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

2. World Wide Rates of overweight and obesity, 2000-2004
US %
UK %
Mexico %
Canada %
Greece %
New Zealand 56.2%
Germany %
Italy %

3. 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

4. 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:
**Finkelstein EA; Health Affairs 28, no. 5 (2009): w822-w831 4

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

6. 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% %–14% %–19% %–24% %–29% ≥30% 6 6

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

8. 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% %–14% %–19% %–24% %–29% ≥30%

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

10. 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

11. 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,

12. 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 home
“What’s for Take Out?” 1.2 vs > 5.0 per week 12

13. 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

14. 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

15. 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

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

18. 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

19. The National Weight Control Registry
“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.
75% weigh them self at least once a week.
62% watch < 10 hours of TV per week.
90% exercise, about 1 hour per day.
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

20. 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)

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

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