Tom Zinnen: Welcome,
I work here at the UW-Madison eveBiotechnology Center.ite I also work for UW Extension I'm Tom Zinnen.
behalf of those folks and the other partners at Wednesday Nite Cooperative Extension, and on
at the Lab, Wisconsin Public Television, Wisconsin Alumni
Association, and PLATO and
the UW-Madison Science Alliance, thanks again for coming to
We do this every Wednesday Wednesday Nite at the Lab.
Dr. Dale Schoeller. He's a professor of nutritional sciences here the UW Madison, and he's an internationally
recognized expert in energy metabolism and body composition.
He's best known as the first person to use the doubly labeled
water method for the measurement
of energy expenditure in humans. He has performed extensive
I don't know why he hasn't research in human obesity.
contacted me. [LAUGHTER] This includes studies of the
role of physical activity and energy intake in the ideology or cause of obesity,
treatments to improve efficacy the comparison of obesity
and development of improved methods for measuring body composition.
He's also been instrumental in
identifying systematic reporting errors in question error based
physical activity. assessments of energy intake and
That's pretty cool. WhichHe's also currentlyof me binvestigating novel stable design.
intake. I don't speak German and I'm not isotope biomarkers of dietary
what that was to me. used to 12 nouns stacked in a row, so I hope you'll explain
[APPLAUSE] Please join me in welcoming Dr. Schoeller to Wednesday Nite at the Lab.
>> Dale Schoeller: Thank you, Tom. How are we on volume?
Is this good? >> Yes. >> All right. Well, let's get started.
Except it's not listening,
from reading the newspaper that there has been a dramatic increase in the number of obese Sindividuals in the Unitedre
States. We can start in 1965 or pretty
there, but in about '65, not much skip to '88. There wasn't a huge change from
shown here, about 10% to 12% of adults were classified as obese. By 1980 it was up to where some
states, especially in and around
Wisconsin, were between, put on my glasses, 10% and 14% of the adults obese.
1996, most states in the Union
were over 10%, and many of them running up in the 15% to 20% range.
And then last year when the statistics were taken, 2010,
34% of adults were classified as obese.
And you'll see there's a hot
zone, if we can get this listening to me, hot zone down
Delta. here along the Mississippi River
And just to put a picture on this, so here we have four
This gentleman was probably in generations of a family.
healthy weight. Probably about 150 pounds. guessing from his weight now, I would have guessed he'd been a
Current generation adult, in Next generation, he's now overweight.
2008 or so when this picture was taken, just on the obese side,
weight. And, of course, the generation I judging from his height and
worry about as an investigator is the next generation after
that. If it continues to get worse, so
is obesity a concern? Well, we're all concerned a little bit how we look but the Just the movement to here, why
point of view is that obesity is real concern from a nutritional
a risk factor for a lot of diseases. It increases the risk threefold,
300%, for diabetes, gall stones,
high blood pressure, high plasma cholesterol and high plasma triglycerides and sleep apnea or
sleep interruption. It increases the risks two- to
threefold for heart disease, osteoarthritis and gout.
Yeah, that one hurts. Fortunately, there's not a lot
of it anymore. And it has a slight increase for
risk for some cancers,
reproductive hormone abnormalities, polycystic ovary syndrome and back pain and knee
pain, which I know I'm having more and more trouble with. So let's walk through this and
diabetes. As we go from the 1990s through 2008, increase in diabetes. yoYou'll see below that theor
increase in the diagnosed diabetes in the US. And it pretty much follows. Darkened areas fall in the same
area. Obesity increases, diabetes increases.
even more so. So that now we're up to about 6% As it increases more, diabetes
to 7%, nationally, of adults have type two diabetes.
And there are probably another
50% more out there who haven't been diagnosed. How is Wisconsin doing?
Not so bad now. When I first moved here,
Wisconsin was up here at the high end.
Not so much in terms of percentage but it was one of the
About 26.3% of Wisconsin adults are classified as obese. more obese states in the Union. And now we're kind of central.
Leanest state in the nation, Colorado, at 21%.
Most obese in the nation, Mississippi, at 34%.
Wisconsin has its hot spots. Milwaukee area, out here a
little bit east of us, go north,
go up to the Indian reservations have the highest percentage of
And the lowest, I think that's obesity in Wisconsin.
