Transcript Why are we fat? John C. Peters, Ph.D. Chief Strategy Officer Anschutz Health and Wellness Center Professor of Medicine.

Why are we fat?
John C. Peters, Ph.D.
Chief Strategy Officer
Anschutz Health and Wellness Center
Professor of Medicine
82 Putative Causes
(From the Downey Obesity Report, February 28th, 2013)
1. agricultural policies
2. air conditioning
3. air pollution
4. antibiotic usage at early age
5. arcea nut chewing
6. assortative mating
7. being a single mother
8. birth by C-section
9. built environment
10. chemical toxins
11. child maltreatment
12. competitive food sales in schools
13. consumption of pastries and chocolate (in
Burkina Faso)
14. decline in occupational physical activity
15. delayed prenatal care
16. delayed satiety
17. depression
18. driving children to school
19. eating away from home
20. economic development
21. endocrine disruptors
22. entering into a romantic relationship
23. epigenetic factors
24. family conflict
25. first-born in family
26. food addiction
27. food deserts
28. food insecurity
29. food marketing to children
30. food overproduction
31. friends
32. genetics
33. gestational diabetes
34. global food system
35. grilled foods
36. gut microbioata
37. having children, for women
38. heavy alcohol consumption
39. home labor saving devices
40. hunger-response to food cues
41. international trade policies (globalization)
42. high fructose corn syrup
43. lack of family meals
44. lack of nutritional education
45. lack of self-control
46. large portion sizes
47. living in the suburbs
48. living in crime-prone areas
49. low levels of physical activity
50. low socioeconomic status
51. market economy
52. marrying in later life
53. maternal employment
54. maternal obesity
55. maternal over-nutrition during pregnancy
56. maternal smoking
57. meat consumption
58. menopause
59. mental disabilities
60. no or short term breastfeeding
61. non-parental childcare
62. overeating
63. participation in Supplemental Nutrition
Assistance Program (formerly Food Stamp
Program)
64. perception of neighborhood safety
65. physical disabilities
66. prenatal maternal exposure to natural
disasters
67. poor emotional coping
68. sleep deficits
69. skipping breakfast
70. snacking
71. smoking cessation
72. stair design
73. stress
74. sugar-sweetened beverages
75. trans fats
76. transportation policies
77. television set in bedrooms
78. television viewing
79. thyroid dysfunction
80. vending machines
81. virus
82. weight gain inducing drugs
Multi-factoral causes
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Portion size
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In schools
Energy expenditure
 Sedentary
High energy density
workplaces
High glycemic index
 Sedentary schools
 Activity “unfriendly”
Soft drinks/”junk
food
Added sugar
community design
Energy intake
Easy food access
conveniences
Low cost
 Elevators/escalators
 Remote controls
 Sedentary
Variety
Convenience
Great taste
Ads/marketing
 Automobiles
 Drive-through
WEIGHT
GAIN
entertainment
 Labor saving devices
 Television/computer
Obesity: Evolutionary Biology, the
Environment, Society and You
The Take Away…
•
Why we are the way we are…survival
•
We have built the environment to serve the biology
•
Obesity is a normal response to the environment
•
To overcome the biology we will have to rely on
cognition—individual and social
•
We must find a better “why” for people and society to
change
•
The “why” must be important for “survival” in the
modern world
The Evolutionary Biology: Why we
are the way we are?
• Humans are hard wired to like sugar, fat and salt
• Humans evolved under conditions in which physical
activity “pulls” appetite
•
We built the environment to
Humans are “energy
servemisers”
the biology
• The biology is not broken…it is doing exactly what it was
designed to do
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7
8
9
10
Even price has limits…
S. French J Nutr 2003
What about physical activity?
A high flux improves regulation of energy
balance (and protects against weight gain)
Adapted from Mayer et al, AJCN, 1956
USA Amish…today
Obesity rate
0%
9%
-603 kcal
day
-436 kcal
day
32%
35%
Amish Men Amish Women US Men
US Women
From Bassett et.al., Med. And Sci. in Sports and Exer., 2004
We don’t get enough
physical activity
• Leisure time physical activity has not
declined
• Physical activity at work has declined
• Physical activity at home has declined
Physical Activity in the USA
2008 Age-Adjusted Estimates of the Percentage
of Adults Who Are Physically Inactive
The Evolving Work Force
90.0
Service Jobs
80.0
70.0
60.0
%
50.0
40.0
30.0
Goods Producing
Jobs
20.0
10.0
0.0
1960
1970
1980
1990
2000
Agricultural
2010 Jobs
Year
Church TS et al. PLoS 2011
Occupation Related Daily Energy Expenditure (calories)
Daily Occupational Caloric Expenditure
Men
1,550
-140 daily kcals
1,450
1,350
Women
-120 daily kcals
1,250
1,150
1960
1970
1980
1990
2000
2010
Year
Church TS et al. PLoS 2011
Trends in Housework Energy
Expenditure (1965-2005)
5000
4653
Kcals/week
4000
3553
3324
3000
2769 2877 2806
Women
2000
1452
1000
1923 1977 2086 2034
1013
0
1965
1975
1985
1995
2005
Archer et al. 45-year Trends in Household Management. In Press. PLOS One
2010
Men
We sit too much…
Hamilton et al, Curr. Cardiovasc. Risk Reports, 2008
…and, it’s lethal
• Over a lifetime, the unhealthful effects of sitting add up.
