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Implications of Public Health Concepts Targeting Prevention of Overweight and Obesity in Youth

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Title: Implications of Public Health Concepts Targeting Prevention of Overweight and Obesity in Youth


1
Implications of Public Health Concepts Targeting
Prevention of Overweight and Obesity in Youth
  • Van S. Hubbard, M.D., Ph.D.
  • RADM, USPHS
  • NIH Division of Nutrition Research Coordination

2
Obesity in the US
  • Nearly two thirds of US adults are overweight
    (BMI ? 25), and over 30 are obese (BMI ? 30)
  • Over 17 of American children are overweight or
    obese (BMI gt 95th percentile for age and gender)
  • Increased deaths per year due to poor
    diet/inactivity
  • Increase in economic costs
  • All states, districts, and territories are
    affected
  • Obesity is also a problem in the World

3
Prevalence of Adolescent Overweight
2003
2005
Note Data are for high school students in grade
9 12. Overweight is defined as 95th
percentile for body mass index, by age and sex,
on the basis of reference data, based on
self-reported weight and height. Source Youth
Risk Behavior Survey, NCCDPHP, CDC.
4
Child and Adolescent Overweight
Decrease desired
2003-06
2010 Target 5
1988-94
4030 20 10 0
Percent

Total White Black Mexican
Female Male
American
Note I 95 confidence interval. Overweight is
defined for ages 6-19 years as BMI gender- and
age-specific 95th percentile from the 2000 CDC
Growth Charts for the United States. Respondents
were asked to select only one race prior to 1999.
For 1999 and later years, respondents were asked
to select one or more races. For all years, the
categories black and white include persons who
reported only one racial group and exclude
persons of Hispanic origin. Persons of
Mexican-American origin may be any race. Source
National Health and Nutrition Examination Survey,
NCHS, CDC.
Obj. 19-3c
5
Child and Adolescent Overweight
Decrease desired
2003-06
2010 Target 5
1988-94
4030 20 10 0
Percent


Total Higher Lower
With Without
Income
Disabilities

Statistically unreliable. Baseline data are
for 1991-94. Note I 95 confidence interval.
Overweight is defined for ages 6-19 years as BMI
gender- and age-specific 95th percentile from
the 2000 CDC Growth Charts for the United States.
Higher income is defined as gt 130 poverty
threshold, and lower as 130. Source
National Health and Nutrition Examination Survey,
NCHS, CDC.
Obj. 19-3c
6
Prevalence of high body mass index, children and
teens 2-19 years, US
Percentiles from the 2000 CDC growth
charts SOURCE Centers for Disease Control and
Prevention, National Center for Health
Statistics, National Health and Nutrition
Examination Survey Ogden et al. 2008
7
Body mass index for age at or above the 95th
percentile by race/ethnicity, boys 2-19 years
SOURCE Centers for Disease Control and
Prevention, National Center for Health
Statistics, National Health and Nutrition
Examination Survey Ogden et al. 2008
8
Body mass index for age at or above the 95th
percentile by race/ethnicity, girls 2-19 years
SOURCE Centers for Disease Control and
Prevention, National Center for Health
Statistics, National Health and Nutrition
Examination Survey Ogden et al. 2008
9
Body mass index for age at or above the 85th
percentile by race/ethnicity, boys 2-19 years
SOURCE Centers for Disease Control and
Prevention, National Center for Health
Statistics, National Health and Nutrition
Examination Survey Ogden et al. 2008
10
Body mass index for age at or above the 85th
percentile by race/ethnicity, girls 2-19 years
SOURCE Centers for Disease Control and
Prevention, National Center for Health
Statistics, National Health and Nutrition
Examination Survey Ogden et al. 2008
11
Obesity Trends Among U.S. AdultsBRFSS, 1990,
1998, 2006
(BMI ?30, or about 30 lbs. overweight for 54
person)
1998
1990
2006
No Data lt10 1014
1519 2024 2529
30
12
Figure 2. Trends in adult obesity, adults aged 20
years and older, by sex, United States, 2005-2006
Women
Men
NOTES Age-adjusted by the direct method to the
year 2000 US Census Bureau estimates using the
age groups 20-39, 40-59 and 60 years. Obesity is
defined as BMIgt30. SOURCE CDC/NCHS, National
Health and Nutrition Examination Surveys
13
Adult Obesity
Decrease desired
60 40 20 0
1988-94
2003-06
2010 Target 15
Percent

