Evolution of the Obesity Epidemic

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Evolution of the Obesity Epidemic

• Information from Time Magazine, National
  Geographic Magazine, and other sources

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Exercise and Body Composition

• Two major factors that lead to obesity
• Over-nutrition consuming too much
• Under-expenditure expending too little energy

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Over-nourishment

• Increased caloric consumption
• Increased portion sizes
• Eating as entertainment

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Exercise and Body Composition

• Decreased daily energy expenditure
• Transportation
• Manual Labor
• Entertainment

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Role of Genetics

• About 2/3rds of tendency for obesity is genetic
• Factors include
• Low RMR 15
• High RQ (low fat oxidation) 5
• Low spontaneous physical activity (fidgeting) 10
• Other???
• (Ravuzzin, ACSM, 2008)

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Ancient History

• Humans started by living in a world of scarcity.
• To survive they developed the habit of eating
  everything that tasted good whenever they could
  find it.

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Ancient History

• That's the way it was during 99.9 of human
  evolution.
• For most of the 7 million years of human
  existence, life has been "nasty, brutish, and
  short"
• Thomas Hobbes

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Ancient History

• Life expectancy was under 30 years - mainly due
  to accidents, infection, childbirth, and
  predation.

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Ancient History

• Early diet consisted of fruits, shoots, nuts,
  tubers, and vegetation - all low in calories -
  took constant work and eating whatever we found
  just to stay alive.
• Fruits were highly desirable so we learned to
  seek fructose and glucose.

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Evolution

• It was some 2.5 million years ago that our
  ancestors developed a taste for meat.
• As a result, the human brain became markedly
  bigger and more complex at the same time.
• We also increased in physical size.

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Evolution

• Because it's packed with nutrients and calories,
  meat gave early humans a respite from constant
  feeding.
• Our ancestors ate a diet composed of lean meats,
  vegetables, and fruits and worked out almost
  nonstop.

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Agriculture

• 150,000 to 100,000 years ago.
• Provided steady source of food.
• No longer hunter/gatherers.
• Farming became major source of food.

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Agriculture

• Nutritionally the shift away from wild meat,
  fruits and vegetables to a diet of mostly
  cultivated grains robbed humans of many of the
  essential amino acids.
• Still physical exertion was common.

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Progress?
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Environment

• Our bodies evolved in an environment where food
  was scare and movement was required
• We now find ourselves in an environment where
  food is abundant and movement is optional
  recent development

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Then and Now

• In 1700, the average Briton consumed 7.5 pounds
  of sugar per year.
• In the US, we currently consume 150 pounds of
  sweetener per year.

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Overconsumption

• We each ate 1775 pounds of food in 2000, up from
  1497 in 1970.
• Although it appears we are eating more
  vegetables, almost 1/3 of these vegetables were
  iceberg lettuce, French fries, and potato chips.

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Now

• Rapid change in environment last 50 years
  compared to previous 50,000 years.
• Removal of physical activity combined with
  abundance of food.

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Now
Daily imbalance is on average small an extra can
of soda per day (150 kcal) can add 15.6 pounds
per year
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Factors Related to Obesity

• Food producers and the "Fast Food industry - if
  theyre successful, we all eat more

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Childhood Obesity

• The growth of the fast food industry and
  increasing portion sizes make it easy for
  children to overeat

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Supersize Me
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Childhood Obesity

• A large fast food meal (double cheeseburger,
  French fries, soft drink, desert) could contain
  2200 kcal, which would require a full marathon
  to burn off
• Ebbeling CB, Pawlak DB, Ludwig DS. Childhood
  obesity public health crisis, common sense cure.
  Lancet 2002360473-82.

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Childhood Obesity

• On days that children and youth eat fast food
  they consume an extra 126 kcals/day (Plt0.0001)
• Bowman S, Gortmaker SL, Ebbeling CB, Pereira MA,
  Ludwig DS. Effects of fast food consumption on
  energy intake and diet quality among children in
  a national household survey. Pediatrics, in
  press.

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Twenty Worst Foods in America
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Childhood Obesity

• Sugar-sweetened beverages contribute to childhood
  obesity incidence

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Childhood Obesity

• For each additional serving of sugar sweetened
  beverage consumed, both BMI (0.243 kg/m2
  P0.03), and incidence of obesity (odds ratio
  1.60 P0.02) increased.
• Ludwig DS, Peterson KE, Gortmaker SL. Lancet
  2001, 357505-8

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Childhood Obesity

• Television and video/film production and
  distribution industry - if theyre successful we
  all watch more

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Now

• Advertisers constantly telling us to "eat this
  now".
• Obesity increases as industrialization increases.

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A Widening Problem

• In a historical first, there are now as many
  overnourished people as undernourished around the
  world.

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Why are we fatter?

• Here's the recipe for obesity on such a global
  scale
• Take technologycars, washing machines,
  elevatorsthat reduces physical exertion.
• Increase calorie consumption, courtesy of
  increasing prosperity.  

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A Widening Problem

• Add television, computers and video games.
• Stir in the intensive marketing of candy and fast
  food, and you have the makings of an epidemic.

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A Widening Problem

• In countries where the food supply has been
  unstable, people are getting fat despite far less
  abundance than in the United States.

