OBESITY: Health Crisis in Orange County Orange County Health Needs Assessment Poor Diet + No Exercise = FAT Why are so many children and adults getting fat? While it is true that several factors have contributed to the rise in overweight and obesity for both youth and adults, the main culprits are poor diet and lack of physical activity. Eating too much and eating poorly are common causes of weight gain. More and more people have come to rely on highcalorie pre-packaged meals, such as those from fast food restaurants. These types of meals tend to have more sugar, fat, calories and salt. In addition, the portions are often supersized. It s a simple equation: when people eat larger portions that are high in fat and calories, they are more likely to gain weight, especially when combined with a lack of physical activity. Physical activity levels have shown a marked decrease, as modern lifestyles, technology, and conveniences have increasingly led to a less active way of life for many. Jobs have moved inside buildings and behind desks. Transportation, even for short trips, is primarily by car. Television, computers and video games keep kids indoors and on the couch. Additionally, due to hectic schedules, people are not making time for physical activity. Less physical activity and more consumed calories lead to expanding waistlines and poor health. There are a variety of factors, besides diet and exercise, that can influence why some people are more prone to obesity than others. For example, genetic background, environment, and socioeconomic status all contribute to the likelihood of obesity. However, none of these directly cause obesity. On the other hand, poor diet and sedentary lifestyles have become increasingly common the recent and epidemic rise in the incidence of obesity in Winter 2005 Inside: Who s Fat in Orange County? Do We Know We Have a Problem? 2 3 Health Impacts 4 Cost in Health Care Dollars Examining Disparities 5 6 Lifestyle Factors 8 Progressing Towards a Healthier Future 9 The Health Benefits of Fruits and Vegetables The 2005 Dietary Guidelines for Americans recommends that adults and children eat 2 1/2 to 61/2 cups of colorful fruits and vegetables every day for better health. 1 Improving dietary practices and increasing physical activity are major strategies for preventing many of the most common chronic diseases, such as heart disease, cancer, obesity, and type 2 diabetes. 2 Being overweight or obese is related to an increased risk of several major diseases and conditions. Simple lifestyle changes, such as including fruits and vegetables in your diet, can lead to improved health overall, as well as reduce the possibility of developing diabetes, high blood pressure, heart disease, or other obesity related conditions. 3 Weight Status: Studies suggest that effective weight loss strategies should focus on eating a greater quantity of healthy foods, rather than on simply eating less. Diabetes: Fruit and vegetable consumption may be associated with reduced risk of developing diabetes and improved control of blood sugar levels. Hypertension: Data indicates that diets including a high intake of fruits and vegetables can be effective at reducing blood pressure.
Defining Overweight and Obese The technical definitions of the terms overweight and obese are determined by the Body Mass Index (BMI), which is the mathematical ratio of an individual s weight to their height. According to the CDC, BMI is closely correlated with body fat. 4 Adults who have a BMI of 25 to 29.9 are considered overweight, while those with a BMI of 30 or greater are considered obese. While BMI is a useful tool, overweight may or may not mean fat, especially for athletes, because lean muscle can also increase weight. Therefore, other factors must be considered, such as muscle mass in proportion to fat, to determine if an adult is truly overweight, obese, or simply muscular. For children, being overweight has traditionally been relative, defined in comparison to the weight of others of the same age. Because children are still growing, measuring their BMI is not as straightforward. The BMI definition for overweight varies based on age because children s body fat composition changes over the years as they grow, and girls and boys differ in their body fat composition as they mature. 