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Prevalence of Obesity: A Public Health Problem Poorly Understood

1 USDA/ARS Children's Nutrition Research Center at Baylor College of Medicine, Department of Pediatrics, 1100 Bates Avenue, Houston, Texas 77030, USA;
2 Louisiana State University Agricultural Center, 261 Knapp Hall, Baton Rouge, Louisiana 70803, USA

Special Issues: Dietary patterns and health: a cardiovascular disease perspective

This review article discusses the Dietary Guidelines for Americans (DGA) in support of a total diet approach to achieving diet and health goals, especially as they relate to the obesity epidemic. However, some scientists and organizations have identified one food, food group, or nutrient as the cause of the obesity epidemic and recommend that simply reducing that food/food group/nutrient will solve the problem. This is simplistic and unlikely to be effective in long term management of the obesity problem. This article also acknowledges discrepancies in the literature and the lack of consensus opinions from systematic reviews. Failure to consider the evidence as a whole can lead to inaccurate reports which may, in turn, adversely influence clinical practice, public policy, and future research. This article also considers where the line should be drawn between individual choice and responsibility and public regulation. Using sugar sweetened beverages as an example, the article considers the lack of a consistent association between added sugars and weight in the literature and calls for policy recommendations that are based on science and emphasizes the need for evidence-based policies rather than policy-based evidence.
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1. Flegal KM, Carroll MD, Ogden CL, et al. (2010) Prevalence and trends in obesity among US adults, 1999-2008. JAMA 303(3): 235-241.

2. Ogden CL, Carroll MD, Curtin LR, et al. (2010) Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA 303(3): 242-249.

3. Flegal KM, Carroll MD, Kit BK, et al. (2012) Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 307(5): 491-497.

4. Ogden CL, Carroll MD, Kit BK, et al. (2012) Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA 307(5): 483-490.

5. Mei Z, Scanlon KS, Grummer-Strawn LM, et al. (1998) Increasing prevalence of overweight among US low-income preschool children: the Centers for Disease Control and Prevention pediatric nutrition surveillance, 1983 to 1995. Pediatr 101(1): E12.

6. Mokdad AH, Serdula MK, Dietz WH, et al. (2000) The continuing epidemic of obesity in the United States. JAMA 284(13): 1650-1651.

7. Webber LS, Cresanta JL, Croft JB, et al. (1986) Transitions of cardiovascular risk from adolescence to young adulthood—the Bogalusa Heart Study: II. Alterations in anthropometric blood pressure and serum lipoprotein variables. J Chron Dis 39(2): 91-103.

8. Serdula MK, Ivery D, Coates RJ, et al. (1993) Do obese children become obese adults? A review of the literature. Prev Med 22(2): 167-177.

9. Guo SS, Roche AF, Chumlea WC, et al. (1994) The predictive value of childhood body mass index values for overweight at age 35 y. Am J Clin Nutr 59(4): 810-819.

10. Calle EE, Rodriguez C, Walker-Thurmond K, et al. (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U. S. adults. N Engl J Med 348(17): 1625-1638.

11. Shike M. (1996) Body weight and colon cancer. Am J Clin Nutr 63(3 Suppl): 442S-444S.

12. Murphy TK, Calle EE, Rodriguez C, et al. (2000) Body mass index and colon cancer mortality in a large prospective study. Am J Epidemiol 152(9): 847-854.

13. Bungum T, Satterwhite M, Jackson AW, et al. (2003) The relationship of body mass index, medical costs, and job absenteeism. Am J Health Behav 27(4): 456-462.

14. Fontaine KR, Redden DT, Wang C, et al. (2003) Years of life lost due to obesity. JAMA 289(2):187-193.

15. Ford ES, Moriarty DG, Zack MM, et al. (2001) Self-reported body mass index and health-related quality of life: findings from the Behavioral Risk Factor Surveillance System. Obes Res 9(1):21-31.

16. Sturm R, Ringel JS, Andreyeva T. (2004) Increasing obesity rates and disability trends. Health Aff (Millwood) 23(2): 199-205.

17. Burton WN, Chen CY, Schultz AB, et al. (1999) The costs of body mass index levels in an employed population. Stat Bull Metrop Insur Co. 80(3): 8-14.

