The Obesity Epidemic: Why Have We Failed?

>> GOOD AFTERNOON, EVERYONE.
I'M FRANCIS COLLINS, DIRECTOR OF
THE NIH.
IT'S A PLEASURE TO WELCOME YOU
ALL TO THIS AFTERNOON'S LECTURE.
THIS IS THE ROBERT S. GORDON JR.
LECTURE IN EPIDEMIOLOGY.
ONE OF THE ESPECIALLY-NAMED
LECTURES THAT OCCURS AS PART OF
OUR WEDNESDAY AFTERNOON LECTURE
SERIES.
LIKE TO EXPRESS A SPECIFIC
WELCOME TO STUDENTS FROM
AMERICAN UNIVERSITY THAT HAVE
JOINED US TODAY.
THANK YOU ALL FOR BEING HERE.
WE'RE DELIGHTED TO HAVE YOU IN
OUR MIDST, AND ALSO WELCOME TO
PEOPLE WHO ARE WATCHING BY
VIDEO.
I KNOW WHAT WE SEE HERE IN THE
AUDITORIUM IS ONLY A FRACTION OF
THOSE WHO ARE GOING TO BE
LISTENING TO PROFESSOR KULLER'S
PRESENTATION.
LET ME SAY A WORD ABOUT ROBERT
S. GORDON JR., FOR WHOM THIS
LECTURE THE NAMED.
THERE'S INFORMATION ABOUT THIS
IN YOUR PROGRAM.
THIS LECTURE IS PRESENTED ANNUAL
TO TO A SCIENTIST WHO HAS MADE
CERTAIN CONTRIBUTIONS IN THE
FIELD OF EPIDEMIOLOGY.
THE RECIPIENT IS SELECTED BASED
ON THE ADVICE AND RECOMMENDATION
OF SENIOR EPIDEMIOLOGIES HERE AT
NIH.
THIS IS THE 18th YEAR THIS AWARD
HAS BEEN GIVEN AND IF YOU LOOK
IN YOUR PROGRAM, YOU'LL SEE THE
DISTINGUISHED LINEUP OF PREVIOUS
PRESENTERS OF THE GORDON
LECTURE.
ROBERT GORDON WAS SOMEONE
DEVOTED MORE THAN 30 YEARS OF
EXCEPTIONAL SERVICE TO THE NSERVING IN
NUMEROUS POSITIONS.
HE WAS SOMEBODY WITH EXTENSIVE
KNOWLEDGE AND EXPERIENCE IN THE
CLINICAL SCIENCES, AND LED HIM
TO BECOME A CHIEF ADVISOR FOR
CLINICAL PRACTICE AND RESEARCH
FOR TWO NIH DIRECTORS.
HE WAS ALSO AN EARLY ORGANIZER
OF EFFORTS TO ADDRESS THE
EMERGING PROBLEM OF HIV/AIDS AND
BECAME A KEY COORDINATOR AT NIH
FOR AIDS RESEARCH.
HE ALSO MADE IMPORTANT
CONTRIBUTIONS TO INTERINSTITUTE
POLICY AND MANAGEMENT ISSUES
REGARDING EPIDEMIOLOGY, CLINICAL
TRIAL AND THE HEALTH EFFECTS OF
ENVIRONMENTAL HAZARDS.
EACH YEAR WE RECOGNIZE THOSE
CONTRIBUTIONS BY THIS SPECIAL
LECTURE.
THIS YEAR'S RECIPIENT OF THE GOR
DAN LECTURE AWARD IS DR. LEWIS
KULLER.
WE'RE FORTUNATE, INDEED, THAT HE
IS HERE WITH US TO GIVE THIS
PRESENTATION ON THE OBESITY
EPIDEMIC: WHY HAVE WE FAIL FPD
DR. CULL SLER THE DISTINGUISHED
UNIVERSITY PROFESSOR AFTER OF
PUBLIC HEALTH AT THE UNIVERSITY
OF PITTSBURGH.
OBTAINED HIS M.D. AT GEORGE
WASHINGTON UNIVERSITY HERE IN
D.C. AND THEN THE MASTERS AND
DOCTOR OF HEALTH AT JOHNS
HOPKINS.
HE WAS FOR TIME ON THE FACULTY
SIMULTANEOUSLY AT JOHNS HOPKINS
AND THE UNIVERSITY OF MARYLAND
BUT THEN MOVED TO THE UNIVERSITY
OF PITTSBURGH WHERE HE HAS BEEN
FOR MOST OF HIS SENIOR CAREER.
AS PROFESSOR AND CHAIR AND THEN
MORE RECENTLY AS DISTINGUISHED
UNIVERSITY PROFESSOR.
HE HAS DONE MUCH TO SERVE THE
NIH, THANK YOU VERY MUCH SH
LEWIS, IN TERMS OF MANY
DIFFERENT PANELS THAT HE HAS
SERVED ON AND COUNCILS, FOR
INSTANCE, TO THE NATIONAL
INSTITUTE OF AGING, AND HAS MADE
SUBSTANTIAL CONTRIBUTIONS ACROSS
THE FIELD OF EPIDEMIOLOGY
INCLUDING THE AREA HE IS GOING
TO TALK ABOUT TODAY.
IT COULD HARDLY BE MORE TIMELY
TO HAVE A FOCUS, TODAY, ON THE
PROBLEM OF OBESITY.
WE HAVE RECENTLY SEEN
PREDICTIONS THAT THIS MAY BE THE
FIRST GENERATION FOR CHILDREN
WHO ARE BORN TODAY WILL LIVE
LESS LONG THAN THEIR PARENTS OR
THEIR GRANDPARENTS BECAUSE OF
THE TOLE OBESITY IS TAKING ON
OUR POPULATION IF WE DO NOT
FIGURE IN HOW TO REIGN IT IN.
THERE'S THE FIRST LADY'S EFFORT
CALLED LET'S MOVE.
IF YOU'VE ALREADY SEEN SOME OF
THE PROMOTIONS ABOUT THE HBO
SPECIAL THAT IS COMING FORWARD
WITH FOUR HOUR-LONG SESSIONS
DESCRIBING THE CAUSES AND THE
POTENTIAL INTERVENTIONS FOR THE
OBESITY EPIDEMIC, YOU WILL BE, I
THINK, INTERESTED IN SEEING HOW
THAT PLAYS OUT BECAUSE MUCH OF
IT IS BASED UPON DATA GENERATED
BY NIH RESEARCH.
WE HAVE RESEARCH BUT WE HAVEN'T
FIGURED OUT HOW TO TURN THIS
AROUND.
PERHAPS WE WILL HEAR SOMETHING
TODAY FROM DR. KULLER ABOUT WHAT
WE MIGHT DO TO TRY TO DO
SOMETHING TO TURN THE TIDE IN
WHAT OTHERWISE IS ONE OF THE
GREATEST THREAT TO THE PUBLIC
HEALTH OF OUR NATION.
SO WITHOUT FURTHER ADO, PLEASE
JOIN ME IN WELCOMING DR. LEWIS
KULLER, THIS YEAR'S GOR DAN
LECTURER.
[APPLAUSE]
GORDON LECTURER.
[APPLAUSE]
>> THANK YOU VERY MUCH,
DR. COLLINS, AN THANK YOU ALL
FOR COMING TO THIS LECTURE.
IT'S QUITE NICE TO SEE SO MANY
PEOPLE INTERESTED IN THIS
TOPIC.
EPIDEMIOLOGISTS HAVE TO TALK
WITH SLIDES.
THE SLIDES ARE ARE NOT THAT
RELEVANT IN TERMS OF THE
IMPORTANCE OF THE SUBJECT, BUT
THEY HELP ME KEEP TRACK OF WHAT
I'M TALKING ABOUT AND HELP YOU A
LITTLE BIT IN TRYING TO
UNDERSTAND THE KEYWORDS THAT
I'LL BE SAYING TODAY, AND I
HOPEFULLY MAKE IT POSSIBLE FOR
MOST OF YOU TO UNDERSTAND WHAT
I'M SAYING INCLUDING MYSELF.
UH, THIS IS AS POINTED OUT A
VERY IMPORTANT TOPIC, AND IF I
LEAVE YOU WITH ONE MESSAGE I
WOULD SAY, IT'S THE FACT THAT IN
ALL OF THESE EPIDEMICS THAT WE
HAVE, THE CHRONIC DISEASE
EPIDEMICS, MUCH LIKE DR. GORDON
REALLY STRESSED, IT'S IMPORTANT
TO USE GOOD SOLID
EPIDEMIOLOGICAL METHODOLOGY TO
TRY AND UNDERSTAND THE EPIDEMIC
AND THEN APPLY PREVENTATIVE
TECHNIQUES.
EPIDEMIOLOGY IS REALLY THE BASIC
SCIENCE OF PREVENTIVE MEDICINE
AND IT'S REALLY NOT A VERY
EXCITING FIELD UNLESS YOU USE IT
TO APPLY TO THE APPROACH TO
PREVENTIVE MEDICINE.
SO WITH THAT I'LL START AND
HOPEFULLY YOU'LL UNDERSTAND.
[LAUGHTER]
OBESITY IS DEFINED AS EXCESS
BODY FAT AND HAS BECOME
INCREASINGLY PREVALENT DURING
THE PAST PAST 30 YEARS IN THE
UNITED STATES AND THE REST OF
THE WORLD.
OBESITY IS ASSOCIATED WITH
EXCESS MORBIDITY AND MORE
TALENT, ESPECIALLY
CARDIOVASCULAR DISEASE, DIABETES
AND CANCER.
WE HAVE FAILED TO CONTROL THIS
OBESITY EPIDEMIC IN THE UNITED
STATES, OBESITY IS BECOMING
ENDEM MIK ESPECIALLY IN LOWER
ECONOMIC CLASSES, 200930% OF
ADULTS WERE OBESE AND 17% OF
CHILDREN.
THE ABILITY TO STORE FAT WAS
PROBABLY A PROTECTION AGAINST
FAMINE.
MANY OF THE DISEASES IN PAST
CENTURIES WERE ASSOCIATED WITH
LOW BODY WEIGHT AND HEIGHT SUCH
AS TUBERCULOSIS AND OTHER
INFECTION DISEASES.
THERE WAS A PREVAILING BELIEF
THAT HIGH FAT AND PROTEIN DIETS
WOULD PROTECT AGAINST THESE
DISEASES.
IN THE 1950s AND EARLY 1960s,
IMAGINE EPIDEMIC OF AMPHETAMINE
USE OCCURRED AMONG UPPER SOCIAL
CLASS WOMEN IN THE UNITED STATES
MARRILY FAR COSMETIC EFFECT.
IT WASLY SUPPORTED BY THE DRUG
INDUSTRY AND MANY PHYSICIANS.
IN 1967, 8 BILLION DOSES OF
AMPHETAMINES WERE PRODUCED
ACCOUNTING FOR 5% OF ALL
PRESCRIPTIONS IN THE UNITED
STATES.
