4%4-6%6% n/a source: mokdad et al., diabetes care 2000;23:1278-83 prevalence of diabetes among u.s....

4% 4-6% 6% n/a

Source: Mokdad et al., Diabetes Care 2000;23:1278-83

Prevalence of Diabetes among U.S. Adults, BRFSS, 1990

4% 4-6% 6% n/a


Prevalence of Diabetes among U.S. Adults, BRFSS, 1991-92

4% 4-6% 6% n/a



Prevalence of Obesity* among U.S. Adults BRFSS, 1985

(*Approximately 30 pounds overweight)



Source: Mokdad A H, et al. Am Med Assoc 2000;284:13

0

5

10

15

6-11y 12-17y

NHES I (1963-65 and 1966-70)

NHANES I (1971-74)

NHANES II (1976-80)

NHANES III (1988-91)

Changes in the Prevalence of Obesity (BMI > 95th Percentile)

Among U.S. Female Children and Adolescents

Changes in the Prevalence of Obesity (BMI > 95th Percentile)

Among U.S. Female Children and Adolescents

Consequences of Childhood and Adolescent Obesity

Consequences of Childhood and Adolescent Obesity

• Growth• Psychosocial• Hyperlipidemia• Hepatic steatosis• Abnormal glucose

metabolism• Persistence into adulthood

• Growth• Psychosocial• Hyperlipidemia• Hepatic steatosis• Abnormal glucose

metabolism• Persistence into adulthood

• Hypertension• Sleep apnea• Pseudotumor• PCOD• Cholelithiasis• Orthopedic

• Hypertension• Sleep apnea• Pseudotumor• PCOD• Cholelithiasis• Orthopedic

CommonCommon UncommonUncommon

Consequences of Adult ObesityConsequences of Adult Obesity

• Psychosocial• Cardiovascular

– Hyperlipidemia– Diabetes mellitus– Hypertension– Respiratory– Cardiac

• Psychosocial• Cardiovascular

– Hyperlipidemia– Diabetes mellitus– Hypertension– Respiratory– Cardiac

• Medical– Polycystic ovary disease– Gall bladder disease– Osteoarthritis– Cancer

• Pregnancy and the postpartum• Mortality

• Medical– Polycystic ovary disease– Gall bladder disease– Osteoarthritis– Cancer

• Pregnancy and the postpartum• Mortality

Annual Direct and Indirect Costs

Attributable to Obesity in the United States

(Billions of 1995 Dollars)

Annual Direct and Indirect Costs

Attributable to Obesity in the United States

(Billions of 1995 Dollars)Type 2 DM

CHD

Hypertension

Gallbladder

Breast Ca

Endometrial Ca

Colon Ca

Osteoarthritis

Total

Type 2 DM

CHD

Hypertension

Gallbladder

Breast Ca

Endometrial Ca

Colon Ca

Osteoarthritis

Total

DiseaseDisease Direct CostsDirect Costs Indirect CostsIndirect Costs$32.4

$ 7.0

$ 3.2

$ 2.6

$ 0.8

$ 0.3

$ 1.0

$ 4.3

$51.6

$32.4

$ 7.0

$ 3.2

$ 2.6

$ 0.8

$ 0.3

$ 1.0

$ 4.3

$51.6

$30.7

$ NA

$ NA

$ 0.1

$ 1.5

$ 0.5

$ 1.8

$ 12.9

$47.5

$30.7

$ NA

$ NA

$ 0.1

$ 1.5

$ 0.5

$ 1.8

$ 12.9

$47.5

Wolf and Colditz, Ob Res 1998;6:97Wolf and Colditz, Ob Res 1998;6:97

Factors Related to the Onset of ObesityFactors Related to the Onset of Obesity

• Altered dietary intake• Decreased physical activity• Increased inactivity


Shifts in Food Practices in the United States

Shifts in Food Practices in the United States

• Fast food consumption• Reduced frequency of family meals• Restrained eating, meal skipping• Consumption of soft drinks - increased

from 27 to 44 gal/y from 1972-92• 30,000 products in supermarkets• 12,000 new food products/year

• Fast food consumption• Reduced frequency of family meals• Restrained eating, meal skipping• Consumption of soft drinks - increased

from 27 to 44 gal/y from 1972-92• 30,000 products in supermarkets• 12,000 new food products/year

Netherlands 30 18 5 45 Germany 12 22 16 49England 8 12 14 62Italy 5 28 16 42Canada 1 10 14 74USA 1 9 3 84