5 The BMI for children, also referred to as BMI-for-age, is plotted on gender specific growth charts published by the CDC. These charts are used from 2 to 20 years of age to determine if a child or teen is overweight. The BMI s of children and teens are evaluated based on percentile, with those who fall into 85th to 94th percentile being at risk of being overweight and those at the 95th or above percentile being overweight. The CDC does not designate a category of obese for children using the BMI because children may or may not become overweight or obese as adults. Who s Fat in Orange County? The CDC ranked obesity, after smoking, as the second leading cause of preventable death in the United States. It accounts for approximately 280,000 deaths in the United States each year. 6 Weight Status of Orange County Adults Normal weight, 47.0% Obese, 9.1% More than 1 million, or 53% of, Orange County adults aged 18 and over were overweight or obese, with a BMI score of 25 or higher. OCHNA found that nearly 13% of adults ages 45 and older were obese. A recent study by from the National Institute of Health reported that the long term risk of developing overweight and obesity was quite high. Over a 30 year period, nine out of 10 men and seven out of 10 women were overweight or became overweight. In addition, more than one in three were obese or became obese. 7 Weight Status of Orange County Children Normal weight, 65.2% At risk of overweight, 12.6% Overweight, 22.3% Overweight, 43.9% 34.9% of children were either at risk of being overweight or overweight, totaling over 190,000. Younger children were more likely to be overweight than older children, with 2 to 5 year olds making up approximately 38% of all overweight children. Boys were more likely to be overweight or at risk of overweight than girls, with approximately 13% more boys reporting BMI scores above the 85th Page 2 OBESITY: Health Crisis in Orange County
To catch the reader's attention, place an interesting sentence or quote from the story here. Do We Know We Have a Problem? When it comes to an individual s weight status, objective indicators such as the numbers on the scale or body mass index (BMI) only tell part of the story. An individual s perception of their own and others weight status is influenced by social, cultural and psychological dynamics. In general, Orange County adults had a fairly accurate picture of their own weight status. However, there were some notable differences between perception and reality along gender lines. Women were more likely to perceive themselves as overweight. In fact, just over 16% felt they were overweight when they were actually 69% of overweight children were described as being about the right weight by their parents. normal weight. On the other hand, approximately 16% of Orange County men were apparently unaware of being overweight or obese. Orange County parents were far less accurate when describing the weight status of their children. Well over twothirds of parents whose children were overweight (with a BMI score in the 95th percentile) were unaware that their child had a weight problem. Orange County Health Needs Assessment Page 3
Health Impacts There are a number of serious health problems that are associated with overweight and obesity. Additionally, OCHNA found that overweight or obese adults in Orange County were 12% more likely to be diagnosed with 3 or more major diseases than normal weight adults. Overweight or obese adults were more likely by 10.1% to indicate their health status as fair or poor as compared to normal weight adults. Adults With Fair or Poor Health by Weight Status 18.9% 20.0% 15.0% 8.8% 10.0% 5.0% 0.0% Normal Weight Overweight or Obese Diabetes Weight Status of Those Diagnosed with Diabetes Overweight or Obese 91% Overweight and obese individuals are at much greater risk of developing type 2 diabetes than those who are normal weight. Extra weight contributes to the body s inability to properly control blood sugar using insulin, and thus makes the development of diabetes more likely. 8 Normal Weight 9% The vast majority of Orange County adults who had been diagnosed with diabetes were also overweight or obese. Heart Disease Obesity is a major risk factor for coronary heart disease. This is partially because obesity also contributes to high blood pressure and high blood cholesterol. 9 Weight Status of Those Diagnosed with Heart Disease Overweight or Obese 67% Approximately three-quarters of those with heart disease were overweight or obese. 74% of those with high blood pressure were also overweight or obese. Normal Weight 33% Page 4 OBESITY: Health Crisis in Orange County