Sheboygan County, and Dane County. Here running about 25% of
adults. But you'll see, again, the same pattern increases in diabetes showing up, again, largely in
Menominee up here and being lowest in Dane County where there's the least obesity.
in this disparity from state to state is some of the racial disparities. What you are seeing a little bit
US, about one out of four are obese with most concentration in The white non-Hispanics in the
people of Hispanic culture, 31% are classified as obese as these states. When you go to Hispanic culture,
37%. adults. And among African Americans,
And you see this same pattern where the races concentrate, you see the highest percentages of
obesity.
And what I worry about, of course, is not only adults are
the data for children. showing up as obese but this is
of children as obese. BThose in the upper weight for, inctheir height range.74. ByIn young children that has5%
increased about twofold.
In 6- to 11-year-olds, it's increased threefold over the last 30-35 years.
And in teenagers also about threefold.
you've got about a 90% And that's a concern because if you are obese as a teenager,
probability of being obese as an adult.
about a 50% chance. Problems not only here in the US As a six-year-old, you've got
but it's a global problem. This is a colored map of the
world.
I don't have the scale on here but orange in the US is that 30%
and males. to 35% range for both females
You'll see the US is not the most obese nation in the world
That's here on in terms of females.
the Sinai Peninsula. But you'll see increases in obesity globally, Canada,
Russia, through Europe, South America it's increasing,
Australia, and it's even starting to show up at about the
7% to 10% range in China in both
It's simply the comparison females and in males. So, energy balance here seems simple.
between the number of calories that you eat every day should equal the number that you
expend, and if you're in
positive energy balance, if you're eating more than you're expending, you're going to start
gaining some weight, laying down
weight. It seems a very simple concept. What is it, though, that tips you're eatthis scale? lose some
What's causes actually globally an increase in body energy
we'll go through some of the stores, or call it obesity? I don't have the full answer but
years but here I pull a paper from 1995 looking at the obesity The long debate that's been around actually for hundreds of
years in Britain increased from about 7% to about 14%. epidemic in Britain which also, as in the US from the last 10
It about doubled during that period.
They're actually falling just a few percentage points behind the
question, is it gluttony, overeating, or sloth? Sedentary lifestyle. And Prentice and Jebb here
survey questionnaires. And they looked at two sets of
increase in the number of One, whaobesity adults. they're And what they see is pretty much And plot it against, here is the
self-reported caloric intake. But where they see what's called a flat line in terms of
a secular trend or secular similarity is as obesity is
increasing you're seeing more cars per household, more miles
driven, fewer walked and increase in television viewing.
Very sedentary behavior.
So they came to the conclusion that the problem for obesity was
food intake. our sedentary lifestyle, not our
Well, I didn't bring the data but something that's not right with their dietary reports, and
we'll come back to that, but
it's now well-known from our measurements with the doubly
expenditure that energy, and labeled water measure of energy
thus energy requirement to stay at a stable weight, increases as you gain weight.
So from that picture that you saw in the United Kingdom with
predict that intake would increase. So maybe intake has something to 10-year interval, we would
And, in fact, if you look not at do with it.
what people tell you they eat in the US, but rather how much food
calories that pass through the is sold in the US, the number of
grocery store, you see a very different picture from 1970 to 2009.
You see an increase in the
number of calories sold of about 500 calories per day per person.
You'll also notice, and we'll come back to this again a little That's a lot of calories.
bit later, where the increase is it's in flour and cereal
products, added fats and oils and caloric sweeteners. Where do you find these foods?
than fresh foods which are your fruit, dairy, meats, eggs, which Mostly processed foods rather
haven't changed much in terms of calories sold over the past 40
years.
Okay, let's look at some of the evidence now, not on caloric intake which has increased and
could account for that obesity
epidemic, but physical activity, which is what you hear a lot
Be more active, burn more calories, lose weight. about in the press.
studies that's been done in the US. This was done in about a hundred physical activity weight loss
It's what's called a randomized controlled trial. People were randomized either to individuals.
regime in which they were not asked to exercise. an exercise regime or a control
They had to come into a gym and sign in and be seen five or six days a week and during that visit, perform 400 calories of
exercise. That would be the equivalent of about two hours of a jog at about five or six miles per
hour. And they were allowed to eat an ad lib diet.
weight loss study. They were not told this was a
And what you see in the men, this is the control group in the
same weight over a period of 16 months. The men in the exercise group lilost a little bit of weight,e
about two kilograms, peaked at
about nine months and then they held that value, about a two kilo weight loss.
