Small Choices, Big Bodies

8/2/2019 Small Choices, Big Bodies

1/65

THE CENTER FOR CONSUMER FREEDOM

BIGSMALL CHOICES,

BODIES

HOW COUNTLESS DAILY DECISIONS

CONTRIBUTE TO AMERICAS

BURGEONING WAISTLINE


2/65The CenTer For Consumer Freedom

BIGSmall ChoICes,

BodIeshow CounTless daIly deCIsIons

ConTrIBuTe To amerICas

BurGeonInG waIsTlIne


3/65

Small Choices, Big Bodies:

How countless daily decisions contr ibute to Americas burgeoning waistlines.

Copyright 2007 by the Center or Consumer Freedom

The Center or Consumer Freedom is a nonprot coalition supported by restaurants,

ood companies, and consumers, working together to promote personal responsibility

and protect consumer choices.

www.ConsumerFreedom.com

All rights reserved. No part o this book may be reproduced or transmitted in any orm

or by any means, electronic or mechanical, including photocopying, recording, or by

any inormation storage and retrieval system without permission in writing rom the

publisher.

Published by the Center or Consumer Freedom, Washington, DC.

Printed in the United States o America

ISBN 978-1-60461-533-3


4/65


5/65


6/65

ConTenTs

InTroduCTIon ......................................1

ChanGes In PhysICal aCTIvITy ........7

Television .........................................................................8

Childs Play ......................................................................10

NEAT ..............................................................................12

Personal and menTal healTh .........15Pharmaceuticals ................................................................16

Smoking Cessation ...........................................................18

Dieting.............................................................................20

Sleep Deprivation .............................................................22

oCCuPaTIons ......................................25

Types o Jobs ....................................................................26

Task Eciency .................................................................28

FamIly lIFe ............................................31

Female Employment ........................................................32

Maternal Age ...................................................................34

Family Structure ...............................................................36

Birth Control ...................................................................38

housInG and TransPorTaTIon .......41

Transportation ..................................................................42

Climate Control ...............................................................44

Urban Sprawl ...................................................................46

Labor-saving Devices ........................................................48


7/65


8/65

InTroduCTIon

sTaTInG The oBvIous

Obesity is a problem in America. Even without news reports or

scientic studies, most individualsby quickly scanning oces and

shopping mallscan arrive at the conclusion that people today are

bigger than ever beore. Though ew would argue that love handles are

less common in modern culture, theres considerable debate about the

cause o those at rolls.

Health activists and ood police single out junk ood as the culprit

behind our burgeoning behinds, but pay little more than lip service

to the couch-potato habits that have become the norm in recent

years. Blindly pushing a narrow, ood-only approach, these sticklers

lobby or highly restrictive public health policies that leave no roomor common sense.

While researchers publish conicting reports on diet trends, ordinary

Americans dont have to wait or the next academic journal to nd the

triggers or our steady weight gain. Questions regarding changes to

individual liestyles can be answered with a short inventory o home

and oce space. Elevators in almost every building ensure that tenants

dont have to climb the stairs. Moving sidewalks in airports nationwide

mean that travelers can make their connections without ever breaking

a sweat. And TV sets in 99 percent o U.S. households suggest that time

between work and sleep can be spent comortably on the soa with a

remote control.

The rise o modern convenience is sel-evident. But in order to

show the link between these creature comorts and the bathroom scale,

we rst have to look to the past.


9/65

an ePIdemIC oF ConvenIenCe

Epidemiology is the study o the source o disease. By denition, disease

is any deviation rom the bodys normal unction caused by inection,

genetic deect, or environmental stress. Ailments such as u, cancer,and cholera all under the scope o epidemiology. But some modern

diseases do not.

Dr. John Snow, a physician during a great cholera epidemic in 19th

century London, is credited as the ather o this branch o medicine.

Most health ocials at that time responded to the outbreak with

hysteria and conjecture about the cause. But Snow tried a more

analytical approachplotting individual cases o the disease on a city

map, decoding the overall pattern, and identiying the common link: a

contaminated water well.

Snows method eectively addressed Londons outbreak, as well

as countless other cases o inectious and chronic diseases since

that time. So why have modern public oicials been unsuccessul

in applying Snows method to todays obesity epidemic?

Because most notably obesity is not a disease but a symptom.

Like a sunburn or swelling, love handles are just evidence o a

problem, not the problem itsel. Just as nausea or ever can be

brought on by any one o a thousand conditions, weight gain canbe the symptom o countless, dierent changes.

Cause versus rIsk

Since Snows discovery in 1854, our communities, households,

and amilies have changed. The study o public health has adjusted

accordingly. The ocus o most epidemiological studies has shited rom

inectious disease to ailments such as heart disease and diabetes, which

are largely governed by genetics and liestyle.Inectious disease ollows a single, linear tack. Only one particular

bacterium can cause an individual to catch cholera. But many modern

diseases do not t in this binary ramework. For instance, a person

cannot catch cancer. So when investigating these chronic diseases,

todays researchers must consider many actors such as amily history,

gender, environment, occupation, and weight.

0th CenturylifeStyle ChangeS

1900:t

b 3.5 c

1910:7. pc u.S. pp- sbbs

1946:appx- 0,000s ss w u.S. ss3

1969:0 pc s w sc bs4

1978:8 pc ss cw 5

1980:3.7 p-c 30--44- w

b s 6

1981:33 pc s wc a/Cp s s 7

1982:56.4 pc w p- s w8

1985:P cpcsp s s 0.4 s9

1990:t sp 49s p b w0


10/65

Traits that are associated with an increased risk o an outcomebut

dont necessarily cause itare known as risk actors. For example, age

is considered a risk actor or some heart diseases. But while olderAmericans have a higher risk or heart attacks and strokes than teenagers,

growing old does not inevitably cause heart disease.

Some people ail to distinguish between risk and cause. Many health

activists have adopted a dangerously myopic ocus on certain oods

considered to be obesity risk actors. In doing so, they have tried

unsuccessully to turn ood into this centurys contaminated water well.

With their relentless campaigns to tax, restrict, and ban unhealthy

oods, these activists neglect to conront the hundreds o other potential

contributors to weight gain. To combat this misrepresentation and

restore balance to the public health debate, the public needs a better

understanding o these other obesity actors.

BIoloGy and modern lIvInG

Diet and exercise have replaced take two aspirin and call me in the

morning as physicians deault prescription or many conditions. In

regard to obesity, the merit o this recommendation stems rom the

rst basic Law o Thermodynamics: energy conservation.

Energy can neither be created nor destroyed. It is, instead, constantly

transormed rom one state to another. This transormation in humans

changes ood energy (calories) into physical energy, and can impact the

bathroom scale when energy in no longer equals energy out.

Fat is the balancing intermediary in this ormula, ofering a storage

site or excess energy and a uel source or excess activity. I our energy

equation remains lopsided or an extended period o time, then we

can grow rom a lean body mass (holding two to three months wortho energy in at) to an obese shape (carrying enough at to provide

energy or more than a year).

Their direct impact o diet and exercise on body at gives them central

roles in the weight debate. But the Big Two,as scientists have dubbed

them, do not provide a sucient model or weight dynamics on their

own because many variables afect both sides o the equation.


11/65

Good sCIenCe Gone Bad

Most studies used by public health activists today base their ndings on

the habits and health o a handul o individuals. Unlike experimental

studies that are designed to determine cause and efect, these epide-miological studies rely on a wide variety o observations and, thereore,

arent designed to isolate any one particular risk actor. So these studies

can only suggest correlations between a actor and a problem.

Still, researchers sometimes try to tease meaningul results out o

mountains o data, matching causes with efects.

Most obesity reports cited by ood activists indict one cause at

a time (a mineral, an ingredient, etc.). However, it is impossible to

remove a single variable rom its greater context. Calcium is ound in

cheese. That cheese could be part o a sandwich. And that meal is only

one part o an entire diet. How efectively can a study isolate the cal-

cium rom every other component in a persons meal or liestyle?

It cant.

Relying solely on oversimplied analysis in the ace o such com-

plexity can yield nonsensical results. And many ood activists promote

quick-x solutions based on isolated ndings rom one study about a

single ood. But when we look at the broader spectrum o collected

observations, a bigger picture o obesitys causes emerges.

symPTom oF ChoICe

Growing waistlines are largely symptoms o our modern liestyle.

The human body is built to survive laborious work and travel. But

most travel today is accomplished in the comortable recline o a driv-

ers seat. And many modern workers sit in air-conditioned oces that

encourage very little physical exertion. Additionally, the prevalence o

excess weighthistorically a sign o wealth and leisureis evidencethat all members o modern society have access to goods and services

that were once considered luxuries.

So obesity does not t into the ramework originally intended or

epidemiology. Obesity is not a disease in the traditional sense o the

word. Its not communicable. Obesity is a consequence o our choices.

And many o those choices are made passively, in a comortable but

rigor-ree environment.

