Living Well. Can Your Street Help You Lose Weight? David Pauer, MNO Cleveland Clinic

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1 Living Well Can Your Street Help You Lose Weight? David Pauer, MNO Cleveland Clinic

2 ODOT is trying to help

3 Health Crisis in U.S. Obesity and other chronic disease have increased significantly Inactivity Poor nutrition Stress

4 Fitness Clubs Are Only First Step Percentage of U.S. adults that belong to health club is 12% Percentage of regular users is only 5% Obesity and physical inactivity continue to be a major problem. International Health, Racquet & Sportsclub Association (IHRSA),

6 Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% Source: Behavioral Risk Factor Surveillance System, CDC.

7 Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% Source: Behavioral Risk Factor Surveillance System, CDC.

8 Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% Source: Behavioral Risk Factor Surveillance System, CDC.

9 Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% Source: Behavioral Risk Factor Surveillance System, CDC.

10 Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% Source: Behavioral Risk Factor Surveillance System, CDC.

11 Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% Source: Behavioral Risk Factor Surveillance System, CDC.

12 Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% Source: Behavioral Risk Factor Surveillance System, CDC.

13 Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% Source: Behavioral Risk Factor Surveillance System, CDC.

14 Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% Source: Behavioral Risk Factor Surveillance System, CDC.

15 Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% Source: Behavioral Risk Factor Surveillance System, CDC.

16 Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% Source: Behavioral Risk Factor Surveillance System, CDC.

17 Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% Source: Behavioral Risk Factor Surveillance System, CDC.

18 Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20 Source: Behavioral Risk Factor Surveillance System, CDC.

19 Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20 Source: Behavioral Risk Factor Surveillance System, CDC.

20 Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20 Source: Behavioral Risk Factor Surveillance System, CDC.

21 Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20 Source: Behavioral Risk Factor Surveillance System, CDC.

22 Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% Source: Behavioral Risk Factor Surveillance System, CDC.

23 Obesity Trends* Among U.S. Adults BRFSS, 2002 (*BMI (*BMI 30, 30, or or ~ 30 lbs overweight for 5 4 for person) 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% Source: Behavioral Risk Factor Surveillance System, CDC.

24 Obesity* Trends Among U.S. Adults BRFSS, 2003 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% Source: Behavioral Risk Factor Surveillance System, CDC.

25 Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI 30, or ~ 30 lbs overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% Source: Behavioral Risk Factor Surveillance System, CDC.

26 Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% Source: Behavioral Risk Factor Surveillance System, CDC.

27 Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% Source: Behavioral Risk Factor Surveillance System, CDC.

28 Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% Source: Behavioral Risk Factor Surveillance System, CDC.

29 Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% Source: Behavioral Risk Factor Surveillance System, CDC.

30 Obesity Trends* Among U.S. Adults BRFSS, 2009 Source: Behavioral Risk Factor Surveillance System, CDC.

2008 Percent 0 20.0 20.1 24.4 24.5 28.2 28.3 32.

31 County level Estimates of Leisure time Physical Inactivity among Adults aged 20 years: United States 2008 Percent > 32.8 Source: Behavioral Risk Factor Surveillance System, CDC.

Children Ages 10 17 Obese and Overweight Source:

32 Children Ages Obese and Overweight Source: Behavioral Risk Factor Surveillance System, CDC.

33 Risk for Obesity Increases with the Age of the Child Overweight at 6 years 50% risk of obesity at 35 yrs Overweight at 10 years 80% risk of obesity at 35 yrs.

34 Consequences of Childhood Obesity Metabolic complications such as diabetes, hypertension, dyslipidemia and non alcoholic fatty liver disease. Mechanical problems such as obstructive sleep apnea syndrome and orthopedic disorders. Psychological and social consequences are prevalent Yung Seng Lee,1MMed (Paed( Med), MRCP (UK), MRCPCH

35 Economic Impact of Childhood Obesity Average medical costs = $2,907 for an obese child and $10,789 for a child with type II diabetes. (average for adults with type II diabetes = $8,844) Dental disease has increased Workers of tomorrow Military of tomorrow Resources: Impact Of Childhood Obesity On Employers Health Affairs: Mar Vol. 29, Iss.. 3; pg. 513; Too Fat To Fight report Mission Readiness, Retired Military Leaders

36 Unfit for Duty Weight is now the primary reason that recruits are rejected Rising obesity rates now make over a quarter of young adults ineligible for military service Endangers the number of battle ready troops by the year 2030 Source: Mission Readiness

