

The Obesity Epidemic: Trends, Causes, Effects and Ways to

Reduce the Incidence

Karen Mason, Ph.D., R.D.Karen Mason, Ph.D., R.D.

Western Kentucky UniversityWestern Kentucky University

Obesity Statistics

The number of overweight and obese The number of overweight and obese Americans has continued to increase Americans has continued to increase since 1960 since 1960

65.1% of adult Americans are categorized 65.1% of adult Americans are categorized as being overweight or obeseas being overweight or obese (NHANES)(NHANES)

Each year, obesity causes at least Each year, obesity causes at least 300,000 deaths in the U.S.300,000 deaths in the U.S.

Obesity Trends

U.S. AdultsU.S. Adults

U.S. Children/AdolescentsU.S. Children/Adolescents

WorldwideWorldwide

Obesity Definitions

Obesity: having a very high amount of Obesity: having a very high amount of body fat in relation to lean body mass, or body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or higher.Body Mass Index (BMI) of 30 or higher.Overweight: having a BMI of 25-29.9Overweight: having a BMI of 25-29.9Body Mass Index (BMI): Body Mass Index (BMI): – a measure of an adult’s weight in relation to a measure of an adult’s weight in relation to

his or her heighthis or her height– the adult’s weight in kilograms divided by the the adult’s weight in kilograms divided by the

square of his or her height in meterssquare of his or her height in meters

Obesity Trends Among U.S. Adults between 1985 and 2003

Source of the data:Source of the data:CDC’s Behavioral Risk Factor Surveillance CDC’s Behavioral Risk Factor Surveillance System (BRFSS)System (BRFSS)Collected by state health departments Collected by state health departments each yeareach yearData collected from a series of monthly Data collected from a series of monthly telephone interviews with U.S. adultstelephone interviews with U.S. adults

Source: Behavioral Risk Factor Surveillance System, CDC.

19961991

2003

Obesity Trends* Among U.S. AdultsBRFSS, 1991, 1996, 2003

(*BMI 30, or about 30 lbs overweight for 5’4” person)

No Data <10% 10% – 14% 15% – 19% 20% – 24% ≥25%


Obesity Trends* Among U.S. AdultsBRFSS, 1985

No Data <10% 10% – 14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)



No Data <10% 10% – 14%




No Data <10% 10% – 14%




No Data <10% 10% – 14%




No Data <10% 10% – 14%




No Data <10% 10% – 14%




No Data <10% 10% – 14% 15% – 19%




No Data <10% 10% – 14% 15% – 19%




No Data <10% 10% – 14% 15% – 19%




No Data <10% 10% – 14% 15% – 19%




No Data <10% 10% – 14% 15% – 19%




No Data <10% 10% – 14% 15% – 19%




No Data <10% 10% – 14% 15% – 19% ≥20




No Data <10% 10% – 14% 15% – 19% ≥20




No Data <10% 10% – 14% 15% – 19% ≥20




No Data <10% 10% – 14% 15% – 19% ≥20




No Data <10% 10% – 14% 15% – 19% 20% – 24% ≥25%



(*BMI 30, or ~ 30 lbs overweight for 5’4” p erson)

No Data <10% 10% – 14% 15% – 19% 20% – 24% ≥25%




Obesity* Trends Among U.S. AdultsBRFSS, 2003


No Data <10% 10% – 14% 15% – 19% 20% – 24% ≥25%

Overweight in Children and Adolescents

Based on BMI-for-Age PercentilesBased on BMI-for-Age Percentiles

BMI-for-Age for Girls

Overweight in Children and Adolescents

Based on BMI-for-Age PercentilesBased on BMI-for-Age Percentiles

8585thth percentile percentile – Overweight (Note: CDC considers “at risk for Overweight (Note: CDC considers “at risk for

overweight”)overweight”)– Equivalent to the adult BMI of 25 Equivalent to the adult BMI of 25

9595thth percentile percentile – Obese (Note: CDC considers overweight)Obese (Note: CDC considers overweight)– Equivalent to the adult BMI of 30Equivalent to the adult BMI of 30

Trends of overweight children

From 1980 to 2002From 1980 to 2002

Overweight children rose from 7% to 15.8%Overweight children rose from 7% to 15.8%

Overweight teenagers tripled from 5% to 16.1%Overweight teenagers tripled from 5% to 16.1%

Based on the National Health and Nutrition Examination Survey published in JAMA 291:2847-50, 2004

Comparison of Kentucky’s High School Students to the U.S.

