Chapter 8

1. 0 Chapter 8 Addressing the Obesity Epidemic: An Issue for Public Health Policy © 2006 Thomson-Wadsworth

2. Learning Objectives • Define the terms obesity and overweight as they apply to adults. • Define the terms overweight and at risk for overweight as they apply to children. • Describe the epidemiology of obesity and overweight among adults and children. © 2006 Thomson-Wadsworth

3. Learning Objectives • Explain how to assess and survey obesity and overweight in the population. • List and discuss determinants of obesity and overweight. • Discuss various interventions and intervention strategies for the prevention and treatment of obesity and overweight among adults and children. © 2006 Thomson-Wadsworth

4. Learning Objectives • Describe potential public health strategies to prevent obesity, including examples of current and proposed policies and legislation. © 2006 Thomson-Wadsworth

5. Introduction • During the past 15 years, obesity has emerged as a significant public health problem in both adults and children. • Genetics and societal and environmental factors contribute to the rising number of obese individuals. © 2006 Thomson-Wadsworth

6. Defining Obesity and Overweight • In adults, overweight is defined as a body mass index (BMI) between 25 and 29.9 whereas obesity is defined as a BMI greater than 30. • In children, overweight is defined as a BMI above the CDC growth chart criterion of 95th percentile whereas at risk for overweight is defined as a BMI between the 85th and 95th percentiles. © 2006 Thomson-Wadsworth

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9. Epidemiology of Obesity and Overweight © 2006 Thomson-Wadsworth

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11. Epidemiology of Obesity and Overweight • Two national surveys from which obesity data is regularly obtained: • The National Health and Nutrition Examination Study (NHANES) • Behavioral Risk Factor Surveillance System (BRFSS) © 2006 Thomson-Wadsworth

12. Epidemiology of Obesity and Overweight • The Youth Risk Behavior Surveillance System (YRBSS) provides the prevalence of youth BMI by state. • The data are self-reported and limited to high school students. • Mississippi and Tennessee reported the highest rates for overweight • Utah, Wyoming, and Idaho were the lowest © 2006 Thomson-Wadsworth

13. Medical and Social Costs of Obesity • The Surgeon General’s Report (2001) estimated the total economic burden of obesity to be $117 billion in 2000. © 2006 Thomson-Wadsworth

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15. Medical and Social Costs of Obesity • Obesity is costly to society because it is associated with chronic diseases including: • Cardiovascular disease • Type 2 diabetes • Hypertension • Stroke • Dyslipidemia • Osteoarthristis © 2006 Thomson-Wadsworth

16. Medical and Social Costs of Obesity • Obesity is costly to society because it is associated with chronic diseases including: • Selected cancers • Gallbladder disease • Sleep-breathing disorders • Musculoskeletal disorders © 2006 Thomson-Wadsworth

17. Medical and Social Costs of Obesity • Overall quality of life is often worse with increasing obesity, and obese people experience prejudice and discrimination. © 2006 Thomson-Wadsworth

18. Determinants of Obesity • Determinants of obesity can be related to either dietary intake or physical activity or both. • They can be genetic, psychological, behavioral, or environmental. © 2006 Thomson-Wadsworth

19. Determinants of Obesity • Referred to more frequently in the literature as causes of obesity are: • an “obesogenic” environment, or one that promotes obesity. • a “toxic environment,” or one that limits the opportunities for physical activity. • Excess weight accumulation occurs with an imbalance in energy, caused by either a surplus of energy intake or lack of energy expenditure. © 2006 Thomson-Wadsworth

20. Determinants of Obesity • Genetic Risk Factors • Psychosocial Risk Factors • Depression • Comfort eating • Behavioral Risk Factors • Caloric Intake • Types of Food Consumed • Physical Activity • Use of Television, Video Games, and Computers © 2006 Thomson-Wadsworth

21. Determinants of Obesity • Environmental Risk Factors • Other Technological Innovations in Food Production and Transportation • Other Technological Changes • Portion Sizes • Eating Away from Home and Consumption of “Fast Foods” • Maternal Employment • Urban Sprawl and the Built Environment • Poverty © 2006 Thomson-Wadsworth

22. Obesity Prevention and Treatment Interventions • In public health applications, interventions that address body weight are often preventive, rather than treatment, oriented. • The goal of an obesity prevention program is to maintain a stable weight and not increase body size over time, in contrast to an obesity treatment program, in which the primary goal is to lose weight over time. © 2006 Thomson-Wadsworth

23. Obesity Prevention and Treatment Interventions • Current recommendations for obesity treatment: • Lifestyle therapy - weight management techniques, increases in physical activity • Behavioral therapy - goal setting • Clinical therapies - pharmacotherapy, weight loss surgery © 2006 Thomson-Wadsworth

24. Obesity Prevention and Treatment Interventions • Adult Interventions • Most adult-based obesity interventions have centered on clinical approaches to obesity treatment, and thus haven’t been largely successful. • Worksite health promotion programs have shown modest effects on weight in the short term. © 2006 Thomson-Wadsworth

