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Results of Public Health Prevention Interventions Harold W. Kohl, III, Ph.D. ILSI Center for Health Promotion Atlanta, GA USA Changes in prevalence of adult obesity among adult men, 7 countries. Percent Popkin and Doak, 1998

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slide1

Results of Public Health Prevention Interventions

Harold W. Kohl, III, Ph.D.

ILSI Center for Health Promotion

Atlanta, GA USA

changes in prevalence of adult obesity among adult men 7 countries
Changes in prevalence of adult obesity among adult men, 7 countries.

Percent

Popkin and Doak, 1998

slide4

Public health prevention of diabetes and obesity

  • What are we preventing/promoting?
  • When do we want to prevent/promote it?
  • In which settings should we put our efforts?
slide5

Public health prevention of obesity

  • Childhood/adolescence
  • overweight
  • obesity

Prevention can mean treatment!

  • Adulthood
  • overweight
  • obesity
slide6

Public health prevention of type II diabetes

  • Childhood/adolescence
  • IFG
  • Diabetes

Prevention can mean treatment!

  • Adulthood
  • IFG
  • Diabetes
slide7

Public health behavior promotion related to obesity and diabetes

  • Childhood/adolescence
  • Physical inactivity
  • Diet behaviors
  • Adulthood
  • Physical inactivity
  • Diet behaviors
slide8

Today’s goal

  • Attempt to summarize status of knowledge in areas of obesity and diabetes public health prevention interventions.
  • Provide framework for other experts on the panel as well as breakout groups.
  • Answer a few questions and raise more.
slide10

Summary of observational studies on obesity (weight gain) prevention

Cross-sectional studies suggest lower weights at higher levels of physical activity and diet ‘quality’ indicators.

Longitudinal studies (n = 12) suggest an attenuation of weight gain at higher levels of physical activity.

Change analyses suggest a lower risk of becoming overweight with an increase in activity

mean weight change by cardiovascular fitness changes acls 1970 1994
Mean weight change by cardiovascular fitness changes, ACLS, 1970-1994

Weight Change (kg)

n=4,599 men and 724 women

Mean time between fitness evaluations: 1.8 y

Mean time of follow-up: 7.5 y

Dipietro, et al, 1998

slide12

Summary of randomized, controlled studies on Type II diabetes prevention

Diabetes Prevention Program (n>3,000)

Diabetes Care 1999;22:623-634.

Finnish Diabetes Prevention Study (n=523)

Br. J. Nutrition 2000;83( Suppl. 1), s137-s142

Da Qing IGT and Diabetes Study (n=577)

Diabetes Care 1997;537-544.

slide13

Summary of trials on diabetes prevention

  • All start with initial population with IFG.
  • Early work suggested possibility, but non-optimal study designs limited interpretation.
  • 2 current studies investigating solely ‘hygienic’ interventions.
  • Results of randomized, controlled trials suggest positive outcomes, incidence reductions of up to 30% may be possible.
six year incidence of diabetes by treatment condition and body composition da qing china
Six-year incidence of diabetes by treatment condition and body composition: Da Qing China

Percent

Xiao-ren Pan, et al, 1997

slide15

Potential settings for health behavior interventions for children and adults

School

Community

Provider

Family

slide16

School-based interventions

  • Some have focused on obese or high-risk children (with physiologic outcomes) while most have included the entire school (behavioral outcomes)
  • Most have been multi-component interventions – behavioral, environmental, educational – and various risk factors
  • Short term results – implications for adult outcomes are unknown.
slide17

School-based interventions

  • Targeted interventions produce short-term weight loss.
  • Overweight children
  • Populations ‘at-risk’
  • Curriculum and environmental changes are possible.
  • Changes in physical activity (PE) and food service policies are achievable as are short term changes in comprehension
slide18

School-based interventions

  • Varying “success”: changes in body composition measures not likely to follow changes in knowledge or behavior.
  • No approach has been tested across several ages or grades.
  • Few attempts for home-support of school intervention.
slide19

Community based interventions

  • Stanford Three-Community
  • Stanford Five-City
  • Minnesota Heart Health Program
  • Pawtucket Heart Health Program
  • North Karelia Project
  • Mauritius
  • Despite positive risk factor changes, no evidence of obesity-related treatment effects in 4 of 6 studies
slide20

Community based interventions

  • Pound of Prevention (only community-based study designed to prevent weight gain).
  • 1200 volunteers randomized to no-contact control, and education (with and without readership incentives) combined with intervention activities.
  • 3 year intervention
  • All three groups gained weight
  • Education alone appears insufficient on the community level.

Jeffrey and French, 1999

slide22

Current Recommendations

Children should accumulate 30-60 minutes of moderate-to-vigorous physical activity each day

slide23

The Program

  • A classroom-based physical activity promotion program designed to reduce periods of inactivity during school day for elementary school children.
slide24

The Program

  • Integrates 10 minute periods of physical activity into school day combined with age-appropriate lessons of math, science, language arts, etc.
the materials
The Materials
  • Physical activity cards are linked to core academic objectives
  • Teacher manual coordinates the lessons
  • TAKE 10!™ Tracking Poster motivates kids
  • Teacher Training Video explains the program