Multicultural Marketing National Conference Cost to Healthcare, Disease Prevention, Encouraging Lifestyle Modification Felicia Wade, M.D. October 17, 2014
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Cost to Healthcare, Disease Prevention, Encouraging Lifestyle Modification The Obesity statistics speak for themselves. Engaging Multicultural communities is a key component. Promoting health and obesity reduction 4
5 Agenda Review current obesity rate for multicultural population segments Plan and engage the segment where they are to promote strong brand connection
6 Cost to Healthcare Budget Busting U.S. Obesity Costs Climb Past $300 Billion a Year The total cost of obesity including direct medical and non-medical services, decreased worker productivity, disability and premature death at $305.1 billion annually. Those direct medical costs - include counseling, outpatient and hospital visits, a range of bariatric surgical procedures, new treatment, nursing home care, rehabilitation and hospice account for $190 billion of the annual costs
7 Cost to Healthcare Direct nonmedical costs -Health education and behavior change efforts, nonmedical obesity treatment costs (e.g., specialized dietary foods, exercise equipment, travel to healthcare providers, patients time involved in treatment). $ 50 Billion a year. Absenteeism and sub-par productivity in the workplace costs an additional $65.1 billion a year. The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight.
8 Obesity Obesity is a national epidemic in the U.S. It is an even greater health concern for multicultural segments Multicultural populations are plagued with the highest obesity rates across all segments Nearly 4 out of 5 Mexican-American and African American women being overweight or obese versus 3 in 5 White non-hispanic women. CONFIDENTIAL
9 Obesity Statistics More than two-thirds of U.S. adults are overweight or obese (Ogden et al., 2014). Recent national data show that 82.0 percent of African-American women and 77.2 percent of Hispanic women are overweight or obese compared to 63.2 percent of White women (Ogden et al., 2014). In addition, over 50% of African American women are obese (versus 37.1 percent of African American men and 32.8 percent of White women) (Ogden et al., 2014). Rates of overweight or obesity are higher for Hispanic men (78.6 percent) compared to African American men (69.2 percent) and White men (71.4 percent) (Ogden et al., 2014). Research also shows that the heaviest Americans have become even heavier the past decade (Beydoun & Wang, 2009).
10 Obesity Statistics Overweight or Obesity BMI >/= 25 kg/m 2 Obesity BMI >/= 30 kg/m 2 Extreme Obesity BMI >/= 40 kg/m 2 All 68.5% 34.9% 6.4% All Females 65.8% 36.1% 8.3% White (non-hispanic) Black (non-hispanic) 63.2% 32.8% 7.4% 82.0% 56.6% 16.4% Hispanic 77.2% 41.4% 7.6% All Males 71.3% 33.5% 4.4% U.S. Prevalence of Adult Overweight and Obesity (NHANES 2011-2012) Source: Ogden C. L., Carroll, M. D., Kit, B.K., & Flegal K. M. (2014). Prevalence of childhood and adult White (non-hispanic) 71.4% 32.4% 3.8% Black (non-hispanic) 69.2% 37.1% 6.9% Hispanic 78.6% 40.1% 3.7%
Obesity affects some groups more than others Non-Hispanic blacks have the highest ageadjusted rates of obesity (47.8%) followed by Hispanics (42.5%), non-hispanic whites (32.6%), and non-hispanic Asians (10.8%) Obesity is higher among middle age adults, 40-59 years old (39.5%) than among younger adults, age 20-39 (30.3%) or adults over 60 or above (35.4%) adults.
12 Obesity and Chronic Disease Considering the tsunami of chronic diseases arising from obesity Diabetes, heart disease, sleep apnea, asthma, depression and increased mortality
13 Type 2 Diabetes Type 2 diabetes is a global public health crisis that threatens the economies of all nations, particularly developing countries. Fueled by rapid urbanization, nutrition transition, and increasingly sedentary lifestyles, the epidemic has grown in parallel with the worldwide rise in obesity. Asia's large population and rapid economic development have made it an epicenter of the epidemic. Asian populations tend to develop diabetes at younger ages and lower BMI levels than Caucasians. Several factors contribute to accelerated diabetes epidemic in Asians, including the normal-weight metabolically obese phenotype; high prevalence of smoking and heavy alcohol use; high intake of refined carbohydrates (e.g., white rice); and dramatically decreased physical activity levels. Poor nutrition in utero and in early life combined with over nutrition in later life may also play a role in Asia's diabetes epidemic. Recent advances in genome-wide association studies have contributed substantially to our understanding of diabetes pathophysiology, but currently identified genetic loci are insufficient to explain ethnic differences in diabetes risk. Nonetheless, interactions between Westernized diet and lifestyle and genetic background may accelerate the growth of diabetes in the context of rapid nutrition transition. Epidemiologic studies and randomized clinical trials show that type 2 diabetes is largely preventable through diet and lifestyle modifications..
