OBESITY IN AMERICA QUIZ

1. The prevalence of overweight & obesity in adults

67%

2. The prevalence of obesity in adolescence

32.2%

3. Prevalence of Morbid obesity

● male 2.9%
● female 6.9%

4. What are the main health concerns tied to obesity in children?

youth is suffering from chronic illnesses that includes secondary diseases like
● Type 2 diabetes- Kidney problems, eye problems, nerve damage.
● CVD
● Hypertension
● Arthritis
● Some cancers

5. From a societal perspective, what is the concern associated with pediatric obesity?
Pediatric obesity consequently leads to high risk of type 2 diabetes in younger age, which in turn
leads to other secondary diseases like Hypertension, CVD, arthritis and some cancers. Studies
have also found that obesity is becoming the major cause of depression among children.

6. What are the main causes of obesity worldwide identified by Barry Popkin?
● Increased intake of sugary beverages
● Abundance of calorically dense foods
● Increased portion sizes, frequency of eating, and affordable prices.
● Geographic location
● Increased depression and disordered eating
● Genetic traits and cultural patterns
● frequent dieting
7. What are the causes of obesity in developing countries that are not similar to the causes
in the US? Try to flesh out from the documentary the causes for the increase in obesity in
developing nations, and then flesh out what is causing to increase in the US?.
● Prominent surge in supermarket
● Availability of energy dense foods
● Access to animal source foods
In the US, the surge in obesity is mainly due to increased consumption of sugary beverages, junk
foods, fast foods, decreased physical activity.

7b. What are the concerns associated with introducing sweet and fatty foods to children at
young ages?
Highly processed food that makes up a significant part of the diet contains abundant taste
additives. This over palatable food does not contain satiating fiber volume, and decrease in micro
nutrients. This is responsible for releasing self addicting opiates that play a central role in
regulating appetite.
Opiates regulate the brain to repeat rich food acquisition behavior which makes us look and
consume food.
If food is introduced during early childhood, the brain develops preferences for glucose rich food
that will make them addictive and overconsumption of food.

9. How would you use the Thrifty genotype theory in trying to explain the surge of obesity
among Pima Indians and other native populations? Take note of the who advanced this
theory and when
Ans: James Neel in 1962
Thrifty gene phenotype predisposes individuals who frequently diet and prac. weight control
behavior to rapid fat deposition after dieting. In past Pima indians, who used to survive by
fishing, farming and hunting, faced alternate years of famines. In order to survive they developed
a thrifty gene that readily synthesized fat stores which helped them to survive during food
scarcity. But due to modernization and increased availability of food, this gene started to show a
negative and detrimental effect on Pima Indian’s health. Consequently, these genes started to
favor more effective synthesis of fat when food was available. Their eating habits caused them to
gain weight as they no longer practice the traditional lifestyle of limited food and more physical
activity.
10. If America is considered a dieting nation, then why is the prominence of obesity
continuously growing in the US?
With frequent dieting, there is a cycle of weight loss followed by weight gain.

In dieting, proportion of lean body mass relative to adipose tissue decreases which result in lower
resting expenditure. Since body fat is less metabolically active to lean tissue, there is an increase
in weight gain as less energy is required at resting level.

Moreover, With the busy schedule and grab and go culture in the US, people prefer to spend less
time cooking at home and thus end up eating more as body satiety mechanism regulates through
volume and weight of food.
Lastly, Dieters find it difficult to continue calorie control and most of the time end up consuming
more food/ calories than before consequently lead to weight gain.

11. Explain how dieting can worsen a weight problem? (Explain many mechanisms here:
metabolic, behavioral, environmental, genetic). Refer to the review my Tracy Mann and
colleagues in the documentary

12. What appears to be the most promising methods of weight loss currently at our
disposal?
Increase physical activity decrease junk food consumption or both

13. If the death rates of obesity rival those of the cholera plague of the late 19th century,
what does the documentary suggest as viable alternatives treating obesity?
● Taxing junk food, soft drinks and fast foods can curb food consumption and decrease
purchasing trends.
● Limit marketing of some foods in schools
● Making it illegal to set up restaurants near or around 1 mile of high school setting.
● Dispense water despite of soda
● Fund programs on prenatal practice.
14. How many kilocalories need to be expended per day through exercise in order to
significantly cause weight loss in obese and overweight people? Refer here to the National
Weight Registry and the doubly labeled water study by Schoeller.
11-12 kcal/kg/day- Schoeller (doubly labeled water study)
NWR- 2862 Kcal/week exercise

