Small Choices, Big Bodies

BIG BODIES
SMALL CHOICES,
HOW COUNTLESS DAILY DECISIONS
CONTRIBUTE TO AMERICAS
BURGEONING WAISTLINE
THE CENTER FOR CONSUMER FREEDOM
BIG BodIes
Small ChoICes,
how CounTless daIly deCIsIons
ConTrIBuTe To amerICas
BurGeonInG waIsTlIne
The CenTer For Consumer Freedom
Small Choices, Big Bodies: How countless daily decisions contribute to Americas burgeoning waistlines. Copyright 2007 by the Center for Consumer Freedom The Center for Consumer Freedom is a nonprofit coalition supported by restaurants, food companies, and consumers, working together to promote personal responsibility and protect consumer choices. www.ConsumerFreedom.com All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system without permission in writing from the publisher. Published by the Center for Consumer Freedom, Washington, DC. Printed in the United States of America ISBN 978-1-60461-533-3
ConTenTs
InTroduCTIon......................................1 ChanGes In PhysICal aCTIvITy ........7
Television .........................................................................8 Childs Play ......................................................................10 NEAT ..............................................................................12
Personal and menTal healTh .........15

Pharmaceuticals ................................................................16 Smoking Cessation ...........................................................18 Dieting.............................................................................20 Sleep Deprivation.............................................................22
oCCuPaTIons ......................................25
Types of Jobs ....................................................................26 Task Efficiency .................................................................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
InTroduCTIon
sTaTInG The oBvIous
Obesity is a problem in America. Even without news reports or scientific studies, most individualsby quickly scanning offices and shopping mallscan arrive at the conclusion that people today are bigger than ever before.Though few would argue that love handles are less common in modern culture, theres considerable debate about the cause of those fat rolls. Health activists and food police single out junk food 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, food-only approach, these sticklers lobby for highly restrictive public health policies that leave no room for common sense. While researchers publish conflicting reports on diet trends, ordinary Americans dont have to wait for the next academic journal to find the triggers for our steady weight gain. Questions regarding changes to individual lifestyles can be answered with a short inventory of home and office 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 of U.S. households suggest that time between work and sleep can be spent comfortably on the sofa with a remote control. The rise of modern convenience is self-evident. But in order to show the link between these creature comforts and the bathroom scale, we first have to look to the past.
0th Century lifeStyle ChangeS
an ePIdemIC oF ConvenIenCe
Epidemiology is the study of the source of disease. By definition, disease is any deviation from the bodys normal function caused by infection, genetic defect, or environmental stress. Ailments such as flu, cancer, and cholera fall under the scope of 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 father of this branch of medicine. Most health officials at that time responded to the outbreak with hysteria and conjecture about the cause. But Snow tried a more analytical approachplotting individual cases of the disease on a city map, decoding the overall pattern, and identifying the common link: a contaminated water well. Snows method effectively addressed Londons outbreak, as well as countless other cases of infectious and chronic diseases since that time. So why have modern public officials been unsuccessful 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 of a problem, not the problem itself. Just as nausea or fever can be brought on by any one of a thousand conditions, weight gain can be the symptom of countless, different changes.
1900: the average

mother gave birth to 3.5 children
1910: 7. percent of the u.S. population lived in suburbs 1946: approximately 0,000 television sets were in u.S. households3 1969: 0 percent
of kids living within a mile of school drove or rode a bus4
1978: 8 percent of
households had a microwave oven5
1980: 3.7 per-
cent of 30-to-44 year-old women gave birth during this year6
1981: 33 percent
of homes with central a/C reported using it all summer long7
Cause versus rIsk

Since Snows discovery in 1854, our communities, households, and families have changed. The study of public health has adjusted accordingly.The focus of most epidemiological studies has shifted from infectious disease to ailments such as heart disease and diabetes, which are largely governed by genetics and lifestyle. Infectious disease follows a single, linear tack. Only one particular bacterium can cause an individual to catch cholera. But many modern diseases do not fit in this binary framework. For instance, a person cannot catch cancer. So when investigating these chronic diseases, todays researchers must consider many factors such as family history, gender, environment, occupation, and weight.
1982: 56.4 percent

of women reported sitting over half their time at work8
1985: Per capita
consumption of diet soft drinks totaled 0.4 gallons9
1990: the average

driver spent 49 minutes per day behind the wheel0
Traits that are associated with an increased risk of an outcomebut dont necessarily cause itare known as risk factors. For example, age is considered a risk factor for some heart diseases. But while older Americans have a higher risk for heart attacks and strokes than teenagers, growing old does not inevitably cause heart disease. Some people fail to distinguish between risk and cause. Many health activists have adopted a dangerously myopic focus on certain foods considered to be obesity risk factors. In doing so, they have tried unsuccessfully to turn food into this centurys contaminated water well. With their relentless campaigns to tax, restrict, and ban unhealthy foods, these activists neglect to confront the hundreds of other potential contributors to weight gain. To combat this misrepresentation and restore balance to the public health debate, the public needs a better understanding of these other obesity factors.
BIoloGy and modern lIvInG

Diet and exercise have replaced take two aspirin and call me in the morning as physicians default prescription for many conditions. In regard to obesity, the merit of this recommendation stems from the first basic Law of Thermodynamics: energy conservation. Energy can neither be created nor destroyed. It is, instead, constantly transformed from one state to another. This transformation in humans changes food 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 formula, offering a storage site for excess energy and a fuel source for excess activity. If our energy equation remains lopsided for an extended period of time, then we can grow from a lean body mass (holding two to three months worth of energy in fat) to an obese shape (carrying enough fat to provide energy for more than a year). Their direct impact of diet and exercise on body fat gives them central roles in the weight debate. But the Big Two,as scientists have dubbed them, do not provide a sufficient model for weight dynamics on their own because many variables affect both sides of the equation.
3
0th Century lifeStyle ChangeS
Good sCIenCe Gone Bad

Most studies used by public health activists today base their findings on the habits and health of a handful of individuals. Unlike experimental studies that are designed to determine cause and effect, these epidemiological studies rely on a wide variety of observations and, therefore, arent designed to isolate any one particular risk factor. So these studies can only suggest correlations between a factor and a problem. Still, researchers sometimes try to tease meaningful results out of mountains of data, matching causes with effects. Most obesity reports cited by food activists indict one cause at a time (a mineral, an ingredient, etc.). However, it is impossible to remove a single variable from its greater context. Calcium is found in cheese. That cheese could be part of a sandwich. And that meal is only one part of an entire diet. How effectively can a study isolate the calcium from every other component in a persons meal or lifestyle? It cant. Relying solely on oversimplified analysis in the face of such complexity can yield nonsensical results. And many food activists promote quick-fix solutions based on isolated findings from one study about a single food. But when we look at the broader spectrum of collected observations, a bigger picture of obesitys causes emerges.
1997: 5 percent
of homes with central a/C reported using it all summer long 83 percent of households had a microwave oven
1999: 69 percent
of kids living within a mile of school drove or rode a bus3
2000: 50 percent of the u.S. population lived in suburbs4 2001: the average driver spent 6 minutes per day behind the wheel5 there are approximately 48 million television sets in u.S. households6
symPTom oF ChoICe
Growing waistlines are largely symptoms of our modern lifestyle. The human body is built to survive laborious work and travel. But most travel today is accomplished in the comfortable recline of a drivers seat. And many modern workers sit in air-conditioned offices that encourage very little physical exertion. Additionally, the prevalence of excess weighthistorically a sign of wealth and leisureis evidence that all members of modern society have access to goods and services that were once considered luxuries. So obesity does not fit into the framework originally intended for epidemiology. Obesity is not a disease in the traditional sense of the word. Its not communicable. Obesity is a consequence of our choices. And many of those choices are made passively, in a comfortable but rigor-free environment.
2002: 7. per-
cent of women reported sitting over half their time at work7 the average mother gave birth to .0 children8
2004: 4. per-
cent of 30-to-44 year-old women gave birth during this year9 Per capita consumption of diet soft drinks totaled 5.8 gallons0
Over the past four decades, many fat-inducing elements of the American lifestyle have driven weight gain. But many health officials and food activists have largely ignored these trends in peoples personal lives or paid lip service to their existence. Instead, in an attempt to influence public policy, they have labeled obesity an epidemic and gone on a witch-hunt for a modern-day contaminated well.
namInG The oTher oBesITy rIsk FaCTors

Countless dimensions of American life impact our weight. Since many factors overlap to some degree, they have been grouped into five categories: Personal and Mental Health, Occupation, Changes in Physical Activity, Housing and Transportation, and Family Life. Viewed separately, the changes outlined in each category seem relatively small. But collectively the small changes in lifestyle 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 during down time. (Pages 713) The Personal and Mental Health chapter examines how prescription drugs, smoking cessation, and yo-yo diets contribute to weight gain. (Pages 1523) The Occupation chapter follows the shift in the type of jobs performed by Americans and the minimization of activity within existing professions. (Pages 2529) The Family Life chapter outlines the changes in Americans family structure, from parental employment to number of siblings, that affect a persons weight. (Pages 3138) The Housing and Transportation chapter highlights the rise in popularity and availability of the car, the suburbs, and the thermostat in modern life. (Pages 4149) Each of the changes listed in the following chapters contributes to a mismatch between modern lifestyle and human biology.
5
0 televiSion 0 ChildS Play 03 neat
ChanGes In PhysICal 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 of 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 of this spare time? Recreational activities today vary greatly from earlier generations in time and type. While countless activities fall under the leisure time category, the popularity of television in particular has skyrocketed over the past half-century. With hundreds of channels from which to choose, adults and children spend more time watching sports than playing them. Even in school settings, todays kids rarely (if ever) play outdoors. With more and more free time spent on the couch, modern Americans simply move less than the generations before them.
TelevIsIon
dId you know?

in 950 the Zenith radio Corporation built and sold the first television remote control in the united States. the device appropriately called lazy Boneswas connected to a tv set by a wire and allowed viewers to change between a handful of channels without leaving the comfort of their sofas.
The New York Times, 2005
In 1950, only 9 percent of U.S. homes had a television. By the turn of the century, almost every household owned one or more TVs. We spend an unprecedented amount of time in front of our TV sets. By 2006, the average American spent more than two months of the year (1,672 hours) watching television. And the average number of TV sets outnumbered the average number of people (2.73 vs. 2.55) per household.3 Passively watching television has been the most popu[a]s the amount of telelar recreational activity for several decades and vision viewed increases has accounted for a higher percentage of leiresting energy expenditure sure time than movies, sporting events, books, decreases these metabolic differences may video games, and gardening combined. become detectable Recent research indicates that the amount over time. of time spent in front of the television is the Eating Behaviors, 2006 single most important factor 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,
The Calorie difference Between watching one hour of Tv and

Bathing the kids
Scrubbing the floor
130
Cal.
448
Cal.
255
Cal.
130
Cal.
raking the lawn

8
folding laundry
source: www.Calorie-Count.com
300
Millions of TV Sets
250 200 150 100 50
TV Sets in US Households
254 229 192 155
287
81
1970 1985
1990
1995
2000
2005
unfortunately, the electronic revolution does not help induce a healthy lifestyle and will have a negative impact on childrens health. those who are not subjected to adequate exercise are expected to develop cardiovascular and/or cerebrovascular risk factors, thus impacting their morbidity and mortality from health complications. they will gain abnormal body weight and may develop a high body mass index (Bmi).0
UN Chronicle, 2006
source: united states Census, Federal Communications Commission. se lected Communications media: 1920 to 2001.
even while a child is resting. This means heavy television watchers burn fewer calories over time compared to occasional viewers regardless of whether they are physically active.5 TV viewing uses only slightly more energy than sleeping; consequently, people who choose surfing 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 more likely 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 fat.
mean child Bmi increased stepwise from least to most television viewing categories, as did unadjusted odds ratios for being overweight or obese.
Journal of Pediatrics and Child Health, 2003
ChIlds Play
dId you know?