25. Obesity Prevention and Treatment Interventions • Child and Adolescent Interventions • Largely implemented in the school environment • Tended to be most effective when they included a component of decreasing television viewing © 2006 Thomson-Wadsworth

26. Public Health Policy Options for Addressing the Global Obesity Epidemic • Although obesity is a significant public health issue, efforts to control obesity at the public policy level in the United States are lacking. © 2006 Thomson-Wadsworth

27. Public Health Policy Options for Addressing the Global Obesity Epidemic • Obesity Surveillance and Monitoring Efforts © 2006 Thomson-Wadsworth

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29. Public Health Policy Options for Addressing the Global Obesity Epidemic • Awareness Building, Education, and Research • Department of Health and Human Services (DHHS) • Centers for Disease Control and Prevention (CDC) • National Institutes of Health (NIH) © 2006 Thomson-Wadsworth

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32. Public Health Policy Options for Addressing the Global Obesity Epidemic • Awareness Building, Education, and Research (continued) • United States Department of Agriculture (USDA) • Federal Trade Commission (FTC) • Recent Legislative Efforts © 2006 Thomson-Wadsworth

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35. Public Health Policy Options for Addressing the Global Obesity Epidemic • Regulating Environments • The Food Environment • The School Environment • The Built Environment © 2006 Thomson-Wadsworth

36. Public Health Policy Options for Addressing the Global Obesity Epidemic • Private Enforcement and Litigation • Personal Responsibility in Food Consumption Act (H.R. 339) • Commonsense Consumption Act (S 1428) © 2006 Thomson-Wadsworth

37. Public Health Policy Options for Addressing the Global Obesity Epidemic • Pricing Policies • The U.S. Congress supports food industries, particularly agribusiness, through subsidies, price fixing, and price supports. • In response, price policies, such as subsidies and taxing, have been suggested as a way to reverse the obesity epidemic. © 2006 Thomson-Wadsworth

38. Public Health Policy Options for Addressing the Global Obesity Epidemic • Societal-Level Solutions • In general, low socioeconomic status (SES) groups are more likely to be obese than their high-SES counterparts in industrialized countries. • Upper SES groups are more likely to be obese in developing countries. • In developing nations, childhood obesity is most prevalent in wealthier sections of the population. © 2006 Thomson-Wadsworth

39. Public Health Policy Options for Addressing the Global Obesity Epidemic • Societal-Level Solutions (continued) • A primary goal of public health initiatives addressing the global obesity epidemic is to increase the consciousness in the non-health sectors of the potential adverse effects of their various actions on the ability of people to maintain energy balance. • Culture and education • Commerce and trade • Development • Planning • Transport © 2006 Thomson-Wadsworth

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41. Coordinated School Health Programs • Coordinated School Health Program - CDC model that views the school in a multidimensional fashion, in which all components at the school level work together to maintain consistent, healthful messages. © 2006 Thomson-Wadsworth

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43. Coordinated School Health Programs • Coordinated Approach To Child Health (CATCH) program • Probably the best example of a coordinated school health program that addresses both nutrition and physical activity © 2006 Thomson-Wadsworth

44. Coordinated School Health Programs • Goals and Objectives • Overall goal = create healthy children and healthy school environments • Specific aims: • Encourage students to consume a diet that is low in fat and saturated fat and higher in fruits and vegetables • Encourage students to participate in increased amounts of moderate to vigorous physical activity (MVPA) © 2006 Thomson-Wadsworth

45. Coordinated School Health Programs • Goals and Objectives • Specific aims (continued): • Increase MVPA in schools to 50% of the physical education class • Provide food in school cafeterias that is lower in fat and saturated fat • Encourage parental participation in the school health program © 2006 Thomson-Wadsworth

46. Coordinated School Health Programs • Priority Population • Target population groups: • Elementary school children and their parents • Elementary school teachers • School administration and staff • Main trial included a cohort of 5,106 third-grade students from 96 schools in 4 sites © 2006 Thomson-Wadsworth

47. Coordinated School Health Programs • Rationale for the Intervention • Children’s diets were high in fat and saturated fat • Health behaviors track from childhood into adulthood • Therefore, changes in children’s diets/physical activity habits would benefit them in the future as well as in the present © 2006 Thomson-Wadsworth

48. Coordinated School Health Programs • Methodology • Randomized clinical trial (main CATCH study) • Each of 96 schools at 4 sites was assigned to 1 of 3 conditions: • Control (usual health program) (n = 40) • School-based program (n = 28) • School-based program plus family component (n= 28) © 2006 Thomson-Wadsworth

49. Coordinated School Health Programs • Methodology (continued) • Main trial followed by dissemination phase • Opinion leaders and change agents were contacted • Opinion leaders - people who influence other people’s attitudes about a program • Change agents - people who can influence decisions to implement a program © 2006 Thomson-Wadsworth

50. Coordinated School Health Programs • Methodology (continued) • They influenced others to adopt the program or suggest legislative efforts • Partnerships formed between groups with the common goal of promoting school-based physical activity and nutrition programs • CATCH dissemination was measured using quantitative and qualitative methods © 2006 Thomson-Wadsworth