15. If soda pop appears to be affecting weight gain, based on the documentary, discuss
whether diet soda is likely affecting the obesity crisis. Be thorough in understanding the
arguments.
Consumption of diet soda is affecting the obesity crisis in the US. Many studies have shown that
obesity has continued to rise even though consumption of sugar substitutes has doubled.
According to the research conducted on rats by Davidson and swithers:
Rats who were consuming sugar diet in early part of the day ate less lab chow while rats who
were fed saccharine-laced drinks ate more calories at subsequent meals resulting in weight gain
They infer that the increased intake of no calorie sugar substitutes promote increased calorie
intake and body weight gain.
Another researcher Fowler S.P. et al showed that people consuming diet sodas are at high risk of
increasing weight.
According to Barry Popkin’s research, Diet sodas if used properly can be helpful in weight loss.
According to him: there are 2 kinds of people consuming diet sodas-
1) People using diet sweeteners as a rationale for having unhealthy diet
2) People using diet sweeteners and consuming healthy diet.
Their research shows that the former had increased risk of CVD and the later with a healthy diet
lost weight, cut calories with decreased risk of CVD.
15a. Search for the quantity of soda consumed in the US by adults and children, in
addition to soda intake in Mexico.
Obese children in US consume around 1000kcal/day from sweetened beverages alone.
Mexico- 350Kcal/day from soft drinks

15b. How many extra calories are consumed per day in the form of sugary beverages?
Search for yearly average intake of soda by Americans and consider as well the historical
intakes of soda by comparison. Think along the line of percent increase in soda
consumption with specific time frames as discussed in the documentary.
Barry popkin: (1970s to 1980s)- avg american adult- 200-300 kcal/day
child- 150-200 kcal/day
obese children- 1000kcal/day
1947-2000- 350% increase in regular soda and 500% increase in (diet soda and regular soda)

16. Explain the difference between the two systems that affect our brain's desire and need
for food. Be ready to explain the hedonic system and the homeostatic mechanism and to be
able to name the endocrine compounds behind food addiction.
Homeostatic mechanisms involving 2 systems
● Long term signal from adipose tissue to arcuate nucleus in hypothalamus using insulin
and leptin.
● An episodic signalling system is generated from gut and involves the hormone Ghrelin,
Cholecystokinin, Glucagon like peptide 1 and Peptide YY
It is the interaction between these two systems that allows the brain to recognize the state of
energy stores in the body. When negative energy balances, the hunger signals are turned on.
When energy stores are imbalanced, Satiety signals are turned on. When on a calorie restrictive
diet, fat energy stores gradually eroded which leads to homeostasis breaking. And consequently
leads to increased hunger thus makes dieting difficult.
Hedonic mechanism is tied to the Corticolimbic neural system. It depends on information from
the external environment which has many cues that stimulate serotonin and dopamine.

17a. In reviewing the documentary, be ready to learn the various techniques used to assess
obesity in the nutritional assessment chapter. Take note of the waist circumference for men
and women above which the risk for heart disease is elevated.
Various measurement techniques are:
● Hydrodensitometry
● skinfold technique
● Plathesmography
● Bioelectrical Impedance
Risk of CVD: male- >40
Female- >35

17b. Explain the principle that governs hydrostatic/hydrodensitometry weighing. Be ready

to explain how the method works
It is the gold standard measurement based on Archimedes Principle that allows measurement of
body fat through body displacement of water.
In this method a subject is allowed to submerge in a tank called Kneeling Submission Tank.
Volume is equal to the water displaced. Weight is measured on land and then compared to
weight measured in water. This helps to assess the amount of fat a person has.

17c. Explain the principle of bioelectric impedance analysis (BIA) and what exactly this
instrument measures and how it measures it.
It is the easiest way of assessing the body composition.
The instrument will pass a small current of electricity from one hand /one part of the body to
another measuring the impedance of the flow of the electricity from one pole to other pole..
Different tissues of the body react differently and have different resistance to electricity. The
assessment is done to measure the amount of water in the body.
The results are then plugged into an algorithm to estimate body composition.