School officials are outlawing everything from cartwheels to duck, duck, goose. While many parents agree that dodge ball may be too violent or damaging to self-esteem to stay in the schoolyard, many seemingly benign activities are also falling in its wake. the games on some schools banned lists include tag; walking up the slide; twisting the swings chains and spinning; gymnastics; rope climbing; duck; duck, goose; and musical chairs. this means thatin addition to missing out on a lot of fun students at these schools will be missing out on about 7 calories burned per hour.
The New York Times, 2005
Where childrens playtime is concerned, older generations may offer 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 indooronly play spaces have practically guaranteed inactivity and obesity in American youth. With reductions in physical education (PE) classes and recess periods, American schools have become sedentary organized sports carry environments. Between 1984 and 2003, much of the burden of student enrollment in PE classes fell from childrens and young 65 to 28 percent. And only 22 percent of peoples sporting activities. Spontaneous sports, those participating were active for more than especially traditional team 20 minutes.14,15 By 2004, almost 40 percent sports, have decreased. of U.S. public school districts had eliminated few people take regular recess entirely. And many others had outlawed physical exercise on their own initiative as their only the most vigorous games: running, tag, kickform of training, and most ball, and touch football.16 people who engage in Even recreational sports no longer guarathletics outside the ausantee vigorous activity for children. Though pices of an organization are also active members participation in youth sports increased during in associations.3 the past two decades, actual activity during Scandinavian Journal these events decreased. Unlike the games of of Nutrition, 2004 tag and dodge ballwhich involve continuous involvement from all participantsmany structured sports have most players on the sidelines, sedentary during much of the time.17 Whether warming the bench every week or jogging twice a year, most young athletes are less active than their sporty counterparts 20 years ago.18
Percentage of elementary schools with recess
90%
989
60%
999
this means that of elementary schools dont allow recess.
40%
0 0
inactivity is a major cause of obesity in the united States. in fact, inactivity might be a far more significant factor in the development of obesity than overeating.4
Research Digest, 2004
are over-
rts is at an anized spo ation in org gerously t particip are still dan rts show tha tivity levels many repo xplained hood ac can be e h, but child tory trend all-time hig ntradic ity from rens activ emingly co pes of child low. this se rent ty at the diffe by looking is days kids eration. sports by to tion to gen ctured genera ontaneous ation in stru e type of sp gh particip thou ged in th les, rents enga imming ho e rides, sw ur grandpa high, o y roup bik ulture of pla baseball, g tinct in a c e (sandlot me ex exercis d have beco tag and re games of at seems to etc.) th promptu s a games. im instill in kid and video s but also dates calorie rn a lot of ot only bu tivity. rover n physical ac ciation for pre lifelong ap
kids unde scheduled
r-active?
Even the home has become a culprit. In recent decades, trends in urban construction have seen larger homes built on smaller lots, practically eliminating backyards.19 Between 1981 and 1997, the number of children participating in outdoor activities declined 50 percent.20 Other reports suggest that the availability of electronics and the perceived safety of neighborhoods also factor [t]he drastic decline in into the increasingly sedentary play-style habitual activity during of American youth. adolescence might be a major factor in the douOne study estimates that modern chilbling of the rate of obesity dren fall short of the amount of energy development in the uSa they need to burn by 110 to 165 calories in the past two decades, each day.21 Researchers estimate that as since no concomitant increase in energy intake few as five hours of PE per week could was apparent.3 diminish obesity risks by 9.2 percent. Lancet, 2005 Another study finds that activities as simple as playing outdoors are strongly tied to a childs BMI.22 All things considered, the engineering of spontaneous activity out of childhood over the last half of the century has clearly contributed to our childrens weight gain.
most children arent playing outside anymore, not in the woods or fields or canyons. A fifth-grader in San diego described his world succinctly: i like to play indoors better cause thats where all the electrical outlets are When asked why their kids resist going outside, parents point to diminishing access to natural areas, competition with electronic entertainment, longer school hours, increased homework, and other time pressures. most frequently, though, they (as well as school officials) cite fearof traffic, of being sued, and, above all, of strangers.5
Sierra, 2006
[in kindergarten] increased physical education time had a strong negative effect on Bmi for overweight girls or girls at risk for becoming overweight if every kindergartner received a minimum of 5 hours of physical education weekly, the prevalence of overweight girls could be lowered by 4. percent and the risk for becoming overweight among all children could be lowered by 9. percent.6
Family and Community Health, 2006

neaT
dId you know?

Based on the average .8 to .0 pounds gained per year by 0-40-yearolds, a 003 study published in Science determined that the recent increase in americans weight has been caused by an energy surplus of 5 to 50 calories per day.7 Because of the way the human body stores energy, the average person would need to burn just 00 calories more per day to offset this energy gap. and that amounts to as little as a 0-minute investment. Burning 00 Calories: Brisk walking 05 min. dancing 0 min. Gardening 30 min. housework 030 min. Biking 0 min. standing 50 min.
Science, 2003
Without a microscope, ruler, or test tube, most people can observe changes in the American way of life during the 21st century. Black-andwhite photographs clearly show the absence neat comprises all energy of televisions in the early 1900s, and school expenditure except that records detail declining participation in PE used during sleeping, eatclasses over recent decades. But some changes ing, and formal exercise. the dramatic decline in that have contributed to weight neat during the past 00 gain are much more subtle. years corresponds with a Basal metabolism similarly dramatic increase describes the amount in obesity.8 of energy needed Mayo Clinic Proceedings, 2007 by your body to complete biological functions. Physical activity includes

exercises such as running or playing sports that we pointedly schedule into our day. All of the other little movements and activities that burn calories fall under one umbrella term: NEAT (Non-Exercise Activity Thermogenesis). NEAT represents the energy used for largely overlooked dayto-day activities. Sitting up straight, vacuuming the house, kissing your sweetie, chewing gum, washing the car, and tapping your fingers are all tasks that require little thought but a lot of energy. For instance, consistently improving postural habits can burn an extra 350 calories per day. Chewing or fidgeting can increase the bodys energy expenditure 20 to 40 percent above resting level. And even a good laugh with friends can boost metabolism.29 Researchers estimate that NEAT varies by as much as 2,000 calories from one person to the next. Just as these tasks can subconsciously People with obesity are punctuate the day, they can also be tremendously efficient. removed with little notice. The mechaany opportunity not nization of societyreplacing physical to waste energy, they tasks with machineshas contributed take. if you think about it that way, it all makes to a decline in NEAT. In a single day, sense. as soon as they replacing manual chores (washing dishes, have an opportunity to mowing the lawn, etc.) with their autosit down and not waste mated versions can add a 100-200 calorie those calories, they do.3 surplus.30 These variations may separately New York Times, 2005 seem small, but collectively, their impact on body fat can be significant.
the potential variance in neat is substantial and can vary for a given person by as much as 000 [calories per day]. neat could therefore be important in obesity. in fact several authors argue that a consistent energetic imbalance of only 00 [calories per day] is sufficient to account for obesity.3
Acta Physiologica Scandinavica, 2005
for instance, did you know if the average woman spent 30 minutes trimming shrubs she would burn the same amount of calories as she would if she spent 7 minutes playing tennis? other everyday ways to get active are washing the car by hand, vacuuming the house and mowing the lawn.33
Daily Post, 2007
3
0 PharmaCeutiCalS 0 Smoking CeSSation 03 dieting 04 SleeP dePrivation
Personal and menTal healTh

The second half of the 20th century witnessed dramatic changes in Americans approach to personal and mental health: Innovations in health care and research boosted the availability of pharmaceuticals. Emerging scientific and social stigmatization drove millions of smokers to kick the habit. The ubiquity of electricity allowed for distractions such as TV and video games that disrupted the sleep habits of children and adults. Changing standards of beauty and growing nutritional knowledge generated an entire industry devoted to weight loss. At a glance, trends in personal and mental health appear to be independent of one another. However, a closer inspection reveals one common denominator: weight gain. As an unprecedented number of Americans were starting diets, quitting cigarettes, losing sleep, and taking medications, they started packing on the pounds. This was more than coincidence. Recent scientific studies explain how changing health habits are linked to expanding waistlines.
5
PharmaCeuTICals
dId you know?

the nations growing use of medication is not dependent on the doctors office. even though americans spent almost $80 billion on prescription drugs in 003, pharmacy-filled medications accounted for only four of the top 0 most frequently used drugs. Six of the most popular drugs were available over the counter.
Journal of the American Medical Association, 00
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 of scientific developments, including the advent of pharmaceutical drugs. But not until the 1940s and 1950s were pharmaceuticals widely consumed. In the 50s, the discovery of antipsychotics revolutionized the treatment of mental health disorders.4 A decade later, the FDA approved the pill as an oral contraceptive.5 As the floodgates opened, a multitude of anticonvulsants, antidepressants, and other therapeutic agents filled the American market.6 Prescription drug use reached unprecedented heights between 1992 and 2004, growing by 253 percent.7
Increased obesity risk from medications

Patients receiving multiple insulin injections have a 73 percent greater risk of obesity. People taking certain mood stabilizers stand to gain between five and 40 pounds.
73%
more likely to become obese
With almost half of the population taking at least one prescription, the nations medicine 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 effect. And their rise in popularity mirrors the increase in obesity rates over the past 30 years.8
6
By prescribing frequency, frequency of weight gain, and importance to treatment, steroid hormones and psychoactive medications are probably the greatest contributors to medication-associated weight gain.3
Southern Medical Journal, 1999
unfortunately, clozapine and some of these other aaPds [atypical antipsychotic drugs], including olanzapine and quetiapine, also stimulate appetite and cause weight gain in patients. Weight gain elicited by aaPds can be significant; one [patient] quickly gained 00 pounds when taking one of these drugs.
Several medications for the treatment of mental and physiological disorders induce significant weight gain. Studies have documented weight gain in patients on antipsychotics exceeding ideal body weight by 20 percent or more.9 In one study, diabetics treated with multiple injections of insulin experienced 73 percent increased risk of becoming overweight.10 As the use of these medications has escalated, their effects have also materialized on patients waistlines.
medication sales/number per Person

from 993 to 003, the number of prescriptions purchased increased 70% (from .0 billion to 3.4 billion), compared to a u.S. population growth of 3%; the average number of prescriptions per capita increased from 7.8 to .8.
Kaiser Family Foundation, 2004
as a result of long-term treatment with antipsychotic drugs, a four-fold rise of clinically relevant adiposity compared to the general population was found in a sample of 6 out-patients Since the first psychotropic agents [were] discovered in the 950s, promotion of appetite and weight gain have been known side effects of many of these drugs. Weight gain can be caused by compounds from every major class such as antidepressants, antipsychotics and mood stabilizers, and it is frequent and of prominent clinical relevance.3
Journal of Psychiatric Research, 2003
1993
2.0 billion
2003
3.4 billion
a majority of currently prescribed psychotropics will cause .38. kg of weight gain over the course of clinical treatment. most psychotropic drugs (antipsychotics, mood stabilizers and antidepressants) are associated with weight gain.4
Obesity Reviews, 2004
7
smokInG CessaTIon
dId you know?

