Definition of obesity: A condition characterized by excess body fat (Webster’s Dictionary) Obesity is a chronic disease; patient and practitioner must understand that successful treatment requires a lifelong effort. (NIH The Practical Guide: Identification, Evaluation, and Treatment of Overweigt and Obesity in Adults)

CHICAGO SCHOOLKIDS TWICE AS LIKELY TO BE OBESE CHICAGO SUN TIMES Wednesday December 3, 2003 CHICAGO SCHOOLKIDS TWICE AS LIKELY TO BE OBESE An ‘astonishing’ 23% of public school pupils under 7 are overweight vs. 10% nationally

Overweight teen 15 – 17 years old is 20 times more likely to be obese at 24 years old than lean teen.

Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults BRFSS, 2006 (*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, 2010 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Prevalence of Overweight Among Children in the United States, National Health & Nutrition Examination Surveys, 1971 - 2002 Girls Boys Percent Percent 1971 – 74 1976 – 80 1988 – 94 1999 – 04 Freedman et al. Obesity 14:301,2006 Ogden et al. JAMA 295:1549, 2006

Physical Consequences of Childhood & Adolescent Overweight & Obesity Sleep apnea Pickwickian syndrome Slipped capital epiphyses Tibial torsion Flat feet Increased risk of sprains and fractures Idiopathic intracranial hypertension Cholelithiasis Gastro-esophageal reflux Menstrual abnormalities Polycystic ovary syndrome Hypercorticism Left ventricular hypertrophy Breathing Problems Bone/Skeletal Problems Vascular Problems Digestive Problems Hormonal Problems Heart Problems

Actual Causes of Death in the US, 1990 & 2000 www.cdc.gov, 2004 JAMA 2004;291:1238-45, erratum 2005;293:293-4.

Wolf & Colditz Obesity Res 1998;6:97-106 Hodgson & Cohen Med Care 1999;37:994-1012 * Adjusted to 1995 dollars

Obesity is Caused by Long-Term Positive Energy Balance Body Fat Stores Energy Expenditure Energy Intake

+ 12 calories per day = 1 pound excess weight per year + 25 calories per day = 2 pounds excess weight per year + 125 calories per day = 10 pounds excess weight per year

Restaurant Portion Sizes – 1985 & Today Bagel 3” diam. 140 kcal 6” diam. 350 kcal Turkey Sandwich 320 kcal 820 kcal Coffee (whole milk & sugar) 8 oz. 45 kcal (whole milk & flavored syrup) 16 oz. 350 kcal Blueberry Muffin 1.5 oz. 210 kcal 4 oz. 500 kcal Spaghetti & Meatballs 1 c. 500 kcal 2 c. 1025 kcal Soda 8 oz. 100 kcal 20 oz. 250 kcal

Calories Burned in 30 minutes – 165 pound person TV/computer/sitting in class 65 Sleeping 40 Walking 95 Basketball – playing in game 300 Basketball – shooting baskets 165 Swimming laps 300 Running, jogging 250

One pound of body fat contains 3500 calories – if you eat 500 calories more each day than you burn off you will gain one pound in a week. Energy In must equal Energy Out to stay the same weight.

Westside Chicago Elementary School 6th Grade 8th Grade Servings of chips 4 3 % of calories 25% 20% Servings of soda 3 2.5 % of calories 16% 15% Servings of milk 1 1 Servings of fruit/veg 1.5 1

What about candy? Calories King Size Reese’s Peanut Butter Cup 420 King Size Baby Ruth 480 Twizzlers - large bag 490 Now ‘N Later (regular pack) 280 Laffy Taffy (10 pcs) 380

What about candy? Calories Hours Walking King Size Reese’s Peanut Butter Cup 420 2hr 10min King Size Baby Ruth 480 2hr 30min Twizzlers - large bag 490 2hr 35min Now ‘N Later (regular pack) 280 1hr 30min Laffy Taffy (10 pcs) 380 2hr Doesn’t matter where the calories come from – fat or sugar – any extra over what you burn will turn to body fat

The New York Times Monday, May 25, 2005

USDA, Economic Research Service 2009 Sugar USDA, Economic Research Service 2009

USDA, Economic Research Service 2009 Vegetable Fruit USDA, Economic Research Service 2009

USDA, Economic Research Service 2009 Whole Total Regular Diet Lower Fat/Skim USDA, Economic Research Service 2009

Trends in Portion Sizes & Energy Intake for Americans, 2 years and older NFS & NHANES 1977-78 1989-91 1994-96 Energy Intake (kcal) Soft drinks 144 157 193 Fruit drinks 139 152 189 French fries 188 247 256 Hamburgers 389 392 486 Portion Size (oz) 13.1 16.8 19.9 11.3 12.6 15.1 3.1 3.5 3.6 5.7 5.9 7.0 Nielsen, S. J. et al. JAMA 2003;289:450-453.

Relationship between Body Fatness & Restaurant Food Consumption in Adults Convenience sample, Boston, n=73 McCrory et al. Obes Res 1999;7:564-71.

Our Toxic Environment 70% more meals eaten away from home >5000 fast food franchises in schools 70% more meals eaten away from home Growing number of high calorie beverages Soft drink contracts with schools (?) Increased use of corn sweeteners 10,000 junk food ads each year Junk food advertising - $45/person Healthy food advertising - $1.50/person Increased TV & video games, Reduced emphasis on physical activity

Avoid fad diets and quick weight loss schemes Healthy Tips Avoid fad diets and quick weight loss schemes Drink plenty of water or other low calorie beverages Never skip meals Get up and go! 30 minutes of activity per day