0th CenturylifeStyle ChangeS

1997:5 pc

s wc a/Cp s s

83 pc ss cw

1999:69 pc s w sc bs3

2000:50 pc u.S. pp- sbbs4

2001:t - sp6 s p b w5

t ppx- 48 s ss u.S. ss6

2002:7. p-c wp s w7

t

b .0 c8

2004:4. p-c 30--44- w b s 9

P cp c-sp s s 5.8 s0


12/65

Over the past our decades, many at-inducing elements o the

American liestyle have driven weight gain. But many health ocials

and ood activists have largely ignored these trends in peoples personal

lives or paid lip service to their existence. Instead, in an attempt

to inuence public policy, they have labeled obesity an epidemic and

gone on a witch-hunt or a modern-day contaminated well.

namInG The oTher oBesITy rIsk FaCTors

Countless dimensions o American lie impact our weight. Since

many actors overlap to some degree, they have been grouped into

ve categories: Personal and Mental Health, Occupation, Changes in

Physical Activity, Housing and Transportation, and Family Lie.

Viewed separately, the changes outlined in each category seem

relatively small. But collectively the small changes in liestyle over

the past several generations can largely explain the populations

growing waistline.

The Changes in Physical Activity chapter covers the increasingly

sedentary activities, entertainment, and hobbies Americans seek dur-

ing down time. (Pages 713)

The Personal and Mental Health chapter examines how prescrip-

tion drugs, smoking cessation, and yo-yo diets contribute to weight

gain. (Pages 1523)

The Occupation chapter ollows the shit in the type o jobs

perormed by Americans and the minimization o activity within

existing proessions. (Pages 2529)

The Family Lie chapter outlines the changes in Americans amily

structure, rom parental employment to number o siblings, thatafect a persons weight. (Pages 3138)

The Housing and Transportation chapter highlights the rise in

popularity and availability o the car, the suburbs, and the thermostat

in modern lie. (Pages 4149)

Each o the changes listed in the ollowing chapters contributes to a

mismatch between modern liestyle and human biology.


13/65


14/65

0 televiSion

0 ChildS Play

03 neat

ChanGes InPhysICal aCTIvITy

Leisure time in the United States is at an all-time high. Americans today

accrue more cumulative work hours than their 1950s counterparts,because more women work outside o the home. But during the past

three decades, new technologies and greater productivity have reduced

the average time spent per person at work. Between 1950 and 2000,

the average hours worked per worker dropped 5 percent. Though more

Americans may be going to work, they are spending less time there.

So what is the population doing with all o this spare time?

Recreational activities today vary greatly rom earlier generations in

time and type.

While countless activities all under the leisure time category,

the popularity o television in particular has skyrocketed over the

past hal-century.

With hundreds o channels rom which to choose, adults and children

spend more time watchingsports thanplayingthem.

Even in school settings, todays kids rarely (i ever) play outdoors.

With more and more ree time spent on the couch, modern Americanssimply move less than the generations beore them.


15/65

0 televiSion

0 ChildS Play

03 neat

dId you know?

i 950 Zr Cp- b sthe rst television c u Ss.

t cpppc lzBsws c-

c tvs b w w ws c bw cs w c-

ss.

The New YorkTimes,2005

In 1950, only 9 percent o U.S. homes had a television. By the turn o the

century, almost every household owned one or more TVs.

We spend an unprecedented amount o time in ront o our TV sets. By

2006, the average American spent more than two months o the year (1,672hours) watching television. And the average number o TV sets outnum-

bered the average number o people (2.73 vs. 2.55) per household.3 Passively

TelevIsIon

T Ci diffc Bt wtcig o h f Tv

[a]s -

s w css

s xp

css s -

bc cs

bc cb

.

Eating Behaviors, 2006

B s

130Cal.

Scrubbing the oor

448Cal.

f

130Cal.

r w

255Cal.

watching television has been the most popu-

lar recreational activity or several decades and

has accounted or a higher percentage o lei-

sure time than movies, sporting events, books,

video games, and gardening combined.

Recent research indicates that the amount

o time spent in ront o the television is the

single most important actor in predicting

weight gain.4 Studies suggest that televisions

impact on basic metabolism, physical activity, and sleep plays an important

role in obesity. More time spent watching TV means less energy burned,

sc: .Ci-Ct.c


16/65

300

Millionsof

TVSets

TV Sets in

US Households250

200

150

50

1970 1985 1990 1995 2000 2005

100

81

287

254

229

192

155

unfornaely, he e

ronc revolon doe

no help ndce a he

lfesyle and wll have

a negave pac o

chldrens healh. tho

who are no sbjece

o adeqae exercse

are expeced o dev

cardovasclar and/o

cerebrovasclar rsk f

ors, hs pacng

orbdy and ora

fro healh coplca

they wll gan abnor

body wegh and a

develop a hgh body

ndex (Bmi).0

UN Chronicle

mean chld Bmi ncrea

sepwse fro leas

os elevson vew

caegores, as dd na

jsed odds raos for b

overwegh or obese.

Journal of Pediatri

Child Healt

even while a child is resting. This means heavy television watchers

burn ewer calories over time compared to occasional viewers regard-

less o whether they are physically active.5

TV viewing uses only slightly more energy than sleeping; con-

sequently, people who choose surfng channels over more active

endeavors expend very little energy during that time.6 Television

can hinder a good nights sleep. And the less we sleep, the morelikely we are to have high Body Mass Indexes (BMIs).7

Accordingly, children with TVs in their bedroom are 30

percent more likely to be obese than their peers.8 These

links between TV and weight gain make turning on

the tube tantamount to turning on the at.

sorce: united state Cen, Federal Conication Coiion.selected Conication media: 1920 to 2001.


17/65

oz sps c

c b

cs

pps sp c-

s. Sps sps,

spc sps, cs.

fw pp

psc xcs

w s

, s

pp w

cs s s-

pcs z

s c bs

sscs.3

Scandinavian Journalof Nutrition, 2004

0 televiSion

0 ChildS Play

03 neat

Where childrens playtime is concerned, older generations may ofer

an objective comparison when they recall the good old days when

children played outdoors, rode bikes, played tag, and skipped rocks. In

contrast, todays deskbound students, structured athletics, and indoor-only play spaces have practically guaranteed inactivity and obesity in

American youth.

With reductions in physical education (PE) classes and recess periods,

ChIlds Play

989

90%999

60%

Pctg f et sc it rc

American schools have become sedentary

environments. Between 1984 and 2003,

student enrollment in PE classes ell rom

65 to 28 percent. And only 22 percent o

those participating were active or more than

20 minutes.14,15 By 2004, almost 40 percent

o U.S. public school districts had eliminated

recess entirely. And many others had outlawed

the most vigorous games: running, tag, kick-

ball, and touch ootball.16

Even recreational sports no longer guar-

antee vigorous activity or children. Though

participation in youth sports increased during

the past two decades, actual activity duringthese events decreased. Unlike the games o

tag and dodge ballwhich involve continu-

ous involvement rom all participantsmany structured sports have most

players on the sidelines, sedentary during much o the time.17 Whether

warming the bench every week or jogging twice a year, most young ath-

letes are less active than their sporty counterparts 20 years ago.18

ts s

40% scs

w css

dId you know?

School ofcials w cws c, c, s.

W ps b b

s-s s sc, sb cs s sw. t s s scsb ssc ; w- p s;ws swscs sp-; scs;

p cb;c; c, s; sc cs.

ts s ss ss sscs w bss b 7 csb p .

The New YorkTimes,2005


18/65

[i ] c

psc c

s -

c Bmi

w s

s bc

w

c

5 s psc c w

, pc

w s c

w b 4. pc

s bc

w

c c b w

b 9. pc.

Family and CommHealth,

ic s j c

bs u

Ss. i c, c-

b

signicant factor in the

p bs

.4

Research Digest,

ms c p s ,

the woods or elds or c

yons. A fth-grader in Sa

d scb s w

sccc: i p

s b cs

w cc

s W s

w s ss

s, ps p

s ccss

s, cp

w cc

, sc

cs w,

psss. m

q, ,

(as well as school ofcia

cite fearof trafc, of

b s, , b

, ss.5

Sierra,

Even the home has become a culprit. In recent decades, trends in

urban construction have seen larger homes built on smaller lots, prac-

tically eliminating backyards.

19

Between 1981 and 1997, the numbero children participating in outdoor activities declined 50 percent.20

Other reports suggest that the availability o electronics and the per-

ceived saety o neighborhoods also actor

into the increasingly sedentary play-style

o American youth.

One study estimates that modern chil-

dren all short o the amount o energy

they need to burn by 110 to 165 calories

each day.21 Researchers estimate that as

ew as ve hours o PE per week could

diminish obesity risks by 9.2 percent.

Another study nds that activities as sim-

[t] sc c

b c

scc b

j c -

b bs

p uSa

ps w cs,

sc cc

cs

ws pp.3

Lancet,2005

areover-schedu

ledkidsunder-ct

ive?

manyreporsshowha

parcpaonnorgan

zedsporssaan

all-ehgh,buchld

hoodacvylevelsar

eslldangerously

low.ths seengly c

onradcoryrend c

an be explaned

bylookng ahe df

ferenypes of chldre

ns acvyfro

generaonogenera

on.

thoughparcpaon

n srucuredsporsby

odayskdss

hgh,ourgrandparen

sengagednheype

ofsponaneous

exercse(sandlobaseball,groupb

kerdes,swngho

les,

ec.)haseesoha

vebecoeexncnaculureofplay

daesandvdeoga

es. ipropugaes

ofagandred

rover no only burn a

lo of calores bu a

lsonsllnkds a

lfelongapprecaon

forphyscalacvy.

ple as playing outdoors are strongly tied to a childs BMI.22 All things

considered, the engineering o spontaneous activity out o childhood

over the last hal o the century has clearly contributed to our chil-

drens weight gain.