38 National Economic Costs Obesity alone costs $147 billion per year in U.S. Annual medical costs for a person with a BMI of 35 or over is 76% higher than a healthy weight individual* Obesity adds 20 days of lost productivity per year/per obese employee, a cost of $5,350** 16.3% of GDP spent on healthcare in 2009 will go to 19.6% by 2016 if we do nothing to change our health. Sources: *Kaiser Permanente, Health Services use and Healthcare costs of obese and nonobese individuals. Arch of Internal Medicine 10/04 **Present Dangers: Disability, Risk & Insurance, March 2004

39 Cost of inactivity CDC estimates physically active people cost $330 less than inactive people Michigan council on physical fitness health and sports found that inactivity among the 55% of adults cost $9 billion in medical care, workers comp and lost productivity.

40 Cost of Chronic Disease $3 out of every $4 spent on healthcare. $7,900 for every American with a chronic disease. Costs for someone who has one or more chronic conditions is 5 times greater than healthy population. References: Centers for Disease Control and Prevention. Chronic Disease Overview: Costs of Chronic Disease. Atlanta: CDC, Available at Accessed July 24, 2007.

41 Emerging Health and Productivity Research Absenteeism associated with chronic conditions resulted in up to 8.85 days lost per year. Presenteeism associated with chronic conditions resulted in up to 91 days lost per year. Riedel & Associates data collected via the Stanford Presenteeism Scale from 8,000 Dow Chemical employees

42 Future Health Insurance Costs Health insurance costs will surpass wages by 2032 if trends of chronic illness continues Source: Creating a Culture of Health at the Workplace report

43 Costs Increase With Behavior Risks & Age Medical Costs by Health Risk Levels and Age Average Annual Paid Amounts $12,000 $9,221 $10,095 $10,000 $8,000 $6,000 $4,000 $2,000 $0 $6,664 $7,268 $3,432 $4,130 $5,445 $2,025 $2,741 $3,601 $3,366 $4,319 $1,247 $1,515 $1,920 < Risks 0 2 Risks 5+ Risks Source: StayWell data analyzed by U of Michigan (N = 43,687)

44 Before we get into inactivity A little about poor nutrition A little about stress

46 Effects of Nutritional Behaviors In general, research suggests that dietary patterns influence: Attention span Short term memory Emotional affect Social functioning Irritability Fatigue

47 Brain Affected by Junk Food Ads Brain scans of normal, hungry people exposed to appetizing food stimuli, such as product ads, had reactions similar to those of cocaine addicts responding to drug stimuli. Marked increase in brain metabolism [triggered] by the presentation of food provides evidence of the high sensitivity of the human brain to food stimuli. Constant food stimuli in the environment is likely to contribute to the epidemic of obesity. NeuroImage Journal April 2004

48 Obesogenic Environment

49 Commute Most Stressful Part of Daily Life One survey found many people believe commuting is more stressful than problems at work or at home or even money worries Commuters can experience greater stress than fighter pilots or riot policemen Commutes are longer

50 Stress and health Emotional distress may accelerate the aging of the body's cells at the genetic level Stress directly affects weight gain and metabolism

51 We Used to Call Exercise Work Past generations viewed physical activity as necessary for labor/work. Leisure time was for not being active/working. You were successful when no need to labor for your employment. We have continued to try to reduce physical labor in any way possible.

52 Mowing the lawn

53 Mowing the lawn?

54 Raking the leaves

55 Raking the leaves?

56 Riding a bike

57 Riding a bike?

58 Riding a scooter

59 Riding a scooter?

60 Walking

61 Walking?

62 Walking?

63 Walking the Dog

64 Walking the dog?

66 Epidemic of Car Dog Walking

67 Barriers to walking

68 Cities Need to Cooperate

69 Isolation in Communities No contact with people No sidewalks No front porches Drive everywhere Affects physical, social, and emotional health.

Complete Streets Can Benefit Older Americans 50% of Americans will be over 55 in 2030.

70 Complete Streets Can Benefit Older Americans 50% of Americans will be over 55 in % of Americans over the age of 65 do not drive. More than 50% of non drivers stay at home on a given day because they lack transportation options. Photo: Michael Ronkin, ODOT

71 Complete Streets Can Benefit People with Disabilities 20% 20% of Americans have a disability that limits their daily activities. Complete Streets can reduce isolation and dependence.