BY 19 # 0 IT HAS -- 1970, THE
EFFECTS LED TO THEIR STRICT
REGULATION.
BODY FAT, AS YOU KNOW,
DISTRIBUTION
DISTRIBUTION VARIES BY AGE, SEX
AND OBESITY.
WOMEN HAVE MORE FAT THAN MEN.
APPROXIMATELY 28% OF FAT FOR
WOMEN VERSUS 15% FOR MEN.
THE PERCENTAGE INCREASES WITH
AGE.
NON-HISPANIC BLACK WOMEN HAVE
LESS PERCENTAGE OF BODY FAT THAN
WHITE WOMEN AT SIMILAR LEVELS OF
BODY SIZE.
LET'S LOOK AT THE OBESITY
EPIDEMIC IN RELATIONSHIP OF TIME
PLACE AND PERSON.
AS YOU KNOW, THERE'S BEEN A
DRAMATIC INCREASE IN THE
PREVALENCE OF OBESITY AMONG BOTH
MEN AND WOMEN -- THIS SLIDE IS
JUST FOR WOMEN SHOWING FROM
1960-1962, TO 1999-2008.
THERE'S NO CHANGE -- RATHER AS
MOST RECENT DATA SHOWS, THE
EVIDENCE SUGGESTS THAT THE
EPIDEMIC PERSISTENT AND IS NOW
PERHAPS BECOME AS I SUGGESTED
ENDEM MIK IN THE POPULATION.
OBESETHE OBESITY HAS BECOME
PERSISTENT IN YOUNG PEOPLE
SHOWING THE CONTINUE RATES FROM
1999-2010.
OES CITY HOW BECOME A SOCIO
ECONOMIC DISORDER WITH MORE MARK
DIFFERENCES FOR WOMEN THAN FOR
MEN IN LEVELS OF OBESITY BY
EDUCATIONAL LEVELS.
IF YOU CAN SEE HERE QUITE
CLEARLY THE DRAMATIC DIFFERENCE
BETWEEN FOUR-YEAR DEGREE OR TO
ONLY 24% VERSUS 36% -- I'M
SORRY, VERSUS 41% FOR THOSE IN
HIGH SCHOOL EDUCATION.
THAT'S IMPORTANT TO RECOGNIZE
AND ALSO FOR SEVERE OBESITY.
OBESITY PREVALENCE IS ALSO MUCH
HIGHER FOR NON-HISPANIC BLACKS.
AGAIN, NOTING HERE.
THIS ESPECIALLY TRUE FOR CLASS
THREE OBESITY WITH BMIs OVER 40.
THIS DATA SUGGESTS THAT IT MIGHT
BE POSSIBLE TO MODIFY THE
OBESITY EPIDEMIC BY
UNDERSTANDING THE DETERMINANTS
OF THE DIFFERENCES INTY BY
EDUCATIONAL LEVELS AND SOCIO
ECONOMIC STATUS.
HOWEVER THE PREVALENCE OF
OBESITY IS 25% AMONG
COLLEGE-EDUCATED AND MUCH HIGHER
THAN IN SOME OTHER COUNTRIES IN
THE PAST.
OBESITY PREVALENCE OF 25% MAY BE
A REASONABLE GOAL IN THE UNITED
STATES WITHOUT A FAMINE.
OBESITY IS AN EXAMPLE OF A
COMMON SOURCE EPIDEMIC.
THE COMMON SOURCE EXCESS ENERGY
INTAKE AND DECREASED ENERGY
EXPENDITURE.
UNFORTUNATELY, IT IS DIFFICULT
TO MEASURE INTAKE FROM DIETARY
SERVERS OR EXPENDITURE FROM
RESTING METABOLIC RATE AND
EXERCISE.
THERE IS A VERY POOR CORRELATION
BETWEEN ESTIMATED CALORIC INTAKE
AND -- WHICH IN MEASURING
PHYSICAL WATER INTAKE INCLUDING
QUESTIONNAIRES, BUT IT'S
DIFFICULT TO COLLECT THE CALORIC
EXPENDITURE IN POPULATION
STUDIES BECAUSE OF THE NEED TO
INCLUDE MEASURES OF SIZE, MUSCLE
MASS AND EFFICIENCY.
THE CONTROL OF OBESITY EPIDEMIC
REQUIRES A BETTER UNDERSTANDING
OF THE EPIDEMIOLOGY AND THE
PATHOPHYSIOLOGY OF OBESITY.
CERTAIN FACTORS ARE ARE
IMPORTANT.
FIRST, AND I THINK THIS IS A
MESSAGE THAT WAS GIVEN BY THE
FIRST DIRECTOR OF THE NATIONAL
HEART INSTITUTE AND THOSE OF US
IN EPIDEMIOLOGY ESPECIALLY FROM
THE ERA OF HOPKINS HAVE CARRIED
IT FORWARD FOREVER -- IT IS
BASICALLY IMPOSSIBLE TO CONTROL
ANY DISEASE SUCCESSFULLY EXCEPT
BY PREVENTION.
SECOND, UNDERSTANDING THE
DETERMINANTS OF THE EPIDEMIOLOGY
OF DISEASE ARE CRITICAL; THE
HOST T AGENT AND THE
ENVIRONMENTAL INTERACTION.
THIRD, EPIDEMICS OF CHRONIC
DISEASES SUCH AS OBESITY ARE DUE
TO CHANGES IN BEHAVIOR, THAT IS
THE HOST, THE INTERACTION OF NEW
AGENTS, AND TECHNOLOGY, AND THE
CHANGES IN THE SOCIAL AND
PHYSICAL ENVIRONMENT THAT
SUPPORT THE EXPANSION AND
DEVELOP THE EPIDEMIC IN A
GENETICALLY-SUSCEPTIBLE
POPULATION.
FOURTH, OVERTIME, HUMANS ARE
DESTINED TO BECOMING HEAVIER
.GIFFEN AN AVAILABLE SUPPLY OF
FOOD AND DECREASED LEVEL OF
ENERGY EXPEND CHUR.
EXPENDITURE.
THE DEVELOPMENT OF THE MODERN
OBESITY EPIDEMIC INCLUDES THE
FOLLOWING: FIRST, THERE HAS AN
AN INTRODUCTION OF NEW AND
EXPANDED BEHAVIORAL LIFESTYLES
INTO THE ENVIRONMENT.
THE MOST POWERFUL FACTOR HAS
PROBABLY BEEN THE CHANGE IN
FAMILY STRUCTURE.
MOST OF OUR CURRENT EPIDEMIC
BEGINS IN THE UPPER SOCIAL CLASS
IN THE BETTER EDUCATION.
NEXT, POPULATIONS BECOME EXPOSED
TO A NEW AGENT, OFTEN ASSOCIATED
WITH NEW TECHNOLOGY.
FOR EXAMPLE T CIGARETTE SMOKING
EPIDEMIC WAS PRIMARY DUE TO THE
DEVELOPMENT OF TECHNIQUES FOR
MANUFACTURING CIGARETTES AND
MATCHBOOKS AT THE TURN OF THE
20th CENTURY.
THE DEVELOPMENT OF TECHNOLOGY TO
MASS PRODUCE FAST FOODS, FOR
EXAMPLE THE WORK OF CROCK AND
LATER AT THE MCDONALD'S COMPANY
WHICH HE RAN AND OTHERS HAVE
PLAYED A KEY ROLE IN THE OES
THETY EPIDEMIC.
ONCE A NEW TECHNOLOGY OR AGENT
IS INTRODUCE INTO THE
POPULATION, ECONOMIC ADVANTAGES
AND MASS MARKETS WILL DETERMINE
THE SUCCESS OF THE SPREAD OF THE
AGENT.
FOOD, FOR EXAMPLE, BECAME A
MAJOR REPLACEMENT CIGARETTE
SMOKING AND ALCOHOL.
OVERTIME, FOOD HAS BECOME OUR
NUMBER ONE SOCIAL BEHAVIOR.
EATING FOR MOST SPEEM NOT A
THERAPEUTIC CHALLENGE IN SPITE
OF THE FEWVIEW OF MANY OF MY
PUBLIC HEALTH COLLEAGUES.
THE NEW BEHAVIORAL LIFESTYLES,
AGENTS, QUICKLY SPREADS
ESPECIALLY TO THE LOWER SOCIO
ECONOMIC CLASS AND LESS SUGGEST
EDUCATED.
WIDE SPREAD AVAILABILITY FOR
FAST FOOD CHAINS AND CHEAP FOOD
IS A FUNCTION OF THE COST
ADVERTISING, APPARENT
PSYCHOLOGICAL BENEFIT, AND AS I
POINTED OUT, REPLACEMENT FOR
OTHER ADVERSE BEHAVIORS.
THERE IS A VERY IMPORTANT
PATHOPHYSIOLOGICAL COMPONENT.
THAT IS AN APPARENT LACK OF
APPETITE SUPPRESSION FOR MANY IN
THE POPULATION.
IF, FOR EXAMPLE, WE HAD VERY
STRONG APPETITE SUPPRESSION,
THEN IT IS LIKELY THAT THE
OBESITY EPIDEMIC WOULD BE LESS
RAMPANT.
RECOGNITION OF THE ADVERSE
EFFECTS OF THE OBESITY IS FIRST
RECOGNIZED IN THE
BETTER-EDUCATED.
THIS IS SIMILAR TO WHAT HAPPENED
WITH THE CIGARETTE SMOKING
EPIDEMIC.
THERE IS A VERY SHARP REVERSAL
OF THE SOCIO ECONOMIC
DISTRIBUTION OF DISEASE.
THE ADVERSE DEBEHAVIOR BECOMES
STIGMATIZED.
OBESITY LIMITS SOCIAL ACCEPTANCE
AND JOB OPPORTUNITIES.
THIS IS INTERESTING.
THE ADVERSE BEHAVIOR THEN
BECOMES A DISEASE OR AN
ADDICTION, GENETIC DISORDER OR
UNIQUE METABOLIC ABNORMALITY.
YOU CAN SEE THAT WHAT HAPPENS TO
THE EPIDEMIC AND THIS IS EXACTLY
WHAT HAPPENS IF EVERY EPIDEMIC.
IT CHANGES AND SUDDENLY BECOMES
A DISEASE AND WE HAVE NEW
BEHAVIORAL INTERVENTIONS,
MEDICAL INTERVENTIONS BUT AT THE
BOTTOM LINE WE HAVE NO CLINICAL
TRIALS THAT REVERSE MORTALITY.
WE STILL DON'T KNOW WHY PEOPLE
EAT TOO MUCH OR DON'T EXERCISE.
WE HAVE NO DRUG FOR THERAPY FOR
OBESITY AND WE HAVE TWO THOUSAND
SURGERI
SURGERIES PER YEAR.
THE ORIGINS OF OES THETY
EPIDEMIC ARE OFTEN SUBMERGED BY
A A FOCUS ON PATHOPHYSIOLOGY AND
DESCRIPTIVE EPIDEMIOLOGY.
