1. Let’s work together to prevent Jeremy Akers, MS, Obesity Prevention Nutritionist Rachael Kennedy, MEd, Obesity Prevention Coordinator Kathy Sergent, MA, RD, Nutrition Liaison July 26, 2005 Health and Physical Activity Institute

2. Goals: Participants will increase their knowledge of obesity in Virginia. Participants will learn how to use “SuperSize Me” as an educational tool. Our goals for today:

3. 9:00-9:10…………… Introduction……………….. Kathy Sergent 9:10-9:30…………… Burden of Obesity………… Jeremy Akers 9:30-9:45…………… Physical Activity Break....... Volunteers 9:45-10:30………….. “SuperSize Me”…………… Rachael Kennedy - Introduction to movie & how to use it - Lesson number 4 - Cafeteria Counter 10:30-10:45…………. Physical Activity Break…… Volunteers - Pop Quiz game Our agenda:

4. Burden of Obesity Obesity

6. B ody M ass I ndex is a tool for indicating weight status in adults. It is a measure of weight for height. wt [kg] / ht [m] 2 For adults over 20 years old, BMI falls into one of these categories: What is BMI? BMIWeight Status Below 18.5Underweight 18.5 – 24.9Normal 25.0 – 29.9Overweight 30.0 and AboveObese What is BMI?

7. Underweight BMI-for-age < 5th percentile At risk of overweight BMI-for-age 85th to < 95th percentile Overweight BMI-for-age > 95th percentile Body Mass Index: BMI for Children and Teens

8. National Child Data

11. Source: Ogden et al. JAMA 2002;288(14):1728-32 Percentage of Overweight Children and Teens Percent Boys 6-11Girls 6-11Male Teens 12-19 Female Teens 12-19 0 2 4 6 8 10 12 14 16 1963–701971–741976–801988–941999–2000

12. Trends in Child and Adolescent Overweight Note: Overweight is defined as BMI >= gender- and weight-specific 95th percentile from the 2000 CDC Growth Charts for the United States. Source: National Health Examination Surveys II (ages 6-11) and III (ages 12-17), National Health and Nutrition Examination Surveys I, II, III and 1999-2000, NCHS, CDC. Percent 1963-671971-741976-801988-94 Percent Males 12-19 Females 12-19 1999-2000 1966-70 Females 6-11 Males 6-11 0 5 10 15 20 0 5 10 15 20

18. Issues within your region that lead to or promote high rising obesity rates. Contributing Factors

19. Genetics

20. Energy IntakeEnergy Expenditure Energy Imbalance

21. Energy Expenditure Inactivity

23. Energy Expenditure Increased Screen Time

25. Behavior Nutrition: Quality vs. Quantity

26. Environment Choices, Choices, Choices

27. Environment

28. Culture/ Perceptions Instant Gratification

29. How do portions today compare to portions sizes 20 years ago? How do portions today compare to portions sizes 20 years ago? –Food choices –Portion sizes –Number of meals daily Energy Intake Perceptions

30. Muffin How long will you have to vacuum to to burn* 310 calories? 20 Years AgoToday 210 Calories 1.5 ounces How many calories are in today’s muffin? 500 Calories 5 ounces Calorie Difference: 310 calories *Based on 150 pound person You will you have to vacuum 1 hour and 20 minutes to burn* 310 calories!

31. 20 Years Ago (Coffee with milk) Today Cafe Latte (Coffee and milk) 45 Calories 8 ounces Calorie Difference: 305 calories How long will you have to walk briskly to to burn* 305 calories? How many calories are in today’s coffee? 350 Calories 20 ounces *Based on 150 pound person You will have to walk briskly for 1 hour and 10 minutes to to burn* 305 calories? Coffee

32. French Fries 20 Years AgoToday 210 Calories 2.4 ounces How many calories are in these fries? 610 Calories 6.9 ounces Calorie Difference: 400 calories *Based on 150 pound person How long will you have to walk to burn* 400 calories? To burn* 400 calories: Walk leisurely for 1 hr 10 minutes

33. Soda 20 Years Ago Today 85 Calories 6 ½ ounces Calorie Difference: 165 calories How many calories are in this soda? 250 Calories 20 ounces *Based on 150 pound person How long would you have to garden to burn 165 calories?. To burn* 165 calories: Garden for 35 Minutes

34. Cheeseburger 20 Years AgoToday 330 Calories Calorie Difference: 257 calories How many calories are in this cheeseburger? 590 Calories *Based on 130 pound person How long would you have to lift weights to burn up 257 calories? To burn* 257 calories: Lift weights for 1 hour and 30 minutes

35. Chicken Stir Fry 20 Years AgoToday 435 calories 2 cups Calorie Difference: 430 calories How long will you have to do aerobic dance to burn* 430 calories? How many calories are in today’s chicken stir fry? 865 calories 4 ½ cups *Based on 150 pound person You will you have to do aerobic dance for 1 hour to burn* 430 calories?