19/65

neat cpss

xp xcp

s sp, -

, xcs.

t c c

neat ps 00

s csps w

s c cs

bs.8

Mayo ClinicProceedings, 2007

0 televiSion

0 ChildS Play

03 neat

dId you know?

Bs .8 .0 ps p b 0-40--s, 003 spbs Science - c cs

acsw s bcs b sps 5 50 csp .7

Bcs w bss , ps w b

js 00 cs p s s p. a s s s 0-- s.B 00Cs: Bi ig

05 .

dcig

0 .

Gig30 .

h030 .

Biig0 .

stig

50 .

Science, 2003

neaTWithout a microscope, ruler, or test tube, most people can observe

changes in the American way o lie during the 21st century. Black-and-

white photographs clearly show the absence

o televisions in the early 1900s, and schoolrecords detail declining participation in PE

classes over recent decades. But some changes

that have contributed to weight

gain are much more subtle.

Basal metabolism

describes the amount

o energy needed

by your body to

complete biological

unctions. Physical

activity includes


20/65

t p c

neat s sbs

c

ps b s c

000 [cs p neat c

b p bs

i c s

css

c bc

00 [cs p

day] is sufcient to

cc bs.

Acta PhysioloScandinavica,

f sc,

w

w sp 30 -

s sbs s

w b s

cs s

s w s sp

s p o ws

c ws

c b , c

s

w w.33

Daily Post,

Pp w bs

tremendously efcient.

a pp

ws ,

. i b

w, s

ss. as s s

pp

s w ws

s cs, .3

New York Times, 2005

exercises such as running or playing sports that we pointedly

schedule into our day. All o the other little movements and

activities that burn calories all under one umbrella term: NEAT

(Non-Exercise Activity Thermogenesis).NEAT represents the energy used or largely overlooked day-

to-day activities. Sitting up straight, vacuuming the house, kissing

your sweetie, chewing gum, washing the car, and tapping your n-

gers are all tasks that require little thought but a lot o energy. For

instance, consistently improving postural habits can burn an extra

350 calor ies per day. Chewing or dgeting can increase the bodys

energy expenditure 20 to 40 percent above resting level. And even

a good laugh with riends can boost metabolism.29 Researchers

estimate that NEAT varies by as much as 2,000 calories rom one

person to the next.

Just as these tasks can subconsciously

punctuate the day, they can also be

removed with little notice. The mecha-

nization o societyreplacing physical

tasks with machineshas contributed

to a decline in NEAT. In a single day,

replacing manual chores (washing dishes,mowing the lawn, etc.) with their auto-

mated versions can add a 100-200 calorie

surplus.30These variations may separately

seem small, but collectively, their impact

on body at can be signicant.


21/65


22/65

Personal andmenTal healTh

The second hal o the 20th century witnessed dramatic changes in

Americans approach to personal and mental health:

Innovations in health care and research boosted the availability

o pharmaceuticals.

Emerging scientic and social stigmatization drove millions o

smokers to kick the habit.

The ubiquity o electricity allowed or distractions such as TV and

video games that disrupted the sleep habits o children and adults.

Changing standards o beauty and growing nutritional knowl-

edge generated an entire industry devoted to weight loss.

At a glance, trends in personal and mental health appear to be

independent o one another. However, a closer inspection reveals one

common denominator: weight gain. As an unprecedented number o

Americans were starting diets, quitting cigarettes, losing sleep, and tak-

ing medications, they started packing on the pounds. This was more

than coincidence. Recent scientic studies explain how changinghealth habits are linked to expanding waistlines.

03 dieting

04 SleeP dePrivatio

0 PharmaCeutiCa

0 Smoking CeSSat


23/65

B pscb qc,

qc w ,

pc -

, s s

pscc -

cs pbb

s cbs

c-ssc

w .3

Southern MedicalJournal, 1999

0 PharmaCeutiCalS

0 Smoking CeSSation

03 dieting

04 SleeP dePrivation

Herbs, roots, minerals, and oils have played medicinal roles in

human cultures throughout the ages. In the 19th century,

alchemy gave way to chemistry as the Industrial Revolution

drove all sorts o scientic developments, including the advento pharmaceutical drugs. But not until the 1940s and 1950s

were pharmaceuticals widely consumed.

In the 50s, the discovery o antipsychotics revolutionized

the treatment o mental health disorders.4 A decade later, the

FDA approved the pill as an oral contraceptive.5 As the ood-

gates opened, a multitude o anticonvulsants, antidepressants,

and other therapeutic agents lled the American market.6 Pre-

scription drug use reached unprecedented heights between

1992 and 2004, growing by 253 percent.7

dId you know?

t sw s c s p the doctors ofce.

e acs sps $80 b pscps 003,pharmacy-lledcscc p 0 sq ss. Sx s pps wb c.

Journal of theAmerican Medical

Association,00

PharmaCeuTICals

With almost hal o the

population taking at least one

prescription, the nations medi-

cine cabinets are more crowded

than everand that surplus can

be seen on the scale, too. Many

commonly used medications

promote weight gain as a side

efect. And their r ise in populari-

ty mirrors the increase in obesity

rates over the past 30 years.8

73%i t

bcb

Ps c p s jc-

s 73 pc s

bs. Pp c s-

bilizers stand to gain between ve and

40 ps.

Ic obit ri f micti


24/65

u, czp

s s

aaPds [pc ps-

cc s], c

zp qp-

, s s pp

cs w

ps. W

c b aaPds c

be signicant; one

[p] qc

00 ps w

s s.

Journal of the American

Medical Association, 2007

as s -

w ps

cc s, -

s cc

ps cp pp

ws sp

6 -ps S

the rst psychotropic

s [w] sc

950s, p

pp w

b w

s cs

s s. W

c b cs b c

ps

css sc s p

ss, psccs

sbzs,

q p

cc c

Journal of Psych

Research,

micti s/nb p P

f 993 003, b p-

scps pcs cs 70% (

.0 b 3.4 b), cp

u.S. pp w 3%; - b pscps p cp

cs 7.8 .8.

Kaiser Family Foundation, 2004

19932.0 bii

20033.4 bii

Several medications or the treatment

o mental and physiological disorders

induce signicant weight gain. Stud-

ies have documented weight gain inpatients on antipsychotics exceeding

ideal body weight by 20 percent or

more.9 In one study, diabetics treat-

ed with multiple injections o insulin

experienced 73 percent increased risk

o becoming overweight.10 As the use

o these medications has escalated,

their eects have also materialized on

patients waistlines.

a j c

pscb psc

w cs .38.

w

cs cc

. ms psc

s (psccs sbzs

psss)

ssc w

w .4

Obesity Reviews,


25/65

[n]c s

b s s c-

, b s,

c-

b w

s s ss

Pss w q s-

b

w

-ss.6

Current Topics inMedicinal Chemistry, 2003

Most people know that smoking is unhealthy. As this knowledge spread

through the population over the last hal-century, many smokers were

motivated to kick the habita great success in public health. Butor all

o the benets to health associated with smoking cessation, there is onedrawback. As Americans put out their cigarettes, they put on additional

smokInG CessaTIon

dId you know?

m w-ss s scs q ss.

ts -ccssc s c fda-ppacpc bscb- ss,wc psc pp.B bc sss cp-s, s sssc cs c cs.

W c,ss q c cs sc cs.as s, pc ps.5

0 PharmaCeutiCalS

0 Smoking CeSSation

03 dieting


pounds. Between 1972 and 2004, the number

o American smokers decreased by 18.2 per-

cent in men and 12.2 percent in women. Over

the same time period, the prevalence o over-

weight and obese Americansas measured by

the Body Mass Index (BMI)grew by 19.3

percent in men and 21.5 percent in women.17

Researchers soon discovered that the relation-

ship between these trends wasnt coincidental.

Scientists rst published studies linking

tobacco to cancer in 1950. At the time o these

reports, approximately hal o the U.S. adult

1965

4.4%

1970

37.4%

1978

34.%

2004

0.9%

1999

3.5%

1987

8.8%

Pctg f at w s

rs c s uS s s c ps

s cs. C dss C P scss s- bw 978 990, s css ws spsb b

-q (.3 9.6 pc ps) cs pc

[] w b -sx (.3 8.0 pc ps)

cs w.3

uit stt dptt f ht h sic, 2006


26/65

l cs s

pc

cc u

Ss, s b

s css

w s-

s. t pc

bs s s c

s

p. S

ssc w w

b ws w

w pc

s. ts s sb

ss p

cs bs

b bcs c

s pc

American JournPublic Health,

Ps-css w

ss p

cs cc

b s p

s

ssc cs

bc Ps

css w

cpx, c

pb cb

b c-s b c

s css

w c.5

Preventive Medicine,

apptit Ic

mtbi dc

surGeon Generals warnInG:

t c s css b

s , wc cbs pp

ss bs. t s

ss ss ss

s ws bs.

