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Why Are We Fat?
Why Are We Fat?
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
Portion size High energy density High glycemic index Soft drinks/junk food In schools Added sugar Easy food access Low cost Variety Convenience Great taste Ads/marketing Energy intake Energy expenditure
Sedentary
workplaces
Automobiles Drive-through
conveniences
WEIGHT GAIN
entertainment
We built the environment to Humans are energy misers serve the biology
____________________________________ ______
10
A high flux improves regulation of energy balance (and protects against weight gain)
USA Amishtoday
Obesity rate
0%
9%
32%
35% US Women
From Bassett et.al., Med. And Sci. in Sports and Exer., 2004
Service Jobs
%
40.0 30.0 20.0 10.0 0.0 1960 1970 1980 Year 1990 2000
Men
1,550
1,350
Women
1,250
1,150
1960 1970 1980 1990 2000 2010
Year
4653
3553
3324
Kcals/week
3000
2000
1000
1452 1013
Men
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
What are the consequences of poor diet, low activity and sitting?
Poor physical and cardiorespiratory fitness Obesity Diabetes Cardiovascular disease Reduced quality of life
Lo w
CR
Ob es
Sm e
ok er
Hy pe r
te ns io n
Hi gh
Di ab et Ch es ol
20 Years
NOW
So What?
What does all of this suggest about ways we might approach the problem differently?
Second ary lev erage points Primary leverag e p oints Behavioral settings Lifesty le Enablers o f cho ice exercise, physical activity & sports industry recreation industry Social Cultural Psycho-bio logical Core
local government developers property owners health club workplace community activity providers restaurants and food outlets
seasonality convenience
restaurants
social roles habits life stage self identities pleasure ethnic identities beliefs values interpersonal relationships situation or context physical and social source of information cost time safety accessibility
parks, recreation centers, senior centers community vehicle of transport shopping mall health care providers school board, districts employer
genetics
hierarchy of needs
physiology
educational attainment
shopping malls
life experience socioeconomic status knowledge local school neighborhood day care
April 20, 20 00
AND, there is no compelling Physical activity is not necessary. reason to change WHY? We are too rich.
Physical activity is not necessary We have disposable income
BIOLOGY
Unhealthy Preferences
Sugar
Fat
Salt Rest Enjoy
AND?
Drive motivation for behavior change by linking desired behaviors to meeting basic needs
Transcendence
Transcendence Well Society Collective purpose, American Values, National Pride National defense, affordable housing, safe neighborhoods Economic health, jobs, global competitiveness, education
Workplaces
We need it all
Individual inspiration, for those who are ready to change themselves Environmental structuring, where possible (e.g., schools, workplaces) Nudgechoice 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 citizenas 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 economythe prosperity engine. There is no win-win business model for healthy behaviorsyet
We have changed our environment more quickly than we know how to change ourselves
Walter Lippmann (1915)
Thank You
Thank You