That's a lot less than you'd
expect for 400 calories per day of exercise. And then the women, which is
always a discouraging thing to
weight but showed no weight see, the conloss.group gained weiSo as an exercise alone at intervention, it's not very
effective for weight loss.
loss of fat mass a pound, but weight didn't change much at increase in muscle mass, an extra pound in the women and a
all. In men, very small weight
change. And what you would have expected
for that 400 calories in about 16 months, you would have
expected a loss of about 12 kilograms or about 25 pounds
Intake equals expenditure, based upon just that simple energy balance equation.
plus change in body stores. Increase expenditure, you'd have predicted a 25-pound weight
loss, and in men what you saw was maybe five. In women, no weight loss. Let's take a look at another
study.
This is one I was involved in with Amy Luke, Loyola University in Maywood, Illinois.
She did a cross-sectional and longitudinal study in two locations.
obesity rates are still less One, Ghana in Africa where the
than 10%. >> That's Nigeria, actually. >> Ah.
It's Nigeria Cameroon.
>> It is Nigeria. Thank you. The study we're doing right now
is in Ghana which is over here. That is Nigeria, thank you. And I even have that up here. And compared that with Maywood,
Illinois, where the obesity rates among the women who were
weights, I didn't bring that studied were about 35%. There were very different
the relationship between the data. There were very different percent fats, but let's look at
amount of calories that they burned in exercise. So they're activity energy
expenditure which includes
everything from getting up, walking across the room to planned exercise.
Although in Nigeria they don't
do much planned exercise. It's largely labor involved in their regular work day.
But if you look at body mass
index here versus activity energy expenditure which was
relationship. The more activity energy adjusted for their body size, no
expenditure they were no more or less obese in terms of their
BMI.
See the same picture in Maywood. It's boosted up a little bit
of 20, a healthy weight. because this starts at a BMI
This one at 15, which is underweight.
above this. Overlays here but no It's boosted up a little bit
cross-sectional relationship between the two.
And more importantly, she brought each of these subjects
schedule them back in the clinic, and saw no relationship between their activity energy lexpenditure, this time not inld
calories but in megajoules, and their weight gain over that period. In fact, the weight gains
between the two populations were
very similar, .6 kilograms per year in Nigeria,
Again, no protective effect of .5 in Maywood.
being on this upper end of physical activity against weight
Children. Here we collaborated with Mickey gain.
Stunkard in Philadelphia in what he called the infant growth
study.
This was a study in 45 infants who had their energy expenditure
water technique at three months of age, two years, four years and six years. measured by our doubly labeled
BMI, their weight over height squared, at age eight and used And then we calculated their
what's called a Z score, measured how far away it was
from the average in that age
group. What you see in terms of energy expenditure, here each point
represents one measured energy
expenditure, and it is adjusted for body size because these kids are growing.
Each time they come back, they're getting a little bit
size against their energy expenditure and figure out if they're above the line or below So we havethe line.their body
And you will notice that there
is indeed a tendency for those who measured at one time to be
usually above the line over here. For those who have low energy expenditures, they tend to stays
below the line throughout.
So there is reproducibility across this dramatic change in age and body size, but when we
look at their energy
above that average line. expenditure, these are the ones who are below the average line. These are the ones that are
If we look at that against their BMI percentile, or their BMI Z
eight, we see absolutely no relationship. So the children with a high energy expenditure are no more
likely to be at a high BMI than those with a low energy expenditure and the other way around.
No relationship.
So, the basic thought with activity energy expenditure and exercise, and this is actually
from Donnelly again who did that
nice intervention study where he added 400 calories per day in physical activity in the women,
it was actually 600 in the men, is that they increased energy expenditure but body weight didn't change much so it must
have been countered by an increase in energy intake.
did show that it went up. Reason for that, of course, is They did measure energy expenditure in a subgroup and
that the energy balance equation isn't just that simple.
