Prevention and Control of Obesity in the US: A Challenging Problem

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1 Prevention and Control of Obesity in the US: A Challenging Problem Laura Kettel Khan PhD Sr Scientist for Policy & Partnerships Division of Nutrition, Physical Activity, and Obesity Centers for Disease Control and Prevention April 28, 2011

2 Obesity Trends Among U.S. Adults BRFSS, 1990, 1999, No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

3 Percentage Prevalence of Overweight Among Children and Adolescents Ages 6-19 Years Ages 6-11 Ages Source: JAMA, April 5, 2006, Vol. 295, No. 13:1549 and Pediatrics 1998; 101:497

4 National Health and Nutrition Examination Survey; Lamb et al, 2009 Obesity and Income Boys, 6 19 Year Old,

5 Prevalence of Obesity Girls, 6 19 Year Old, by Race/ethnicity and Household Income, US, NHANES, National Health and Nutrition Examination Survey Lamb et al, 2009

6 Impact of Childhood Overweight (BMI > 95 th percentile) on Adult Obesity (BMI > 30) 25% obese adults were overweight children 4.9 BMI unit difference in severity Onset < 8y more severely obese as adults (BMI = 41.7 vs 34.0) 50% of adults with BMI > 40 were obese as children Freedman et al, Pediatrics 2001; 108: 712

7 Percent Changes in Obesity Prevalence by Race/ethnicity, Boys 2-19 Years Non-Hispanic White Non-Hispanic Black Mexican American Ogden CL et al. JAMA 2008;299:2401

8 Percent Changes in Obesity Prevalence by Race/ethnicity, Girls 2-19 Years Non-Hispanic White Non-Hispanic Black Mexican American Ogden CL et al. JAMA 2008;299:2401

9 Changes in Prevalence of Obesity in Men Prevalence Year White Black M-A Flegal KM et al. JAMA 2010;303:235

10 Changes in Prevalence of Obesity in Women Prevalence White Black M-A Year Flegal KM et al. JAMA 2010;303:235

11 Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes Obesity (BMI 30 kg/m 2 ) No Data <14.0% % % % >26.0% Diabetes No Data <4.5% % % % >9.0%

12 Costs of Obesity 1998 vs Total costs $78.5 B/y $147 B/y Medical costs 6.5% 9.1% Increased prevalence, not increased per capita costs, was the main driver of the increase in costs Finkelstein et al. Health Affairs 2009; 28:w822

13 Annual Adult per Capita Cigarette Consumption and Major Smoking and Health Events US Thousands per year 1st World Conference on smoking and health 1st Surgeon General s report Broadcast advertising ban 1st Great American smokeout End of WW II Fairness Doctrine messages on TV and radio Nicotine medications Available over the counter Master settlement agreement Great Depression 1st smoking cancer concern Nonsmoker s rights movement begins Federal cigarette tax doubles Surgeon General s report on environmental Tobacco smoke Year 1998

14 1952

15 Shifts in Food Practices in the United States Increased cost of healthful foods Decreased cost of junk foods Increased portion size Increased variety Increased school vending and a la carte foods 15

16 % of Trips Standardized Share of Transportation Mode to School National Personal Transportation Survey Year McDonald NC. Am J Prev Med 2007;32:509 Car Bus Walk/bike Public transit

17 Disconnected Network/ Connected Network Source: Frank Speilberg

18 Principal Targets for Obesity Prevention and Control Pregnancy: pre-pregnant weight, weight gain, diabetes, smoking Reduce energy intake Decrease high and increase low E D foods Increase fruit and vegetable intake Reduce sugar drinks Decrease television time Breastfeeding Increase energy expenditure Increase daily physical activity

19 CDC s Perspective Identification of effective interventions more important than identification of cause Focus on population strategies that change the food and physical activity environments Interventions aimed at single targets likely less effective than comprehensive multi-sectoral approaches Rely on evidence-based practice and practice-based evidence 19

20 Settings for Prevention and Control of Obesity Medical Settings Child care School Work Site Industry Community State

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22 What we learned along the way What they are and what they are not: Strategies are grounded in existing evidence &/or expert opinion (some are exploratory) Measures are suggested indicators - not validated and are not standards (yet) Simplicity is key Data collection Indicators not comprehensive assessment Local government is the focus with public schools a necessary venue Local government and public health are non-traditional partners

23 Resources CDC s MMWR R&R Implementation & Measurement Guide Measures are incorporated into ICMA s Center for Performance Measurement system

24 Early Assessment of Programs and Policies to Prevent Childhood Obesity: Systematic Screening and Assessment Method

25 Project Purpose Convene a panel of experts to identify and review potential environmental programs and policies Assess environmental programs and policies readiness for evaluation Synthesize findings and share promising practices with the field Develop a network of public health and evaluation professionals with the skills to conduct evaluability assessments

26 Systematic Screening & Assessment Method Inputs Steps Products Guidance Nominations, existing inventories, descriptions Expert review panel Distributed network of practitioners/researchers 1. CHOOSE priorities 2. SCAN environmental interventions 3. REVIEW AND IDENTIFY INTERVENTIONS that warrant evaluability assessment 4. EVALUABILITY ASSESSMENTS of priority interventions Focus Brief descriptions List of interventions Report on each intervention Expert review panel Communicate with all stakeholders 5. REVIEW AND RATE interventions for promise/ readiness for evaluation 6. USE information 7. SYNTHESIZE what is known Ratings and reports Constructive feedback Plan for rigorous evaluation Report of intervention and evaluation issues

27 Discovering Practice Based Evidence Systematic, screening, & assessment method builds evidence base through practice based evidence 458 nominations 48 EAs 33 ready for evaluation