Adults and obesity: a growing problem with solutions

Jeffrey Levi, PhD

Executive Director, TFAH

Grantmakers in Health Webinar

September 14, 2009

F as in Fat 2009

Key Findings: F as in Fat, 2009 Adult obesity continue to rise in 23 states with no states

experiencing a decrease. Four states have rates above 30 percent -- Mississippi,

Alabama, West Virginia, and Tennessee. More than 25 percent of adults are obese in 32 states, an

increase from 28 states last year. More than 20 percent of adults are obese in every state except

Colorado. Type 2 diabetes rates increased in 19 states in the past year.

In seven states, more than 10 percent of adults now have Type 2 diabetes.

Seven of the top 10 states with the highest obesity rates are also in the top 10 for highest poverty rates.

Key Findings: Heaviest StatesRank State Percentage of Adult Obesity

(2006-2008)

1 Mississippi 32.5% (+/-0.9)

2 Alabama 31.2% (+/-1.1)

3 West Virginia 31.1% (+/-1.0)

4 Tennessee 30.2% (+/-1.3)

5 South Carolina 29.7% (+/-0.8)

Key Findings: Least Heavy StatesRank State Percentage of Adult Obesity

(2006-2008)

51 Colorado 18.9% (+/- 0.6)

50 Massachusetts 21.2% (+/- 0.6)

49 Connecticut 21.3% (+/- 0.8)

48 Rhode Island 21.7% (+/- 0.9)

47 Hawaii 21.8% (+/- 0.9)

States with the Highest Rates of Physical InactivityRank State Percentage of Adult Physical

Inactivity (2006-2008)Obesity Ranking

1 Mississippi 31.8% (+/-0.9) 1

2 Kentucky 30.4% (+/-1.0) 7

3 (tie) Louisiana 30.3% (+/-0.9) 8

3 (tie) Oklahoma 30.3% (+/-0.8) 6

5 Tennessee 29.8% (+/-1.2) 4

States with the Lowest Rates of Physical Inactivity

Rank State Percentage of Adult Physical Inactivity (2006-2008)

Obesity Ranking

51 Minnesota 16.3% (+/-0.9) 31

50 Oregon 17.6% (+/-0.8) 28

48 (tie) Colorado 17.9% (+/-0.6) 51

48 (tie) Washington 18.1% (+/-0.4) 28

47 Vermont 18.5% (+/-0.7) 46

Disparities in U.S. Obesity Rates, 2006--2008 Overall, 25.6% of U.S. adults were obese; however, there

were significant differences among racial/ethnic groups. African Americans -- 35.7% Hispanics -- 28.7% Whites -- 23.7%

This pattern was consistent across most U.S. states. However, state obesity rates varied substantially. Obesity rates for: African Americans ranged from 23.0% in New Hampshire to 45.1%

in Maine Hispanics ranged from 21.0% in Maryland to 36.7% in Tennessee Whites ranged from 9.0% in the District of Columbia to 30.2% in

West Virginia

Source: CDC. “Differences in Prevalence of Obesity Among Black, White, and Hispanic Adults --- United States, 2006—2008.” MMWR 58, no. 27 (2009): 740-744.

Health Impact of Obesity, Physical Inactivity, and Poor Nutrition More than 80 percent of people with type 2 diabetes are overweight.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) found that a seven percent weight loss together with moderate levels of physical activity (walking 30 minutes a day, five days a week) decreased the number of new type 2 diabetes cases by 58 percent among people at-risk for diabetes.

People who are overweight are more likely to suffer from high blood pressure, high levels of blood fats, and LDL, or bad cholesterol, which are all risk factors for heart disease and stroke. Physically inactive people are twice as likely to develop coronary heart

disease as regularly active people Approximately 20 percent of cancer in women and 15 percent of cancer

in men is attributable to obesity Among individuals who have received a doctor’s diagnosis of arthritis

68.8 percent are overweight or obese

Obesity and Baby Boomers Alabama has the highest rate of obese 55- to 64-year-olds at

38.7%; Colorado the lowest at 21.8% As the Baby Boomers age, the percentage of obese

individuals age 65 and older could increase significantly, from 5.2% in New York to 16.3% in Alabama

Health care costs for obese seniors (65+) are an additional $1,400 to $6,100 per year compared to non-obese individuals

Medicare spending is projected to triple from 3% of U.S. GDP in 2007 to 10% by 2057 – much of the growth is driven by treatment for obesity-related conditions