Csq, c b

ps.

population smoked cigarettes. By the 1960s, the Surgeon General

labeled smoking a health hazard, and Congress mandated written

warnings on cigarette packages. By the 1980s and 90s, ederal and

social pressure pushed smoking out o airplanes, commercial build-

ings, and bars. The result? As o 2004, the proportion o American

smokers had dropped to one in ve adults.18

Smoking cessation promotes weight gain, so much so that people

who stop smoking are twice as likely to become obese as people who

have never smoked.19 When an individual stops smoking, multiplephysiological changes result in spontaneous weight gain. The nicotine

in cigarette smoke increases metabolism and suppresses appetite.20

Ater quitting, the absence o nicotine causes a persons metabolism

and physical activity levels to drop. Additionally, the nicotine removal

disrupts the hormones that control appetite, making ormer smokers

eel hungry.21 These cumulative changes can contribute to an overall

weight gain o up to 10 percent o original weight.22


27/65

As Americans try to eat less, they end up weighing more. Despite innovations

in research and technology that provide recent generations more access to

health and nutrition inormation than ever beore, children o todays more

inormed generations are atter than their less knowledgeable ancestors.The last hal o the 20th century witnessed a dramatic rise in the avail-

ability o diet books, commercial programs, athletic clubs, and weight-loss

dIeTInG0 PharmaCeutiCalS

0 Smoking CeSSation

03 dieting


dId you know?

m sc ss ,00 cs p s s b z-tions to denes.t b ps s p ss. o ,00-c, bcs w sww c-s w s .Csq,x wc spsccw .6

st. Jeccpi f

Pp Ct,2000

T dit Pxd qc s c s pc w gain.33 W? t

-s s bs css cs, s

sc bs x cs: sc s

b b s. i ss w s, ,

s b , -s ss pp sz

s. ds, , s sz

s ws.34 ts pxc b ss /

b . i s s b s

s s bw , s s w

c. ts b s c s

- .

Journal of Behavioral Medicine,1988

T dit

T n-it

383 c.

616 c.

535 c.

221 c.

ds 152cimore

c w sb c

n-s 395 ciless c w sb c


28/65

The most striking ndin

ws

c w-s

s pc

sbsq w

w

z

bs.36

Journal of ConsultingClinical Psychology,

gb ps

w ss w

ssc w

cs b w

bs

bc. B cs, p

of engaging in speci

bs

bc

w c w

css ssc

w w c.

International JournObesity and Re

Metabolic Disorders,

d s ssc w

pss, b b

, s

ss. d s

cps pccp

w .

Journal of Social Issues

hw c sc-

w s

s c

p s s-c

bs pc. e

, w ss?38

Health at Every Size,

C u f l-ci, sg-fF Bg

i w s 5,05 acs cc J 004

b ac Sps d, ic. (aSd), pp (49%)said that at some point during 2003, they attempted to lose at least ve

ps; 6% c

w.35

pills. Relatively unknown in the 1960s, groups such as Weight Watchers

enrolled approximately 8 million adults per year less than our decades

later.27 Between 1984 and 2004, the number o Americans purchasing

diet oods and beverages more than doubled. And by 2003, diet prod-ucts and services constituted a $40 billion industry.28, 29 Currently, more

than hal o U.S. consumers are trying to lose weight, but many studies

show that most dieting actually results in weight gain. 30

With ad diets, strict regimes, and loty promises, the weight-loss

industry oten perpetuates the problem the industry claims to solve.

Food deprivation lowers the bodys basal metabolic rate (BMR) to

promote at storage and energy conservation. Food restriction

encourages cravings and leads to binge eating.31 Seemingly unattain-

able ideals promote depression among participants and cycle dieters

back toward overeating. These physiological and psychological mech-

anisms ight so eectively against weight loss that researchers

estimate that the ailure rate among dieters is greater than 95 percent.32

004180 ii c

big it f

98468 ii c

big it f

ts 180%cs


29/65

i, sp

b c sb ss

bc q

Sp s pbb

sw b-

s pc, b s

c s b

ss, s s

cs b-

ance are benecial.4

Archives of Diseasein Childhood, 2006

Americans are sleeping less and weighing more. Over the past

century, changing trends in general habits (longer work hours,

sleeP dePrIvaTIon0 PharmaCeutiCalS

0 Smoking CeSSation

03 dieting


dId you know?

rc ss cc c s sp p .

i s,pp wsp ss 7.7 s sw ppcs Bmss ix(Bmi). asc s sssp s ssss. a sss,s w w, s c-s pcs ps.40

Public Library ofScience Medicine,

2004

greater coee consumption, and more

television viewing) contr ibuted to a dis-ruption in sleep patterns. National data

indicate that children and adults spend

less and less time asleep every year. In

1910, we slept on average nine hours per

night. By 2002, that igure had allen to

seven hours, with many Americans get-

ting less than ive hours per night.42 And

these declining sleep rates are showing

up in the nations girth.43

ag h spt p nigt

9009 h

000

6.9 h


30/65

[S]p s

b p

b w bs b

mones [T]hese nd

p

cc pcs

p

bs.48

International Joof Obesity,

well-resTed sleeP-

dePrIved.

ThewellresTedwon

TlosesleePoverTh

IsmaTCh

aPPeTITe

appeie-

conrollinghormonesr

e

sensiiveosleep.

Consequenly,

poornighs

rescnled

ofernoon

munchies.

enerGylevel

Performnce

school,work,nd

hegymislrgelydependeno

n

personsreshe

previousnigh.

meTaBolIsm

toolilesleep

cnlerhe

bodysphwys

formebolizing

sugr,soringf,

ndrelesing

sresshormones.

Numerous studies correlate the efects o sleep on weight. One

study ound that sleep deprivation increases levels o certain pro-

teins that alter metabolism and hunger cues.44 And another report

concluded that lack o sleep also disrupts hormones that control

appetite.45 The direct impact o a good nights rest on the bodys

ability to regulate hunger outlines the clear relationship between

sleep and body weight.

[S]p

ac s csb w [s]

sc

0 c. o

s p

cc b

s b

[C]c p s

ss s ssc w

cs cs

c, cs

p s, cs

cs

s c

c cs.47

Journal of CliEndocrinology

Metabolism,

obs b

sp p W

cs c b

cs b sp

bs, c

c c c

ss sw

pp w sp

p xpc

sps

s cs

pp.46

Annals of Int

Medicine,

TheheavyweIGhTCh

amPIonshIPoFTheP

Illow

sc: uit stt dptt f ht h sic. rpt f t nti Cii

Sleep Disorders Research. 1993, Washington, DC: U.S. Government Printing Ofce.nti sp Fti. 2006 sp i aic P.


31/65


32/65

0 tyPeS of JoBS

0 taSk effiCienCy

oCCuPaTIons

In the early parts o the 20th century, most o the American workorce

could be ound in actories or elds. With little machinery or

technology, manual laborers perormed most tasks themselves. Even

clerical tasks such as researching and ling required a great deal ophysical movement. Since that time, technology has introduced aster,

easier ways to do the jobs that once demanded a great deal o time

and energy. Accordingly, the work o modern Americans difers rom

earlier generations in two ways:

The types o jobs held by todays employees are primarily in

the service sector, as opposed to the high percentage o mining,

manuacturing, and arming positions o the past.

Technology has eliminated most physical exertion rom day-to-

day tasks perormed at work.

The absence o physical activity in the nations labor orce is best

illustrated by the size o the average American worker.


33/65

Blue-collar workers1.6 hours

Technicians3.3 hours

Scientists4.9 hours

Administrative5.7 hours

Professional/Manageria6.2 hours

ag Ti spt sittig dig wThe current ndings present the sedentary workplace as a potentially hostile

s w bs. t pc

wpc b-s c cs c psc c,

w cc xp b w.7

American Journal of Preventive Medicine, 2005

0 taSk effiCienCy

0 tyPeS of JoBS

dId you know?

t ps s3,000 5,000sps (s cs 0,000cb acCc ex-cs). Cs s a-

cs sp csb w s w, ws jobs largely inu-cs psc c.

Agricultural workers accounted or 43.5 percent o the American work-

orce in 1900.4 Farm work was grueling, physically demanding labor.

Horses and mules ofered little assistance, so the industry needed a

great deal o manpower to generate the desired volume. In the ol-lowing decades, gasoline-powered arm equipment replaced beasts o

TyPes oF JoBs

as u Ss

s b p b

psc c bcs

jbs q

psc b. W s

p cz

s

w-w jbs

x psc

ccp

expenditure has signi-

c c.3

Journal of Women inCulture and Society, 2006

burden. New pesticides, ertilizers, and ir-

rigation systems produced a higher yield.

Innovations in mechanized arming required

ewer workers to cultivate more crops.

During the last century, changes in tech-

nology and market demands have adjusted

the type o work Americans perorm and,

consequently, the physical demands o

that work. Between 1910 and 2000, the

workorce shited rom a high percentage

o manual laborers (declining by 96 per-

cent) to a large proportion o proessional

employees (increasing more than ourold).5

As low-activity jobs in the proessional and

service sectors grew, opportunities in the most physically demanding

eldsmining, agriculture, construction, manuacturing, and trans-portationdiminished.

nss

8,648 stp

Scs

4,327 stp

tcs

4,726 stp

lws

5,062 stp

Police Ofcers

5,336 stp


34/65

1900

sic 25%

Gt 4%G 27%

2000

sic 63%

Gt 16%

G 19%

agict 2%

ditibti f ep i mj It sct i pps psc c ccp

s pc c

b

bs ss

pp

b 0 s

p

w c f s w

[s p

c c]

[s psc

c],

b bs c b

c b s c

- w psc

c ccp.9

International Jo

of Obesity,

t pc p

sss

w s b s

psc c

s

c

cs bs

cs sz

i pps

w s s cc

bz s b

ssc w c

psc c

cs bs.

hb f obit,

[i] s b s

c - c

s

w s ssc w

5% 7% cs

bs tp

bs, spc,

c

u.S. w.0

International JournBehavioral Medicine,

t b pss

p w-c-

ccps ws

6 950, 33.7

970,

58. 000.8

Annual Review ofPublic Health, 2005

From blue-collar to white-collar, the shit in labor demographics

resonates in workers waistlines. An administrative assistant needs only

102 calories per hour to complete oce work, while a armer burns

approximately 544 calories in the same

amount o time shoveling hay.6 Because

o the prevalence o low-energy jobs,

todays employees expend, on aver-

age, less energy than workers 50 years

ago. And, unortunately, less physically

demanding occupations translate to

more well-rounded workers.