Netherlands 30 18 5 45 Germany 12 22 16 49England 8 12 14 62Italy 5 28 16 42Canada 1 10 14 74USA 1 9 3 84

Modal Travel in Urban Areas: Europe and North America Percent of Trips by

Mode

Modal Travel in Urban Areas: Europe and North America Percent of Trips by

Mode

Transportation Quarterly 1997; 51:31Transportation Quarterly 1997; 51:31

Public Country Bicycle Walking Transport Car

Public Country Bicycle Walking Transport Car

Distribution of Hours of TV Per Day: NHES Youth Aged 12-17 in 1967-70 and

NLSY Youth Aged 12-17 in 1990

Distribution of Hours of TV Per Day: NHES Youth Aged 12-17 in 1967-70 and

NLSY Youth Aged 12-17 in 1990

0-10-1 1-21-2 2-32-3 3-43-4 4-54-5 5+5+

TV Hours (Youth Report)TV Hours (Youth Report)

Prevalence of Obesity by Hours of TV per Day: NHES Youth Aged 12-17 in 1967-70 and NLSY Youth Aged 10-15 in 1990

Prevalence of Obesity by Hours of TV per Day: NHES Youth Aged 12-17 in 1967-70 and NLSY Youth Aged 10-15 in 1990

Effect of Reduced Inactivity or Exercise on Obesity

Effect of Reduced Inactivity or Exercise on Obesity

Percent

Overweight

Change

Percent

Overweight

Change

Time (months) Time (months)00 44 88 1212

0 0

-5 -5

-10-10

-15-15

-25-25

-20-20

Exercise Exercise

Sedentary Sedentary

Epstein et al, Health Psychol 1995; 14:109 Epstein et al, Health Psychol 1995; 14:109

Intervention Sites to Prevent or Treat ObesityIntervention Sites to Prevent or Treat Obesity

• Medical Settings• School• Work Site• Community


Prevalence of weight loss advice from a health care provider among obese persons:

Prevalence of weight loss advice from a health care provider among obese persons:

Did not receive advice58%

Receive advice42%

Galuska DA et al. JAMA 1999

Weight Loss Advice and Self-reported Attempts to Lose Weight

(BRFSS, 1996)

Weight Loss Advice and Self-reported Attempts to Lose Weight

(BRFSS, 1996)

1

2.8

0

0.5

1

1.5

2

2.5

3

No Yes

Advised to lose weight

Odds ratio

Galuska DA et al. JAMA 1999

57.6% 79.5%

School-based Approaches to Treat or Prevent Obesity

• Physical education classes• Media curricula and TV turnoffs• Competitive foods and pouring contracts• Comprehensive school-based interventions


Daily Physical Education Classes in School (9-12th graders)

Daily Physical Education Classes in School (9-12th graders)

Year

19911997

Year

19911997

%

42%27%

%

42%27%

Source: YRBSSource: YRBS

Effects of Increased Choices and Reduced Price on Fruit and Vegetable Consumption

0

10

20

30

40

Jeffery et al, Prev Med 1994; 23:788Jeffery et al, Prev Med 1994; 23:788

Fruits(#/day)Fruits(#/day)

InterventionInterventionBaselineBaseline Follow-upFollow-up

Vegetables(lbs/day)

Vegetables(lbs/day)

Effects of the Promotion of Low-fat Items in Vending Machines

Effects of the Promotion of Low-fat Items in Vending Machines

0

100

200

300

400

500

600

Baseline Low Price Follow-up

Regular

Low-fat

Effects of Planet Health on Obesity* Prevalence

Effects of Planet Health on Obesity* Prevalence

School Baseline Followup

Girls ControlIntervention

21.5%23.6%

23.7%20.3

Boys ControlIntervention

34.7%29.3%

31.827.8

*BMI and TSF> 85th percentile**p< 0.05*BMI and TSF> 85th percentile**p< 0.05

Coca Cola HealthWorks/POWERaDECoca Cola HealthWorks/POWERaDE

Community-based Approaches

• Communications• Community programs• Environmental change

– Sidewalks and bicycle trails– Access– Neighborhood safety– Building design– Urban planning

• Communications• Community programs• Environmental change

– Sidewalks and bicycle trails– Access– Neighborhood safety– Building design– Urban planning

Community Structure and Physical Activity

4%4-6%6% n/a source: mokdad et al., diabetes care 2000;23:1278-83 prevalence of diabetes among u.s....

Documents

adults brfss

prevalence of obesity

pounds overweightsource

prevalence of diabetes

diabetes care

food practices

new food productsyearshifts

onset of obesitynetherlands