1. UNDERSTANDING AND MANAGING SWEETNESS CONFERENCE September 17, 2009, Taj Mahal Hotel, New Delhi, India All Calories Count — Why Manage Calorie Balance John P. Foreyt, Ph.D. Baylor College of Medicine Houston, TX

2. Sweetness, Obesity & Health Public health officials worldwide are frustrated that consumers do not follow dietary guidelines to promote good health Private health practitioners and providers have similar frustrations Governments predict steep increases in the rates of chronic diseases, putting serious strains on the world’s healthcare systems and on national budgets

3. PREVALENCE (%) OF OVERWEIGHT (BMI > 25) AMONG ADULTS MALE FEMALE UNITED STATES 71 62 AUSTRALIA 68 52 NEW ZEALAND 62 50 ENGLAND 65 56 GERMANY 75 59 IOTF Website 2005; Ogden et al, JAMA 2006

4. PREVALENCE (%) OF OVERWEIGHT (BMI > 25) AMONG ADULTS MALE FEMALE FINLAND 68 52 ICELAND 64 54 SWEDEN 51 42 IOTF Website, Updated March 16, 2005

5. PREVALENCE (%) OF OVERWEIGHT (BMI > 25) AMONG ADULTS MALE FEMALE CROATIA 79 50 CZECH REPUBLIC 73 58 HUNGARY 63 49 IOTF Website, Updated March 16, 2005

6. PREVALENCE (%) OF OVERWEIGHT (BMI > 25) AMONG ADULTS MALE FEMALE MEXICO67 72 ARGENTINA 67 55 CHILE 60 60 BRAZIL 38 39

7. PREVALENCE OF OVERWEIGHT & OBESITY IN BEIJING CHINESE MEN (1998) Overweight (%) Obese (%) (BMI > 24-27.9) (BMI > 28) Beijing Workers 51 7 Farmers 50 8 Urban Residents 52 7 Wu et al, 2002

9. PACIFIC ISLANDERS ARE THE MOST OBESE (BMI > 30) IN THE WORLD 70% Tongan Women Obese 63% Samoan Women Obese 79% Nauru Women Obese IOTF Website, Updated March 16, 2005

10. PREVALENCE (%) OF OVERWEIGHT (BMI>25) AMONG U.S. ADULTS % 1980 1 46.0 1990 1 56.0 2000 1 64.5 2010 2 73.5 2020 2 82.5 2030 2 91.5 2040 2 100.0 1 Flegal et al., JAMA, 2002; 2 Foreyt Projected 2006

11. PREVALENCE (%) OF OBESITY (BMI>30) AMONG U.S. ADULTS % 1980 14.4 2000 1 30.5 2020 2 46.5 2040 2 62.5 2060 2 78.5 2080 2 94.5 2100 2 100.0 1 Flegal et al., JAMA, 2002; 2 Foreyt Projected 2006

13. HEALTH RISKS OF OBESITY For every increase of 2 BMI units the relative risk of: CHD ↑ 14% Stroke ↑ 4% Ischemic Stroke ↑ 16%

14. PREVALENCE OF OVERWEIGHT & OBESITY IN U.S. CHILDREN (AGES 6-11) 30.3% Overweight 15.3% Obese Obesity has quadrupled over 25 years African American, Hispanic American & Native American children have highest obesity prevalence American Obesity Association, 2005

17. ESTIMATES OF PREVALENCE OF DIABETES IN 2000 & 2010 (IN MILLIONS OF CASES) 2000 2010 Increase (%) Asia 84 132 57 North America 14 17 23 Europe 26 32 24 South America 16 22 44 Africa 9 14 50 World Average 151 221 46 Eckel et al, Circulation 2004

21. FINNISH DIABETES PREVENTION STUDY Design: 522 middle-aged overweight (BMI 31) 172 men and 350 women Mean duration 3.2 years Intervention Group: Individualized counseling Reducing weight, total intake of fat and saturated fat Increasing uptake of fiber, physical activity Tuomilehto J. et al., NEJM, 2001; 344: 1343-1350