THERE WAS A NATIONAL PICKUP
PUBLIC HEALTH RESPONSE OFTEN
BASED ON THE LIMITED EVIDENCE OF
SPECIFIC INTERVENTIONS.
THE MEDIATE NEED TO DO SOMETHING
TO STOP THE EPIDEMIC HAS A HIGH
PRIORITY, UNFORTUNATELY IT MAY
TAKE YEARS OF TRIAL AND ERROR TO
DEVELOP A GOOD STRATEGY BECAUSE
OF LIMITED UNDERSTANDING OF THE
DERMENT NANTS OF THE EPIDEMIC.
OFTEN THE DETERMINANTS OF THE EP
MIK ARE POLITICALLY
UNACCEPTABLE.
NUMEROUS COMMITTEES,
ORGANIZATIONS AND SOCIETY ISSUE
VOLUMES OF REPORTS ON SOLUTION
TO EPIDEMIC.
POSSIBLY SOME OF THESE COULD
SERVE AS APPETITE SU P PRESANTS.
THE SIMPLE RULE IS, IF YOU DON'T
KNOW WHAT TO DO, ORGANIZE
COMMITTEES, WORKSHOPS AND SPREAD
THE PROBLEM.
[LAUGHTER]
NOW LOOK AT SOME OF THE MORE
DETAILED ASPECTS OF THE
DETERMINANTS OF WAETH GAIN.
THE AMOUNT OF [INDISCERNIBLE]
ENERGY EXPENDITURE PRIMARILY FOR
FROM EXERCISE ARE THE KEY
VARIABLES.
THE MAJOR DETERMINANTS OF -- THE
CORRELATION BETWEEN 4 HOUR
RESTING METABOLIC RATE AND
FAT-FREE MASS IS ABOUT 0.8.
THERE'S A VERY HIGH CORRELATION
BETWEEN FAT-FREE MASS AND BMI.
IN CONTROLLED EXPERIMENTS --
THIS IS A BEAUTIFUL STUDY FROM
LOUISIANA BY GEORGE BRAY --
ENERGY INIS LINEAR RELATED WITH
CHANGE IN BODY FAT AND CHANGE IN
LEAN BODY MASS.
INDIVIDUALS GAIN WAIT BECAUSE
THEY EAT MORE CALORIES.
FAT PEOPLE DO NOT EAT MORE
CALORIES IN SPITE OF WHAT SOME
PEOPLE THINK.
THERE WAS A DRAMATIC INCREASE
OVER TIME IN CALORIC INTAKE PER
DAY EVEN AFTER ADJUSTMENT FOR
FOOD SUPPLY AND WASTE.
THE UNITED STATES DEPARTMENT OF
AGRICULTURE REPORTS THAT THE
ESTIMATED DAILY CONSUMPTION OF
CAKE HOUSE IN THE YEAR 2000 WAS
95% GREATER.
THE INCREASE IN [INDISCERNIBLE]
WAS DUE TO REFINED -- FAT 24%,
SUGAR 23% FROM 1970-1985.
NOT OBESE -- SORRY, NOT OBESE
ADULTS [INDISCERNIBLE] INGEST
ABOUT NINE UNTHOUSAND KAY CALLS
PER YEAR.
-- AN AVERAGE 20-POUND WEIGHT
GAIN OVER THE AGE OF 20-55
REPRESENTS ONLY A VERY SMALL
DAILY VARIATION OF INGESTED
CALORIES, CERTAINLY NOT
MEASURABLE BY ANY OF OUR
STANDARD TECHNIQUES.
THE AMOUNT OF SMALL DIFFERENCES
BETWEEN ENERGY INTAKE AND
EXPENDITURE OVERCAN RESULT IN A
VERY MAJOR INCREASE IN BODY
WEIGHT.
FOR EXAMPLE, A WOMAN AGE 50-59
GAINS A ABOUT 25 POUNDS OVER 28
YEARS, ABOUT ONE-AND-A-HALF
POUNDS A YEAR OR AN EXTRA 50-75
KAY CALLS PER DAY.
IN ORDER TO MAINTAIN THIS EXCESS
WEIGHT T CALORIC INTAKE WOULD
HAVE TO INBY A370 CALORIES PER
DAY.
HIGH CALORIC INTAKE MUST BE MAIN
INTANED AFTER GAINING WEIGHT TO
MAINTAIN THE HIGH BMI. TANED AFTER GAINING WEIGHT TO
MAINTAIN THE HIGH BMI.TANED AFTER GAINING WEIGHT TO
MAINTAIN THE HIGH BMI. TANED AFTER GAINING WEIGHT
TO MAINTAIN THE HIGH BMI.A TANED AFTER GAI NING
GHTOAIAITHI B.NAN AERAINGGH BMI. TEDFT GNI
EIT MNTN E GHMIAN AERAING
EIT MNTNE GHMID TEGAINWEHT
O ININHEIGBM
A 10% WEIGHT LOSS WOULD REQUIRE
A CONSTANT DECREASE OF 15-250
KAY CALLS PER DAY AND A 20%
ABOUT 325-430 KAY CALLS PER DAY.
FIRST, AS A WOMAN, LET'S SAY,
LOSES WEIGHT, BOTH FAT AND
NON-FAT TISSUES WOULD BE LOST AS
WELL AS WATER.
3,500 KAY CALL REDUCTION IN DIET
OVER A WEEK, 500 CALORIES PER
DAY WOULD CAUSE ABOUT A ONE
POUND WEIGHT REDUCTION IN FAT
PER WEEK.
FOLLOWING -- THE WEIGHT LOSS
WILL PLATEAU FURTHER DECREASES
IN KAY CALL.
THIS IS A MAJOR PROBLEM IN
WEIGHT LOSS PROGRAMS AS
INDIVIDUAL --.
THE SECOND BIG FACTOR IS ENERGY
EXPENDITURE.
WE ARE THE VICTIMS OF THE
SUCCESSES OF THE PREVIOUS
GENERATIONS IN DEVELOPING NEW
TECHNOLOGIES THAT GREATLY REDUCE
ENERGY EXPENDITURE AT WORK AND
IN THE HOME.
THIS IS A DUH STU DPRI 1800 FROM
GREAT BRITAIN AND IT SHOWS THAT
IN THE HIGHEST INTAKE GROUP T
HIGHEST BMI OF 26 THE KAY CALL
CON SUFRPS IS OVER ABOUT FIVE
THOUSAND CALORIES AND THIS IS
BECAUSE AS WE'LL SEE, THEIR
ACTIVITY.
THIS IS BECAUSE OF VERY HIGH
LEVELS OF PHYSICAL ACTIVITY ON
THE WORK.
INTERESTING ON THE AVERAGE THESE
INDIVIDUALS WERE SHORT.
THE HIGHEST SI -- THE LOWEST SI
OF THE BMI, 26, WAS ASSOCIATED
ABOUT A FIVE FOOT, 11 INCH MAN,
BUT THE MIDDLE RANGE IS ONLY
ABO
ABOUT FIVE FEET FOUR TO FIVE
FEET FIVE.
THE SHORTER AND THINNER
INDIVIDUALS DIED AT AN EARLY
AGE.
THE CALORIC EXPENDITURE AND THE
PARS IS THE RATE OVER THE BASE L
METABOLIC RATE.
THIS IS FOR A MAN IN THE 1800s
IN THE SAME PERSON IN ENGLAND
AND IT SHOWS IN INTAKE AND YOU
CAN SEE THE NUMBER OF HOURS AND
WHAT THEY DID.
SHOWS TREMENDOUS AMOUNT OF
PHYSICAL ACTIVITY REQUIRED IN
THE 1800s FOR THESE INDIVIDUAL,
FAR GREATER THAN THE PRESENT
TIME.
THUS, IN PAST GENERATIONS THERE
WAS BOTH THE VERY HIGH CALORIC
INTAKE IN RESPONSE TO A VERY
SUBSTANTIAL ENERGY EXPENDITURE.
SIMILAR DATA HAS BEEN COLLECTED
IN THE UNITED STATES FROM
POPULATIONS AROUND THE 1850s.
FURTHERMORE T LOWEST LEVEL OF
CALORIC INTAKE IN THESE
POPULATIONS COULD PROBABLY NOT
WORK AND HAD VERY HIGH MORTALITY
AT YOUNGER AGES.
OUR ENERGY EXPENDITURE IS LOW
AND HAS NOT DECREASED VERY MUCH
DURING THE OBESITY EP EPIDEMIC.
EFFORTS TO INCREASE ENERGY
EXPENDITURE FOR THE MOST PART
ARE MINUSCULE COMPARED TO WHAT
WE'VE SEEN IN PREVIOUS
GENERATIONS.
LET'S ARE REVIEW THE DETAILS OF
THE OBESITY EPIDEMIC.
MOST LIKELY, EITHER PARENTS OR
SINGLE PARENT AT HOME WERE
WORKING OUTSIDE OF THE HOME.
THIS HAD A MAJOR IMPACT ON THE
OBESITY EPIDEMIC IN A
GENETICALLY-SUSCEPTIBLE
POPULATION.
THE CHANGES IN FAMILY STRUCTURE,
EMPLOYMENT OUT OF THE HOME HAD
THREE MAJOR IMPACTS AND A HAS
RESULTED IN THE DECREASE OF
MEALS AT HOME DUE TO LACK OF
TIME.
IT HAS POSITIVELY LEAD TO
INCREASED FAMILY INCOME WHICH
MADE IT POSSIBLE TO BUY GREATER
AMOUNTS OF SNACK FOODS OUT OF
THE HOME AND FAST FOODS AND
INCREASE THE MARKET FOR FAST
FOODS AND PROBABLY REDUCED
CHILDREN, ADULTS LEISURE TIME
OUT OF THE HOME.
THIS IS THE REALITY OUT OF THE
SITUATION, WE HAVE TO LIVE WITH
THIS CHANGE AND MODIFY OUR
PRECHTIVE PROGRAMS IN
RELATIONSHIP TO THIS.
CHANGES IN WORK -- OOPS, SORRY.
OKAY.
CHANGES IN WORK PATTERNS ARE A
WELL-KNOWN TO EVERYBODY
INCLUDING THE PERCENTAGE OF
MOTHERS IN THE LABOR FORCE WITH
CHILDREN OURND 18 AND WOMEN
WORKING LONG HOURS.
THAT'S SHOWN HERE IN THESE
MARKED HERE AND THEN THE RED
CHANGES HERE.
THIS IS NOT UNIQUE IN THE UNITED
STATES AND THEREFORE CANNOT BE
THE SOLE EXPLANATION OF THE
OBESITY EPIDEMIC.
THIS COMPARES THE NUMBER OF MEN
AND WOMEN WORKING, THE
PERCENTAGE DIFFERENCE BETWEEN
MEN AND WOMEN AND YOU CAN SEE
HERE THE UNITED STATES BUT ALSO
FRANCE AND ALSO IN JAPAN WHERE
AGAIN THERE'S BIG DIFFERENCES
AND SO THIS IS NOT THE
EXPLANATION -- ALONE CANNOT
EXPLAIN EPIDEMIC.
