Obesitybe DAMMED what it will take to turn the tide

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Obesitybe DAMMED!-what it will take to turn the
tide-

• David L. Katz, MD, MPH, FACPM, FACP
• Director, Prevention Research Center
• Yale University School of Medicine
• President Founder, Turn the Tide Foundation,
  Inc.
• Medical Contributor, ABC News
• Claridge Food Group Conference
• Aventura, FL
• February 12, 2007

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On the menu-

• What ?
• Why ?
• How ?
• When Who ?

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• What?

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Our sea of dietary troubles
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Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1986
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1987
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1988
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1989
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1991
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1992
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1993
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1994
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1996
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs overweight for 5 4 woman)
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Obesity Trends Among U.S. AdultsBRFSS, 2001
(BMI 30, or 30 lbs overweight for 5 4 woman)
No Data lt10 1014 1519
2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI 30, or 30 lbs overweight for 5 4 woman)
(BMI ?30, or 30 lbs overweight for 54 person)
No Data lt10 1014 1519
2024 25
Source Behavioral Risk Factor Surveillance
System, CDC
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Obesity Trends Among U.S. AdultsBRFSS, 2003
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014 1519
2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2004
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014 1519
2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 1991,
1996, 2004
(BMI ?30, or about 30 lbs overweight for 54
person)
1996
2004
No Data lt10 1014 1519
2024 25
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The wave has not yet crested

• Ogden CL et al. Prevalence of Overweight and
  Obesity in the United States, 1999-2004. JAMA.
  20062951549-1555

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No escape at the border

• Prevalence of Obesity Levels in Canada,
  1994/95-2000/01
• Source National Population Health Survey, Health
  Share Files, 1994/95-1998/99 Canadian Community
  Health Survey, Share File, 2000/01
• Since 1994/95, the prevalence of each obesity
  level has been increasing. Efforts aimed at
  promoting healthy eating, such as Canada's Food
  Guide, and physical activity, such as the
  Vitality program, are targeted toward combating
  obesity in Canada.
• Note This chart uses the new Health Canada
  guidelines on obesity, as defined by Body Mass
  Index (BMI), which is weight (in kg) divided by
  height (in m) squared. Obesity Level I classifies
  people with a Body Mass Index (BMI) between 30
  and 34.9. Obesity Level II classifies people with
  a BMI between 35 and 39.9. Obesity Level III
  classifies people with a BMI of 40 or more.

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Obesity crosses its Rubicon

• More overfed than hungry human beings on the
  planet
• The Associated Press
• 10th International Congress on Obesity
• Sydney, Australia 9/3/06

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Obesity Portends Diabetes
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Diabetes Trends Among Adults in the U.S.
(Includes Gestational Diabetes) BRFSS
1994Source www.cdc.gov
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Diabetes Trends Among Adults in the U.S.
(Includes Gestational Diabetes) BRFSS
1995Source www.cdc.gov
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Diabetes Trends Among Adults in the U.S.
(Includes Gestational Diabetes) BRFSS
1996Source www.cdc.gov
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Diabetes Trends Among Adults in the U.S.
(Includes Gestational Diabetes) BRFSS
1997Source www.cdc.gov
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Diabetes Trends Among Adults in the U.S.
(Includes Gestational Diabetes) BRFSS
1998Source www.cdc.gov
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Diabetes Trends Among Adults in the U.S.
(Includes Gestational Diabetes) BRFSS
1999Source www.cdc.gov
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Diabetes Trends Among Adults in the U.S.
(Includes Gestational Diabetes) BRFSS
2000Source www.cdc.gov
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Diabetes Trends Among Adults in the U.S.
(Includes Gestational Diabetes) BRFSS
2001Source www.cdc.gov
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Diabetes Trends Among Adults in the U.S.
(Includes Gestational Diabetes) BRFSS
2002Source www.cdc.gov
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Diabetes Trends Among Adults in the U.S.
(Includes Gestational Diabetes) BRFSS
2003Source www.cdc.gov
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Diabetes Trends Among Adults in the U.S.
(Includes Gestational Diabetes) BRFSS
2004Source www.cdc.gov
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the Rising Tides of Nutritional Tribulation
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What it is
Adult Population
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Overweight / Obesity
Insulin Resistance
Diabetes Mellitus
Cardiovascular Disease
Time
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And What it SHALL be
Children !!
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Overweight / Obesity
Insulin Resistance
Diabetes Mellitus
Cardiovascular Disease
Time
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• Why?

