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Addressing the Obesity Epidemic: Trends, Challenges, and Solutions

This comprehensive update examines the recent changes in obesity prevalence among youth and adults, highlighting key data and trends from various studies, including NHANES. It delves into the prevalence of severe obesity, medical complications, adverse childhood experiences, and the equity framework for integrated care systems. Strategies for obesity prevention and control are explored, focusing on prenatal and postnatal interventions, community infrastructure, worksite initiatives, and technology reimbursement. The text emphasizes the importance of addressing transgenerational obesity and provides actionable steps for mitigating this public health crisis.

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Addressing the Obesity Epidemic: Trends, Challenges, and Solutions

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  1. Update on the Obesity Epidemic William H. Dietz MD, PhD Chair, Redstone Global Center for Prevention and Wellness

  2. 40% Changes in the Prevalence of Obesity among Youth 2-19 yo and Adults > 20 yoNHANES 1999-2000 – 2013-2014 35% % 17% Year

  3. Recent Changes in Prevalence among 2-5 yo NHANES Data Prevalence (%) Years

  4. Obesity Prevalence in 2-4 yo WIC Participants 2000 - 2014 % Year Pan L et al. MMWR 2016; 65:1256

  5. Changes in Obesity Prevalence among 2 - 4 yo – WIC 2010-2014 Group20102014Change AI/AN 20.9% 18.0% - 2.9% Hispanics 19.3% 17.3% - 2.0% Asian/Pacific Islanders 12.5% 11.1% - 1.4% Non-Hispanic Blacks 12.7% 11.9% - 0.8% Non-Hispanic Whites 12.8% 12.2% - 0.6% Pan L et al. MMWR 2016; 65:1256

  6. Changes in Prevalence of Obesityin Michigan 2-4 yo % Pan L et al. MMWR 2016; 65:1256

  7. States and Communities Reporting Decreases in the Prevalence of Childhood Obesity Portland, ME King County Cambridge, MA Kearney, NE DuPage County, IL Somerville, MA Fitchburg, MA MA New York City OH Philadelphia, PA WV CA Vance, NC Granville, NC San Diego, CA NM MS Chula Vista, CA El Paso, TX Anchorage, AK

  8. 9% Changes in the Prevalence of Severe Obesity (BMI >120% of 95th Percentile) in 2-19 yo YouthNHANES 1999-2000 – 2013-2014 8% % Year Skinner AC et al. Obesity 2106;24:1116

  9. Changes in the Prevalence of Severe Obesity (BMI > 40) in Adults NHANES 1999-2000 – 2013-2014 10% 6% % Year

  10. Medical Complications of Obesity Source: Rudd Center for Food Policy and Obesity

  11. Adverse Childhood Experiences (ACEs) Victimized or witnessed abuse Verbal Sexual Physical Exposures Hunger Homelessness Incarceration Household instability – divorce, separation, death Mental illness or maternal depression Drug or alcohol abuse

  12. Frequency of Exposure within Households to Adverse Childhood Experiences: BRFSS Results from 5 States(AR, TN, LA, WA, NM) # Aces % MMWR 2010; 59:1609

  13. Consequences of Exposure to ACES Smoking Illicit drug use Adult alcohol abuse Unintended pregnancy Sexually transmitted diseases Attempted suicide Depression Severe obesity and other chronic diseases

  14. Equity Framework for Integrated Clinical and Community Systems of Care Training &Education Family & Individual Empowerment and Engagement Care Delivery • Information Systems • Decision Support • Delivery System Design • Self Management Support • Local patient environment • Clinicians • Community • Systems • Economic Resource • Social resources • Community capacity • Healthy options • Social norms Integration Convener, Advocacy, Data Exchange, Financing, Governance/Regulation, Referral Processes, Communications Population Health Metrics

  15. Equitable Opportunity Economic and Educational Environment Supportive Community Environments Wealth building efforts Employment Jobs Connected networks Collective efficacy Political efficacy People Socio-cultural Environment Place Physical/built Environment Desirable housing Safe public spaces Healthy products

  16. Targets for Obesity Prevention and Control Reduce stigma and bias Reduce energy intake Reduce sugar drinks Decrease high ED foods – pizza, fast food Decrease television time Increase daily physical activity Pregnancy: pre-pregnant weight, weight gain, diabetes, smoking Breastfeeding Sleep

  17. Strategies to Address Childhood Obesity Early childhood Breastfeeding Baby Friendly Hospitals Worksite lactation support in ACA ECE Child care & Head Start standards PHA agreement with ECE centers Empowering caregivers Menu labeling in ACA Revision of nutrition facts panel Healthcare PHA’s Healthy Hospital initiative Use of EHRs to monitor progress Healthy food in schools Healthy Hunger-free Kids Act Competitive food standards

  18. Strategies to Address Childhood Obesity Access to healthy affordable food Physical access to food Healthy Food Financing Initiative Drink up! Campaign Food reformulation Institute standards in public institutions –hospitals, city government Tax sugar drinks Increasing physical activity Increase PE/PA in schools Engage Parks and Recreation Departments

  19. Prevalence of Obesity – NHANES 2013-2014 % Age

  20. Prevalence of Excessive 10 Year Weight Gain (> 20Kg) between 1985-86 and 1995-1996 (CARDIA) % Lewis CE et al. Am J Epidemiol 2000;151:1172

  21. Strategies to Prevent and Mitigate Transgenerational Obesity Prenatal: pre-pregnant weight, weight gain during pregnancy, gestational diabetes, tobacco use Postnatal: Breastfeeding, WIC, Early Head Start, Maternal, Infant, and Early Childhood Home Visiting program Community infrastructure for physical transport Worksite initiatives Technology Reimbursement – focus on family care

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