1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

50 75 100 125 150 175 200 225 250

Are You Overweight?

Source: Report of the

Dietary Guidelines Advisory

Committee on the Dietary

Guidelines for Americans , 1995,

pages 23-24.

6’6”

6’5”

6’4”

6’3”

6’2”

6’1”

6’0”

5’11”

5’10”

5’9”

5’8”

5’7”

5’6”

5’5”

5’4”

5’3”

5’2”

5’1”

5’0”

4’11”

4’10”H

ealt

hy W

eigh

tM

oder

ate

Ove

rwei

ght

Seve

re O

verw

eigh

t

Pounds (without clothes)

Hei

ght

(wit

hou

t sh

oes)

23.022

Obesity* Trends Among U.S. AdultsBRFSS, 1985

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

Source: BRFSS, CDC.

No Data <10% 10%-14% 15-19% 20%

Obesity* Trends Among U.S. AdultsBRFSS, 1986

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

No Data <10% 10%-14% 15-19% 20% Source: BRFSS, CDC.

Obesity* Trends Among U.S. AdultsBRFSS, 1987

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

Source: BRFSS, CDC.

No Data <10% 10%-14% 15-19% 20%

Obesity* Trends Among U.S. AdultsBRFSS, 1988

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

Source: BRFSS, CDC.

No Data <10% 10%-14% 15-19% 20%

Obesity* Trends Among U.S. AdultsBRFSS, 1989

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

Source: BRFSS, CDC.

No Data <10% 10%-14% 15-19% 20%

Obesity* Trends Among U.S. AdultsBRFSS, 1990

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

Source: BRFSS, CDC.

No Data <10% 10%-14% 15-19% 20%

Obesity* Trends Among U.S. AdultsBRFSS, 1991

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

Source: BRFSS, CDC.

No Data <10% 10%-14% 15-19% 20%

Obesity* Trends Among U.S. AdultsBRFSS, 1992

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

Source: BRFSS, CDC.

No Data <10% 10%-14% 15-19% 20%

Obesity* Trends Among U.S. AdultsBRFSS, 1993

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

Source: BRFSS, CDC.

No Data <10% 10%-14% 15-19% 20%

Obesity* Trends Among U.S. AdultsBRFSS, 1994

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

Source: BRFSS, CDC.

No Data <10% 10%-14% 15-19% 20%

Obesity* Trends Among U.S. AdultsBRFSS, 1995

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

Source: BRFSS, CDC.

No Data <10% 10%-14% 15-19% 20%

Obesity* Trends Among U.S. AdultsBRFSS, 1996

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

Source: BRFSS, CDC.

No Data <10% 10%-14% 15-19% 20%

Obesity* Trends Among U.S. AdultsBRFSS, 1997

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

Source: BRFSS, CDC.

No Data <10% 10%-14% 15-19% 20%

Obesity* Trends Among U.S. AdultsBRFSS, 1998

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

Source: BRFSS, CDC.

No Data <10% 10%-14% 15-19% 20%

Obesity* Trends Among U.S. AdultsBRFSS, 1999

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

Source: BRFSS, CDC.

No Data <10% 10%-14% 15-19% 20%

Obesity* Trends Among U.S. AdultsBRFSS, 2000

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

Source: BRFSS, CDC.

No Data <10% 10%-14% 15-19% 20%

%

(Flegal, JAMA 2002)

overweight / obese

obese

0

10

20

30

40

50

60

70

1988 - 1994 1999 - 2000

0

5

10

15

1960's

1971-74

1976-80

1988-91

Changes in the Prevalence of Obesity (BMI > 95th Percentile) Among U.S.

Female Children and Adolescents

Obesity in the USA, 1991-98Region

0%2%4%6%8%

10%12%14%16%18%20%

1991 1998

Per

cen

tag

e O

bes

e

New England: + 46%

Pacific: + 67%

Midwest: + 36%Mid-Atlantic: +32%Southeast: + 67%

0

1

2

3

4

5

6

21 22 23 24 25 26 27 28 29 30

Body-Mass Index

Rel

ativ

e R

isk

Type 2 diabetes

Cholelithiasis

Hypertension

Coronary heart disease

Women

Calle et al., 2003

Relative Risk of Cancer MortalityWomen

RR

0.0

1.0

2.0

18.5 - 24.9 25.0 - 29.9 30.0 - 34.9 35.0 - 39.9

BMI

Colorectal Panceatic Breast Kidney

Why are we engulfedin an epidemic of obesity?

-- reductions in physical activity

-- increased caloric intake

-- bad nutritional advice

Low-Fat Weight Loss Trials

50

55

60

65

70

75

80

85

90

95

100

0 6 12 21

Length of Follow-up (months)

Bod

y W

eigh

t (k

g)NDH (1968) (35 vs 30% E)

Boyd (1990) (37 vs 21% E)

Jeffery (1995) (33 vs 26% E)

Black (1994) (40 vs 21% E)

Sheppard (1991) (38 vs 20% E)

Kasim (1993) (36 vs 17% E)

Simon (1997) (34 vs 18% E)

Knopp (1997) (27 vs 22% E)

McManus (2001) (35 vs 20% E)

26.062

Role of the food industryin the obesity epidemic

-- creation of maximally seductive foods based on sugar, refined starch, trans fats, and salt

-- “convenience”

-- supersizing as a value

-- aggressive marketing of junk to children and adults

Who can help control the epidemic?

– Researchers (Epidemiologists, Nutritionists, etc)– Health Care Providers– Schools– Governments, Community Organizations– Worksites– Parents– Individuals