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Why are we eating ourselves to death !?!
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BECAUSE WE CAN!The nature of our trouble,the
trouble in our nature
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Causes of Obesity ? Complex Simplicity

• energy imbalance calories in, calories out!
• basal metabolism
• postprandial thermogenesis
• physical activity
• genetic factors
• metabolic syndrome
• Ob gene
• neurohormonal regulation (e.g., neuropeptide Y
  adiponectin PYY ghrelin resistin etc.)
• basal metabolic rate (Pima Indians)
• Hypertrophic vs. hyperplastic obesity
• metabolic set-point
• the weight loss plateau

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Too many calories in

• 3800 calories produced in US each day for every
  man, woman, and child (www.usda.gov) something
  has to be done with them all!
• Nielsen SJ, Popkin BM. Pattern and Trends in Food
  Portion Sizes, 1977-1998. JAMA. 2003289450-453

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too few calories out.
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• How?

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At present, still all wet

• The Institute of Medicines (IOM) Committee on
  Progress in Preventing Childhood Obesity report,
  Progress in Preventing Childhood Obesity How Do
  We Measure Up? 9/13/06

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Drying out-

• One sandbag at a time

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When the going gets tough
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The Tough Better Get UnbefuddledNewsweek
Cover 3/7/06
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All diets work

• but no diet works!
• Dansinger ML, Gleason JA, Griffith JL, Selker
  HP, Schaefer EJ. Comparison of the Atkins,
  Ornish, Weight Watchers, and Zone diets for
  weight loss and heart disease risk reduction a
  randomized trial. JAMA. 200529343-53

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Recipe for ReconciliationsA dash of dietary
Darwinism...

• Eaton SB, et al. Evolutionary Health Promotion.
  Prev Med. 200234109-118
• Eaton SB, Eaton SB III, Konner MJ. Paleolithic
  nutrition revisited A twelve-year retrospective
  on its nature and implications. Eur J Clin Nutr.
  199751207-216
• Lev-Ran A. Human obesity an evolutionary
  approach to understanding our bulging waistline.
  Diabetes Metab Res Rev. 200117347-62

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Along with a dash of

• DASH, a pat of PREMIER, a pinch of the DPP, a
  smidgen of the NWCR
• Sacks FM et al. N Engl J Med 20013443-10
• Writing Group. JAMA 20032892083-93
• Knowler WC et al. N Engl J Med 2002346393-403
  
• Wing RR, Hill JO. Annu Rev Nutr. 2001
• Not to mention an abundance of other science
• Hu FB, Willett WC. Optimal diets for the
  prevention of coronary heart disease. JAMA.
  20022882569-78
• Grundy SM et al. Diet composition and the
  metabolic syndrome what is the optimal fat
  intake? Am J Med. 200211325s-29s
• Katz DL. Dietary Recommendations for Health
  Promotion and Disease Prevention. In Katz DL.
  Nutrition in Clinical Practice. Lippincott
  Williams Wilkins. 2000
• Walker KZ, ODea K. Annu Rev Nutr. 200111244-8
• Brunner EJ et al. Int J Obes Relat Metab Disord.
  20012545-53
• Gibney MJ. Optimal macronutrient balance. Proc
  Nutr Soc. 199958421-5
• McKeown NM. Am J Clin Nutr. 200276390-8
• Riccardi G, Rivellese AA. Br J Nutr.
  200083s1s143-8

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So perhaps its time to stop parsing

• and pass the parsley!
• Hit me in the head if you dont agree we should
• Reduce trans fat
• Reduce saturated fat
• Reduce sodium
• Increase fruits and vegetables
• Increase whole grains
• Reduce refined starches and simple sugars
• Replace bad fats with good
• Increase fiber
• Increase micronutrients
• Control portion size and total calories
• Increase physical activity
• TIME Magazine / ABC News Summit on Obesity 6/04

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Apply skill power,

• not just will power.

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Or in other words
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Sensory Specific Sabotage

• in the supermarket.

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Sodium Content per 100 calories

• Chex Cereal
• YooHoo Chocolate Drink
• Fritos Corn Chips
• Cape Cod Potato Chips

• 233 mg
• 131 mg
• 100 mg
• 73 mg

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Sugar Content per 100 calories

• Ragu Pasta Sauce
• Smuckers Dark Chocolate Ice Cream Topping

• 12 grams
• 11 grams

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The Food Industrys Smoking Gun?

• Where there's smoke, there might be food
  research, too
• Documents indicate Kraft, Philip Morris shared
  expertise on how the brain processes tastes,
  smells
• By- Patricia Callahan, Jeremy Manier and Delroy
  Alexander
• The Chicago Tribune, January 29, 2006

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Reinventing the food label

• For dummies.
• Katz DL. Op-Ed, the Hartford Courant, 10/03

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c O-N-Q-I ringnutritionalCONFUSION

• Overall Nutritional Quality
• Index
• Coming soon
• to a supermarket near you!

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Not your fathers food label

• Onqi Onqi
• Onqi

• A

• C

• B

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Lets eat out!Getting health there, from
herevirtually.