many weightloss drugs also increase the quit rate of smokers. these dualfunctioning medications such as the recent fdaapproved acompliaact on the bodys endocannabinoid system, which helps control appetite. By blocking the systems receptors, these drugs simultaneously reduce cravings for nicotine and the munchies. Without the aid of medication, smokers trying to quit often convert their cigarette hankerings into snack attacks. as a result, they pack on the pounds.5
Most people know that smoking is unhealthy. As this knowledge spread through the population over the last half-century, many smokers were motivated to kick the habita great success in public health. Butfor all of the benefits to health associated with smoking cessation, there is one drawback. As Americans put out their cigarettes, they put on additional pounds. Between 1972 and 2004, the number [n]icotine is already of American smokers decreased by 18.2 perbeing used as an effeccent in men and 12.2 percent in women. Over tive, albeit erroneous, the same time period, the prevalence of overtreatment for controlling body weight in at weight and obese Americansas measured by least some smokers the Body Mass Index (BMI)grew by 19.3 Persons who quit smokpercent in men and 21.5 percent in women.17 ing have been found Researchers soon discovered that the relationto gain more weight than non-smokers. 6 ship between these trends wasnt coincidental. Scientists first published studies linking Current Topics in Medicinal Chemistry, 2003 tobacco to cancer in 1950. At the time of these reports, approximately half of the U.S. adult
Percentage of adults who smoke
rates of cigarette smoking among uS adults steadily declined during the past several decades. Center for disease Control and Prevention scientists estimated that between 978 and 990, smoking cessation was responsible for about one-quarter (.3 of 9.6 percentage points) of the increase in the prevalence [of] overweight in men and for about one-sixth (.3 of 8.0 percentage points) of the increase in women.3
united states department of health and human services, 2006
1965 4.4% 1970 37.4% 1978 34.% 1987 8.8% 1999 3.5% 2004 0.9%
8
surGeon Generals warnInG:

appetite Increases
the nicotine in smoke causes the body to release adrenaline, which curbs appetite and raises metabolism. the removal of this drug from a former smokers system raises hunger levels and lowers metabolism. Consequently, kicking the habit may add the pounds. large declines in smoking prevalence have occurred in the united States, a result of both smoking cessation and lower smoking-initiation rates. the prevalence of obesity has also increased markedly over the same time period. Smoking is associated with lower body weights and with a lower prevalence of obesity. thus it is reasonable to assume that part of the increase in obesity may be because of decreases in smoking prevalence.4
American Journal of Public Health, 2007
metabolism decreases
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, federal and social pressure pushed smoking out of airplanes, commercial buildings, and bars. The result? As of 2004, the proportion of American smokers had dropped to one in five 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, multiple physiological changes result in spontaneous weight gain.The nicotine in cigarette smoke increases metabolism and suppresses appetite.20 After quitting, the absence of nicotine causes a persons metabolism and physical activity levels to drop. Additionally, the nicotine removal disrupts the hormones that control appetite, making former smokers feel hungry.21 These cumulative changes can contribute to an overall weight gain of up to 10 percent of original weight.22
Post-cessation weight gain stems primarily from increased caloric intake, but also partly from removal of the smokingassociated increase in metabolic rate Postcessation weight gain is a complex, multifactorial problem that combines the formidable challenges of both cigarette smoking cessation and weight control.5
Preventive Medicine, 2007
9
dIeTInG
dId you know?

many diets recommend eating less than ,00 calories per daythe same intake used by health organizations to define starvation. the human body interprets a severe drop in energy intake as starvation. on a ,00-calorie diet, bodily functions will slow down to conserve energy and work to store fat. Consequently, extremely low calorie regiments physiologically encourage weight gain.6
st. James encyclopedia of Popular Culture, 2000
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 information than ever before, children of todays more informed generations are fatter than their less knowledgeable ancestors. The last half of the 20th century witnessed a dramatic rise in the availability of diet books, commercial programs, athletic clubs, and weight-loss
The dieters Paradox
dieting frequency is actually a strong predictor of weight gain.33 Why? though non-dieters usually base their food decisions on internal hunger cues, dieters tend to select their food based on external cues: restrictive eating regiments or forbidden bad foods. in studies when given a small, medium, or large milkshake before a meal, non-dieters eat less food in proportion to the size of milkshake. dieters, on the other hand, eat more of their meal as the size of the milkshake grows.34 this paradoxical behavior stems from a good food/ bad food mentality. if dieters eat something on the bad food listlike the milkshake in the studythey feel that they blew it, so they might as well go ahead and eat enough to make it count. this habit is often cited as the root of yo-yo dieting.
Journal of Behavioral Medicine,1988
The dieters
dieters ate 152 calories more at lunch when given a milkshake before lunch
383 cal.
535 cal.
The non-dieters
0
616 cal.
221 cal.
non-dieters ate 395 calories less at lunch when given a milkshake before lunch
pills. Relatively unknown in the 1960s, groups such as Weight Watchers enrolled approximately 8 million adults per year less than four decades later.27 Between 1984 and 2004, the number of Americans purchasing diet foods and beverages more than doubled. And by 2003, diet products and services constituted a $40 billion industry.28, 29 Currently, more than half of U.S. consumers are trying to lose weight, but many studies show that most dieting actually results in weight gain. 30 With fad diets, strict regimes, and lofty promises, the weight-loss industry often perpetuates the problem the industry claims to solve. Food deprivation lowers the bodys basal metabolic rate (BMR) to promote fat storage and energy conservation. Food restriction encourages cravings and leads to binge eating.31 Seemingly unattainable ideals promote depression among participants and cycle dieters back toward overeating.These physiological and psychological mechanisms fight so effectively against weight loss that researchers estimate that the failure rate among dieters is greater than 95 percent.32
Consumer use of low-calorie, sugar-free Foods and Beverages
in a nationwide study of 5,05 americans conducted in January 004 by american Sports data, inc. (aSd), nearly half the population (49%) said that at some point during 2003, they attempted to lose at least five pounds; another 6% indicated they had made an effort to maintain their weight.35
The most striking finding was that elevated dieting and radical weight-loss efforts predicted greater subsequent growth in relative weight and an elevated hazard for onset of obesity.36
Journal of Consulting and Clinical Psychology, 1999
global reports of dieting for weight loss were not associated with changes in body weight or behaviours related to energy balance. By contrast, reported duration of engaging in specific behaviours related to energy balance and weight control were consistently associated with weight change.37
International Journal of Obesity and Related Metabolic Disorders, 1999
984 68 million consumers buying diet foods
004 180 million consumers buying diet foods
how ironic if a discontinuation of weight loss efforts might actually help solve the so-called obesity epidemic. eat more, weigh less?38
Health at Every Size, 2004
dieting is associated with negative mood and depression, binge behavior, and the onset of eating disorders. dieting also precipitates preoccupation with food and eating.39
thats a 180% increase
Journal of Social Issues,1999

sleeP dePrIvaTIon
dId you know?

recent studies have given credence to the recommended eight hours of sleep per night. in one study, people who slept less than 7.7 hours showed a proportional increase in Body mass index (Bmi). additional research has found that less sleep leads to heightened stress levels. and stress, as we all know, is one more mechanism that packs on the pounds.40
Public Library of Science Medicine, 2004
Americans are sleeping less and weighing more. Over the past century, changing trends in general habits (longer work hours, greater coffee consumption, and more intriguingly, sleep may television viewing) contributed to a disbe a factor that alters both sides of the energy ruption in sleep patterns. National data balance equation indicate that children and adults spend Sleep is probably not the less and less time asleep every year. In only answer to the obe1910, we slept on average nine hours per sity pandemic, but its effect should be taken night. By 2002, that figure had fallen to seriously, as even small seven hours, with many Americans getchanges in energy balting less than five hours per night. 42 And ance are beneficial.4 these declining sleep rates are showing Archives of Disease in Childhood, 2006 up in the nations girth. 43
average hours slept per night
9 hours
900
6.9 hours
000

The h
ChamPIon eavyweIGhT
shIP oF The P
Illow
well-resTed
aPPeTITe
appetitecontrolling hormones are eep. sensitive to sl y, Consequentl s a poor night rest can lead to afternoon munchies.
The wel
vs. sleeP-dePr
Ived
l enerGy leve
meTaBolIsm
at Performance and school, work, ely the gym is larg na dependent o the persons rest t. previous nigh
p too little slee can alter the ays bodys pathw ing for metaboliz fat, sugar, storing and releasing es. stress hormon
obesity may be linked to sleep deprivation While other factors could be causing both sleepiness and obesity, more convincing evidence comes from studies showing that people who are sleep deprived experience hormonal disruptions that result in increased hunger and appetite.46
Annals of Internal Medicine, 2005
T lose sl l resTed won
eeP over ThIs
maTCh
Numerous studies correlate the effects of sleep on weight. One study found that sleep deprivation increases levels of certain proteins that alter metabolism and hunger cues.44 And another report concluded that lack of sleep also disrupts hormones that control appetite.45 The direct impact of a good nights rest on the bodys ability to regulate hunger outlines the clear relationship between sleep and body weight.
[S]leep duration in america has decreased by one to two [hours] during the second half of the 0th century. over the same time period, the incidence of obesity has nearly doubled [C]hronic partial sleep loss is associated with decreased glucose tolerance, decreased leptin levels, increases in evening cortisol levels, and adverse cardiovascular effects.47
Journal of Clinical Endocrinology and Metabolism, 2004
[S]leep duration seems to be important in the regulation of body weight and metabolism by the modulation of key hormones [T]hese findings might have important clinical implications for the prevention and treatment of obesity.48
sources: united states department of health and human services. report of the national Commission on Sleep Disorders Research. 1993, Washington, DC: U.S. Government Printing Office. national sleep Foundation. 2006 sleep in america Poll. International Journal of Obesity, 2006
3
0 tyPeS of JoBS 0 taSk effiCienCy
oCCuPaTIons
In the early parts of the 20th century, most of the American workforce could be found in factories or fields. With little machinery or technology, manual laborers performed most tasks themselves. Even clerical tasks such as researching and filing required a great deal of physical movement. Since that time, technology has introduced faster, easier ways to do the jobs that once demanded a great deal of time and energy. Accordingly, the work of modern Americans differs from earlier generations in two ways: The types of jobs held by todays employees are primarily in the service sector, as opposed to the high percentage of mining, manufacturing, and farming positions of the past. Technology has eliminated most physical exertion from day-today tasks performed at work. The absence of physical activity in the nations labor force is best illustrated by the size of the average American worker.
5
TyPes oF JoBs
dId you know?

the average person takes 3,000 to 5,000 steps a day (a stark contrast to the 0,000 recommended by the american Council on exercise). Considering that most americans spend a considerable amount of their waking hours at work, the amount workers move at their jobs largely influences their total physical activity. nurses
8,648 steps
Agricultural workers accounted for 43.5 percent of the American workforce in 1900.4 Farm work was grueling, physically demanding labor. Horses and mules offered little assistance, so the industry needed a great deal of manpower to generate the desired volume. In the following decades, gasoline-powered farm equipment replaced beasts of burden. New pesticides, fertilizers, and iradults in the united States rigation systems produced a higher yield. used to be paid to be Innovations in mechanized farming required physically active because fewer workers to cultivate more crops. many jobs required hard During the last century, changes in techphysical labor. While it is important to recognize nology and market demands have adjusted that there are still many the type of work Americans perform and, low-wage jobs that are consequently, the physical demands of extremely physically that work. Between 1910 and 2000, the demanding overall occupational energy workforce shifted from a high percentage expenditure has signifiof manual laborers (declining by 96 percantly declined.3 cent) to a large proportion of professional Journal of Women in Culture and Society, 2006 employees (increasing more than fourfold).5 As low-activity jobs in the professional and service sectors grew, opportunities in the most physically demanding fieldsmining, agriculture, construction, manufacturing, and transportationdiminished.
average Time spent sitting during work
The current findings present the sedentary workplace as a potentially hostile environment in terms of overweight and obesity. the proclivity of the modern workplace for labor-saving technology reduces incidental physical activity, and with it the caloric expenditure needed to maintain healthy body weight.7
American Journal of Preventive Medicine, 2005
Police Officers
5,336 steps
lawyers
5,062 steps
teachers
4,726 steps
Secretaries
4,327 steps
6
Blue-collar workers 1.6 hours
Technicians 3.3 hours
Scientists 4.9 hours
Administrative 5.7 hours
Professional/Managerial 6.2 hours
distribution of employees in major Industry sectors
services 25%
Goods 27%
1900
Government 4%
agriculture 44%
services 63%
it appears that a physically active occupation has a protective effect on the likelihood of being obese for the diseasefree adult population above 0 years of age employed in high and low activity for those individuals who engage in no [leisure time physical activity] or irregular [leisure time physical activity], the likelihood of being obese can be reduced by as much as one-half with a physically active occupation.9
International Journal of Obesity, 2001
2000
Government 16% Goods 19% agriculture 2%

source: wyatt, I.; hecker, d. occupational Changes during the 20th Century. Monthly Labor Review 2006.
[i]t has been estimated that each -hour increment in sitting time at work is associated with a 5% and 7% increase in obesity and type diabetes, respectively, in a large cohort of u.S. women.0
International Journal of Behavioral Medicine, 2004
From blue-collar to white-collar, the shift in labor demographics resonates in workers waistlines. An administrative assistant needs only 102 calories per hour to complete office work, while a farmer burns approximately 544 calories in the same the number of persons amount of time shoveling hay.6 Because employed in low-activof the prevalence of low-energy jobs, ity occupations was todays employees expend, on aver6 million in 950, 33.7 million in 970, and age, less energy than workers 50 years 58. million in 000. 8 ago. And, unfortunately, less physically Annual Review of demanding occupations translate to Public Health, 2005 more well-rounded workers.
Photo sources: library of Congress Prints and Photographs division. Chicago, Illinois. Telegraph switch board of the Pennsylvania railroad in the Pennsylvania telegraph room at the union station. library of Congress Prints and Photographs division. The white house, washington, d.C. (c1905). library of Congress Prints and Photographs division. Palestine, Jewish farmer with modern machinery.
the importance of population sedentariness is well illustrated by studies of physical activity levels for individuals moving from agricultural communities to urban environments or of the effects of industrialization. in many populations where this has occurred, urbanization has been associated with decreased physical activity and increased obesity.
handbook of obesity, 2001
7
Task eFFICIenCy
dId you know?