Arthritis Weight Status of Those Diagnosed with Arthritis Normal Weight 37% Overweight or Obese 63% Overweight is strongly implicated in arthritis, especially osteoarthritis. Research from the National Health and Nutrition Examination Survey (NHANES) has shown that obese women have almost a four times greater risk of osteoarthritis than lean women. For men, the risk was almost five times as great. 10 Well over half of adults diagnosed with arthritis were overweight or obese. Mental Health While overeating or excess weight do not qualify as psychiatric disorders, there can be a complex relationship between obesity and mental/emotional health. For example, a consequence of obesity is poor physical health, which is linked to depression and anxiety. Weight gain can also be a consequence of some of the behaviors associated with depression; lethargy and overeating are common symptoms of depression. 11 Weight Status of Those Diagnosed with a Mental Health Condition Overweight or Obese 78% Over three-quarters of those suffering from a mental health condition in Orange County were also overweight or obese. Cost in Health Care Dollars A diagnosis of a chronic condition due to being overweight or obese has an obvious impact on an individual s health, but such obesity-related illnesses impact economic factors in the community as well. California spends an estimated $7.7 billion dollars a year in MediCal and Medicare costs associated with obesity. 12 This cost estimate only includes direct medical expenses, including preventative, diagnostic and treatment services. It does not include the potential losses resulting from indirect costs, such as premature Normal Weight 22% death or decreased productivity in the workplace. Adults who are hospitalized for diabetes, a condition usually related to obesity, incur an estimated expense of $15,625 per hospital stay. 13 The cost of care for 500,000 people hospitalized for diabetes could be as much as $7.8 billion. 14 There are also negative and long lasting physical, emotional and social consequences of childhood obesity. The Institute of Medicine reported that among obese children aged 5 to 10 years, approximately 60% had at least one cardiovascular disease risk factor and 25% had two or more. 15 Other physical health consequences include type 2 diabetes, hypertension, elevated cholesterol, sleep apnea, menstrual abnormalities, impaired balance, and orthopedic problems. Emotional health problems include low self-esteem, negative body image, and depression. Social health consequences include stigma, negative stereotyping, discrimination, teasing and bullying, and social marginalization. Orange County Health Needs Assessment Page 5
Examining Disparities Socioeconomic status and ethnicity are not determining factors to obesity, but there are higher percentages of overweight adults and children among low-income and certain racial and ethnic groups in Orange County. Socioeconomics Socioeconomic status can affect obesity in a variety of indirect ways. For example, the nutritional quality of food available to low income households may be poor and low income residents may be more likely to live in environments adverse to outdoor activities. Children are especially affected by socioeconomic factors. A lack of financial or community resources means that low-income children may not be getting the nutrition or the physical activity they need to grow up healthy. A May 2004 survey by the California Endowment found that half (50%) of Californians rate their neighborhood as a poor or very poor place for children to get healthy foods. The figure was comparable (49%) in the region including Orange County. 16 Additionally, nearly 4 in 10 Californians rate their neighborhood as fair, poor, or very poor in its opportunities for children to get physical activity. This number is 35% in the region including Orange County. 17 The incidence of overweight children from low-income families in Orange County has increased across all age groups. Survey results reported by the Annual Report on the Conditions of Children showed that, from 2001 to 2002, the number of overweight two to five year olds from low-income families increased from 16.3% to 17%. 18 For the same years, the percentage of overweight children in the county aged 5 to 20, increased from 19.7% to 21.1%. 19 Additionally, the Healthcare Foundation of Orange County recently reported that 14.6% of low income children in the county are classified as obese. 20 Race and Ethnicity The OCHNA survey found some very marked differences in rates of obesity and overweight between different racial and ethnic groups. Both Latino/Hispanic adults and children are at the greatest risk of being overweight. In the United States, Hispanics or those of Hispanic origin, which includes Mexicans, South and Central Americans, Cubans, and Puerto Ricans, are the largest minority community and the fastest growing population. 21 Additionally, the Hispanic population is relatively young; Approximately 72% of Hispanic adults are overweight or obese. Nearly 42% of Hispanic children have a BMI above the 85th percentile 35% are less than 18 years old compared to only 25.7% of the total U.S. population. 22 In Orange County, Hispanic/Latino children make up almost half (47.4%) of the 0 to 5 year Overweight or Obese Adults Within Each Race/Ethnicity Overweight Obese 70.0% 61.9% 60.0% 50.0% 44.1% 49.2% 40.0% 30.0% 25.2% 20.0% 10.0% 9.9% 10.6% 10.5% 2.5% 14.9% 2.2% 10.7% 0.0% White Black Hispanic Other Asian/PI Vietnamese Other Page 6 OBESITY: Health Crisis in Orange County
