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
–
–
–
–
–
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Jenny Craig, Inc
Alere
Technogym
Cancer Foundation for Life
Santech
Clarity Project
• Research Funding
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NIH
Body Media
Coca Cola
Department of Defense
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
Activity/fitness is far more
important than fatness as a
clinical or public health
problem
Ranking of selected risk factors: 6 leading causes of
death by income group, estimates for 2004
High blood pressure
Tobacco use
High blood glucose
World
Low-income countries
Middle-income countries
Physical inactivity
High-income countries
Overweight and obesity
High cholesterol
0
10
20
30
40
50
60
Percentage of total (total: 1.53 billion)
World Health Organization.
http://www.who.int/healthinfo/global_burden_disease/global_health_risks/en/index.htm
Physical Activity and CRF as Predictors of Allcause Mortality
•
•
•
•
31,818 men and 10,555
women
1492 deaths in men
during average followup of 14.6 years, and
230 deaths in women
during average followup 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
RR for All-cause and CVD Mortality in Fit and Unfit
ACLS Men by Body Fat Categories
4.5
4
3.5
3
2.5
Adj RR*
2
1.5
1
0.5
0
Fit
Unfit
<17 17-25 >25
Body Fat%
All-cause Mortality
<17 17-25 >25
Body Fat%
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
Adjusted RR for All-Cause Mortality by
Fitness and BMI, ACLS Women
Fit
Unfit
4
3.5
3
2.5
Adj RR*
2
1.5
*adj for age,
exam year,
smoking,
& health
status
1
0.5
0
Normal
Weight
Overweight
Farrell et al. Obes Res. 2002; 10:417-423
Obese
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
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
Uncritical, Unfounded, or
Unusual Comments about
Obesity and Health
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
We must improve school
lunches because American
children eat 50% of their
calories at school.
Mrs. Obama
February 2010
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
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
Model in the Article
1. Sky Reach-15 reps each side
2. Speed Intervals-10 sec at a
moderate pace then 20 seconds at
a fast pace for a total of 2 minutes
3. Bench Push-ups-15 reps
4. Walking Lunge-2 minutes
5. Tree Back Rows-15 reps
6. Speed Intervals (same as #2)
7. Jump Pull-ups-15 reps
8. Speed Steps-up and down stairs
for 2 minutes
9. Hanging Leg Raise-15 reps
10.Speed Intervals (same as #2)
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
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
Causes of the Obesity
Epidemic
It’s calories that count
Energy In
Portion size
High-fat foods
Energy dense
Low-fiber
Soft drinks
Snack foods
Energy Out
BMR
Thermic effect of food
Media (TV,PC)
Cars
No heavy labour
Exercise
Is the Average Total Daily
Caloric Intake Increasing?
Trends in Energy Intake
NHANES 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
Trends in Energy Intake
1971 to 2000, Men, NHANES
Kcal/day
3000
1971-74
1976-80
1988-94
1999-00
2500
2000
1500
1000
500
0
All Ages
20-39 y
Source: MMWR Feb 6, 2004
40-59 y
60-74 y
Trends in Energy Intake
1971 to 2000, Women, NHANES
Kcal/day
2500
1971-74
1976-80
1988-94
1999-00
2000
1500
1000
500
0
All Ages
Source: MMWR Feb 6, 2004
20-39 y
40-59 y
60-74 y
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
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
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
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
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
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 inline 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 ….
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
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
Thank you for your attention,
and for allowing me to
express my provocative ideas