1. NYTimes.com > Health Some Extra Heft May Be Helpful, New Study Says By GINA KOLATA Published April 20, 2005 26.088

2. CHl for trend =3.27 P = 0.001 All Women, 1976-1992 (4726 Deaths) Body-Mass Index (Manson et al, 1995) Age-Adjusted Relative Risk 23.012

3. = = 3.23.4 Women Who Never Smoked and Had Stable Weight, 1980-1992 (531 Deaths) Multivariate Relative Risk Body-Mass Index Chi for trend = 4.67 p<0.001 (Manson et al., 1995) 23.015

4. 29.027

5. Obesity in the USA, 1991-98 Educational Level Percentage Obese College grad: +63% Some college: +68% <High school: +46% High school: +46% 29.022 (Mokdad et al. JAMA 1999)

6. Obesity in the USA, 1991-98 Region Percentage Obese New England: + 46% Pacific: + 67% Midwest: + 36% Mid-Atlantic: +32% Southeast: + 67% 29.023 (Mokdad, et al. JAMA 1999)

7. Controlling the Obesity Epidemic – Strategies – Examples 29.034

8. Experiences with Other Public Health Problems Related to Human Behavior: – smoking – not wearing seat belts – drunk driving – poor immunization rates 29.036

9. Features of Past Successful Public Health Campaigns: (WHO) – Adequate duration and persistence – A slow and staged approach – Legislative action – Education – Advocacy – Shared responsibility by consumers, communities, food industry, and governments 29.037

10. In theory, control is simple: calories eaten = calories burned 29.035

11. 21.004

12. Bray and Popkin prediction 26.063

13. 29.045 McManus K et al, 2001 Int J Obes 25:1503

14. Obesity as the TargetWeight Control as a Life Skill - Promotes stigmatization- Inclusive - Ignores much of risk- Consistent with scientific evidence - Focus on treatment- Focus on prevention - Likely to involve expensive- Requires a supportive drugs and surgery environment 29.074

15. New England Strategic Plan for Weight Control (NECON 2004) Schools Health Care Providers Work Sites Media Physical Environment Food Environment Data for Action Economic Analysis 29.075 www.neconinfo.org

16. Worksites: –Encourage physical activity and weight control –Exercise areas at work, shower facilities –Financial incentives to walk, cycle, or use public transportation 29.049

17. Governments & Community Organizations: –Urban design to provide safe walking areas, bikeways –Building codes to encourage use of stairs –Financial incentives to use bikes and walk 29.048

18. Is it Possible To Control the Epidemic? – Socioeconomic example – Swedish and Japanese women (examples) 29.052

19. School-based Intervention in Singapore (Toh CM, Br Med J, 2004) Program (1992 to 2000) nutrition education integrated into curriculum foods and drinks in schools controlled provision of plain drinking water trim and fit awards to schools Outcome: Change in prevalence of obesity primary schools: 16.6% to 14.6% secondary schools: 15.5% to 13.1% 29.125

20. Conclusions The focus on low fat/high carbohydrate diets has been, at best, a lost opportunity to improve the health of Americans. To address the epidemic of obesity engulfing our country, a comprehensive approach will be needed that includes nearly all members and institutions of our society. We should not assume that this will be without costs. 29.091