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We owe our children a world that is as beautiful, healthful and diverse as the one we were given.

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95th percentile BMI-for-age, CDC Growth Charts, 2000. ... 30 minute bicycle trip burns 250 calories each way (for a 190 pound man) ... – PowerPoint PPT presentation

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Title: We owe our children a world that is as beautiful, healthful and diverse as the one we were given.


1
We owe our children a world that is as beautiful,
healthful and diverse as the one we were given.
Richard Joseph Jackson, MD MPH Dickjackson_at_berkele
y.edu Colorado Healthy Living Summit March 30,
2007
2
The Check Up
  • 42 year Colorado resident comes in for check up
  • …is married with two children
  • …Lives in Fort Collins and works in Denver
  • …Complains of low energy

3
Problem List
  • 28 pounds overweight (BMI 30)
  • BP 145/92
  • Blood glucose elevated, urine normal
  • Cholesterol 270
  • Signs of Depression

4
Treatment Plan
  • Meeting with Nutritionist
  • Weight loss program
  • Exercise club membership
  • Pedometer 10,000 steps a day
  • Meeting with psychotherapist
  • Easing back on work and life commitments

5
Insurance Plan Partially Covers
  • One meeting with a nutritionist
  • Short term outpatient psychotherapy

6
Two Months Later…
  • No place to Walk
  • No Time for exercise
  • Day is already too full

7
2 months later our patient is taking
  • Antihypertensive medication
  • Oral Hypoglycemic agent
  • Antidepressant
  • Cholesterol lowering agent
  • Monthly medication costs
  • 385

8
And our patient and his wife decide to move to
Denver
  • They sell one car
  • He plans to use public transit.
  • He buys a bicycle and plans to bicycle to work
    three days per week

9
US Health Care Expenditures as Percent of GDP
Projections
Heffler et al. U.S. Health Spending Projections
for 2004-2014. Health Tracking, February 23,
2005
10
Disease in the 21st Century
  • Diseases and costs of care for Aging Populations.
  • Overweight Diabetes II, Heart Disease
  • Mental Disorders Depression, Anxiety,
    Developmental, Substance Abuse
  • Macro-environment Climate, Conflict

11
What in the syndemic
  • Is caused by our creating of a world for cars?

12
What happens when we create a world for cars?
13
Bigger more distant houses
14
The US has paved over 60,000 square miles of
Green Cover
15
Less Density More Driving
16
We have changed how much we walk or bike
  • Percent of children who walk or bike to school
  • 1974 66
  • 2000 13 (CDC, 2000)

17
Microsized Fitness of Californias Children
  • Annual California Fitnessgram
  • Conducted in Grades 5, 7, and 9
  • Measures 6 major fitness areas
  • (e.g. aerobic capacity, body composition,
    flexibility)
  • 2004 Results Who passed all standards?
  • 25 ?Grade 5
  • 29 ?Grade 7
  • 26 ?Grade 9

18
I like to play indoors better cause thats
where all the electrical outlets are,
-fourth grader.
Richard Louv Last Child in the Woods
19
Americans …..
Are Too Fat
Los Angeles Times, 6/6/05
20
Obesity Trends Among U.S. Adults BRFSS, 1990
(BMI 30, or 30 lbs overweight for 5 4
person)
21
Obesity Trends Among U.S. Adults BRFSS, 1997
(BMI 30, or 30 lbs overweight for 5 4
person)
22
Obesity Trends Among U.S. Adults BRFSS, 2004
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
23
US Obesity Woes Put a Strain on Hospitals
24
California Prevalence of Overweight
Children aged 5 to lt20 years by
age
21.7
Year 2010 target
gt 95th percentile BMI-for-age, CDC Growth
Charts, 2000.
Year 2010 target reduce
the proportion of children and adolescents aged 6
to 19 years who are overweight to 5.

2003 California Pediatric Nutrition Surveillance
(PedNSS)
25
GI Surgery for Severe Obesity
Risk and Complications
  • 10-20 require follow-up surgery
  • Abdominal hernia
  • Break down of staple line
  • Gallstones
  • 30 develop nutritional deficiency