12.5%

13.0%

13.5%

14.0%

14.5%

15.0%

15.5%

KY US

At risk ofoverweight

Overweight

Source: Youth Behavioral Risk Surveillance, 2003

Worldwide obesity trends

Obesity is a global problemObesity is a global problem

Rapid increase in lower- and middle- Rapid increase in lower- and middle- income developing countriesincome developing countries

Increase with the poorIncrease with the poor

Source: Popkin and Gordon-Larsen, 2004Source: Popkin and Gordon-Larsen, 2004

Worldwide obesity statistics

More than 1 billion adults are overweight More than 1 billion adults are overweight and at least 300 million of them are and at least 300 million of them are clinically obese clinically obese

Source: World Health Organization, 2005

Obesity Etiology

GeneticsGenetics

Calorie ConsumptionCalorie Consumption

Physical inactivityPhysical inactivity

Obesity Etiology

Energy Energy Imbalance:Imbalance:Calories Calories

consumed are consumed are greater than greater than calories usedcalories used

Identical twin studies support that genes Identical twin studies support that genes influence body weight and body fat.influence body weight and body fat.

However, the obesity epidemic cannot be However, the obesity epidemic cannot be explained by changes in the human explained by changes in the human genome.genome.

Weight gain results from an interaction Weight gain results from an interaction between genetics and environment between genetics and environment (“obesity-promoting environment”).(“obesity-promoting environment”).

Obesity and Genetics

Source: Loos and Rankinen, 2005

Obesity and Calorie Consumption

Americans spent 46% of their food budget Americans spent 46% of their food budget away from home in 2002 and 27% in away from home in 2002 and 27% in 1962. (Variyam 2005)1962. (Variyam 2005)

Table-service restaurants now serve from Table-service restaurants now serve from 12-inch plates rather than the standard 12-inch plates rather than the standard 10½-in plates10½-in plates


Individuals consume more calories when Individuals consume more calories when served larger portions.served larger portions.

Americans consume more than 53 Americans consume more than 53 teaspoons of added sugars each day teaspoons of added sugars each day (Gardner 2001).(Gardner 2001).


From 1971-2000, the average daily caloric From 1971-2000, the average daily caloric intake rose:intake rose:– for men, 2,450 kcals to 2,618 kcals for men, 2,450 kcals to 2,618 kcals – for women, 1,542 kcals to 1,877 kcals for women, 1,542 kcals to 1,877 kcals

(http://www.cdc.gov/nchs/) (http://www.cdc.gov/nchs/)

62% of Americans are unaware the portion 62% of Americans are unaware the portion sizes have increased in the last 10-15 sizes have increased in the last 10-15 years.years.

Larger Portion Sizes (comparison of portion sizes 15 years ago)

FoodFood ThenThen NowNow

French friesFrench fries 2 oz2 oz >4 oz>4 oz

Deli bagelDeli bagel 2 oz2 oz 4-7 oz4-7 oz

MuffinMuffin 2 oz2 oz 6-8 oz6-8 oz

SodaSoda 6 ½ oz6 ½ oz 12-20 oz12-20 oz

ChipsChips ½ - 1 oz½ - 1 oz 2-4 oz2-4 oz

Candy barCandy bar 1 ½ oz1 ½ oz 2-4 oz2-4 oz

CHEESEBURGER

15-20 Years Ago Today

333 calories How many calories are in today’s cheeseburger?

Calorie Difference: 257 calories

590 calories

CHEESEBURGER

15-20 Years Ago Today

333 calories

FRENCH FRIES 15-20 Years Ago Today

210 Calories

2.4 ounces How many calories are intoday’s portion of fries?

610 Calories6.9 ounces

Calorie Difference: 400 Calories

FRENCH FRIES 15-20 Years Ago Today

210 Calories

2.4 ounces

85 Calories 6.5 ounces

How many calories are in today’s portion?

SODA15-20 Years Ago Today

Calorie Difference: 165 Calories

250 Calories 20 ounces

85 Calories 6.5 ounces

SODA15-20 Years Ago Today

Would you like a combo meal?

““value meals” and “combo meals” are used value meals” and “combo meals” are used for profit by the food companies.for profit by the food companies.

When people are served more food, they eat When people are served more food, they eat more food.more food.

For a small price, you get more calories and For a small price, you get more calories and saturated fat.saturated fat.

Now that’s a value!