17d. Explain the principle of plethysmography, how it works, and what it measures.
Also known as Air displacement technique. A subject is placed in a chamber called Bod Pod and
displacement of air around the body is measured following the same Archimedes principle and
thus body fat can be estimated.

17e. Explain the principle of skinfold measurements and what exactly they measure.
This technique measures the subcutaneous fat in specific areas of the body with the help of
specific types of callipers.
This technique uses specific formulas the clinicians can establish through the use of % body fat

18a. Be ready to defend the point that sugar intake through sweetened beverages is
elevated and is causing several health problems, notably in the young. Be ready to make
several points using evidence presented in the documentary
There are many factors that are contributing to increased sugar intake in young children that are
causing long term serious health issues.
● young children are introduced to such sugary beverages in early years. As the brain
perceives the pleasantness and palatability of the food, the cortex produces signals from
which the cognitive decision to eat is made. The inappropriate sensitization of hedonic
systems through frequent consumption of Na, sugar and fat which consequently makes it
difficult for the young children to like the taste of healthy food thus leading to weight
gain.
● Secondly, children are consuming around 150-200 kcal/day extra from sweetened
beverages. The reason can be due to the busy schedule of their parents and unsupervised
children. This is leading to increased risk of obesity thus leading to threefold increase in
type 2 diabetes among children and consequently leading to several secondary diseases
like high BP, arthritis, cancers and depression. According to the research conducted by
Amann, children and adolescents are suffering from various degree of depression
● As per American psychiatric association- 8.3% adolescents and 2.5% children are
suffering from depression
18b. Be ready to discuss the impact of artificial sweeteners on weight management
Obesity has continued to rise even though the consumption of sugar substitutes have doubled.
The three most common artificial sweeteners are- Aspartame, Saccharin and Sucrulose most
commonly in the form of diet sodas. But the research conducted by Barry Popkins showed that
there are two types of people who consume diet sweeteners. One who eats unhealthy food rich in
Na, fat calorie dense and takes diet soda as a rationale to eat an unhealthy diet. On the other hand
people who eat healthy and nutritious food and consuming diet sweeteners. Their study showed
that those who followed the later food habit had a weight loss and thus decreased risk of CVD.

19. Why are westernized women of upper classes remaining thin despite the growing girth
of the rest of the population? Explain this paradox in good detail.
The westernized women of upper class remain thin despite the growing girth of the rest of the
population because access to fresh produce is getting limited due to increased food cost. Thus,
they become accessible only to the higher income group. On the contrary, the other calorie-rich
foods that flourished in the market are quite inexpensive and selectively purchased by lower
income groups thus contributing to obesity among lower income groups.

20. Be ready to explain the “shareholder value movement” described in the documentary
and its importance in the US obesity crisis
In the 1980s, the advent of the shareholder movement started. Stakeholders started demanding
higher short term returns. Because of this food companies developed few strategies to increase
their sale in the marketplace. They increased in between meals, snacking, and large portion sizes.
they soon understand that oversized packages draw consumers attention and thus lead to more
food consumption, thus contributing to increased obesity in the US.
21. Explain why some people that are obese find it very difficult to lose…almost impossible
despite lowering caloric intakes. Discuss the physiological and metabolic implications here.
You should also be able to discuss behavioral factors using some of the subjects interviewed
during the documentary.
Obese people find it difficult to lose weight even after lowering caloric intake because obese
people have more fat and less lean mass which leads to decrease resting energy expenditure.

22. If dieting is no longer recognized as a valuable therapeutic tool for weight loss over the
long term, and if the taste preferences of the young are already corrupted by a toxic food
supply by early school age, then what options are left? Be ready to argue the point based on
the content of the documentary: OBESITY IN AMERICA: A NATIONAL CRISIS.
● Establishing nutritious behaviors in pregnant mothers
● Follow through rigorous parenting programs that teach parents the importance of
breastfeeding and how to feed nutritious diets to their children.
● Keeping away from sodas and junk food.
● Taxing junk food, soft drinks and fast foods can curb food consumption and decrease
purchasing trends.
● Limit marketing of some foods in schools
● Making it illegal to set up restaurants near or around 1 mile of high school setting.
● Dispense water despite of soda
● Fund programs on prenatal practice.

