1. Definition of obesity: A condition characterized by excess body fat (Webster’s Dictionary) Obesity is a chronic disease; patient and practitioner must understand that successful treatment requires a lifelong effort. (NIH The Practical Guide: Identification, Evaluation, and Treatment of Overweigt and Obesity in Adults)

2. CHICAGO SUN TIMES Wednesday December 3, 2003 CHICAGO SCHOOLKIDS TWICE AS LIKELY TO BE OBESE An ‘astonishing’ 23% of public school pupils under 7 are overweight vs. 10% nationally

3. Overweight teen 15 – 17 years old is 20 times more likely to be obese at 24 years old than lean teen.

4. Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

5. Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

6. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

7. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

8. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

9. Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

10. Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

11. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

12. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

13. Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

14. Obesity Trends* Among U.S. Adults BRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

15. Obesity * Prevalence among High School Students – Youth Risk Behavior Surveillance System * Obesity defined as ≥ 95 th percentile BMI-for-age http://www.cdc.gov/healthyyouth/obesity/obesity-youth.htm 20 09 20 13

16. Ogden et al. JAMA 295:1549, 2006 Ogden et al. JAMA 303:242, 2010 * Obesity defined as ≥ 95 th percentile BMI-for-age Girls Prevalence of Obesity* – US Children 2-19 yr NHANES Surveys ■ 2012

17. Ogden et al. JAMA 295:1549, 2006 Ogden et al. JAMA 303:242, 2010 * Obesity defined as ≥ 95 th percentile BMI-for-age Prevalence of Obesity* – US Children 2-19 yr NHANES Surveys

18. Bogalusa Heart Study, 6-17 years old at baseline, n=2610 Freedman et al. Pediatrics 115:22, 2005 Proportion of Children Who Became Obese in Young Adulthood

20. Physical Consequences of Childhood & Adolescent Overweight & Obesity Sleep apnea Pickwickian syndrome Slipped capital epiphyses Tibial torsion Flat feet Increased risk of sprains and fractures Idiopathic intracranial hypertension Cholelithiasis Gastro-esophageal reflux Menstrual abnormalities Polycystic ovary syndrome Hypercorticism Left ventricular hypertrophy Breathing Problems Bone/Skeletal Problems Vascular Problems Digestive Problems Hormonal Problems Heart Problems

21. Actual Causes of Death in the US, 1990 & 2000 www.cdc.govwww.cdc.gov, 2004 JAMA 2004;291:1238-45, erratum 2005;293:293-4.

22. * Adjusted to 1995 dollars Wolf & Colditz Obesity Res 1998;6:97-106 Hodgson & Cohen Med Care 1999;37:994-1012

23. Energy Intake Energy Expenditure Body Fat Stores Obesity is Caused by Long-Term Positive Energy Balance

24. + 12 calories per day = 1 pound excess weight per year + 25 calories per day = 2 pounds excess weight per year + 125 calories per day = 10 pounds excess weight per year

25. Restaurant Portion Sizes – 1985 & Today Bagel3” diam.140 kcal 6” diam.350 kcal Turkey Sandwich320 kcal 820 kcal Coffee (whole milk & sugar) 8 oz. 45 kcal (whole milk & flavored syrup) 16 oz.350 kcal Blueberry Muffin1.5 oz.210 kcal 4 oz.500 kcal Spaghetti & Meatballs1 c.500 kcal 2 c.1025 kcal Soda 8 oz.100 kcal 20 oz.250 kcal

26. Calories Burned in 30 minutes – 165 pound person TV/computer/sitting in class65 Sleeping 40 Walking 95 Basketball – playing in game 300 Basketball – shooting baskets 165 Swimming laps 300 Running, jogging 250

27. One pound of body fat contains 3500 calories – if you eat 500 calories more each day than you burn off you will gain one pound in a week. Energy In must equal Energy Out to stay the same weight.

28. Westside Chicago Elementary School 6 th Grade8 th Grade Servings of chips 4 3 % of calories 25% 20% Servings of soda 3 2.5 % of calories 16% 15% Servings of milk 1 1 Servings of fruit/veg 1.5 1

29. What about candy? Calories King Size Reese’s Peanut Butter Cup 420 King Size Baby Ruth 480 Twizzlers - large bag 490 Now ‘N Later (regular pack) 280 Laffy Taffy (10 pcs) 380

30. What about candy? Calories Hours Walking King Size Reese’s Peanut Butter Cup 420 2hr 10min King Size Baby Ruth 480 2hr 30min Twizzlers - large bag 490 2hr 35min Now ‘N Later (regular pack) 280 1hr 30min Laffy Taffy (10 pcs) 380 2hr Doesn’t matter where the calories come from – fat or sugar – any extra over what you burn will turn to body fat

31. The New York Times Monday, May 25, 2005

32. USDA, Economic Research Service 2009 Sugar

33. USDA, Economic Research Service 2009 Vegetable Fruit

34. USDA, Economic Research Service 2009 Whole Lower Fat/Skim Total Regular Diet

35. Our Toxic Environment >5000 fast food franchises in schools 70% more meals eaten away from home Growing number of high calorie beverages Soft drink contracts with schools (?) Increased use of corn sweeteners 10,000 junk food ads each year Junk food advertising - $45/person Healthy food advertising - $1.50/person Increased TV & video games, Reduced emphasis on physical activity

36. Healthy Tips Avoid fad diets and quick weight loss schemes Drink plenty of water or other low calorie beverages Never skip meals Get up and go! 30 minutes of activity per day

37. What policy changes do you think would be effective? 1.Soda tax 2.Restricting advertising 3.Required phys ed with no opt-outs