• www.healthydiningfinder.com

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Stop (peddling) candy (to) babies-

• IOM report on food marketing to children, 12/05
• gaming the system.
• Its Childs Play Advergaming and the Online
  Marketing of Food to Children. Kaiser Family
  Foundation, 7/06

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Be sure that Schools lead, follow, or

• are ashamed!
• National School Lunch Program Policies
• http//www.fns.usda.gov/cnd/Lunch/CompetitiveFoods
  /state_policies_2002.htm

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School Foods Report Card
VT F
NH F
MA F
RI F
CT B-
NJ B
DE F
MD D
DC C
A
B
AK F
C
D
F
http//www.cspinet.org/schoolreportcard.html
6/06
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Of Will, Ways-

• The WAY Program http//www.wayplanet.com
• Planet Health
• CATCH
• http//www.sph.uth.tmc.edu/catch/
• WE CAN
• http//www.nhlbi.nih.gov/health/public/heart/obesi
  ty/wecan/live-it/go-slow-whoa.htm
• Heres to You, Mr. Robinson-
• http//notv.stanford.edu/
• PE4Life
• Take 10!
• http//www.take10.net/

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Meanwhile, back at the ranch-
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No Child Left (on their) Behind-Square Peg,
Round Hole?

• As easy as ABC for Fitness-
• Activity Bursts in the Classroom

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I think therefore I am ?

• I am (active), therefore I think (better)!
• Sallis JF, McKenzie TL, Kolody B, Lewis M,
  Marshall S, Rosengard P. Effects of
  health-related physical education on academic
  achievement project SPARK. Res Q Exerc Sport.
  199970127-34.

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Cafeteria as Classroom

• The New York Times
• February 24, 2006
• Op-Ed Contributor
• Eating for Credit
• By ALICE WATERS
• Berkeley, Calif.

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Foodfor Thought- HEALTH! -the
Nutrition Detectives Program-

• A Katz Katz Production
• updated March, 2006

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David L. Katz, MD, MPH, FACPM, FACPYale
University School of MedicineCatherine S. Katz,
PhD Family
NUTRITION DETECTIVES was created in 2003 and
is revised annually to keep up with the changes
in the food industry
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Being Smarterthan the Average Bear!
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Supermarket

• Spy Kids!

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• BEFORE you learn how to read
• a food label

• It's a mad jumble of letters!

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• Its just like finding Waldo !

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• YOU DID IT!

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• AFTER you learn how to read
• a food label

• jump at you

• the bad words will
• at a glance!

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• REMEMBER the 5 clues !

Dont be fooled by THE BIG LETTERS on the front
of the package Look for the label instead! The
FIRST ingredient is always the biggest!! Avoid
partially hydrogenated oil high fructose corn
syrup (its like finding Waldo!) Avoid foods
with a LONG ingredient list! FIBER is your
friend, so look out for whole grain imposters!
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• Thanks for coming!

the KATZ FAMILY (2003)
www.davidkatzmd.com
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Avoiding (gastric) Bypass-by Resolving an
Impasse.

• O-W-C-H this wont hurt a bit...
• On-line Weight Counseling instruction for
  Healthcare Providers National Obesity Action
  Forum, Washington, DC 6/06
• Katz DL. Behavior Modification in Primary Care
  the Pressure System Model. Prev Med. 20013266-72

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The Vision-

• On-line training
• CME credits
• Quality control indicators embedded
• Controlled access at first
• Cost-utility analysis
• Trust, verify, disseminate

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Can you hear me NOW?

• The CONFIDANT System
• http//www.confidantinc.com/

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If health is not its own incentive-

• then incentivize health
• http//www.incentahealth.com/

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Denialis not just a river in Egypt

• Arkansas, the application of compassionate
  candor-
• Arkansas Center for Health Improvement
• ACHI Releases Year 3 (Fall 2005- Spring 2006)
  Statewide BMI Assessment ReportSummary of Year 3
  Results

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The falsely alluring alternatives to doing all
the right thingsPharmacotherapeutic Phantasies
Cold Hard Steel-

• McFarlane SI, Rundek T, Nicasio J, Deshmukh M,
  Sowers JR. The DREAM trial and the prospect of
  diabetes prevention. Curr Diab Rep. 20066205-6
  
• FDA approves OTC Orlistat 2/7/07
• Obesity Surgery Increases by 600 Percent
• Safer Techniques, More Insurance Coverage and
  Celebrity Patients Make It More Appealing ABC
  News Medical Unit, May 31, 2006

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Beware our Birthmark

• Like Hawthornes hapless heroine, we all are
  marked from birth
• Katz DL. The Scarlet Burger. Wall Street
  Journal, Op-Ed. 11/19/03

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If we build it
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Who should lend a hand-

• and stack a bag of sand?

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The right actions at present

• for a better future
• are informed by the past!
• Time to go BACK to our nutritional future

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Thank you.

• David L. Katz, MD, MPH, FACPM, FACP
• Director, Yale Prevention Research Center
• President, Turn the Tide Foundation, Inc.
• 130 Division St.
• Derby, CT 06418
• [phone]
• David.katz_at_yale.edu
• www.davidkatzmd.com