Cost 20,000 to 50,000
Source NIDDK
Highest Increase Rate of all Pediatric Surgeries
26
Bariatric Procedures Annual Numbers
JAMA 2005 pp1909-1917
27
(No Transcript)
28
Relationship Between BMI and Risk of Type 2
Diabetes
93.2
Men Women
54.0
Age-Adjusted Relative Risk
42.1
40.3
27.6
21.3
15.8
8.1
5.0
11.6
4.3
2.9
2.2
6.7
4.4
1.5
1.0
1.0
1.0
Body Mass index (kg/m2)
Chan J et al. Diabetes Care 199417961. Colditz
G et al. Ann Intern Med 1995122481.
29
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1993-94
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence
of obesity, diabetes, and other obesity-related
health risk factors, 2001. JAMA 2003 Jan
1289(1).
30
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1999
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence
of obesity, diabetes, and other obesity-related
health risk factors, 2001. JAMA 2003 Jan
1289(1).
31
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 2001
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence
of obesity, diabetes, and other obesity-related
health risk factors, 2001. JAMA 2003 Jan
1289(1).
32
Diabetes Projected Risks For Babies Born in 2000
  • Girls 38 lifetime risk
  • If diabetic before age 40, Lifespan shortened by
    14 years (Quality of life by 19 years)
  • Boys 33 lifetime risk
  • If diabetic before age 40, Lifespan shortened
    by 12 years. (Quality of life by 22 years)

V Narayan et al JAMA 8 Oct 2003
33
(No Transcript)
34
Changes in CO2 and Temperature in the last
400,000 years
A. V. Fedorov et al. Science 312, 1485 (2006).
35
  • Eleven of the last twelve years (1995 -2006)
    rank among the 12 warmest years in the
    instrumental record of global surface temperature
    (since 1850)

Intergovernmental Panel on Climate Change 2007
36
(No Transcript)
37
(No Transcript)
38
  • New York Times Feb 3, 2007

39
Turning the Syndemic Around
40
Food
41
Doof
42
(No Transcript)
43
10,000 Steps a Day Originated from Japanese
Manpo-Kei

44
10,000 steps
  • 3234 people with IGT (Pre-Diabetes)
  • walked or exercised five times a week for 30
    minutes
  • lost 5 to 7 of their body weight
  • reduced their risk of diabetes by 58

45
More time in a car? Higher probability of obesity
46
More walking less obesity
47
Higher density and connectivity lower obesity
Atlanta study 2004
48
Our Fort Collins Patient who moved to Denver
  • His new Denver home is five miles from work
  • The house is smaller and costs 150,000 more than
    the home he sold in Fort Collins.
  • He does use public transit two days and bicycles
    to work three days per week.
  • He no longer eats fast food while commuting and
    has most evening meals at home with family

49
The New Denver Bicycle Commuter
  • 30 minute bicycle trip burns 250 calories each
    way (for a 190 pound man)
  • 3 days per week 1500 calories per week, 78,000
    calories/year.
  • Converts to 22 pounds of body fat.

50
The New Denver Bicycle Commuter One year follow
up
  • Weight - 168 pounds (BMI 24.5)
  • BP - 130/78
  • Blood sugar Normal
  • Cholesterol 175
  • Energy level and Mood - Good

51
The New Denver Bicycle Commuter Financial
  • Using only a small dose of cholesterol
    medication- Total medical cost 35/month (4200
    saving per year)
  • Saves 14,000 per year on car expenses
  • Home has appreciated 25,000

52
Our Fort Collins to Denver Commuter Loads 16 tons
  • 65 miles each way
  • In an energy efficient vehicle
  • 14,650,000 grams of GHG into the atmosphere
  • 32,500 pounds per year

53
Greenhouse Gas loading of the atmosphere Travelin
g just one mile
  • Walking or bicycling 1 gram
  • A good car 450 grams

54
One year of 3 day/week cycling
  • Walking or cycling 3 pounds per year
  • Car 2 days/ week 500 pounds/yr
  • Plus public transit GHG emissions

55
1 cent per teaspoon HFCS?
  • Average American consumes 63 pounds of HFCS each
    year (6,048 teaspoons).
  • CA population 35.4 million
  • 0.01 per teaspoon HFCS would generate…

2.1 billion a year in California
56
Role of the Academy of Pediatrics
57
California Assembly Bill 437-(Jones-D) Health
Officer Assistance to Planners.
  • Authorizes the county health officer to provide
    assistance to cities and counties with local land
    use planning and transportation planning
    processes as they relate to public health.
  • This assistance may relate to (a) The
    prevention of obesity and chronic diseases such
    as diabetes, some forms of cancer, arthritis and
    stroke in relation to physical activity, and
    issues of ease of walking and biking and vehicle
    miles traveled.
  • (b) Respiratory disease and air quality. (c)
    Injury prevention and motor vehicle crashes. (d)
    Healthier eating opportunities and community
    design. (e) Drinking water quality. (f)
    Mental well-being and parks, trails, and
    open-space. (g) Social capital and sense of
    community. (h) Violence prevention and street
    safety."

58
We owe our children a world that is as beautiful,
healthful and diverse as the one we were
given. And, it is about Happiness
Richard Joseph Jackson, MD MPH Dickjackson_at_berkele
y.edu Colorado Healthy Living Summit March 30,
2007
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