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Pat Crawford, DrPH, RD

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Title: Pat Crawford, DrPH, RD


1
Health Disparities

Food Insecurity
Obesity
Connecting the Dots
Pat Crawford, DrPH, RD Adjunct Professor,
Nutrition Specialist and Co-Director Center for
Weight Health University of California at
Berkeley
2
  • OUR MISSION
  • Provide leadership for the development of
    interdisciplinary science-based solutions to
    weight, health and hunger related problems
  • visit http//nature.berkeley.edu/cwh/index.html

3
CWH Conducting epidemiologic studies
  • Longitudinal development of obesity in children
  • Development of eating patterns in Black and White
    girls
  • Effects of pregnancy on adolescent growth and
    health
  • Childhood factors associated with the development
    of peak bone mass in young women

4
CWH Conducting intervention studies
  • Sodas out of Schools (SOS) a high school
    beverage intervention
  • Evaluation of Californias SB 19 Pupil
    Nutrition Act an elementary and middle school
    nutrition physical activity intervention
  • Prevention of type 2 diabetes in at-risk African
    American children a collaboration with the YMCA

5
CWH Supporting community efforts
  • Developing Children Weight What
  • communities can do how-to kit
  • Supporting the development of Videonovelas
  • and Fotonovelas Fit Families For parents
  • who want the most for their children
  • Creating Lets Get Moving materials for
  • parents and teachers of pre-school aged children
  • Providing evaluation support for Department of
  • Education and WIC
  • Working with local Cooperative Extension on
    outreach research

                                         
6
CWH Synthesizing literature
  • Pediatric Overweight A Review of the
    Literature (CA Dept. of Health Services)
  • Determinants of Energy Imbalance
  • (CDC-SIP-07) soon to be published by CRC
    Press
  • Prevention of Type 2 Diabetes in Youth
  • Prevention and Treatment of Childhood Obesity
    (An evidenced-based position paper for the
    American Dietetic Association) in press

7
CWH Providing resources
  • Website http//nature.berkeley.edu/cwh/index.html
  • Listserv click on website to join
  • Lectures and Conferences

Mark your 2007 Calendar! January 2326,
2007 California Child Obesity Conference Marriott
Hotel, Anaheim http//www.cce.csus.edu/cts/co07/in
dex.htm
8
Definitions
  • BMI (metric) weight (kilograms)/height2
    (meters)
  • BMI (American) weight (pounds)/height2 (inches)
    x 703

9
Definitions for Children
95th percentile Overweight
85th percentile At risk for overweight
5th percentile Underweight
10
Today we are going to play Fact or Fiction
The rules are simple Will I say, Fact or
Fiction? If it is a Fact wave your arms If it
is Fiction stomp your feet
11
Today for the first time, there are almost as
many overweight children as there are overweight
adults
Fact or Fiction?
12
Stomp your feet Fiction
There are over 4 times as many overweight adults
as there are overweight children.
13
But we are very concerned about childhood because
pediatric overweight has increased by about 300
in the last 30 years.
Fact or Fiction?
14
Wave your arms Fact
Overweight has tripled for children adolescents.
15
As a comparison Changes among adults
16
The risk of pediatric overweight is similar for
low income children regardless of race or
ethnicity.
Fact or Fiction?
17
Stomp your feet Fiction Rates of overweight in
young low income children are significantly
greater for Hispanic and American Indian
children. (The disparity is even greater when
analyses are not adjusted for income.)
PedNSS 2001 data
18
Racial ethnic disparities in child obesity
rates are getting larger.
Fact or Fiction?
19
Disparitiesare increasing
Wave your arms Fact
SOURCE Centers for Disease Control and
Prevention, National Center for Health
Statistics, National Health and Nutrition
Examination Survey.
20
In the last 30 years
  • Obesity has increased in
  • Both sexes
  • All age groups
  • All racial/ethnic groups
  • All income levels

21
  • However, those at the
  • lowest income levels have increased the most.

Fact or Fiction?
22
Wave your arms Fact
  • Overweight has replaced malnutrition as the most
    prevalent nutritional problem among the poor.

23
Why is obesity increasing?
and why is obesity increasing faster in
low-income and food insecure families?
24
Sociodemographic factors?
Genetics?
Biologic factors?
Environmental changes?
Economics?
25
Genetics?
  • Heritability of body fatness is believed to be
    about 65. This is similar to heritability of
    schizophrenia (68) and greater than that of
    breast cancer (45)

Tuomilebb, NEJM 2001
26
Sociodemographic Factors?
  • Household Income
  • Parental Education
  • Family Composition
  • Acculturation
  • Food Insecurity

27
  • Obesity risk associated with low income
    overshadows effects of race and ethnicity.

Fact or Fiction?
28
Differential association between household income
and overweight by race
Stomp your feet Fiction
Patterson Crawford, 1997
29
Acculturation
  • Second- and third-generation Asian and Mexican
    American children are more likely to be
    overweight than first generation children.

