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The Burden of Obesity in North Carolina

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Title: The Burden of Obesity in North Carolina


1
The Burden of Obesity in North Carolina
  • North Carolina Division of Public Health

2
Executive Summary
  • 65.7 of N.C. adults are overweight or obese
  • NC ranks 5th worst in childhood obesity
  • Four of the 10 leading causes of death in the
    U.S. are related to obesity
  • coronary heart disease, type II diabetes, stroke,
    and several forms of cancer

3
The Burden of Obesity in North Carolina
  • Defining Obesity

4
Body Mass Index (BMI)
  • defined as weight (in kilograms) divided by
    height (in meters) squared
  • correlates with amount of body fat
  • easily obtainable in a clinical setting

5
Child Weight Definitions
  • 2007 Expert Committee on the Assessment,
    Prevention, and Treatment of Child and Adolescent
    Overweight and Obesity, convened by
  • The American Medical Association (AMA)
  • The Department of Health and Human Services
    (DHHS),
  • Health Resources and Services Administration
    (HRSA), and
  • The Centers for Disease Control and Prevention
    (CDC).

6
Classification of Child Weight
  • The Expert Committee recommends classifying
    children and youth ages 2-18 as
  • Overweight if BMI is 85 percentile but lt95
    percentile for age and sex.
  • Obese if BMI is 95 percentile for age and sex,
    or exceeds 30 kg/m2.

7
Weight Categories
8
The Burden of Obesity in North Carolina
  • Obesity in Children and Youth

9
(No Transcript)
10
Obese children are almost six times more likely
than children with healthy weights to have an
impaired quality of life--equal to that of
children undergoing treatment for
cancer. --JAMA, 2003
11
NC ranks 5th worst in Childhood Obesity
12
Obesity and Children
  • Nationally, more than one third of children and
    youth are overweight and 17 are obese.
  • Approximately 25 million children and youth are
    obese or overweight. The rate of childhood
    obesity more than tripled from 1980 to 2004.

13
The Child Health Assessment and Monitoring
Program (CHAMP)
  • A N.C. statewide comprehensive surveillance
    system
  • Monitors health and risk behaviors for children
    and adolescents (ages 0-17)
  • During the Behavioral Risk Factor Surveillance
    System (BRFSS) interview, the respondent is asked
    to participate in a survey about child health
  • The interviewer calls back within a week to
    administer CHAMP to the primary caregiver of the
    child.

14
N.C. Children and Youth
  • In 2008, among N.C. children ages 10-17, 17.6
    were overweight, and 15.2 were obese (a combined
    32.8 were overweight or obese), compared to
    61.3 who were at a healthy weight.
  • One-third of N.C. children typically consumed one
    serving or less of vegetables per day and 20 of
    children did not meet the physical activity
    recommendation of 60 minutes per day.
  • In 2007, 50 of children watched more than two
    hours of television on a typical day.

15
N.C. Children by BMI
16
Gender
17
Age Group
18
Race/Ethnicity
19
Physical Activity
20
Fruit and Vegetable Consumption
21
The North Carolina Nutrition and Physical
Activity Surveillance System (NC-NPASS)
  • Child health indicators from local public health
    departments and Women, Infants and Children (WIC)
    programs
  • Includes height, weight, a few lab measures and
    limited behavioral data
  • May not be representative of the total population
    as a whole

22
N.C. Children and Youth Overweight Trends
23
N.C. Children and Youth Obesity Trends
24
The Youth Risk Behavior Surveillance System
(YRBSS)
  • Developed by CDC to monitor priority health-risk
    behaviors among youth
  • National, school-based survey
  • Completed by students (in approximately 45
    minutes) in the classroom
  • Conducted biennially since 1991, at the national,
    state and local levels.

25
Trends in Weight of N.C. High School Students
26
N.C. Middle and High School Students, by Grade
27
Students Who Described Themselves as Overweight
or Were Trying to Lose Weight
28
N.C. High School Students, by Race/Ethnicity
29
The Burden of Obesity in North Carolina
  • Obesity in Adults

30
(No Transcript)
31
The Behavioral Risk Factor Surveillance System
(BRFSS)
  • Established in 1984 by the Centers for Disease
    Control and Prevention
  • State-based system of health surveys that collect
    information on
  • health risk behaviors
  • preventive health practices
  • health care access
  • Random-digit dialing, individuals age 18 years
    and older are randomly selected from each
    household called
  • Largest telephone health survey in the world

32
(No Transcript)
33
The National Burden of Obesity
  • 2 out of 3 adults are overweight or obese
  • None of the states have experienced a decrease in
    obesity for 16 years
  • In the past year, 31 states experienced an
    increase in obesity

34
Obesity Trends Among U.S. Adults BRFSS, 2008
No Data lt10 1014
1519 2024 2529 30
(BMI 30, or 30 lbs. overweight for 5 4
person)
Source Behavioral Risk Factor Surveillance
System, CDC
35
The National Health and Nutrition Examination
Survey (NHANES)
  • Designed to assess the health and nutritional
    status of adults and children
  • Combines personal interviews and physical
    examinations
  • Used to determine the basis for national
    standards for such measurements as height, weight
    and blood pressure.