a group of australian researchers recently studied the activity of men living in a simulated historical lifestyle and men working in a modern lifestyle. the participants in the historical re-enactment of old Sydney town were as much as three times more active than their desk-jockey counterparts. the modern workers, like taxi drivers and accountants, walked between 5 to 0 miles less than men living the old-fashioned lifestyle (a difference of 600 to ,00 calories per day).
The Medical Journal of Australia, 00
At the turn of the 20th century, telegrams and typewriters dominated communication in the business world. Workers performed tasks manually, and productivity levels were low. Mechanized [t]here is probably 300-500 and electrical technologies gradually replaced calories less unmeasured these manual methods. Telephones took the low-intensity activity now than there was 30-50 years place of telegraphs. Surveillance cameras disago [t]here has been placed patrolling watchmen. Computerized a pervasive shift toward barcodes eliminated the need for physical labor-saving devices, inventories. One hundred years of new techsuch as snowblowers and other devices that nologies made the American workforce faster, reduce effort in yardwork more efficientand heavier. as well as the use of Computers, fax machines, intercoms, copie-mail and desktop printers, and printers enable the modern worker to ers that eliminate walks down the hall in the accomplish in 20 minutes what would have office or other job-related taken two weeks in the early 1900s. Even in physical activity.3 the last 50 years, business output has increased Medicine and Science in threefold per business hour.14 Improved proSports and Exercise, 2006 ductivity has reduced the time and energy spent by the average employee on everyday
ways modern occupations Contribute to Inactivity
delivering on Bike (563 cal./hr) vs. driving truck (36 cal./hr)
Controlling robot ( cal./hr) vs. Working assembly line (04 cal./hr)
8
Tracking Efficiency: Producing Pages per Minute

Before Johannes gutenberg invented mechanical printing in the 5th century, copies were made by hand. one book took an entire year for a scribe to replicate. But gutenbergs invention changed printing from manual to mechanical labor, thereby speeding up the process. the same is true for modern copiers and other work-saving machines. Work done mechanically (or electronically) is much more efficient and requires less energy than manual efforts.8
959 7.5 pages/ per min.
003 90 pages/ per min.
Sedentary occupation reflected by long hours of sitting or standing at work was significantly associated with risk of obesity. in contrast, even light activities such as standing or walking around at home (which probably reflects household work) and brisk walking were associated with a significantly lower risk of obesity and diabetes. our study suggests that 30% of obesity cases and 43% of type diabetes cases can be potentially prevented by following a relatively active lifestyle.5
projects. Elevators, e-mail, and speed-dial require a fraction of the calories burned by climbing the stairs, walking to a co-workers office, and dialing a phone number. While these individual changes are small, the cumulative effects over time may account for a percentage of the populations weight gain.
[S]pending minutes an hour sending e-mail rather than minutes walking down the hall to speak to a colleague results in a 5-kg weight gain in 0 years.6
Mayo Clinic Proceedings, 2007
hammering (46 cal./hr) vs. using nail gun (36 cal./hr)
Computers and communication technology (cellular phones, faxes, electronic mail, etc.) have reduced the need for people to commute from home to work and to walk from one place to another at the worksite when considered over months or years these small reductions in energy expenditure could significantly contribute to the increase in obesity as seen in americans over the past 0 years.7
Journal of Women in Culture and Society, 2006
Watching monitor (88 cal./hr) vs. Walking Patrol (8 cal./hr)

9
0 female emPloyment 0 maternal age 03 family StruCture 04 Birth Control
FamIly lIFe
Characterized by an unprecedented shift in gender dynamics, historians often refer to the 60s and 70s as the sexual revolution. The shifting family dynamics of the sexual revolution led more women into the workforce. Women born after the Baby Boom generation had fewer children. Innovations in reproductive technology allowed women to postpone childbirth until a later age. Arguably the most pivotal moment for this movement occurred on May 11, 1960, when the FDA approved Enovid, the first hormonal birth control drug. While recent studies have dismissed the notion that oral contraceptives are directly responsible for weight gain, the pill has had a domino effect on American family life andthrough those changeshas influenced the nations weight. The typical nuclear family of the 1950s (male breadwinner, young bride, and 3.5 children) is no longer the norm today. Instead, changing family dynamics have ushered in a more heterogeneous and noticeably heavier family for the new century.
3
Female emPloymenT
dId you know?

Jobs considered traditional female occupations (nurses, teachers, and administrative assistants) are some of the most sedentary positions. But jobs regarded as masculine occupations (construction workers and miners) are some of the most physically intense. Calories Burned: Teaching 70 cal./hour Office Work 0 cal./hour Patient Care 04 cal./hour hauling debris 408 cal./hour shoveling Coal 476 cal./hour
In 1900, less than one woman for every five men had a job in the American labor market. A century later, that ratio had narrowed considerably, with women comprising almost half of the labor force.2 Many historians attribute this change in sex roles to the availability of effective birth control.3 By postponing child-rearing, more American women in the second half of the 20th century could finish 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 for the domestic duties traditionally assigned to women in earlier generations.
Energy Used at Home vs. at the Office
Playing with Children 272 cal./hour
Composting 340 cal./hour
Sitting at the Office 102 cal./hour

those who believe that dual-career families may be contributing to changes in childrens diet and exercise habits have a compelling prima facie case. the rise in women working outside the home coincides with the rise in childhood weight problems.
Journal of Health Economics, 2003
This reallocation of time inspired major changes. The demographic of Americas workforce shifted from men to women, from old to young, and from single-person households to married-person households.5 As young, married women spent more time outside of the home, men generally did not fill the void. Consequently, Americans overall dedicated less time to physically demanding household chores.6 In 1950, more than 60 percent of households consisted of a male breadwinner
3
source: united states Bureau of labor statistics, Bulletin 2307. marital status of women in the Civilian labor Force: 1960 to 2005.
Percentage of married women in the workforce

23% of married women worked
950
40.5% of married women worked
970
the results of this study indicated that workers spend significantly more time (about 6 h/day) sitting in connection with travel, work, and recreation than mothers of young children [W]omen in part-time work and full-time home duties reported significantly lower sitting times for travel, work, and recreation.
990
000
and female housewife, but by 1998 only 24 percent still met the defining criteria of the traditional Norman Rockwell family.7, 8 Womens entrance into the workforce redefined the labor market, the domestic sphere, and the family. Impacting both women and children, weight gain is one of the most surprising effects of female employment on the transformation of the American family. The suggested connection between working women and their obesity stems from occupational inactivity. During the period from 1950 to 2000when adult female employment jumped from 28 percent to 53 percentoccupational energy expenditures fell an estimated 300 to 500 calories per day.9 The net effect of these trends was more women burning fewer calories, and the energy imbalance fueled rising obesity statistics. Carefully noting that maternal employment is a small part of a big picture, studies also link childhood obesity trends to the growing female workforce. Researchers propose several mechanisms: nutritional shortcomings of childcare providers, poor food 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 families, the increase in hours worked between 1975 and 1994 accounted for as much as a 35 percent increase in likelihood of excess childhood body weight.10
Over the past fifty years, the proportion of wives in the labor force has nearly tripled, from 3 percent in 950 to 6 percent in 000. of the nations 3.7 million women with infants under the age of one, almost 60 percent were in the labor force. this was a record high and almost doubled the 30 percent participation rate of mothers twenty-five years ago. of these 3.7 million women with infants, 36 percent were working full-time, 7 percent were working part-time, and 6 percent were actively seeking employment.
Families in america, 2002
33
maTernal aGe
dId you know?

having an older mother increases a persons propensity for obesity by about 4 percent for every five years added to moms age. Being an only child increases a persons risk of obesity. the percentage of 40-something mothers having only one child grew from 9.6 percent in 976 to 7.4 in 004.3 the physiological effects of later birth age and the social ramifications of more single-child families may have a compounding effect on the countrys obesity.
Influenced by population trends, social factors, and medical technology, the average age of an American womans first childbirth jumped by 3.7 years between 1968 and 2002.15 U.S. Census data from 1970 documented approximately 15 million and 12 million women giving birth in their twenties and thirties, respectively. At the turn of the century, the population of women giving birth in their twenties had grown by less than 3 million, while the number of first-time mothers in their thirties had swelled by more than 9 million.16
Catch-up Growth
different kids grow at different rates. But the greatest variation in childrens weight gain occurs in the first two years after birth. Studies have shown that premature or low birth weight babies go through an accelerated period of weight gain called catch-up growth during this time. this speedy growth may result in an acceleration of growth postnatally that overshoots the genetic trajectory and leads to obesity later in life.4
British Medical Journal, 2000
normal Birth weight Children
Premature/ low Birth weight Children
Additional surveys reported that this growing demographic used reliable birth control, delayed commitment to marriage, and worked outside of the home more than any prior generation. These trendsin tandem with innovations in reproductive technologyallow modern women to wait longer to start a family than their mothers or grandmothers. But these opportunities are not without consequence.
34
Growth in multiple Births
[e]pidemiological studies have suggested that people who had low birth weight or whose growth faltered during infancy and childhood, but who subsequently showed catch-up growth have higher susceptibility for the development of obesity, type diabetes and cardiovascular diseases later in life.0
source: Centers for disease Control and Prevention, national Center for health statistics. Twin and higher order multiple Births: 1971-2004.
00 215.7 per thousand live births
99 104.5 per thousand live births
98 57.5 per thousand live births 97 46.9 per thousand live births
the intrauterine experience appears to program the fetus in ways that may lead to risk of obesity later in life the combination of lBW [low birth weight] with subsequent rapid weight gain during childhood is associated with increased Bmi, increased central obesity, and increased risk of chronic disease in adulthood.
obesity, 2006
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, triplets, etc.) than younger mothers. And women older than 40 display the highest rates of multiple births.17 Infants involved in a multiple birth are typically underweight. These small infants exhibit rapid weight gain called catch-up growth, which programs an infants body early on for an excessive appetite, insulin resistance, and slow metabolism later in life.18 Due to these factors, every five-year increase in maternal age results in a 14 percent greater risk for childhood obesity.19
Between 990 and 996, the number of births to women 35 years of age and older increased from 8.4% to .6%. among these women, preterm deliveries increased by 4%, and multiple birth rates increased by 5% for twins, and 4% for triplets. When compared with younger women, those of advancing maternal age were 40% more likely to deliver preterm.
Healthcare for Women International, 2005
35
FamIly sTruCTure
dId you know?

a 00 study by the John tung foundation found that children without brothers and sisters are 5 percent more likely to become overweight.3 according to the researchers, boredom in the absence of siblings or playmates forces an only child to develop sedentary habits such as watching tv and playing video games. more active games such as four-square, dodge ball, and tetherball burn more than 300 calories per hour but require a partner.
In the final decades of the 20th century, the characteristics of the American family changed dramatically. Social trends in divorce, fertility, and employment rates impacted the number of parents, children, and incomes in the average household. These structural changes influenced the everyday activities of family members. Between 1970 and 1996, the number of divorced Americans rose from 4.3 million to 18.3 million.24 The declining fertility rate increased the number of only child households. The rising employment ratesespecially among working mothersexpanded the number of dual-income families and latchkey children. With more single parents, fewer siblings, and more time away from home, families eat fewer meals together and participate less in physical activity.
hes using my crayons. shes touching my stuff.

