Childhood Obesity: A Riverside County Perspective. Danyte S. Mockus, PhD, MPH November 16, 2010 Riverside County Department of Public Health

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1 Childhood Obesity: A Riverside County Perspective Danyte S. Mockus, PhD, MPH November 16, 2010 Riverside County Department of Public Health

2 STATUS OF OUR NATION AND COUNTY

3 Obesity Statistics Between , 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 self reported data, Blacks had 51% higher prevalence of obesity, and Hispanics had 21% higher obesity prevalence compared with whites. - Adapted from

4 Average weight in1960 Average weight in 2002 Man = lbs Woman = lbs 10 year-old-boy = 74.2 lbs 10 year-old girl = 77.4 lbs Man = 191 lbs Woman = lbs 10 year-old-boy = 85 lbs 10 year-old-girl = 88 lbs Americans Slightly Taller, Much Heavier than 40 Years Ago. Published October 27,

5 Overweight versus Obese Height Overweight (lbs) Obese (lbs)

6 Global Trends in Obesity Overweight - Prevalence in men aged 15 and over (2002, overweight = Body Mass Index 25 kg per meter squared). CDC. (accessed 12/01/07)

7 Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

8 Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19%

9 Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20%

10 Obesity Trends* Among U.S. Adults BRFSS 2005 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

11 Obesity Trends* Among U.S. Adults BRFSS 2009 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

12 "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:

13 Prevalence of overweight among US children and adolescents 20% 18% 16% 14% 12% 10% 8% 6-11 years years 6% 4% 2% 0% (Ogden CL, et al. 2007, 2010)

14 Geographic Patterns Among Low- Income, Preschool-Aged Children

15 This may be the first generation of children who do not outlive their parents. -Deborah Taylor-Tate Commissioner, FCC

16

17

18 CAUSES OF OBESITY

19 Genetic and Pre/PostnatalFactors Combination and interaction of many factors Pre/Postnatal factors Caloric deprivation during critical periods in utero Maternal insulin-dependent diabetes Maternal obesity Higher birth weight Infant feeding practices Genetic background Predisposition to obesity (Ebbeling, et al., 2002; Kramer, et al., 1985, Rolland-Cachera, et al., 1995; Safer, et al., 2001; Whitaker & Dietz, 1998)

20 Behavioral and Environmental Contributing Factors Increasing portion sizes Increased saturated fat consumption Increased simple carbohydrate consumption Increased sugar-sweetened beverage consumption and energy-dense, nutrient poor food choices Decreased physical activity Increased sedentary behavior (AAP, 1997; Anderson, et al., 1998; Ebbeling, et al., 2002; Epstein & Goldfield, 1999; McGloin, et al., 2002)

21 Dietary Behaviors Increased consumption of sugar sweetened beverages Continued low consumption of fruits and vegetables - Adapted from

22 Dietary Behaviors Increased frequency of meals eaten away from home - Adapted from

23 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 - Adapted from

24 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). - Adapted from

25 Community Design & the Built Environment Standardized Share of Mode for Trips to School: National Personal Transportation Survey Car % of Trips Year McDonald NC. Am J Prev Med 2007;32:509 Bus Walk/bike Public Transit - Adapted from

26 Community Design & the Built Environment Environmental 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 facilities Access to safe places to play and be active Access to public transit Mixed use & Transit Oriented Developments - Adapted from

27 CONSEQUENCES OF OBESITY

28 Obesity Increases the Risk for High blood pressure High cholesterol Heart disease Stroke Diabetes Cancer (colon, breast, ovarian, ut erine, esophageal, kidney, blood, gallbladder, panc reas) Arthritis Heartburn Disability Sleep disorders Alzheimer s Depression Infertility Erectile Dysfunction Urinary Incontinence Birth Defects

29 Top Ten Causes of Death in the United States 1. Heart Disease 616, Cancer 562, Stroke 135, Lung Disease 127, Accidents 123, Alzheimer's disease 74, Diabetes 71, Influenza and Pneumonia 52, Nephritis, nephrotic syndrome, nephrosis 46, Septicemia 34,828 National Vital Statistics Report. Deaths: Final Data for CDC.

30 Economic Consequences 9.1 percent of total U.S. medical expenditures (1998) US: $78.5 billion CA: $7.7 billion Direct medical costs Preventive, diagnostic, treatment services Indirect costs Morbidity Income lost from decreased productivity, restricted activity, absenteeism, bed days Mortality Future income lost by premature death (BRFSS ; Finkelstein, et al., 2003; Wolf and Colditz, 1998; Wolf, 1998)

31 PREVENTING OBESITY

32 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. - Adapted from

33 REASONS TO TREAT OBESE CHILDREN AND ADOLESCENTS Increasing prevalence nearly tripled (6% to 17%) from Obesity in childhood tracks into adulthood 70% of obese children aged will become obese adults Health consequences e.g., cardiovascular disease, type 2 diabetes Psychosocial consequences e.g., teasing, stigma, lower quality of life CDC/NCHS, 2006; Ogden et al., 2002/2006; Schwimmer et al., 2000; Whitaker et al., 1997

34 CDC Framework for Preventing Obesity (adapted from IOM 2005) Home and Family School Community Work Site Healthcare Genetics Psychosocial Other Personal Factors Food and Beverage Intake Social Norms and Values Sectors of Influence Behavioral Settings Individual Factors Physical Activity Food and Beverage Industry Agriculture Education Media Government Public Health Systems Healthcare Industry Business and Workers Land Use and Transportation Leisure and Recreation Energy Intake Energy Expenditure Energy Balance Prevention of Overweight and Obesity Among Children, Adolescents, and Adults Draft last revised, March 24, Adapted from

35 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 - Adapted from

36 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 farms 6. Provide incentives for the production, distribution, and procurement of foods from local farms - Adapted from

37 CDC s Recommended Strategies to Prevent Obesity 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 - Adapted from

38 CDC s Recommended Strategies to Prevent Obesity Strategy to Encourage Breastfeeding 11. Increase support for breastfeeding Strategies to Encourage Physical Activity or Limit Sedentary Activity Among Children and Youth 12. Require Physical Education in schools 13. Increase the amount of physical activity in PE programs in schools 14. Increase opportunities for extracurricular physical activity 15. Reduce screen time in public service venues - Adapted from

39 CDC s Recommended Strategies to Prevent Obesity Strategies to Create Safe Communities That Support Physical Activity 16. Improve access to outdoor recreational facilities 17. Enhance infrastructure supporting bicycling 18. Enhance infrastructure supporting walking 19. Support locating schools in residential neighborhoods 20. Improve access to transportation 21. Zone for mixed-use development 22. Enhance personal safety where people are or could be physically active 23. Enhance traffic safety in areas where persons are or could be physically active Strategy to Encourage Communities to Organize for Change 24. Participate in community coalitions or partnerships to address obesity - Adapted from

40 For questions Danyte S. Mockus, PhD, MPH Epidemiologist, Epidemiology and Program Evaluation Branch Department of Public Health Riverside County Community Health Agency Office:

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