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A Widening Problem

• The implication?
• Newly industrialized nations in Asia, Africa, the
  Caribbean, and Latin America may develop even
  higher rates of obesity-related health problems
  than in the U.S.

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A Widening Problem
gt24 20-24 15-19 10-14 0-9 No data
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A Widening Problem

• North AmericaStates with the highest obesity
  ratesMississippi and Alabamaare in the South.
  The more affluent and outdoorsy western states of
  Colorado and Utah have the lowest rates. South
  AmericaAs Latin America becomes more developed,
  supermarkets stocked with processed foods have
  become the norm, rising from 20 percent of food
  retail during the 1980s to 60 percent in 2000. 

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A Widening Problem

• EuropeCandy, fast food, and sweetened cereals
  account for more than half the food ads in ten
  European Union nations. In the U.K. snack food
  consumption rose nearly 25 percent in five
  years. AfricaIn some parts of Africa obesity
  afflicts more children than malnutrition. In
  Tunisia the urban population is shifting from
  traditional healthy whole grain breads to white
  bread. 

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A Widening Problem

• AsiaIn Shanghai, roads once filled with
  pedestrians and cyclists are now congested with
  cars. KFC opened a drive-through restaurant in
  Beijing in 2002, with more to come. OceaniaPaci
  fic Islanders have always valued hefty physiques.
  Now their shift away from local foods to a
  high-fat, Western diet has made them among the
  world's fattest people

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Now

• The Puget Sound ferries in Washington have
  increased the width of their seats from 18 to 20
  inches to allow squeeze-in room for bigger
  bottoms.

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Now

• In Colorado, an ambulance company has retrofitted
  its vehicles with a winch and a plus-size
  compartment to handle patients weighing up to
  half a ton (1000 lbs).

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Now

• An Indiana manufacturer of caskets now offers a
  double-oversize model - 38 inches wide, compared
  with a standard 24 inches.

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Discrimination

• In one study at Michigan State University,
  undergraduates said they would be more inclined
  to marry an embezzler or cocaine user than an
  obese person.

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Discrimination
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The Stigma of Childhood ObesityCan be
devastating

• An obese childs quality of life is similar to
  the life of a child diagnosed with cancer, which
  has been determined as the lowest quality of life
  score.1

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The Stigma of Childhood Obesitycan be
devastating

• Adolescents who are teased about their weight are
  2 to 3 times more likely to have suicidal
  ideation and attempts compared to adolescents who
  are not teased about their weight. 2

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The Stigma of Childhood ObesityCan be
devastating

• Obese children and adolescents are 4 times more
  likely to experience impaired school function
  when compared with healthy children and
  adolescents. 1
• Obese children and adolescents have been found to
  miss an average of 4.2 days of school during the
  month. 1

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It starts early

• Low self esteem is not a characteristic in inner
  city obese African American children or obese
  preschool children. 3
• Levels of self esteem of preschool children do
  not differ between non obese and obese children,
  but upon entering school this feelings change
  substantially. 3

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Negatively affects school aged children and
adolescents

• 4-11 year old children describe obese peers has
  ugly, selfish, lazy stupid, dishonest,
  socially isolated and subjects of teasing
  compared to their average weight peers who were
  described as clever, healthy, attractive,
  kind, happy, socially popular and a
  desirable playmate. 4
• Overweight adolescents are more likely to be
  isolated and peripheral to social networks then
  their normal weight peers. 5

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Negatively affects school aged children and
adolescents

• Social marginalization is more pronounced in
  white non Hispanic adolescent girls. 5
• 90 of 9-11 year old overweight children believe
  that teasing and harassment from their peers
  would end if they could lose weight and 69 felt
  that if they were thinner they would have more
  friends. 6

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It is also seen in homes, schools and clinical
settings

• 30.0 of adolescent girls and 24.7 of adolescent
  boys report being teased about their weight by
  their peers. 2
• 28.7 of adolescent girls and 16.1 of adolescent
  boys report being teased about their weight by
  someone in their families. 2
• 14.6 of adolescent girls and 9.6 of adolescent
  boys report being teased about their weight by
  both their peers and family members.2

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It is also seen in homes, schools and clinical
settings

• Parents communicate to their children negative
  stereotypes about obese children. 7
• Parents of overweight children are criticized and
  feel that they are guilty and to blame for their
  childs obesity. 6
• On implicit and explicit measures, health
  professionals labeled obese people as lazy,
  stupid or worthless. 8

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Perception vs Reality

• Who do we think we are or strive to be?
• vs
• Who we actually are?

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Mr and Ms America?
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Mr. And Ms. America
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Conan the Governor
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Jack Nicholson
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Jack Nicholson
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Denise Richards
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• What this leads to is body disatisfaction

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Eating Disorders
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Progress?

• By contrast, among people who still live in
  conditions most like those of our distant Stone
  Age ancestors - Maku or Yanomami of Brazil -
  there is virtually no obesity at all.

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Tsunami of Health Care
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Tsunami of Health Care

• Cardiovascular Disease
• Diabetes Mellitus
• Glucose Intolerance
• Overweight and Obesity
• Sedentary Lifestyle