Pt c: lib f Cg Pit Ptgp diii. Cicg, Iii. Tgp itc b f t

Pi i i t Pi tgp t t ui stti. lib f Cg Pit Ptgp diii. T wit h, wigt, d.C. (c1905).

lib f Cg Pit Ptgp diii. Pti, Ji f it ci.

sc: wtt, I.; hc, d. occpti Cg dig t20t Ct. Monthly Labor Review 2006.

agict 44%


35/65

[t] s pbb 300-500

cs ss s

w-s c w

ws 30-50 s

[t] s b

ps s w

b-s cs,

sc s swbws

cs

c w

s w s s

- sp p-

s ws

w

ofce or other job-related

psc c.3

Medicine and Science inSpor ts and Exercise, 2006

0 taSk effiCienCy

0 tyPeS of JoBS

dId you know?

a p asscsc s c s s-c s w s.

t pcps sc-c o Stw w sc s s c s-jccps. t ws, x s ccs,

w bw5 0 s ss -ss ( -c 600 ,00 csp ).

The MedicalJournal of Australia,

00

At the turn o the 20th century, telegrams and typewriters dominated com-

munication in the business world. Workers perormed tasks manually, and

Task eFFICIenCy

productivity levels were low. Mechanized

and electrical technologies gradually replacedthese manual methods. Telephones took the

place o telegraphs. Surveillance cameras dis-

placed patrolling watchmen. Computerized

barcodes eliminated the need or physical

inventories. One hundred years o new tech-

nologies made the American workorce aster,

more ecientand heavier.

Computers, ax machines, intercoms, copi-

ers, and printers enable the modern worker to

accomplish in 20 minutes what would have

taken two weeks in the early 1900s. Even in

the last 50 years, business output has increased

threeold per business hour.14 Improved pro-

ductivity has reduced the time and energy

spent by the average employee on everyday

w m occpti Ctibt t Ictiit

d B (563 c./) s. d tc (36 c./)

C rb ( c./) s. W assb l (04 c./)


36/65

S ccp

reected by long hou

s s

work was signicantly

ssc w s

bs. i cs,

cs s

s s w

(wc

probably reects hou

w) bs

w w ssc-

ated with a signican

w s bs

bs. o s s

ss 30% b

css 43% p

bs css c b

p p

b w c s.5

Journal of the Ame

Medical Association,

[S]p s

s -

s w

w sp

c ss 5-

w 0 s.

Mayo CProceedings,

Cps c-

c c

(c ps, xs

cc , c.)

c

pp c

w

w pc

w

w cs

s s s

s cs -

xp c

signicantly contribute

cs bs

s acs

ps 0 s.7

Journal of WomeCulture and Society,

projects. Elevators, e-mail, and speed-dial require a raction o the calo-

ries burned by climbing the stairs, walking to a co-workers oce, and

dialing a phone number. While these individual changes are small,

the cumulative efects over time may account or a percentage o the

populations weight gain.

Tracking Efciency: Producing Pages per Minute

9597.5 pg/

p i.

00390 pg/

p i.

h (46 c./) s. us n g (36 c./)

Wc m (88 c./) s. W P (8 c./)

B Js gb cc p 5

c, cps w b . o b

scb pc. B gbs c p

cc b, b sp p pcss.

t s s cps w-s cs.

Work done mechanically (or electronically) is much more efcient and

qs ss s.8

sc: .Ci-Ct.c


37/65


38/65

FamIly lIFe

0 femaleemPloyment

0 maternal age

03 family StruCtur

Characterized by an unprecedented shit in gender dynamics, histo-

rians oten reer to the 60s and 70s as the sexual revolution.

The shiting amily dynamics o the sexual revolution led morewomen into the workorce.

Women born ater the Baby Boom generation had ewer children.

Innovations in reproductive technology allowed women to post-

pone childbirth until a later age.

Arguably the most pivotal moment or this movement occurred

on May 11, 1960, when the FDA approved Enovid, the rst hor-

monal birth control drug.

While recent studies have dismissed the notion that oral contra-

ceptives are directly responsible or weight gain, the pill has had a

domino efect on American amily lie andthrough those chang-

eshas inuenced the nations weight. The typical nuclear amily

o the 1950s (male breadwinner, young bride, and 3.5 children) is

no longer the norm today. Instead, changing amily dynamics have

ushered in a more heterogeneous and noticeably heavier amily or

the new century.

04 Birth Control


39/65

ts w b

-c s

b cb

cs cs

xcs bs cp p

c cs. t s

w w s

ccs w

s c

w pbs.

Journal of HealthEconomics, 2003

In 1900, less than one woman or every ve men had a job in the American

labor market. A century later, that ratio had narrowed considerably, with

women comprising almost hal o the labor orce.2 Many historians attribute

this change in sex roles to the availability o efective birth control.3

By post-poning child-rearing, more American women in the second hal o the 20th

century could nish degrees and embark on careers. The average weekly

hours worked per woman rose 82 percent between 1950 and 2000.4 More

hours spent in the classroom and in the boardroom meant less time or the

domestic duties traditionally assigned to women in earlier generations.

dId you know?

Jbs cs cc-ps (ss,cs, sssss) s

s spss. Bjbs s scccps(cscws -s) s s ps-c s.Cs B: Tcig

70 c./ Ofce Work

0 c./

Ptit C04 c./

hig dbi408 c./

sig C476 c./

Female emPloymenT0 female

emPloyment

0 maternal age

03 family StruCture

Energy Used at Home vs. at the Ofce

This reallocation o time inspired major

changes. The demographic o Americas

workorce shited rom men to women,

rom old to young, and rom single-person

households to married-person house-holds.5 As young, married women spent

more time outside o the home, men gen-

erally did not ll the void. Consequently,

Americans overall dedicated less time to

physically demanding household chores.6

In 1950, more than 60 percent o house-

holds consisted o a male breadwinner

P w C272 c./

Cps340 c./

Sitting at the Ofce102 c./

04 Birth Control

sc: .Ci-Ct.c


40/65

t ss s s

c w

spend signicantly mo

(b 6 /)

s cc

w , w,

c

s c

[W] p-

w -

s p s-

nicantly lower sitting

s , w

c.


Over the past fty yea

pp w

b c s

p, 3

pc 950 6

pc 000. o

s 3.7 w w s

, s 60

pc w

c. ts ws c

s b

30 pc pc

p

twenty-ve years ago

o s 3.7

w w s, 3

pc w w

-, 7 pc w

w p-,

6 pc w c

s p

Fiaic,

and emale housewie, but by 1998 only 24 percent still met the

dening criteria o the traditional Norman Rockwell amily.7, 8

Womens entrance into the workorce redened the labor market,

the domestic sphere, and the amily.

Impacting both women and children, weight gain is one o the

most surprising efects o emale employment on the transormation

o the American amily. The suggested connection between working

women and their obesity stems rom occupational inactivity. Dur-

ing the period rom 1950 to 2000when adult emale employment

jumped rom 28 percent to 53 percentoccupational energy expen-

ditures ell an estimated 300 to 500 calories per day.9The net efect o

these trends was more women burning ewer calories, and the energy

imbalance ueled rising obesity statistics.

Careully noting that maternal employment is a small part o a big

picture, studies also link childhood obesity trends to the growingemale workorce. Researchers propose several mechanisms: nutri-

tional shortcomings o childcare providers, poor ood choices by

unsupervised children, and less time engaged in outdoor activities.

The strongest correlation exists between mothers work time and

childrens BMI in wealthy households. For these amilies, the increase

in hours worked between 1975 and 1994 accounted or as much as a

35 percent increase in likelihood o excess childhood body weight.10

Pctg f mi w i t wfc

95023% w w

97040.5% w w

99058.4% w w

00062.1% w w

sc:uitsttBflbsttitic,B

ti2307.

mit

st

tfwitCiviilbFc:1960t2005.


41/65


42/65

t

xpc pps

p s

ws

bs

t cb lB

[w b w] w

sbsq p w

c

s ssc w

cs Bmi, cs

c bs,

cs s c

ss .obit,

[e]pc s

ss

pp w w

b w ws

w

c c

b w sbsq

sw cc-p

sscpb p

bs, p b

csc

sss .0


Bw 990 99

b bs

w 35 s

cs

8.4% .6%. a

s w, p

s cs b

4%, p bs cs b 5%

ws, 4% p

W cp w

w, s

c

w 40%

p.