36
The entire adult population is heavier, and the
heaviest have become much heavier since 1980.
37
Adult Obesity in N.C.
  • 65.7 of N.C. adults are overweight or obese,
    above the national average.
  • 56 are not meeting the physical activity
    recommendation
  • 78 are not meeting the fruits or vegetables
    recommendation

38
Adult Obesity in N.C.
  • Physical inactivity and unhealthy eating combined
    are the 2nd leading preventable cause of death in
    N.C., and both increase the risk of
  • Heart disease
  • Certain types of cancer
  • Diabetes
  • High blood pressure
  • Stroke
  • Obesity

39
N.C. Adults, BMI Trends
40
Healthy People 2010
  • Launched in January 2000, by The Department of
    Health and Human Services
  • A comprehensive, nationwide health promotion and
    disease prevention agenda
  • Contains objectives to increase quality and years
    of healthy life and to eliminate health
    disparities by the year 2010

41
By 2010, increase the percentage of adults who
are at a healthy weight to 60.
42
By 2010, reduce the percentage of adults (20
years old or older) who are obese to 15.
43
N.C. Adults Who Were Overweight or Obese, by
Gender
44
N.C. Adults Who Were Overweight or Obese, by Age
Group
45
N.C. Adults Risk Factors, by Race/Ethnicity
46
N.C. Adults who were Overweight or Obese by Income
47
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48
The Burden of Obesity in North Carolina
  • Special Populations Obesity

49
Special Populations in North Carolina
  • Life expectancy for North Carolinas minority
    population is almost five years less than the
    white population.
  • African Americans are the largest minority group,
    accounting for 21 percent of the population.
  • Hispanics now comprise approximately seven
    percent of the population, six times the
    percentage in 1990.
  • About one percent of North Carolinians are
    American Indian.

50
N.C. Risk Factor Percentages by Race/Ethnicity
51
Racial Ethnic Disparities and Obesity
  • African Americans were more likely than whites to
    be obese, have high blood pressure, be physically
    inactive, and have inadequate fruit and vegetable
    consumption.

52
N.C. Adults by Race
53
Older Adults and Obesity
  • In 2008, 72.3 of adults in the 55-64 age group
    were overweight or obese.

54
Older U.S. Adults and Obesity

i Centers for Disease Control and Prevention
and The Merck Company Foundation. The State of
Aging and Health in America 2007. Whitehouse
Station, NJ The Merck Company Foundation 2007.
www.cdc.gov/aging/saha.htm
55
Educational and Socio-economic Disparities and
Obesity
  • In general, among white children, obesity
    typically declines as income and parental
    education increase. Only rates of obesity for
    white girls decrease as family income rises.
  • Obesity rates for African American girls are
    higher in the lowest and highest income ranges
    than in the in-between bracket.

56
Educational Disparities N.C. Children and Youth
who are Overweight or Obese
57
Economic Constraints
  • In 2007, nearly 5 of N.C. primary caregivers cut
    the size of their childs meals because there was
    not enough money for food.

58
Economic Constraints
  • Food insecurity and obesity are linked
  • Low-income families may consume lower-cost foods
    with relatively higher levels of calories per
    dollar,
  • Families sacrifice food quality for food quantity
    to stretch limited resources,
  • Mothers in particular sacrifice their own
    nutrition to feed their children, yet may overeat
    when food is available again, and
  • The body may store fat more efficiently to
    conserve energy when there are periods of food
    deprivation.

59
Rural Areas and Obesity
  • Nationally, rural areas have higher rates of
    adult obesity than urban areas.
  • Nearly 14 of children in rural N.C. had early
    risk factors for diabetes and heart disease.
  • In N.C., the odds of being obese were 50 higher
    for rural children.

60
Environmental Factors
  • Keeping adolescents in their same environments
    and changing only family income and parental
    education had a limited effect on the disparities
    in obesity prevalence.
  • Efforts to reduce obesity disparities between
    ethnic groups should look at other factors, such
    as environmental, contextual, biological, and
    socio-cultural factors.

61
The Burden of Obesity in North Carolina
  • Obesity Costs

62
U.S. Costs
  • The direct medical costs of obesity in the U.S.
    have been estimated to be greater than 92
    billion a year.
  • Obese people have annual medical costs that are
    37 higher than their healthy weight
    counterparts, representing an additional 732 per
    obese person per year.
  • Nearly one half of overweight and obesity
    attributable medical spending is the
    responsibility of the public sector (Medicaid and
    Medicare).

63
Workplaces
64
U.S. Costs to Employers
  • Obese workers have 21 higher health care costs
    compared with those of a healthy weight.
  • In 1994, the estimated cost of obesity to U.S.
    businesses was 12.7 billion, including 7.7
    billion in health care costs alone.

65
U.S. Lost Workdays
66
U.S. Medical Claims Indemnity Costs
67
North Carolina Costs
  • In N.C., overweight and obesity accounted for 83
    million in medical costs in 2003 for those with
    Blue Cross Blue Shield (BCBS) coverage.
  • The N.C. BCBS customers who were obese had costs
    32 higher than those with healthy weights.