old population. 23 If trends continue with no changes made to nutritional habits and physical activity, a growing Hispanic population with a high percentage of overweight and obese could have a tremendous future impact on the health care system in terms of the costs associated with obesity related health issues. When looking at the population of overweight children, it is clear that racial and ethnic minorities are overrepresented. This trend is substantiated by data from other reporting agencies in the county. Latino two to five year old and five to twelve year olds had the highest percentage of overweight, at 17% and 21% respectively in 2001. 24 In the twelve to 20 year old age bracket, African American youth had the highest percentage overweight (23%) followed closely by white and Hispanic youth, both at 20%. 25 The CalTEENS survey found that nearly one in three California adolescents was at risk or was already overweight, twice the expected rate; rates were highest among Latino and African- American youth. 26 Even though certain groups had higher percentages than others, the percentage of overweight children has increased for all racial and ethnic groups in Orange County over the past ten years. Making the Connection While data has shown differences in obesity rates between ethnic groups, it may not be race or ethnicity that is a determining factor. Since racial and ethnic minorities tend to be overrepresented in low-income groups, it may be that socioeconomics is, in fact, the more influential factor. With its overall economic wealth and prosperity, many assume that poverty is not an issue in Orange County. The 2003 American Community Survey (ACS), which is under the U.S. Census Bureau, reported that 9.6% (277,320) of the Orange County population are living below the federal poverty line. 27 OCHNA data, which coincides with that from ACS, shows that there are a number of poor families living in Orange County and that many of them are Hispanic. 12.7% (227,128) of Orange County households have an annual income of less than $25,000. 43.5% of respondents who have an annual household income of less than $25,000 are Hispanic, while 18.3% are Vietnamese. 72.2% (384,412) of Hispanics/ Latinos in Orange County are overweight or obese, with a BMI of greater than 25. Poverty influences obesity by acting as a barrier to affordable healthy foods and minimizing opportunities for an active lifestyle. The OC Register reported that people living in unsafe and unpleasant neighborhoods are 1 ½ times more likely to be overweight than adults in safer neighborhoods. 28 Low income residential areas are often adverse environments for maintaining a healthy weight, with such obstacles as poor lighting, unsafe streets, and lack of parks and playgrounds. In addition, it may be more difficult for low-income households to juggle allocating time and resources to work, care for their family, eat right, and exercise. Overweight and At Risk of Overweight Children Within Each Race/Ethnicity At risk of overweight (85th to <95th percentile) Overweight ( >95th percentile) 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 14.6% 15.0% 15.9% 11.1% 30.7% 9.7% 30.2% 16.6% 16.5% White Black Hispanic Other Vietnamese Asian/PI 7.0% Other 18.5% Orange County Health Needs Assessment Page 7
Lifestyle Factors Obesity is directly caused by the combination of two lifestyle factors: poor nutrition and lack of physical activity. Many adults and children in Orange County are falling short of health experts recommendations in these two crucial areas. Adults The Surgeon General recommends regular physical activity for improving health, preventing disease, and even promoting psychological well-being. More than 50% of adults in the U.S. do not get enough exercise to provide health benefits and 25% are not active at all in their leisure time. 29 In California, the trend is comparable. According to the 2003 Behavioral Risk Factor Surveillance System (BRFSS), more than half (53.3%) of California s adults do not meet the recommended guidelines for moderate physical activity, such as walking at least 30 minutes a day, 5 days a week. 30 The 2003 BRFSS also indicates that 71.4% of Californian adults do not meet the recommended guidelines for vigorous physical activity, such as running or biking 20 minutes a day, 3 days a week. 31 In the USDA s latest 2004 Dietary Guidelines for Americans, key recommendations were adequate nutrients within calorie needs and adherence to the 5-a-day program and the food pyramid. In California, only one third of adults reported eating 5 or more servings of fruits and vegetables a day, with the average consumption being just 2 servings a day. 32 Children Physical activity among children has declined significantly in recent years with the rising popularity of television, video games, and other sedentary forms of youth entertainment. The amount of daily moderate physical activity recommended for children is 60 minutes, an amount which many are missing out on. The CalTEENS survey found that fewer than one in three adolescents reported getting the recommended minimum of one hour of vigorous physical activity per day. 33 The survey also found that twice as much time was spent by teens watching television or playing video games as being physically active. 