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James O. Hill, Ph.D. Anschutz Professor Executive Director Anschutz Health and Wellness Center University of Colorado
Obese
Extremely Obese
Note: Age-adjusted by the direct method to the year 2000 US Bureau of the Census using age groups 20-39, 40-59 and 60-74 years. Pregnant females excluded. Overweight defined as 24,=BMI; obesity defines as BMI>=30; Extreme obesity defines as BMI>=40.
Note: Overweight is defined as BMI>=gender and weight-specific 95th percentile from the 2000 CDC Growth Charts. Source: National Health Examination Surveys II (ages 6-11) and III (ages 12-17), National Examination Surveys, I, II, III and 1999-204, NCHS, CDC.
Inherited Factors
Efficiency Adaptive thermogenesis Food preferences
Energy Stores
Environmental Factors
Food environment Physical activity environment
Energy Intake
Active Regulation/Integration
Energy Expenditure
Body Weight
Active Regulation
EIn
The obesity epidemic arose from EOut gradual weight gain over time
Body Wt (lbs)
160
155
150
145
140
135
Amish Men
US Women
Energy Intake
Energy Expenditure
Muscles Insulin Sensitivity Nutrient Metabolism Fat Cells Appetite Brain function
Hypothetical Model for the Cause of the Obesity Epidemic of the Late 20th Century
Body Weight
Energy Intak
1920
1950
1980
2013
Energy Stores
Energy Intake
Active Regulation/Integration
Energy Expenditure
How much behavior change is needed for successful weight loss maintenance?
Obesity
-10% (10 kg) = 190-200 kcal/day
Energy Gap
Comparison of weight loss diets with different compositions of fat, protein and carbohydrates (n=811)
1.Eating a Reduced Calorie-Reduced Fat Diet 2.Engaging in a high level of physical activity 3.Limiting TV Viewing 4.High level of dietary restraint 5.Frequent self-weighing 6.Maintaining dietary consistency 7.Eating breakfast
Body Weight
Energy Gap
Obese
Overweight
Healthy Weight
Addressing Obesity
Biology
Behavior
Environment
Healthy Environment
Economics
Obesity
Food
Increased Energy Intake
Social Systems
Available Social Environment of Wellness Good tasting Energy dense Inexpensive Large portions
20 years
NOW
DPP
??
Menu Labeling
Ideas Knowing calorie content could reduce intake basic and clinical research Very little clinical research
Development of No real testing Science-based programs Very little evaluation in controlled settings
Education Research
Clinical
Community Engagement