Childhood Obesity: A Riverside County Perspective Obesity...Average weight in1960 ¾ Man = 166.3 lbs...

Childhood Obesity: A Riverside County Perspective

Danyte S. Mockus, PhD, MPHNovember 16, 2010

Riverside County Department of Public Health

STATUS OF OUR NATION AND COUNTY

Obesity Statistics

Between 1980–2008, obesity prevalence among U.S. adults doubled, and recent data indicate an estimated 34% of adults are obese (BMI ≥ 30) .

More than one in six U.S. children is obese, three times the rate in the 1970’s (BMI at or above the 95% percentile of the sex specific BMI for age growth charts).

According to 2006-2008 self reported data, Blacks had 51% higher prevalence of obesity, and Hispanics had 21% higher obesity prevalence compared with whites.

- Adapted from http://www.cdc.gov/obesity/downloads/CDC_Healthy_Communities.pdf

Average weight in1960

Man = 166.3 lbsWoman = 140.2 lbs10 year-old-boy = 74.2 lbs10 year-old girl = 77.4 lbs

Man = 191 lbsWoman = 164.3 lbs10 year-old-boy = 85 lbs10 year-old-girl = 88 lbs

Americans Slightly Taller, Much Heavier than 40 Years Ago. Published October 27, 2004. www.cdc.gov/od/oc/media/pressrel/r041027.htm

Average weight in 2002

Overweight versus ObeseHeight Overweight (lbs) Obese (lbs)5’0’’ 128 1535’2’’ 136 1645’4’’ 145 1745’6’’ 155 1855’8’’ 164 1975’10’’ 174 2096’0’’ 184 2216’2’’ 194 233

Global Trends in Obesity

Overweight - Prevalence in men aged 15 and over (2002, overweight = Body Mass Index ≥ 25 kg per meter squared). CDC. http://apps.nccd.cdc.go/dcpcglobalatlas/DietNutrition.aspx#WorldMap (accessed 12/01/07)

Obesity Trends* Among U.S. AdultsBRFSS, 1990

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. AdultsBRFSS 2005


No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsBRFSS 2009


No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

"The U.S. population may be inadvertently saving Social Security by becoming more obese."

Olshansky et al. A Potential Decline in Life Expectancy in the United States in the 21st Century. NEJM March 17, 2005; 352: 1138-45.

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

1963-70 1971-74 1976-80 1988-94 1999-2000 2001-02 2003-04 2007-08

6-11 years12-19 years

Prevalence of overweight among US children and adolescents

(Ogden CL, et al. 2007, 2010)

Geographic Patterns Among Low-Income, Preschool-Aged Children 2006-2008

“This may be the first generation of children who do not outlive their parents.”

-Deborah Taylor-TateCommissioner, FCC

CAUSES OF OBESITY

Genetic and Pre/PostnatalFactorsCombination and interaction of many factors

Pre/Postnatal factorsCaloric deprivation during critical periods in uteroMaternal insulin-dependent diabetesMaternal obesityHigher birth weightInfant feeding practices

Genetic backgroundPredisposition to obesity

(Ebbeling, et al., 2002; Kramer, et al., 1985, Rolland-Cachera, et al., 1995; Safer, et al., 2001; Whitaker & Dietz, 1998)

Behavioral and Environmental Contributing Factors

Increasing portion sizesIncreased saturated fat consumptionIncreased simple carbohydrate consumptionIncreased sugar-sweetened beverage consumption and energy-dense, nutrient poor food choicesDecreased physical activity Increased sedentary behavior

(AAP, 1997; Anderson, et al., 1998; Ebbeling, et al., 2002; Epstein & Goldfield, 1999; McGloin, et al., 2002)

Dietary Behaviors

Increased consumption of sugar sweetened beverages

Continued low consumption of fruitsand vegetables


Dietary Behaviors

Increased frequency of meals eaten away from home


The Food Environment

Increased number of fast food establishments in the U.S.

Lack of access to full service grocery stores selling affordable healthful foods

Less healthy food & beverage advertising aimed at children


Physical Activity

35.5% of adults do not engage in recommended levels of physical activity for health benefits (21) and 25.4% of adults report no leisure-time activity (23)

In 2009, 81.6% of high school students did not participate in 60 or more minutes of physical activity on any day of the previous 7 days (22).

Only 30.3% of high school students, grades 9-12, have daily P.E. (23).


Community Design & the Built EnvironmentStandardized Share of Mode for Trips to School:

National Personal Transportation Survey

0

10

20

30

40

50

60

1969 1977 1983 1990 1995 2001

Year

% o

f Trip

s

Car

Bus

Walk/bike

Public Transit

McDonald NC. Am J Prev Med 2007;32:509


Community Design & the Built EnvironmentEnvironmental factors beyond the control of individuals contribute to increased obesity rates by reducing the likelihood of healthy eating and active living behaviors.

