Koplan_The Obesity Epidemic ANT 231 Feb 2011

Koplan_The Obesity Epidemic ANT 231 Feb 2011 - The Obesity...

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Unformatted text preview: The Obesity Epidemic The Obesity Epidemic Jeffrey P. Koplan, MD, MPH Emory Global Health Institute Anthropology 231 Predictive Health and Society February 3, 2011 ROBUST, FAT, ROTUND, OBESE, ZAFTIG, SOLID, OVERWEIGHT, HEAVY, STOUT, PLUMP, LARGE, CORPULENT, HEARTY, FULL­BODIED, STRONG, TOUGH, PUDGY, HEFTY Consequences of Childhood and Consequences of Childhood and Adolescent Obesity Common Uncommon Growth Psychosocial Hyperlipidemia Hepatic Steatosis Abnormal glucose metabolism Persistence into adulthood Hypertension Sleep apnea Pseudotumor PCOD Cholelithiasis Orthopedic Consequences of Adult Obesity Consequences of Adult Obesity Psychosocial Cardiovascular ­ Hyperlipidemia ­ Diabetes mellitus ­ Hypertension ­ Respiratory ­ Cardiac Medical ­ Polycystic ovary disease ­ Gall bladder disease ­ Osteoarthritis ­ Cancer Pregnancy and the postpartum Mortality Increase Risk of Obesity – Related Increase Risk of Obesity – Related Diseases Associated with High BMI Disease BMI of less than 25 BMI of 25 To 29.9 BMI of 30 to 34.9 BMI of 35 or more Diabetes (type 2) 1.00 2.42 3.35 6.16 Gallstone 1.00 1.97 3.30 5.48 Hypertension 1.00 1.92 2.82 3.77 Arthritis 1.00 1.56 1.87 2.39 Stroke 1.00 1.53 1.59 1.75 Heart Disease 1.00 1.39 1.86 1.67 Source: Robertwood Johnson Fdtn: A Nation at Risk: Obesity in the United States Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2007, 2009 (*BMI ≥ 30, or about 30 lbs. overweight for 5’4” person) 1998 1990 2007 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% An Epidemic of Childhood Obesity An Epidemic of Childhood Obesity Since the 1970s, obesity prevalence • Doubled for adolescents aged 12­19 years • Tripled for children aged 6­11 years • Upward trend for children < 2 years • Doubled for preschool children aged 2­5 years > 9 million U.S. children and youth > 6 years obese Mirror similar trends • U.S. adults & adults and children internationally Energy Balance Energy Balance Energy intake = Energy expenditure For children, maintain energy balance at a healthy weight while protecting health, growth and development, and nutritional status Mother was right. “Eat your veggies….” “Go out and play.” Shifts in Food Practices in the Shifts in Food Practices in the United States Fast food consumption Reduced frequency of family meals Restrained eating, meal skipping Consumption of soft drinks – increased from 27 to 56.1 gal/y from 1972 – 1998 50,000 products in supermarkets Increased portion size 10” plate 12” plate Ref: Jahns L, Siega­Riz AM, Popkin BM. 2001. The increasing prevalence of snacking among US children from 1977 to 1996. J Pediatr 138(4):493–498. Fast Food 1970 1980 2001 2006 Outlets in 30,000 140,00 222,000 243,000 USA 0 Eating Out of Home I Eating Out of Home I 1970 – 25% total food spending occurred in restaurants 1995 – 40% (Paeratakul, J. Am Diet Assoc 2003) Over the past 30 years, US spending on fast food increased from $6 billion to $110 billion (18 fold) (Schlosser, Fast Food Nation, 2001) Children ages 11­18 eat at fast food restaurants twice a week (Paeratakul, J Am Diet Assoc 2003) Percentage of food consumed by children in restaurants and fast food outlets nearly tripled from 1977 (6.5%) to 1996 (19.3%) (St. Orge, Am J Clin Nutr 2003) Eating Out of Home II Food eaten out of home, higher in total fat, saturated fat and sodium and lower in fiber And likely to eat more foods and in larger portions (Bowman, Pediatrics 2004) Days when children eat fast food, they consume on an average of 187 more total calories (Bowman, Pediatrics, 2004) Children eat nearly twice as many calories (770) at restaurants as in a meal at home (420) (Zoumas­Merse, J Am Diet Assoc, 2001) Observational Studies of Sugar­sweetened Observational Studies of Sugar­sweetened Beverage Consumption and Weight Change Study Population Findings Striegel­Moore 2400 9 ­ 10yo +ive relationship Lugwig 548 11 ­ 12yo +ive relationship Berkey 11000 9 ­ 14yo +ive relationship boys Welsh 11000 2 ­ 3yo +ive relationship Phillips 132 9 ­ 10yo +ive relationship w/BMI Striegel­Moore R et al. J Pediatrics, 