Healthcare for WoInternational,

00215.7 p s

bs

99104.5 p s

bs

9857.5 p s

bs

9746.9 p s

bs

Gt i mtip Bit

The increase in maternal age between 1970 and 2000 brought an

increase in population weight through multiple births and low birth

weights. Women older than 30 have more multiple births (twins, trip-lets, etc.) than younger mothers. And women older than 40 display the

highest rates o multiple births.17 Inants involved in a multiple birth

are typically underweight. These small inants exhibit rapid weight

gain called catch-up growth, which programs an inants body early

on or an excessive appetite, insulin resistance, and slow metabolism

later in lie.18 Due to these actors, every ve-year increase in mater-

nal age results in a 14 percent greater risk or childhood obesity.19

sc:CtfdiCtPvti,

ntiCtf

htsttitic.Tihigomtip

Bit:1971-2004.


43/65

In the nal decades o the 20th century, the character istics o the Ameri-

can amily changed dramatically. Social trends in divorce, ertility, and

employment rates impacted the number o parents, children, and

incomes in the average household. These structural changes inlu-enced the everyday activities o amily members.

Between 1970 and 1996, the number o divorced Americans rose rom

4.3 million to 18.3 million.24 The declining ertility rate increased the

number o only child households. The rising employment ratesespe-

cially among working mothersexpanded the number o dual-income

amilies and latchkey children. With more single parents, ewer siblings,

and more time away rom home, amilies eat ewer meals together and

participate less in physical activity.

FamIly sTruCTure

dId you know?

a 00 s b J tf cw bs sss 5 pc bc

w.

3

acc scs, b- bsc sbs p-s cs c p s- bssc s wctv p s.

m cs scs -sq, b, bb 300 cs p b q p.

0 femaleemPloyment

0 maternal age

03 family StruCture

h ig c.s tcig tff.

Sb qs xs-

ps . B

s cs s p

w s .

From ghts in the car to games

bc, c-

bw bs

sss s cs

sc c.

04 Birth Control


44/65

Sbsp sz (b

c )

has a strong inuence

w,

Bmi.33

Internal Joof Obesity,

o-c

s sw

s, s

ws s

p w. h

s

s s

p p

sps p. a

c w

b s

s cs bp w. Csq

sp

,

wc s,

w s

p p

cp.34

uit stt dptht h s

C w

cs

bs w

to be signicantly mor

sc -. obs c

were signicantly less

c

bs, b

signicantly more likel

s

c

w c.

Nutrition Bulletin,

Since the amily environment is a signicant predictor o health

risk actors, changes to the amilys structure alter the health o its

members.25 Between 1970 and 2000, shits in three amily variables(marital status, shared meals, and number o siblings) contributed to

the rise o childhood obesity. Children o dual-parent amilies are

more physically active and spend less time watching TV.26 But the

rise in divorce rates over the last several decades has signicantly

decreased the number o two-parent households, with almost three

out o every 10 children now living in a single-parent home.27, 28

Nutritional research shows that kids who regularly eat break-

ast are more likely to have ideal body weight. But between 1965

and 1991, breakast consumption declined by almost 20 percent in

certain age groups.29, 30 Children with siblings participate in more

active playtime compared to an only child. However, declines in

ertility rates in the last hal o the 20th century contributed to a

decline in average amily size.31 These cumulative changes may have

made wide waistlines the most notable distinction o the modern

American amily.

ag h siz

sc: u.s. C B, Ct Ppti s. ag nb f Ppp Fi h wit o Ci u 18.

900

4.76 pp

904.34 pp

9802.76 pp

9603.33 pp

0002.62 pp

9403.67 pp


45/65

Efective amily planning is a concept unique in recent history. In the ear-

ly 20th century, American couples rarely practiced birth control, and the

methods available were oten unreliable.36 However, the introduction o

the pill in the 1960s all but guaranteed women the opportunity to plantheir pregnancies. In 1959beore the drug was even ocially released to

the publichal a million American women took Enovid. And by the

1960s that number multiplied more than tenold.37 Companies created

and improved other methods to compete in the birth control market; con-

sequently, by 2003 more than 38 million women in their childbearing years

used some orm o contraception.38

In the years immediately preceding Enovids debut, the total ertility rate

in the U.S. was 3.45 average births per childbearing woman. A decade later,

that gure dropped to 3.31. And, by the turn o the century, the ertility

rate had allen to 2.04.39 Though the decline in ertility rates was an antici-

pated efect o reliable birth control, the decline indirectly impacted obesity

through a shit in social standards: increased womens employment, older

maternal age, and smaller amily size.

dId you know?

ec bc s sc q acw - sc 0c. t

sccss cb- bcc c pp-s w.o -c csp s s, bc .

t cb- s wcs (cp,c bc w )s p ps b b w s.35

sci T Iict usa, 2003.

BIrTh ConTrol0 female

emPloyment

0 maternal age

03 family StruCture

effcti f difft Tp f Bit Ct

04 Birth Control

sc:htc,r.;

T,

J.;

st

t,

F.;t.Ctcptiv

Tcg,

17trvieiti.

n

yk:IvigtPb-

iIc.,

1998.

85%

n m

25%

nf

P

0.5%

fSz

5%

t P

20%dp

14%

m lxC

t css b c b w

b p psp cb.


46/65

housInG andTransPorTaTIon

0 tranSPortation

0 Climate Contro

03 urBan SPraWl

04 laBor-Saving

deviCeS

There were about ve people or every horse in the average U.S. household

o the early 1900s. Set in the sprawling countryside, the archetypal

American home had no toilet, no electricity, and no central heating. A

predominantly agricultural workorce exemplied the rural households

and active liestyles o the early 20th century. But as manuacturing trans-

ormed Americas economy, the countrys landscape changed as well.

Declines in arming and a rise in manuacturing sparked an exodus

rom rural to major metropolitan areas. Companies and urban planners

rushed to meet the changing needs o a newly urbanized population:

Henry Fords assembly line energized the automotive industry,

making the car a common xture in most households.

Technological innovations brought central air conditioning and

heating units to oce buildings, schools, and homes.

Developers lured amilies rom inner cities to surrounding

suburban areas.

Successive economic booms boosted the number o households with

enough discretionary income to aford labor-saving appliances.

By the end o the century, Americans saw the cumulative shits in

housing and transportation on their thermostats, in their driveways,

and on their bathroom scales.


47/65

as xpc, sp-

s p

s s s

p Bmis.

Health and Place, 2007

a b spc

ccz b

pc

b s-

p w,sc, spp

s cs, s

cs cc

cc c

psc c

bs.3

Environmental HealthPerspectives, 2004

0 tranSPortation

0 Climate Control

03 urBan SPraWl

04 laBor-SavingdeviCeS

At the beginning o the 20th century, distances that people could not

cover on oot were traveled primarily by horse, bicycle, or train. Motor-

ized conveyances were relatively new and owned only by the wealthiest

segment o the population. Inventions such as the escalator, the airplane,and the assembly line were in their inancy. Gradually, roadways improved

dId you know?

t s-ppc w -- s c w bs.

acc

007 p,w s s wb pscc. B c cs b s bpc b cs.t scsc bw

c w (cbw ps-) - c s8 ps c.

Ititt f

epeit

Pic, 2007

TransPorTaTIon

1

diig p d

6% cs2

% cs

3

8% cs

4

4% cs

ri f obit p h f diig ec d

and highways developed. One hundred years later, the car is kingdomi-

nating all other transportation choices or U.S. travel near and ar.

The modern Americans travel behavior parallels the automotive

industrys growth over the past centurymost notably in recent decades.

In 1969, the average household had 1.2 vehicles

or its 1.6 licensed drivers. And these motorists

traveled only about 7,100 miles annually. But by

2001, the average number o household vehi-

cles (1.9) exceeded the number o drivers (1.8).Americans averaged 14,500 miles per year, and

three out o our trips o less than one mile were

taken by car.4, 5

The growing popularity o the automobile

corresponded to diminished use o other orms

o transportation. In 1960, workers on oot and

in public transit accounted or 22.9 percent o


48/65

m xps b

bs s p

cs b c

xcs

c

cs w

pcs

w s

International Jo

of Obesity,

t p

uS sbb s-

, w s

pc

p b

p sx

cs spw

b w, s

bs p

Environmental H

Perspectives,

W

c p

cs,

ws sc

ssc bw

c w

b c -

w bs

cp w c

sp w sc

s w, cc pbc sp.

International Journalof Obesity, 2006

t s s

ac

b

ps cs

b cs

c p

c b

w csp

cs pbc

s w

t j w

p uS

Css, xp

ps p

c w

b pbc

.6% 4.7% 000

t s w

0.3%

.9%. Cs,

p cs s

w ps s

66.9% 87.9%.5

National HighTrafc and S

Administration,

1960 2000

64%88%

12%5%

10%

7%

7%

3%

3%

1%

d

W

o

d

Pbctsp

W

n t

o

commutes, but that gure ell to 7.6 percent by 2000. Almost hal o

students walked or cycled to school in the late 60s compared to just

14 percent in 2001.6, 7 The increasing number o vehicles, drivers,

and trips increased the amount o time thenation spent sitting in a car.8

The growing prevalence o automotive

travel contributes to the increase in the sed-

entary nature o American lives. One 2005

study ound that car commuters were 13 per-

cent more likely to be obese or overweight

compared to those who walked or cycled

to work.9 Another calculated that every 60

minutes per day in a car added 6 percent to

a persons odds o being obese, while those

odds decreased by 4.8 percent or every

kilometer walked.10 One hour spent walk-

ing briskly or cycling quickly can burn 325 or 720 calories, respectively,

while sitting in a car uses only about 80 calories per hour.11

m f Tptti t w

n t

Pbctsp

sc:uitsttdpttfhigubdvpt.

mfTpttitwkftus:19602000.