23. Be able to argue whether Americans have been consuming more calories per person
since the 1980s and whether there are more calories available per person to consume since
the 1980s. Find in the documentary the estimated amounts.
The number of calories consumed per day has also been increased due to frequent snacking,
consumption of soda pops and junk foods and fast foods.
24. Be able to argue whether American society is expending less calories at work and away
from work since the 1950s. Be able to quantify the difference in caloric expenditure
between the 1950s and now
According to the study published by Passmore et al.
In the 1950s A reference man used to spend 3200 kcal/ day. Assuming that a ref. man was a
farmer, he used to burn around 1200 kcal/day ie; around 400kcal more than a sedentary clerk and
1200 kcal less than a heavy laborer. After the transformation from manufacturing to servicing
units, the physical activity certainly declined. There was a drop of 400kcal/day for a reference
man. The situation even got worse when the energy expenditure outside work drops to 1100kcal/
day from 1500kcal/day
In 1950s,A few activities away from work includes walking (381 kcal/day), cleaning
(450kcal/day) along with cooking food (348 kcal/day)
In 2005, a typical reference man 180lbs heavier and thus their daily work breakdown is walking
(103), cleaning (104) cooking (206)

25. Be ready to explain and defend the amount of calories that need to be expended per day
or per week in order to support and sustain weight loss.
According to the doubly labeled water studies conducted by Scholler et al. for significant weight
loss a person has to generate 11-12 kcal/kg/day .The national weight control registry estimated
that for a successful weight loss people burn on an average 2682 kcal/ week.
Caloric expenditure from exercise needs to be 400-900 kcal/day or 2800-6580 kcal/ week.
For eg. a 30 min- workout in a gym- 124 kcal --------------372 kcal/week this much calorie burn
is not enough to get a sustainable weight loss so it should be coupled with some other exercises
like running , swimming biking to burn desired calories

26. Explain why Laura Paxton was not successful losing weight by contrasting her
statements with those of her mother
27. Explain why Michael Paxton was at an elevated health risk because of his diet?
Michael Paxton’s consumption of sugary beverages per day was- 6-20 fl oz mountain dew/ day
which contributes to 1848 kcal/ day from sugary beverages. Given 19 tsp of sugar/ 20 fl oz= 371
lbs sugar/ year. This amount of sugar had a chronic shock effect on his pancreas and there are
high chances that he will soon become insulin resistant and will develop type 2 diabetes.

28. Obesity prevalence tends to be low in oppressive regimes and high in westernized
nations. Explain why this is not always true using China as an example.
Obesity prevalence tends to be low in oppressive regimes and high in westernized nations. This
is not always true because in china there is a rapid increase in morbid obesity especially among
children with the age group of 6-10 years. they are certainly 6-8 lbs heavier for the same height.
And this condition is really alarming.

29. If the deaths from obesity rival those of Cholera Epidemics of the 19th century, then
what public health measures, proposed by Farley and Cohen, could significantly decrease
the obesity epidemic?
● Taxing junk food, soft drinks and fast foods can curb food consumption and decrease
purchasing trends.
● Limit marketing of some foods in schools
● Making it illegal to set up restaurants near or around 1 mile of high school setting.
● Dispense water despite of soda
● Fund programs on prenatal practice.

30. Document both the increase in available calories that has been produced by the food
industry and identify what the Life Science Research Office has documented in terms of
increased calories consumed between the 1970s and 90s
avg american adult- 200-300 kcal/day
child- 150-200 kcal/day
LSR- additional 200-300 kcal/capita/day
1980s- 3200 available
2006- 3900 available
31. What are the main concerns, expressed by health officials, tied to exposing young
children to foods such as French fries, chips and sodas?
Early exposure to these foods creates preferences through an habituation of the brain's
hedonic system. The children then become addicted to the pleasurable sensation of
food making very difficult to like the subtler tastes of healthy fruits and vegetables

32. If weight loss diets have been shown to be therapeutic failures, then what are the likely
alternatives for dealing with the obesity crisis according to the documentary?
● Maintain regular physical activity that develops lean body mass by doing isometric
exercises
● Decrease food/ calorie intake Or both
● Establishing nutritious behavior in pregnant mothers
● Parenting program that teach parent the imp. of breastfeeding and how to feed nutritious
diet to their children

