The Roots of the Obesity
Epidemic
KATHERINE L TUCKER, PHD
CHAIR, DEPARTMENT OF HEALTH SCIENCES
NORTHEASTERN UNIVERSITY
“Obesity is the loss of the coordinated
control of caloric intake and energy
expenditure” (Velloso, 2012)
“Today, 66 percent of adults in the United
States are considered overweight or obese.
Obesity puts people at increased risk for
chronic diseases such as heart disease,
type 2 diabetes, high blood pressure, stroke,
and some forms of cancer.”
http://win.niddk.nih.gov/publications/understanding.htm
Velloso, L.A. Maternal consumption of high fat diet disturbs hypothalamic neuronal function in the
offspring: implications for the genesis of obesity. 2012. Endocrinology. Vol. 153, No. 2, pp. 543-545
http://www.cdc.gov/obesity/causes/index.html
Obesity Trends* Among U.S. Adults
BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1986
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1987
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4”
person)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1988
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1989
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1991
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1992
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1993
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1994
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1996
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 1999
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 2001
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2002
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2003
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2004
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2005
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 2006
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 2007
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 2008
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 2009
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 2010
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 1990, 2000, 2010
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2000
1990
2010
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
So What Happened?
 an environment that promotes excessive food intake and discourages
physical activity.
 Although humans have evolved excellent physiological mechanisms to
defend against body weight loss, they have only weak physiological
mechanisms to defend against weight gain when food is abundant.
 Control of portion size, consumption of a diet low in fat and energy
density, and regular physical activity are behaviors that protect against
obesity, but it is difficult to maintain these behaviors in the current
environment.
James O. Hill and John C. Peters Environmental Contributions to the Obesity Epidemic
DOI: 10.1126/science.280.5368.1371
Popkin B, The World is Fat
“…from 30 years ago to today, we've had an exponential
explosion in what we can think of as the "obesogenic
environment." You see food available everywhere. ..In most
of the world, it used to be that people mostly drank water…
The average American has … added 22 ounces of caloric
beverages to his diet, …300 extra calories per day.
We naturally prefer sweet and fatty foods because of what
those foods used to mean for survival when we were huntergatherers. They had the nutrients we needed, and they let us
store more energy for the hungry season.
Popkin, B., The world is fat. Scientific American. 2007 . Vol. 297, pp. 88 – 95
doi:10.1038/scientificamerican0907-88
Sweetness Preference was
Essential to Survive: Huge Shift in
Amounts, Energy Density
Popkin, B., The world is fat. Scientific American. 2007 . Vol. 297, pp. 88 – 95
doi:10.1038/scientificamerican0907-88
Waist circumference (cm)
APOA1 -75 and total fat intake
P-value for interaction=0.005
106
105
104
103
102
101
100
99
98
97
96
103.7
P=0.005
CC
CT+TT
103.2
101.3
P=0.235
99.3
<31%
≥31%
Total fat intake, % from energy
Mattei, J., et al. Apolipoprotein A5 Polymorphisms Interact with Total Dietary Fat Intake in Association with
Markers of Metabolic Syndrome in Puerto Rican Older Adults. 2009. The Journal Of Nutrition Genomics,
Proteomics, and Metabolomics. Vol. 139, pp. 2301-2308
Ghr.nlm.nih.gov
Biology
Sweet Preferences
Technology
Cheap caloric sweeteners, food
processing benefits
Thirst and hunger/satiety
Mechanisms not linked
Caloric beverage revolution
Fatty food preference
Edible oil revolution; high yield
oil seeds; cheap removal of oils
Desire to eliminate exertion Technology in all phases of
movement/exertion
Popkin, B.M., et al. Global Nutrition transition and the pandemic of obesity in developing countries. 2011. Nutrition Reviews. Vol. 70, No.
1, pp. 3-21. doi:10.1111/j.1753-4887.2011.00456.x
Sources of Major Global Dietary Shifts
Globally:
 large increases in consumption of caloric beverages and
increasing snacking
 increased intake of ultra processed foods, refined
carbohydrate
 reduced intake of fruits and vegetables and legumes
 reduced preparation time, increased use of precooked
foods
Lower income countries:
 increased edible oil
Popkin, B., The world is fat. Scientific American. 2007 . Vol. 297, pp. 88 – 95
doi:10.1038/scientificamerican0907-88
•In the U.S., calories from caloric beverages reached
21.0% by 2002
•Several metabolic outcomes relate to regular diet
beverage consumption, particularly when coupled with
certain dietary patterns such as a Western diet
•“fructose acutely increases thermogenesis,
triglycerides, lipogenesis and blood pressure…In
controlled feeding studies, changes in body weight, fat
storage and triglycerides are observed as well as an
increase in inflammatory markers. “ Bray 2010
•Diet soda has been associated with a
greater risk of incident metabolic
syndrome, type 2 diabetes, and doubled
the risk of overweight and obesity
•Tate, D.F., et al. 2012. Am J Clin Nutr. Vol. 95, pp. 555-63.
