Harold W' Kohl, III, Ph'D'

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Results of Public Health Prevention Interventions
Harold W. Kohl, III, Ph.D. ILSI Center for
Health Promotion Atlanta, GA USA
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Changes in prevalence of adult obesity among
adult men, 7 countries.
Percent
Popkin and Doak, 1998
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Changes in prevalence of adult obesity among
adult women, 7 countries.
Percent
Popkin and Doak, 1998
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Public health prevention of diabetes and obesity

• What are we preventing/promoting?
• When do we want to prevent/promote it?
• In which settings should we put our efforts?

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Public health prevention of obesity

• Childhood/adolescence
• overweight
• obesity

Prevention can mean treatment!

• Adulthood
• overweight
• obesity

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Public health prevention of type II diabetes

• Childhood/adolescence
• IFG
• Diabetes

Prevention can mean treatment!

• Adulthood
• IFG
• Diabetes

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Public health behavior promotion related to
obesity and diabetes

• Childhood/adolescence
• Physical inactivity
• Diet behaviors

• Adulthood
• Physical inactivity
• Diet behaviors

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Todays goal

• Attempt to summarize status of knowledge in areas
  of obesity and diabetes public health prevention
  interventions.
• Provide framework for other experts on the panel
  as well as breakout groups.
• Answer a few questions and raise more.

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Summary of randomized, controlled studies on
obesity (weight gain) prevention
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Summary of observational studies on obesity
(weight gain) prevention
Cross-sectional studies suggest lower weights at
higher levels of physical activity and diet
quality indicators. Longitudinal studies (n
12) suggest an attenuation of weight gain at
higher levels of physical activity. Change
analyses suggest a lower risk of becoming
overweight with an increase in activity
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Mean weight change by cardiovascular fitness
changes, ACLS, 1970-1994
Weight Change (kg)
n4,599 men and 724 women Mean time between
fitness evaluations 1.8 y Mean time of
follow-up 7.5 y
Dipietro, et al, 1998
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Summary of randomized, controlled studies on Type
II diabetes prevention
Diabetes Prevention Program (ngt3,000) Diabetes
Care 199922623-634. Finnish Diabetes
Prevention Study (n523) Br. J. Nutrition
200083( Suppl. 1), s137-s142 Da Qing IGT and
Diabetes Study (n577) Diabetes Care
1997537-544.
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Summary of trials on diabetes prevention

• All start with initial population with IFG.
• Early work suggested possibility, but non-optimal
  study designs limited interpretation.
• 2 current studies investigating solely hygienic
  interventions.
• Results of randomized, controlled trials suggest
  positive outcomes, incidence reductions of up to
  30 may be possible.

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Six-year incidence of diabetes by treatment
condition and body composition Da Qing China
Percent
Xiao-ren Pan, et al, 1997
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Potential settings for health behavior
interventions for children and adults
School
Community
Provider
Family
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School-based interventions

• Some have focused on obese or high-risk children
  (with physiologic outcomes) while most have
  included the entire school (behavioral outcomes)
• Most have been multi-component interventions
  behavioral, environmental, educational and
  various risk factors
• Short term results implications for adult
  outcomes are unknown.

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School-based interventions

• Targeted interventions produce short-term weight
  loss.
• Overweight children
• Populations at-risk
• Curriculum and environmental changes are
  possible.
• Changes in physical activity (PE) and food
  service policies are achievable as are short term
  changes in comprehension

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School-based interventions

• Varying success changes in body composition
  measures not likely to follow changes in
  knowledge or behavior.
• No approach has been tested across several ages
  or grades.
• Few attempts for home-support of school
  intervention.

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Community based interventions

• Stanford Three-Community
• Stanford Five-City
• Minnesota Heart Health Program
• Pawtucket Heart Health Program
• North Karelia Project
• Mauritius
• Despite positive risk factor changes, no evidence
  of obesity-related treatment effects in 4 of 6
  studies

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Community based interventions

• Pound of Prevention (only community-based study
  designed to prevent weight gain).
• 1200 volunteers randomized to no-contact control,
  and education (with and without readership
  incentives) combined with intervention
  activities.
• 3 year intervention
• All three groups gained weight
• Education alone appears insufficient on the
  community level.

Jeffrey and French, 1999
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What to do?
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Current Recommendations
Children should accumulate 30-60 minutes of
moderate-to-vigorous physical activity each day
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The Program
A classroom-based physical activity promotion
program designed to reduce periods of inactivity
during school day for elementary school children.
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The Program

• Integrates 10 minute periods of physical
  activity into school day combined with
  age-appropriate lessons of math, science,
  language arts, etc.

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The Materials

• Physical activity cards are linked to core
  academic objectives
• Teacher manual coordinates the lessons
• TAKE 10! Tracking Poster motivates kids
• Teacher Training Video explains the program

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Primary core academic curriculum objectives
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Secondary Curriculum Objectives