Environmental factors that influence physical activity behavior (26, 27):

Lack of infrastructure supporting active modes of transportation, i.e. sidewalks & bike facilitiesAccess to safe places to play and be activeAccess to public transitMixed use & Transit Oriented Developments


CONSEQUENCES OF OBESITY

Obesity Increases the Risk for…High blood pressureHigh cholesterolHeart diseaseStrokeDiabetesCancer (colon, breast, ovarian, uterine, esophageal, kidney, blood, gallbladder, pancreas)

ArthritisHeartburnDisabilitySleep disordersAlzheimer’sDepressionInfertilityErectile DysfunctionUrinary IncontinenceBirth Defects

Top Ten Causes of Death in the United States

1. Heart Disease 616,0672. Cancer 562,8753. Stroke 135,9524. Lung Disease 127,9245. Accidents 123,7066. Alzheimer's disease 74,6327. Diabetes 71,3828. Influenza and Pneumonia 52,7179. Nephritis, nephrotic syndrome, nephrosis 46,44810. Septicemia 34,828

National Vital Statistics Report. Deaths: Final Data for 2007. CDC. http://www.cdc.gov/nchs/fastats/deaths.htm

Economic Consequences

9.1 percent of total U.S. medical expenditures (1998)

US: $78.5 billionCA: $7.7 billion

Direct medical costsPreventive, diagnostic, treatment services

Indirect costs Morbidity – Income lost from decreased productivity, restricted activity, absenteeism, bed daysMortality – Future income lost by premature death

(BRFSS 1998-2000; Finkelstein, et al., 2003; Wolf and Colditz, 1998; Wolf, 1998)

PREVENTING OBESITY

Why Should Local Governments Care?

The Cost of Obesity is High:

In 2008, the annual healthcare cost of obesity in the US was estimated to be as high as 147 billion dollars a year, double the amount a decade ago.

Annual medical expenses for the obese are estimated to be 42 percent higher than for a person of a healthy weight.


REASONS TO TREAT OBESE CHILDREN AND ADOLESCENTS

Increasing prevalencenearly tripled (6% to 17%) from 1980-2004

Obesity in childhood tracks into adulthood70% of obese children aged 10-13 will become obese adults

Health consequencese.g., cardiovascular disease, type 2 diabetes

Psychosocial consequencese.g., teasing, stigma, lower quality of life

CDC/NCHS, 2006; Ogden et al., 2002/2006; Schwimmer et al., 2000; Whitaker et al., 1997

CDC Framework for Preventing Obesity(adapted from IOM 2005)

Energy Intake Energy Expenditure

Energy Balance

Prevention of Overweight and Obesity Among Children, Adolescents, and Adults

Individual Factors

Behavioral Settings

Social Norms and ValuesHome and Family

School

Community

Work Site

Healthcare

Genetics

Psychosocial

Other Personal Factors

Food and Beverage Industry

Agriculture

Education

Media

Government

Public Health Systems

Healthcare Industry

Business and Workers

Land Use and Transportation

Leisure and Recreation

Food and Beverage Intake

Physical Activity

Sectors of Influence

Draft – last revised, March 24, 2005- Adapted from http://www.cdc.gov/obesity/downloads/CDC_Healthy_Communities.pdf

Target Behaviors for Change

CDC focuses on six target behaviors for the prevention of obesity and other chronic diseases

1. Increase physical activity

2. Increase consumption of fruits and vegetables

3. Increase breastfeeding initiation, duration, and exclusivity

4. Decrease consumption of sugar sweetened beverages

5. Decrease consumption of high energy dense, nutrient poor, foods

6. Decrease television viewing


CDC’s Recommended Strategies to Prevent Obesity

Strategies to Promote the Availability of Affordable Healthy Food & Beverages

1. Increase availability of healthier food and beverage choices in public service venues

2. Improve availability of affordable healthier food and beverage choices in public service venues

3. Improve geographic availability of supermarkets in underserved areas

4. Provide incentives to food retailers to locate in and/or offer healthier food and beverage choices in underserved areas

5. Improve availability of mechanisms for purchasing foods from farms6. Provide incentives for the production, distribution, and procurement

of foods from local farms



Strategies to Support Healthy Food and Beverage Choices

7. Restrict availability of less healthy foods and beverages in public service venues

8. Institute smaller portion size options in public service venues

9. Limit advertisements of less healthy foods and beverages

10. Discourage consumption of sugar-sweetened beverages



Strategy to Encourage Breastfeeding11. Increase support for breastfeeding

Strategies to Encourage Physical Activity or Limit Sedentary Activity Among Children and Youth

12. Require Physical Education in schools13. Increase the amount of physical activity in

PE programs in schools14. Increase opportunities for extracurricular

physical activity15. Reduce screen time in public service venues



Strategies to Create Safe Communities That Support Physical Activity

16. Improve access to outdoor recreational facilities17. Enhance infrastructure supporting bicycling18. Enhance infrastructure supporting walking19. Support locating schools in residential neighborhoods20. Improve access to transportation21. Zone for mixed-use development22. Enhance personal safety where people are or could be physically

active23. Enhance traffic safety in areas where persons are or could be

physically active

Strategy to Encourage Communities to Organize for Change24. Participate in community coalitions or partnerships to address obesity


For questions…

Danyte S. Mockus, PhD, MPHEpidemiologist,

Epidemiology and Program Evaluation BranchDepartment of Public Health

Riverside County Community Health AgencyOffice: 951.358.5557

Email: [email protected]

Childhood Obesity: A Riverside County Perspective Obesity...Average weight in1960 ¾ Man = 166.3 lbs...

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