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

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

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%

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%

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

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

Summary Non-Hispanic blacks, Hispanics, & non-Hispanic whites Non-Hispanic blacks, Hispanics, & non-Hispanic whites For non-Hispanic blacks 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%

Summary For Hispanics 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 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%

What else has changed? Humans have a genotype that permits energy intake > expenditure Humans have a genotype that permits energy intake > expenditure Political decisions & industrialization of farms  growth of grain for livestock, rather than humans Political decisions & industrialization of farms  growth of grain for livestock, rather than humans 1 st in recorded history cost of meat < vegetables. 1 st in recorded history cost of meat < vegetables. ↑ portion sizes, ↑ fat intakes, sweetened beverages ↑ portion sizes, ↑ fat intakes, sweetened beverages Lack of physical activity: ↓ Manual Labor, Computer/Screen time, increased automation allows for less home Lack of physical activity: ↓ Manual Labor, Computer/Screen time, increased automation allows for less home “What’s for Take Out?” 1.2 vs > 5.0 per week “What’s for Take Out?” 1.2 vs > 5.0 per week

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

Frank J. Domino, M.D. Jill Grimes, M.D. Barbara Olendzki, RD, MPH

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

“Successful Losers” “Successful Losers” The National Weight Control Registry >5000 successful losers Members lost an average of 66 lbs (range= lbs) x 5.5 years (= 1 lb/month x 5 years) 78% eat breakfast every day. 78% eat breakfast every day. 75% weigh them self at least once a week. 75% weigh them self at least once a week. 62% watch < 10 hours of TV per week. 62% watch < 10 hours of TV per week. 90% exercise, about 1 hour per day. 90% exercise, about 1 hour per day.

What about the average person? Daily Practices Survey 2004 US > 18 Yrs. “Successful Weight Loss Maintainers” Survey 2004 US > 18 Yrs. “Successful Weight Loss Maintainers” 1. Eat Fast Food < 2/Week 2. > 5 Fruits & Vegetables/day ** AND Minutes physical activity (25 Min/Day)

What else can your Patients Do? 3200 Japanese, Yrs Survey Japanese, Yrs Survey BMI, Eating “until full” & speed of eating BMI, Eating “until full” & speed of eating Odds of Being Overweight MaleFemale Eating Till Full Eating Till Full Eating Quickly Eating Quickly Full & Quickly Full & Quickly Triple the odds !!! BMJ 2008: 337: a2002 Eat Slowly and question if still wants more