•Duffey, K.J., et al. 2012. Am J Clin Nutr. Doi:
10.3945/ajcn.111.026682
•Bray, G.A. Current Opinion in Lipiology. 2010. Vol 21 , No. 1 , p p.51–57
•fatshapeofitshape.blogspot.com
People who consume >= 1 sugar sweetened beverage per day have a 26%
greater risk of developing type 2 diabetes and 20% greater risk of
developing the Metabolic Syndrome. Malik et al
Metabolic Syndrome was highest in women with
an Empty Calorie dietary pattern in the
Framingham Heart Study.
Sonnenberg et al
Dietsinreview.com
Malik, V.S., et al.. 2010. Diabetes Care. Vol. 33, No. 11,
pp. 2477-2483.
Sonnenberg, L., et al. 2005. Obesity Research. Vol. 13,
No. 1, pp. 153-162.
Baltimore Longitudinal Study of Aging
459 men and women, 30-80 y
White
bread
Healthy Meat
Alcohol Sweets
White bread
15.8
3.2
5.3
6.3
7.1
Fruit
4.5
9.9
5.7
4.1
5.1
High fiber cereal
3.0
7.0
2.8
2.9
3.3
Whole grain bread
1.7
4.5
4.2
2.9
3.3
Meat
6.4
4.1
8.0
7.3
6.6
Potato
2.2
2.2
3.2
2.1
2.8
Alcohol
2.7
1.8
3.0
14.8
2.2
Baked sweets
5.2
4.7
3.4
4.0
11.2
Newby et al Am J Clin Nutr 2003;77:1417–25.
Change in BMI
(Kg/m2/y)
0.35
*
0.3
0.25
0.2
0.15
0.1
0.05
0
White bread
Healthy
Meat
Alcohol
Sweets
Change in Waist Circumference
(cm/y)
1.4
*
1.2
1
0.8
0.6
0.4
0.2
0
White bread
Healthy
Meat
Alcohol
Sweets
•
Foods high on the GI chart can
increase appetite, cause weight gain
and increase risk for obesity
(Monsivais, 2011)
•
Replacing saturated fatty acids with
carbohydrates low on the GI was
protective against MI
Replacing them with carbohydrates
high on the GI yielded a higher risk
of MI (Jakobsen 2010)
•
•
Lower risks of CHD from a low GI
diet may be through lower insulin
and blood glucose (Rahelic, 2011)
•Monsivais, P., et al. s. 2011. Appetite. Vol. 56, pp. 9-14
•Jakobsen, M.U., et al.. 2010. Am J Clin Nutr. Vol. 91, pp. 1764-8
•Rahelic, D, et al. 2011. Coll Antropol. Vol. 35, No. 4, pp. 13631368
Prostate-cancer.org,
peaknutrition.wordpress.com
Many food companies are ignoring
the caloric value requirements and
recommendations for the public
to view in their establishments
(Mooney, 2012)
• Evidence that a diet high in fat yields a significant
percentage of new cells in a part of the brain related
to the hypothalamus where hunger, thirst, and eating
controls are executed.
•The heightened level of brain cells in this area may
interrupt normal hunger and eating regulations in
that area
Fox News Report
http://www.foxnews.com/health/2012/03/26/fatty-diet-may-casue-new-brain-cells-to-sprout/
Theblaze.com,
yogiwellnesshourney.blogspot.com ,
healthdoctrine.com
Mooney, H. BMJ2012;344:e2131
Huang et al state:
•
Human imaging studies suggest that the brain has automatic
approach responses to food that these can be influenced
by product advertising and pricing.
•
The reward and executive control patterns in the brain can be
induced and modulated by palatable, energy-dense foods in a
way similar to addictive substances.
•
These neural systems are powerful in defending the
body from undernutrition but have little capacity to
defend against overnutrition. (Huang, 2009)
Writingfordesigners.com, esquire.com, goncava.com
Huang, T.T., et al. A systems oriented multilevel framework for addressing obesity in
the 21st century. 2009. Preventing Chronic Disease. Vol. 6, No. 3, pp. 1-10
•Maternal diet and health can affect the risk of a child developing obesity via fetal
programming.
•A child is “biologically programmed” to more readily gain weight from signals in the womb
and when they are later exposed to an obesigenic environment they then become
overweight.
•Bottle fed infants may have more childhood obesity than breastfed infants, due to
overfeeding leading to loss of satiety signals.
