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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 Jenny Craig, Inc Alere

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slide1

My Most Provocative Recommendations to the USAJoint Commission on Sports Medicine and SciencePhiladelphia, PAFebruary 27, 2001

Steven N. Blair

Professor

Arnold School of Public Health

University of South Carolina

disclosures
Disclosures
  • Medical/Scientific Advisory Boards
    • Jenny Craig, Inc
    • Alere
    • Technogym
    • Cancer Foundation for Life
    • Santech
    • Clarity Project
  • Research Funding
    • NIH
    • Body Media
    • Coca Cola
    • Department of Defense
outline
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
slide5

Ranking of selected risk factors: 6 leading causes of death by income group, estimates for 2004

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 all cause mortality
Physical Activity and CRF as Predictors of All-cause Mortality

31,818 men and 10,555 women

1492 deaths in men during average follow-up of 14.6 years, and 230 deaths in women during average follow-up 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

slide7

RR for All-cause and CVD Mortality in Fit and Unfit

ACLS Men by Body Fat Categories

Body Fat%

Body Fat%

All-cause Mortality

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
Adjusted RR for All-Cause Mortality by Fitness and BMI, ACLS Women

*adj for age,

exam year,

smoking,

& health

status

Farrell et al. Obes Res. 2002; 10:417-423

crf and body fat on mortality risk in 13 155 hypertensive men
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

outline10
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
jama used pages for this
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
slide13
We must improve school lunches because American children eat 50% of their calories at school.Mrs. ObamaFebruary 2010
which causes more deaths in the u s smoking or obesity
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
outline15
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
Model in the Article
  • Sky Reach-15 reps each side
  • Speed Intervals-10 sec at a moderate pace then 20 seconds at a fast pace for a total of 2 minutes
  • Bench Push-ups-15 reps
  • Walking Lunge-2 minutes
  • Tree Back Rows-15 reps
  • Speed Intervals (same as #2)
  • Jump Pull-ups-15 reps
  • Speed Steps-up and down stairs for 2 minutes
  • Hanging Leg Raise-15 reps
  • Speed Intervals (same as #2)
drop 12 pounds this month
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
outline21
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
it s calories that count
It’s calories that count

Energy Out

Energy In

Portion size

High-fat foods

Energy dense

Low-fiber

Soft drinks

Snack foods

BMR

Thermic effect of food

Media (TV,PC)

Cars

No heavy labour

Exercise

trends in energy intake nhanes 1971 2000
Trends in Energy IntakeNHANES 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
Trends in Energy Intake1971 to 2000, Men, NHANES

Kcal/day

Source: MMWR Feb 6, 2004

nhanes survey methods 1971 2000
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
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

outline30
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 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
outline32
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
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 in-line 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 ….
outline34
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
outline35
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