Mexican American
Mexican American
White Black
White Black
Female
Male
Note I 95 confidence interval. Data are for
ages 20 years and over, and age adjusted to the
2000 standard population. Obesity is defined as
BMI 30.0. Respondents were asked to select only
one race prior to 1999. For 1999 and later years,
respondents were asked to select one or more
races. For all years, the categories black and
white include persons who reported only one
racial group and exclude persons of Hispanic
origin. Persons of Mexican-American origin may be
any race. Source National Health and Nutrition
Examination Survey, NCHS, CDC.
Obj. 19-2
14
Medical Complications of Obesity
Stroke
Idiopathic intracranial hypertension
Pulmonary disease abnormal function obstructive
sleep apnea hypoventilation syndrome
Cataracts
Coronary heart disease
Pancreatitis
Diabetes
Nonalcoholic fatty liver disease steatosis steatoh
epatitis cirrhosis
Dyslipidemia
Hypertension
Gynecologic abnormalities abnormal
menses infertility polycystic ovarian syndrome
Gall bladder disease
Cancer breast, uterus, cervix, prostate,
kidney colon, esophagus, pancreas, liver
Osteoarthritis
Phlebitis venous stasis
Skin
Gout
15
Obesity is a Chronic Health Problem
  • Adverse health effects are part of a continuum
  • Time-limited treatments are rarely effective
  • Multiple sectors of the community impact
    effectiveness of prevention and intervention
    efforts

16
What Is BMI?
  • Body mass index (BMI)
  • weight (kg)/height (m)2
  • BMI is an effective screening/epidemiologic tool
    it is not a diagnostic tool
  • For children, BMI is age and gender specific, so
    BMI-for-age is the measure used

17
Degree of risk increases with degree of overweight
18
Risk influenced by Regional Fat Deposition and
Degree of Visceral Adiposity
19
Heterogeneity of Body Fat Content for a Given BMI
Class in Males
Percent
body fat n BMI Mean Min Max 27 20-22 17 8 32 76 23
-25 22 11 35 46 26-27 26 16 40 27 28-30 28 15 41 M
en aged 35-54 yrs, determined from underwater
weighing
Bouchard C, The Genetics of Obesity, 1994
05 1220 01
20
Variation in AVF by BMI and Body Fat in Males
Visceral fat, cm2 fat n BMI (range) Mean
Min Max
15 21-22 14-18 58 31 84 19 24-25 19-24 89 50 140
18 27-28 25-29 133 63 199 16 30-31 30-33 153 77
261
Bouchard C, The Genetics of Obesity, 1994
21
Obesity and Diabetes Risk
Incidence New Cases per 1,000 Person-Years
BMI Levels
Knowler WC, et al. Am J Epidemiol.
1981113144-156.
22
Weight Gain and Diabetes Risk
Weight Change Since Age 21
Relative Risk
Body Mass Index at Age 21
Chan JM, et al. Diabetes Care. 1994 17960-969.
23
Prevalence of complications men
Slide adapted from data compiled by Graham Colditz
24
Overweight and Obesity
  • Multiple complex factors contribute to overweight
    and obesity, such as
  • Inherited
  • Metabolic
  • Behavioral
  • Environmental
  • Cultural
  • Socio-economic components
  • Including their interactions

25
Why the increase?
  • Calories and physical activity
  • Complex issue
  • Lifestyles, environment genes
  • Underlying suggested factors
  • Larger food portion sizes eating out increased
    consumption of sugar sweetened drinks computers
    television labor-saving technologies fear of
    crime
  • However, data is lacking

26
Surgeon Generals Call to Action to Prevent and
Decrease Overweight and Obesity
Released December 2001
Surgeon Generals Priorities
27
Who should be involved?
  • Schools
  • Businesses
  • Health care organizations
  • Media
  • Families
  • Communities
  • Governments
  • You