68
North Carolina Costs
69
Estimated Adult Obesity-Attributable Medical
Expenditures (2003 dollars in millions)
Finkelstein EA., Fiebelkorn IC, Wang G.
State-level estimates of annual medical
expenditures attributable to obesity. Obes Res.
2004 12 18-24.
70
N.C. is 10th Highest for Obesity-Attributable
Costs
71
Obesity-Attributable Medical Costs Southeastern
States
72
U.S. Costs Children and Youth
  • Among children 6-17 years old, obesity-associated
    annual hospital costs increased from 35 million
    during 1979-1981 to 127 million during
    1997-1999.

73
North Carolina Costs Children and Youth
  • Direct and indirect costs of obesity in N.C.
    youth were nearly 16 million dollars per year.

74
The Burden of Obesity in North Carolina
  • Understanding Obesity

75
Understanding Obesity
  • Excessive weight gain in the American population
    is largely due to changes in our culture.
  • Energy-dense, highly-refined food choices,
    dietary habits, and food insecurity have been
    identified as potential contributors to the
    obesity epidemic.

76
The Burden of Obesity in North Carolina
  • Physical Inactivity

77
Physical Activity Recommendations
  • Adults Children

Children and adolescents should do 60 minutes (1
hour) or more of physical activity each day.
78
Physical Activity
  • Physical activity is any bodily movement produced
    by skeletal muscles that results in an
    expenditure of energy.
  • Moderate physical activity refers to a level of
    effort in which a person should experience some
    increase in breathing or heart rate.
  • Vigorous physical activity refers to a level of
    effort that may be intense enough to represent a
    substantial challenge to an individual and a
    large increase in breathing or heart rate.

79
Physical Education
  • Physical Education is a course taught by a
    certified physical education teacher, that
    provides the environment where students learn,
    practice, and receive assessment on
    developmentally appropriate motor skills, social
    skills and knowledge as defined in the North
    Carolina Healthful Living Standards Course of
    Study. (HSP-S-000)

80
Physical Inactivity in Children
  • Less than half (44) of North Carolina high
    school students and just over half (55) of
    middle school students were physically active for
    a total of at least 60 minutes per day on five or
    more of the past seven days.
  • Recommendation Children and adolescents should
    do 60 minutes (1 hour) or more of physical
    activity each day.

81
N.C. Children and Youth Physical Activity
82
Physical Inactivity in Children
  • Among children and youth, lack of physical
    activity is one of the most marked causes of
    obesity, diabetes, and cardiovascular disease.

83
Trends in U.S. Schools
  • U.S. Schools requiring physical education
  • 50 in grades 1-5
  • 25 in grade 8
  • 5 in grade 12
  • Overall, 22 of schools did not require students
    to take any physical education.

84
The National Association of Sports and Physical
Education (NASPE)
  • NASPE recommends
  • Elementary school students
  • At least one 20-minute recess period daily
  • 150 minutes of physical education weekly
  • Middle school and high school students
  • 225 minutes of physical education weekly

85
N.C. Healthy Active Children Policy
  • 30 minutes of physical activity per day in K-8
    through
  • Regular physical education class
  • Recess
  • Dance
  • Classroom energizers
  • Curriculum-based physical education activity
    programs
  • No withholding recess for punishment or to do
    extra work
  • No severe physical activity for punishment

86
Walking to School
  • Nationally, 10 of children walk to school,
    versus 80 who walked during their parents
    generation.
  • In 2006, only 5 of N.C. children walked or biked
    to school.

87
Safe Routes to School
Assist communities in developing successful Safe
Routes programs and strategies http//www.saferou
tesinfo.org/
88
Distance from School
89
Walking to School in N.C.
90
Physical Inactivity in Adults
  • Nearly 40 of N.C. adults get no leisure-time
    physical activity.
  • In 2007, 56 of N.C. adults did not meet the
    recommendation for physical activity.
  • Recommendation Moderate physical activity for
    30 or more minutes per day, five or more days per
    week OR vigorous physical activity for 20 or more
    minutes per day, three or more days per week.

91
N.C. Adults who did NOT get any Leisure Time
Physical Activity by Gender and Age
92
N.C. Adults who did NOT get any Leisure Time
Physical Activity by Education and Income
93
U.S. Transportation Trends
  • Between 1977-1995, trips made by walking declined
    by 40, while driving trips increased to almost
    90.
  • One-in-four trips people make are one mile or
    less, yet three-fourths of these short trips are
    made by car.

94
U.S. Transportation Trends
  • Almost 70 of all children and youths trips were
    by car.
  • Parents driving their children and youth to
    school represents between 20 and 30 of peak-hour
    morning traffic.

95
Walkability quality of the walking conditions
  • In the U.S., 43 percent of people with safe
    places to walk met recommended activity levels,
    compared with 27 of those without safe places to
    walk.

96
Importance of Walkability
  • People who live in low-density counties
  • Walk less
  • Weigh more
  • Are more likely to be obese
  • Are more likely to have hypertension
  • than people living in high-density counties.

