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The Problem: Obesity in America

The Problem: Obesity in America. Frank J. Domino, M.D. Barbara Olendzki, RD, MPH. World Wide Rates of overweight and obesity, 2000-2004. US 66.3% UK 63.0% Mexico 62.3% Canada 57.5% Greece 57.1% New Zealand 56.2% Germany 49.2% Italy 42.6%.

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The Problem: Obesity in America

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  1. The Problem: Obesity in America Frank J. Domino, M.D. Barbara Olendzki, RD, MPH

  2. World Wide Rates of overweight and obesity, 2000-2004 US 66.3% UK 63.0% Mexico 62.3% Canada 57.5% Greece 57.1% New Zealand 56.2% Germany 49.2% Italy 42.6%

  3. Consequences of Obesity 66% of Americans are overweight* 22% of Americans are obese Deaths from Obesity: 300,000 premature deaths associated with obesity annually (CDC) 25,000/month, 5,769/week, 821/day, 34/hour. 450,000 from tobacco-related disease 10.4 million people with type II diabetes 47 million with metabolic syndrome *CDC 2006

  4. Is treating obesity a way to save the economy? • 2003: 9.1 % of U.S. health expenditures* • Estimated annual medical spending due to overweight and obesity (BMI >25) to be as much as $92.6 billion in 2002 dollars* • 2006: 10% of U.S. expenditures** • $147 billion in 2006 dollars** • (Afghan war ~ 28 Billion per year over 8 Yrs) *Finkelstein EA; Health Affairs Web Exclusive. 2003; W3:219-226. **Finkelstein EA; Health Affairs 28, no. 5 (2009): w822-w831

  5. Obesity Trends* Among U.S. AdultsBRFSS, 1985 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

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

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

  8. Obesity Trends* Among U.S. AdultsBRFSS,1990, 1999, 2009 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1999 1990 2009 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  9. State-specific Prevalence of Obesity* Among U.S. Adults, by Race/Ethnicity, 2006-2008 White non-Hispanic Black non-Hispanic Hispanic (*BMI 30)

  10. Summary • Non-Hispanic blacks, Hispanics, & non-Hispanic whites • For non-Hispanic blacks • Overall prevalence of obesity—35.7% • Midwest and South • Prevalence ranged from 23.0% (New Hampshire) to 45.1% (Maine) • 40 states had a prevalence of ≥ 30% • 5 states (Alabama, Maine, Mississippi, Ohio, and Oregon) had a prevalence of ≥ 40%

  11. Summary • For Hispanics • Overall prevalence of obesity—28.7% • Lower prevalence was observed in the Northeast • Prevalence ranged from 21.0% (Maryland) to 36.7% (Tennessee) • 11 states had a prevalence of ≥ 30% • For non-Hispanic whites • Overall prevalence of obesity—23.7% • Higher prevalence in the Midwest and South • Prevalence ranged from 9.0% (DC) to 30.2% (West Virginia) • Only one state (West Virginia) had a prevalence of ≥ 30% • 5 states (California, Colorado, Connecticut, Hawaii, and New Mexico) and DC had a prevalence of <20%

  12. What else has changed? Humans have a genotype that permits energy intake > expenditure Political decisions & industrialization of farms  growth of grain for livestock, rather than humans 1st in recorded history cost of meat < vegetables. ↑ portion sizes, ↑ fat intakes, sweetened beverages Lack of physical activity: ↓ Manual Labor, Computer/Screen time, increased automation allows for less activity @ home “What’s for Take Out?” 1.2 vs > 5.0 per week

  13. BAGEL 20 Years Ago Today 140 calories 3-inch diameter 350 calories 6-inch diameter If you rake the leaves for 50 minutes you will burn the extra 210 calories.* Calorie Difference: 210 calories 5 days/wk X 50 weeks=15.6 lb.

  14. CHEESEBURGER Today 20 Years Ago 333 calories 590 calories Calorie Difference: 257 calories If you lift weights for1 hour and 30 minutes,you will burn approximately 257 calories.*

  15. FRENCH FRIES You need to walk for1 hour and 10 minutes to burn approximately 400 extra calories 20 Years Ago Today 210 Calories 2.4 ounces 610 Calories 6.9 ounces Difference: 400 Calories

  16. The Solution:You and a little knowledge Frank J. Domino, M.D. Jill Grimes, M.D. Barbara Olendzki, RD, MPH

  17. Barriers to nutritional counseling Confusion over current guidelines Lack of time & compensation Effectiveness of interventions Confusion: nutrition as it relates to disease GOAL: 5 Brief Concepts to Recommend

  18. “Successful Losers” The National Weight Control Registry >5000 successful losers Members lost an average of 66 lbs (range=30-300 lbs) x 5.5 years (= 1 lb/month x 5 years) 78% eat breakfast every day. 75% weigh them self at least once a week. 62% watch < 10 hours of TV per week. 90% exercise, about 1 hour per day. http://www.nwcr.ws

  19. What about the average person?Daily Practices Survey 2004 US > 18 Yrs. “Successful Weight Loss Maintainers” Eat Fast Food < 2/Week > 5 Fruits & Vegetables/day ** AND 150 Minutes physical activity (25 Min/Day)

  20. What else can your Patients Do? 3200 Japanese, 30-69 Yrs Survey 2003-6 BMI, Eating “until full” & speed of eating Odds of Being Overweight Male Female Eating Till Full 2.00 1.84 Eating Quickly 1.84 2.09 Full & Quickly 3.13 3.21 Triple the odds !!! BMJ 2008: 337: a2002 Eat Slowly and question if still wants more

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