•More meals eaten outside the home (including fast-food), larger portion sizes, unhealthy
school food and vending machines
•Children no longer regularly walk or bike to school, reduced time in schools for PE, and lack
of a safe environment for children to be active in.
•Watching television, playing video games, and spending time on the computer are all
sedentary activities
Petersen C, http://eruditiononline.co.uk/experimentation/article.php?id=1306
•Overweight and obese children are at risk for:
1. Respiratory disorders
2. Decreased ventilatory function
3. Hyperlipidemia
4. Hyperinsulinemia
5. Glucose intolerance
6. Hypertension
7. Joint problems
8. Fatty liver disease
9. Gall stones
10. Acid reflux
11. Social and psychological problems
•Modifiable risk factors is KEY for
targeting and preventing childhood
obesity
Healthontherun.net, Epianalysis.wordpress.com,
•Newby, P.K. et al. Beverage Consumption is not associated with changes in weight and body mass index among low-income
preschool children in North Dakota. JADA. , 2004, doi:10.1016/j/jada.2004.04.020
•CDC.gov/childhoodoverweightobesity)
Urbanization plays a significant role in the global obesity pandemic
Malik, V.S., et al. Sugar Sweetened Beverages, Obesity, Type 2 Diabetes Mellitus, and Cardiovascular Disease Risk. 2010. Contemporary
Reviews In Cardiovascular Medicine. Vol. 121. pp. 1356-1364
•Association of environmental estrogens – such as the synthetic estrogen
diethylstilbestrol (DES), bisphenol A (BPA) used in the production of
plastics, and phytoestrogens in foods such as soy isolates – has been
shown with the development of obesity.
•Links to other EDCs, such as organotins, phthalates, pesticides, and
persistent organic pollutants in animal studies … are supported by both
experiments with cells in culture and epidemiology studies.
Newbold, R.R. Contribution of Endocrine Disrupting Chemicals to the Obesity Epidemic: Consequences of Developmental Exposure.
Research and Perspectives in Endocrine Interactions, 2011, 101-112
Sympathetic activation is an important metabolic adaptation limiting weight
gain.
Weight-matched β-blocker users, compared to controls, showed diet-induced
thermogenesis, fat oxidation rate and weekly habitual activity were lower by
50%, 32% and 30% (all P<0.04), respectively.
Adjusted mean body weight of β-blocker users was 9.2 kg higher at baseline
among those attending a diabetes clinic, 17.2 kg higher in a hypertension clinic
compared with patients not treated with β-blockers. (all P<0.01)
Conclusions: EE is reduced and body weight increased in chronic β-blocker
users. Chronic β-blockade may cause obesity by blunting estradiol.
Lee P, Kengne AP, Greenfield JR, Day RO, Chalmers J, Ho KKY. Metabolic Sequelae of Β-blocker Therapy: Weighing in on The Obesity
Epidemic? Int J Obesity 2011;35:1395-1403
Department of Health and Human Services Food and Drug Administration
Calories Count Report of the Working Group on Obesity
 “The problem of obesity has no single cause. Rather, it is
the result of numerous factors acting together over time.
Similarly, there will be no single solution; obesity will be
brought under control only as a result of numerous
coordinated, complementary efforts from a variety of
sectors of society.”
Figure 2. Levels of
determinants and
sectors of society
implicated in the
complex systems of
obesity.
Huang, T.T., et al. A systems
oriented multilevel framework
for addressing obesity in the
21st century. 2009.
Preventing Chronic Disease.
Vol. 6, No. 3, pp. 1-10
Tips to help consumers translate the Dietary Guidelines into
their everyday lives:
• Enjoy your food, but eat less.
• Avoid oversized portions.
• Make half your plate fruits and vegetables.
• Switch to fat-free or low-fat (1%) milk.
• Compare sodium in foods like soup, bread, and frozen
meals – and choose the foods with lower numbers.
• Drink water instead of sugary drinks.
Eastpointhealthandfitness.com
Food Labeling
• Calories: … give more prominence to calories on the food label
• Serving Sizes: Encourage manufacturers immediately to …label as a
single-serving those food packages where the entire content of the package
can reasonably be consumed at a single-eating occasion.
• Comparative Labeling Statements: ...use appropriate comparative
labeling statements that make it easier for consumers to make healthy
substitutions, including calories
Enforcement Activities
• …increase enforcement against weight loss products having false or misleading claims.
• Consider enforcement action against products that declare inaccurate serving sizes.
Educational Partnerships
• …establish relationships with youth-oriented organizations to educate Americans about
obesity and leading healthier lives through better nutrition .
Restaurants
• …launch a nation-wide, voluntary, nutrition information campaign for consumers.
Department of Health and Human Services, Food and Drug Administration
Calories Count Report of the Working Group on Obesity 2004