72 Inactive From the Start Encourage sedentary behaviors Drive them for short trips Restrict playing outdoors Confined to school or home for most of the day Setting them up for a lifetime of inactivity and chronic illness

73 Game Off Kids do not play outside. Most play is organized. Organized sports not as active as we think. (too much standing around waiting for playing time plus treat culture is prevelant) Resource: Michael F. Bergeron, director of the environmental physiology laboratory at the Medical College of Georgia.

School Commute In 1969, 87% of children living within 1 mile of school walked or bicycled. Today, fewer than 15% of children use active modes of transportation.

74 School Commute In 1969, 87% of children living within 1 mile of school walked or bicycled. Today, fewer than 15% of children use active modes of transportation. 63% of high schoolers are no longer physically active American Council of Exercise US Department of Transportation; Federal Highway Administration National Personal Transportation Survey: travel to school.

75 There is hope..

76 Traditional Prevention Has Focused on Modifying Individuals Lifestyles Environment Lifestyle Health Regulation Family Schools Worksite Community Streets Nutrition Physical activity Alcohol Tobacco Safety Obesity Diabetes Heart disease Cancer Injury

A New Paradigm: Using Planning and Transportation Strategies to Promote Active Living Behaviors The Concept: Integrating additional physical

77 A New Paradigm: Using Planning and Transportation Strategies to Promote Active Living Behaviors The Concept: Integrating additional physical activities such as walking and bicycling into a daily routine may be a better public health strategy than traditional structured and organized programs.

Active Living Concept Active Living integrates

for transportation, exercise or pleasure; playing in

78 Active Living Concept Active Living integrates physical activity into daily routines. The goal is 30 minutes of activity each day. Individuals may achieve this by walking or bicycling for transportation, exercise or pleasure; playing in the park; working in the yard; taking the stairs; and using recreation facilities.

79 Physical Activity Guidelines Advisory Committee Report US Dept of Health and Human Services,

Moderate Physical Activity Prevents Disease Walking 30 minutes 6 days a week (the equivalent of about 11 miles per week) is enough to reduce the risk of metabolic syndrome.

80 Moderate Physical Activity Prevents Disease Walking 30 minutes 6 days a week (the equivalent of about 11 miles per week) is enough to reduce the risk of metabolic syndrome. Those who exercised the most, jogging about 17 miles per week, gained only slightly more benefit in terms of lowered metabolic syndrome scores. American Journal of Cardiology, December 15, 2007

81 Positive (and immediate) Outcomes from Physical Activity Mood and motivation improve Stress and anxiety are reduced Energy and creativity increase Sleep and self image improve Bones and muscles are stronger Memory, learning, attention, decision making and multi tasking tasking improve Pain decreases Plus disease prevention

82 Walkable Neighborhoods People living in walkable neighborhoods were more likely to know their neighbors, participate politically, trust others, and be socially engaged. People who are socially engaged with others and actively involved in their communities tend to live longer and be healthier physically and mentally. Social engagement has also been shown to be linked to the prevention of crime and enhanced economic development. Social Capital and the Built Environment: The Importance of Walkable able Neighborhoods, Kevin Leyden, PhD. American Journal of Public Health, September 2003

83 Benefits of Cycling Reduce symptoms of ADHD and ADD Reduce symptoms of Parkinsons Disease

Built Environment and Physical Activity Research Conclusions Living in Activity Friendly Communities can Generate 2 more walk/bike trips per person per week Prevent up to 1.

84 Built Environment and Physical Activity Research Conclusions Living in Activity Friendly Communities can Generate 2 more walk/bike trips per person per week Prevent up to 1.7 pounds of weight gain per year Positively impact the total number of minutes of physical activity (40% more physical activity) Increase life expectancy by 4 years. Ewing et al 2003, Saelens et al 2003, Giles Corti 2003, Frank et al 2003, Sturm et al 2004, Frank et al 2004, Lopez 2004

85 Active Outside is Healthier Provide contact with nature known to enhance well being and health including lower bp,, cholesterol, stress and quicker recovery from surgery and cancer treatment. Int J Immunopathol Pharmacol Apr Jun;20(2 Suppl 2):3 8. Forest bathing enhances human natural killer activity and expression of anti cancer proteins.

86 Evidence is growing that parks, trails, and greenways have positive affects on increasing physical activity. People with access to neighborhood parks were nearly twice as likely to be physically active as those without access to parks. Environmental determinants of physical activity in the United States. American Journal of Public Health,, 91(12), percent of trail users reported they participated more in activities, such as walking and biking, as a result of the trail in their community. Indiana University, School of Health, Physical Education and Recreation, Eppley Institute for Parks and Public Lands. (2001).