OKAY.
THE DECLINE IN CIGARETTE SMOKING
AND ALCOHOL CONSUMPTION HAS
PLAYEDPLAYED A VERY IMPORTANT
ROLE.
THERE'S A -- FOLLOWING SMOKING
CESSATION.
CERTAINLY WE DO NOT WANT TO HAVE
ANOTHER SMOKING EPIDEMIC.
FOOD IS OUR NUMBER ONE SOCIAL
OUTLET.
LET'S MEET FOR LUNCH OR COME TO
A DINNER PARTY.
THIS IS A NEW PHENOMENON OF THE
PAST 20 OR 30 YEARS.
THERE'S AN INCREASE IN THE
CONSUMPTION OF FAST FOODS AND
SNACKS AND CALORICALLY DENSE
FOOD.
HARVARD HAS ARGUED THAT THE
INCREASE IN SNACKS ARE THE MAJOR
DERMENTS OF THE OES THETY
EPIDEMIC BASED ON THEIR ANALYSIS
OF DATA FROM THE CONTINUING
SURVEY OF FOOD.
PRIMARY INCREASE WAS FROM SNACKS
WHICH I MARKED HERE IN BOTH MEN
AND WOMEN, WITH LITTLE CHANGE
THEY CLAIM IN CALORIES FOR
BREAKFAST LUNCH AND DINNER.
THIS IS PICTURE FROM MCDONALD'S
AND WE'RE ALL FAMILIAR WITH
THIS.
AT THIS PICTURE, WHICH IS VERY
EARLY IN THE EPIDEMIC, MCDONALD
HAMBURGERS WERE 15 CENTS AND
THEY SOLD OVER A MILLION AND
THERE HAS BEEN A MUCH GREATER
SALE OF THIS OVER TIME.
THE PERCENTAGE OF THE TOTAL
DISPOSAL INCOME FOR FOOD HAS
DROPPED DRAMATICALLY IN THE
UNITED STATES BUT YOU'LL LOOK AT
THE BOTTOM AS THE COST OF FOOD
HAS DROPPED THERE'S STILL AN
INCREASE IN THE COST OF FOOD OUT
OF THE HOME.
THIS IS DUE TO BETTER
TECHNOLOGY, OBVIOUSLY.
IN 20006 THE AMERICANS SPENT 48%
OF THEIR FOOD DOLLARS ON FOOD
OUTSIDE OF THE HOME IN
COMPARISON TO ONLY 28%.
THE ABILITY TO MANUFACTURE LARGE
AMOUNTS OF CHEAP, HIGH CALORIC
FAST FOOD, MUCH LIKE THE
DEVELOPMENT OF THE MACHINES TO
MAKE CIGARETTES IS A MAJOR FAK
NOR THE OBESITY EPIDEMIC.
WE ARE THE PRODUCT OF SUCCESSES
OF PAST GENERATIONS.
BASELINE FREQUENCY OF FAST FOOD
AND THE CHANGES IN FAST FOOD IS
STRIKINGLY RELATED TO THE WEIGHT
GAIN IN THE YOUNG ADULTS.
THIS POINT THIS IS OUT VERY
NICELY.
THE OUT MIGRATION FROM URBAN
AREAS AND WORK ENVIRONMENT HAVE
A ALSO HAD A GREAT EFFECT.
TRANSPORT TO WORK IS BY CAR,
TRUCK, ORPHAN VAN.
VERY FEW WALK OR BIKE TO WORK.
ALSO TIME TO AND FRO FROM WORK
HAS INCREASED FOR MANY
INDIVIDUALS WHICH REDUCES THE
POTENTIAL PLEASE SURE TIME FOR
PHYSICAL ACTIVITY.
LEISURE TIME IS SCARCE AND VERY
EXPENSIVE.
PEOPLE SELECT THEIR ACTIVITIES
CAREFULLY.
SPORTS AND EXERCISE ONLY SKRIBT
A VERY SMALL AMOUNT OF LEISURE
TIME.
LET'S LOOK AT THE RESEARCH
AREAS.
WHAT ARE THE RESEARCH
RECOMMENDATIONS?
WHAT SHOULD WE D B DOING?
ONE OF THE MOST IMPORTANT
RESEARCH QUESTIONS TO DECREASE
THE EPIDEMIC?
FIRST, MOST PEOPLE CANNOT
MAINTAIN WEIGHT LOSS BY DIET OR
CONTINUED HIGH LEVELS OF
EXERCISE; WHY?
THEY ARE GAINING WEIGHT UP TO
AGE 50 OR 60.
WE DO A POOR JOB OF PREVENTING
WEIGHT GAIN.
ARE THERE SPECIFIC NUTRIENTS
INDEPENDENT OF CALORIC INTAKE
THAT WOULD MODIFY EATING
BEHAVIOR?
WE HAVE NO DECENT DRUGS FOR THE
TREATMENT OF OBESITY.
MOST SUCCESSFUL TREATMENT HAS
BECOME BARIATRIC SURGERY.
WHY DO SOME PEOPLE MAINTAIN A
LOW BODY WEIGHT AND GOOD HEALTH
IN THE FACE OF THE OBESITY
EPIDEMIC?
IS THIS GENETIC?
HOST SUSCEPTIBILITY?
A MAJOR PROBLEM IN WEIGHT GAIN
AND INABILITY TO LOSE WEIGHT IS
THE LACK OF [INDISCERNIBLE]
AFTER EATING RESULTING IN
FURTHER FOOD INTAKE.
THE CHANGES IN BODY FAT AND
WEIGHT LOSS TRIGGER RESPONSES IN
THE BRAIN THAT LEAD TO HUNGER
AND DECREASED METABOLIC RATE.
WEIGHT GAIN SHOULD LEAD TO
OPPOSITE RESPONSES.
JUST AN EXAMPLE OF THIS AND SO
MANY OF YOU JUST TO SHOW YOU BUT
BASICALLY THERE'S A -- THIS IS
JUST A VERY SIMPLISTIC MODEL OF
RELATIONSHIP BETWEEN THE BRAIN T
FAT STORES T MUSCLE, ENERGY
EXPENDITURE AND WHAT SHOULD BE
HAPPENING AND THE HORMONES THAT
SHOULD BE AFFECTING THESE
RESULTS.
UNFORTUNATELY T SYSTEM SOUNDS
GREAT BUT IT'S NOT WORKING VERY
WELL FOR US., T SYSTEM SOUNDS
GREAT BUT IT'S NOT WORKING VERY
WELL FOR US.T T SYSTEM SOUNDS
GREAT BUT IT'S NOT WORKING VERY
WELL FOR US.HE T SYSTEM
SOUNDS GREAT BUT IT'S NOT
RKG RYELFOUST ST SND
RE B IS T RKG RY
ELFOUST ST SND
GRT T 'SOTORNGER
WE F U TYSM UN
GRT T 'SOTORNGER
WE F UT ST SND
GRT T 'SOTORNGER
WE F U TYSM UN L R .TYSM UNVE
GRT T 'SOTORNGER
WE F UH SYEM
OUS EABUIT N RNGERWE F U NDGRT T 'SO.T ST
TBRNTEIN O
EGATN TO BODY FAT CONTENT.
AS WE INCREASE BODY FAT WE
SHOULD LOSE THE DESIRE TO EAT,
INCREASE ENERGY, LOSE THE
WEIGHT; BUT IT DOESN'T WORK.
THE SYSTEM IS DRIVEN TO THE
POSITIVE ENERGY BALANCE WEIGHT
GAIN.
SHOWS YOU A LITTLE BIT OF THAT
WHICH SHOWS THAT THIS IS THE
GROUP IN THE BOTTOM WHEN YOU
GAIN WEIGHT AND YOU START WEIGHT
LOSS AND THIS IS NORMAL WEIGHT
BUT IF YOU LOOK, THE DRIVING
FORCE IS HERE ARE BAY SEC THINK
FACTORS THAT CONTROL WEIGHT
GAIN, WEIGHT GAIN RATHER THAN
WEIGHT LOSS AND SO HERE WE'RE
DRIVEN PRIMARILY IN THIS
DIRECTION WHICH IS ESSENTIALLY
TO WEIGHT GAIN.
THIS COMPLEX PHYSIOLOGICAL
SYSTEM, VERY SIMPLISTIC MODEL,
BUT THE KEY POINT IS THAT THERE
MAY BE A FEW KEY PLAYERS THAT
WOULD MAKE THE DIFFERENCE.
THERE ARE VARIETY OF HORMONES
THAT ARE SEE CREATED BY THE THE
G. VMENT TRACT WHICH DETERMINE
INSULIN SECRETION AND METABOLISM
ESPECIALLY IN RELATIONSHIP TO
EATING BEHAVIOR.
ALL RIGHT.
CLINICAL TRIALS TO EVALUATE
WEIGHT LOSS HAVE BEEN UNSCUFFLE
IN THE LONG TERM ESPECIALLY IF
WE USE RECOMMENDED 10% WEIGHT
LOSS AS A GUIDELINE THP.
THIS SLIDE SHOWS A VARIETY OF
STUDY AND THE MIDDLE CURVE SHOWS
THE AVERAGE OF WEIGHT LOSS OVER
THE FIVE YEARS.
IT'S ESTIMATED THAT OVER FIVE
YEARS THE AVERAGE WEIGHT LOSS IN
THESE GOOD TRIALS IS THREE THE
TO FOUR KILOGRAMS OR 68 POUNDS.
WOMAN'S STUDY, WHICH WE DID IN
PITTSBURGH WAS A 48-PONT TRIAL.
DOCUMENTED LIFESTYLE SPER VENGS
HAD A 3.4 KILOGRAM WEIGHT LOSS
AT 48 MONTHS.
THIS WAS SIGNIFICANT BUT MUCH
SMALLER THAN AT 6 MONTHS.
THE PERCENTAGE OF WOMEN WHO LOST
GREATER THAN 10% OF THEIR WEIGHT
DROP FROM 47% TO ONLY 21% OF THE
WOMEN AT 48 MONTHS.
THE KEY DERMENT DETERMINANT
NANT -- WOMEN WHO LOST LESS THAN
10 POUNDS AT SIX MONTHS WERE
FOUR POUND ABOVE BASELINE AT 48
MONTHS.
EATING -- CHANGES IN EATING
FISH, EATING FRUITS AND
VEGETABLES AND INCREASING ENERGY
EXPENDITURE WERE SOME OF THE KEY
FACTORS ASSOCIATED WITH
OBTAINING WEIGHT LOSS.
WEIGHT GAIN WAS FROM INCREASE
DESERTS AND FRIED FOODS AND MEET
AND CHEESE.
NO DATA ON SNACKS.
THESE ARE SIMILAR DATA TO OTHER
STUDY.
THE INTERVENTIONS WERE STOPPED
OR REDUCED OVER TIME IN ALL OF
THESE STUDIES WITH SUBSTANTIAL
WEIGHT REGAIN.