Sibling quarrels are exhausting for parents to referee. But these dynamics also provide a workout for the kids involved. From fights in the car to games in the backyard, the interaction between brothers and sisters is a constant source of activity.
36
average household size
900 4.76 people 940 3.67 people 980 2.76 people
Children who did not eat cereals for breakfast were found to be significantly more likely to snack midmorning. obese children were significantly less likely to have cereal for breakfast, but significantly more likely to add sugar to their cereal than normal or overweight children.3
Nutrition Bulletin, 2006
90 4.34 people
960 3.33 people
Sibship size (number of children in the family) 000 has a strong influence on 2.62 people height and weight, and in turn the Bmi.33
Internal Journal of Obesity, 2006
source: u.s. Census Bureau, Current Population survey. average number of People per Family household with own Children under 18.
Since the family environment is a significant predictor of health risk factors, changes to the familys structure alter the health of its members.25 Between 1970 and 2000, shifts in three family variables (marital status, shared meals, and number of siblings) contributed to the rise of childhood obesity. Children of dual-parent families are more physically active and spend less time watching TV.26 But the rise in divorce rates over the last several decades has significantly decreased the number of two-parent households, with almost three out of every 10 children now living in a single-parent home.27, 28 Nutritional research shows that kids who regularly eat breakfast are more likely to have ideal body weight. But between 1965 and 1991, breakfast 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 fertility rates in the last half of the 20th century contributed to a decline in average family size.31 These cumulative changes may have made wide waistlines the most notable distinction of the modern American family.
only-children seemed somewhat disadvantaged, as there was no one else to play with. having others around in the same age seemed to be important for providing spontaneous play. an only child with no one their age living in the neighborhood does not have the kids close by to play with. Consequently, they tended to spend more time alone, watching television, talking with friends on the phone and playing on the computer.34
united states department of health and human services, 2003
37
BIrTh ConTrol
dId you know?

effective birth control is a resource unique to american women during the second half of the 0th century. the successful delay of childbearing broadened academic and career opportunities for women. other healthcare advances improved the survival rate of infants, thereby reducing the need for more. the combination of these two factors (cheap, effective birth control and low infant mortality) has put options on the table never available to women at any other time in history.35
social Trends and Indicators usa, 2003.
Effective family planning is a concept unique in recent history. In the early 20th century, American couples rarely practiced birth control, and the methods available were often unreliable.36 However, the introduction of the pill in the 1960s all but guaranteed women the opportunity to plan their pregnancies. In 1959before the drug was even officially released to the publichalf a million American women took Enovid. And by the 1960s that number multiplied more than tenfold.37 Companies created and improved other methods to compete in the birth control market; consequently, by 2003 more than 38 million women in their childbearing years used some form of contraception.38 In the years immediately preceding Enovids debut, the total fertility rate in the U.S. was 3.45 average births per childbearing woman. A decade later, that figure dropped to 3.31. And, by the turn of the century, the fertility rate had fallen to 2.04.39 Though the decline in fertility rates was an anticipated effect of reliable birth control, the decline indirectly impacted obesity through a shift in social standards: increased womens employment, older maternal age, and smaller family size.
effectiveness of different Types of Birth Control
the effectiveness of modern birth control enabled women to better plan or postpone childbirth.
25% natural family Planning 20% diaphragm 0.5% female Sterilization
14% male latex Condom 5% the Pill
38
source: hatcher, r.; Trussell, J.; stewart, F.; et al. Contraceptive Technology, 17th revised edition. new york: Irvington Publishers Inc., 1998.
85% no method
0 tranSPortation 0 Climate Control 03 urBan SPraWl 04 laBor-Saving deviCeS
housInG and TransPorTaTIon

There were about five people for every horse in the average U.S. household of the early 1900s. Set in the sprawling countryside, the archetypal American home had no toilet, no electricity, and no central heating. A predominantly agricultural workforce exemplified the rural households and active lifestyles of the early 20th century. But as manufacturing transformed Americas economy, the countrys landscape changed as well. Declines in farming and a rise in manufacturing sparked an exodus from rural to major metropolitan areas. Companies and urban planners rushed to meet the changing needs of a newly urbanized population: Henry Fords assembly line energized the automotive industry, making the car a common fixture in most households. Technological innovations brought central air conditioning and heating units to office buildings, schools, and homes. Developers lured families from inner cities to surrounding suburban areas. Successive economic booms boosted the number of households with enough discretionary income to afford labor-saving appliances. By the end of the century, Americans saw the cumulative shifts in housing and transportation on their thermostats, in their driveways, and on their bathroom scales.
39
TransPorTaTIon
At the beginning of the 20th century, distances that people could not cover on foot were traveled primarily by horse, bicycle, or train. Motorized conveyances were relatively new and owned only by the wealthiest segment of the population. Inventions such as the escalator, the airplane, and the assembly line were in their infancy. Gradually, roadways improved
risk of obesity per hour of driving each day
dId you know?

the gradual disappearance of walking from day-to-day life is a dominant factor in the growth of obesity. according to one 007 report, walking is the most widely available form of physical activity. But in recent decades travel by foot has largely been replaced by cars. the researchers claim thatby walking one hour each week (the difference between an average driver and a pedestrian)an individual could lose 8 pounds over a decade.
Institute for european environmental Policy, 2007
1 hour driving per day 6% increase 2 hours % increase 3 hours 8% increase 4 hours 4% increase
as expected, respondents reporting higher levels of auto use also reported higher Bmis.
Health and Place, 2007
and highways developed. One hundred years later, the car is kingdominating all other transportation choices for U.S. travel near and far. 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 an urban space for its 1.6 licensed drivers. And these motorists characterized by traveled only about 7,100 miles annually. But by over dependence on automobile trans2001, the average number of household vehiportation for work, cles (1.9) exceeded the number of drivers (1.8). school, shopping and Americans averaged 14,500 miles per year, and leisure activities, is three out of four trips of less than one mile were considered a crucial ecological factor of taken by car.4, 5 physical inactivity The growing popularity of the automobile and obesity.3 corresponded to diminished use of other forms Environmental Health of transportation. In 1960, workers on foot and Perspectives, 2004 in public transit accounted for 22.9 percent of
40
commutes, but that figure fell to 7.6 percent by 2000. Almost half of students walked or cycled to school in the late 60s compared to just 14 percent in 2001.6, 7 The increasing number of vehicles, drivers, and trips increased the amount of time the We found that after nation spent sitting in a car.8 controlling for potential The growing prevalence of automotive confounders, there travel contributes to the increase in the sedwas a significant association between entary nature of American lives. One 2005 commuting to work study found that car commuters were 13 perby car and overcent more likely to be obese or overweight weight or obesity compared to those who walked or cycled compared with active transport to work such to work.9 Another calculated that every 60 as walking, cycling or minutes per day in a car added 6 percent to public transport. a persons odds of being obese, while those International Journal odds decreased by 4.8 percent for every of Obesity, 2006 kilometer walked.10 One hour spent walking briskly or cycling quickly can burn 325 or 720 calories, respectively, while sitting in a car uses only about 80 calories per hour.11
means of Transportation to work
source: united states department of housing and urban development. means of Transportation to work for the us: 1960 and 2000.
the predominant uS suburban housing form, with its over dependence on the private automobile, developed over six decades of sprawling urban growth, as did the obesity epidemic.3
Environmental Health Perspectives, 2004
many experts believe that obesity is primarily caused by a lack of exercise and too great a reliance on driving cars to work and other places rather than walking to their destinations.4
1960
2000
drive
64% 12% 10% 7% 7% 5% 3% 3% 1%
88%
Public transportation Walk no travel other
drive
Public transportation Walk no travel other
the most salient trend in american travel behavior over the past four decades has been increased reliance on the private car for urban travel, with corresponding declines in public transit and walking. the journey to work portion of the uS Census, for example, reports that the percentage of work trips made by public transit fell from .6% in 960 to only 4.7% in 000. the share of walk trips fell from 0.3% to only .9%. Conversely, the private cars share of work trips rose from 66.9% to 87.9%.5
National Highway Traffic and Safety Administration, 2003
4
ClImaTe ConTrol
dId you know?

many of this reports lifestyle factors overlap in their impact on body weight. Psychologist Steve ilardi studies a phenomenon known as therapeutic lifestyle Change that focuses on elements of the hunter-gatherer lifestyle to treat obesity, depression, and other modern maladies. one component of the therapy recommends lowering the thermostat an hour before bedtime. the benefits are twofold: better sleep and higher metabolism.6
The Kansas City Star, 2007
In the beginning of the 20th century, Americans had few tools to control their indoor environments. But gradually, air-conditioning units have replaced open windows and wide verandas. Between 1978 and 2001, the number of U.S. households with air conditioning increased by 40.2 million.18 Similarly, the availability of heat[S]ome evidence suging systems has increased in the past several gests that indoor comfort decades, moving with it the average indoor standards (but not the temperature. In 1923 Americans considered physiology that underpins them) have systematical64F to be a comfortable household temly changed over the past perature in the winter. But 63 years later, several decades. u.S. homeowners had turned up the thermoindoor thermal standards stat to an average of 76F. 19 These trends for winter comfort have risen from 64f (8C) in gradually narrowed the range of ambient 93 to 76f (4.6C) in temperatures in homes, schools, and offices. 986. in the 90s, 90 A more narrow range in ambient tempercent of workers in a perature results in a lower metabolic rate. A u.S. light industrial plant rated 70 to 7.5f ( contributing factor to human metabolism, to .5C) too warm shivering burns a considerable amount of these changes may also calories. This mechanism helps regulate the be related to increasingly human bodys core temperature (between sedentary lifestyles.7 98F and 100F). The amount of energy Nutritional Needs in Hot Environments, 1993 expended correlates to the degree of differ-
Thermostat Troubles
this could lower an individuals metabolism as much as 39 calories a day.
93
64 F
986
76F
Several studies suggest that raising the indoor temperature f during the winter months can reduce individual metabolism by as much as 39 calories per day.
4
Percentage of u.s. homes with air Conditioning (units or systems)
77%
68% 64% 57%
Subtle perturbations in energy balance can lead to obesity. to put it another way, longterm constancy of body weight can only be achieved if the matching between energy intake and energy expenditure is extremely precise, since an error of only % between input and output of energy, if persistent, will lead to a gain or loss of kg per year or some 40 kg between the age of 0 to 60 years. yet, a difference of 5% between energy intake and energy expenditure is hardly measurable with available techniques.4
Physiology and Behavior, 2004
50%
980
987
993
00
source: u nited states department of energy, energy Information administration. appliances in u.s. households, selected years, 1980-2001.
ence between a persons body temperature and that of the surrounding environment.The amount of energy burned by basal metabolismthe amount of energy required at restcan it is now widely believed increase between 30 and 60 percent in that body weight or body severe cold exposure.20 fat or some associated Without exposure to a wide range variable is also regulated. moreover, there is reason of temperatures, occupants of modern to believe that the level homes burn fewer calories than their at which body weight/fat grandparents. One study calculated is regulated may shift in the energy difference between a response to various inputs, perhaps including enviclimate-controlled and a mildly cold 3 ronmental temperature. environment to be between 36 and Nutritional Needs in 347 calories per day. 21 That means Hot Environments, 1993 resisting adjustments to the thermostat could roughly equate to a three mile jog every day. Given the impact on metabolism, the rising ubiquity of air-conditioned environments since 1970 may have contributed to the growing rates of obesity.
Short-term (60 h) exposure to 6C (6f) of normal weight men who were acclimatized to an ambient temperature of C (7f), caused a significant increase in [energy expenditure] thus, the increased [energy expenditure] at the lower ambient temperature, while executing the same daily activities protocol and wearing the same clothing, indicates that energy requirements are higher at this temperature.5
European Journal of Clinical Nutrition, 2002
43
urBan sPrawl
dId you know?