97
The Burden of Obesity in North Carolina
  • Unhealthy Eating

98
Recommendation for Fruits Vegetables
  • Boys and girls ages 4-8 need 3 to 4 cups of
    fruits and vegetables a day, with 1½ cups coming
    from fruit and the rest from vegetables.

Centers for Disease Control and Prevention
99
Unhealthy Eating in U.S. Children
  • On average, children ages 6-11 ate a combined
    average of less than 3½ servings of vegetables
    and fruits daily.
  • Overall, only one in five children met the
    recommended minimum goal of five servings of
    fruits and vegetables per day.

100
Unhealthy Eating
  • Nationally, children ages 6-11 ate two vegetable
    servings per day
  • 5 dark green vegetables
  • 5 deep yellow vegetables
  • 23 tomatoes
  • 43 white potatoes
  • Childrens intakes of dark green and orange
    vegetables should almost triple and their potato
    consumption should be cut in half.

101
U.S. Adults Who Consumed 2 Fruits 3
Vegetables (2007)
102
Most Commonly Consumed Foods for U.S. Children,
Ages 2-5
103
N.C. Students Vending Machines
104
Fast Food in America
  • Every day, one-in-four Americans eats a fast-food
    meal
  • The number of fast food establishments in the
    country has increased from 70,000 in 1970 to
    almost 200,000 in 2002.

105
Unhealthy Eating N.C. Children
  • 82 of high school students ate fewer than five
    servings of fruits and vegetables daily in the
    seven days prior to the survey.
  • 75 of children, ages 5-17, ate less than the
    recommended three servings of vegetables on a
    typical day
  • 43 ate less than the recommended two servings of
    fruit.

106
N.C. Students and Fruits and Vegetables
Source North Carolina Youth Risk Behavior
Surveillance System, North Carolina Department of
Public Instruction and North Carolina Department
of Health and Human Services. (2007).
107
N.C. Children and Youths Daily Healthy Eating
Behaviors
108
The Burden of Obesity in North Carolina
  • Meals Eaten Away from Home

109
The percentage of total calories from foods eaten
away from home increased from 18 in the 1970s to
32 in the 1990s.
110
N.C. Adults Main Meal Prepared at Home, by
Income
111
Foods and Beverages in U.S. Schools
  • 77 percent of high schools still sell soda or
    fruit drinks that are not 100 percent juice
  • 61 sell salty snacks not low in fat in their
    vending machines or school stores

112
N.C. Students Vending Machines
113
Meals Away from Home
  • There is an association between meals eaten away
    from home and risk for overweight or obesity.
  • Teens who ate fast food more often
  • ate more calories and fat
  • drank more soft drinks
  • drank less milk
  • ate fewer fruits and vegetables

114
The Burden of Obesity in North Carolina
  • Portion Sizes

115
What is a Portion?
  • A portion" is the amount of food or beverage a
    person chooses to eat or drink.
  • A serving is a standard amount established by
    the U.S. Food and Drug Administration.

116
Larger Food Portions
  • McDonalds French Fries
  • 1950s size
  • 2.4 ounces 210 calories
  • 2006 size
  • 7 ounces 610 calories

117
Larger Drinks
  • Bottle of Coke
  • 1916 size
  • 6 fluid ounces
  • 1970s size
  • 13.6 fluid ounces
  • 1996 size
  • 21 fluid ounces

118
Food and Beverage Portion Sizes Continue to
Increase
  • For 50 or less, a person can add up to 400
    calories in a fast-food meal

119
Potato Chips Portion Size
  • One study gave people a bag of potato chips for a
    snack and a subsequent meal each day for several
    days.
  • The package size of the potato chips varied each
    day.
  • People ate more chips when the package size was
    larger.
  • When they ate more chips as a snack, they did not
    eat less at mealtime.

120
The Burden of Obesity in North Carolina
  • Soft Drink Consumption

121
Soft Drink Consumption
  • Between 1970 and 1997, yearly per capita
    consumption of non-diet soft drinks rose 86 in
    the United States. The prevalence of obesity
    increased 112 during that same time.
  • The most popular American beverage is the
    carbonated soft drink, which accounts for 28 of
    total beverage consumption.
  • Milk is accounts for about 11.

122
U.S. Daily Soft Drink Consumption
  • More than half (56) of 8-year-olds drink soft
    drinks daily.
  • Most adolescents, 65 of girls and 74 of boys,
    drink soft drinks daily.

123
Children (Age 8-14) Consuming Soft Drinks Daily
124
Soda is the most common soft drink.
  • On average, adolescents get 15 teaspoons of sugar
    from soft drinks daily.
  • A 12-ounce can of soda has 150 calories and 10
    teaspoons of sugar in the form of high-fructose
    corn syrup.

125
High-Fructose Corn Syrup
  • High-fructose corn syrup is a sweetener developed
    from processing corn that is added to regular
    soda.
  • One soda a day could lead to a weight gain of 15
    pounds in one year.
  • For each additional sugar-sweetened drink
    consumed daily, adult BMI increased by 60.