ONE KEY MESSAGE IS THAT
BEHAVIORAL INTERVENTIONS ARE
LIKE DRUG THERAPY FOR HYPER
TENSION OR ELEVATED LIPIDS.
MOST LIKELY, THEY MUST BE
CONTINUED FOR THE LIFETIME OF
THE INDIVIDUAL.
THE NATIONAL WEIGHT LOSS
REGISTRY IS AN INTERESTING
PROJECT DEVELOPED BY DR. WING
FOLLOWING A SAMPLE OF INDIVIDUAL
WHO IS LOST GREATER THAN 30
POUNDS AND HAVE MAINTAINED
WEIGHT LOSS FOR AT LEAST ONE
YEAR.
MOST HAD LOST WEIGHT ON THEIR
OWN.
SIMILARLY, DECREASES IN CALORIC
INTAKE, INCREASES IN PHYSICAL
ACTIVITY, INCREASE IN EATING
BREAKFAST, CAREFULLY DAILY
WEIGHING AND REDUCTION IN EATING
OUT OF HOME ARE MAJOR FACTORS
ASSOCIATED WITH SUCCESSFUL
LONG-TERM WEIGHT LOSS.
THE KEY FINDING HOWEVER IS THAT
THE PARTICIPANT EVEN MANY YEARS
AFTER WEIGHT LOSS MUST CONTINUE
TO CAREFULLY MONITOR THEIR
WEIGHT AND LIFESTYLES AND AREEN
REGAINING WEIGHT AFTER MANY
YEARS OF SUCCESS.
THE SITUATION IS VERY DIFFERENT
WHEN IT COMES TO BARIATRIC
SURGERY AND THIS IS THE GASTRIC
BY PASS GROUP OVER TEN YEARS.
THIS IS FROM THE SWEDISH OBESITY
STUDY.
THEY REPORTED SUCCESSFUL WEIGHT
LOSS OVER 10 YEARS FOLLOWING
GASTRIC BYPASS SURGERY.
THE SURGERY IS A UNIQUE SURGERY
WITH BYPASSES PART OF THE
STOMACH AND BASICALLY THE
DUODENUM -- AND A PIECE OF THIS
IS MISSING UP HERE -- AND SMALL
INTESTINE.
WE SHOWED YEARS AGO E THAT
BARIATRIC SURGERY WAS ASSOCIATED
WITH SUBSTANTIAL REDUCTION IN
THE PREVALENCE OF DIABETES FROM
PREOP TO POST OP FROM 65-13% IN
THE USE OF THE ORAL DIABETIC
DRUGS RIGHT HERE AND FROM 27-6%
FOR INSULIN USE, IRRESPECTIVE OF
THE DURATION OF DIABETES.
FURTHER STUDY SHOW THAT THE
DIABETES DISAPPEARS LONG BEFORE
THE WEIGHT LOSS AND EVEN WITHOUT
WEIGHT LOSS AFTER THE SURGERY.
JUST MANIPULATION O OF THE GA
TROE INTESTINAL TRACK RESULTS IN
THE DISAPPEARANCE OF THE
DIABETES.
THIS IS A VERY IMPORTANT CLUE TO
THE CONTROL OF BOTH THE OBESITY
EPIDEMIC AND DIABETES.
THERE WAS A REDUCTION IN
CARDIOVASCULAR EVENTS IN THE
SWEDISH OBESITY STUDY AS WELL
BUT STRIKINGLY IT WAS UNRELATED
TO THE WEIGHT LOSS IN THE TRIAL
OR TO THE BMI AT THE BEGINNING
OF THE TRIAL.
LET LOOK AT GEN X A LITTLE BIT.
WHY ARE SOME ABLE TO REMAIN THIN
WHILE OTHERS BECOME OBESE?
STUDIES SUGGEST THAT 40-70% OF
INDIVIDUAL VARIATION OES CITY
DUE TO GENETIC FACTORS.
THERE'S A VERY HIGH CORRELATION
OF OES THETY WITHIN FAMILIES.
A FEW RARE MAJOR GENES HAVE BEEN
IDENTIFIED THAT ACCOUNT FOR A
VERY SMALL NUMBER OF SEVERE
OBESITY, ESPECIALLY IN CHILDREN.
RECENT GENETIC STUDIES HAVE
FOCUSED ON VERY LARGE
POPULATIONS USING GENOMIC-WIDE
ASSOCIATION STUDIES.
THESE VERY LARGE STUDIES
INCLUDING OVER A HUNDRED
THOUSAND INDIVIDUALS HAVE
IDENTIFIED MAYBE EIGHT LOCI
CONSISTENTLY RELATED TO OBESITY.
MOST GENES RELATED TO OES THETY
SO FAR HAD THEIR EFFECTS IN THE
CENTRAL NERVOUS SYSTEM.
UNFORTUNATELY, MOST OF THE
IDENTIFIED [INDISCERNIBLE]
MARKERS HAVE VERY SMALL EFFECTS
ON BODY WEIGHT OR ON THE RISK OF
OBESITY WITH RELATIVE ARE RISK
FROM 1.1-1.4 RANGE.
SPEAKMAN HAS APPROACHED EVOLVING
[INDISCERNIBLE] SOMEWHAT
DIFFERENTLY.
HE NOTED THAT TWO MILLION YEARS
AGO PREDATION WERE REMOVED AS A
SIGNIFICANT FACTOR FOR THE
PROMPT OF SOCIAL BEHAVIOR,
WEAPONS AND FIRE.
THE ABSENCE OF PREDATION LED TO
CHANGE IN THE POPULATION
DISTRIBUTION OF BODY FATNESS DUE
TO RANDOM MUTATIONS AND DRIP.
THESE RANDOM MUTATIONS FAVORED
THE DEVELOPMENT OF OES THETY
BECAUSE THINNER INDIVIDUALS WERE
AT HIGHER RISK OF PREMATURE
MORTALITY FROM VARIOUS INFECTION
DISEASES, MALNUTRITION AND VERY
THIN WOMEN DID NOT REPRODUCE.
IT WAS SUGGESTED -- IT'S ALSO
SUGGESTED THAT THE POPULATION
THERE WERE INDIVIDUALS WHO STILL
HAVE GENETIC CHARACTERISTIC
WHICH LEAD THEM TO BE VERY LOW
BODY WEIGHT.
OVER TIME THERE HAVE BEEN
MULTIPLE MUTATIONS IN MANY GENES
THAT HAVE SHIFTED TO SET POINT
SO THE SET POINT IS GRADUALLY
MOVING HERE FROM THE AMBULANCE
WHERE THE SET POINT IS PUSHING
TOWARD HIGH BMIT SET POINT HAS
BEEN GRADUALLY LOWERED.
HUMANS HAVE -- GO ON, NOW --
HUMANS HAVE VERY LARGE BRAINS.
HUMAN BABIES ARE FAT.
SOME OF THE FATNESS IN HUMANS IS
CERTAINLY BROWN FAT WHICH
PROTECTS AGAINST THE COLD
ENVIRONMENT LEAVING THE WOMB.
HUMAN BABIES AT BIRTH HA HAVE
THE MOST FATNESS BECAUSE THE
HEAD SIZE IS SMALL AND THERE'S A
NEED FOR HIGH ENERGY SUPPLY
EARLY IN LIFE IN ORDER TO
NORMALIZE BRAIN GROWTH.
THERE'S SUBSTANTIAL POST NATAL
BRAIN GROWTH.
OUR LARGE BRAINS MAY HAVE BEEN
THE EVOLUTIONARY PRESSURE TO
INCREASED FATNESS AND ALSO BEEN
ABLE TO PRODUCE AN ENVIRONMENT
WHERE WE'RE ABLE TO ENHANCE AND
SURVIVE GIVEN THE FACT THAT
THERE'S PLENTY OF FOOD
AVAILABLE.
THERE MAY HAVE BEEN GENETIC
SELECTION AGAINST BABIES -- THE
HUMAN VEE BRAL CORTEX HAVE --
THE FRONT L LOBE ESPECIALLY HAS
AN IMPORTANT ROLE IN EXECUTIVE
FUNCTIONS, COMPLEX DECISION
MAKING AND EMOTIONAL RESPONSES.
DAMAGE IN UTERO OR EARLY IN LIFE
DURING RAPID BRAIN GROWTH COULD
HAVE A PRIVATE EFFECT ON FUTURE
BEHAVIORS.
THERE CONTINUES TO BE A
PREVALENCE OF CHILDREN BORN
SMALL [INDISCERNIBLE] AND WHO
ARE EXPOESZED IN UTERO TO EARLY
LIFE BRAIN DAMAGE THAT
CONTRIBUTES TO OBESITY DURING
HIELD HOOD AND ADULT LIFE.
IN FACT, IT IS POSSIBLE THAT WE
MAY HAVE LOST THE BATTLE EVEN
BEFORE WE'VE STARTED.
THIS IS AN INTERESTING STUDY
WE'RE DOING PITTSBURGH OF
PSYCHOLOGICAL AND BEHAVIORAL
DEVELOPMENT OF CHILDREN,
ESPECIALLY LOW-INCOME
POPULATIONS.
THERE'S A VERY HIGH PREVALENCE
OF SEVERE OBESITY AMONG THESE
YOUNG GIRL.
8.2% OF A FRO AMERICAN GIRLS ARE
SEVERELY OBESE WITH BMI CLOSE TO
40.
THIS IS A VERY SERIOUS PROBLEM
IN A COMMUNITY LIKE PITTSBURGH
WHERE WE HAVE EXCELLENT
PEDIATRIC SERVICES T EFFORTS OF
MANY INVESTIGATORS TO MODIFY THE
OBESITY EPIDEMIC.
THE GIRLS CALORIC IMPLAN INTAKE
VERSUS ENERGY IS UP TO ONE
THOUSAND CALORIES A DAY BECAUSE
OF THEIR EXCESS WEIGHT.
OTHER IMPORTANT GENETIC DERMENTS
OF THIS RAPID SEVERE OBESITY IN
CHILDREN, WE DON'T KNOW.
OBESITY RATES VARY DRAMATICALLY
AMONG COUNTRIES.
OF CONSIDERABLE IMPORTANCE IF S
THE LOW RATES OF OBESITY IN
JAPAN AND FRANCE.
WHETHER THE MAJOR DIFFERENCES IN
THE JAPANESE DIET IS THE HIGH
INTAKE OF OMEGA FATTY ACIDS FROM
FISH.
THEY ARE THE MAJOR FATTY ACIDS
IN THE BRAIN.
THERE'S A VERY HIGH INTAKE OF
FLAVOR NOID IN THE JAPANESE DIET
AND LESS BEEF CONSUMPTION.
THE FRENCH DO NOT EAT A
SO-CALLED MEED TRAIN YAN DIET.
THE DIET IS DOMINATED BY HIGH
FAT FOODS, RICH SAUCES AND
CHEESE AND HIGH INTAKES OF
OMEGA-3 FATTY ACIDS FROM SAUCES.
