Promoting Community-based Obesity Prevention

Surgeon General’s Call to Action to Prevent & Decrease Overweight & Obesity

“Overweight and obesity may soon cause as much preventable disease and death as

cigarette smoking.

People tend to think of overweight and obesity as strictly a personal matter, but there is much

that communities can and should do to address these problems.”

US Surgeon General David Satcher, MD, PhD

Surgeon General’s Call to Action to Prevent & Decrease Overweight & Obesity

“Communities can help when it comes to health promotion and disease prevention.

When there are no safe places for children to play, or for adults to walk, jog, or ride a bike, that’s a

community responsibility.

When school lunchrooms or workplace cafeterias don’t offer healthy and appealing food choices, that

is a community responsibility.

And when we don’t require daily physical education in our schools, that is also a community

responsibility.”

Building Healthier Communities

By community, we mean a group of people who share a common place, experience, or interest. Such as those in the same town, ethnic and/or religious community.

Community health refers to the well-being of everyone in a community. It asks the question, “How healthy are all of the children of the community? Older adults? The poor?

Collaborative partnerships are alliances that are used to improve the health of a community. They encourage people to get involved and make a difference.

Who Should Be Involved?

For example, a community partnership to promote child health might include representatives from: The media The business community Area schools Civic and community organizations Youth organizations Local government Health organizations The Faith community Financial institutions

You are an important collaborative partner in

Obesity Prevention!

In a healthy community, working together for the good of the community is a constant part of everyone’s lives.

What is Obesity?

Obesity - having a very high amount of body fat in relation to lean body mass, or in adults, a Body Mass Index (BMI) of 30 or higher.

Overweight - increased body weight in relation to height, when compared to some standard (BMI over 25).

Body Mass Index (BMI) - a measure of weight in relation to height.

What is BMI?

A screening tool to identify: Overweight At risk for overweight Underweight BMI-for-Age in children correlates with health risks in adulthood

Elevated insulin levels Cardiovascular disease High blood pressure

Calculate your BMI

To calculate your body mass index (BMI)

Multiply your weight (in pounds) by 700 and divide by your height (in inches) squared (Weight x 700/height2)

A BMI of 20-25 is associated with the lowest health risk.

BMI Categories for Adults

BMI Categories for Adults At a BMI

You are considered:

Below 18.5 Underweight

18.5 to 24.9 Normal

25 to 29.9 Overweight

30 to 34.9 Mildly obese

35 to 39.9 Moderately obese

40 and above Extremely obese

Source: NIH Evidence Report on Overweight & Obesity, 1998

Overweight in Children in Texas

Overweight – Body Mass Index equal to or greater than the 95th percentile is overweight in standard reference tables based on age and gender

Norms for BMI: NCHS/CDC, http://www.cdc.gov/growthcharts/

Example: 95th Percentile Tracking Age BMI

2 yrs 19.3 4 yrs 17.8 9 yrs 21.013 yrs 25.1

http://www.cdc.gov/nccdphp/dnpa/bmi/bmi-for-age.htm

For Children, BMI Differs by Age

Boys: 2 to 20 years

BMI BMI

BMI BMI

Source: CDC Growth Chart Slides

What does the 95th percentile look like?

For a girl: 4th grade, 9 ½ years old, 48 inches (4’)

85th percentile = 64 lbs. 95th percentile = 73 lbs.

8th grade, 13 ½ years old, 60 inches (5’) 85th percentile = 118 lbs. 95th percentile = 137 lbs.

11th grade, 16 ½ years old, 66 inches (5’ 6”) 85th percentile = 154 lbs. 95th percentile = 181 lbs.

Causes of Obesity

Genetic Factors

Environmental Factors

Psychological factors

Other causes

Some facts about the Some facts about the health status of adults health status of adults and children in the U.S.and children in the U.S.

Trends in Adult Obesity in Texas

Between 1990 and 2002, the prevalence of overweight and obesity in Texas adults rose from 42.9% to 63%

In Texas, obesity is more pronounced among low-income adults, while overweight is more prevalent among high-income adults.