todays youth have been dubbed the first generation of indoor children. Health officials believe that modern youths disconnection from nature is contributing to their weight gain. even over a short period, from 997 to 003, researchers found a 50 percent drop in the number of pre-teens playing outside or engaging in activities like hiking, fishing, and walking.6
the (deleware), The News Journal, 007
Without convenient means of traveling long distances regularly, most Americans in the early 20th century lived in small agricultural communities. Growing rates of industrialization and automotive travel led people from rural to urban areas.This rush to major cities created a unique spatial arrangement called urban sprawl: a pattern With people spending of development where large portions of the more and more of their population live around a city in low-density waking hours as drivers residential areas. Compared to the rural towns or passengers of automobiles, more and more of the early 1900s, modern sprawl meant hours of relative physical greater distances between Americans homes inactivity result a and their destinations. national survey conductSome researchers link the rise of the suburbs ed to document personal energy expenditure found to a rise in obesity. Urban sprawl increases that although driving a our dependency on non-active travel, and car required little energy, increases the sedentary lifestyle of suburbanites. it was the top-ranked catOne study calculated a 12.2 percent decline in egory of personal energy expenditure, accounting obesity for every 25 percent increase in mixedfor 0.9 percent of the use real estate planning (which puts residents daily total.7 closer to their working and shopping destinaEnvironmental tions).Put simply,people who live in mixed-use Health, 2005 communities engage more often in physical
distribution of urban households Between Central Cities and suburbs
1910
residents Walking
25% Suburb
44
75% Central City
distance Between residents and shopping, work, or school

the walkability of a persons neighborhood can have a profound impact on his or her weight. People in the suburbsas compared to their metropolitan counterpartsusually travel greater distances to get to work, school, or shopping destinations, so they depend more heavily on cars. as a communitys density increases (becoming more metropolitan), residents rely less on their cars and more on their feet. and their waistlines show the difference. urban sprawl was associated with an increased risk for being overweight or obese when individual variables were controlled this suggests [a] potential pathway of causality between urban sprawl and disease status: urban sprawl increased automobile use decreased physical activity obesity increased cardiovascular disease, diabetes, and other health problems.9
American Journal of Public Health, 2004
MARKET
activity.28 A lack of this planning diversity also means fewer sidewalks, bike paths, and community parks. So children are more likely to stay indoors and watch TV than play outside. These changing factors of the built environment are conducive to physical inactivity and, thus, obesity.
MARKET
2000
source: u.s. Census Bureau. Percent of Total Population living in metropolitan areas and in Their Central Cities and suburbs: 1910 to 2000. decennial census of population.
residents driving
38% Central City 62% Suburb
our analysis found obesity to be associated with urban transportation indicators related to automobile use. recent research on obesity and urban housing patterns has reported greater levels of obesity in communities where the private automobile is the dominant means of transportation. over dependence on the automobile has been in turn linked to urban sprawl where low residential density and lack of mixed land uses are common.30
Environmental Health Perspectives, 2004
45
laBor-savInG devICes
dId you know?

it wasnt too long ago that families walked to outhouses, fetched bath water, and hung their clothes out to dry. modern families have automated those tasks and then some. Before you press a button or hit a switch, try looking at household tasks as forms of exercise, rather than chores. Consider the fat-burning potential of: Brisk vacuuming 5 cal./min. Cooking dinner 3.7 cal./min. Trimming hedges 6 cal./min. Pushing a lawn mower 9 cal./min.3
Brisbane Times, 2007
Early in the 1900s, leaders of the womens rights movement sought to bring industrialization into the domestic sphere. Prothe emergence of indusponents of domestic electrification argued trialization and wealth has been associated with that the creation of electric machines could a variety of labor-saving reduce the time women spent on housework.33 machines. Because such The gradual movement of women into the machines are habituworkforce during the 20th century increased ally used in high-income countries, the cumulative consumer demand for these labor-saving energetic impact on our appliances, and an economic boom in the 1950s energy expenditure is likeboosted the number of households with discrely to be substantive and tionary income for these luxury products.With to have contributed to the obesity epidemic.3 less time and more money, convenience devices the journal Obesity, 2003 such as microwave ovens, electric can openers,
energy difference: manual vs. automated Tasks
By taking a do-it-yourself approach to everyday tasksthat means saying no to drive-through car washes, remote controls, even interoffice e-mailthe average person stands to considerably increase her monthly energy expenditure, up from ,700 calories the automated way to as much as 0,500 the active way, according to a commentary in the mayo Clinic Proceedings. i think that inactivity is the major public-health problem of this century, says study author Steven n. Blair, a researcher at the Cooper institute in dallas. Physical activity has been engineered out of daily life.36
Health magazine, 2002
washing dishes by hand: 09.8 cal./hr using a dishwasher: 78.6 cal./hr
hand washing Clothes: 4. cal./hr using a washer/dryer: 79. cal./hr

46
Percentage of u.s. households with Computers

source: united states Census Bureau, department of Commerce. Current Population survey, 1984, 1993, 2000.
Thats a
43%
years
increase in only
16
blenders, food processors, and dishwashers became common fixtures in American homes by the early 80s.34 Many reports link Americas increasingly sedentary home life with a rise in body weight. And laborin england, the use of saving devices contribute to inactivity. labor-saving devices between the 950s Some health officials estimate that the and 990s reduced energy discrepancy between automatcaloric expenditure ed tasks and active tasks can be as much by 65 percent.37 as 8,800 calories per month.35 Though syndrome X, 2000 our accumulation of automated gadgets occurred gradually, over the course of several decades Americans have incrementally replaced their house chores with fat stores.
in the united States, the publication of Betty friedans the feminine mystique in 963 dissected the myth of the happy housewife heroine. in the 90s and 930s, female advocates of domestic electrification had genuinely believed that widespread ownership of electric appliances would release women from domestic thralldom. they calculated the number of hours that could be saved by electrifying the execution of household tasks and concluded that time spent on housework could be reduced by as much as three-quarters.38
Gadgets and necessities, 2000
Taking the stairs: 5 cal./hr Taking the elevator: 78 cal./hr
walking to work: 7. cal./hr driving to work: 65.4 cal./hr
Computers and communication technology (cellular phones, faxes, electronic mail, etc.) have reduced the need for people to commute from home to work and to walk from one place to another at the worksite when considered over months or years these small reductions in energy expenditure could significantly contribute to the increase in obesity as seen in americans over the past 0 years.39
Signs: Journal of Women in Culture and Society, 2006
47
48
endnoTes
20Th CenTury lIFesTyle ChanGes TImelIne
1. Centers for Disease Control and Prevention. Morbidity and Mortality Report Weekly. December 3, 1999. 2. United States Census Bureau, decennial census of population, 1910 to 2000. http://www. census.gov/prod/2002pubs/censr-4.pdf. Accessed August 15, 2007. 3. Sterling, Christopher H. Electronic Media. New York: Praeger, 1984. 4. Office of Highway Policy Information, Federal Highway Administration. 1969 Nationwide Personal Transportation Survey. http://www.fhwa.dot.gov/ohim/1969/1969page.htm. Accessed August 15, 2007. 5. United States Bureau of 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 of Energy. Trends in Residential Air-Conditioning Usage from 1978 to 1997. http://www.eia.doe.gov/emeu/consumptionbriefs/recs/actrends/recs_ac_ trends.html. Accessed August 15, 2007. 8. Steffen, L. et al. Population Trends in Leisure-Time Physical Activity: Minnesota Heart Survey, 1980-2000. Medicine and Science in Sports and Exercise 2006; 38: 1716-1723. 9. United States Department of Agriculture, Economic Research Service. Food Consumption, Prices, and Expenditures, 19701997; Food Consumption (Per Capita) Data System. http:// www.ers.usda.gov/data/foodconsumption. Accessed August 15, 2007. 10. United States Department of Transportation. National Household Travel Survey 2001. http://www.fhwa.dot.gov/policy/2004cpr/chap1.htm. Accessed August 15, 2007. 11. United States Department of Energy. Trends in Residential Air-Conditioning Usage from 1978 to 1997. http://www.eia.doe.gov/emeu/consumptionbriefs/recs/actrends/recs_ac_ trends.html. Accessed August 15, 2007. 12. United States Bureau of Labor Statistics, op.cit. 13. Office of Highway Policy Information, op.cit. 14. United States Census Bureau, decennial census of population, 1910 to 2000. http://www. census.gov/prod/2002pubs/censr-4.pdf. Accessed August 15, 2007. 15. United States Department of Transportation, op.cit. 16. United States Census Bureau. The Number of Television Sets in United States Households in 2001. http://www.census.gov/prod/www/statistical-abstract-03.html. Accessed August 15, 2007. 17. Steffen, op.cit. 18. Centers for Disease Control and Prevention. National Vital Statistics Report: Reproduction Rates for 19902002 and Intrinsic Rates for 20002001: United States. March 18, 2004.
49
19. United States Census Bureau, Current Population Reports, P20-555; and earlier reports. 20. United States Department of Agriculture, op.cit.
ChanGes In PhysICal aCTIvITy

1. Lee, Jennifer. 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 of Obese and Non Obese Girls Metabolic Rate During Television Viewing, Reading, and Resting. Eating Behaviors 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 of Obesity 2006; 30: 171175. 5. Cooper, op.cit. 6. Norman, G.; Schmid, B.; Sallis, J.; Calfas, K.; Patrick, K. Psychosocial and Environmental Correlates of Adolescent Sedentary Behaviors. Pediatrics 2005; 116: 908916. 7. Wilson, Jennifer Fisher. Is Sleep the New Vital Sign? Annals of Internal Medicine 2005; 142: 877880. 8. Adachi-Mejia, A.; Longacre, M.; Gibson, J.; Beach, M.; Titus-Ernstoff, L.; Dalton, M. Children With a TV in Their Bedroom at Higher Risk for Being Overweight. International Journal of Obesity 2007; 31: 644651. 9. Haskell, William L. Physical Activity, Sport, and Health: Toward the Next Century. Research Quarterly for Exercise and Sport 1996; 67: S37. 10. Ackad, Tarek. Health Watch: Can the Electronic Revolution Affect Childrens Health? UN Chronicle December 2006February 2007; 43: 4444. 11. Wake, M.; Hesketh, K.; Waters, E. Television, Computer Use and Body Mass Index in Australian Primary School Children. Journal of 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 of 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 of School Health 2001; 71: 145. 15. Pratt, M.; Macera, C.; Blanton C. Levels of Physical Activity and Inactivity in Children and Adults in the United States. Medicine and Science in Sports and Exercise 1999; 31: S52633. 16. Kumar, Ruma. Demise of Playtime. The Baltimore Sun, December 1, 2006. 17. Engstrm, op.cit. 18. Bocarro, J.; Kanters, M.; Casper, J. Research Update: Leisure for Life. Parks and Recreation 2006; 41: 2227. 19. Dollman, J.; Norton, K.; Norton, L. Evidence for Secular Trends in Childrens Physical Activity behavior. British Journal Sports Medicine 2005; 39: 892897. 20. Zygmunt-Fillwalk, E.; Bilello, T. ParentsVictory in Reclaiming Recess for 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 for Coronary Heart Disease Risk Factors in Early Childhood. Scandinavian Journal of Medicine and Science in Sports 2004; 14: 143149. 23. Kimm, et al. Lancet 2005. 24. Wilmore, J. Exercise, Obesity, and Weight Control: Presidents Council on Physical Fitness and Sports. Research Digest 2004; 1: 111.
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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 from Here? Science 2003; 7: 853855. 28. Thompson, W.; Cook, D.; Clark, M.; Bardia, A; Levine, J. Treatment of Obesity. Mayo Clinic Proceedings 2007; 82: 93102. 29. Buchowski, M.; Majchrzak, K.; Blomquist, K.; Chen, K.; Byrne, D.; Bachorowski, J. Energy Expenditure of Genuine Laughter. International Journal of 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 Life. Daily Post; Liverpool, April 28, 2007.
Personal and menTal healTh