126
Is Diet Soda Better?
  • Surprisingly, the risk of obesity in people only
    drinking diet soft drinks was even higher than
    regular soda.
  • There was a 41 increase in risk of being
    overweight for every can or bottle of diet soft
    drink a person consumes each day.

127
Regular and Diet Soda Increase Obesity Risk
128
Soda vs. Milk
  • U.S. youth are drinking twice as much soda as
    milk.
  • Only three in ten (36) boys and less than two in
    ten (14) girls are getting enough calcium.

129
The Burden of Obesity in North Carolina
  • Screen Time

130
Screen Time
  • Nearly 80 of U.S. households have multiple TV
    sets.
  • More than two-thirds of households with children
    own video and computer games.
  • Children, on average, spend up to 5-6 hours per
    day involved in sedentary activities.

131
Video and Computer Games
  • Almost all (92) of U.S. children and adolescents
    ages 2-17 play video games.
  • On any given day, 30 of all children ages 2-18
    will play a video game.
  • Children spend an average of more than an hour
    playing video games.

132
Increased hours of screen time
  • The average screen time for children is more than
    5 hours per day.
  • Children spend more time sitting in front of
    screens than any other activity besides sleeping.
  • About 43 percent of North Carolina children
    watched an average of 2-4 hours of television a
    day.

133
N.C. Students Screen Time
134
Approximately 33 of U.S. Children watch more
than 3 hours of TV per day
135
Patterns of TV and Media Use
  • 43 of children, age 2 or younger, watch TV every
    day
  • 41 of children 2-3 years old and 43 of
    children 4-6 years old use screen media for more
    than 2 hours per day
  • Children, ages 8-18, watch an average of 3 hours
    of TV per day
  • The average family owns 4 TV sets

136
Food Advertisements
  • Food ads account for more than 50 of all ads
    targeting children and youth.
  • Food manufacturers spend almost 7 billion
    annually on advertising, and 75 of this is
    allocated to television.

137
Food Advertisements
  • Fast-food restaurants alone spend over 3 billion
    a year in television ads targeted to children

138
Increased screen time can contribute to obesity
  • While watching TV, children may
  • snack more
  • watch more commercials for high-calorie and/or
    high-fat foods and select these foods
  • have a lower metabolic rate
  • substitute screen time for activities that burn
    more calories

139
The Burden of Obesity in North Carolina
  • Obesity-Related Chronic Disease

140
Obesity-Related Chronic Disease
  • More than half (53) of all deaths of North
    Carolinians are preventable.
  • Overweight and obesity are significantly
    associated with diabetes, high blood pressure,
    high cholesterol, asthma, arthritis, and poor
    health status.
  • Inadequate fruits and vegetables, lack of leisure
    time physical activity, obesity, and overweight
    make up 80 of N.C.s risk factor or behaviors.

141
Preventable Causes of Death in N.C.
State Center for Health Statistics, North
Carolina Department of Health and Human Services,
(2007).
142
The Burden of Obesity in North Carolina
  • Diabetes and Pre-diabetes

143
Diabetes Prevalence in North Carolina
  • In 2007, nearly one-in-ten (9.1) adults reported
    having been diagnosed with diabetes, higher than
    8.1 among U.S. adults.
  • Diabetes prevalence has more than doubled since
    1995.
  • More than 1.2 million adults have pre-diabetes or
    diabetes, and many are unaware of their
    condition.

144
Pre-diabetes and Obesity
  • Pre-diabetes is a precursor of type 2 diabetes.
  • Since 1995, the prevalence of obesity in North
    Carolina increased by about 70 percent.
  • Overweight individuals are more than twice as
    likely to develop diabetes as healthy-weight
    individuals. Among the obese, the risk is three
    times greater, and is six times greater for the
    morbidly obese.

145
Diabetes Hospitalization in North Carolina
  • In 2006, 38.1 of adults reported never having
    had diabetes screening.
  • In 2006, 16,219 North Carolinians were discharged
    from the hospital after receiving care for
    diabetes as the primary admitting diagnosis.
  • Hospitalization costs associated with the
    principal diagnosis of diabetes reached 257
    million in 2006.

146
Diabetes Mortality in North Carolina
  • Diabetes ranked as the 7th leading cause of death
    in North Carolina in 2006.
  • Diabetes was the 4th leading cause of death among
    African Americans in North Carolina and third
    among American Indians.
  • Diabetes prevalence increases with age, affecting
    nearly one in every ten adults over 35 years old
    in 2006 in North Carolina.

147
Childhood Diabetes in North Carolina
  • Several national studies have reported increases
    in prevalence and incidence of type 2 diabetes in
    children and youth with one of the key links
    being obesity.
  • In 2005-2006, the North Carolina Annual School
    Health Services Reports for public schools
    reported that
  • 4,437 public school students had diabetes in
    2005-2006
  • 3,419 monitored blood glucose at school
  • 1,918 received insulin injections at school
  • 1,414 had insulin pumps

148
The Burden of Obesity in North Carolina
  • Heart Disease and Stroke

149
Heart Disease and Obesity
  • Excess weight in the form of body fat puts a
    strain on the entire circulatory system. 
  • People who are overweight or obese are more
    likely to develop heart disease and stroke even
    if they have no other risk factors. 