14 Multicultural segment 6 factors Obesity makes an ideal case study for examining how the preventative health benefit can be utilized to engage the multicultural consumer. A review of obesity studies identified six key culturallysensitive/culturally-competent programs factors which increase the effective intervention and successful adoption of obesity treatment programs among multicultural populations: 1. Distinct Cultural Body & Weight Perceptions 2. Traditional Foods Tied to Cultural Heritage & Identity 3. Socioeconomic Barriers/Issues 4. Language Issues 5. Health Literacy- 6. Physical Activity
15 Distinct Cultural Body & Weight Perceptions Much research has pointed at a significant disparity in perception and awareness of weight and obesity among Hispanics and African Americans. Among Asian and non-hispanic white, the ideal body image is much more lean, but it is not as ideal among African-American and Latino cultures.2 In fact, weight and obesity misperception are significantly higher among African Americans women -3 to 5 times at greater odds than their Caucasian counterparts. Obesity tolerance is largely processed through cultural glasses. A recent study by the University of Alabama found that socioeconomic status, education, fruit and vegetable intake, and physical exercise explains only 10 percent of the differences in obesity between non-hispanic white women and African American women. Genetics and culture may play a much larger role in obesity than previously believed.
16 Traditional Foods Tied to Cultural Heritage & Identity It is extremely hard to shift any family to a low-fat diet. It is certainly even harder for families that have close bonds to cultural roots which are manifested in traditional foods, specialty cuisines, and celebratory rituals. After migration, culture is kept alive through cooking habits passed down through generations. Diets or weight programs like Jenny Craig, Nutri System, or the Mediterranean Diet might prove challenging to maintain for those with strong cultural food traditions, such as tortillas, fried chicken, or fried plantains. Diet programs that acknowledge and embody cultural palates and norms are much more practical for traditional multicultural families faced with changing dietary behaviors. CONFIDENTIAL
17 Socioeconomic Barriers/Issues Hispanic and African American families often face more pressing issues relating to daily survival such as employment, safety, limited finances, immigration status, language barriers, and education, which take priority over the issues of overweight and obesity. Tighter budgets in unsafe urban neighborhoods lead to unhealthy food alternatives and physical inactivity.
Obesity and socioeconomic status Among non-hispanic African American and Mexican-American men, those with higher incomes are more likely to have obesity than those with low income. Higher income women are less likely to have obesity than low-income women. There is no significant relationship between obesity and education among men. Among women, however, there is a trend those with college degrees are less likely to have obesity compared with less educated women.
19 Language Issues - Researchers found that language barriers blocked full engagement into the obesity treatment programs It limited understanding of medical issues, nutrition aspects, and cooperation in the activities. Materials and programs must be presented in-language to deliver results and build cooperative relationship.
20 Health Literacy Although they understand how being overweight has an extensive impact on other health problems Many of the multicultural participants in studies may need additional health knowledge to be able to understand BMI screening tools, Overweight versus obesity Food and nutrition knowledge
21 Physical Activity Several studies note that currently the most practiced obesity models revolves around diet, BMI and Weight Maintenance. Physical activity is so important to success that medical community needs to design long-term programs and methods to keep patients engaged in physical activity. Exercise programs and methods, however, must factor in cultural nuances, because what seems natural in the American culture may not be traditionally accepted in other cultures. For example, a recent Latina immigrant wanting to go for an evening walk is very likely to encounter lower acceptance and support from her Latino husband, impacting her motivation and perseverance. Such distinct cultural nuances should be considered in any dietary or physical program development.
Meeting where the person is for brand connection /engagement and outcomes A successful, targeted, preventative health care engagement model can then be replicated across other conditions, such as Diabetes and Cardiovascular disease, resulting in on-going connections to your health care image and brands, building loyalty and improving health outcomes. Proactive outreach efforts will also provide the additional benefit of beginning to close the historical disparities that have long existed among multicultural segments in health care access, education, behavior and treatment. 22
Genuine awareness and Development of a Trusted Partnership The benefits for engagement of these segments through obesity detection, management and reduction can go beyond strong brand connection to positive clinical outcome. 23 Insurers, hospitals and medical professionals who wish to capture some of ACA's newly insured may want to develop a culturally competent engagement program for obesity as a means of establishing their brand and image within the newly insured multicultural segments. Utilizing programs with a relevant in-culture/in-language approach will help: o Effective intervention, treatment, patient & family care and support o Educate newly insured on a proactive health lifestyle and the new healthcare system o Establish a genuine awareness and connection with your brand o Build trusted partnerships in health care o Result in strong brand ambassadors with family and friends, in these highly social and connected communities
Information Across Multicultural Segments Breast Cancer 24 After menopause, women with obesity have a higher risk of developing breast cancer
25 Cardiovascular disease (CVD) In middle and older age women, heavier weight is associated with an increased risk of cardiovascular disease (CVD) and CVD risk factors
26 Direct Association There is a direct association between body weight and deaths from all causes in women between 30 and 55 years of age.
27 Osteoarthritis Women with obesity are four times more likely to develop osteoarthritis as nonobese women
28 Fertility Obesity affects ovulation (fertility or ability to conceive), response to fertility treatment, pregnancy rates and pregnancy outcomes.
29 Stress Recurring emotional stress may trigger a stronger biochemical response in overweight people, possibly increasing their risk of chronic illnesses such as heart disease and type 2 diabetes a new study suggests. Researchers found that overweight people repeatedly placed in a stressful situation exhibited increasing amounts of interleukin-6, a protein that promotes inflammation in the body, in their saliva. Normal weight people did not exhibit this escalation in interleukin-6 levels when exposed to repeated stress. The inflammation caused by interleukin-6 has been associated with a number of conditions for which obesity itself creates an increased risk, including hardening of the arteries, type 2 diabetes, cancer and fatty liver disease
30 Bibliography Journal of American Medicine (JAMA CDC National Center for Health Statistics (NCHS) American Society of Actuaries Brain, Behavior and Immunity Journal
31 Thank You and Questions