Opportunities for Government and Industry to Address the Obesity Epidemic

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Opportunities for Government and Industry to
Address the Obesity Epidemic

• Julie L. Gerberding, MD, MPH
• Director
• Centers for Disease Control and Prevention

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Obesity Trends Among U.S. AdultsBRFSS, 1991
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Obesity Trends Among U.S. AdultsBRFSS, 1992
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Obesity Trends Among U.S. AdultsBRFSS, 1993
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Obesity Trends Among U.S. AdultsBRFSS, 1994
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Obesity Trends Among U.S. AdultsBRFSS, 1995
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Obesity Trends Among U.S. AdultsBRFSS, 1996
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Obesity Trends Among U.S. AdultsBRFSS, 1997
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Obesity Trends Among U.S. AdultsBRFSS, 1998
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Obesity Trends Among U.S. AdultsBRFSS, 1999
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Obesity Trends Among U.S. AdultsBRFSS, 2000
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Obesity Trends Among U.S. AdultsBRFSS, 2001
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Changes in the Prevalence of Severe Obesity (BMI
gt40)
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Consequences of Adult Obesity

• Psychosocial
• Cardiovascular
• Hyperlipidemia
• Diabetes mellitus
• Hypertension
• Respiratory
• Cardiac

• Medical
• Polycystic ovary disease
• Gall bladder disease
• Osteoarthritis
• Cancer
• Pregnancy and the postpartum
• Mortality

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Diabetes Trends Among Adults in the
U.S.,(Includes Gestational Diabetes) BRFSS,
1990,1995 and 2001
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Prevalence of Overweight Among U.S. Children
and Adolescents

• Gender- and age-specific BMI gt the 95th
  percentile
• Source Centers for Disease Control and
  Prevention (CDC), National Center for Health
  Statistics (NCHS) National Health Examination
  Survey (NHES), National Health and Nutrition
  Examination Survey (NHANES)

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Consequences of Childhood and Adolescent Obesity
Common
Uncommon

• Growth
• Psychosocial
• Hyperlipidemia
• Hepatic steatosis
• Abnormal glucose metabolism
• Persistence into adulthood

• Hypertension
• Sleep apnea
• Pseudotumor
• PCOD
• Cholelithiasis
• Orthopedic

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Impact of Childhood Overweight (BMI gt 95th
percentile) on Adult Obesity (BMI gt 30)

• 25 obese adults were overweight children
• 4.9 BMI unit difference in severity
• Onset lt 8y more severely obese as adults
• ( BMI 41.7 vs 34.0)
• CVD risk factors reflect adult BMI
• Freedman et al, Pediatrics 2001 108
  712

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Annual Median Medical Charges
(Including Drug Charges) by Weight Groups
Source Wang et al, Am. Journal of Health
Promotion, 200317183.
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Factors Related to the Onset of Obesity

• Altered dietary intake
• Decreased physical activity
• Increased inactivity

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Shifts in Food Practices in the United States

• Fast food consumption
• Reduced frequency of family meals
• Restrained eating, meal skipping
• Consumption of soft drinks-increased from 27 to
  44 gal/y from 1972-1992
• 30,000 products in supermarkets
• Increased portion size

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Comparison of Portion Sizes of Fast Foods to USDA
Portion Sizes
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Effects of Portion Size on Food Consumption Among
Young (3.6 years) and older (5.0 years) Children
Amount consumed (g)
Portion size
Source Rolls, Engell and Birch. JADA 2000
100232
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Daily Physical Education Classes in School
(9-12th graders)
Year 1991 1999
42 29
Source YRBS
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Distribution of Hours of TV Per Day NHES Youth
Aged 12-17 in 1967-70 and NLSY Youth Aged 12-17
in 1990
TV Hours (Youth Report)
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Prevalence of Obesity by Hours of TV per Day
NHES Youth Aged 12-17 in 1967-70 and NLSY Youth
Aged 10-15 in 1990
TV Hours Per Day (Youth Report)
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Intervention Sites to Prevent or Treat Obesity

• Medical Settings
• School
• Work Site
• Community

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School-based Approaches to Treat or Prevent
Obesity

• Physical education classes
• Walk to school programs
• Media curricula and TV turnoffs
• Competitive foods and pouring contracts
• Comprehensive school-based interventions

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Community-based Approaches

• Communications
• Community programs
• Environmental change
• Sidewalks and bicycle trails
• Parks and recreational facilities
• Neighborhood safety
• Building design
• Urban planning

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Americans Evaluation of Health Problems

• Very serious Serious
• Cancer 76 23
• AIDS 71 23
• Heart disease 60 37
• Diabetes 48 47
• Obesity 36 50

Source Lee and Oliver JFK School of Government
Working Paper
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Reported Causes of Obesity by Health
Professionals or the Public

• Cause Provider Public
• Lack exercise 60 41
• Poor diet 55 24
• Sedentary lifestyle 39 20
• Junk food 13 25
• Portion size 11 0
• Genetics/metabolism 8 16

Unpublished Discovery Health Survey
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Effective Interventions to Promote Physical
Activity

• Informational
• Community-wide education
• Point of decision prompts
• Behavioral and social
• School-based PE
• Non-family social support
• Individually adapted behavior change
• Environmental and policy
• Enhanced access with outreach
• Urban design and land use

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Adult per Capita Cigarette Consumption and Major
Environmental and Policy Changes in the US
1900-1990
Thousands per year
Fairness Doctrine messages on radio and
television
Nonsmokers rights movement begins
First Medical reports linking smoking and cancer
US Surgeon Generals first report
Broadcast advertising ban
Federal cigarette tax doubles
End of WW II
Great Depression
Year
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Division of Nutrition and Physical Activity
Website

• www.cdc.gov/nccdphp/dnpa