18. Cawley J, Meyerhoefer C. (2012) The medical care cost of obesity: an instrumental variables approach. J Health Econ 31(1): 219-230.

19. Wojcicki JM, Heyman MB. (2012) Reducing childhood obesity by eliminating 100% fruit juice. Am J Public Health 102(9): 1630-1633.

20. Santos FL, Esteves SS, da Costa Pereira A, et al. (2012) Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obes Rev 13(11): 1048-1066.

21. Wycherley TP, Moran LJ, Clifton PM, et al. (2012) Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials. Am J Clin Nutr 96(6): 1281-1298.

25. Lustig R. Fat Chance. (2012) Beating the odds against sugar, processed food, obesity, and disease. New York: Hudson Street Press.

26. Medical College of Wisconsin. Elimination of Juice/Empty Calories. (2013) Available from: http://www. mcw. edu/NDTN/Overweight/DietInterventions/EliminationofJuiceEmptyCalories. ht m. (Accessed on April 26,

27. O'Neil C, Nicklas T. (2008) A Review of the Relationship between 100% Fruit Juice Consumption and Weight in Children and Adolescents. Am J Lifestyle Med 2(4): 315-354.

28. Dharmasena S, Capps O, Jr. (2012) Intended and unintended consequences of a proposed national tax on sugar-sweetened beverages to combat the U. S. obesity problem. Health economics 21(6): 669-694.

29. Fletcher JM, Frisvold DE, Tefft N. (2011) Are soft drink taxes an effective mechanism for reducing obesity? J Policy Anal Manage 30(3): 655-662.

33. Bray GA. (2013) Energy and fructose from beverages sweetened with sugar or high-fructose corn syrup pose a health risk for some people. Adv Nutr 4(2): 220-225.

34. Lustig R. (2013) Fructose: It's "Alcohol without the Buzz". Adv Nutr 4(2): 226-235.

35. Rippe J, Angelopoulos T. (2013) Sucrose, high-fructose corn syrup, and fructose, their metabolism and potential health effects: what do we really know? Adv Nutr 4(2): 236-245.

36. White J. (2013) Challenging the fructose hypothesis: New perspectives on fructose consumption and metabolism. Adv Nutr 4(2): 246-256.

37. Klurfeld D. (2013) What do government agencies consider in the debate over added sugars? Adv Nutr 4(2): 257-261.

38. Gillespie D. (2008) Sweet poison: Why sugar is making us fat. Melbourne: Viking Australia.

39. Max Rubner——1854-1932. (1965) Energy physiologist. JAMA 194(1): 86-87.

40. von Noorden C. (2013) Clinical Treatises on the Pathology and Therapy of Disorders (Vol. 1). Charleston: Nabu Press.

41. Sievenpiper J, de Souza R, Mirrahimi A, et al. (2012) Effect of fructose on body weight in controlled feeding trials: a systematic review and meta-analysis. Ann Intern Med 156(4):291-304.

42. Ha V, Sievenpiper JL, de Souza RJ, et al. (2012) Effect of fructose on blood pressure: a systematic review and meta-analysis of controlled feeding trials. Hypertension 59(4): 787-795.

43. Sievenpiper JL, Carleton AJ, Chatha S, et al. (2009) Heterogeneous effects of fructose on blood lipids in individuals with type 2 diabetes: systematic review and meta-analysis of experimental trials in humans. Diabetes Care 32(10): 1930-1937.

44. Cozma AI, Sievenpiper JL, de Souza RJ, et al. (2012) Effect of fructose on glycemic control in diabetes: a systematic review and meta-analysis of controlled feeding trials. Diabetes Care 35(7):1611-1620.

45. Sievenpiper JL, Chiavaroli L, de Souza RJ, et al. (2012) 'Catalytic' doses of fructose may benefit glycaemic control without harming cardiometabolic risk factors: a small meta-analysis of randomised controlled feeding trials. Br J Nutr 108(3): 418-423.

49. Krebs-Smith SM, Guenther PM, Subar AF, et al. (2010) Americans do not meet federal dietary recommendations. J Nutr 140(10): 1832-1838.