2006; in press Ludwig et al. Lancet 2001; 357:505 Berkey CS et al. Obesity Res 2004; 12:778 Phillips SM et al. Obesity Res 2004; 12:461 Bigger Food Portions Bigger Food Portions From 1977 to 1998 Average soft drink from 144 calories to 193 calories French Fries (chips) from 188 calories to 256 calories Hamburger from 389 calories to 486 calories Source: Nielsen, Poplins JAMA 2003 http://www.divinecaroline.com/article/22178/49492­portion­size­­now/2 http://www.divinecaroline.com/article/22178/49492­portion­size­­now/2 http://www.divinecaroline.com/article/22178/49492­portion­size­­now/2 Comparison of Portion Sizes of Comparison of Portion Sizes of Fast Foods to USDA Portion Sizes Muffin (57 gm) Bagel (71 gm) Steak (85 gm) French Fries (50 gm) Cookie (10 gm) Soda (12 oz) 0 200 400 600 800 Fast Food Portion Size: Percent Larger* 1000 Amount consumed (g) Effects of Portion Size on Food Consumption Among Young (3.6 years) and older (5.0 years) Children 150 100 50 0 Small Medium Portion size Source: Rolls, Engell and Birch. JADA 2000; 100:232 Large Hardee’s MONSTER Thickburger two­thirds of a pound of beef, four bacon strips, three cheese slices and mayonnaise on a buttered bun 1400 calories 940 calories fat Working it off 1.9 hours of running 2.1 hours of stair climbing 2.4 hours in an aerobics class 3.2 hours of baseball 4.8 hours of golf (walking) 5.4 hours of grocery shopping 6.3 hours of bowling 7.5 hours of brushing your teeth 18.3 hours of watching TV “Is this a good shoe for sitting?” Employment/Occupation Relative % Employment/Occupation Relative % Work in low PA Occupation 1950 2000 + 82.8 Work in high PA Occupation 1950 2000 ­ 25.2 Travel behavior Travel behavior Average daily vehicle miles traveled by person 224.0 1950 2000 + Proportion trips by walking 1960 2000 ­ 71.2 Proportion trips to work by public transportation 1950 2000 ­ 68.5 Source: Brownson, Ann Rev PH 2005 Move to the Suburbs 115% increase in suburban residents, 1950 – ’00 Source: Ann Rev of PH, R Brownson, St Louis Univ 8% decrease in urban residents, 1950 – ’00 Land Use Land Use % U.S. Residents living in suburbs 1950 to 2000 115% Source: Brownson, Ann Rev PH 2005 Sedentary Behavior Sedentary Behavior Youth 8 ­ 18 yo – daily screen time TV 3 hrs 51 minutes Computer 1 hr 2 minutes Video Games 49 minutes Reading 43 minutes Source: Kaiser Family Foundation 2005 Televisions in bedrooms Televisions in bedrooms 25 % of 2 year olds 65% of all children Schools Daily physical education or equivalent Elementary Schools 8 % Middle Schools 6.4 % High Schools 5.8% Source: J. School Health 2001 Increasing Size: Increasing Size: Disneyland – increasing costume and uniform sizes Uniforms now size 2 to size 30 Men’s trousers – up to 58 inches at the waist “Aiming for a more diverse workforce” Lounge chairs Toilet seats Coffins Airline seat belts Normalizing an epidemic…. Key Conclusions Key Conclusions Serious nationwide health problems requiring a population based prevention approach The goal is energy balance – healthful eating behaviors and regular physical activity to achieve a healthy weight while protecting health and normal growth and development Societal changes at all levels are needed – multiple sectors and stakeholders What is Needed? Leadership Evaluation Resources Efforts at all levels Change in societal norms Obesity Prevalence Increasing Healthful Eating Behaviors and Physical Activity are the Norm Changing Social Norms Changing Social Norms Public Health Precedents Tobacco control Underage drinking Highway safety Use of seatbelts and child car seats Vaccines Fluoridation Changing Social Norms: Changing Social Norms: Diet: how we eat what we eat when we eat why we eat Activity: need to value as desirable not onerous Key Stakeholders Involved Key Stakeholders Involved Families Government Schools Media Communities Industry Health care Preventing Childhood Obesity will require population based interventions that are: Multi­focal Multi­sectoral Long term Adequately supported ...
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This note was uploaded on 02/15/2012 for the course ANTHRO 231 taught by Professor Dr.lampl during the Spring '11 term at Emory.

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