hubbard ohds

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Published on August 6, 2007

Author: Woodwork

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National Strategies Concerning Issues of Childhood Overweight and Obesity and Implications for Long-term Health:  National Strategies Concerning Issues of Childhood Overweight and Obesity and Implications for Long-term Health Van S. Hubbard, M.D., Ph.D. CAPT, USPHS Director, NIH Division of Nutrition Research Coordination Defining Overweight and Obesity:What are the Issues?:  Defining Overweight and Obesity: What are the Issues? What Is BMI?:  What Is BMI? Body mass index (BMI) = weight (kg)/height (m)2 BMI is an effective screening tool; it is not a diagnostic tool For children, BMI is age and gender specific, so BMI-for-age is the measure used Slide4:  CDC Growth Charts 2000 Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Division of Nutrition and Physical Activity Maternal and Child Nutrition Branch Slide5:  Indicators of Nutritional Status in Youth:  Indicators of Nutritional Status in Youth Overweight andgt; 95th percentile of BMI-for-age Risk of overweight andgt; 85th to andlt; 95th percentile of BMI-for-age Advantages of BMI-for-Age:  Advantages of BMI-for-Age Provides a reference for adolescents that was not previously available Consistent with adult standards so can be used continuously from 2 years of age to adulthood Tracks childhood overweight into adulthood Tracking BMI-for-Age from Birth to 18 Years with Percent of Overweight Children who Are Obese at Age 251 :  Tracking BMI-for-Age from Birth to 18 Years with Percent of Overweight Children who Are Obese at Age 251 Whitaker et al. NEJM: 1997;337:869-873 Correlation of BMI With Total Body Fat:  Correlation of BMI With Total Body Fat Body Mass Index Adipose Tissue (kg) Zumoff, B et al. J Clin Endocrinol Metab. 1990; 70:929-931. Obesity Classificationfor Adults:  Obesity Classification for Adults Overweight: BMI andgt; 25 kg/m2 Obesity: BMI andgt; 30 kg/m2 Obesity BMI Class 25.0 – 29.9 Overweight 30.0 – 34.9 Obesity I 35.0 – 39.9 Obesity II andgt; 40.0 Extreme Obesity III NHLBI Guidelines, June 1998 Slide11:  Obesity Trends* Among U.S. Adults BRFSS, 1991, 1995 and 2000 (*BMI  30, or ~ 30 lbs overweight for 5’4' woman) Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. Prevalence of Overweight and Obesity U.S. Adults, Age 20-74 Years*:  Prevalence of Overweight and Obesity U.S. Adults, Age 20-74 Years* % Overweight 32 33 34 (BMI 25.0-29.9) % Obese 15 23 27 (BMI andgt; 30.0) *Age-adjusted by the direct method to the year 2000 U.S. Bureau of the Census estimates using the age groups 20-34, 35-44, 45-54, 55-64, and 65-74 years. NHANES II NHANES III NHANES 1976-80 1988-94 1999 n = 1,446 n=11,207 n=14,468 % Overweight or Obese 47 56 61 (BMI andgt; 25.0) Prevalence of Overweight* Among U.S. Children and Adolescents:  Prevalence of Overweight* Among U.S. Children and Adolescents *Gender- and age-specific BMI andgt; the 95th percentile Source: Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS) Degree of risk increases with degree of overweight:  Degree of risk increases with degree of overweight Risk influenced by Regional Fat Deposition and Degree of Visceral Adiposity:  Risk influenced by Regional Fat Deposition and Degree of Visceral Adiposity Obesity and Mortality Risk:  Obesity and Mortality Risk Mortality Rate Associated with Obesity:  Mortality Rate Associated with Obesity Obese individuals have a 50 to 100% increased risk of death from all causes, compared with normal-weight individuals. Most of the increased risk is due to cardiovascular causes. Obesity and Hypertension Risk:  Obesity and Hypertension Risk % Systolic andgt; 140 mm Hg BMI Levels Canadian Guidelines for Healthy Weights. Cat No. H39-134/1989E; 1988:69. Obesity and Diabetes Risk:  Obesity and Diabetes Risk BMI Levels Incidence New Cases per 1,000 Person-Years Knowler WC, et al. Am J Epidemiol. 1981;113:144-156. Weight Gain and Diabetes Risk:  Weight Gain and Diabetes Risk Body Mass Index at Age 21 Relative Risk Weight Change Since Age 21 Chan JM, et al. Diabetes Care. 1994; 17:960-969. Slide21:  Overarching Purpose::  Overarching Purpose: TO CALL THE NATION’S ATTENTION TO THE EPIDEMIC OF OVERWEIGHT AND OBESITY AND IDENTIFY ACTIONS THAT WE AS A NATION CAN UNDERTAKE Overweight and Obesity: A Public Health Priority:  Overweight and Obesity: A Public Health Priority Prevention or intervention to improve health Need to be aware of social, cultural, and environmental influences Must have access to family and community support Everybody must do their share Obesity is a Chronic Disease:  Obesity is a Chronic Disease Often treated as a 'subacute' illness, in which time-limited treatment will lead to a complete cure Genetics:  Genetics Humans have evolved genes favoring energy intake and storage. 70+ loci, genes, or markers may be involved in causing a susceptibility to obesity. 20-40% of Obesity Is Due to Genetic Factors Prevention and Intervention Strategies:  Prevention and Intervention Strategies Modification toward more healthful lifestyles Increase 'purposeful' activity Decrease sedentary behaviors Improve dietary choices Use available support mechanisms Issues Influencing Behavioral Change:  Issues Influencing Behavioral Change Appropriateness of messages Reading level Racially/ethnically correct Scientifically sound Issues Influencing Behavioral Change:  Issues Influencing Behavioral Change Consistency of messages Motivation to adopt modified behavior Availability of appropriate and accessible options or choices Who Should Be Involved?:  Who Should Be Involved? Families Schools Businesses Health care organizations Communities Media Families and Communities:  Families and Communities Cultural and environmental influences Access to safe activity Access to support mechanisms Schools:  Schools Food Service Pricing Vending machines Activity General Intramural Varsity Health Education Worksite:  Worksite Support of infrastructure for families and communities Data on work efficiency Value for the money Wellness programs Health Care:  Health Care Awareness (early identification) Access Training Reimbursement Acceptance of chronic disease model Media and Communications:  Media and Communications Improve recognition and translation of what is important Media emphasizes conflict Conflicts often presented without appropriate filter Terminology Success stories Why Should Groups Work Together?:  Why Should Groups Work Together? Efficiency and common resources Many groups are consulting with the same experts Many groups are seeking support from the same sources Many goals are overlapping Improved consistency of efforts Monitoring Our Status:  Monitoring Our Status Leading Health Indicators within Healthy People 2010 – Annual Report Card Subpopulations Measured versus self-report Cross-sectional versus longitudinal Modification of health risks Summary:  Summary Life-long modification of behaviors will be needed Prevention is the ultimate goal for those who are not overweight Improvement in health risk is the goal for all Everyone needs to become a Partner Paul Ambrose:  Paul Ambrose Let us all strive to make a difference:  Let us all strive to make a difference

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