50. Freeland-Graves J, Nitzke S. (2013) Position of the Academy of Nutrition and Dietetics: Total diet approach to healthy eating. J Acad Nutr Diet 113(2): 307-317.

53. Nitzke S, Freeland-Graves J. (2007) Position of the American Dietetic Association: Total diet approach to communicating food and nutrition information. J Am Diet Assoc 107: 7.

54. Briefel RR, Wilson A, Cabili C, et al. (2013) Reducing calories and added sugars by improving children's beverage choices. J Acad Nutr Diet 113(2): 269-275.

55. Barclay AW, Brand-Miller J. (2011) The Australian paradox: a substantial decline in sugars intake over the same timeframe that overweight and obesity have increased. Nutrients 3(4):491-504.

56. Welch J, Sharma A, Grellinger L, et al. (2011) Consumption of added sugars is decreasing in the United States. Am J Clin Nutr 94(3): 726-734.

57. Sylvetsky A, Welsh J, Brown R, et al. (2012) Low-calorie sweetener consumption is increasing in the United States. Am J Clin Nutr 96: 640-646.    

59. Ford E, Dietz W. (2013) Trends in energy intake among adults in the United States: findings from NHANES. Am J Clin Nutr 97(4): 848-853.

60. Malik VS, Schulze MB, Hu FB. (2006) Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 84(2): 274-288.

61. Vartanian LR, Schwartz MB, Brownell KD. (2007) Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health 97(4): 667-675.

62. Olsen NJ, Heitmann BL. (2009) Intake of calorically sweetened beverages and obesity. Obes Rev10(1): 68-75.

63. Wolff E, Dansinger ML. (2008) Soft drinks and weight gain: how strong is the link? Medscape J Med 10(8): 189.

64. Malik VS, Popkin BM, Bray GA, et al. (2010) Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation 121(11): 1356-1364.

65. van Dam R, Seidell J. (2007) Carbohydrate intake and obesity. Europ J Clin Nutr 61(Suppl 1):S75-S99.

66. Woodward-Lopez G, Kao J, Ritchie L. (2010) To what extent have sweetened beverages contributed to the obesity epidemic? Public Health Nutr 14(3): 499-509.

67. Te Morenga l, Mallard S, Mann J. (2012) Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. Br Med J 346: e7492.    

68. Pereira MA, Jacobs DR, Jr. (2008) Sugar-sweetened beverages, weight gain and nutritional epidemiological study design. Br J Nutr 99(6): 1169-1170.

69. Bachman CM, Baranowski T, Nicklas TA. (2006) Is there an association between sweetened beverages and adiposity? Nutr Rev 64(4): 153-174.

70. Gibson S. (2008) Sugar-sweetened soft drinks and obesity: a systematic review of the evidence from observational studies and interventions. Nutr Res Rev 21(2): 134-147.

71. Mattes RD, Shikany JM, Kaiser KA, et al. (2011) Nutritively sweetened beverage consumption and body weight: a systematic review and meta-analysis of randomized experiments. Obes Rev12(5): 346-365.

72. Libuda L, Kersting M. (2006) Soft drinks and body weight development in childhood: is there a relationship? Curr Opin Clin Nutr Metab Care 12(6): 596-600.

73. Van Baak M, Astrup A. (2009) Consumption of sugars and body weight. Obes Rev 10(Suppl 1):9-23.

74. Monasta L, Batty G, Cattaneo A, et al. (2010) Early-life determinanats of overweight and obesity: a review of systematic reviews. Obes Rev 11: 695-708.    

75. Forshee RA, Anderson PA, Storey ML. (2008) Sugar-sweetened beverages and body mass index in children and adolescents: a meta-analysis. Am J Clin Nutr 87(6): 1662-1671.

76. Ruxton CH, Gardner EJ, McNulty HM. (2010) Is sugar consumption detrimental to health? A review of the evidence 1995-2006.

77. Janssen I, Katmarzyk PT, Boyce WF, et al. (2005) Health behaviour in school-aged children obesity working group: Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns. Obes Rev6(2): 123-132.

78. Weed DL, Althuis MD, Mink PJ. (2011) Quality of reviews on sugar-sweetened beverages and health outcomes: a systematic review. Am J Clin Nutr 94(5): 1340-1347.