McDonald’s Quarter McDonald’s Quarter 530 calories530 calories

Pounder w/CheesePounder w/Cheese 13 g saturated fat13 g saturated fat

Quarter Pounder w/CheeseQuarter Pounder w/Cheese 1190 calories1190 calories

Extra Value MealExtra Value Meal 17 g saturated fat17 g saturated fat

Wendy’s Classic Double Wendy’s Classic Double 760 calories760 calories

w/Cheesew/Cheese 19 g saturated fat19 g saturated fat

Classic Double w/CheeseClassic Double w/Cheese 1360 calories1360 calories

Combo MealCombo Meal 26 g saturated fat26 g saturated fat

$1.41

$1.57

A better choice at McDonald’s

McGrilled Chicken sandwichMcGrilled Chicken sandwich

400 calories, 17 g fat, 3 g saturated fat400 calories, 17 g fat, 3 g saturated fat

Side saladSide salad

100 calories, 6 g fat, 3 g saturated fat100 calories, 6 g fat, 3 g saturated fat

Low fat Italian salad dressingLow fat Italian salad dressing

50 calories50 calories

WaterWater

Obesity and Physical Inactivity

Statistics of physical inactivity

More than 50% of U.S. adults do not get More than 50% of U.S. adults do not get enough physical activity enough physical activity

More than a third of young people in More than a third of young people in grades 9–12 do not regularly engage in grades 9–12 do not regularly engage in vigorous physical activity. Daily vigorous physical activity. Daily participation in high school physical participation in high school physical education classes dropped from 42% in education classes dropped from 42% in 1991 to 28% in 2003.1991 to 28% in 2003.

Source: CDC, 2005

How long will you have to walk leisurely in order to burn those extra 400 calories?*

*Based on 160-pound person

Maintaining a Healthy Weight is a Balancing ActCalories In = Calories Out


If you walk leisurely for 1 hour and 10 minutes you will burn approximately 400 calories.*

Calories In = Calories Out

How long will you have to work in the garden to burn those extra calories?*


Maintaining a Healthy Weight is a Balancing ActCalories In = Calories Out

If you work in the garden for 35 minutes, you will burn approximately 165 calories.*


Calories In = Calories Out

Children and TV watching

Children and Children and adolescents who adolescents who

watched the most TV watched the most TV were more obese were more obese than peers who than peers who

watched less TV.watched less TV.

Benefits of physical activity

Reduced risk for many chronic diseasesReduced risk for many chronic diseases

Weight controlWeight control

Promotes healthy bones, muscles, and Promotes healthy bones, muscles, and jointsjoints

Reduces symptoms of anxiety and Reduces symptoms of anxiety and depressiondepression

Associated with fewer hospitalizations, Associated with fewer hospitalizations, physician visits, and medications.physician visits, and medications.

Source: CDC, 2005

Physical activity recommendations

Adults: minimum of 30 minutes of Adults: minimum of 30 minutes of moderate-intensity physical activity on moderate-intensity physical activity on most days of the weekmost days of the week

Children and adolescents: at least 60 Children and adolescents: at least 60 minutes of physical activity most days of minutes of physical activity most days of the weekthe week

Source: Dietary Guidelines for Americans, USDA, 2005

Effects of Obesity

Medical/health Medical/health

EconomicEconomic

Social/PsychologicalSocial/Psychological

Health Effects of Obesity

Mortality – increased risk of premature Mortality – increased risk of premature deathdeath

Source: Sizer and Whitney, 2006

Health Effects of Obesity

MorbidityMorbidity– Type 2 DiabetesType 2 Diabetes– HypertensionHypertension– Heart diseaseHeart disease– Some cancersSome cancers– Breathing ProblemsBreathing Problems– ArthritisArthritis– Reproductive ComplicationsReproductive Complications

Prevalence of disease in people who are overweight or obese

Type 2 DiabetesType 2 Diabetes– 67% of all diabetics have a BMI 67% of all diabetics have a BMI 27 27

HypertensionHypertension– 41.9% of men and 37.8% of women with a BMI 41.9% of men and 37.8% of women with a BMI

greater than 30 have high blood pressuregreater than 30 have high blood pressure

High blood cholesterolHigh blood cholesterol– 22% of men and 27% of women with a BMI greater 22% of men and 27% of women with a BMI greater

than 30 have high blood cholesterolthan 30 have high blood cholesterol

CancerCancer– A BMI greater than 25 accounts for 14% of cancer A BMI greater than 25 accounts for 14% of cancer

deaths among men and 20% among womendeaths among men and 20% among womenSource: http://win.niddk.nih.gov/statistics/index.htm (Weight Control Information Network)

Economic Effects of Obesity

American families, businesses, and American families, businesses, and governments were estimated to have governments were estimated to have spent $117 billion in 2001 on obesity spent $117 billion in 2001 on obesity related problems, primarily health carerelated problems, primarily health care

