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My Most Provocative Recommendations to the USA Joint Commission on Sports Medicine and Science Philadelphia, PA February

My Most Provocative Recommendations to the USA Joint Commission on Sports Medicine and Science Philadelphia, PA February 27, 2001. Steven N. Blair Professor Arnold School of Public Health University of South Carolina. Disclosures. Medical/Scientific Advisory Boards Jenny Craig, Inc Alere

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My Most Provocative Recommendations to the USA Joint Commission on Sports Medicine and Science Philadelphia, PA February

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  1. My Most Provocative Recommendations to the USAJoint Commission on Sports Medicine and SciencePhiladelphia, PAFebruary 27, 2001 Steven N. Blair Professor Arnold School of Public Health University of South Carolina

  2. Disclosures • Medical/Scientific Advisory Boards • Jenny Craig, Inc • Alere • Technogym • Cancer Foundation for Life • Santech • Clarity Project • Research Funding • NIH • Body Media • Coca Cola • Department of Defense

  3. Outline • Activity/fitness, or obesity—which is most important? • Misinformation about obesity and health • Quackery and nostrums about diet and exercise • What should we do • Discover the cause of the obesity epidemic • Expertise on the President’s Council on Fitness, Sports & Nutrition • Equal attention to diet and physical activity • K-12 education on behavioral change • Increase gasoline tax

  4. Activity/fitness is far more important than fatness as a clinical or public health problem

  5. Ranking of selected risk factors: 6 leading causes of death by income group, estimates for 2004 Percentage of total (total: 1.53 billion) World Health Organization. http://www.who.int/healthinfo/global_burden_disease/global_health_risks/en/index.htm

  6. Physical Activity and CRF as Predictors of All-cause Mortality 31,818 men and 10,555 women 1492 deaths in men during average follow-up of 14.6 years, and 230 deaths in women during average follow-up of 12.8 years PA mortality trends not significant after adj for CRF CRF trends significant after adj for PA Phys Act CRF Lee DC, et al. BJSM; pub online April 23, 2010

  7. RR for All-cause and CVD Mortality in Fit and Unfit ACLS Men by Body Fat Categories Body Fat% Body Fat% All-cause Mortality CVD Mortality *adjusted for age, exam year, smoking, alcohol, & parental history Lee CD, Blair SN, & Jackson AS. Am J Clin Nurt 1999; 69:373-80

  8. Adjusted RR for All-Cause Mortality by Fitness and BMI, ACLS Women *adj for age, exam year, smoking, & health status Farrell et al. Obes Res. 2002; 10:417-423

  9. CRF and %Body Fat on Mortality Risk in 13,155 Hypertensive Men * Adjusted for age, exam year, physically inactive, family history, smoking, alcohol, resting SBP and DBP, & diabetes and hypercholesterolemia

  10. Outline • Activity/fitness, or obesity—which is most important? • Misinformation about obesity and health • Quackery and nostrums about diet and exercise • What should we do • Discover the cause of the obesity epidemic • Expertise on the President’s Council on Fitness, Sports & Nutrition • Equal attention to diet and physical activity • K-12 education on behavioral change • Increase gasoline tax

  11. Uncritical, Unfounded, or Unusual Comments about Obesity and Health

  12. JAMA Used Pages for This? • Obesity in the National Football League. JAMA 2005; 293:1061-2 • Nearly all were overweight • More that 25% had Class 2 obesity • In other words, NFL players are big

  13. We must improve school lunches because American children eat 50% of their calories at school.Mrs. ObamaFebruary 2010

  14. Which causes more deaths in the U.S.—smoking or obesity? • ~40% of U.S. adults think obesity causes at least as many deaths as does smoking • ~20% of U.S. adults think obesity causes more deaths than smoking • The truth • Smoking causes ~440,000 deaths/year • Obesity causes ~110,000 deaths/year

  15. Outline • Activity/fitness, or obesity—which is most important? • Misinformation about obesity and health • Quackery and nostrums about diet and exercise • What should we do • Discover the cause of the obesity epidemic • Expertise on the President’s Council on Fitness, Sports & Nutrition • Equal attention to diet and physical activity • K-12 education on behavioral change • Increase gasoline tax

  16. Model in the Article • Sky Reach-15 reps each side • Speed Intervals-10 sec at a moderate pace then 20 seconds at a fast pace for a total of 2 minutes • Bench Push-ups-15 reps • Walking Lunge-2 minutes • Tree Back Rows-15 reps • Speed Intervals (same as #2) • Jump Pull-ups-15 reps • Speed Steps-up and down stairs for 2 minutes • Hanging Leg Raise-15 reps • Speed Intervals (same as #2)