IT MAY NOT BE RELATEDED TO WHAT
THEY EAT BUT HOW THEY EATED IT.
THEY CONSUME MOST OF THEIR FOODS
AT MEAL TIMES SHARED WITH
OTHERS.
THEY SHARE MUCH MORE TIME EAT
THARG MEALS AND THEY RARELY
SMACK BETWEEN MEALS.
THERE WERE TWO EATING STYLES
WHAT WE CALL THE STABLES OF THE
UNITED STATES WILL WHERE
INDIVIDUALS EAT ANY TIME OF THE
DAY AND THE ZOO FOR THE FRENCH
WHERE THE INDIVIDUALS EAT ONLY
AT SPECIFIC FEEDING TIMES.
MAYBE THE UNITED STATES HAS TO
GO ON A ZOO PROGRAM.
[LAUGHTER]
EAT WELL, WHAT DOES IT MEAN?
FOR AMERICANS IT'S FOR THE
HEALTH AND FOR THE FRENCH, THE
IT'S FOR PLEASURE.
THIRD GROUP IS VEGETARIANS AND
AGAIN VEGETARIANS, ESPECIALLY
DOWN HERE PURE VEGETARIANS HAVE
EXTREMELY LOW BMI.
THIS IS GENERATED INTEREST ABOUT
WHETHER BEEF CONSUMPTION COULD
PERHAPS BE A CONTRIBUTED TO THE
OBESITY EPIDEMIC.
BEEF CONSUMPTION INCREASED AFTER
WORLD WAR II, BUT SINCE THEN IT
HAS BEEN FLAT OR EVEN
DECREASING.
THEREFORE IT'S UNLIKELY THAT
INCREASE IN BEEF CONSUMPTION IS
THE CAUSE OF THE OBESITY
EPIDEMIC.
HOWEVER THE UNITED STATES
COMPARE WITH JAPAN AND MANY
OTHER COUNTRIES HAS EXTREMELY
HIGH INTAKE OF BEEF WELL ABOVE
WHAT HAS BEEN RECOMMENDED IN THE
UNITED STATES, THUS THE HIGH
LEVELS OF BEEF CONSUMPTION IN
THE UNITED STATES MAY IN PART
CONTRIBUTE TO THE OBESITY
EPIDEMIC.
FURTHER AN INTERESTING
PHENOMENON IS THE CONSUMPTION OF
BOTTLED WATER IN THE UNITED
STATES.
SINCE 1908 WE HAVE DRAMATICALLY
INCREASED THE CONSUMPTION AND
SOFT DRINKING.
WE HAVE CONVINCED THE PUBLIC
THAT DRINKING WATER OUT OF A TAP
IS DANGEROUS TO YOUR HEALTH.
THIS IS A LITTLE BIT COMPLEX SO
I'LL POINT IT OUT THAT WE
CONSUME ABOUT 465 CALORIES PER
DAY FROM FLUIDSES IN THE UNITED
STATES DIET.
FURTHERMORE WE HAVE SWITCHED THE
SUGARS FROM SUCROSE TO FRUCTOSE.
DIFFERENCES IN METABOLISM
BETWEEN FRUCTOSE AND GLUCOSE ARE
STILL A LIVELY DEBATE.
FRUCTOSE IS ALMOST COMPLETELY
METABOLIZED IN THE LIVER AS
IMPORTANT SOURCE OF FATTY ACIDS
IN THE LIVER AND MAY CONTRIBUTE
TO INCREASED [INDISCERNIBLE] AND
INSULIN RESISTANCE.
SIMILARLY CHANGES IN OUR DIET
HAVE AFFECTED THE GUT BACTERIA
IN MICE SIT POSSIBLE TO VARY THE
RISK OF OBESITY IN RELATIONSHIP
TO THE BACTERIA GLOR RA.
IN FARM ANIMALS PROBIOTICS INTO
THE FOOD CHAIN THEY MAY HAVE HAD
AN EFFECT ON OUR GUT BACTERIA
AND OBESITY EPIDEMIC.
I'M GOING SAIL A LONG A LITTLE
BIT HERE.
I JUST WANT TO SHOW YOU, UH,
WHAT I THINK IS [INDISCERNIBLE].
JUST GOING SKIP A COUPLE OF
SLIDES BECAUSE OF TIME.
OKAY.
ONE OF THE INTERESTING AREAS, I
THINK, TO LOOK AT -- I DIDN'T
HAVE TIME TO SHOW THIS IN DETAIL
IS WHAT WE CALL EP TOMIC FAT A
ACCUMULATIONS.
THIS LEADS TO INSULIN
RESISTANCE, DIABETES AND
INABILITY TO LOSE WEIGHT.
THE EXCESS FAT TRIGLYCERIDES CAN
BE STORED IN [INDISCERNIBLE] AND
CARDIAC MUSCLE.
THE AMOUNT OF FAT INCREASES WITH
AGE IN MEN AND WOMEN.
THERE ARE TWO FAT DEPOTS IN
SKELETAL MUSCLES.
THE AMOUNT OF INTERMUSCULAR FAT
INCREASES WITH BOW'S THE PI.
MRS. THAT'S POSITIVE ASSOCIATION
BETWEEN INTERMUSCULAR FAT AND
TYPE 2 DIABETES.
IT'S POSSIBLE THAT'S WHAT'S
HAPPENING HERE THAT AS WE STORE
THE FAT IN OUR MUSCLE THIS MAY
HAVE EFFECT ON MITE COUNTRY YAN
FUNCTION AND LT MATELY LEAD BACK
TO A FACT OF MUSCLE INEFFICIENCY
AND USING ENERGY, INCREASED
DEMAND FOR CALORIES AND WEIGHT
REGAIN.
THIS MAY BE ANOTHER CLUE TO
WHAT'S HAPPENING.
VERY QUICKLY, WHAT ARE THE
OPTIONS NOW FOR THE PREVENT OF
OES THETY?
OBESITY.
FIRST OF ALL THE STIGMA
TIEIZATION OF -- WE SHOULD END
THE STIGMA TIEIZATION OF
OBESITY, THIS SHOULD BE STOPPED
FOR CHILDREN.
EATING IS AN IMPORTANT SOCIAL
BEHAVIOR AND NOT A THERAPEUTIC
TRIAL.
PEOPLE ARE OBESE NOT BECAUSE
THEY WANT TO BE BUT BECAUSE OF
THE INTERACTION OF THE AGENTS T
DIETS THE EXERCISE T ENVIRONMENT
AND THEIR GENETIC
SUSCEPTIBILITY.
SECOND, PREVENTION OF EIGHT GAIN
IN CHILDREN AND YOUNG ADULTS
SHOULD CLEARLY HAVE THE HIGHEST
PRIORITY.
THIS REQUIRES A TOTAL APPROACH
NOT PIECEMEAL.
CHANGES IN SCHOOL NUTRITION OR
POORLY DESIGNED PHYSICAL
ACTIVITY PROGRAMS.
WE NEED THE SAME SUCCESSFUL
APPROACHES THAT REDUCE CHILDHOOD
INFECTION DISEASES IN THE PAST;
VERY GOOD PUBLIC HEALTH AND
PREVENTATIVE MEDICINE WITH
DOCUMENTED OBJECTIVE OUTCOMES,
CAREFULLY CONTROLLED AND
EVALUATED OVERTIME WITH HARD END
POINTS.
PREVENTION PROGRAMS MUST BE FOR
THE WHOLE.
THEIR EATING BEHAVIOR IS NOTED
AND ESPECIALLY SNACK FOODS HAS
BECOME OUR MOST IMPORTANT ROLE
AND WE SHOULD FOCUS ON THIS
AREA.
REGULAR FOOD CONSUMPTION
ESPECIALLY BREAKFAST DINNER AND
EATING MEAL AT HOME ARE
CRITICAL.
FOURTH WE SHOULD INCREASE
CONSUMPTION OF TAP WATER.
THIS NEEDS TO BE A NATIONAL
EFFORT TO USE TAP WATER AS A
REPLACEMENT FOR BOTTLES DRINKS.
BECAUSE OF TIME I'M GOING SKIP A
LITTLE OF THIS.
FIFTH WE NEED TO IMPROVE AND
MODIFY THE PHYSICAL ACTIVITY
PROGRAMS FOR CHILDREN AND ADULTS
SO THAT THEY HAVE
[INDISCERNIBLE] UTILITY, ARE
INTERESTING AND ARE CONSISTENT
WITH THE CAPABILITIES.
WE SHOULD BE UPGRADING
FACILITIES AND IMPROVING
ACCESSIBILITY.
IN NEW YORK CITY, IN THE 1950s,
TEACHERS [INDISCERNIBLE] WERE
PROVIDED FOR PHYSICAL ACTIVITY
FROM KINDERGARTEN TO HIGH SCHOOL
GRADUATION.
A BOOK IN 1958 STATED THAT THE
EDUCATION IN YOUNG PEOPLE WE
REALLY MORE AND MORE THE VALUE
OF PHYSICAL ACTIVITY IN THE
SCHOOL CURRICULUM.
THE PROGRAM WAS INTEGRATED IN
SCHOOL CURRICULUM.
THE PRIMARY PURPOSE WAS NOT
HEALTH OR OBESITY PREVENTION,
BUT RATHER THE BELIEF THAT TO BE
SUCCESSFUL IN LIFE A STUDENT
MUST DEVELOP SKILLS AND
ENJOYMENT OF PHYSICAL
ACTIVITIES.
THESE SKILLS WERE LINKED TO THE
ABILITIES AND INTERESTS OF THE
STUDENTS TO TRY AND ENSURE
CONTINUATION OVER TIME.
UNFORTUNATELY, THIS ELITIST
APPROACH WAS LOST IN THE
NUMEROUS POLITICAL AND SOCIAL
CHANGES IN EDUCATION.
THE OBESITY EPIDEMIC IS A COMMON
SOURCE EPIDEMIC AND THEREFORE IS
IMPORTANT WITH INDUSTRY E TO
DEAL WITH THIS COMMON SOURCE
EPIDEMIC.
MUST BE DONE AS AN ACTIVITY
COLLABORATIVE APPROACH SIMILAR
TO WHAT'S DONE IN EFFORTS TO
REDUCE THE AMOUNTS OF
CHOLESTEROL AND SATURATED FAT IN
THE DIET LEADING TO SUBSTANTIAL
DECREASE IN LEVELS.
MAJOR EFFORT TO DEVELOP FOODS
THAT WILL DECREASE THE APPETITE
AND INCREASE THE
[INDISCERNIBLE].
SUBSTANTIAL INCREASE IN OMEGA-3S
IN THE DIET, PERHAPS, MAYBE TO
ONE GRAM A DAY AS IN JAPAN,
WITHOUT USE OF PILLS.
THERE NEEDS TO BE A GOOD TRIAL,
A TEST AT WHETHER FRUCTOSE IN
DIET IS REALLY HAZARDOUS.
