2. Learning outcomes Define obesity Identify the prevalence of obesity worldwide, nationwide and in Texas List the various health risks associated with obesity Identify how nutrition and obesity are connected List the benefits of menu nutrition labeling Identify how nutrition labeling can help to address the problem of obesity

3. Obesity Defined Abnormal or excessive fat accumulation affecting health BMI (Body Mass Index) is used for determination (weight and height) Weight in kilograms divided by height in kilograms per meters squared Overweight: BMI greater or equal to 25 Obese: BMI greater or equal to 30 Overweight and obesity are leading causes of death globally 3.4 million adult deaths each year 44% of diabetes burden; 23% of ischemic heart disease [World Health Organization (WHO, 2014)].

4. The Obesity Crisis Obesity is a growing problem Doubled worldwide since 1980 In 2008: 1.4 billion adults (20 years and older) were overweight 200 million men and 300 million women obese (2008) 42 million children under 5 years were overweight or obese in 2013 (WHO, 2014)

5. The Obesity Crisis Cont…  More than a third of the adult population in the United States (U.S) is obese  34.9% or 78.6 million  Major, preventable health problems  Heart disease, stroke, cancer, type 2 diabetes  High medical cost due to obesity  $US147 billion in 2008  Video on the obesity epidemic http://www.cdc.gov/CDCTV/ObesityEpidemic/ [Centers For Disease Control and Prevention (CDC, 2014)]; (CDC, 2013)

6. Obesity Prevalence among U.S Adults (2009-2010) (CDC, 2012c)

7. Obesity Prevalence among U.S children and adolescents (2009-2010) (CDC, 2012c)

8. Obesity in Texas  Overweight and obesity is a problem in Texas  Adults age 18 and over  65.9% overweight (BMI 25 or more); 31.0% of adults are obese  Adolescents (grades 9 to 12)  15.6% overweight; 13.6% obese  Children (2 to 5 years)  16.8% overweight; 15.3% obese (CDC, 2012a)

9. Problem in South Texas  Obesity and even bigger issue in South Texas  Home to 18% of the Texas Population  Predominantly Hispanic, low income, less health care access  Higher obesity rates compared to the rest of the state  32.7% obese adults; 29.1 in Texas; 27% nationwide (South Texas Health Status Review, 2013)

10. Causes of Obesity  Variety of factors come into play  Energy imbalance  Intake of more calories than you use  Genetics, metabolism, environment, behavior  Behavior and environment play major roles  Greatest areas for prevention and treatment (CDC, 2012b)

11. Nutrition and Obesity Increase in the number of meals eaten outside the home On average six times a week Negative health and nutritional impacts due to higher calorie intake High calorie fatty foods, less fruits, vegetable, fiber Positive relation between weight increase and frequency of eating out at restaurants Eating in restaurants linked to obesity and poor diet (Saelens, Glanz, Sallis & Frank, 2007; Wootan, Osborn & Malloy, 2006)

12. Menu Nutrition Labeling  Allow consumers to make informed decisions and exercise responsibility for their health  Help to manage weight and reduce risk of heart disease, diabetes, high blood pressure  78% are in favor of nutrition information in restaurants  Makes for easier comparison of options  Help in prevention measures against obesity [Center For Science in the Public Interest (CSPINET, 2011)]

13. Menu Nutrition Labeling (Benefits)  Reduce calorie intake in customer choices by 14% (Stanford Study)  Used by 15% of customers; 100 fewer calories used (New York Study)  Improvements in choices from various restaurants  Starbucks- 5% cut in calories and 15% fat cut from pastry items; 14% calories and 36% fat from drinks  Cosi- reduced fat dressing and half cheese in salad; 610 to 380 calories  Smaller portions introduced on menus (CSPINET, 2011)

14. Menu Nutrition Labeling (Benefits) Cont…  Promote a balanced diet  Better understanding of nutritional value of food  Compare nutritional value of similar food products; make healthier decisions  Enables those with certain health issues (diabetes, hypertension) to help better manage condition  Saves lives and health care costs  U.S : Savings ($4400 million to $26000 million) associated with cancer and coronary heart disease  Australia and New Zealand: 320 to 460 lives annually saved if mandatory nutrition labeling (Centre For Food Safety, 2010)