36. Caesar Side Salad (romaine lettuce, croutons, dressing, and parmesan cheese) 20 Years Ago Today 140 calories 1 ½ cups Calorie Difference: 330 calories How long do you have to walk the dog to burn* 330 calories? How many calories are in today’s Caesar Side Salad? 470 calories 3 ½ cups *Based on 150 pound person To burn* 330 calories you must walk the dog for 1 hr and 35 minutes.

37. Popcorn (cooked in vegetable shortening, without extra butter) 20 Years Ago Today 270 Calories 5 cups Calorie Difference: 360 calories How to long do you have to do water aerobics to burn* 360 calories? How many calories are in today’s popcorn? 630 Calories 11 cups *Based on 150 pound person You will have to do water aerobics for 1 hour and 20 minutes to burn* 360 calories.

38. Total Intake Today’s Diet Breakfast –Muffin 500 kcal –Coffee350 kcal Lunch –Cheeseburger 590 kcal –Fries 610 kcal –Soda 250 kcal Dinner –Chicken Stir Fry865 kcal –Caesar Side Salad 470 kcal Snack –Popcorn630 kcal TOTAL 4,265 Kcal 20 years ago Diet Breakfast –Muffin 210 kcal –Coffee 45 kcal Lunch –Cheeseburger 210 kcal –Fries 85 kcal –Soda 330 kcal Dinner –Chicken Stir Fry435 kcal –Caesar Side Salad 140 kcal Snack –Popcorn270 kcal TOTAL 1,725 Kcal Difference of 2,540 Calories You would have to jog 3.6 hours@ 6 mph to burn* of the calorie difference. *Based on 150 pound person

39. Billions, $ Obesity 1 75.0 Type 2 Diabetes* 2 73.7 Coronary heart disease 3 52.4 Hypertension 4 28.2 Arthritis 5 23.9 Breast Cancer 6 7.1 1 Finkelstein EA, Obes Res 2004;12 4. Hodgson TA et al. Med Care 2001;39:599 2 ADA Diabetes Care, 2003;26:917 5 Yelin & Callahan. Arthritis Rheum 1995;38:1351 3 Hodgeson TA et al. Medical Care 1999:37:994. 6 Brown ML, et al. Medical Care; 2002;40(suppl): IV- 104 Direct Cost of Chronic Diseases in the U.S. (2003) The Cost of Obesity is Comparable to other Chronic Diseases

40. $1.64 billion annually Source: Finkelstein et al. Obes. Res. 2004;12 5.7% of adult medical expenditures 42% financed by Medicare & Medicaid VA had the 14 th highest costs compared to all of the other states Cost of Obesity in Virginia (2003)

41. Obesity Related Standards in Schools? –2 out of 5 State Initiatives for All Residents? –2 out of 6 7 Trust for American’s Health. “F as in Fat: How Obesity Policies are Failing in America. Issue Report. October 2004. How is VA Doing?

42. 8 University of Baltimore. National Report Card Shows States ‘Failing’ to Check Obesity. August 9, 2004. www.ubalt.edu/glance/ur_releases/2004/08_09_04_obesity.html.www.ubalt.edu/glance/ur_releases/2004/08_09_04_obesity.html Virginia’s Grade

43. Jeremy.akers@vdh.virginia.gov 804-864-7842, information on nutrition initiatives addressing obesity and data Rachael.kennedy@vdh.virginia.gov 804-864-7789, information on obesity prevention & health promotion initiatives, success stories from the field Kathleen.sergent@vdh.virginia.gov 804-864-7832, information on nutrition programs and nutrition science We welcome you to contact us:

44. The educationally enhanced version can be purchased by internet: www.supersizeme.com, click on “learn more aboutwww.supersizeme.com the EE version” on the right side of the screen. by phone: 800-444-0653 by email us at: eesupersize@hartsharpvideo.comeesupersize@hartsharpvideo.com *Cost is $39.99+$4.95 s/h (2- 4 wks) or $9.95 s/h (1 week)*