Fact or Fiction?
30
Rates of adolescent obesity for immigrants
Wave your arms Fact
Obesity defined as 85th percentile
Source Popkin BM, Udry JR. Adolescent Obesity
Increases Significantly in Second and Third
Generation U.S. Immigrants The National
Longitudinal Study of Adolescent Health. J Nutr
1998 Apr128(4)701-6.
31
Food Insecurity
  • Food insecurity is a risk factor for obesity in
    low income adults and children.

Fact or Fiction?
32
Food insecurity is associated with obesity in
women, but not in men or children.
Stomp your feet Fiction
Townsend M, 2001
33
Biologic Factors?
  • Those exposed to inadequate or fluctuating food
    consumption generate adaptive methods to achieve
    a high level of efficiency in the use of energy
    and deposition of fat.
  • Those malnourished in early pregnancy may have
    impaired mechanisms for handling nutrients, which
    leads to a greater susceptibility to obesity.

34
Environment Factors?
  • Food availability
  • Beverage shifts
  • Portion size shifts
  • Food ads
  • Automobiles
  • Neighborhood design
  • TV video games
  • Sedentary jobs
  • Etc.

35
Secular Trend of Kcal
2800
2500
Calories per person per day
2000
Adapted from Putnam et al. Food Review, 2002.
36
How is this happening?
1 oz
6 oz
8 fl oz
32-64 fl oz
16 cups
3 cups
Trends from 1957-2001 (Nicklas, 2001)
37
Secular Trends in Sweetened Beverage Consumption
38
Television hours are increasing
NHANES III, 1988-1994 8-16 year old children
adolescents Crespo et al. Arch Pediatr
Adolesc., 2001.
39
Automobile time is increasing
40
But why are low-income persons at higher risk for
obesity?
  • First, energy-dense foods cost less, encouraging
    a shift to foods that provide the maximum
    calories for the least cost among low-SES
    households

(Drewnowski 2004)
41
  • Second, the food industry markets mass,
    low-quality products with higher fat and sugar
    content to sectors with less purchasing power.

(Aguirre P, Obesity and Poverty, 2000)
42
  • Third, a healthy basket of food has been found to
    cost more in disadvantaged areas than in affluent
    areas

(Acheson D, 1998)
43
  • Fourth, children from low income families were
    less likely to participate in physical activities
    in school PE, as well as programs outside of
    school.
  • (Sallis, 1996)

44
  • Fifth, adolescents from low income families
    participate in less vigorous physical activity,
    even after controlling for gender and
    race/ethnicity

(Lowry, 1996)
45
Economists say that technological change has

the
of consuming calories
and
the
of expending calories
Fact or Fiction?
46
Wave your arms Fact

The
of consuming calories has decreased, while
The
of expending calories has increased.
(Phillipson Posner, 1999)
47
What can be done?
48
First
  • Understand that the poor need
  • more nutrient dense food
  • to prevent malnutrition,
  • to promote health,
  • to prevent hunger, and also
  • to prevent obesity.

49
Second
  • Understand that individual choices are made in a
    community or environmental context.
  • Individuals will chose the
  • tastiest,
  • most fun,
  • cheapest, and
  • most convenient options

50
  • Policy makers must help promote healthy choices
    which are fun, cheap, and convenient.

51
Actions for anti-poverty, anti-hunger, and
anti-obesity advocates
  • Find ways to incorporate nutritious foods and
    nutrition education in what is distributed by
    food banks and other assistance agencies
  • Ensure that programs linking low-income groups to
    healthy foods (e.g. WIC Farmers Market Nutrition
    Program) are funded, promoted, and used
  • Ensure that the school breakfast and lunch
    programs meet nutrition standards and are utilized

52
  • Support grass-roots community efforts to healthy
    environments.
  • Urge stakeholders in each sector of society
    (schools, worksites, built environment,
    transportation, advertising, media, food
    beverage supply system, insurance health care,
    community groups, and government) to play a role
    in the solution.
  • Gather, share, and promote best practices. (CWH
    website Governors Summit on Obesity Resource
    Kit, September 2005)
  • Use the Spectrum of Prevention to provide a
    multi-level approach to obesity prevention.
  • Prevention Institute

53
Spectrum of Prevention
Influencing Policy and Legislation
Changing Organizational Practices
Fostering Coalitions and Networks
Educating Providers
Promoting Community Education
Strengthening Individual Knowledge and Skills
Prevention Institute
54
  • Remember
  • An environmental versus an individual approach to
    prevention of obesity and hunger
  • reaches the hard-to-reach population
  • is more cost-effective
  • is more sustainable

55
(No Transcript)
56
Together we have the capacity to improve the
health status of our population and reduce
obesity, poverty, and hunger rates.
Fact or Fiction?
57
Wave your arms Fact
  • We have the capacity
  • and the will is building!
  • http//cnr.berkeley.edu/cwh
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