33. According to the documentary, what would be the three main food products that are
contaminating the American food inventory and making healthy eating very difficult to
fully embrace?
Soda pops
fast foods
junk foods
34. According to the documentary, can obesity be explained by a lower level of physical
activity according to researchers Young and Nestle?

c. Because exercise levels have not changed since the mid01980s, weight gain between 1988 and
1998 could only be attributed to greater calorie consumption

35. Listen carefully to what Dr. Popkin contends to be the most significant causes of obesity
in third world developing countries and contrast with the cause of obesity in America.
Explain how the international causes of obesity are different from the causes of obesity in
America
increased consumption of sweetened beverages, dairy products and vegetable oils
a. Increased prominence of large supermarkets, energy-dense foods and animal
products
Frequent snacking, the larger portions sizes, and soda consumption

36. It has been argued that the Pima Indian diet changed significantly from its traditional
makeup once the Pima indian adopted the eating habits of Caucasians. Identify, below, the
percent of calories as Fat in the traditional Pima diet
traditional modern
carb- 65-70% 45%
protein 15% 15%
fat 15% 40%

37. The fact that the US consumes such abundant amounts of soda has a devastating
impact on health, according to the Obesity in America: National Crisis documentary.
Identify below what medical research has been able to attribute to the overconsumption of
sodas
d. To significant weight gain,
type-2 diabetes,
demineralization of bone, and
loss of tooth enamel

38. There is a controversy regarding the impact that diet sodas have on the increased
prevalence of obesity. How does Dr Barry Popkin, an epidemiologist from the University of
North Carolina, Chapel Hill, explains the impact of diet sodas on weight?
According to Barry Popkind there are 2 groups of people consuming diet sweeteners/diet sodas.
3) People using diet sweeteners as a rationale for having unhealthy diet
4) People using diet sweeteners and consuming healthy diet.
Their research shows that the former had increased risk of CVD and the later with a healthy diet
lost weight, cut calories with decreased risk of CVD.

39. In order to cause significant and sustained weight loss with exercise, identify below,
according to the documentary: OBESITY IN AMERICA: A National Crisis, the minimum
amount of calories that need to be expended per day through exercise.

400-900 kcal/day

40. According to the documentary, our dietary practices are nothing less than a national
catastrophe. It is argued in the documentary that there are three dietary elements
contaminating the American landscape and contributing to the obesity epidemic. Identify
the most significant dietary elements that comprise our nutrition and expose us to serious
addictions that are maintained through the habituation of our hedonic system.

Sugary beverages like soda pops

Fast foods

Snack foods
41. Given that the documentary, OBESITY IN AMERICA, A National Crisis, makes the
case that dieting, as a therapeutic modality, has been a total failure, and makes the case for
the most promising methods that are likely to provide better long term results.

With frequent dieting, there is a cycle of weight loss followed by weight gain.

In dieting, proportion of lean body mass relative to adipose tissue decreases which result in lower
resting expenditure. Since body fat is less metabolically active to lean tissue, there is an increase
in weight gain as less energy is required at resting level.

So, to get better long term results, increasing physical activity that develops lean body mass by
doing isometric exercises along with consumption of food with high nutrient value.

42. Between 1977 and 1996 the Life Science Research Office of the Federation of the
American Societies for Experimental Biology (FASEB) estimated that American were
eating additional calories that could explain weight gain. Identify, below, the estimated
additional calories consumed per person during that time period in the US

200-300 kcal/capita/day

43. According to the USDA Economic Research Service what percent increase in the total
production of soda (regular and diet) took place between 1947 and the year 2000?

500%

44 In what year did the American Medical Association's Council on Food and Nutrition
warn of the danger of carbonated beverages on the health of youth?

1942

45. According to the Federal Trade Commission, how many 6.5fl-oz of soda did Americans
consume on average in the 1940s?

20 bottles / person/year or 1 gallon

46. According to the documentary: OBESITY IN AMERICA: A National Crisis, how many
gallons of soda did American consume per year, on average, by 2001?