49/65

[S] c s-

ss c

ss (b

ps ps

) ssc-

c ps

s cs. u.S.

ss

w c

s 64f (8C)

93 76f (4.6C)

986. i 90s, 90

pc ws

u.S. s p

70 7.5f (

.5C) w

s cs s

b cs

s ss.7

Nut ritional Needs inHot Environments, 1993

0 tranSPortation

0 Climate Control

03 urBan SPraWl


In the beginning o the 20th century, Americans had ew tools to con-

trol their indoor environments. But gradually, air-conditioning units have

replaced open windows and wide verandas. Between 1978 and 2001,

the number o U.S. households with air conditioning increased by 40.2

dId you know?

m sps scs p pc b w.PscsS iss p-

ws tpcls C css s -s bs, ps-s, -s. ocp p

csw s bb. tbenets arew: bsp bs.6

The Kansas CityStar, 2007

ClImaTe ConTrol

9364F

98676F

S ss ss

s p-

f w

s c c -

bs b s c

s 39 cs p .

ts c w s bs

s c s 39 cs .

Ttt Tb

million.18 Similarly, the availability o heat-

ing systems has increased in the past several

decades, moving with it the average indoor

temperature. In 1923 Americans considered

64F to be a comortable household tem-

perature in the winter. But 63 years later,

homeowners had turned up the thermo-

stat to an average o 76F. 19 These trends

gradually narrowed the range o ambient

temperatures in homes, schools, and oces.

A more narrow range in ambient tem-

perature results in a lower metabolic rate. A

contributing actor to human metabolism,

shivering burns a considerable amount o

calories. This mechanism helps regulate the

human bodys core temperature (between

98F and 100F). The amount o energyexpended correlates to the degree o difer-


50/65

Sb pbs

bc c

bs. t p

w, -

csc b

w c b

c cbw

xp

s x pcs, s

%

bw p

p , p

ss, w

ss p

s 40 bw

0 60

y, c 5%

bw

xp

s sb w

b cqs.

Physio logyBehavior,

S- (60 ) xps 6C (6f)

w w

w ccz

b p

C (7f), cs

sc cs

[ xp]

ts, cs [

xp]

b p

w xc s cs

pc w-

s c

cs

qs

s p.

European Journ

Clinical Nutrition,

i s w w b

b w b

s ssc

b s s .

m, s s

b

wc b w/

s s

sps s ps,

pps c -

p.3

Nut ritional Needs inHot Environments, 1993

980 987 993 00

Pctg f u.s. h itai Citiig (uit st)

57%

64%

68%

77%

ence between a persons body temperature and that o the surroundingenvironment. The amount o energy burned by basal metabolismthe

amount o energy required at restcan

increase between 30 and 60 percent in

severe cold exposure.20

Without exposure to a wide range

o temperatures, occupants o modern

homes burn ewer calories than their

grandparents. One study calculated

the energy dierence between a

climate-controlled and a mildly cold

environment to be between 36 and

347 calories per day.21 That means

resisting adjustments to the thermostat

could roughly equate to a three mile jog every day. Given the impact

on metabolism, the rising ubiquity o air-conditioned environments

since 1970 may have contributed to the growing rates o obesity.

50%

sc: uit stt dptt f eg, eg Ifti aiitti .

appic i u.s. h, sct y, 1980-2001.


51/65

W pp sp

w s s s

psss -

bs,

s psc

c s a

s cc-

c ps

xp

c q ,

ws p- c-

ps

xp, cc

0.9 pc

.7

EnvironmentalHealth, 2005

0 tranSPortation

0 Climate Control

03 urBan SPraWl


Without convenient means o traveling long distances regularly, most

Americans in the early 20th century lived in small agricultural communi-

ties. Growing rates o industrialization and automotive travel led people

rom rural to urban areas. This rush to major cities created a unique spatial

dId you know?

ts bdubbed the rst c.Health ofcialsb s

scc scb w .e sp, 997 003,scs 50pc p b p-sp s

cs hiking, shing, w.6

t (dw),The News

Journal, 007

urBan sPrawl

arrangement called urban sprawl: a pattern

o development where large portions o the

population live around a city in low-density

residential areas. Compared to the rural towns

o the early 1900s, modern sprawl meant

greater distances between Americans homes

and their destinations.

Some researchers link the rise o the suburbs

to a rise in obesity. Urban sprawl increases

our dependency on non-active travel, and

increases the sedentary liestyle o suburbanites.

One study calculated a 12.2 percent decline in

obesity or every 25 percent increase in mixed-

use real estate planning (which puts residents

closer to their working and shopping destina-

tions). Put simply, people who live in mixed-use

communities engage more oten in physical

ditibti f ubh BtCt Citi sbb

75%

C C

25%

Sbb

1910

rssW


52/65

o ss

bs b ssc

w b sp

cs

b s. rc

sc bs

b s

ps s p

s bs

cs w

p b

s

sp. o

pc

b s b b

spw w w

s s

c x s

c.30

Environmental H

Perspectives,

ub spw ws ss

w cs

s b w

bs w

bs w c

ts sss [] p

pw cs

bw b spw

ss ss: b

spw cs

b s cs

psc c

bs cs

csc ss

bs,

pbs.9

American JournPublic Health,

ditc Bt rit sppig, w, sct wb pss b c p

pc s w. Pp sbbss cp

p cpss scs

w, sc, spp ss, s p

cs. as cs s css (bc p),

ss ss cs . a wss

sw c.

activity.28 A lack o this planning diversity also means ewer sidewalks,

bike paths, and community parks. So children are more likely to

stay indoors and watch TV than play outside. These changing ac-

tors o the built environment are conducive to physical inactivity

and, thus, obesity.

38%

C C

62%

Sbb

2000

MARKET

rssd

sc:u.s.

CB.

PctfTtPptilivigi

mtpitai

TiCtCitisb-

b:1910t2000.

dcicfppti.


53/65

B --s ppc ss s s

drive-through car washes, remote controls, even interofce e-mailthe aver-

ps ss csb cs xp, p

,700 cs w s c s 0,500 c w,

cc c m Cc Pcs. i c-

s j pbc- pb s c, ss s S

n. B, sc Cp is ds. Psc c s b

.36

Health gzi, 2002

wig di

b h:

09.8 c./

uig di:

78.6 c./

t c s-

z w

s b ssc w b-s

cs. Bcs sc

cs b-

s -c

cs, c

c pc

xp s -

b sbs

cb

bs pc.3

t j Obesity, 2003

0 tranSPortation

0 Climate Control

03 urBan SPraWl


Early in the 1900s, leaders o the womens rights movement sought to bring

dId you know?

i ws s w ss,c bw, cs . m

s s ss s.

B pss b swc, - sss s s xcs, cs.Cs -b

p :

Bicig5 c./.

Cig i3.7 c./.

Tiigg6 c./.

Pig

9 c./.3

BrisbaneTimes, 2007

laBor-savInG devICes

industrialization into the domestic sphere. Pro-

ponents o domestic electrication argued

that the creation o electric machines couldreduce the time women spent on housework.33

The gradual movement o women into the

workorce during the 20th century increased

consumer demand or these labor-saving

appliances, and an economic boom in the 1950s

boosted the number o households with discre-

tionary income or these luxury products. With

less time and more money, convenience devices

such as microwave ovens, electric can openers,

h wig Ct:

4. c./

uig w/d:

79. c./

eg diffc: m . att T


54/65

Cps c-

c c

(c ps, xs

cc , c.)

c

pp c

w

w pc

w

w cs s s s

s cs -

xp c

signicantly contribute

cs bs

s acs

ps 0 s.39

Signs: Journal of WomCulture and Society,

i e, s

b-s cs

bw 950s

990s c

cc xp

b 65 pc.37

s X, 2000

i u Ss,

pbc B

fs t f

msq 963 s-

sc

pp sw

. i 90s

930s, c

of domestic electrica

b

wsp w

sp cc pp

w s w

sc

t cc

b s c

s b c xc s

ss cc

sp sw

c b c b

c s -q

Ggtnciti,

blenders, ood processors, and dishwashers became common xtures in

American homes by the early 80s.34

Many reports link Americas increasingly sedentary home lie

Pctg f u.s. h it Cpt

Tt

43%ic

i

16

wig t w:

7. c./

diig t w:

65.4 c./

Tig t sti:

5 c./

Tig t et:

78 c./

with a rise in body weight. And labor-

saving devices contribute to inactivity.

Some health ocials estimate that the

energy discrepancy between automat-

ed tasks and active tasks can be as much

as 8,800 calories per month.35 Though

our accumulation o automated gadgets

occurred gradually, over the course o several decades Americans haveincrementally replaced their house chores with at stores.

sc:uitsttCB,

dpttf

Cc.

C

tPptisv,

1984,

1993,

2000.


55/65


56/65

endnoTes

20Th CenTury lIFesTyle ChanGes TImelIne1. Centers or Disease Control and Prevention. Morbidity and Mortality Report Weekly.

December 3, 1999.

2. United States Census Bureau, decennial census o population, 1910 to 2000. http://www.

census.gov/prod/2002pubs/censr-4.pd. Accessed August 15, 2007.