It can’t all be fixed in the doctor’s office

Health BehaviorsHealth Behaviors50%50%

EnvironmentEnvironment20%20%

Access to Care 10%Access to Care 10%

GeneticsGenetics20%20%

Prevention 4%Prevention 4%

Medical ServicesMedical Services96%96%

Factors InfluencingHealth

National Health Expenditures

SOURCE:SOURCE: Blue Sky Initiative, University of California at San Francisco, Institute of the Future, 2000Blue Sky Initiative, University of California at San Francisco, Institute of the Future, 2000

Why community prevention? Clinical interventions – one person at a time

Coverage of medical treatment and counseling is critical “Prescriptions” for obesity require supportive community

environment – whether improved nutrition or increased physical activity

Create the social and structural environment that makes healthy choices the easy choices

Community interventions – an entire population Addresses the needs of those already obese and those at risk – both

“treatment” and “prevention” Evidence of success (and cost savings) from some population level

interventions (tobacco control, helmet laws, sanitation) We can change norms and behaviors and see positive health

outcomes

What is community prevention?

Interventions that promote healthy environments and behaviors – making it easier for people to make healthy choices, such as: Changing community norms and empowering communities

Coalition and social network building Social marketing campaigns

Changing the physical and social environments Organizational practices and governmental policies Facilities and programs Walkability – lighting, sidewalks, signs; Access to healthy foods

Increasing individual knowledge and skills

What is a successful program? Multi-faceted – no magic bullet to preventing

or reversing obesity Targeted at the needs of particular

communities – geographic and racial/ethnic REACH, Healthy Communities Program

(formerly the Steps Program), Pioneering Healthier Communities, Shape Up Somerville, HEAC

Path to success – kids or adults? Singular focus on kids can be perceived

(incorrectly) as writing off adults. Changing norms requires reaching both kids

and adults – they influence each other in different ways Increasing evidence that weight of parents affects

weight of kids Impact of kids on changing behavior of their

parents

There is an evidence base….

NYAM, A Compendium of Proven Community-Based Prevention Programs

NACCD, Compendium of Successful Community Based Interventions

Healthy Eating Active Living Convergence Partnership, Promising Strategies

REACH, Steps

Small changes make big differences STOP Obesity Alliance recommends a sustained

weight loss of 5-10% as a measure of success and can achieve major health improvements Similar data for increased fitness (physical activity) with

or without weight loss Important message for policy makers AND for

communities Translates into real declines in associated diseases

Delaying costs or “compressing morbidity”?

Prevention for a Healthier America: Financial Return on Investment?

INVESTMENT: $10 per person per year

HEATH CARE COST NET SAVINGS:

$16 Billion annually

within 5 years

RETURN ON INVESTMENT

(ROI):

$5.60 for every $1

With a Strategic Investment in Proven Community-Based Prevention Programs to Increase Physical Activity and Good Nutrition and

Prevent Smoking and Other Tobacco Use

If it’s all local – where do the Feds come in? Part of national strategy to improve health Can change norms in state and local government by

investing in these programs Bending the cost curve

Senior health care cost: Costs among obese 36.8% to 88% higher ($1486-$6192 per

person) Those 55-64 are 7.6%-16.3% more obese than current

population over 65 (range is by state)

Worker productivity

Policy implications: A natural experiment $650 million in stimulus bill to “carry out evidence-

based clinical and community-based prevention and wellness strategies…that deliver specific, measurable health outcomes that address chronic disease rates.”

“a historic commitment to wellness initiatives will keep millions of Americans from setting foot in the doctor's office in the first place -- because these are preventable diseases and we're going to invest in prevention.” – President Barack Obama, Feb. 17, 2009

Policy implications: Health reform Senate HELP bill: Community

Transformation Grants Senate Finance bill: Incentives for Healthy

Lifestyles House bill: Community-Based Prevention and

Wellness Services grants Opposition CBO issues

Convergence Partnership Statement “our work has demonstrated the important health impacts that

community prevention efforts can provide. These examples also highlight the tremendous benefit that modest investments in underserved communities can yield in improving health outcomes. Many initiatives have included a rigorous evaluation and, in some cases, resulted in articles in peer-reviewed journals to help the field build from lessons learned. In short, this is a strong platform for the nation to build on, and with additional resources, it could bring considerable improvements in health for all Americans. It is time to scale up these efforts by including robust financial support for community prevention in any health systems reform.”

Links www.healthyamericans.org

State by state data Prevention for a Healthier America F as in Fat

www.healthyamericans.org/health-reform Updates on legislation Compendia and success stories