Jim Krieger, MD, MPH "I"CANN Leadership Forum for a Healthier Generation September 12, 2013

Jim Krieger, MD, MPH"I"CANN Leadership Forum for a Healthier

GenerationSeptember 12, 2013

The Big Picture: Obesity in South King County & Beyond

Obesity•Overview of the data

– National– South King County

•What is driving the obesity epidemic?•What can we do about it?

Today’s Presentation

Overview of the National Data

Obesity Trends* Among U.S. AdultsBRFSS, 1985

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%



No Data <10% 10%–14%



No Data <10% 10%–14%



No Data <10% 10%–14%



No Data <10% 10%–14%



No Data <10% 10%–14%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19% ≥20%



No Data <10% 10%–14% 15%–19% ≥20%



No Data <10% 10%–14% 15%–19% ≥20%



No Data <10% 10%–14% 15%–19% ≥20%



No Data <10% 10%–14% 15%–19% 20%–24% ≥25%



No Data <10% 10%–14% 15%–19% 20%–24% ≥25%



No Data <10% 10%–14% 15%–19% 20%–24% ≥25%



No Data <10% 10%–14% 15%–19% 20%–24% ≥25%



No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%



No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%



No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%



No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%



No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%



No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trend since the 1960’s

Obesity projections- adults

Childhood Obesity trends

• The very young: age 0-2– 1 in 10 children are overweight

• The young: age 2-5– 1 in 5 are overweight/obese– Rate has doubled over the past 30 years

• The rate of overweight increases most rapidly in elementary school-age kids

• The “child will grow out of it with time” is a myth.– If overweight during preschool, 5 times higher risk of being

overweight at age 12

Obesity in early childhood: what do we know?

Consequences of Obesity

Health Consequences of Obesity

• 27% of increase in health spending between 1987-2001 due to obesity3

• More recent estimates:2

– Obese people cost $2826 MORE per person per year in medical costs relative to normal weight people

– Obesity now accounts for 16.5% of national spending on medical care

1 Finkelstein et al., Health Affairs: 20092 Crawley and Myerhofer. Natl Bur Ec Res. Working Paper 16467, 20103 Thorpe, et al. Heatlh Affairs W4:480, 2004

Medical Costs 1988 20081

(inflation adjusted) $78.5 billion/yr

$147 billion/yr

Medical Costs of Obesity

Impact on business

• For a firm with 1000 employees, obesity costs $285,000 per year (30% absenteeism, 70% medical costs4)

• Obese workers have 1-5 more sick days per year1, 3

• 10% of corporate health care costs attributable to obesity2

1 Neovius. Obes Rev 10:17-27, 2009, Tsai Ann Epidemiol. 18:8-14, 20082 http://www.npr.org/2011/10/27/141760591/workplaces-feel-the-impact-of-obesity

3 Hammond. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 20104 Finkelstein & Brown. NC Medical Journal. 67:310-312, 2006

Impact on Business

http://www.npr.org/2011/10/27/141760591/workplaces-feel-the-impact-of-obesity

A Look at South King County

South County Adult Obesity Rate – Health Reporting Areas

Adult Obesity Rate by City – South County

How does South King County compare to the rest of the County?

Obesity Disparities in South King County

Youth Obesity Rate in King County – 2012

How does South King County compare to the rest of the County?

Youth Obesity in South County – 2012

Early Childhood Obesity Rate – King County (Low Income Children)

Looking to the future

Comparing Diabetes in King County

Schoenthaler, Celeste

delete and use previous instead?

Too many calories INNot enough calories OUT

ENERGY GAP – 30-175 CALORIES A DAY

What is causing the epidemic?

Calories in: How much food is that?