15. Research Studies  2007 New York fast food chains study  7318 customers; 275 restaurants; 11 fast food chains  Those who saw calorie information purchased 52 fewer calories; fewer purchase high calorie meals  37% of those who used the information reported having an effect on purchase  Those who saw and used information purchased 99 fewer calories than those who saw and it had no effect on (Basset et al., 2008)

16. Research Studies Continued…  2009 Study: How caloric information affect college students’ choices  Students randomly assigned to receive menus with and without calorie information (111 men; 177 women)  Women ordered fewer calories per meal and lower calorie item when information was given  Translate to 7,592 calories annually; 2.2 pounds lost in a year; eating once a week  Choosing lower calorie items  No change with men (Gerend, 2009)

17. Concluding Statements  Obesity is on the rise  The health of the world, a nation, and a city is at risk  Increase in eating outside the home  Food and nutrition play a vital role in obesity  Restaurants can contribute by providing nutrition information

18. References Basset, M. T., Dumanovsky, T., Huang, C., Silver, L. D., Young, C., Nonas, C.,... Frieden, T. R. (2008). Purchasing behavior and calorie information at fast- food chains in New York City, 2007. American Journal of Public Health, 98 (8), p. 1457-1459. doi:10.2105/AJPH.2008.135020 Centers For Disease Control and Prevention. (2014). Adult Obesity Facts. Retrieved from http://www.cdc.gov/obesity/data/adult.html Centers For Disease Control and Prevention. (2012b). Causes and Consequences. Retrieved from http://www.cdc.gov/obesity/adult/causes/index.html Centers For Disease Control and Prevention. (2013). CDC-TV: The Obesity Epidemic. Retrieved from http://www.cdc.gov/CDCTV/ObesityEpidemic/http://www.cdc.gov/CDCTV/ObesityEpidemic/ Centers For Disease Control and Prevention. (2012c). NCHS Data Brief. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db82.htm Centers For Disease Control and Prevention. (2012a). Texas's Response to Obesity. Retrieved from http://www.cdc.gov/obesity/stateprograms/fundedstates/texas.html http://www.cdc.gov/obesity/stateprograms/fundedstates/texas.html

19. References Cont… Center For Science in the Public Interest. (2011). Nutrition labeling on menus at restaurants. Retrieved from http://cspinet.org/new/pdf/factsheet-why-menu- labeling2011.pdfhttp://cspinet.org/new/pdf/factsheet-why-menu- Centre For Food Safety. (2010). Benefits of nutrition information on food labels. Retrieved from http://www.cfs.gov.hk/english/programme/programme_nifl/programme_nifl _02.html Gerend, M. A. (2009). Does calorie information promote lower calorie fast food choices among college students? Journal of Adolescent Health, 44, p. 84-86. doi: 10.1016/j.jadohealth.2008.06.014 Saelens, B. E., Glanz, K., Sallis, J. F. & Frank, L. D. (2007). Nutrition environment measures study in restaurants (NEMS-R). American Journal of Preventive Medicine, 32 (4), p. 273-281. doi:10.1016/j.amepre.2006.12.022 South Texas Health Status Review. (2013). Obesity, diabetes are the biggest health threats in South Texas. Retrieved from https://ihpr.uthscsa.edu/sites/ihpr/files/SouthTXReview-News-8-20-13.pdf https://ihpr.uthscsa.edu/sites/ihpr/files/SouthTXReview-News-8-20-13.pdf

20. References Cont… World Health Organization. (2014). Obesity and overweight. Retrieved from http://www.who.int/mediacentre/factsheets/fs311/en/ Wootan, W. G., Osborn, M. & Malloy C. J. (2006). Availability of point-of-purchase nutrition information at a fast-food restaurant. Preventive Medicine, 43, p. 459-459.doi:10.1016/j.ypmed.2006.07.008

21. Additional Links http://www.fda.gov/Food/IngredientsPackagingLabeling/La belingNutrition/ http://www.fda.gov/Food/IngredientsPackagingLabeling/La belingNutrition/ucm217762.htm http://www.fda.gov/Food/IngredientsPackagingLabeling/La belingNutrition/ucm2006870.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6327a1. htm http://www.cdc.gov/obesity/downloads/menulabeling.pdf

22. Any Questions? Thank You!!!