WE ALSO NEED TO TEST WHETHER
PLANT-BASED DIETS WILL CHANGE
EATING BEHAVIORS IN THE LONG
TERM.
FINALLY WHAT DOESN'T WORK?
MANY OF THE CURRENT ACTIVITIES
THAT HAVE BEEN SUCCESSFUL AND
YET CONTINUE TO BE UTILIZED
NEVER BEEN SCIENTIFICALLY
EVALUATED PRIOR TO WIDE SPREAD
DISSEMINATION INCLUDING WEIGHT
LOSS PROGRAMS HAVE MINIMAL LONG
TERM E EFFECTS.
WE SHOULD BE FOCUSING ONLY ON
WELL-DESIGNED LONG TERM WEIGHT
LOSS TRIALS WITH TESTABLE
HYPOTHESIS.
THERE HAS TO BE COMMITMENT TO
LONG-TERM STUDIES OR WE
SHOULDN'T BE DOING THEM AT ALL.
NUTRITION EDUCATION AND PUTTING
CALORIES ON THE MENUS HAS VERY
SMALL OR LIMITED EFFECTS.
MORE DIETARY INTERVENTION ALONE
IN OBESE INDIVIDUALS WILL NOT
REDUCE DIABETE ENOUGH EXCEPT IN
THE SHORT TEM.
WE SHOULD END THE PROCESS OF
RESTRICTING JOBS OR CHANGING
INSURANCE FOR OBESE PEOPLE.
THIS IS WRONG AND DOESN'T HELP.
NOTIFYING PARENTS THAT CHILDREN
ARE OBESE ARE ONLY
[INDISCERNIBLE] THREE YEARS.
[LAUGHTER]
FINALLY AND MOST IMPORTANT --
AND AISLE STOP HERE -- IS THAT
DOING GOOD AND TRYING TO REDUCE
THE OBESITY EPIDEMIC WITHOUT ANY
EVIDENCE THAT THE PROGRAM OR
PROGRAMS WILL HAVE ANY REAL
POSITIVE BENEFITS IS NOT GOOD.
WE HAVE CLEARLY DEMANDED
WELL-DOCUMENTED CLINICAL TRIALS
AND EFFECTIVENESS STUDIES BEFORE
WE IMPLEMENT LARGE PUBLIC HEALTH
PROGRAMS WHICH IN THE END ARE
COSTLY AND HAVE LITTLE EFFECTS.
SIMPLISTIC APPROACHES LIKE
TRYING TO RAISE THE PRICE OF
SUGAR RI DRINKS TO WIPE OUT THE
OBESITY EPIDEMIC ARE MISTAKE AND
COUNTER PRODUCTIVE.
IT'S TIME TO END THE COMMITTEE
ON HOW TO REDUCE EPIDEMIC.
RATHER, WE SHOULD DEPEND ON GOOD
SCIENTIFIC INVESTIGATION
TRANSLATED INTO EFFECTIVE
PROGRAMS.
THANK YOU.
[APPLAUSE]
>> WE HAVE TIME FOR SOME
QUESTIONS, SO PLEASE IF YOU HAVE
A QUESTION, USE THE MIKE TONE
PHONES SO THAT EASY TO LISTENING
TO THE VIDEO CAST CAN HEAR THE
QUESTION.ONE
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>>XCE . RE AIFIAESBO
SWTERSHAPELEAKBY
HEON
>> ARTIFICIAL SWEETENERS IN
RELATIONSHIP TO OBESITY?
>> OR DO THEY HELP?
DO THEY PROVIDE [INDISCERNIBLE]?
>> THEY'RE A LITTLE PIECE OF A
BIG PROBLEM AND THEY'RE NOT
GOING SOLVE THE PROBLEM ALL BY
THEMSELVES.
SO JUST SAYING WE HAVE
ARTIFICIAL SWEETENERS WILL WIPE
OUT THE PROBLEM, IT WAS LIKE THE
ERA A FEW YEARS AGO WHERE WE
BASICALLY TRIED TO HAVE ALL THE
FOODS LABELED LOW-FAT BUT
BASICALLY HAD THE SAME NUMBER OF
CALORIES; IT DIDN'T DO ANY GOOD.
>> I HAVE A COMMENT IN THAT WE
ONLY HAVE ONE DRUG CURRENTLY
AVAILABLE FOR OBESITY AND YET WE
TACK ABOUT OBESITY AND WE'RE
VERY UPSET THAT WE ONLY GET A
FEW KILO WEIGHT LOSS.
WITH THE MEDICINE THERE WAS A
TRIAL WITH FOUR-YEAR FOLLOW-UP
WITH ONLY 2-AND-A-HALF KILO
WEIGHT LOSS DIFFERENCE, IT WAS A
1/3 REDUCTION IN THE INCIDENCE
IN DIABETES.
I WANT YOUR OPINION ON WHAT IS
THE GOAL OF TREATING OBESITY.
IT'S NOT KOZ MEE SIS, I WOULD
HOPE YOU'D AGREE THAT PRESUME
COMBLI IT'S BETTER HEALTH AND
HERE WE HAVE A CONCRETE EXAMPLE
WITH A FOUR-YEAR FOLLOW UP THAT
ONLY TWO-AND-A-HALF KILOS
REDUCTION IS OF BENEFIT.
>> I HAVE TWO COMMENTS ABOUT
THAT AND I WANT TO BE
[INDISCERNIBLE] ABOUT IT, BUT
ONE, IF YOU LOOK AT THE DPP
RESULTS OUT OVER TEN YEARS TO
SEE WHAT'S HAPPENING THAT
BASICALLY THERE'S VERY LITTLE
CHANGE IN DIABETE AFTER THE
FIRST PART OF THE STUDY BUT WHAT
HAPPENS IS IF YOU START OUT WITH
PEOPLE IN A STUDY WHERE THE
DEFINITION OF DIABETES A BLOOD
GLUCOSE OF 126 AND YOU START OUT
WITH PEOPLE WITH BLOOD GLUCOSE
OF 122, IT DOESN'T TAKE MUCH TO
GET IT UP TO 126.
I JUST WROTE A PAPER WHERE I
BASICALLY THINK WE SHOULD
ABANDON THIS IDEA OF STRICT
LABEL OF DIABETES AT SOME BLOOD
SUGAR LEVEL BUT TREAT IT LIKE
CLOSET ROLL AS A CONTINUOUS
LEVEL.
HOW MUCH BLOOD GLUCOSE DOES IT
LOWER AND HOW MUCH DOES THAT
LOWER THE DISEASE STROKE.
WE DON'T HAVE CLINICAL TRIALS TO
SUGGEST THAT LITTLE BIT OF
WEIGHT LOSS IS GOING TO HAVE
EFFECT ON MAJOR CARDIOVASCULAR
OR CANCER OUTCOME.
IF IT DID, IT WOULD BE AMAZING
BUT I DOUBT IT VERY MUCH.
>> THE TRIAL SIZE WOULD HAVE TO
BE HUGE.
>> THANK YOU FOR COVERING ALL
THIS ISSUES.
LOOKS LIKE [INDISCERNIBLE] IS
NOT WORKING.
WE COULD SEE PART OF THE
OUTCOMES FOR SOME OF THESE
STUDIES BUT THERE IS NO WAY TO
CONTROL THE BEHAVIOR TO KEEP THE
FOOT AWAY FROM THE MOUTH.
[LAUGHTER]
SO IT IS NEUROBEHAVIORAL SYSTEM
WHERE WE NEED A DIFFERENT
APPROACH.
ANY IDEA YOU MIGHT COME UP WITH?
>> WELL, I THINK YOU'RE RIGHT.
I THINK WE HAVE TO BASICALLY
LOOK AT THIS AS A
NEUROBEHAVIORAL PROBLEM GIVEN
THE FACT THAT WE'RE NOT GOING TO
GO BACK TO A LIFESTYLE OF THE
DISTANT PAST OR START CHOPPING
DOWN TREES TO PREVENT OBESITY,
AND I THINK RIGHT NOW WE HAVE TO
TRY AND WORK ON IMPROVING THE
DIET IN RELATIONSHIP TO
INCREASING SEW TIETY AND
DECREASING APPETITE AFTER EATING
FOODS BUT ALSO UNFORTUNATELY I
THINK WE NEED ULTIMATELY NEED
SOME DRUGS THAT WORK.
>> THANK YOU.
>> HI.
DO YOU THINK THAT CHANGES IN
AGRICULTURAL SUBSTIES COULD MAY
A ROLE IN DECREASING OBESITY.
I'M THINKING OF DECREASING DIS
FOR [INDISCERNIBLE] AND
INCREASES FOR VEJTDABLES AND
FRUITS?
>> NOW WE TALKED ABOUT THAT FOR
UMP TEEN YEARS IN TERMS OF WHEN
IT WAS RELATED TO CLOSET ROLL
LEVELS AND TRYING TO LOWER BLOOD
CREST ROLLS AND THINGS LIKE
THAT.
IT SOUNDS GOOD BUT UNFORTUNATELY
IN OUR SOCIETY IT DOESN'T WORK
VERY WELL, SO IT SOUNDS GOOD BUT
IT'S EXTRAORDINARILY DIFFICULT
TO IMPLEMENT.
THE OTHER THING TO REMEMBER IS
THAT ALL THESE EPIDEMICS MOVE
DOWNWARD IN THE SOCIO ECONOMIC
STRAIN AND THAT'S THE GROUP
THAT'S HARDEST TO REACH WITH
THESE CHANGES.
IT'D BE NICE TO CHANGE FOOD
PRODUCTION IN A POSITIVE WAY.
I THINK THE IDEA IS TO GET RID
OF SNACK FOODS AND GET PEOPLE TO
STOP SNACKING WOULD PROBABLY
HAVE THE BIGGEST EFFECT.
EASIER SAID THAN DONE.
>> WHAT ABOUT THE ENVIRONMENTAL
POLLUTANTS POSED BY -- THEY
DON'T REALLY KNOW WHY, BUT THEY
THINK THAT THERE ARE SOME KIND
OF ESTROGENS THAT ARE BEING
EXUDED BY PLASTICS AND ALSO THE
HORMONAL INGESTION OF FOOD
THAT'S BEEN GIVEN ALL THESE
ANTIBIOTICS AND HORMONES IN THIS
COUNTRY.
IT'S VERY HARD TO BELIEVE THAT
THIS DOESN'T HAVE AN INFLUENCE.
>> IT'S POSSIBLE BUT YOU TO
REMEMBER THAT THE OBESITY
EPIDEMIC HAS HAPPENED NOT ONLY
IN THE UNITED STATES BUT IN
AUSTRALIA, GREAT BRITAIN,
CANADA, MANY COUNTRIES AROUND
THE WORLD.
SO WHATEVER YOU LINK TO THE
OBESITY EPIDEMIC IN TOTALITY,
YOU HAVE TO THEN TEST IT WHETHER
THE SAME PHENOMENON EXISTS IN
THESE OTHER COUNTRIES AND IN
MOST CASES THEY DON'T.