  17. Drop 12 Pounds this Month • Lose 5 pounds the first week • Consume 1200 kcal/day • Do the 10 exercises/day (total of 40 min) • Estimate her weight 100-110 pounds (~50 kg) • Estimate the 40 min workout is an average increase of 4 times resting metabolic rate • 1 MET=1 kcal/kg/hour • So, 4 x 50 X .66=132 kcal/workout • Five pounds/week=calorie deficit of almost 16,000 calories • Somehow the math doesn’t work

  18. Outline • Activity/fitness, or obesity—which is most important? • Misinformation about obesity and health • Quackery and nostrums about diet and exercise • What should we do • Discover the cause of the obesity epidemic • Expertise on the President’s Council on Fitness, Sports & Nutrition • Equal attention to diet and physical activity • K-12 education on behavioral change • Increase gasoline tax

  19. Causes of the Obesity Epidemic

  20. It’s calories that count Energy Out Energy In Portion size High-fat foods Energy dense Low-fiber Soft drinks Snack foods BMR Thermic effect of food Media (TV,PC) Cars No heavy labour Exercise

  21. Is the Average Total Daily Caloric Intake Increasing?

  22. Trends in Energy IntakeNHANES 1971-2000 • Data sources • NHANES I—1971-1974 • NHANES II—1976-1980 • NHANES III—1988-1994 • NHANES—1999-2000 • Surveys were representative samples of noninstitutionalized U.S. women and men aged 20 to 74 years Source: MMWR Feb 6, 2004

  23. Trends in Energy Intake1971 to 2000, Men, NHANES Kcal/day Source: MMWR Feb 6, 2004

  24. Trends in Energy Intake1971 to 2000, Women, NHANES Kcal/day Source: MMWR Feb 6, 2004

  25. NHANES Survey Methods 1971-2000 • NHANES I and NHANES II • 24-hour dietary recall, Monday-Friday • NHANES III and NHANES • 24-hour dietary recall, Monday-Sunday • Other changes in methodology included better probing techniques and better training of interviewers • Other changes in dietary behavior included more meals eaten away from home and increasing portion sizes

  26. Obesity Epidemic Caused by Eating too Much, Claims Academic • Average caloric expenditure in 1980 • Women=950 kcal/day • Men=1380 kcal/day • Average caloric intake is now 3,500 kcal/day • “Over the past 25 years…there has been no change in our levels of physical activity” “there has been no change in energy expenditure” Article on British Science Festival in the September 16, 2010 Daily Telegraph

  27. Outline • Activity/fitness, or obesity—which is most important? • Misinformation about obesity and health • Quackery and nostrums about diet and exercise • What should we do • Discover the cause of the obesity epidemic • Expertise on the President’s Council on Fitness, Sports & Nutrition • Equal attention to diet and physical activity • K-12 education on behavioral change • Increase gasoline tax

  28. President’s Councils • President’s Council of Economic Advisors • Chair, Austan Goalsbee, on leave from the Univ of Chicago Booth School of Business • Cecilia Rouse, Professor of Economics and Public Affairs, Princeton University • President’s Council on Fitness, Sports & Nutrition • Co-Chair, Drew Brees, New Orleans Saints • Co-Chair, Dominique Dawes, Olympic gymnast

  29. Outline • Activity/fitness, or obesity—which is most important? • Misinformation about obesity and health • Quackery and nostrums about diet and exercise • What should we do • Discover the cause of the obesity epidemic • Expertise on the President’s Council on Fitness, Sports & Nutrition • Equal attention to diet and physical activity • K-12 education on behavioral change • Increase gasoline tax

  30. Liposuction can’t salvage Navy career-Washington Post, 1/31/11 • Mick Kruger, 38 year old master-at-arms • Never failed a fitness test • Routinely scores ‘excellent’ on 1.5 mile run • Has run one marathon and done 3 others on in-line skates • Performance evaluations laud him for ‘superb military performance’ • 6’ 4” tall and 240 pounds • Neck=16” and Waist=40.5 inches • Navy is dismissing him because he is too fat • Who would you rather have defending you against a bad guy? • Mick or ….

  31. Outline • Activity/fitness, or obesity—which is most important? • Misinformation about obesity and health • Quackery and nostrums about diet and exercise • What should we do • Expertise on the President’s Council on Fitness, Sports & Nutrition • Equal attention to diet and physical activity • K-12 education on behavioral change • Increase gasoline tax

  32. Outline • Activity/fitness, or obesity—which is most important? • Misinformation about obesity and health • Quackery and nostrums about diet and exercise • What should we do • Expertise on the President’s Council on Fitness, Sports & Nutrition • Equal attention to diet and physical activity • K-12 education on behavioral change • Increase gasoline tax

  33. Thank you for your attention, and for allowing me to express my provocative ideas

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