If you change energy
expenditure, what happens? You get hungry because we have a
regulate our body weight. You start to burn off fat, you marvelous control system to
which feed back to your brain and say I'm hungry. If you become more sedentary, you start laying down fat, you
signal the brain to eat less. It works pretty well. Not perfect.
while simple and correct So this energy balance equation,
according to every law of physics, energy can't be created, it can't be destroyed,
so the energy balance equation
has to work. But it's not so simple that you can just increase or decrease
energy expenditure a little bit and expect to change or increase
Because we have all these feedback systems. or Our hunger and satiety a little bit and expect to change.
We have an effect of body weight. If you're overeating and gained a little bit of weight, well,
you're a bigger body so you burn
more calories. Both of these things try to keep
weight. Now, what I don't want to say, the body at about the same
on body weight if you start an well what I do want to say is that don't expect a huge effect
It's important. One, adding exercise, and this But what I don't want to say is don't do that exercise.
is Donnelly's experiment showing individual weight changes with
that added exercise.
I want you to notice there's a lot of variability. For some people adding exercise
works.
Here's a loss of about 10 pounds in one woman. And in one man down here he lost
30 pounds during that period. Now, we don't know why there's
this much variability. We don't know if it's genetic
and the differences in the
feedback system or if it's behavioral. My personal hypothesis is that
people that lost weight probably
entered that exercise saying, boy, if I'm doing all this exercise I'm going to lose some
weight and they watched their diet. Where the people up at this end said, boy, I'm doing that
exercise, I don't have to watch my diet anymore.
But that's a theory. Only a theory.
So another study which shows the
benefit of exercise, this is a study in individuals over 65
in which the subjects were years of age, a one-year study,
randomized into four different groups. A caloric restriction of about
500 to 700 calories per day,
exercise with not a caloric restriction but just a maintenance diet but they were
exercising about three times a
week for a 90 minutes, combination of aerobic exercise on the treadmill or exercise
cycle or weight training, a group that combines both the
diet with the exercise, and then a control group which we're told
don't do anything to change your
weight. And what I want to show you here is not the weight change.
The weight changes between the
fitness level as measured by VO2 diet exercise and diet groups were about the same, but what I want to show you is their
max, the maximum amount of oxygen that they can pull into
And what you see compared to the their lungs and utilize.
control group, the control group went down a little bit. They were less fit.
Exercise group, well, let's actually look at the diet group first.
went up. The diet group, their fitness
That's a weight effect because the VO2 max here is presented as
consume per pound of weight. the amount of oxygen that you
That diet group lost some weight so it was largely an artifact that this number went up.
The exercise group didn't lose
And then you'll notice the diet mand exercise showed both ans increase in fitness due to the fitness.
loss effect. exercise as well as the weight
Why is fitness important? This is a study by Steve Blair in which he looked at mortality.
How many people out of a hundred
about 12-14, I take that back, survived. If they were unfit at the beginning and remained unfit,
habits, started doing exercise about 25% of the population did not survive through 16 years. Whereas, those who changed their
So exercise is important even if and became fit had half the mortality over this 16-year follow up.
it doesn't change your weight. Let's change this a little bit, though.
We've talked about some big weight changes. 20 pounds.
about how we gain weight. Do we gain that suddenly or not? Well, let's talk a little bit
As a population we really don't. This is a redrawing of the
weight data for the US
population from 1962 through 2004. And on average, there's been an
increase among the women and
among the men of about 23 pounds over this 45-year period. That's all of three-fourths of a
pound per year on average.
Each year a pound heavier, Not much. In fact, that's been my problem through my life.
right? If you calculate how many calories lead to that
three-quarter pound gain, it's
only about 2,450 calories. It's about three Big Macs.
calories per day. A Life Saver contains six calories. So, despite this weight gain,
the body has done pretty well at
controlling energy balance, but it has a little error on the positive side.
And do remember, of course, that
going up because they're larger, all this time that these adults are gaining that 23 pounds, their energy expenditure is
walk and move across the room or they have to keep a bigger body functioning, and they have to move a bigger body when they
to the car or to shopping. So there are actually two energy
we talk about weight gain. gaps that we can talk about when
One is this little bit of positive energy gap averaged across 365 days a year for a
seven-tenths of a pound weight
gain, or seven-tenths of a kilo, little over a pound weight gain.
maintained on average in our That little gap is being
population so that we're constantly gaining weight for year to year to year.