240 180 150

2,000

2,100

2,200

2,300

2,400

2,500

2,600

2,700

2,800

1971

1973

1975

1977

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

Dai

ly C

alo

ries

USDA ERS website http://www.ers.usda.gov/Data/foodconsumption/FoodGuideSpreadsheets.htm

Daily per capita calories(adjusted for spoilage and waste)

• Half of 2-3 year olds drank at least one sugary drink a day

• A quarter of calories consumed by 2-3 year olds are from sweets and sugary drinks2

• 30% ate no vegetables on the day of the survey, 5% ate no fruit

• French fries were the most commonly consumed vegetable from 12 months to 4 years of age

1 Nestlé Nutrition Institute; JADA 2010.2 Reedy & Krebs-Smith JADA, Oct 2010

What are pre-schooler’s eating and drinking?1

74%

King County youth who do not eat recommended amounts of fruits and vegetables

US, 1988-1994 vs. 1999-2002

Source: Wang YC et al., Pediatrics: 2006 and Wiecha et al., Archives of Pediatric and Adolescent Medicine: 2006.

How to reduce about 150 calories:• Replace 1 can of soda (12 oz) with water

• Reduce TV watching by an hour

• Increase PE from 1 to 3 times/week

Average Weight Gain (lb)

Daily Increase in Calories

All Teens 10 110 - 165

Overweight Teens

58 678 - 1,017

Teens are eating more caloriesand gaining weight

40% of total calories are empty calories

170 calories a day 165 calories a day

Reedy & Krebs-Smith JADA, Oct 2010Institute of Medicine. Preventing Childhood Obesity, 2005

Top sources of calories for 9-18 year olds

Each extra serving of a sugary drink consumed per day increases the chance of becoming obese by 60%

soda energy drinks sports drinks sweetened water fruit drinks

Dramatic increase in availability

How much are King County youth drinking?

Snacking on the rise

• Snacks contribute 30% of the total calories in preschoolers diets (mainly crackers, cookies, and candy)

• Kids age 6-11 eat three times as many chips, crackers, popcorn and pretzels than in the mid-1970s1

• 52% of teens now eat 2 or more snacks a day compared to 25% in the 1970s

1 Nationwide Food Consumption Survey 1977-78 and What We Eat in America, NHANES 2005-062 Popkin 2011

• TV advertising Influences consumption by

children ages 2–11 years Associated with body fatness

in children 2–18 years

Exposure to fast food ads between increased by1:

• 21% for preschoolers• 34% for children• 39% for teens

• $4.2 billion dollars in 2009 for fast food marketing ($1.6 billion to children)

1 between 2003-2009

Unhealthy foods regularly marketed to kids

Portion sizes have grown

Less healthy food is everywhere

• We are eating out more and eating more when eating out

• High calorie foods are featured in supermarkets

• Vending machines and convenience stores carry high calorie food

• Cafeterias at worksites and schools tempt us

Selected Food Price Trends, 1961-2009Inflation Adjusted

Source: BLS; NHES-I 1960-62; NHANES, 1971-74, 1976-80, 1988-94, 1999-2000, 2001-02, 2003-04, 2005-06

Selected Food Price Trends, 1978-2009Inflation Adjusted

Source: BLS; NHES-I 1960-62; NHANES, 1971-74, 1976-80, 1988-94, 1999-2000, 2001-02, 2003-04, 2005-06

Calories out: How much activity is that?

Based on 175 pound person

60 minute leisure bike ride:

Approx. 300

60 minutes of swimming: Approx. 400

60 minutes of running:

Approx. 500

No Leisure Time Physical Activity – South County

Where would you walk?

?

http://www.flickr.com/x/t/0092009/photos/completestreets/4566182096/

76%

King County youth who do not meet guidelines for daily physical activity

Children are not active enough

Daily PE Attendance

To 31% in 2011 from 42% in 1991 35% of high school

students watch 3 or more hours of television per day

0

10

20

30

40

50

60

70

AfricanAmerican

AI/ AN Asian NH/ PI Multiracial Hispanic/Latino

White

pe

rce

nt

More than 3 hours screen time per day

King County 2010, Grades 8 10 12

What can we do to reverse the trend?

It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change. - Institute of Medicine

Frieden. American J Public Health, 2010

Thank you!

Documents

Jim Krieger, MD, MPH "I"CANN Leadership Forum for a Healthier Generation September 12, 2013