THE ONE COMMONALITY IN MOST OF
THESE THINGS HAS BEEN THE
INTRODUCTION OF FOOD PROCESSES
AND THE REDUCED COST IN FOOD AND
THE CHANGES IN FAMILY STRUCTURE.
I THINK THE TECHNOLOGY AND THE
CHANGES IN THE SOCIAL
ENVIRONMENT ARE PROBABLY
OVERWHELMING MANY OF THESE OTHER
FACTORS WHICH COULD ALSO BE
IMPORTANT.
>> WELL WITH OCEAN [LOW AUDIO].
>> THANK UH YOU SO MUCH FOR A
WONDERFUL TALK.
WHAT DO WE DO WITH THE LOW
INCOME OR UNDERPRIVILEGED
POPULATIONS THAT ARE REALLY THE
ONES THAT ARE SUFFERING THE MOST
FROM THIS BECAUSE THEY CANNOT
AFFORD TO HAVE FRUITS AND
VEGETABLES AND HALE FOODS.
THEY ALSO ARE FACING OTHER TYPES
OF CHALLENGES.
THEY DON'T NECESSARILY HAVE THE
BEST ACCESS TO HEALTH CARE.
WHAT EXACTLY CAN WORK IN THESE
PARTICULAR POPULATIONS?
>> THAT'S A GOOD QUESTION AND MY
OWN -- I TREE TO GET THAT AT THE
END.
I REALLY THINK WE NEED TO GO
BACK TO SOME OF THE TRADITIONAL
PUBLIC HEALTH APPROACHES.
WHEN I FIRST STARTED THE PUBLIC
HEALTH DEPARTMENT, FOR EXAMPLE,
IN PITTSBURGH HAD ABOUT 400
PUBLIC HEALTH NURSES AND THEY
MADE CERTAIN THAT EVERY KID GOT
IMMUNIZED AND ADEQUATE NUTRITION
AND FOLLOW-UP AND CARE.
IT DOESN'T EXIST ANYMORE.
WE'VE GIVEN THAT UP AND I THINK
UNFORTUNATELY WE MAY HAVE TO GO
BACK TO SUCH A SYSTEM.
WE'VE INSTITUTIONALIZED IT IN
OUR MEDICAL CENTERS AND THE
PROBLEM IS OUT IN THE COMMUNITY.
>> SECOND THING, WHAT ABOUT THE
ADDICTION DIMENSION OF THINGS?
SO A LOT OF PEOPLE, I MEAN AS
HAS ALREADY BEEN MENTIONED IN
NEUROBEHAVIORAL SYSTEM THE IT'S
HAS BEENTIVE EAT BUG ALSO THE
FACT OF HOW EATING OR CONSUMING
HIGH-SUGAR CONTENT BEVERAGES IS
ADDICTIVE.
>> AGAIN, I THINK THAT'S
IMPORTANT BUT IF YOU LOOK AT THE
TOTALITY EPIDEMIC IN DIFFERENT
COUNTRY TARNSD WORLD, YOU GOT TO
FOCUS ON THE COMMONALITY OF THE
FACTORS.
THAT'S PROBABLY AN IMPORTANT
FACTOR, THOUGH, AS WELL.
>> YES.
WHEN I GO TO THE GROCERY STORE,
HOW DO YOU FEEL ABOUT
UNAVAILABILITY OF ANYTHING OTHER
THAN PROCESSED FOODS?
DOES THAT HAVE ANY EFFECT ON
WEIGHT GAIN?
>> OH, SURE IT DOES.
THE FOODS ARE ALL PROCESSES AND
THE HIGH CALORIC IS MAJOR
EFFECT.
THE GOVERNMENT'S TRYING TO PUSH
THE IDEA OF EATING MORE FRUITS
AND VEGETABLES AND LOW CALORIC
FOODS, BUT IT'S A VERY, IT'S A
MAJOR CHALLENGE.
>> WONDERING IF I COULD GET YOUR
COMMENT ON A COLLEGELATION THAT
WE PUBLISHED A COUPLE OF YEARS
AGO REGARDING THE FOOD SUPPLY
AND FOOD WAIST TRENDS THAT HAVE
OCCURRED IN THE U.S. SINCE THE
70s.
ONE OF THE THINGS WE NOTICED WAS
THAT FOOD WASTE HAS GONE UP BY
ABOUT FIVE HUNDRED CALORIES PER
DAY WHEREAS FOOD INTAKE HAS ONLY
GONE UP BY ABOUT TWO HUNDRED TO
THREE HUNDRED CALLIES WER DAY.
OUR INTERPRETATION WAS THAT
WE'RE PUSHING THE CALORIES INTO
THE FOOD SYSTEM, WE ACTUALLY
ONLY EAT A LITTLE BIT OF IT.
MORE OF THAT EXCESS WENT IN THE
TRASH.
>> THAT'S PROBABLY TRUE.
MY LUNCH TODAY SO YOU'RE
PROBABLY CORRECT.
[LAUGHTER]
I THINK THAT'S VERY TRUE AND I
THINK THAT'S TRUE BECAUSE OF THE
FACT THAT WE EAT FAST AND EAT
FAST FOODS AND WE DON'T SIT
DOWN.
AETDING ALL DAY LONG AND EATING
HERE AND THERE AND THROWING AWAY
AND STARTING ON SOMETHING ELSE.
>> ONE MORE QUESTION.
>> YOU MENTIONED EARLIER IN YOUR
TALK HOW THERE IS A STRONG, UM,
ASSOCIATION BETWEEN CHILDREN
THAT ARE OBESE AND PARENTS THAT
ARE OBESE AND UH YOU MENTIONED
IT'S AN INTERPLAY OF
ENVIRONMENTAL FACTORS AND THEN
LATER YOU SAID THAT NUTRITION
EDUCATION ISN'T EFFECTIVE AND
THAT RAISING THE AWARENESS OF
PARENTS ARE NOT EFFECTIVE.
HOW WOULD YOU SUGGEST THAT WE
APPROACH THE PROBLEMS OF OBESITY
IN YOUNG CHILDREN THAT ARE
ALREADY OBESE.
>> I HOPE I DIDN'T SAY THAT.
WHAT I SAID IS IT'S NOT A GOOD
IDEA TO SOUND OUT OR SADDLE OUT
ONLY THE FAT KIDS AS PART OF
YOUR NUTRITION EDUCATION.
NUTRITION EDUCATION SHOULD BE
FOR EVERYONE AND SHOULD AIM TO
THE ENTIRE POPULATION.
IT DOESN'T DO GOOD TO JUST SEND
A NOTE HOME TO THE MOTHER AND
SAY YOU HAVE A FAT KID.
THE MOTHER KNOWS THAT AND MAY BE
OBESE AS WELL.
AS OPPOSED TO NUTRITIONAL
EDUCATION FOR EVERYONE AND WHICH
I THINK WOULD HAVE A MUCH BIGGER
EFFECT.
>> JUST A FOLLOW-UP ON THAT.
THERE'S BEEN A LOT OF STUDIES
THAT HAVE SHOWN THAT PARENTS ARE
NOT AWARE THAT THEIR CHILD IS
OBESE.
DO YOU THINK THERE'S ANY VALUE
IN RAISING THAT AWARENESS?
>> I WOULD BE SURPRISED THAT THE
PARENTS DON'T REALIZE THE CHILD
IS OBESE; I WOULD HAVE SURPRISED
IF IT WOULD HAVE ANY EFFECT.
I COULD BE WRONG.
THERE'S NO EVIDENCE OR STUDIES
THAT HAS ANY REAL EFFECT.
YOU COULD THAT ON A GOOD STUDY
AND FIND OUT WHAT HAPPENS BUT
RIGHT NOW I THINK IT'S MOSTLY
HEARSAY AND WE NEED SOLID
SCIENTIFIC EVIDENCE THAT THESE
THINGS WORK.
>> THANKS.
>> SO LAST QUESTION HERE AND I
APOLOGIZE BAUDS WE'RE PASSED THE
HOUR BUT I'M SURE OUR SPEAKER
WILL STAY DOWN IN FRONT IF YOU
WANT TO COME AND ASK OTHER
QUESTIONS.
I'M JUST SENSITIVE TO THE TIME.
>> I REMEMBER BACK IN PITTSBURGH
YOU ALWAYS PROMOTED THAT IF ONE
COULD INSTITUTE POLICY CHANGE,
THAT WAS GOING TO BE THE BEST
WAY TO GET SOMETHING TO BE PUT
IN PLACE, SO PREVENT CARS, I
REMEMBER -- ACCIDENTS, I
REMEMBER YOU SAYING REDUCE THE
SPEED.
IF YOU HAVE -- SCHOOL SITUATION.
WOULD YOU RECOMMEND -- WHAT
WOULD YOU RECOMMEND THE GREATEST
EFFECT FOR AN INTERVENTION?
WOULD BIT FOCUSSED ON TRYING TO
IMPROVE PHYSICAL ACTIVITY?
GETTING A HOLD OF THE MENU AND
NUTRITION ENVIRONMENT IN
SCHOOLS?
IF YOU COULD ONLY REALLY CHANGE
ONE ITEM OR ONE ITEM AT A TIME?
>> I TRY TO -- MY OWN FEELING
WOULD BE, WOULD BE ON PHYSICAL
ACTIVITY AND I WOULD SAY THAT GO
GET THE 1958 EDITION OF NEW YORK
CITY BOARD OF HEALTH PROGRAM FOR
EDUCATION OF PHYSICAL ACTIVITY
FOR THE SCHOOL KIDS.
THE IT'S FANTASTIC.
I ALMOST TEMPTED TO PUT A NEW
COVER ON IT, I THOUGHT THE
FOUNDATION WOULD GIVE ME HUGE
AMOUNTS OF MONEY.
[LAUGHTER]
THEN I FELT I'D BE IN BIG
TROUBLE LATER ON.
IT'S A FANTASTIC DOCUMENT.
IT LAYS OUT THE PHYSICAL
ACTIVITY PROGRAM BEGINNING IN
KINDERGARTEN AND GOING ALL THE
WAY THROUGH HIGH SCHOOL,
LITERALLY, AND IN DETAIL,
NOTHING TO DO WITH OBESITY OR
HEALTH BUT JUST TO DO WITH THE
SOCIAL DESIRABILITY OF PHYSICAL
ACTIVITY AND DIFFERENT TYPES OF
ACTIVITY.
SO IT'S NOT WALKING AROUND THE
BLOCK OR CLIMBING AND IT GOES
ALL THE WAY FROM TEACHING KIDS
HOW TO PLAY GOLF, TENNIS,
SWIMMING, YOU NAME IT, AND IT'S
ORIENTED, I THINK, BEAUTIFULLY.
THAT'S WHAT WE NEED IN THE
SCHOOL SYSTEM.
I THINK THAT WOULD BE THE NUMBER
ONE PRIORITY.
>> THANK YOU.
>> LET'S THANK OUR SPEAKER
AGAIN.
[APPLAUSE]
>> THANK YOU.