Trends Summit on Obesity Chicago, ILJuly 20 - 22, 2005 James S. Marks, M.D., M.P.H.Senior Vice PresidentThe Robert Wood Johnson Foundation
20 15 10 5 Ages 2-5 years Ages 6-11 years 0 1976-80 1988-94 1963-67 1966-70 1971-74 1999-2000 Preventing Childhood Obesity Percent Percentage of children with BMI at or above theage- and gender-specific 95th percentile. Institute of Medicine; Preventing Childhood Obesity, 2005
How many deaths? • 365,000 vs. 112,000 • Differences in scientific methodology • Better Treatments • Still a very large number
Estimated Adult Obesity-Attributable Medical Expenditures 2003 – Dollars in millions State costs related to obesity Obesity Research, January 2004
Both Sides of the Energy Balance Equation Energy Balance Calories In Calories Out Food Environment Activity Environment < > = Gain weight Maintain weight Lose weight
Interventions • School-based approaches • Community-based approaches • Public education campaigns
The Guide to Community Preventive Services: Recommended Physical Activity Interventions • Point-of-decision prompts • Community-wide campaigns • School-based PE • Social support interventions in community settings • Individually adapted health behavior change programs • Creation of or enhanced access to places for physical activity combined with informational outreach activities www.thecommunityguide.org
Paid media campaign to promote walking among sedentary older adults in Wheeling, WV Results 90% of area residents exposed to campaign 14% net rise in number of residents increasing their walking compared to control group Wheeling Walks • www.wheelingwalks.org/results.asp
Child and Adolescent Trial for Cardiovascular Health (CATCH) • Program included educational, behavioral and school environment components. • Results: • Less total and saturated fat • More physical activity • Effects still found 3 years after intervention ended • www.childtrends.org
Planet Health • Two-year intervention aimed at decreasing TV viewing and high-fat foods, and increasing activity and fruit and vegetable consumption • Results: • Obesity prevalence among girls was reduced • Decreased TV viewing seemed most important • No differences found among boys • Gortmaker et al, Arch Pediatr. Adolesc. Med., 1999; 153: 409-418
30 25 20 15 Christchurch Obesity Prevention Project Control boys Control girls Prevalence (%) Intervention boys Intervention girls Baseline 12 months • Mean change in % of overweight and obese children age 7-11 after education program to decrease sugared soda consumption • James et al; BMJ 2004; 328: 1237-9
Safe Routes to School (SR2S) • 30 yrs. ago, 66% of kids walked or biked to school; today, roughly 13% do • In first 2 years of Marin County SR2S program: • 64% rise in number of kids walking to school 114% increase in number of kidsbiking • States passing SR2S legislation • CA - $20 million/yr. set aside • WA – all school districts must have SR2S route plans for elem. schools CDC, KidsWalk-to-School: A Guide to Promote Walking to School; Staunton et al, Amer. J. Pub. Health, 2003; 93(9): 1431-34
Access to Supermarkets • 3x as many supermarkets in wealthier neighborhoods1 • 4x as many in white neighborhoods as in African-American neighborhoods1 • Fruit and vegetable consumption increased by 1/3 for each additional supermarket in the community. • African-American women in Detroit who shop at supermarkets consume more fresh fruit • and vegetables than women who shop • at independent neighborhood markets. Morland et al. “Neighborhood Characteristics Associated with the Location of Food Stores and Food Service Places.” Amer. J. . Preven. Medicine, 2002; 22(1): 23-29. Morland et al. “The Contextual Effect of the Local Food Environment on Residents’ Diets: The Artherosclerosis Risk in Communities Study.” Amer. J. Pub. Health, 2002; 92(11): 1761-1767.
Over the 2-year period between the first and third surveys, current cigarette usedeclined by 40% among middle school students andby 18% among high school students. Bauer et al, JAMA, 2000; 284: 723-28
VERB™ Youth Media Campaign • Paid media campaign to get kids age 9-13 to become more active • Cutting-edge TV, Web, concerts and more • Longitudinal survey results: • 22% increase in free-time activity sessions/week • Kids exposed to campaign had more favorable attitudes about being active • Activity levels of unexposed children decreased • Highlights of the Year Two Evaluation Findings, April 2005
What Can Policymakers Do? • Restrict / eliminate junk foods in schools • Improve access to healthy foods in schools • Improve health education curricula to provide information on nutrition • Link school food policies with nutrition curricula • Increase physical education instruction • Improve health education classes Wisconsin Public Health & Health Policy Institute; An Ounce of Prevention: What Can Policymakers Do About the Obesity Epidemic?
What Can Policymakers Do? (cont’d) • Eliminate sales tax exemptions on unhealthy foods and dedicate the money to health programs • Promote policies that encourage walking and bicycling • Maximize state receipt of federal money • Improve workplace wellness programs • Improve counseling by medical professionals on diet and physical activity Wisconsin Public Health & Health Policy Institute; An Ounce of Prevention: What Can Policymakers Do About the Obesity Epidemic?
Focusing on issues that demand attention Supporting programs that create meaningful and timely change – helping Americans lead healthier lives Making a difference in your lifetime…and theirs