1. Kaufman, D.; Kelly, J.; Rosenberg, L.; Anderson, T.; Mitchell, A. Recent Patterns of Medication Use in the Ambulatory Adult Population of 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 Modifiable Contributor to Obesity. Southern Medical Journal 1999; 92: 898904. 4. Mller, D.; Muglia, P.; Fortune, T.; Kennedy, J. Pharmacogenetics of 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.; Denicoff, K.; Frye, M.; Dunn, R.; Leverich, G.; Osuch, E.; Speer, A.. A History of the Use of Anticonvulsants as Mood Stabilizers in the Last Two Decades of 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 from medical records rather than individuals. Medications that were prescribed or provided during the ED and OP visits were recorded on the patient record form. 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: Exploring the Roads Less Traveled. International Journal of Obesity 2006; 30: 15851594. 9. Chue, P.; Cheung, R. The Impact of Weight Gain Associated With Atypical Antipsychotic Use in Schizophrenia. Acta Neuropsychiatrica 2004; 16: 113123. 10. Malone, M. Medications Associated with Weight Gain. The Annals of Pharmacotherapy 2005; 39: 20462055. 11. Hampton, Tracy. Antipsychotics Link to Weight Gain Found. Journal of the American Medical Association 2007; 297: 13051306. 12. Kaiser Family Foundation. Prescription Drug Trends, 2004. http://www.kff.org/rxdrugs/ upload/Prescription-Drug-Trends-October-2004-UPDATE.pdf. Accessed August 7, 2007. 13. Zimmermann, U.; Kraus, T.; Himmerich, H.; et al. Epidemiology, Implications and Mechanisms Underlying Drug-induced Weight Gain in Psychiatric Patients. Journal of Psychiatric Research 2003; 37: 193220.
5
14. Schwartz, T.; Nihalani, N.; Jindal, S.;Virk, S.; Jones, N. Psychiatric Medication-induced Obesity: A Review. Obesity Reviews 2004; 5: 115-121. 15.Vesely, Rebecca. New Methods Help Smokers Kick Habit. Contra Costa Times, March 18, 2007. 16. Li, M.; Kane, J.; Konu, O. Nicotine, Body Weight and Potential Implications in the Treatment of Obesity. Current Topics in Medicinal Chemistry 2003; 3: 899. 17. Leavitt, M.; Gerberding, J.; Sondik, E. Health, United States, 2006. Department of Health and Human Services (30th Report). 18. Heyes, Eileen. Tobacco USA:The Industry Behind the Smoke Curtain. Brookfield, CT: TwentyFirst Century Books, 1999. 19. Bray, G.; Bouchard, C. Handbook of Obesity: Clinical Applications. New York: Marcel Dekker Inc., 2004. 20. Walker, J.; Collins, L.; Rowell, P.; Goldsmith, J.; Moffatt, R.; Stamford, B. The Effect of Smoking on Energy Expenditure and Plasma Catecholamine and Nicotine Levels During Light Physical Activity. Nicotine and Tobacco Research 1999; 1: 365. 21. Lee, H. et al. Increased Leptin and Decreased Ghrelin Level After Smoking Cessation. Neuroscience Letters 2006; 409: 4751. 22. Powledge, Tabitha M. Nicotine as Therapy. Public Library of Science 2004; 2: 17071710. 23. Leavitt, op.cit. 24. Flegal, Katherine M. The Effects of Changes in Smoking Prevalence on Obesity Prevalence in the United States. American Journal of Public Health 2007; 97: 1510-1514. 25. Alberg, A.; Carter, C.; Carpenter, M. Weight Gain as an Impediment to Cigarette Smoking Cessation: A Lingering Problem in Need of Solutions. Preventive Medicine 2007; 44: 296-297. 26. Pendergast, T.; Pendergast, S. St. James Encyclopedia of Popular Culture. Detroit: St. James Press, Gale Group, 2000. 27. Bettelheim, Adriel. Are Americans Eating Themselves to Death? CQ Researcher 1999; 9: Abstract. 28. Calorie Council National Consumer Survey (19842004). http://www.caloriecouncil.org. Accessed December 1, 2006. 29. Sherrid, Pamela. Piling on the Profit: Theres No Slimming Down for Companies Selling Diet Products. US News & World Report 2003. 30. ibid. 31. Polivy, J.; Herman, C. An Evolutionary Perspective on Dieting. Appetite 2006; 47: 3035. 32. Mark, Allyn L. Dietary Therapy for Obesity Is a Failure and Pharmacotherapy is the Future: A Point of View. Clinical and Experimental Pharmacology and Physiology 2006; 33: 857862. 33. Field, A.; Austin, S.; Taylor, C.; Malspeis, S.; Rosner, B.; Rockett, H.; Gillman, M.; Colditz, G. Relation Between Dieting and Weight Change Among Preadolescents and Adolescents. Pediatrics 2003; 112: 900906. 34. Weber, J.; Klesges, R.; Klesges, L. Dietary Restraint and Obesity: Their Effects on Dietary Intake. Journal of Behavioral Medicine 1988; 11: 185-199. 35. Calorie Council National Consumer Survey (19842004). http://www.caloriecouncil.org. Accessed December 1, 2006. 36. Stice, E.; Cameron, R. Naturalistic Weight-reduction Efforts Prospectively Predict Growth in Relative Weight and Onset. Journal of Consulting and Clinical Psychology 1999; 67: 967. 37. French, S.; Jeffery, R.; Murray, D. Is Dieting Good for You: Prevalence, Duration and Associated Weight and Behaviour Changes for Specific Weight Loss Strategies Over Four Years in US Adults. International Journal of Obesity and Related Metabolic Disorders 1999; 23: 320. 38. Gaesser, Glenn A. Eat Less, Weigh More? Calorie Restriction and the Fattening of Americans. Health at Every Size 2004: 18; 3132.
5
39. Cogan, J.; Ernsberger, P. Dieting, Weight, and Health: Reconceptualizing Research and Policy. Journal of Social Issues 1999; 55: 187205. 40. Taheri, S.;Lin, L.; Austin, D.;Young, T.; Mignot, E. Short Sleep Duration Is Associated with Reduced Leptin, Elevated Ghrelin, and Increased Body Mass Index. Public Library of Science Medicine 2004; 1: e62. 41. Taheri, S. The Link Between Short Sleep Duration and Obesity: We Should Recommend More Sleep to Prevent Obesity. Archives of Disease in Childhood 2006; 91: 881884. 42. Wilson, Jennifer Fisher. Is Sleep the New Vital Sign? Annals of Internal Medicine 2005; 142: 877880. 43. Kauffman, Lena. Could Sleep Cause Obesity? Sleep Review JulyAugust 2006. 44. Milewicz, A.; Jedrzejuk, D. Climacteric Obesity: From Genesis to Clinic. Gynecological Endocrinology 2006; 22: 1824. 45. Schuessler, P. et al. Nocturnal Ghrelin LevelsRelationship to Sleep EEG, the Levels of Growth Hormone, ACTH and Cortisoland Gender Differences. Journal of Sleep Research 2005; 14: 329336. 46. Wilson, op.cit. 47. Spiegel, K. et al. Leptin Levels are Dependent on Sleep Duration: Relationships with Sympathovagal Balance, Carbohydrate Regulation, Cortisol, and Thyrotropin. Journal of Clinical Endocrinology and Metabolism 2004; 89: 57625771. 48. Chaput, J.; Brunet, M.; Tremblay, A. Relationship Between Short Sleeping Hours and Childhood Overweight/Obesity: Results from the Qubec en Forme Project. International Journal of Obesity 2006; 30: 10801085.
oCCuPaTIons
1. Anders, Mark. Do You Do 10k a Day? American Council on Exercise 2006; 12: 15. 2. ibid. 3.Yancey, A.; Leslie, J.; Abel, E. Obesity at the Crossroads: Feminist and Public Health Perspectives. Signs: Journal of Women in Culture and Society 2006: 31; 425443. 4. Bureau of the Census. Historical Statistics of the United States. Washington, DC, 1975. 5. Wyatt, I.; Hecker, D. Occupational Changes During the 20th Century. Monthly Labor Review 2006; 3557. 6. Occupation. http://www.calorie-count.com. Accessed December 27, 2006. 7. Mummery, K.; Schofield, G.; Steele, R.; Eakin, E.; Brown, W. Occupational Sitting Time and Overweight and Obesity in Australian Workers. American Journal of Preventive Medicine 2005; 29: 9197. 8. Brownson, R.; Boehmer, T.; Luke, D. Declining Rates of Physical Activity in the United States: What Are the Contributors? Annual Review of Public Health 2005; 26: 421443. 9. King, G.; Fitzhugh, E.; Bassett Jr, D.; McLaughlin, J.; Strath, S.; Swartz, A.; Thompson, D. Relationship of Leisure-time Physical Activity and Occupational Activity to the Prevalence of Obesity. International Journal of Obesity 2001; 25: 606612. 10. Miller, R.; Brown, W. Steps and Sitting in a Working Population. International Journal of Behavioral Medicine 2004; 11: 219224. 11. Bray, G.; Bouchard, C.; James, W. Handbook of Obesity: Etiology and Pathophysiology. New York: Marcel Dekker, 2004. 12. Egger, G.;Vogels, N.; Westerterp, K. Estimating Historical Changes in Physical Activity Levels. The Medical Journal of Australia 2001; 175: 635636. 13. Steffen, Lyn M. et al. Population Trends in Leisure-Time Physical Activity: Minnesota Heart Survey, 19802000. Medicine and Science in Sports and Exercise 2006; 38: 17161723.
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14. United States Department of Labor, Bureau of Labor Statistics. Incidence Rate of Occupational Injuries and Illness for Private Industry by Selected Case Types, 19732000. www/bls.gov/news.release/osha.t06.htm. Accessed December 12, 2006. 15. Hu, F.; Li, T.; Colditz, G.; Willett, W.; Manson, J. Television Watching and Other Sedentary Behaviors in Relation to Risk of Obesity and Type 2 Diabetes Mellitus in Women. JAMA 2003; 289: 17851791. 16. Thompson, W.; Cook, D.; Clark, M.; Bardia, A.; Levine, J. Treatment of Obesity. Mayo Clinic Proceedings 2007; 82: 93102. 17.Yancey, op.cit. 18. Schlager, N.; Lauer, J. Science and Its Times: Understanding the Social Significance of Scientific Discovery. Detroit: Gale Group, 2000.
FamIly lIFe
1. Anderson, P.; Butcher, K.; Levine, P. Maternal Employment and Overweight Children. Journal of Health Economics 2003; 22: 477504. 2. United States Bureau of Labor Statistics, Employment and Earnings, 1900-2000. 3. Turner, Jeffrey S. Families in America: A Reference Handbook. Santa Barbara, CA: ABC CLIO, 2002. 4. McGrattan, E.; Rogerson, R. Changes in Hours Worked, 19502000. Quarterly Review 2004; 28: 1433. 5. ibid. 6. Bianchi, S.; Milkie, M.; Sayer, L.; Robinson, J. Is Anyone Doing the Housework? Trends in the Gender Division of Household Labor. Social Forces 2000; 79: 191234. 7. Turner, op.cit. 8. Cinotto, Simone. Everyone Would Be Around the Table: American Family Mealtimes in Historical Perspective, 18501960. New Directions for Child and Adolescent Development 2006; 2006: 1733. 9. Steffen, L. et al. Population Trends in Leisure-Time Physical Activity: Minnesota Heart Survey, 19802000. Medicine and Science in Sports and Exercise 2006; 38: 17161723. 10. Anderson, P.; Butcher, K.; Levine, P. Maternal Employment and Overweight Children. Journal of Health Economics 2003; 22: 477504. 11. Brown, W.; Miller,Y.; Miller, R. Sitting Time and Work Patterns as Indicators of Overweight and Obesity in Australian Adults. International Journal of Obesity 2003; 27: 1340. 12. Turner, op.cit. 13. United States Department of Health and Human Services, National Center for Health Statistics (NCHS),Vital Statistics of the United States. Live Births by Age of Mother, 1933-2000. 14. Ong, K.; Ahmed, M.; Emmett, P.; Preece, M.; Dunger, D. Association Between Postnatal Catch-up Growth and Obesity in Childhood: Prospective Cohort Study. British Medical Journal 2000; 320: 967971. 15. Hamilton, B.;Ventura, S. Fertility and Abortion Rates in the United States, 19602002. International Journal of Andrology 2006; 29: 3445. 16. Centers for Disease Control, National Vital Statistics Report. Births: Final Data for 2000. 17. Darnay, A.; Fisher, H. Social Trends and Indicators USA. Detroit: Gale Group, 2003. 18. Dulloo, A.; Jacquet, J.; Seydoux, J.; Montani, J. The Thrifty Catch-up Fat Phenotype: Its Impact on Insulin Sensitivity During Growth Trajectories to Obesity and Metabolic Syndrome. International Journal of Obesity 2006; 30: S23S35. 19. Patterson, M.; Stern, S.; Crawford, P.; McMahon, R.; Similo, S.; Schreiber, G.; et al. Sociodemographic Factors and Obesity in Preadolescent Black and White Girls: NHLBIs Growth and Health Study. Journal of National Medical Association 1997; 89: 594600.
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20. Dulloo, op.cit. 21. Woodward-Lopez, G.; Ritchie, L.; Gerstein, D.; Crawford, P. Obesity: Dietary and Developmental Influences. New York: Taylor & Francis Group, 2006. 22. Newburn-Cook, C.; Onyskiw, J. Is Older Maternal Age a Risk Factor for Preterm Birth and Fetal Growth Restriction? A SystematicReview. Health Care for Women International 2005; 26: 852875. 23. Global News Wire. Only Child More Likely to Suffer Weight Problems. China Post, April 4, 2001. 24. United States Census Bureau, Current Population Survey. Marital Status and Living Arrangements, annual reports for 1980 and 1990. 25. Moore, K.;Vandivere, S.; Redd, Z. A Sociodemographic Risk Index. Social Indicators Research 2006; 75: 4581. 26. Hesketh, K.; Crawford, D.; Salmon, J. Childrens Television Viewing and Objectively Measured Physical Activity: Associations With Family Circumstance. International Journal of Behavioral Nutrition and Physical Activity 2006; 3: 36. 27. ibid. 28. United States Census Bureau, op.cit. 29. Siega-Riz, A.; Popkin, B.; Carson, T. Trends in Breakfast Consumption for Children in the United States from 1965 to 1991. American Journal of Clinical Nutrition 1998; 67: 748S56S. 30. Jefferson, A. Breaking Down Barriers Examining Health Promoting Behaviour in the Family: Kelloggs Family Health Study 2005. Nutrition Bulletin 2006; 31: 6064. 31. Ravelli G., Belmont L. Obesity in Nineteen-year-old Men: Family Size and Birth Order Associations. American Journal of Epidemiology 1979; 109: 6670. 32. Jefferson, op.cit. 33. Kozie, S.; Szklarska, A.; Bielicki, T.; Malina, R. Changes in the BMI of Polish Conscripts Between 1965 and 2001: Secular and Socio-occupational Variation. International Journal of Obesity 2006; 30: 13821388. 34. Spencer Hall. Inspiring Childrens Physical Activity: Exploratory Research with Parents. United States Department of Health and Human Services, Centers for Disease Control and Prevention Report 2003; 124. 35. Darnay, op.cit. 36. Davis, William L. Family Planning Services: A History of U.S. Federal Legislation. Journal of Family History 1991; 16: 382. 37. PBS. The Pill. http://www.pbs.org/wgbh/amex/pill/peopleevents/e_usa.html. Accessed December 8, 2006. 38. Centers for Disease Control and Prevention, National Center for Health Statistics. National Survey of Family Growth. Health, United States 2006. 39. Encyclopedia Britannica World Data Analyst. http://search.eb.com.ezproxy.lib.utexas.edu/ analyst/chrono/table?sct=24&axis=horizontal&ccl=181. Accessed November 7, 2006.
housInG and TransPorTaTIon

