The Problem: Obesity in America Frank J. Domino, M.D. Barbara Olendzki, RD, MPH

World Wide Rates of overweight and obesity, US 66.3% UK 63.0% Mexico 62.3% Canada 57.5% Greece 57.1% New Zealand 56.2% Germany 49.2% Italy 42.6%

Consequences of Obesity 66% of Americans are overweight* 22% of Americans are obese Deaths from Obesity: 300,000 premature deaths associated with obesity annually (CDC) –25,000/month, 5,769/week, 821/day, 34/hour. 450,000 from tobacco-related disease 10.4 million people with type II diabetes 47 million with metabolic syndrome *CDC 2006

Obesity Trends* Among U.S. Adults BRFSS, 1985 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Is treating obesity a way to save the economy? 2003: 9.1 % of U.S. health expenditures* Estimated annual medical spending due to overweight and obesity (BMI >25) to be as much as $92.6 billion in 2002 dollars* 2006: 10% of U.S. expenditures** $147 billion in 2006 dollars** (Afghan war ~ 28 Billion per year over 8 Yrs) *Finkelstein EA; Health Affairs Web Exclusive. 2003; W3: **Finkelstein EA; Health Affairs 28, no. 5 (2009): w822-w831

What else has changed? Humans have a genotype that permits energy intake > expenditure Political decisions & industrialization of farms  growth of grain for livestock, rather than humans 1 st in recorded history cost of meat < vegetables. ↑ portion sizes, ↑ fat intakes, sweetened beverages Lack of physical activity: ↓ Manual Labor, Computer/Screen time, increased automation allows for less home

140 calories 3-inch diameter Calorie Difference: 210 calories 350 calories 6-inch diameter BAGEL 20 Years Ago Today 5 days/wk X 50 weeks=15.6 lb. If you rake the leaves for 50 minutes you will burn the extra 210 calories.*

Calorie Difference: 257 calories 590 calories CHEESEBURGER 20 Years Ago Today 333 calories If you lift weights for 1 hour and 30 minutes, you will burn approximately 257 calories.*

610 Calories 6.9 ounces Difference: 400 Calories FRENCH FRIES 20 Years AgoToday 210 Calories 2.4 ounces You need to walk for 1 hour and 10 minutes to burn approximately 400 extra calories

Difference: 165 Calories 250 Calories 20 ounces 85 Calories 6.5 ounces Drinks 20 Years AgoToday 20 Years Ago Coffee (with whole milk &sugar) Today Mocha Coffee (with steamed whole milk and mocha syrup) 45 calories 8 ounces 350 calories 16 ounces Difference: 305 calories

Restaurant Perils Alcohol Bread Volume of food served Variety Atmosphere Company Distraction

Restaurant Tricks Alcohol: –↓ mindful behaviors of eating, –↓ inhibitions or restraint of eating Bread and other goodies brought to the table: –combined with fats (butter, cheese) –stimulates hunger –↓ inhibitions

Restaurant Perils and Pitfalls Volume: –Increase in portion sizes parallel the increase in obesity rates. –The standard plate size grew from 10 to 12 inches in the 1990s.  25% more food. –Further influences quantities served at home. –Studies show people do not eat until they are full; rather eat till food presented is finished Rolls, BJ Sensory-specific satiety, Nut Rev 44:

Fast food and satiety Fast food is characterized by high-calorie, high fructose, and low fiber, which encourages insulin resistance and obesity. CNS insulin resistance may be a cause of leptin resistance and stimulate endorphins. Isganaitis E, Lustig RH. Fast food, central nervous system insulin resistance, and obesity. Arterioscler Thromb Vasc Biol Dec;25(12):

How about Eating Out? T.G.I. Fridays Pecan Crusted Chicken Salad 1,360 calories Fat: unknown (The company refuses to disclose the nutritional content of the food) Eat This Instead! Cobb Salad 590 calories Fat: unknown Sodium: unknown

Chili’s Smokehouse Bacon Triple-The-Cheese Big Mouth Burger with Jalapeno Ranch Dressing 2,040 calories 150 g fat (53 g saturated) 110 g protein 4,900 mg sodium That is 2 1/2 day’s worth of fat; 1/3 of which is saturated. Equivalent to about eight 6-ounce steaks. Eat This Instead! Old Timer Burger on a Whole Wheat Bun 420 calories 27 g fat (10 g saturated fat) 670 mg sodium

Quizno’s Tuna Melt (large) 2,090 calories 175 g fat (31 g saturated fat, 2.5 g trans fats) 2,190 mg sodium A large homemade Tuna Melt would be 1/4th of the calories. Eat This Instead! Small Honey Bourbon Chicken on Wheat Bread 310 calories 4 g fat (1 g saturated fat) 920 mg sodium

Summary Obesity results from changes in society (work/convenience) plus an ability to eat more than is necessary US leads the world in rates of obesity Calories from common foods have increased Restaurant portion & calorie sizes have increased dramatically We have met the enemy, now on to the solution!