Alpa Patel, an epidemiologist at the American Cancer
Society, tracked the health of 123,000 Americans
between 1992 and 2006. The men in the study who
spent six hours or more per day of their leisure time
sitting had an overall death rate that was about 20
percent higher than the men who sat for three hours or
less. The death rate for women who sat for more than
six hours a day was about 40 percent higher. Patel
estimates that on average, people who sit too much
shave a few years off of their lives.
New York Times, April 14, 2011
Just say NO to screen time?
• One recent study compared adults who spent less
than two hours a day in front of the TV or other
screen-based entertainment with those who
logged more than four hours a day of recreational
screen time. Those with greater screen time had:
– A nearly 50 percent increased risk of death from
any cause
– About a 125 percent increased risk of events
associated with cardiovascular disease, such as
chest pain (angina) or heart attack
• The increased risk was separate from other
traditional risk factors for cardiovascular disease,
such as smoking or high blood pressure.
From J Levine, Mayoclinic.com
We are deficient in non-exercise
activity thermogenesis (NEAT)
Hamilton et al, Diabetes, 2007
What are the consequences of poor
diet, low activity and sitting?
•
•
•
•
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Poor physical and cardiorespiratory fitness
Obesity
Diabetes
Cardiovascular disease
Reduced quality of life
Attributable Fractions (%) for
All-Cause Deaths
40,842 Men & 12,943 Women, ACLS
18
16
14
12
10
8
6
4
2
0
Men
Women
Lo
w
CR
F
Ob
es
e
Sm
ok
er
Hy
Hi
Di
gh
ab
pe
et
rt
Ch
es
en
o
l
si
on
Blair SN. Br J Sports Med 2009; 43:1-2.
Humans are biased toward action, not
thought (thought is expensive)
The Biology of Choice…we choose
for the moment
20 Years
NOW
The marketplace plays to the biology
So What?
What does all of this suggest about ways
we might approach the problem differently?
The Environment and YOU
Behavior Settings
Framework for determinants
of physical activity and
eating behavior
food industry
transportation
system
Second ary lev erage points
Primary leverag e p oints
Behavioral settings
Lifesty le
Enablers o f cho ice
architecture
& building codes
political advocacy/
lobbying
Social
exercise,
physical activity
& sports industry
Cultural
local government
food stores
developers
family
Psycho-bio logical
Core
recreation
industry
property owners
food stores
health club
home
community activity
providers
social
trends
seasonality
health care
industry
restaurants and
food outlets
workplace
restaurants
convenience
social roles
accessibility
habits
life stage
self identities
ethnic
identities
pleasure
genetics
hierarchy
of needs
physiology
beliefs
values
interpersonal
relationships
situation or context –
physical and social
nonprofit
providers
community
vehicle of transport
cost
neighborhood
knowledge
information
industry
government
health care
providers
school board,
districts
day care
local school
shopping
mall
shopping malls
time
safety
labor-saving
device
industry
parks, recreation centers,
senior centers
life experience
socioeconomic
status
entertainment
industry
non-government
organizations
religious, community
and non-government
organizations
source of
information
educational
attainment
education
system
recreation
facilities
employer
April 20, 20 00
Nutrition Reviews, 59, 2001
The Environment and YOU: Systems
Foresight Diagram
YOU are here
What is the real problem?
Food is cheap
AND, therePhysical
is no
compelling
activity is
not necessary.
reason to change…
WHY?
We
are too rich.
Physical activity is
not necessary
We have
disposable income
Godzilla Meets Bambi
Sugar
Fat
Salt
Rest
Enjoy
Unhealthy Preferences
BIOLOGY
Market more fresh produce
Sidewalks, brighter stairwells
Restrictions on “bad” food
Reduced health premiums
T-shirts, water bottles
…AND?
Drive motivation for behavior change by linking
desired behaviors to meeting basic needs
Transcendence
Self-actualization
Esteem
Belongingness and Love
Safety and Security
Physiological
Need to move
the focus
Social motivation hierarchy
Transcendence
Well Society
Collective purpose,
American Values,
National Pride
National defense, affordable housing,
safe neighborhoods
Economic health, jobs, global
competitiveness, education
Strategies for change
• Try to “structure” each behavior environment separately
• Continue to focus on individual motivation
• Leverage a collective motivation across society that is
consistent with today’s priorities and values
• Plant the seeds to create demand for a healthier
environment
NEW “THINKING”
SPACE
Regulate,
mandate,
tax,
control
Opportunities
for healthy
choices
Demand
for healthy
choices
(why?)
NEW “DOING” SPACE
Leave
people
alone and
let them
choose
It’s about
creating
demand…
Catalyzing demand: Where do we start?
Workplaces
Schools & Home
Commerce, the “Environment”
We need it all…
• Individual inspiration, for those who are
ready to change themselves
• Environmental structuring, where
possible (e.g., schools, workplaces)
• Nudge—choice architecture, where
possible
• Continued product and service
innovation to make healthy behaviors
more desirable, accessible, affordable
and convenient (supply)
• A more important WHY for the average
citizen—as a way to build demand
Summing Up
• Changing behavior of individuals or of communities is
opposing biological preferences.
• We built the environment to serve the biology.
• To manage and work with the biology we need an equally
strong cognitive motive that would matter to individuals and
society as a whole
• The “WHY” should be important for “survival” in the modern
world
• Sustainable solutions must provide short-term tangible
rewards for individuals
• Sustainable solutions must provide rewards for the social
collective, e.g., be integral to the economy…the “prosperity
engine”.
• There is no “win-win” business model for healthy
behaviors…yet
“We have changed our environment
more quickly than we know how to
change ourselves”
Walter Lippmann (1915)
Thank You
Thank
You