150
Heart Disease and Obesity
  • High blood pressure is twice as common in adults
    who are obese than in those who are at a healthy
    weight.
  • Overweight individuals are nearly 40 percent more
    likely to develop heart disease than healthy
    weight individuals the rate increases to 50
    percent for obese individuals.
  • Morbidly obese persons have an elevated risk of
    nearly 70 percent.

151
High Blood Pressure Among Children
  • High blood pressure in children is strongly
    correlated with being overweight.
  • The percentage of children with high blood
    pressure in the U.S. appears to be increasing as
    the percentage of children and youth who are
    overweight increases.

152
The Burden of Obesity in North Carolina
  • Kidney Disease

153
Kidney Disease and Kidney Failure
  • Adults who are obese have up to a 7 times greater
    risk of kidney failure than adults at a healthy
    weight (even after adjustment for blood pressure
    and diabetes status).
  • Results suggest that even a mildly overweight
    person is roughly 90 more likely to develop
    end-stage renal failure than a person at a
    healthy weight, with the risk reaching over 700
    greater for the morbidly obese.

154
The Burden of Obesity in North Carolina
  • Cancer

155
Cancer
  • About 41,000 new cases of cancer in 2002 in the
    United States were estimated to be due to
    obesity.
  • 14 percent of cancer deaths among men and 20 of
    cancer deaths among women may be due to
    overweight and obesity.

156
The Burden of Obesity in North Carolina
  • Asthma

157
Asthma
  • Obesity is associated with a higher prevalence of
    asthma.
  • Obesity was significantly related to use of
    prescription asthma inhalers, asthma
    episodes/attacks, and emergency room (ER) visits.
  • Asthmatics who are obese
  • have to use prescription asthma inhalers more
    often than non-obese asthmatics
  • have more asthma episodes/attacks and make more
    ER visits

158
Asthma
159
The Burden of Obesity in North Carolina
  • Disability

160
Disability
161
Disability Measures
162
The Burden of Obesity in North Carolina
  • Arthritis

163
Arthritis and Obesity
  • Obese adults are twice as likely to develop knee
    osteoarthritis as adults at a healthy weight.
  • For every two-pound increase in weight, the risk
    of developing arthritis is increased by 9 to 13.

164
Arthritis and Obesity
165
Suggestions from a Health Professional
166
Arthritis and Physical Activity
  • Among older adults with knee osteoarthritis,
    engaging in moderate physical activity at least
    three times per week can reduce the risk of
    arthritis-related disability by 47.

167
The Burden of Obesity in North Carolina
  • Mental Health

168
Mental Health and Obesity
  • Obese kids are almost six times more likely to
    have an impaired quality of life than healthy
    kids equal to that of kids undergoing treatment
    for cancer.
  • Overweight children are rejected by their peers
    more than any other handicap and are teased more
    than their normal weight peers.

169
Dangerous Behaviors Among Children
170
The Burden of Obesity in North Carolina
  • Oral Health

171
Oral Health and Obesity
  • Periodontitis (gum disease) occurs almost twice
    as frequently in obese individuals as in those at
    a healthy weight.
  • Periodontitis was found 76 more frequently in
    obese adults, aged 18 to 34 years, than in
    age-matched adults at a healthy weight.
  • Children who are obese are at an increased risk
    for dental caries.

172
The Burden of Obesity in North Carolina
  • Reproductive Complications

173
Pregnancy Risk Assessment Monitoring System
(PRAMS)
  • A surveillance system used by CDC and state
    health departments to collect state-specific,
    population-based data on maternal attitudes and
    experiences before, during, and shortly after
    pregnancy.
  • Process of administering PRAMS
  • The PRAMS sample of women who have had a recent
    live birth is drawn from the state's birth
    certificate file.
  • Each participating state samples between 1,300
    and 3,400 women per year.
  • Women from some groups are sampled at a higher
    rate to ensure adequate data are available in
    smaller but higher risk populations.
  • Selected women are first contacted by mail. If
    there is no response to repeated mailings, women
    are contacted and interviewed by telephone.

174
Reproductive Complications
  • There is evidence linking obesity to early
    pregnancy and recurrent pregnancy loss.
  • Among obese pregnant women, the risk of
    developing pregnancy-related hypertension and
    diabetes is significantly greater than it is
    among women with lower BMIs.

175
Obesity Among N.C. Mothers
176
Obesity Among N.C. Mothers
177
Reproductive Complications Mothers and Babies
  • Obese women are more likely to become diabetic,
    hypertensive, and develop pre-eclampsia during
    their pregnancies.
  • Infants of obese women are at elevated risk of
    neural tube defects such as spina bifida and
    other fetal abnormalities, as well as still birth
    and neonatal death.
  • Infants born to obese mothers are not only at
    risk of being of high birth weight (gt9.9 lbs),
    but are at higher risk of developing metabolic
    syndrome.