34 Children are getting more so-called screen time, that is, time spent in front of some kind of screen, whether it be television, video game, or computer. The average American child spends four hours and 41 minutes of screen time every day. 35 Television is without question the main culprit, as it has become the focal point in many American homes. As a result of these and other factors, there has been a significant decrease in daily physical activity for children. In addition, excessive television watching can also contribute to poor nutrition and eating habits. A research study at Tufts University found that families who had their television sets on during mealtimes consumed more meats, salt, soda, and quick-preparation foods and less fruits and vegetables. 36 A significant number of families do eat in front of the television. Survey results from another study found that 40% of Americans reported always or often watching television while eating dinner. 37 Orange County children spent an average of 2.8 hours daily in front of a screen. A child s likelihood of being overweight increased with the number of hours per day he or she watched television. Overweight children watched an average of 2.2 hours of television per day; normal weight children watched an average of 1.9 hours per day. Weight Status Within The Number of Hours Spent Watching Television 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 72.2% Normal weight 10.9% 66.4% Overweight ( >95th percentile) 21.5% 60.9% 26.1% 59.3% 27.6% None 1-2 hours 3-4 hours 5 or more hours Hours per day Page 8 OBESITY: Health Crisis in Orange County
Progressing Towards a Healthier Future The exposure of the obesity crisis has mobilized national, state and local agencies and organizations to develop various programs and campaigns to help both adults and children learn to make better choices in nutrition and to encourage them to be more physically active. Making a Difference Locally Orange County is taking steps to create a healthy environment and to assist its residents to make better choices. Most recently in 2005, KOCE, an Orange County public television station, produced a four-part series titled Our Children s Health which highlights food and fitness issues affecting local kids. With the goal of promoting a healthconscious community environment for children, the show features information about available resources, expert advice, local solutions, and a call-in portion where viewers questions are answered. Orange County is taking steps to create a healthy environment and to assist its residents to make better choices. The Register in Education Program, with funding assistance from Kaiser Permanente, is helping bring nutrition and physical activity education to school classrooms. Communities, policymakers, educators, planners, and health advocates are coming together to create healthier environments for Orange County residents. Efforts Orange County Health Needs Assessment include the Orange County Nutrition and Physical Activity Collaborative (NuPAC), the 5 A Day Power Play Campaign, the Steps to Healthy Living Campaign and much more. One such example in Santa Ana is Project ALISA (Active Living in Santa Ana). The goal of the project is to make accessible more opportunities for physical activity and to address the issues, such as crime, safety, and land use, which prevent residents from being physically active. Orange County hospitals are active in combating the obesity crisis, especially among adults. They provide seminars, workshops, and counseling on nutrition and weight control for their patients. Hospitals provide a comprehensive range of support, through counseling and support groups to weight reduction surgery. Several local health funding organizations have made addressing nutrition, physical activity and obesity prevention a priority, generating all types of collaborative efforts; projects range from advocating for local environmental and policy changes to the publication of a nutrition information supplement series in the local newspaper to the development of targeted curriculum for children s nutrition and exercise promotion. What is on the Horizon Damage Control The obesity