Current Status, Future Impact and Community Solutions

1. Current Status, Future Impact and Community Solutions Critical Issues Facing Today’s Youth: A Forum on Childhood Obesity April 5, 2007 Lea Susan Ojamaa, MPH Community Liaison Coordinator Division of Health Promotion and Disease Prevention MA Department of Public Health

2. Obesity Trends* Among U.S. AdultsBRFSS, 1985 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

3. Obesity Trends* Among U.S. AdultsBRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

4. Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

5. Obesity Trends* Among U.S. AdultsBRFSS, 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

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

7. Overweight and Obesity in Massachusetts Adults • 56% of adults are overweight or obese • 21% of adults are obese 2005 BRFSS, MDPH

9. Overweight and Obesity in Massachusetts Children and Youth • More than one third of children aged 2 to 5 years that participate in the WIC program are either at risk (17%) or already overweight (16.6%) 2003 MA PedNSS, MDPH • 27% of all high school students are either at risk for overweight (16%) or definitely overweight (11%) on the basis of their Body Mass Index. This is significantly higher than the 23% found in 1999, when height and weight questions were first included in the YRBS 2005 MYRBS, MDOE

10. Chronic Disease in Massachusetts Adults • 10% are living with asthma; 14% have had asthma during their lifetime • 9% have heart disease • 6% have been diagnosed with diabetes; it is estimated that an additional 2% remain undiagnosed • 3% have had a stroke 2005 BRFSS, MDPH

11. Burden - Health Care Costs • In 2003, hospitalization charges for heart disease and stroke were $1.66 billion • Estimated direct costs of overweight and obesity in 2003 were $1.8 billion • Hospitalization charges for diabetes averaged $490 million a year from 1996-1999

12. Burden - MA Lives Lost in 2004 • Heart disease was the leading cause of death, accounting for 25.3% of all deaths (13,792 lives) • Cancer claimed 13,312 lives, accounting for 24.5% of all deaths • 3,252 people died from a stroke (6% of all deaths) • Diabetes was the 8th leading cause of death, accounting for 2.4% of all deaths (1,327), when counted as either an underlying or contributing cause (diabetes-related), diabetes was associated with 3,987 or 7.3% of all deaths

13. Modifiable Risk Factors • Nutrition • Activity patterns

14. Nutrition and Physical Activity in Massachusetts Adults • 29% eat the recommended five or more servings of fruits and vegetables a day • 53% get regular physical activity 2005 BRFSS, MDPH

15. Nutrition and Physical Activity in Massachusetts Youth • 10% eat the recommended five or more servings of fruits and vegetables a day • 63% engage in vigorous physical activity for 20 minutes at least three times per week • 25% engage in moderate physical activity at least five times per week • 59% attend a PE class one or more times in average school week • 33% of students watch three or more hours of television on an average school day 2005 MYRBS, MDOE

16. Most Common Approaches to Health Behavior Change Trying to change individual behavior directly through: • Education • Awareness • Early Intervention

17. What’s Wrong With This Approach? • Knowledge alone does not alter behavior • Individual behavior is determined to a large extent by social environment

18. “ It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change.” Institute of Medicine

19. Socio-Ecological Framework

20. Individual vs. Environmental • Individual approaches focus on helping people develop the knowledge, attitudes, and skills they need to change their behavior • Environmental approaches focus on creating an environment that makes it easier for people to engage in healthy behavior

21. Public Health and the Built Environment • Obesity • Diabetes • Asthma • Heart Disease and stroke • Cancer • Injuries

22. Impact of Sprawl on Health •  Air and water pollution •  Car crashes •  Pedestrian injuries •  Physical activity •  Social cohesion/social capital

23. What Communities Can Do • Areas of Focus • Active Living • Recreation and Open Space • Walking and Bicycling • Safety • Healthy Eating • Disease Prevention and Emergency Care

24. Community Initiatives - Active Living • Maintain and promote greenspace/conservation land by, in part, preventing over development • Connect neighborhoods, schools, stores and parks with walking/biking trails and sidewalks • Establish a sidewalk committee to assess walkability of community, accessibility for use by all residents, and maintenance needs • Assess municipality to identify potential locations and support for shared use paths • Add bike lanes and proper signage to key roads • Develop walk-to-school programs, utilizing the “safe routes to school” model where appropriate

25. Community Initiatives - Pedestrian Safety • Separate pedestrians from vehicles through signaling, refuge islands, wide sidewalks and bike paths • Make pedestrians more visible by improving lighting and utilizing raised intersections • Utilize traffic calming measures to reduce vehicle speeds

26. Community Initiatives - Healthy Eating • Attract grocery stores to under-served areas • Improve transportation options to grocery stores and other large food outlets • Establish farmers’ markets and/or community gardens • Increase use of locally grown foods in schools

27. Role for Public Health • Collaborate with other disciplines • Transportation • Planning • Engineering • Smart Growth coalitions • Public Health brings • Data • Effective strategies • Skills in reaching the public and policy makers

28. Contact Information • Lea Susan Ojamaa, Community Liaison Coordinator 617-994-9843 lea.ojamaa@state.ma.us • Lynda Graham-Meho, Community Liaison, Northeast Region 978-851-7261 x4067 lynda.graham-meho@state.ma.us