3. Sterling, Christopher H. Electronic Media. New York: Praeger, 1984.

4. Oce o Highway Policy Inormation, Federal Highway Administration. 1969 Nationwide

Personal Transportation Survey. http://www.hwa.dot.gov/ohim/1969/1969page.htm.

Accessed August 15, 2007.

5. United States Bureau o Labor Statistics. Bulletin 2307; and Employment and Earnings,

Monthly. January 2006. http://www.bls.gov/cps/home.htm. Accessed August 15, 2007.

6. United States Census Bureau, Current Population Reports, P20-555; and earlier reports.

7. United States Department o Energy. Trends in Residential Air-Conditioning Usage rom

1978 to 1997. http://www.eia.doe.gov/emeu/consumptionbries/recs/actrends/recs_ac_

trends.html. Accessed August 15, 2007.

8. Stefen, L. et al. Population Trends in Leisure-Time Physical Activity: Minnesota Heart

Survey, 1980-2000. Medicine and Science in Sports and Exercise2006; 38: 1716-1723.

9. United States Department o Agriculture, Economic Research Service. Food Consumption,

Prices, and Expenditures, 19701997; Food Consumption (Per Capita) Data System. http://

www.ers.usda.gov/data/oodconsumption. Accessed August 15, 2007.

10. United States Department o Transportation. National Household Travel Survey 2001.

http://www.hwa.dot.gov/policy/2004cpr/chap1.htm. Accessed August 15, 2007.

11. United States Department o Energy. Trends in Residential Air-Conditioning Usage rom

1978 to 1997. http://www.eia.doe.gov/emeu/consumptionbries/recs/actrends/recs_ac_

trends.html. Accessed August 15, 2007.

12. United States Bureau o Labor Statistics, op.cit.

13. Oce o Highway Policy Inormation, op.cit.14. United States Census Bureau, decennial census o population, 1910 to 2000. http://www.

census.gov/prod/2002pubs/censr-4.pd. Accessed August 15, 2007.

15. United States Department o Transportation, op.cit.

16. United States Census Bureau. The Number o Television Sets in United States

Households in 2001. http://www.census.gov/prod/www/statistical-abstract-03.html.

Accessed August 15, 2007.

17. Stefen, op.cit.

18. Centers or Disease Control and Prevention. National Vital Statistics Report: Reproduction

Rates or 19902002 and Intrinsic Rates or 20002001: United States. March 18, 2004.


57/65

19. United States Census Bureau, Current Population Reports, P20-555; and earlier reports.

20. United States Department o Agr iculture,op.cit.

ChanGes In PhysICal aCTIvITy1. Lee, Jennier. The Ultimate Remote Means Never Having to Leave the Couch. The New

York Times, September 14, 2000.

2. Cooper, T.; Klesges, L.; DeBon, M.; Klesges, R.; Shelton, M. An Assessment o Obese and

Non Obese Girls Metabolic Rate During Television Viewing, Reading, and Resting.EatingBehaviors 2006; 7: 105114.

3. CBC Arts. Average U.S. Homes Have More TV Sets Than People. http://www.cbc.ca/

arts/story/2006/09/22/tv-america-homes.html. Accessed November 9, 2006.

4. Hancox, R.; Poulton, R. Watching Television is Associated With Childhood Obesity: But is

It Clinically Important? International Journal o Obesity 2006; 30: 171175.

5. Cooper, op.cit.

6. Norman, G.; Schmid, B.; Sallis, J.; Calas, K.; Patrick, K. Psychosocial and Environmental

Correlates o Adolescent Sedentary Behaviors. Pediatrics 2005; 116: 908916.

7. Wilson, Jennier Fisher. Is Sleep the New Vital Sign?Annals o Internal Medicine2005; 142:

877880.

8. Adachi-Mejia, A.; Longacre, M.; Gibson, J.; Beach, M.; Titus-Ernstof, L.; Dalton, M.

Children With a TV in Their Bedroom at Higher Risk or Being Overweight. International

Journal o Obesity 2007; 31: 644651.

9. Haskell, William L. Physical Activity, Sport, and Health: Toward the Next Century. Research

Quarterly or Exercise and Sport1996; 67: S37.

10. Ackad, Tarek. Health Watch: Can the Electronic Revolution Afect Childrens Health?

UN ChronicleDecember 2006February 2007; 43: 4444.

11. Wake, M.; Hesketh, K.; Waters, E. Television, Computer Use and Body Mass Index in

Australian Primary School Children.Journal o Pediatrics and Child Health 2003; 39: 130134.

12. Ellin, Abby. Games Children Played. The New York Times, January 16, 2005.

13. Engstrm, Lars-Magnus. Social Change and Physical Activity. Scandinavian Journal o

Nutrition 2004; 48: 108113.

14. Lowry, R.; Wechsler, H.; Kann, L.; Collins, J. Recent Trends in Participation in Physical

Education Among US High School Students.Journal o School Health 2001; 71: 145.

15. Pratt, M.; Macera, C.; Blanton C. Levels o Physical Activity and Inactivity in Children and

Adults in the United States. Medicine and Science in Sports and Exercise1999; 31: S52633.

16. Kumar, Ruma. Demise o Playtime. The Baltimore Sun, December 1, 2006.

17. Engstrm, op.cit.

18. Bocarro, J.; Kanters, M.; Casper, J. Research Update: Leisure or Lie. Parks and Recreation

2006; 41: 2227.

19. Dollman, J.; Norton, K.; Norton, L. Evidence or Secular Trends in Childrens Physical

Activity behavior. British Journal Sports Medicine2005; 39: 892897.20. Zygmunt-Fillwalk, E.; Bilello, T. Parents Victory in Reclaiming Recess or Their

Children. Childhood Education 2005; 82: 1923.

21. Hellmich, Nanci. Energy Gap Factors into Child Obesity. USA Today, December 4, 2006.

22. Skslahti, A.; Numminen, P.; Varstala, V.; Helenius, H.; Tammi, A.; Viikari, J.; Vlimki, I.

Physical Activity as a Preventive Measure or Coronary Heart Disease Risk Factors in

Early Childhood. Scandinavian Journal o Medicine and Science in Sports 2004; 14: 143149.

23. Kimm, et al. Lancet2005.

24. Wilmore, J. Exercise, Obesity, and Weight Control: Presidents Council on Physical Fitness

and Sports. Research Digest2004; 1: 111.


58/65

25. Louv, Richard. Leave No Child Inside. Sierra 2006; 91: 5255.

26. Harper, Mary G. Childhood Obesity. Family and Community Health 2006; 29: 288298.

27. Hill, J.; Wyatt, H.; Reed, G.; Peters, J. Obesity and the Environment: Where Do We Go

rom Here? Science2003; 7: 853855.

28. Thompson, W.; Cook, D.; Clark, M.; Bardia, A; Levine, J. Treatment o Obesity. Mayo

Clinic Proceedings 2007; 82: 93102.

29. Buchowski, M.; Majchrzak, K.; Blomquist, K.; Chen, K.; Byrne, D.; Bachorowski, J. Energy

Expenditure o Genuine Laughter. International Journal o Obesity 2006; 31: 131137.

30. Thompson, op.cit.31. Grady, Denise. The Fit Tend to Fidget, and Biology May Be Why, a Study Says. The New

York Times, January 28, 2005.

32. Levine, J.; Kotz, C. NEAT; Non-exercise Activity Thermogenesis; Egocentric and

Geocentric Environmental Factors vs. Biological Regulation.Acta Physiologica Scandinavica

2005; 184: 309318.

33. British Heart Foundation. How Having Sex Could Save Your Lie. Daily Post; Liverpool,

April 28, 2007.

Personal and menTal healTh1. Kauman, D.; Kelly, J.; Rosenberg, L.; Anderson, T.; Mitchell, A. Recent Patterns o

Medication Use in the Ambulatory Adult Population o the United States: The Slone

Survey.JAMA 2002; 287: 337344.

2. Schwartz, T.; Nihalani, N.; Virk, S.; Jindal, S.; Chilton, M. Psychiatric Medication-induced

Obesity: Treatment Options.Obesity Reviews 2004; 5: 233238.

3. Cheskin, L.; Bartlett, S.; Zayas, R.; Twilley, C.; Allison, D.; Contoregci, C. Prescription

Medications: A Modiable Contributor to Obesity. Southern Medical Journal1999; 92: 898904.

4. Mller, D.; Muglia, P.; Fortune, T.; Kennedy, J. Pharmacogenetics o Antipsychotic-induced

Weight Gain. Pharmacological Research 2004; 49: 309.

5. Enovid [33 Fed. Reg. 9001]. Skokie, IL: G.D. Searle & Co; 1970.

6. Post, R.; Denicof, K.; Frye, M.; Dunn, R.; Leverich, G.; Osuch, E.; Speer, A.. A History

o the Use o Anticonvulsants as Mood Stabilizers in the Last Two Decades o the 20th

Century. Neuropsychobiology 1998; 38: 152-166.

7. National Hospital Ambulatory Medical Care Survey 1992 and 2004: Data collection in the

National Hospital Ambulatory Medical Care Survey is rom medical records rather than

individuals. Medications that were prescribed or provided during the ED and OP visits were

recorded on the patient record orm. Generic as well as brand name drugs are included, as

are nonprescription and prescription drugs.

8. Keith, S. et al. Putative Contributors to the Secular Increase in Obesity: Explori

Small Choices, Big Bodies

Documents

Transcript of Small Choices, Big Bodies