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

World Wide Rates of overweight and obesity, 2000-2004 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 3

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) Afghan war cost in DOLLARS to US over the last 8 years was 228 Billion *Finkelstein EA; Health Affairs Web Exclusive. 2003; W3:219-226. **Finkelstein EA; Health Affairs 28, no. 5 (2009): w822-w831 4

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

Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980. No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% 6 6

Obesity Trends* Among U.S. Adults BRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2009 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1990 1999 2009 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

State-specific Prevalence of Obesity. Among U. S State-specific Prevalence of Obesity* Among U.S. Adults, by Race/Ethnicity, 2006-2008 White non-Hispanic Black non-Hispanic Hispanic (*BMI 30)

Non-Hispanic blacks, Hispanics, & non-Hispanic whites Summary Non-Hispanic blacks, Hispanics, & non-Hispanic whites For non-Hispanic blacks Overall prevalence of obesity—35.7% Midwest and South Prevalence ranged from 23.0% (New Hampshire) to 45.1% (Maine) 40 states had a prevalence of ≥ 30% 5 states (Alabama, Maine, Mississippi, Ohio, and Oregon) had a prevalence of ≥ 40% Compared to non-Hispanic whites, non-Hispanic blacks had about 50% higher prevalence of obesity, and Hispanics had about 20% higher prevalence

For non-Hispanic whites Summary For Hispanics Overall prevalence of obesity—28.7% Lower prevalence was observed in the Northeast Prevalence ranged from 21.0% (Maryland) to 36.7% (Tennessee) 11 states had a prevalence of ≥ 30% For non-Hispanic whites Overall prevalence of obesity—23.7% Higher prevalence in the Midwest and South Prevalence ranged from 9.0% (DC) to 30.2% (West Virginia) Only one state (West Virginia) had a prevalence of ≥ 30% 5 states (California, Colorado, Connecticut, Hawaii, and New Mexico) and DC had a prevalence of <20% The 11 states with a prevalence >=30% among Hispanics are Alaska, Arizona, Illinois, Kansas, Michigan, New Hampshire, North Dakota, Oklahoma, Pennsylvania, Tennessee, and Texas,

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 1st 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 activity @ home “What’s for Take Out?” 1.2 vs > 5.0 per week 12

Calorie Difference: 210 calories BAGEL 20 Years Ago Today 140 calories 3-inch diameter 350 calories 6-inch diameter If you rake the leaves for 50 minutes you will burn the extra 210 calories.* Calorie Difference: 210 calories 5 days/wk X 50 weeks=15.6 lb. 13

CHEESEBURGER Today 20 Years Ago 333 calories 590 calories Calorie Difference: 257 calories If you lift weights for 1 hour and 30 minutes, you will burn approximately 257 calories.* 14

FRENCH FRIES 20 Years Ago Today You need to walk for 1 hour and 10 minutes to burn approximately 400 extra calories 20 Years Ago Today 210 Calories 2.4 ounces 610 Calories 6.9 ounces Difference: 400 Calories 15

The Solution: You and a little knowledge Frank J. Domino, M.D. Jill Grimes, M.D. Barbara Olendzki, RD, MPH

Barriers to nutritional counseling Confusion over current guidelines Lack of time & compensation Effectiveness of interventions Confusion: nutrition as it relates to disease GOAL: 5 Brief Concepts to Recommend

The National Weight Control Registry “Successful Losers” The National Weight Control Registry >5000 successful losers Members lost an average of 66 lbs (range=30-300 lbs) x 5.5 years (= 1 lb/month x 5 years) 78% eat breakfast every day. 75% weigh them self at least once a week. 62% watch < 10 hours of TV per week. 90% exercise, about 1 hour per day. http://www.nwcr.ws Does wt loss work? Can MD’s make a difference? The National Weight Control Registry  The National Weight Control Registry (NWCR), established in 1994 by Rena Wing, Ph.D. from Brown Medical School, and James O. Hill, Ph.D. from the University of Colorado, is the largest prospective investigation of long-term successful weight loss maintenance. Given the prevailing belief that few individuals succeed at long-term weight loss, the NWCR was developed to identify and investigate the characteristics of individuals who have succeeded at long-term weight loss. The NWCR is tracking over 5,000 individuals who have lost significant amounts of weight and kept it off for long periods of time. 19 19 19

What about the average person? Daily Practices Survey 2004 US > 18 Yrs. “Successful Weight Loss Maintainers” Eat Fast Food < 2/Week > 5 Fruits & Vegetables/day ** AND 150 Minutes physical activity (25 Min/Day)

What else can your Patients Do? 3200 Japanese, 30-69 Yrs Survey 2003-6 BMI, Eating “until full” & speed of eating Odds of Being Overweight Male Female Eating Till Full 2.00 1.84 Eating Quickly 1.84 2.09 Full & Quickly 3.13 3.21 Triple the odds !!! BMJ 2008: 337: a2002 Eat Slowly and question if still wants more

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