Annual medical spending due to Annual medical spending due to overweight and obesity was estimated to overweight and obesity was estimated to be $92.6 billion dollars in 2002be $92.6 billion dollars in 2002

Source: http://win.niddk.nih.gov/statistics/index.htm (Weight Control Information Network)

Social/Psychological Effects of Obesity

More likely to be judged by appearanceMore likely to be judged by appearance

Less often sought after for romanceLess often sought after for romance

Less often hiredLess often hired

Associated with low self-esteem and poor Associated with low self-esteem and poor body imagebody image

Stereotyped as lazy and self-indulgentStereotyped as lazy and self-indulgent

Sources: Sizer and Whitney, 2006 and Viner 2005

Ways to Reduce the Incidence of Obesity

Weight reduction

Prevention of weight gainPrevention of weight gain

Treatment of weight gainTreatment of weight gain

Select Findings from the Childhood Obesity Resource

Planning Project

Funded through an American Funded through an American Academy of Pediatrics CATCH Academy of Pediatrics CATCH

Planning GrantPlanning Grant

CATCH Grant

Pediatricians, Parents, and Educators Pediatricians, Parents, and Educators were surveyed in the Barren River Area were surveyed in the Barren River Area Development District (10 counties in Development District (10 counties in Bowling Green area)Bowling Green area)

Parent’s Identification of Children’s Overweight Status

0

20

40

60

80

100

Correct Incorrect

%o

f re

spo

nd

ents

Parents’ Attitudes and Beliefs73.4% of parents believe their MD would 73.4% of parents believe their MD would tell them if their child was overweighttell them if their child was overweight

Most parents believe that overweight Most parents believe that overweight children have an increased risk for health children have an increased risk for health problemsproblems

However, most parents are not concerned However, most parents are not concerned about children’s weightabout children’s weight

Most parents believe talking to children Most parents believe talking to children about their weight will cause eating about their weight will cause eating disorders or problems with self-esteemdisorders or problems with self-esteem

MDs’ Attitudes and Beliefs

Many MDs do not discuss dietary changes Many MDs do not discuss dietary changes or exercise with their overweight patientsor exercise with their overweight patients

Many MDs believe that parents/family lack Many MDs believe that parents/family lack motivation for child to lose weightmotivation for child to lose weight

Educators’ Attitudes and Beliefs

They feel they have no control over the They feel they have no control over the amount of activity student get per day.amount of activity student get per day.

They feel it is important to have healthy They feel it is important to have healthy snack options at school, but most (91%) snack options at school, but most (91%) used food as an incentive or rewardused food as an incentive or reward

88% of KY schools use food as rewards88% of KY schools use food as rewards

How to Get Involved

Site-Based Councils

Set policies for what can and cannot be sold Set policies for what can and cannot be sold in schoolsin schools

Reevaluate the contracts between your Reevaluate the contracts between your district and soft drink industriesdistrict and soft drink industries

Require schools to have daily physical activityRequire schools to have daily physical activity

Schools should have the equipment and Schools should have the equipment and supervision for children to meet physical supervision for children to meet physical activity needsactivity needs

Recent KY Legislation

Kentucky lawmakers passed SB 172 in Kentucky lawmakers passed SB 172 in March 2005March 2005 1) bans soft drink sales in elementary school 1) bans soft drink sales in elementary school

during the school day during the school day

2) limits retail fast food in cafeterias to once a 2) limits retail fast food in cafeterias to once a week week

3) requires each school district to have a 3) requires each school district to have a credentialed nutrition specialist to plan credentialed nutrition specialist to plan luncheslunches

School Administrators

Promote healthier eating and physical activity Promote healthier eating and physical activity in your schoolin your school

Have a Health Educator, Registered Dietitian, Have a Health Educator, Registered Dietitian, County Extension Agent or School County Extension Agent or School Foodservice Director come to your Foodservice Director come to your faculty/staff meetings to bring unity on this faculty/staff meetings to bring unity on this issueissue

Give students healthier options in the vending Give students healthier options in the vending machinesmachines

Foodservice Directors

Make healthy food options appealingMake healthy food options appealing

Provide low-fat, low-calorie, and low-sugar Provide low-fat, low-calorie, and low-sugar food itemsfood items

Reduce access to high-fat, high-calorie, Reduce access to high-fat, high-calorie, high-sugar foods, and excessive portion high-sugar foods, and excessive portion sizessizes

Plan school menu with a group of parents Plan school menu with a group of parents and teachersand teachers

