1. Your Health Today: Choices in a changing society Sara Mackenzie, MD, MPH Clinical Instructor, Health Services School of Public Health University of Washington

2. Body weight and body composition (chapter 8)

3. 3 Overview of Obesity Definitions U.S. Obesity Trends Medical significance of obesity Employability and obesity Factors influencing weight

5. 2008 Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes Obesity (BMI ≥30 kg/m 2 ) Diabetes 1994 2000 No Data 26.0% No Data 9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics 2008

6. 6

7. 7 Definitions Body Mass Index (BMI)= Weight (kg) Height (m) 2 Body Mass Index= Weight (lbs) x 703 Height (inches) 2 Some limitations to BMI; only an estimate and does not reflect body fat percentage or body fat distribution

8. 8 BMI Standards Adult Underweight: BMI<18.5 Healthy Weight: BMI=18.5-24.9 Overweight: BMI=25-29.9 Obese: BMI≥30

9. 9 Why is the concern about overweight and obesity relevant? Medical significance of obesity. Associated with increased risk for many conditions: High blood pressure Diabetes Elevated cholesterol Heart Disease Stroke Gall bladder disease Sleep apnea Certain cancers: uterine, prostate, colorectal

10. 10 Employment Significance of Obesity: Bias and Discrimination Hiring prejudice Inequity in wages, promotions and termination Education setting Medical setting Source: Puhl R, Brownell, KD. Bias, discrimination, and obesity. Obesity Research. 2001 Dec; 9(12):788-805

11. Costs of obesity 11 Source: The George Washington University School of Public Health. (2010). First-ever report on the individual cost of obesity. Retrieved online from: http://www.gwumc.edu/newsevents/firsteverreportontheindividualcostofobesityunveiled

12. Obesity: Heart disease Cancer Diabetes Stroke Hypertension High cholesterol … Diet Physical Activity Economic status Inequity Education Social environment Built environment Racism Policy … Primary and secondary preventionTertiary prevention

13. ACCESS TO CARE ENVIRONMENT GENETICS HEALTH BEHAVIORS ACCESS TO CARE 88 % OTHER 8% HEALTH BEHAVIORS 4% 10% 20% 50% Factors that Influence Health Status Influence National Health Expenditures $1.2 Trillion Sources: Centers for Disease Control and Prevention, University of California at San Francisco, Institute for the Future. Reprinted from Advances: The Robert Wood Johnson Foundation Quarterly Newsletter, 2000, Issue 1, supplement, page 1

14. What factors influence your weight? Genetics Hormonal influences Gender and age Medical illnesses Insert figure 8.2

15. Let’s think about food “choices”

17. Environment and weight status: Neighborhoods have disparity in access to healthy foods in the U.S. Unhealthy foods are more available, more convenient, more heavily advertised and less expensive (especially in low income neighborhoods) Proximity to fast-food restaurants positively associated with likelihood of gaining more than 20kg weight during pregnancy For residents of urban neighborhoods, higher concentrations of small grocery stores was positively related to obesity and BMI

18. Environment and weight status: More affluent neighborhoods – more supermarkets, easier access to whole grains, low-fat foods, more diverse fresh fruits and vegetable choices Increase in portion sizes at restaurants and pre-packaged foods

20. Food environment (“obesogenic environment?)

21. Copyright  2002 by John Wiley & Sons, Inc.

22. From Wallet to Waistline: The Hidden Cost of Super Sizing. The National Alliance for Nutrition and Activity Portion Size

23. It may look like one, but the large muffin counts as two servings – what is the cost?

24. Portion Size Nielsen SJ, Popkin BM: JAMA 2003

25. Food at home & away from home 1990- 2004 Source: USDA Economic Research Service

26. Foods Eaten Away From Home CSPI

28. Hub Store

29. King county menu labeling regulations May 2010 Amended June 2010 to be in line with proposed FDA regulations Chain restaurant (15 or more locations) – Calories must be posted on menu board – Dietary statement must be posted – Additional information must be available in written form: total fat, saturated fat, cholesterol, sodium, carbohydrates, complex carbs, sugars, dietary fiber and protein

30. Why Menu Labeling? Consumer “Right to Know” Strong consumer support Difficult to make informed choices without nutrition information

31. Foods Eaten Away From Home

32. A Big Mac Two Egg McMuffins A large chocolate shake Four regular hamburgers Which item at McDonald’s has the MOST calories? ?? Foods Eaten Away From Home

33. A Big Mac 540 Two Egg McMuffins 600 A large chocolate shake 1160 Four regular hamburgers 1000 Which item at McDonald’s has the MOST calories? ?? Foods Eaten Away From Home

34. Conceptual Model:

35. Source: The Economist, December 13-19, 2003.

36. How might living in a bad neighborhood affect your health?

37. Rental house B IMA Rental house A Built environment Lake Union Supermarket To Campus Sports fields Seven-eleven

38. Environment and weight status: 25% of all trips in U.S. are less than 1 mile and yet 75% of these trips are taken by car Increased time in car per day increases risk of obesity Safety and community design influence method of transportation; the more “walkable” a community, the lower the risk of obesity

41. Environment and weight status: Surgeon General report in 2010 – 8 to 18 year olds spend over 7 hours per day playing video games, on the computer, or watching TV Social norms influence weight – if your friends gain weight, you are more likely to gain weight

42. Where would you rather walk?