22. Finnish Diabetes Prevention Trial Modest, sustained reduction reduced morbidity Cumulative Probability of Remaining Free of Diabetes Study Year 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0123456 Wt change – 0.9 + 4.2% – 0.9 + 4.2% Intervention group Control group Adapted from Tuomilehto J, et al. NEJM 2001; 344: 1343-50 Wt change -4.7+5.4%

23. DIABETES PREVENTION PROGRAM INCIDENCE OF DIABETES Lifestyle = 7% weight loss, 150 min physical activity/week Diabetes Prevention Program. NEJM, 2002; 346: 393-403

25. Big Texan Steak Ranch Amarillo, Texas 72-oz Steak FREE if eaten within 1 hour

29. Sweetness, Obesity & Health Global concern regarding increase in obesity & obesity-related diseases Critics have singled out sugar & sweetness as primary suspects for obesity & obesity-related diseases Scientific evidence does not support “single culprit” theory

30. Sweetness, Obesity & Health The “culprit” is an excess of calories There is a need to understand the “calorie equation” If calories in exceed calories burned off, excess becomes body fat, & weight goes up

31. Sweetness, Obesity & Health In studying diets of obese people, scientists have not determined that any specific food or beverage is the root cause of obesity A well-balanced diet is the key According to the American Dietetic Association, all food and beverages can be a part of a well-balanced diet

32. Sweetness, Obesity & Health In 2004, scientists and researchers met to develop a scientific consensus statement about sweetness & health They introduced the concept of managing sweetness to teach the calorie equation They encourage consumers to incorporate it into their daily lives so they can enjoy the pleasures of the table, but do so wisely

33. Sweetness, Obesity & Health The conference was entitled “Scientific Straight Talk on Sweetness & Health: Managing Sweetness Conference” Organized by Oldways Preservation Trust, Boston, USA Held in Mexico City, Mexico

34. Sweetness, Obesity & Health In 2006, scientists and researchers met in Brussels, Belgium at the EU to update the scientific research on managing sweetness since 2004

35. Sweetness, Obesity & Health In 2007, Oldways and scientists presented Managing Sweetness to health professionals, scientists and media in four Latin American countries (Brazil, Chile, Argentina and Mexico)

36. Sweetness, Obesity & Health In 2008, scientists and researchers met in Beijing, China and Istanbul, Turkey to update the scientific research on managing sweetness since 2006. In 2009, scientists met in Bangkok to review the scientific research on managing sweetness. And now in New Delhi, India -- scientists are meeting to update the consensus statement on sweetness.

37. Sweetness, Obesity & Health Conference Summary Research results indicate that individuals can incorporate sugars and sweeteners into a healthy eating plan and meet guidelines for healthful diets There is no credible evidence that total sugar intake is associated with the development of type 2 diabetes

38. Sweetness, Obesity & Health Conference Summary Children are born with a liking for sweet taste It is important for parents to learn to manage, not banish, sweet foods

39. Sweetness, Obesity & Health Conference Summary Research suggests banishing favorite foods, like sweets, can lessen a child's ability to control intake of these foods when not under supervision Research has shown sugar in food and beverages does not cause hyperactivity in children All foods and beverages can be part of a healthy diet

40. Sweetness, Obesity & Health Conference Summary Carbohydrates in food and beverage, including sparkling beverages, provide energy for daily activities There is no need to give up favorite foods Consumption in moderation with an active lifestyle is the key to weight management A balanced diet is the key

41. Sweetness, Obesity & Health Conference Summary The achievement and maintenance of good health depends on the wise management of the energy from all food and beverage sources, along with a habit of regular physical activity Sweet foods and beverages can compliment a balanced diet, regular physical activity, and other healthy lifestyle choices

42. Sweetness, Obesity & Health Conclusions Managing sweetness involves reconciling our innate taste preferences with the realities of our modern life and food supply All foods and beverages can be part of a healthy lifestyle

43. “The Current Epidemics of Chronic Diseases are a Result of Discordance Between Our Ancient Genes and Modern Lifestyle.” Eaton et al., The Paleolithic Prescription. 1988. NATURE VS. NURTURE