1. Weber, J.; Klesges, R.; Klesges, L. Dietary Restraint and Obesity: Their Effects on Dietary Intake. Journal of Behavioral Medicine 1988; 11: 185-199. 2. Pendola, R.; Gen, S. BMI, Auto Use, and the Urban Environment in San Francisco. Health and Place 2007; 13: 551556. 3. Wakefield, Julie. Fighting Obesity Through the Built Environment. Environmental Health Perspectives 2004: 112; A616A618. 4. Hu, P.; Reuscher, T. Summary of Travel Trends: 2001 National Household Travel Survey. United States Department of Transportation 2004; 1135.
55
5. Pucher, J.; Renne, J. Socioeconomics of Urban Travel: Evidence from the 2001 NHTS. Transportation Quarterly 2003: 57; 4977. 6. Hu, op.cit. 7. Pucher, op.cit. 8. Transport Research Board. Does the Built Environment Influence Physical Activity? Examining the Evidence. Institute of Medicine of the National Academies, 2005. 9. Wen, L.; Orr, N.; Millett, C.; Rissel, C. Driving to Work and Overweight and Obesity: Findings from the 2003 New South Wales Health Survey, Australia. International Journal of Obesity 2006; 30: 182786. 10. Frank, L.; Andresen, M.; Schmid, T. Obesity Relationships with Community Design, Physical Activity and Time Spent in Cars. American Journal of Preventative Medicine 2004; 27: 8796. 11. Counting Calories. Newsweek 2003; 141: 63. 12. Wen, L.; Orr, N.; Millett, C.; Rissel, C. Driving to Work and Overweight and Obesity: Findings from the 2003 New South Wales Health Survey, Australia. International Journal of Obesity 2006; 30: 182786. 13. Wakefield, op.cit. 14. Petit, W.; Adamec, C. The Encyclopedia of Endocrine Diseases and Disorders. New York: Facts on File, 2005. 15. Pucher, op.cit. 16. Eveld, Edward. Stone Age Solutions: A University of Kansas Psychologist Has Stone Age Solutions to Depression. The Kansas City Star, February 20, 2007. 17. Socolow, R. Space Heating Technology Atlas. Boulder, CO: E Source, Inc., 2004. 18. United States Census Bureau. American Housing Survey for the United States. Housing Reports. http://www.census.gov/hhes/www/housing/ahs/nationaldata.html. Accessed August 13, 2007. 19. Socolow, op.cit. 20. Ooijen, M.;Van Marken Lichtenbelta, W.;Van Steenhovenb, A.; Westerterpa, K. Seasonal changes in metabolic and temperature responses to cold air in humans. Physiology and Behavior 2004; 82: 545553. 21. ibid. 22. Herman, Peter. Effects of Heat on Appetite. Nutritional Needs in Hot Environments 1993; 187213. 23. ibid. 24. Dulloo, A.; Seydoux, J.; Jacquet, J. Adaptive Thermogenesis and Uncoupling Proteins: A Reappraisal of Their Roles in Fat Metabolism and Energy Balance. Physiology and Behavior 2004; 83: 587602. 25. Westerterp-Plantenga, M.; van Marken Lichtenbelt, W.; Strobbe, H.; Schrauwen, P. Energy Metabolism in Humans at a Lowered Ambient Temperature. European Journal of Clinical Nutrition 2002; 56: 288296. 26. Kenney, Edward. In Summer, More Kids Prefer to Chill Indoors. The News Journal (Wilmington, Delaware) June 25, 2007. 27. Frumkin, Howard. Environmental Health: From Global to Local. San Francisco: John Wiley & Sons, 2005. 28. Frank, op.cit. 29. Lopez, Russ. Urban Sprawl and Risk for Being Overweight or Obese. American Journal of Public Health 2004; 94: 15741579. 30. Wakefield, op.cit. 31. Roginski, Alexandra. Worldwide Work-Out. Brisbane Times, May 1, 2007. 32. Lanningham-Foster, L.; Nysse, L.; Levine, J. Labor Saved, Calories Lost: The Energetic
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Impact of Domestic Labor-saving Devices. Obesity 2003; 11: 11781181. 33. Webb, P.; Suggitt, M. Gadgets and Necessities: An Encyclopedia of Household Innovations. Denver, CO: ABC-CLIO, 2000. 34. Freeman, June. The Making of the Modern Kitchen: A Cultural History. New York: Berg Publishers, 2004. 35. Thompson, W.; Cook, D.; Clark, M.; Bardia, A.; Levine, J. Treatment of Obesity. Mayo Clinic Proceedings 2007; 82: 93102. 36. Asp, K.; Chillot, R.; Eller, D.; Krieger, L.; Marer, E.; Matlack, J.; Reid, S.; Williams, L.; Walch, A. A Calorie Bonfire-Outside the Gym. Health 2002; 16: 22. 37. Challem, J.; Berkson, B.; Smith, M. Syndrome X:The Complete Nutritional Program to Prevent and Reverse Insulin Resistance. New York: John Wiley & Sons, 2000. 38. Webb, op.cit. 39.Yancey, A.; Leslie, J.; Abel, E. Obesity at the Crossroads: Feminist and Public Health Perspectives. Signs: Journal of Women in Culture and Society 2006; 31: 425443.
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BIG BODIES

THE CENTER FOR CONSUMER FREEDOM

The CenTer For Consumer Freedom

Personal and menTal healTh .........15

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

housInG and TransPorTaTIon .......41

0th Century lifeStyle ChangeS

1900: the average

1980: 3.7 per-

cent of 30-to-44 year-old women gave birth during this year6

of homes with central a/C reported using it all summer long7

Cause versus rIsk

1982: 56.4 percent

1985: Per capita

consumption of diet soft drinks totaled 0.4 gallons9

1990: the average

BIoloGy and modern lIvInG

0th Century lifeStyle ChangeS

Good sCIenCe Gone Bad

2002: 7. per-

2004: 4. per-

namInG The oTher oBesITy rIsk FaCTors

0 televiSion 0 ChildS Play 03 neat

ChanGes In PhysICal aCTIvITy

dId you know?

The Calorie difference Between watching one hour of Tv and

raking the lawn

250 200 150 100 50

dId you know?

this means that of elementary schools dont allow recess.

kids unde scheduled

dId you know?

0 PharmaCeutiCalS 0 Smoking CeSSation 03 dieting 04 SleeP dePrivation

Personal and menTal healTh

dId you know?

Increased obesity risk from medications

more likely to become obese

medication sales/number per Person

dId you know?

surGeon Generals warnInG:

dId you know?

984 68 million consumers buying diet foods

004 180 million consumers buying diet foods

thats a 180% increase

Journal of Social Issues,1999

dId you know?

T lose sl l resTed won

eeP over ThIs

0 tyPeS of JoBS 0 taSk effiCienCy

dId you know?

Blue-collar workers 1.6 hours

Technicians 3.3 hours

Scientists 4.9 hours

Administrative 5.7 hours

Professional/Managerial 6.2 hours

distribution of employees in major Industry sectors

Government 16% Goods 19% agriculture 2%

dId you know?

delivering on Bike (563 cal./hr) vs. driving truck (36 cal./hr)

Tracking Efficiency: Producing Pages per Minute

959 7.5 pages/ per min.

003 90 pages/ per min.

hammering (46 cal./hr) vs. using nail gun (36 cal./hr)

0th Century lifeStyle ChangeS

1980: 3.7 per-

consumption of diet soft drinks totaled 0.4 gallons9

0th Century lifeStyle ChangeS

2002: 7. per-

2004: 4. per-

0 televiSion 0 ChildS Play 03 neat

0 PharmaCeutiCalS 0 Smoking CeSSation 03 dieting 04 SleeP dePrivation

984 68 million consumers buying diet foods

004 180 million consumers buying diet foods

0 tyPeS of JoBS 0 taSk effiCienCy

delivering on Bike (563 cal./hr) vs. driving truck (36 cal./hr)

959 7.5 pages/ per min.

003 90 pages/ per min.

hammering (46 cal./hr) vs. using nail gun (36 cal./hr)

Watching monitor (88 cal./hr) vs. Walking Patrol (8 cal./hr)

0 female emPloyment 0 maternal age 03 family StruCture 04 Birth Control

00 215.7 per thousand live births

99 104.5 per thousand live births

900 4.76 people 940 3.67 people 980 2.76 people

90 4.34 people

960 3.33 people

0 tranSPortation 0 Climate Control 03 urBan SPraWl 04 laBor-Saving deviCeS

washing dishes by hand: 09.8 cal./hr using a dishwasher: 78.6 cal./hr

hand washing Clothes: 4. cal./hr using a washer/dryer: 79. cal./hr

Taking the stairs: 5 cal./hr Taking the elevator: 78 cal./hr

walking to work: 7. cal./hr driving to work: 65.4 cal./hr