Fat Busters

All across the University, scholars are attacking America's epidemic of obesity.

By Rich Broderick

Let’s face it: America is fat.

Sixteen percent of American children—and an astonishing 10 percent of kids between 2 and 5—are overweight. Since 1980, the number of overweight children has doubled; the number of overweight adolescents has tripled.

What’s more, these overweight children often become overweight teens, who have a 70 percent chance of growing up to be overweight adults. Small wonder that some two-thirds of all adults 20 or older are overweight, nearly half of whom meet the Body Mass Index (BMI) standard for obesity. Today, one out of every 50 adults in this country is 100 or more pounds overweight.

The percentage of overweight Americans began rising after World War II, but the number has surged since the 1980s. Though there are no definitive answers as to why this is, researchers do point to one likely suspect.

“First off, the consensus among professionals is that what has happened is not the result of an infectious disease or some radical change in our genetic makeup,” says Robert Jeffery, one of the directors of the AHC’s Obesity Prevention Center, a multidisciplinary research and clinical center created in 2004 as part of a University Presidential Initiative. “To the extent that there is a smoking gun, it is in our diet. It’s true that we lead increasingly sedentary lifestyles, but not enough to explain the increase in obesity,” he says.

With the epidemic of obesity has come a host of increased health risks—including, but not limited to, type 2 diabetes, cardiovascular disease and stroke, and liver disease. In response, the University is devoting energy and resources—within the AHC and beyond—to find ways to combat the problem. Jeffery himself is involved in no fewer than 10 obesityrelated research and clinical projects. Two of the biggest are TREC (Transdisciplinary Research on Energetics and Cancer), a multi-institution, five-year project backed by $54 million in funding from the National Institutes of Health (NIH), and the Look AHEAD project, in which 5,000 obese individuals with type 2 diabetes will be tracked for 12 years to see if weight loss can reduce the risk of heart attack and stroke.

Jeffery, of course, is not alone. The following is just a small sample of University researchers and their projects:

• Sarah Jane Schwarzenberg, a pediatrician, founded the University of Minnesota Pediatric Weight Management Clinic in 2003 as a direct response to childhood obesity and the appearance of heretofore “adult” problems—including type 2 diabetes, obstructive sleep apnea, fatty liver disease and even cirrhosis of the liver—among younger and younger children. One child she has treated was a mere 18 months old.

“We are having to manage these diseases in children, and there is every reason to believe that these conditions will shorten life expectancy,” she warns. Unless checked, a child's obesity, she says, “will create a great deal of misery for these children throughout the course of their lives.”

The Weight Management Clinic is also involved in teaching and research. At the moment, Schwarzenberg, whose primary interest is co-morbid conditions associated with childhood obesity, hopes to receive funding for a study of urinary incontinence among overweight girls. ”It’s a source of shame for these children, it creates social problems, and—worst of all—it tends to prevent them from getting exercise,” she says.

• Mark Pereira, a professor in the School of Public Health’s Division of Epidemiology and Community Health, has just completed a pilot project with a small group of overweight or obese young adults in the Twin Cities who ate regularly at fast-food outlets, to see what effect dietary advice and other direct intervention might have in influencing eating habits, weight loss, and insulin resistance—a precursor to type 2 diabetes. He now wants to follow up this pilot program with a year-long randomized study of 360 overweight adults.

This new project follows earlier research conducted by Pereira and investigators at several other institutions, who studied the relationship between fast food, weight gain, and the development of insulin resistance. The study, which followed over 3,000 healthy Americans over a 15 years, was published two years ago in The Lancet; it confirmed what many health experts had suspected for some time: Fast food is bad for your health.

“I’m pretty convinced that it is multifactorial,” says Pereira. “Fast foods feature high caloric density, lots of saturated fat and trans-fatty acids, sugar, and sodium. They also feature high intakes of starch and low intake of fiber. In other words, they are overwhelmingly obesity-encouraging diets that drive risk factors for cardiovascular disease and diabetes.”

• Marti Kubik, a School of Nursing researcher, has just completed an innovative pilot project called Team COOL (Controlling Obesity and Overweight for Life), which tested whether direct intervention can help high-school students make more healthful food choices and increase their physical activity.

For the pilot program of the NIHfunded study, Kubik and her team chose several alternative high schools in the Twin Cities. Many students attending alternative schools come from lowerincome families. “Youth from lowerincome homes are disproportionately at risk for obesity and often have limited access to healthy food choices and physical activity opportunities,” Kubik explains.

Over a six-month period, the University team worked with students in the classroom making healthy snacks and providing new activity choices in PE, as well as with school staff to offer healthier snacks and drinks in vending machines and school stores. They also worked with youth advisory councils set up by the students themselves, offering the councils not only advice and materials but small grants of $1,500 to $2,000 to spend on projects to promote good health habits. “The advisory councils reviewed the grant proposals and made final decisions on the grants,” she says. “So the experience was very empowering for the students.” One of the project's biggest hits was the Fruit Smoothie Days, organized and staffed by advisory council members and using yogurt donated by Kemps.

“A lot of students had never tried smoothies before and really loved them,” Kubik says. “Plus, the students were making them—it made a big difference to the success that everybody was participating.” She is now seeking funding to support a full program version of Team COOL to work with 16 to 20 high schools.

• James Pankow, an epidemiologist in the School of Public Health, is studying adiponectin, a protein hormone produced by fat cells, to determine what role it, and other proteins or molecules created by fat cells, might play in the development of type 2 diabetes.

“For a long time we thought that adipose tissue is just a storage space for excess energy,” he says. “Now we are discovering that it is metabolically active.”

For example, researchers now think that fatty tissue may play a role in promoting inflammation, which in turn can place stress on the immune system—and set the stage for type 2 diabetes. “We think that being overweight or obese is a pro-inflammatory state,” Pankow says. “We know that chronic inflammation is higher in obese people. Some of the molecules produced by fat cells may act as mediators, while others might have a causative role in the development of diabetes.”

• Project EAT (Eating Among Teens) began in 1999 with data about diet, physical activity, and weight gathered from nearly 5,000 adolescents attending 31 middle and high schools in Minnesota. The purpose of this massive project is to determine which factors influence teenage eating and activity habits, to better fashion intervention programs that will help American teens develop more healthful behaviors. In particular, Project EAT’s principal investigator, Dianne Neumark-Sztainer, a School of Public Health researcher, is interested in the “intersection between body image and obesity.”

“Our data indicate that teens who diet, and particularly those who use unhealthy weight control behaviors, place themselves at risk for both obesity and eating disorders over time. Parents can help their children avoid both eating disorders and obesity by talking less about weight and doing more to ensure their home environments facilitate healthy eating and exercise,” observes Neumark-Sztainer, who has also published an advice book for parents called “I’m, Like, SO Fat!”: Helping Your Teen Make Healthy Choices about Eating and Exercise in a Weight-Obsessed World.”

It is still too early into the obesity epidemic to know precisely what the long-term effects will be for the nation’s overall health. Some experts project that obesity, and the complications that go along with it, may soon rank first among causes of preventable death in the United States. Others go even further, declaring that if the epidemic isn't checked, average life expectancy in America will actually decline for the first time in the nation’s history. But even if the latter doesn't prove to be the case, there is consensus that the problem is serious—and getting worse each year.

“The long-term consequences for this country’s health are not going to be positive,” Jeffery declares. “It’s hard to predict how negative it is going to be. I tend to take a conservative view, but even so, we can be sure that type 2 diabetes—which is directly linked to BMI—will continue to rise along with other health problems.”