But as we're getting larger as a
population, do remember maintenance energy has increased.
So there are two gaps, actually.
There's about a 240K cal per day gap in the amount of energy that
back to this weight but to you have to consume to not fall
maintain this higher weight, and then that little tiny gap to
year. If we're talking about moving not from a healthy weight, gain a little bit of weight each
men and women of 140 pounds but to an obese weight of almost 200 average healthy weight between
pounds, we need a little bit bigger gap each day, on average
now twice as big, 14 calories,
and the maintenance energy gap is almost 500 calories. But, again, for this slow weight
creep, we're only talking about a little bit of an error
weight a little bit each day. We fluctuate. Anyone who's gotten on the scale Now, fortunately, we don't gain
couple to three pounds from day to day depending on what you eat knows that it fluctuates a
But this was a fascinating study and how much you're fully hydrated or not.
months through the year. in which they measured actually employees at the National Institute of Health every three
During the period from mid-September to November,
Again, there's a range they gained .2 kilos on average.
out there. Some of them gained 5 pounds, 10 pounds, some of them
lost 5 pounds.
What happens between November But theand January?period from mid-November to January, they gained .4-kilos.
We've got Christmas, Hanukkah. We've got the holidays. We've got Thanksgiving.
All of these things where we're eating more frequently and where This was back before Super Bowl was in February.
And then afterward, unfortunately what didn't happen we're surrounded by even more food.
They didn't fall back. is they didn't lose this. They hung on to it.
So that this holiday weight gain accounted for about two-thirds
about a pound a year. This means, though, that here they're overeating an average about 13 calories per day not 7.
It's a little bigger number.
Well, what if we break it down even further? This is a study in which
Susan Racette measured or had people weigh themselves at home every day, week in, week out, week in, week out,
for about three months. And then she averaged that data across. So Friday morning, we'll call
that zero.
Saturday morning, after Friday night, they've gained not a lot.
Two ounces? Across Saturday, another 50 grams?
another two ounces. Now we're up to six ounces, 50 gra third of a pound.nces. AcAnd then the control systemms,
starts to regulate, starts to kick in.
Monday they lose a little bit, Tuesday they lose a little bit
more, Wednesday a little bit
more, but the problem here, and I think what the problem is with holidays, is that before you
fall back you start overeating
again because you've got another Christmas party, you've got another holiday party, you've
got another Super Bowl party
coming up. And that's my theory of what the
So, yeah, it's simply a matter problem is.
of energy balance. You have to balance your resting
of meals, activity energy expenditure, your total energy metabolic rate, thermic effect
expenditure against the calories that you eat as carbohydrates,
fat and protein.
So we say eat less and exercise more.
How's that working for you? [LAUGHTER] Simple.
Anybody find it so simple? Yes?
One question. [INAUDIBLE]
The question is some people find
And in fact, the data does say that after exercise. they actually lose their appetite. They don't eat more.
that when you exercise and warm up your core body temperature, you do get a temporary reduction
in appetite but that goes away. And then most people, maybe that
they'll have eaten a little bit more. firsOkay, yes it's a simplettle bequation, but if I ask you to,
keep track of how many calories you eat and how many calories you expend, this is typical data
These were about a thousand individuals in Germany who were asked to report how many that you'll see.
exercise they do, what calories they eat and what
activities they do during the day. And they calculated energy
expenditure, energy intake, and here the difference, energy intake minus energy expenditure.
the people down here at healthy weight are reporting that they And you'll notice, on average,
eat 2,000 calories more than they expend every day.
Well, of course, they should be gaining weight. A lot of weight.
reporting that they eat 500 to And the obese individuals are
1500 calories less than they expend per day. So, of course, their obesity
should be going away. Well, it doesn't. This is the problem of survey techniques.
People underestimate what they
eat, almost everyone, and overestimate their activity. The best way to measure your
energy balance is keep track of your weight.
Every week, week in, week out, across the year.
It's a far more sensitive tool
than trying to measure energy intake or expenditure. So that's lesson one from my
talk. But we still have the obesity problem.