28
Goals and Objectives of PHS Regional Meetings
  • Engage all sectors of the community
  • Promote awareness of ongoing and planned
    activities
  • Promote networking among community organizations
  • Promote sharing of resources
  • Support grassroots efforts
  • Develop new and sustained actions
  • Modify community and individual priorities
    relating to diet and activity

29
Steps to a Healthier Nation
  • Shift approach from a disease care system to a
    health care system recognizing 75 of our
    nations health care are spent on chronic
    preventable diseases
  • Promote active involvement towards healthier
    lifestyles, with emphasis on improved nutrition
    and physical activity
  • Strive to seek socio-cultural (social norms)
    change for healthier living
  • Charge organizations to develop actions with
    concept of sustainability

30
We Need to Better Understand the Problem at
various levels
  • Population
  • Individual
  • Intervention
  • Prevention

31
Research Priorities
  • What do we need to know?
  • What is it about obesity that leads to increased
    health risk?
  • Do/Why interventions work for some and not for
    all?
  • Will earlier interventions be more effective?
  • What are the long-term benefits of weight loss?
  • What determines behavior or choice?
  • What are critical social/cultural factors?

32
Strategic Plan for NIH Obesity Research
  • Posted at www.obesityresearch.nih.gov

33
Realities
  • There is a finite limit of financial and human
    resources
  • Consequently, interactions across Agencies and
    other organizations are imperative in order to
    enhance our investments

34
To solve the obesity epidemic, we need to
emphasize the role of partnering in the
implementation of Individual, Community, and
National Strategiesand providing added value
35
US Department of Health and Human ServicesOffice
of the Surgeon General of theUnited States of
America
HHS Childhood Overweight and Obesity Prevention
Council
36
Healthy Youth For a Healthy Future
37
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38
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39
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40
A Label Education Program for Tweens
41
FDA Educational Initiatives
Make Your Calories Count
  • Three Steps
  • Size up your Serving and Calories
  • See whats in if for you
  • Nutrients to limit
  • Nutrients to get enough of
  • Judge if it is right for you
  • Low, moderate, or high in calories
  • Using the Daily Value

http//www.cfsan.fda.gov
http//www.cfsan.fda.gov
42
Spot The Block Get your food facts first
  • Educate tweens to use Nutrition Facts to make
    healthier food choices
  • Partnership Between FDA and Cartoon Network
  • A complimentary education campaign for parents is
    being developed.
  • Network of partners established.

http//www.cfsan.fda.gov
http//www.cfsan.fda.gov
43
Improving Diets through Federal Nutrition
Assistance
  • Programs reach 1 in 5 Americans in the course of
    a year
  • Integrated nutrition promotion interventions in
    each major program
  • Food Stamp Nutrition Education
  • Child Nutrition Programs -- Team Nutrition,
    HealthierUS School Challenge, local school
    wellness policies
  • WIC Nutrition education, breastfeeding
    promotion/peer counseling
  • Eat Smart. Play Hard. cross-program nutrition
    educationand physical activity promotion

44
Community Priorities
  • Supportive environment for healthy lifestyle
    choices (social norms)
  • Involvement of all sectors of the community
  • Safe, convenient, affordable venues for activity
  • Food preparation instruction in schools,
    community centers, and other locations

45
Family and Individual Priorities
  • Priorities are influenced and supported by those
    around you.
  • Culture
  • Socio-economic
  • Environment
  • Peers
  • Time

46
Time A barrier to lifestyle modification?
47
Multidimensional Effect of Time
  • Time Constraints
  • Time Allocation
  • Impact of time constraints on time allocation

48
Time Pressure/Constraints
  • Real or Perceived?
  • Increased stress or stress reduction?

49
Time Allocation
  • Are our concerns with time more related to our
    priority setting?
  • Challenges
  • How do we elevate healthful eating and increased
    physical activity in peoples lives?
  • ..especially in the complex lives of the poor
    and minorities?

50
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51
Our ultimate goal is to prevent disease and
disability
  • Effective Translation of our Research Is Key to
    Success

52
Let us all strive to make a difference Thank
you for Listening
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