178
The Burden of Obesity in North Carolina
  • Appendices

179
The Burden of Obesity in North Carolina
  • Appendix I
  • Healthy People 2010 Objectives, U.S.

180
Healthy People 2010, U.S.
  • Launched in January 2000, by The Department of
    Health and Human Services
  • A comprehensive, nationwide health promotion and
    disease prevention agenda
  • Contains objectives to increase quality and years
    of healthy life and to eliminate health
    disparities by the year 2010

181
Healthy People 2010, U.S., Obesity Goals
  • 19-1 By 2010, increase the percentage of adults
    who are at a healthy weight to 60.
  • 19-2 By 2010, reduce the percentage of adults
    (20 years old or older) who are obese to 15.
  • 19-3 By 2010, reduce the percentage of children
    and adolescents (age 6-19 years old) who are
    obese to 5.

182
Healthy People 2010, U.S., Nutrition Goals
  • 19-5 By 2010, increase the percentage of persons
    aged 2 years and older who consume at least two
    daily servings of fruit to 75.
  • 19-6 By 2010 increase the percentage of persons
    aged 2 years and older who consume at least 3
    daily servings of vegetables, with at least one
    third being dark green or orange vegetables to
    50.
  • 19-7 By 2010, increase the percentage of persons
    aged 2 years and older who consume at least six
    daily servings of grain products, with at least
    three being whole grains to 50.
  • 19-8 By 2010, increase the percentage of persons
    aged 2 years and older who consume less than 10
    percent of calories from saturated fat to 75.
  • 19-9 By 2010, increase the percentage of persons
    aged 2 years and older who consume no more than
    30 percent of calories from total fat to 75.
  • 19-10 By 2010, increase the percentage of persons
    aged 2 years and older who consume 2,400 mg or
    less of sodium daily to 65.
  • 19-11 By 2010, increase the percentage of persons
    aged 2 years and older who meet dietary
    recommendations for calcium to 75.
  • 19-15 By 2010, increase the proportion of
    children and adolescents aged 6 to 19 years whose
    intake of meals and snacks at school contributes
    to good overall dietary quality.
  • 19-16 By 2010, increase the percentage of
    worksites that offer nutrition or weight
    management classes or counseling to 85.
  • 19-17 By 2010, increase the proportion of
    physician office visits made by patients with a
    diagnosis of cardiovascular disease, diabetes, or
    hyperlipidemia1 that include counseling or
    education related to diet and nutrition to 75.

183
Healthy People 2010, U.S., Physical Activity
Goals
  • 22-1. By 2010, reduce the percentage of adults
    who engage in no leisure-time physical activity
    to 20. (NC 200126.4).
  • 22-2 By 2010, increase the percentage of adults
    aged 18 years and older who engage in regularly,
    preferably daily, in moderate physical activity
    for at least 30 minutes per day to 30.
  • 22-3 By 2010, increase the percentage of adults
    who engage in vigorous physical activity that
    promotes the development and maintenance of
    cardio-respiratory fitness 3 or more days per
    week for 20 or more minutes per occasion to 30.
  • 22-4 By 2010, increase the percentage of adults
    who perform physical activities that enhance and
    maintain muscular strength and endurance to 30.
  • 22-5 By 2010, increase the percentage of adults
    who perform physical activities that enhance and
    maintain flexibility to 43.
  • 22-6 By 2010, increase the proportion of
    adolescents who engage in moderate physical
    activity for at least 30 minutes on 5 or more of
    the previous 7 days to 35.
  • 22-7. By 2010, increase the percentage of
    adolescents who engage in vigorous physical
    activity that promotes cardio-respiratory fitness
    3 or more days per week for 20 or more minutes
    per occasion to 85.
  • 22-8 By 2010, increase the proportion of the
    Nation's public and private schools that require
    daily physical education for all students a 47
    percent improvement for middle and junior high
    schools and a 150 percent improvement for senior
    high schools.
  • 22-9 By 2010, increase the percentage of
    adolescents who participate in daily school
    physical education to 50.
  • 22-10 By 2010, increase the percentage of
    adolescents who spend at least 50 percent of
    school physical education class time being
    physically active to 50.
  • 22-11 By 2010, increase the proportion of
    adolescents who view television 2 or fewer hours
    on a school day to 75.
  • 22-12 By 2010, increase the percentage of the
    Nations public and private schools that provide
    access to their physical activity spaces and
    facilities for all persons outside of normal
    school hours (that is, before and after the
    school day, on weekends, and during summer and
    other vacations) to 75.
  • 22-13 By 2010, increase the percentage of
    worksites offering employer-sponsored physical
    activity and fitness programs to 75.
  • 22-14 By 2010, increase the proportion of trips
    made by walking adults aged 18 years older
    making trips of 1 mile or less to 25 and
    children and adolescents, aged 5 to 15 years,
    making trips to school of 1 mile or less to 50.
  • 22-15 By 2010, increase the proportion of trips
    made by bicycling adults aged 18 years older
    making trips of 5 miles or less to 2 and
    children and adolescents, aged 5 to 15 years,
    making trips to school of 2 miles or less to 5.