What evidence do we have of what We still have this going on.
might be the problem? Well, we don't know exactly what it is but there is something
that's coming back. This is fascinating study out of
Harvard in which over a number of four-year periods they ask
people what they ate, okay the
calories were off but they could look at what foods were being reported, and they looked at a
four-year weight change.
And then they averaged this across a lot of different foods. And the foods that they found to
be problems, those associated with a weight gain of about one and a half to two pounds per
about a half a pound per year. year, or that's four years, so
Things like potato chips. They're high in fat, high in calories.
They're also snack foods. Potatoes or fries, and it's actually fries, it wasn't so
Processed meats, red meats and much other forms of potatoes.
then things that didn't have much of an affect either way, butter, sweets or desserts,
refined grains. The things that were a little protective, vegetables, nuts, whole grains containing fiber,
fruits, and another dairy food, yogurt. These, surprisingly, are all the
nutritionists, call a healthy diet. Low in processed foods, low in things that we, as
vegetables and whole grains. snack foods, high in fruits and
High in fiber. Among the beverages, sugar
associated with a small weight sweetened beverages are
Dairy, fairly neutral. gain. Sugared fruit juices, even 100% fruit juices are the same.
Zero calorie diet sodas, pretty much neutral.
[LAUGHTER] What's this?
These are the points of lights. This is a point of light for every McDonald's
in the United States. That's another thing that's changed dramatically in the last
The further distance between any 45 years.
two McDonald's in the US is only 145 miles.
within 10 minutes. If you're in a city, you're
Now, if you add to this Wendy's, just add them up, Popeye's, Kentucky Fried Chicken, all of
these fast food places means
you're minutes away from fast food, food that you can get at any time.
It tastes good so it encourages us to eat.
sizes here in the last 35 years. And, in fact, to make it worse, look what's happened to portion
They're not 850 calories. Cheeseburger, 330, in fact even the old McDonald's that I used about 500 calories.
I was in high school would have been even a little bit smaller to get for 15 cents in 1966 when
than this. Now, your cheeseburger,
double burger, Quarter Pounder, almost 600 calories.
Cup of coffee, coffee with a And you can get hamburgers that are 1500 calories if you want.
little milk and sugar used to be 45 calories.
latte, 330 calories. Now you go get your double
Bagels, bagel used to be pretty small little piece of bread, 140 calories.
Now it's a handful. 350 calories. So not only is food easily
or any fast food restaurant, but available from almost any store
what you're served is larger. Now, we can't totally blame fast food because you have a choice.
You can order a meal, Quarter Pounder with cheese,
large fries, medium shake, 1600 calories with 55 grams of
saturated fat.
Or you can order the McChicken with a side salad, southwest
two apple slices, 655 calories. This is about your caloric salad, little dressing,
requirement. This is over half your caloric
requirement.
So you do have a choice, but unfortunately many people order this one.
And in fact, a little aside, in New York City when they passed
people at McDonald's, largely young males, 20 to 35 years of the law that you had to label menus, what happened is that
wanted more for their dollar. The only place that the menu age, tended to order more and more calories because they
shops, the coffee shops. labeling showed a change in behavior were in the beverage
picture of it. There people started ordering fewer calories. So, here's the problem, or a
It's not a terrible problem. This is a picture of a week's worth of food, average food, in
a US family.
What do you see? Okay, high calorie pizza. Okay, my eyes are getting bad.
Snack foods.
Little bit of a red meat. Little bit of fruit. Processed food.
Low in fiber. Other sugar drinks up here. We do see milk. Not the ideal diet.
Not the ideal healthy diet. Compare that to China.
there. First of all, you'll notice there's about half the food
Also a family of four. They are shorter so their energy
they're smaller people. You see more fruit and requirement is smaller because
see much in the way of vegetables. You do see meats, but you don't
pre-prepared foods. You don't see much in the way of snacks.
These are snacks but there are
not a lot of them. Fresh bread.
Eggs. Meat. Again, a lot more prepared food. Some drinks.
the perfect answer. The wife here, she is overweight, possibly obese. NoAnd actually if we go back,not
no one in this picture would be classified as obese.
So it's not a yes or no simple answer, but it is a big part of
the problem.
So thank you. [APPLAUSE]