Information for Foodservice Directors

High school students changed their food High school students changed their food choices based solely on the availability of choices based solely on the availability of nutrition labels posted at the POS - more nutrition labels posted at the POS - more healthful entrees increased (Conklin 2005)healthful entrees increased (Conklin 2005)

TeachersHave some form of movement in the health Have some form of movement in the health curriculumcurriculumFor bake sales/class parties, have parents For bake sales/class parties, have parents bring healthy snacksbring healthy snacksDo not reward students with food or punish Do not reward students with food or punish students by taking away recessstudents by taking away recessRaise awareness to students and staff on the Raise awareness to students and staff on the benefits of physical activitybenefits of physical activityHave a health educator speak to students on Have a health educator speak to students on ways to be more activeways to be more active

Parents

Limit TV, movies, video and computer games Limit TV, movies, video and computer games for children to 1-2 hours per day (American for children to 1-2 hours per day (American Academy of Pediatrics)Academy of Pediatrics)Encourage child to be involved in organized Encourage child to be involved in organized sports, 4-H programs, outdoor activities, active sports, 4-H programs, outdoor activities, active playtime at homeplaytime at homeEnjoy regular exercise with the entire familyEnjoy regular exercise with the entire familyAssign active chores to all family membersAssign active chores to all family membersContact your school/school board to let them Contact your school/school board to let them know that you are concerned about food and know that you are concerned about food and physical activity at school physical activity at school

ParentsBuy healthier snacks (like fruit and vegetables)Buy healthier snacks (like fruit and vegetables)Be a healthy role model for your childrenBe a healthy role model for your childrenReduce the consumption of soft drinks and snack foods Buy only 100% fruit juice Buy only 100% fruit juice Consuming adequate calciumConsuming adequate calciumEat meals together at the dinner tableEat meals together at the dinner tableAvoid watching TV during mealtimesAvoid watching TV during mealtimesLimit fast food eating to no more than once per Limit fast food eating to no more than once per weekweekAvoid using food as a reward or using the lack Avoid using food as a reward or using the lack of food as a punishmentof food as a punishment

Civic Leaders

Work with city planners and engineers to Work with city planners and engineers to plan for sidewalks and bicycle pathsplan for sidewalks and bicycle paths

Designate a place and promote a farmer’s Designate a place and promote a farmer’s marketmarket

Create a community coalition to address Create a community coalition to address childhood overweight in your areachildhood overweight in your area

Success stories

http://www.cdc.gov/healthyyouth/nutrition/Making-It-http://www.cdc.gov/healthyyouth/nutrition/Making-It-Happen/Happen/1. 1. Establish nutrition standards for competitive foodsEstablish nutrition standards for competitive foods

2. 2. Influence food and beverage contractsInfluence food and beverage contracts 3. 3. Make more healthful foods and beverages availableMake more healthful foods and beverages available 4. 4. Adopt marketing techniquesAdopt marketing techniques 5. 5. Limit student access to competitive foodsLimit student access to competitive foods 6. 6. Use fundraising activities and rewardsUse fundraising activities and rewards

Growing Healthy Kids in KentuckyFourth Annual Conference

November 3-4, 2005November 3-4, 2005Lexington, KentuckyLexington, Kentuckywww.kyeatright.orgwww.kyeatright.org

Sources

Center for Disease Control. www.cdc.gov. Accessed July 2005.

Conklin, MT, DA Cranage, and CU Lambert. Nutrition Information at Point of Selection Affects Food Chosen by High School Students. The Journal of Child Nutrition and Management. 29(1) Spring 2005

Gardner, G. Being Overweight Now Epidemic. Vital Signs. Pages 136-137. 2001

Hedley, AA, CL Ogden, C.L. Johnson, MD Carroll, LR Curtin, and KM Flegal. Prevalence of Overweight and Obesity Among US Children, Adolescents, and Adults, 1999-2002. Journal of the American Medical Association

SourcesLoos, RJF and T Rankinen. Gene-Diet Interactions on Body Weight

Changes. Journal of the American Dietetic Association. 105:S29-S34. 2005

Popkin, BM and P Gordon-Larsen. The Nutrition transition: worldwide obesity dynamics and their determinants. International Journal of Obesity. 28:52-59. 2004

Variyam, JN. Nutrition Labeling in the Food-Away-From-Home Sector. ERS Report Summary. April 2005

Viner, RM and TJ Cole. Adult socioeconomic, educational, social, and psychological outcomes of childhood obesity: a national birth cohort study. British Medical Journal. 330(7504):1354-7. 2005

Youth Behavioral Risk Surveillance. Available online at http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf. 2003.

Documents

The Obesity Epidemic: Trends, Causes, Effects and Ways to Reduce the Incidence