Adult Trends - The Facts

Obesity is highest among African Americans (42%) and Hispanics (30%)

Prevalence of obesity and overweight combined in Texas is higher among men (69%) than women (55%) and among people 45-64 years of age (70%)

Source: Mokdad AH, Marks JS, Stroup DF, and Gerberding JL. Actual Causes of death in the United States, 2000. (JAMA 2004;291:1238-45)

Actual Causes of Death, 2000

Tobacco

Poor diet/Lack of exercise

Alcohol

Infectious Agents

Pollutants/Toxins

Firearms

Sexual Behavior

Motor Vehicles Crashes

Illicit Drug Use

Percentage of all deaths

0 5 10 15 20

435,000 *

400,000

85,000

75,000

55,000

43,000

29,000

20,000

17,000

* number of deaths

Obesity Trends* Among U.S. AdultsBRFSS, 1995

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

Obesity Trends* Among U.S. AdultsBRFSS, 1996

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

Obesity Trends* Among U.S. AdultsBRFSS, 1997

No Data <10% 10%–14% 15%–19% ≥20

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

Obesity Trends* Among U.S. AdultsBRFSS, 1998

No Data <10% 10%–14% 15%–19% ≥20

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

Obesity Trends* Among U.S. AdultsBRFSS, 1999

No Data <10% 10%–14% 15%–19% ≥20

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

Obesity Trends* Among U.S. AdultsBRFSS, 2000

No Data <10% 10%–14% 15%–19% ≥20

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

Obesity Trends* Among U.S. AdultsBRFSS, 2001

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

Source: Behavioral Risk Factor Surveillance System, CDC

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

Obesity Trends* Among U.S. AdultsBRFSS, 2002

School-aged Children Trends

Nationally the prevalence of overweight and obesity has doubled in the last 20 years and is highest among minorities and males.

SPAN study indicates that the prevalence of child and adolescent overweight may be increasing at a rate similar to that of the adult population!

Prevalence of Overweight in Texas School Children

Combined male and female findings by grade: 4th grade – 22.4% 8th grade – 19.2% 11th grade – 15.5%

TDH Innovation Grant, University of Texas Health Science Center – School of Public Health – Houston

Prevalence of Overweight in Texas School Children

Overweight prevalence highest among: Hispanic boys 29.5%-32.6% 4th grade Hispanic girls 26.7% 4th grade African American girls 30.8% 8th grade African American girls 23.1%

Overweight prevalence lowest among: 11th grade White/other girls 5.5%

TDH Innovation Grant, University of Texas Health Science Center – School of Public Health – Houston

Map of Public Health Regions in Texas

11th Grade Prevalence of Overweight* by Public Health Region in Texas, 2000-2002

*Overweight is > 95th Percentile for BMI by Age/Sex

8th Grade Prevalence of Overweight* by Public Health Region in Texas, 2000-2002

*Overweight is > 95th Percentile for BMI by Age/Sex

4th Grade Prevalence of Overweight* by Public Health Region in Texas, 2000-2002

*Overweight is > 95th Percentile for BMI by Age/Sex

The Harsh Reality One Texas school-aged child out of three is

overweight or obese. CDC projected that the lifetime risk of developing

diabetes for children born in 2000 was more than 30% for males and 40% for females.

A child who is overweight at age 12 has a 75% chance of being overweight as an adult.

Two out of three Texas adults are overweight or obese.

In 2001, one out of every 200 Texans went to the hospital because of a problem linked to being overweight or obese.

Increased Cost Burden

$117 billion spent in 2001 according to Surgeon General report

A significant portion of the increased costs of obesity are passed on to the American public adding an average of $732 to the mean yearly medical bills of all Americans.

The Cost of Adult Overweight & Obesity in Texas

Estimated $10.4 billion in 2001 Includes $4.2 billion for health care An additional $6.2 billion impact from lost

productivity due to illness, disability, and premature death.

Total cost estimates range in value from $8.8 billion to $14.2 billion, depending on the underlying assumptions.

Texas Dept. of Health - Preliminary Analysis, Jan. 2004

Mortality Rate Associated with Obesity

Obese individuals have a 50 to 100% increased risk of death from all causes, compared with normal-weight individuals.

Most of the increased risk is due to cardiovascular causes.

Health Consequences of Obesity for Children

Depression/low self-esteem Asthma High blood pressure Type 2 diabetes Sleep apnea Progression to adult obesity Other disorders (i.e. PCOS, fatty liver)

Most Logical Approach is PREVENTION

Health Benefits of Obesity Prevention for the General Population

Reduced development of chronic diseases

Improved nutrition reducing gastro-intestinal problems and osteoporosis as well as CVD, diabetes and cancer

Improved fitness

Improved academic performance

Best prevention approach is:

TARGET CHILDREN and THEIR FAMILIES

Four Goals of the Strategic Plan for the Prevention of Obesity in Texas

Build awareness of the problem

Mobilize families, schools, & communities

Advocate for a supportive environment

Monitor progress

Strategic Plan for the Prevention of Obesity in Texas is intended as a

SPRINGBOARD for ACTION

Thought for the Day

If an answer to this obesity epidemic is not found soon, for the first time in at least a century, the present generation of children will not live

as long as their parents.