184
The Burden of Obesity in North Carolina
  • Appendix II Healthy People 2010 Objectives,
    North Carolina

185
Healthy People 2010, North Carolinas Goals
  • North Carolinas 2010 Health Objectives set out a
    comprehensive and ambitious statewide agenda that
    provides a direction for improving the health and
    well being of North Carolinians over the next
    decade.
  • In 1999, Governor James B. Hunt, Jr., appointed
    the Governors Task Force for Healthy Carolinians
    through an Executive Order.
  • A major assignment of the Governors Task Force
    for Healthy Carolinians was to develop a list of
    health objectives for the Year 2010.

186
Healthy People 2010, N.C., Obesity Goals
  • By 2010, reduce the percentage of children and
    adolescents who are overweight or obese to 10
    (age 2-4), 10 (age 5-11), and 10 (age 2-18).
  • By 2010, reduce the percentage of adults who are
    obese to 16.8.
  • By 2010, increase the proportion of adults who
    are at a healthy weight.

187
Healthy People 2010, N.C., Nutrition Goals
  • By 2010, increase the proportion of adults eating
    five or more servings of fruits and vegetables
    each day to 25.1.
  • By 2010, increase the percent of middle school
    and high school students who eat any fruit or
    fruit juice on a given day to 95 for both middle
    and high school students.
  • By 2010, increase the percent of middle school
    and high school students who eat any vegetables
    on a given day to 95 for both middle and high
    school students.
  • By 2010, decrease the percent of middle school
    and high school students who eat high-fat meats
    on a given day to 50 for both middle and high
    school students.
  • By 2010, decrease the percent of students who eat
    high-sugar snack foods on a given day to 50 for
    both middle and high school students.

188
Healthy People 2010, N.C., Physical Activity
Goals
  • By 2010, Increase the percentage of middle and
    high school students who report participating in
    vigorous physical activity for at least 20
    minutes on 3 or more of the previous seven days
    to 80.
  • By 2010, Increase the proportion of middle and
    high school students who report participating in
    moderate physical activity for at least 30
    minutes on 5 or more of the previous seven days.
  • By 2010, Increase the percentage of adults (18
    years and older) who engage in physical activity
    for at least 30 minutes on 5 or more days of the
    week to 20.
  • By 2010, Reduce the percentage of adults (18
    years and older) who engage in no leisure-time
    physical activity to 29 .

189
The Burden of Obesity in North Carolina
  • Appendix III
  • Data Sources

190
Behavioral Risk Factor Surveillance System (BRFSS)
  • A state-based system of health surveys that
    collects information on
  • health risk behaviors
  • preventive health practices
  • health care access primarily related to chronic
    disease and injury
  • Process of administering BRFSS
  • Phone numbers are randomly selected throughout
    the state.
  • Business and nonworking numbers are omitted.
  • Individuals age 18 years and older are randomly
    selected from each household called.

191
Child Health Assessment and Monitoring Program
(CHAMP)
  • A statewide comprehensive surveillance system to
    monitor health and risk behaviors for children
    and adolescents (ages 0-17).
  • Process of administering CHAMP
  • NC-CHAMP- Follow-Back to BRFSS
  • During the BRFSS interview, households with
    children are identified as part of the
    demographic section.
  • The primary caregiver (PC) who is most
    knowledgeable with selected childs health is
    identified and an interviewer calls back within
    a week to administer CHAMP.

192
North Carolina Nutrition and Physical Activity
Surveillance System (NC-NPASS)
  • NC-NPASS includes height, weight, a few lab
    measures, and limited behavioral data
  • Comprised of data collected on children seen in
    NC Public Health sponsored Women, Infants and
    Children and child health clinics and some
    school-based health centers.

193
National Health and Nutrition Examination Survey
(NHANES)
  • Designed to assess the health and nutritional
    status of adults and children nationally by
    combining interviews and physical examinations.
  • Process of administering NHANES
  • Conducted as a series of surveys to represent the
    U.S. population of all ages.
  • A nationally representative sample of about 5,000
    persons each year across the country.

194
Pregnancy Risk Assessment Monitoring System
(PRAMS)
  • A surveillance project used by CDC and state
    health departments to collect state-specific,
    population-based data on maternal attitudes and
    experiences before, during, and shortly after
    pregnancy.
  • Process of administering PRAMS
  • Sample of women who have had a recent live birth
    is drawn from the state's birth certificate file.
  • Each state samples between 1,300 and 3,400 women
    per year by mail or interviewed by telephone.

195
Youth Risk Behavior Surveillance System (YRBSS)
  • A surveillance system to monitor priority
    health-risk behaviors among youth based on risk
    behaviors that contribute markedly to the leading
    causes of death, disability, and social problems.
  • Process of administering YRBSS
  • A national school-based survey is conducted by
    CDC as well as state, territorial, and local
    school-based surveys, conducted by education and
    health agencies.
  • Biennial surveys since 1991, drawing
    representative samples of The questionnaire,
    covering six categories of behavior, is completed
    by students in approximately 45 minutes in the
    classroom.
  • Survey is conducted biennially, every odd year at
    the national, state, and local levels for
    students in grades 912.
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