4%4-6%6% n/a source: mokdad et al., diabetes care 2000;23:1278-83 prevalence of diabetes among u.s....
Post on 11-Jan-2016
215 Views
Preview:
TRANSCRIPT
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
Source: Mokdad et al., Diabetes Care 2000;23:1278-83
Prevalence of Diabetes among U.S. Adults, BRFSS, 1991-92
4% 4-6% 6% n/a
Source: Mokdad et al., Diabetes Care 2000;23:1278-83
Prevalence of Diabetes among U.S. Adults, BRFSS, 1993-94
4% 4-6% 6% n/a
Source: Mokdad et al., Diabetes Care 2000;23:1278-83
Prevalence of Diabetes among U.S. Adults, BRFSS, 1995-96
4% 4-6% 6% n/a
Source: Mokdad et al., Diabetes Care 2000;23:1278-83
Prevalence of Diabetes among U.S. Adults, BRFSS, 1997-98
Prevalence of Obesity* among U.S. Adults BRFSS, 1985
(*Approximately 30 pounds overweight)
Prevalence of Obesity* among U.S. Adults BRFSS, 1986
(*Approximately 30 pounds overweight)
Prevalence of Obesity* among U.S. Adults BRFSS, 1987
(*Approximately 30 pounds overweight)
Prevalence of Obesity* among U.S. Adults BRFSS, 1988
(*Approximately 30 pounds overweight)
Prevalence of Obesity* among U.S. Adults BRFSS, 1989
(*Approximately 30 pounds overweight)
Prevalence of Obesity* among U.S. Adults BRFSS, 1990
(*Approximately 30 pounds overweight)
Prevalence of Obesity* among U.S. Adults BRFSS, 1991
(*Approximately 30 pounds overweight)
Prevalence of Obesity* among U.S. Adults BRFSS, 1992
(*Approximately 30 pounds overweight)
Prevalence of Obesity* among U.S. Adults BRFSS, 1993
(*Approximately 30 pounds overweight)
Prevalence of Obesity* among U.S. Adults BRFSS, 1994
(*Approximately 30 pounds overweight)
Prevalence of Obesity* among U.S. Adults BRFSS, 1995
(*Approximately 30 pounds overweight)
Prevalence of Obesity* among U.S. Adults BRFSS, 1996
(*Approximately 30 pounds overweight)
Prevalence of Obesity* among U.S. Adults BRFSS, 1997
(*Approximately 30 pounds overweight)
Prevalence of Obesity* among U.S. Adults BRFSS, 1998
(*Approximately 30 pounds overweight)
Prevalence of Obesity* among U.S. Adults BRFSS, 1999
(*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
• 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
Factors Related to the Onset of ObesityFactors Related to the Onset of Obesity
• Altered dietary intake• Decreased physical activity• Increased inactivity
• Altered dietary intake• Decreased physical activity• Increased inactivity
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
Factors Related to the Onset of ObesityFactors Related to the Onset of Obesity
• Altered dietary intake• Decreased physical activity• Increased inactivity
• Altered dietary intake• Decreased physical activity• Increased inactivity
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
• 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%
Intervention Sites to Prevent or Treat ObesityIntervention Sites to Prevent or Treat Obesity
• Medical Settings• School• Work Site• Community
• Medical Settings• School• Work Site• Community
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
• 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
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
• Physical education classes• Media curricula and TV turnoffs• Competitive foods and pouring contracts• Comprehensive school-based interventions
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
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
• Physical education classes• Media curricula and TV turnoffs• Competitive foods and pouring contracts• Comprehensive school-based interventions
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
Intervention Sites to Prevent or Treat ObesityIntervention Sites to Prevent or Treat Obesity
• Medical Settings• School• Work Site• Community
• Medical Settings• School• Work Site• Community
Coca Cola HealthWorks/POWERaDECoca Cola HealthWorks/POWERaDE
Intervention Sites to Prevent or Treat ObesityIntervention Sites to Prevent or Treat Obesity
• Medical Settings• School• Work Site• Community
• Medical Settings• School• Work Site• Community
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
top related