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A Public Health Crisis

and the Demographics of


Obesity

Non-Hispanic
White

Hispanic

Ursula E Bauer
Director, National Center for Chronic Disease Prevention and
Health Promotion
Centers for Disease Control and Prevention

Non-Hispanic
Black

What is obesity
Do we have an obesity
crisis?

Whos obese?

Outline

Public Health
Crisis

Demographics of
obesity

So what and who


cares?
Consequences of
obesity

What causes obesity?


What do we do about
it?

Public
Health

Public health refers to all organized measures


(whether public or private) to prevent disease,
promote health, and prolong life among the
population as a whole.
Its activities aim to provide conditions in which people
can be healthy and focus on entire populations, not
on individual patients or diseases.

World Health Organization

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The founding
promise of the
United States

1. To secure certain
inalienable rights
2. To effect the safety
and happiness of the
people
3. All men are created
equal

The
Declaration

He has refused
his Assent to
Laws,
the most
wholesome
and
necessary for the
Public Good.

Public
Health
Crisis -

epidemic

Epidemic refers to an increase, often sudden, in the


number of cases of a disease above what is normally
expected in that population in that area.
The amount of a particular disease that is usually
present in a community is referred to as the baseline
or endemic level of the disease. This level is not
necessarily the desired level, which may in fact be
zero, but rather is the observed level.

Centers for Disease Control and Prevention

Excess body fat


BMI: proxy measure, weight
for height
Does not measure fat

Adults: absolute values,


weight in Kg per height in M2

What is
obesity?

Children: compared to ageand sex-specific growth


charts
Underweight (<5th
percentile)
Healthy weight (5th to <85th
percentile
Overweight (85th to <95th
percentile)
Obese (95th percentile or
higher)

Female 54 <108 lbs


Male
59 <125 lbs

108-145 lbs 145-173 lbs >174 lbs


125-168 lbs 169-202 lbs >202 lbs

Prevalence
of obesity,
US 2014

Prevalence of Self-Reported Obesity Among U.S. Adults,


BRFSS, 1994

No Data

<10%

10%14%

15%19%

Prevalence of Self-Reported Obesity Among U.S. Adults,


BRFSS, 2004

No Data

<10%

10%14%

15%19%

20%24%

25%

%
40

2-5 years

6-11 years

12-19 years

%
30

Trends in obesity
by age:
US, 1960 -1962
through 2011-12

%
20

%
10

0
1960-1962

1971-74

1976-80

1988-94

Year

199900

2003- 2007-082011-12
04

Source: CDC/NCHS. National Health Examination Surveys II (ages 6-11), III (ages 12-17), and National Health and Nutrition Examination Surveys (NHANES) I-III, and
NHANES 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010 and 2011-2012.
http://www.cdc.gov/nchs/data/hestat/obesity_child_11_12/obesity_child_11_12.htm CDC/NCHS National Health Examination Survey, 1960-1962.

Prevalence of obesity among youth and adults by age,

2 to 60 and over: United States, 2011-2014

45
40.2

40

37

35

Obesity
rates
increase
with
increasing
age

32.3

30

Percent

25
20.5
20

17.5

15
10

8.9

5
0

2 to 5

6 to 11

12 to 19

20 to 39

Age (years)

40 to 59

60 & over

Prevalence of obesity among adults aged 20 and over, by sex, race and Hispanic origin: United States 2011-2014
Women

Women have
higher obesity
rates than men.
Blacks and
Hispanics have
higher rates
than whites and
Asians.
Variations by
race/ethnicity
are greater for
women than
men.

60

Men

56.9

50
45.7

40
35.5

39

37.5
33.6

30
Percent

20
11.9

11.2

10

Non-Hispanic White

Non-Hispanic Black

Non-Hispanic Asian

Race and Hispanic Origin

Hispanic

Prevalence of obesity among adults aged 20 years and over, by poverty income ratio, education and sex: United States, 2005-2008
Men
45

For women,
obesity rates are
inversely
associated with
education and
income.
For men, the
highest rates are
in the middle.

42.1

40

39

34.8

35

Percent
25

42

39.8

38.4
36.2

30

Women

32.1

34.6

32.9

29

27.4

29.2

23.4

20
15
10
5
0

Education

Poverty Income Ratio (PIR)


SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005-2008

Health is a public good


Public health prevents
disease and promotes
health of the population

Where are
we?

Protecting health is part of


governments charge to
effect safety and
happiness and promote
the general welfare
Organized measures,
taken by society, provide
the conditions in which
people can be healthy
Public health crisis occurs
when a disease or condition
exceeds normal expectancy

Obesity refers to an
excess of body fat
Obesity rates have
doubled for adults and
tripled for children since
the 1970s
Obesity rates vary by
age, sex, race/ethnicity,
education, income and
geography
Though common, some
segments of population
are affected more than
others

So what and
who cares?
The consequences of
obesity

What caused
the increase
in obesity?

Institute of Medicine: Preventing Childhood Obesity, 2004 http://www.nap.edu/read/11015/chapter/5#85

Designed
for disease

Some
trends

Calories consumed
increased by 314/day
from mid-1970s to early
2000s, then decreased
by 74/day, for adults
Fewer than 3 of 10 high
school students get 60
minutes/day of physical
activity
Work energy expenditure
decreased by
100+calories/day

http://www.blabystayinghealthy.co.uk/portion-size

Factors that Affect Health


Examples
Smallest
Impact

Counseling
& Education

Clinical
Interventions
Long-lasting
Protective Interventions
Changing the Context
Largest
Impact

to make individuals default


decisions healthy

Socioeconomic Factors

Eat healthy, be
physically active
Rx for high blood
pressure, high
cholesterol, diabetes
Immunizations, brief
intervention, cessation
treatment, colonoscopy
Fluoridation, 0g trans
fat, iodization, smokefree laws, tobacco tax
Poverty, education,
housing, inequality

Goal: Decrease energy intake, increase energy output


Evidence-based practices
Promising practices

Multicomponent interventions in multiple settings

What do we
do about it?
And what solutions are
already underway?

Children: interventions in childcare and schools that


improve nutrition quality of foods and increase physical
activity
Adults: worksite programs that make healthy foods
available and offer opportunities/incentives for physical
activity

Harvard CHOICES model:


Excise tax on sugary drinks
Elimination of tax subsidy for advertising unhealthy
food to children
Nutrition standards for foods and drinks sold in schools
Menu labeling

Whats
already
underway?
And may be working

Health is a public good


Obesity is a threat to
public health

Wrap up

Common, costly and


debilitating
Rates doubled for
adults and tripled for
children since the 1970s

Causes of obesity include


Increases in calorie
intake
Decreases in physical
activity
Changes to the food
and physical
environments

Solutions include
Laws most wholesome
and necessary for the
public good
Healthy Hunger-free
Kids Act
Menu Labeling rules

Organized measures
Lets Move
Safe Routes to School
Farm to Institution

Interventions at all levels


of the pyramid

Thank you
www.cdc.gov/obesity