OBESITY , NUTRITION & Environment

1. OBESITY , NUTRITION & Environment Dr Swati Y Bhave Chairperson IAP Environment & Child Health Group Member IPA Environment committee

2. Today’s Environment promotes obesity :increased energy intake and decreased physical activity Lecture contents • How -Current environment is contributing to obesity epidemic • Why -our physiology is permissive to the gradual weight gain produced by the current environment. • Brief discussion - nature of body weight regulation & how different environments could differentially impact this regulation • Consider- strategies for dealing with the environment to reduce the prevalence of obesity.

3. WHY DOES OUR PHYSIOLOGY PERMIT GRADUAL WEIGHT GAIN-1 • Older environments - an unreliable food supply & high need for physical activity to procure food to survive. • No logical reason for humans to develop a strong physiological defense against weight gain. • The weak physiological regulation of energy balance was effective.

4. WHY DOES OUR PHYSIOLOGY PERMIT GRADUAL WEIGHT GAIN-2 • Gradual weight gain currently seen - is a relatively new phenomenon and likely attributable to • a changing environment that provides a constant food supply and with reduced needs for physical activity for procurement to survive. • Affluent people : with abundant food supply Need to Restrict energy intake in order to match a very low level of energy expenditure.

5. How has the obesity epidemic arisen • Most of the Affluent population has been in slight positive energy balance over the past 10-15 years. • Cardia study : gradual small, consistent weight gain, produced by a small, consistent degree of positive energy balance of less than 50 kcal/day causing weight of .5-2 kg/yr • Theoretically, prevention of this wt gain should take far less than 60-90 min/day of moderate intensity physical activity. CARDIA Websitehttp://www.dopm.uab.edu/cardia/

6. Our Current Environment Each component of our environment facilitates obesity. • The Built environment. • The Commercial environment • The Policy environment • The Social and cultural environment. Booth SL, Sallis JF, et al Environmental and societal factors affect food choice and physical activity: rationale, influences and leverage points. Nutrition Reviews 2001, 9(3):S21-S39.

7. Built environment • Includes transportation systems, architectural design, use of land, parks, and public spaces. • Life style discourages physical activity / encourage automobile use • Neighborhoods without sidewalks - discourage walking. • Tall buildings discourage stair case / encourage elevator and escalator use Booth SL, Sallis JF, et al • http://ceq.eh.doe.gov/nepa/nepanet.htm

8. Commercial environment • Low cost junk food available everywhere heavily advertised especially to children. • Many schools -vending machines HED / fast food outlets. • Heavy promotion of activities and products that discourage physical activity. • Sedentary forms of entertainment eg Home entertainment systems etc Booth SL, Sallis JF, et al

9. Policy environment Change policies • Restrictions on "undesirable" eating behavior. • Remove junk foods from schools, • Taxes on "unhealthy foods“ Ban soft drinks, • Regulate advertising for undesirable foods • Lable all nutritive contents , • Reduce sugar consumption • Discourage consumption of HDE/ manufactured foods • Encourage consumption of fruits and vegetables. • Physical Education in schools made compulsory • More physically active transportation.

10. Social & cultural Environment Previous environments, high levels of physical activity to acquire food Physiological control food intake to match the energy requirement Extremely difficult to restrict food given the constant availability of good-tasting, low cost food or affluence for high cost food and a environment that promotes eating when food is available. healthy body wt difficult to achieve a without conscious effort. Cognitive management is vital to restrict food intake and increase physical activity Hill JO, Wyatt HR, Reed GW, Peters JC. Obesity and the Environment: Where do we go from here? Science 2003;299:853-855.

11. Environmental factors that reduce physical activity Technological advancesreduce need for physical activity • In most occupations • In most jobs • For daily living and household activities • In schools • Competition from attractive sedentary activities: • television, video/DVD, video/computer games, internet Low level of physical activity is well known to cause weight gain

12. Environment factors that promote overeating • Portion Size • High Fat • Energy Dense • High Glycemic Index • Soft Drinks • Sugar • Fast foods • Snack foods • Low calcium • Easy accessibility • Low Cost • Taste • Variety

13. STRATEGIES FOR DEALING WITH THE OBESITY EPIDEMIC • Modifying PHYSICAL ACTIVITY • Modifying DIET • choosing a strategy to change the environment • Behavior changes • primary prevention of weight gain • Prevention of further weight gain • Weight loss • prevention of weight regain Best to Begin with small changes

14. America on the Move: A catalyst for Change • National initiative to inspire people to make two small changes to prevent further weight gain and improve lifestyle. AOM asks people to • 1) walk an additional 2000 steps (about 1 mile) each day (burns about 100 kcal) • 2) choose one eating behavior each day that eliminates about 100 kcal. • These two simple behaviors, most of the population, regardless of age, can prevent further weight gain. • For children, these changes can reduce excessive weight gain. America on the Move (AOM; americaonthemove.org)

15. MODIFYING DIET TO PREVENT WEIGHT GAIN • Public support for healthier lifestyles needs to begin with our children. • Teach early - why physical activity and healthy eating are so important. • Provide them with the knowledge and the cognitive skills to manage energy balance in the modern environment. • http://ceq.eh.doe.gov/nepa/nepanet.htm • http://www.surgeongeneral.gov/topics/obesity/

16. MONITORING AND COUNSELLING THE ADOL • Most Fetal origin of adult diseases related disorders can be prevented or effectively managed if picked up early in life • Main preventive public health campaign directed towards life style changes in the family / society as a whole. • The benefits of healthy eating, increased physical activity and reduction in sedentary activities have to be inculcated from early age. • School based programmes are most likely to be successful but health authorities and media have an important role to play to spread awareness. Greydanus DE, Bhave Swati YEditorial : Obesity and adolescents. Time for increased activity. Indian Pediatr 2004; 41: No 6

17. Summary • The global epidemic of obesity is driven by an environment that encourages overeating and discourages physical activity, creating a consistent bias toward positive energy balance. • This small degree of sustained, positive energy balance is causing weight gain at a rate of .5-2 kg/year. • Urgent need for action - increasing physical activity is the best place to start, 60-90 min /day • Substantial efforts be directed toward modifying the environment to increase physical activity.