87 Fitness Centers for Kids Safe and well maintained playgrounds are important resources for communities. Unstructured play is important for physical, social, and psychological development. Parents are more active too!

89 Rails to Trails: Active Transportation for America

95 Active Living by Design

98 Strategies for Cleveland Clinic Workplaces and employers offer and promote access to healthy foods and beverages and opportunities for physical activity. Health care organizations and providers promote healthy eating and active living in their own institutional policies and in their clinical practices.

99 Vision for Wellness Cleveland Clinic has taken the lead, advocating for wellness and prevention nationally, in our community and among our own employees. Dr. Toby Cosgrove

100 What is Wellness? Good quality of life Feeling of well being Productive work Not merely the absence of disease More than physical (also emotional, social, etc.) Health

101 Cleveland Clinic Wellness Timeline July 2005: All Cleveland Clinic campuses smoke free January 2007: Free smoking cessation services to Cuyahoga County residents for 6 months February 2007: Banned trans fats from all public and patient menus May 2007: Healthy snack choices in vending machines September 2007: Stopped hiring smokers November 2007: Chief Wellness Officer appointed January 2008: Established the Wellness Institute May 2008: Free yoga classes for employees and patients/visitors July 2008: Weekly farmers market for employees and community August 2008: Free Weight Watchers for EHP member employees October 2008: Lifestyle 180 behavior modification program starts November 2008: Free memberships to Curves and Cleveland Clinic owned fitness centers for EHP member employees January 2009: GO Foods healthy labeling in all Cleveland Clinic cafeterias

102 Health Risk Assessment 40% 35% 30% 25% 20% Cleveland Clinic 15% 10% 5% 0% Weight Loss Physical Activity Nutrition Stress Smoking

103 Program Components Physical Activity Nutrition Weight Loss Stress Management Tobacco Treatment Wellness Education Employee Wellness Committees

104 Cleveland Clinic Walks Walk at Work events Walking meetings Walking break Walking maps Walking logs Take the Stairs Also: Cleveland Clinic Bikes, etc.

105

106 Before and After

107 Count Your Steps 2,000 more steps every day (one extra mile). statistically meaningful drops in body mass index and blood pressure. Visible sign of culture of wellness and activity. Monitor calories burned too. Journal of the American Medical Association.

108 Walk with a Doc

109 Cleveland Clinic Fitness Centers Walker Building (main campus) Parker Building (building employees only) Fairview Hospital (24/7) Lyndhurst Campus Wooster Family Health Center

110 Cleveland Clinic Yoga Classes are free for any Cleveland Clinic employee! Sites throughout the health system Classes are 45 minutes long Wear comfortable clothing for stretching

111 Wellness Education Programs Wellness Grand Rounds (CME( CME s) Wellness Connection short lunch presentations Center for Leadership and Learning programs

112

113 Healthy Cooking Demonstrations

114 Stress Management Initiatives Concern EAP Cleveland Clinic YOGA Center for Integrative Medicine Sleep initiatives

115 EHP Wellness Initiatives Nutritional Counseling Weight Watchers Curves and Cleveland Clinic owned fitness centers Employee Assistance Program Healthy Choice Rebate Tobacco Cessation (Dependents included)

116 Reward Healthy Life Style Choices Target controllable chronic diseases: Weight Management (Obesity) Diabetes Type II Hypertension Hyperlipidemia (Cholesterol) Smoking Asthma

117 Cleveland Clinic Active Living More bike parking Free showers if bike to work Encourage walking during day Encourage biking around main campus to meetings, etc. Campus pedestrian audit Lower insurance for walking and biking through shape up and go program

118

119 Cleveland Clinic Bikes

120 Cleveland Clinic Bikes

121 One Solution Lessons learned from tobacco control Denormalization (Community Norm Change)

122

123 Change Will Happen

124 Cleveland Clinic Communications Frequently Include Bicycles

125 Vision for Healthcare We are in the sickness business, we need to get into the health business. Dr. Toby Cosgrove

126 Cleveland Clinic Wellness Contact us for more information about Cleveland Clinic Wellness! On line: E mail: pauerd@ccf.org or wellness@ccf.org Phone:

127

Monroe County Community Health Needs Implementation Plan. Approved May 21, 2013 Mercy Memorial Hospital System Board of Trustees

Monroe County Community Health Needs Implementation Plan Approved May 21, 2013 Mercy Memorial Hospital System Board of Trustees Chronic Conditions- Diabetes and Obesity CHRONIC CONDITIONS- DIABETES AND