Undernutrition and Obesity: the View from the Public Sector

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Undernutrition and Obesity the View from the
Public Sector
William H. Dietz, MD, PhD Division of Nutrition
and Physical Activity CDC
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Undernutrition and Obesity

• Undernutrition Obesity
• Women gt men Women gt men
• Ethnic differences
• SES gradient SES gradient in white women
• Children esp vulnerable Adults gt children
• Large disease and financial burden
• Breastfeeding protects
• Food insecurity Food insecurity?

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Examples of the Elimination of Micronutrient
Malnutrition in the United States

• Iodine deficiency
• Pellagra
• Neural tube defects

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The Full Spectrum of Iodine Deficiency
Cretinism
Goiter
Reduced intellectual performance
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Iodized Salt in the United States
Morton develops Iodized salt to help prevent
goiters, which were common at the time. The Food
and Drug Administration later requests that the
product be labeled with the message, This salt
provides iodide, a necessary nutrient.
1924
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Salt Iodization in the US Trend in Goiter
Prevalence in Michigan
WHO Monograph Series No. 44
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Examples of the Elimination of Micronutrient
Malnutrition in the United States

• Iodine deficiency
• Pellagra
• Neural tube defects

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Morbidity and Mortality Rates of Pellagra in
Mississippi
1000
Mandatory Enrichment Law Became Effective (1945)
100
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Mortality and Morbidity Rates per 100,000
Population
Voluntary Bread Enrichment Began (1938)
1
0.1
1925
1935
1945
1955
1940
1930
1950
Year
Source AMJ Public Health 2000 90727
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Examples of the Elimination of Micronutrient
Malnutrition in the United States

• Iodine deficiency
• Pellagra
• Neural tube defects

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Prevalence of spina bifida and anencephaly by
year and quarter of birth for 24 surveillance
programs (1995-99)
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World Bank Rankings of Cost Effective
Interventions
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Copenhagen ConsensusVery Good Proposals

• Challenge Opportunity
• Diseases Control of HIV/AIDS
• Malnutrition Providing micronutrients
• Subsidies trade Trade liberalization
• Diseases Control of malaria

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What Can Industry Do?

• New product development
• Help make the case for fortification
• Recognize success
• Develop and argue the ROI
• Use business to business networks
• Support a level playing field
• Market the approach

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Global Prevalence of Obesity, 1988-94
Women
Men
Age range
25-69
Samoa (urban)
18
Kuwait
25-64
East Germany
20-74
USA
15
Saudi Arabia
25-69
W. Germany
20-65
Czech Republic
16-64
England
18-74
Canada
20-59
20-69
Netherlands
15-64
Australia
25-64
Brazil
20
Japan
20-45
China
80
60
40
20
0
20
40
60
80
population
Source International Obesity Task Force
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Obesity Trends Among U.S. Adults1991, 1996, 2004
1996
2004
No Data
lt10
10-14
15-19
20-24
? 25
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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
• Erectile dysfunction

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Diabetes Trends Among U.S. Adults, BRFSS 1990,
1996, and 2004
1990
1996
2004
No Data lt4 46
68 810 gt10
Includes Gestational Diabetes
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Duration of Diabetes and Nephropathy (Pima
Indians)
Cumulative Incidence Nephropathy ()
35 - 44 Y

• The duration of diabetes, rather than the age at
  diagnosis, is predictive of nephropathy (Krakoff.
  Diabetes Care 20032676)

15 - 24 Y
25 - 34 Y
Duration (years)
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Costs of Obesity

• Costs of illness
• Costs of absence from work
• Costs of reduced productivity
• Costs of injuries
• Costs of disability

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Annual Direct and Indirect Costs Attributable to
Obesity in the United States (Billions of 1995
Dollars)
Disease
Direct Costs
Indirect Costs

• Type 2 DM
• CHD
• Hypertension
• Gallbladder
• Breast Ca
• Endometrial Ca
• Colon Ca
• Osteoarthritis
• Total

32.4 7.0 3.2 2.6 0.8 0.3 1.0
4.3 51.6
30.7 NA NA 0.1 1.5 0.5 1.8
12.9 47.5
Wolf and Colditz, Ob Res 1998697
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Total Change in Spending by Top 10 Conditions
1987-2000

• Heart disease
• Pulmonary conditions
• Mental disorders
• Cancer
• Hypertension
• Trauma
• Cerebrovascular disease
• Arthritis
• Diabetes
• Back problems

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Thorpe et al. Health Affairs 2004 W4-437
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Costs of Obesity

• Costs of illness
• Costs of absence from work
• Costs of reduced productivity
• Costs of injuries
• Costs of disability

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Effects of Obesity on Health and Disability among
50-69 yo Women with BMI gt 35

• Report poor health 40.5
• Chronic conditions 2.31
• Any ADL limitation 21.4
• Report health limits work 45.7
• Sturm et al. Health Affairs 200423199

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Partners in the Prevention and Treatment of
Obesity

• Medical Settings
• School
• Work Site
• Community
• Industry

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Relationship Between Energy Requirements,
Physical Activity, and Weight
Energy Requirements
Energy Requirements
Weight
Level of Physical Activity
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What Can Industry Do?

• Recognize the threat
• Use business to business contacts
• Become model worksites healthful choices,
  medical benefit packages
• New product development
• Create and meet consumer demand
• Use creative packaging
• Share non-proprietary market research

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Division of Nutrition and Physical Activity,
Adolescent and School Health, and VERB Websites

• cdc.gov/nccdphp/dnpa
• cdc.gov/nccdphp/dash
• cdc.gov/youthcampaign
• VERBnow.com
• VERBparents.com
• healthierus.gov/steps