crisis is impacting Americans at great cost, in terms of health and economics. The prevalence of chronic diseases, such as diabetes and heart disease, will increase among adults and children. Furthermore, the cost of obesity related health care will escalate dramatically if Americans do not change their lifestyles. Time, however, is on our side. We can look forward to a healthier future by changing the outlook and behavior of adults and youth, teaching them to be more physically active and to make wise decisions about food. In addition, we can improve the environment of our local communities to make it easier to make those healthy decisions. We can look forward to a healthier future by changing the outlook and behavior of adults and youth. Recommendations include: Changing the perception of overweight and obesity at all ages. The primary concern should be one of health and not appearance. Aggressive and consistent social marketing campaigns, similar to anti-smoking efforts, which focus on moderate eating and good nutrition targeted to both adults and youth. Culturally appropriate education in schools and communities about healthy eating habits and regular physical activity. This can be facilitated by channeling information through key community organizations that regularly interact with neighborhood residents. The development of tools and models for incorporating physical activity into existing health care and service provision settings; for example, quick health and fitness assessments, and other appropriate on-site activities. Increased research on disparities in the prevalence of overweight and obesity among racial, gender, socioeconomic, and age groups; research can then be used to identify effective and culturally appropriate interventions. Page 9
Orange County Health Needs Assessment 2024 N. Broadway, Ste. 100-101 Santa Ana, CA 92706 Phone: 714-547-3631 Fax: 714-547-3529 E-mail: staff@ochna.org About OCHNA OCHNA is a community based, public-private, not-for-profit collaborative, which serves as the primary source for data on the health needs and well-being of Orange County s 3 million residents. Data from the tri-annual OCHNA survey provides a comprehensive overview of the health status of Orange County and also serves to highlight the unmet health needs of residents. Since 1997, OCHNA has grown into the largest health assessment of its kind at the county level in California. To obtain a copy of the full-length 2005 Data Report, which contains in-depth data on obesity and a number of other health topics, or if you have any questions, please contact OCHNA. Technical Writer: Adriana Alexander We re on the Web! www.ochna.org We first make our habits, and then our habits make us. -John Dryden References 1 U.S. Department of Health and Human services and the USDA, 2005. New dietary guidelines will help Americans make better food choices, live healthier lives. 2 CDC, 2003. Overweight and obesity: Factors contributing to obesity. 3 Produce for Better Health Foundation, 2002. The Health Benefits of Fruits and Vegetables. 4 Center for Disease Control and Prevention (CDC), 2004. Defining overweight and obesity. 5 CDC, 2004. BMI for children and teens. 6 CDC, 2004. 7 National Heart, Lung and Blood Institute, 2005. Vast majority of adults at risk of becoming overweight or obese. 8 North American Association for the Study of Obesity, 2005. 9 American Heart Association, 2005. 10 American Obesity Association, 1996. 11 Harvard Mental Health Letter, 2004. 12 CDC, 2004. Overweight and obesity: Economic consequences. 13 Health Care Coverage Guide, 2004. Average California hospital charges. 14 15 Institute of Medicine, 2003. 16 California Endowment, May 2004. A survey of Californians about the problem of childhood obesity. 17 18 Children and Families Commission of Orange County, 2004. 10th Annual Report on the Conditions of Children. 19 20 The Healthcare Foundation of Orange County, 2003. Childhood obesity in Orange County. 21 Guzman, B., 2000. Census brief: the Hispanic population. 22 California Department of Finance, 2004. 23 24 Children and Families Commission of Orange County, 2004. 10th Annual Report on the Conditions of Children. 25 26 California Teen Eating Exercise and Nutrition Survey (CalTEENS), 2000. 27 American Community Survey, 2003. 28 Orange County Register, 2004. Creating a fit city. 29 CDC, 2004. The importance of physical activity. 30 Behavioral Risk Factor Surveillance System (BRFSS), 2003. 31 32 U.S. Department of Health and Human services and the USDA, 2005. New dietary guidelines will help Americans make better food choices, live healthier lives. 33 California Teen Eating Exercise and Nutrition Survey (CalTEENS), 2000. 34 35 TV Turnoff Network, 2003. Facts and figures about our TV habit. 36 Dietz, W. H., 1998. Journal of Nutrition. 37