79. Cope MB, Allison DB. (2010) White hat bias: examples of its presence in obesity research and a call for renewed commitment to faithfulness in research reporting. Int J Obes (Lond) 34(1):84-88.

80. James J, Thomas P, Cavan D, et al. (2004) Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial. Br Med J 328(7450):1237.

81. Ebbeling CB, Feldman HA, Osganian SK, et al. (2006) Effects of decreasing sugar-sweetened beverage consumption on body weight in adolescents: a randomized, controlled pilot study. Pediatrics 117(3): 673-680.

82. Nicklas T, O'Neil C, Liu Y. (2011) Intake of added sugars is not associated with weight measures in children 6-18 years of age: NHANES 2003-2006. Nutr Res 31(5): 338-346.

83. Storey ML, Forshee RA, Weaver AR, et al. (2003) Demographic and lifestyle factors associated with body mass index among children and adolescents. Int J Food Sci Nutr 54(6): 491-503.

84. Marriott BP, Olsho L, Hadden L, et al. (2010) Intake of added sugars and selected nutrients in the United States, National Health and Nutrition Examination Survey (NHANES) 2003-2006. Crit Rev Food Sci Nutr 50(3): 228-258.

85. Fisher JO, Mitchell DC, Smiciklas-Wright H, et al. (2001) Maternal milk consumption predicts the tradeoff between milk and soft drinks in young girls' diets. J Nutr 131(2): 246-250.

86. Harnack L, Stang J, Story M. (1999) Soft drink consumption among US children and adolescents: nutritional consequences. J Am Diet Assoc 99(4): 436-441.

87. Anderson GH, Luhovyy B, Akhavan T, et al. (2011) Milk proteins in the regulation of body weight, satiety, food intake and glycemia. Nestle Nutr Workshop Ser Pediatr Program 67:147-159.

88. Barba G, Russo P. (2006) Dairy foods, dietary calcium and obesity: a short review of the evidence. Nutr Metab Cardiovasc Dis 16(6): 445-451.

89. Deddo L. (2007) Connecting the dots. Aeon Publishing Inc. Available from: http://www. amazon. com/Connecting-The-Dots-Leonard-Deddo/dp/1595266941/ref=sr_1_1?ie= UTF8&qid=1364933001&sr=8-1&keywords=Connecting+the+Dots+leonard+deddo. (Accessed on April 2, 2013).

90. Darmon N, Drewnowski A. (2008) Does social class predict diet quality? Am J Clin Nutr 87(5):1107-1117.

91. Monsivais P, Drewnowski A. (2009) Lower-energy-density diets are associated with higher monetary costs per kilocalorie and are consumed by women of higher socioeconomic status. J Am Diet Assoc 109(5): 814-822.

92. Brownell KD, Farley T, Willett WC, et al. (2009) The public health and economic benefits of taxing sugar-sweetened beverages. N Engl J Med 361(16): 1599-1605.

93. Brownell KD, Frieden TR. (2009) Ounces of prevention—the public policy case for taxes on sugared beverages. N Engl J Med 360(18): 1805-1808.

94. Fletcher J, Frisvold D, Tefft N. (2010) Can soft drink taxes reduce population weight? Contemp Econ Policy 28(1): 23-35.

96. Fletcher JM, Frisvold DE, Tefft N. (2010) The effects of soft drink taxes on child and adolescent consumption and weight outcomes. J Public Econ 94(11-12): 967-974.

97. Sturm R, Powell LM, Chriqui JF, et al. Deddo L. (2010) Soda Taxes, Soft Drink Consumption, And Children's Body Mass Index. Health Affairs 29(5): 1052-1058.

98. Ogden CL, Kit BK, Carroll MD, et al. (2011) Consumption of sugar drinks in the United States, 2005-2008. NCHS Data Brief 71: 1-8.

99. Cohen DA, Sturm R, Scott M, et al. Deddo L. (2010) Not Enough Fruit and Vegetables or Too Many Cookies, Candies, Salty Snacks, and Soft Drinks? Public Health Rep 125: 88-95.

100. Reedy J, Krebs-Smith SM. Deddo L. (2010) Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States. J Am Diet Assoc 110(10):1477-1484.

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