54 gallon/person/year

47. Popkin and Nielsen estimated that the intake of sweetened beverages between 1977 and
2004 was very alarming. How many extra kilocalories did they estimate Americans were
consuming per day in the form of sweetened beverages?

Calories from sweetened beverages increases 135% with an overall increase of 278 kcal
/person/day

48. According to the documentary: OBESITY IN AMERICA: A National Crisis, how many
gallons of soda are consumed on average per year, by males in the US between the ages of
12 and 29?

160 gallons/ year

49. According to the documentary: OBESITY IN AMERICA: A National Crisis, soda

consumption is much worse in Mexico than in the US. On average, how many extra calories
in the form of sodas do Mexicans consume per day?

350kcal/day from soft drinks

50. Identify the most efficacious and implementable strategies that are better than
individual diet counseling in reversing this obesity epidemic according to the documentary:
OBESITY IN AMERICA/ A National Crisis. 

● Establishing nutritious behaviors in pregnant mothers

● Follow through rigorous parenting programs that teach parents the importance of
breastfeeding and how to feed nutritious diets to their children.
● Keeping away from sodas and junk food.
51. According to the documentary, OBESITY IN AMERICA: A National Crisis, there is
convincing evidence that dieting is actually making us fat as a nation. Provide 3 arguments
that could explain this paradox (provide complete explanations that are based on the broad
perspectives presented in the documentary) (HINT: METABOLIC, BEHAVIORAL,
ENVIRONMENTAL)

a. People who chronically diet lose weight and regain it afterwards causing a progressive loss of
fat free mass thereby causing the REE to decrease thereby making weight loss more difficult and
increased weight gain more likely

b. People who diet follow dietary protocols that they are not likely to follow on the long term.
When they reach their goal they go back to eating the way they use to thereby resulting in weight
regain

c. Chronic dieting on very low caloric intakes causes the dieter to be fatigued and therefore less
prone to exercise and therefore unable to maintain a healthy lifestyle

d. Chronic dieting causes dieters to binge on food more often leading to excessive weight regain
after having reached their goals. In fact 33 to 67% of dieters gain more weight than originally
lost

52. From a societal and medical perspective, what are the concerns associated with
pediatric obesity? (Make 2 arguments)

Pediatric obesity is causing a detrimental effect on health. Childhood obesity is leading to

increased risk of type 2 diabetes among children which in turn is leading to increased risk of
secondary diseases of obesity like CVD, hypertension, arthritis and cancers in the longer term.
As the prevalence of obesity is increasing, healthcare costs to manage this problem is also
increasing. From the 1970s to 2000 the cost to manage pediatric obesity had a surge of 549%
increase. Impact of managing overweight and obese children has overburdened healthcare
system thus, soon leading to financial crises and increased presure on the system.

Secondly, Childhood or pediatric obesity is leading to an increased rate of depression among

small children thus decreasing their self esteem and confidence which in turn increases the
psychological problems among children.
53. Make the case for why soda pop should not be consumed by either the young or
adults based on the knowledge acquired from the documentary: OBESITY IN AMERICA:
A National Crisis. Formulate 3 distinct arguments

Soda pop consumption is causing detrimental effects on the health of both young as well as
adults.

It increases the risk of weight gain: The average american adult is adding around 200-
300Kcal/day from sugary beverages and children are adding around 150-200 kcal/day. This
addition of kcal along with sedentary lifestyle has increased the risk of weight gain among young
and adults. Also studies Garcia Contreras showed the correlation between bone density and soda
intake. consumption of soft drinks has led to hypocalcemia and decreased bone density.

Increases the risk of type 2 diabetes: Looking at the amount of sugar consumed from the soda
pops, ie; an obese children can consume around 1000kcal/day from sugary beverages alone. This
equals around 8-10 oz soft drinks / day which means 203 lbs of sugar/ year.

According to Schulze and colleagues JAMA 2004- research shows the association between
increased medical risk and soda consumption. They showed that if a female consumes 1 or more
sugar sweetened drinks, relative risk of type 2 diabetes increases.

Increases the risk of tooth decay.

Increased consumption of sugary beverages has also led to increased risk of tooth decay that
ultimately leads to cavities. Klaus J. et al showed in his studies that soft drinks induced
demineralization of dental enamel has increased sharply.