Health:

1
Health
The Cot of Weight
Wednesday, July 19, 2006 Noon to 1PM Anchorage
Legislative Information Office 716 W.
4th Ave. (Room 220) Participate via local
LIOs Call 1- 800-922-3875 for info Light lunch
served in Anchorage.
2
Agenda

• Health the Cost of Weight
• July 19, 2006
• Introductions/Opening Remarks
  Rep. Sharon Cissna
  and Senator Donny Olson (if available)
• Global and National Perspectives on Obesity from
  the CDC(calling in)- Susan Anderson, Public
  Health Nutritionist, Center for Disease Control
  in Atlanta
• The Burden of Obesity in Alaska - Erin
  Peterson, Program Manager, State of AK Obesity
  Program
• Mayors Task Force on Obesity and Health 10-Year
  Plan Creating a Healthy Community - Nathan
  Johnson, Municipality of Anchorage, HSS
• Obesity and the Alaska Native Community (from the
  Fairbanks LIO) Sarah Vent, Nurse, Tanana
  Chiefs Conference - Fairbanks
• Weight and the Community Fit not Fat, Why School
  Fitness? - Peter Mjos, MD, Anchorage
  Neighborhood Health Center, Take Heart Alaska
• Addressing Obesity Through Public Policy
  - Suzanne Munier, American Heart Association
• Health and Wellness Efforts in the Schools
  - Lynda Sather, Fairbanks School District
  (from the Fairbanks LIO) Dawn
  Hensley-Maranville, Benefits Coordinator, FNSBSD
• Weight and Personal Choice - Sandy Baker,
  Manager, Anchorage Curves Heather Conway,
  Juneau Racquet Club (in Juneau LIO) Phyllis
  Finley, Anchorage Weight-Watchers
• Discussion.

3
Overweight Defined

• Due to potential negative connotations associated
  with the term obesity, overweight is
  preferred when referring to children and
  adolescence.
• At risk of overweight BMI between the 85th and
  95th percentiles for ages 2 20 years.
• Overweight BMI above the 95th percentile.

4
Obesity Defined

• Obesity having a very high amount of body fat in
  relation to lean body mass, or Body Mass Index
  (BMI) of 30 or higher.
• Body Mass Index (BMI) a measure of an adults
  weight in relation to his or her height,
  specifically the adults weight in kilograms
  divided by the square of his or her height in
  meters.

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Obesity and Public Health The CDC Perspective

• Presentation for the Alaska Health Caucus
• "Health-The cost of weight
• July 19th 12-100pm PDT
• Susan M. Anderson, MS, RD
• Division of Nutrition and Physical Activity

6
Obesity is a Top Public Health Problem and a
CDC Priority

• Obesity prevalence in the United States has
  soared since 1980
• Doubled in adults
• Doubled in children
• Tripled in adolescents

7
Obesity rates are increasing among adults

• with serious health consequences
• type 2 diabetes
• heart disease
• high blood pressure
• stroke
• some cancers
• arthritis
• other illnesses and conditions

8
Obesity rates are increasing among adults -

• An estimated 66 percent of U.S. adults are either
  overweight or obese, BMIgt25
• Approximately 32 percent are obese, BMIgt30
• (2003-2004 NHANES survey NHANES uses measured
  heights and weights)

9
Healthy People 2010 objective

• Reduce adult obesity to less than 15 percent by
  2010
• But at 32 for 2003-2004, the rate is up from
  23 in the period 1988-94
• (2003-2004 NHANES survey, measured heights and
  weights)

10
(No Transcript)
11
State-level Obesity Trends Among U.S.
Adults1991, 1996, 2004 BRFSS (self-report,
percent of population BMIgt30)
1996
2004
No Data
lt10
10-14
15-19
20-24
? 25
12
Percentage of U.S. Children and Adolescents Who
Are Overweight
gt95th percentile for BMI by age and sex based
on 2000 CDC BMI-for-age growth charts Data are
from 1963-65 for children 6-11 yrs of age and
from 1966-70 for adolescents 12-17 yrs of age
Source National Center for Health Statistics
13
1995-2004 National PedNSS Trends 1995 and
2004(low income - under 5 years)
Among children 2 up to 5 years, 2000 CDC Growth
Reference, one record per child.
14
1995-2004 National PedNSS Trends 1995 and
2004(low income - under 5 years)
Among children 2 up to 5 years, 2000 CDC Growth
Reference, one record per child.
15
Prevalence of obesity is increasing in many
countries

• Prevalence of overweight (BMI gt25 kg/m2)
  increased in virtually all Western European
  countries, Australia, the USA, and China from
  early 1980s to mid 1990s.1
• Rates for adults in Great Britain almost tripled
  between 1980 and 2002.2

1Silventoinen et al, Int J Obes Relat Metab
Disord. 200428710-718. 2Rennie et al, Obes
Rev. 2005611-12.
16
Prevalence of obesity is increasing in many
countries

• Among preschool children in urban areas of China,
  the prevalence of obesity increased from 1.5 in
  1989 to 12.6 in 1997.3
• Analysis of various surveys conducted in Brazil,
  China and the United States in the 1980s and
  1990s show increasing trends in overweight and
  decreasing trends in underweight.4
• In Russia, by contrast, overweight rates
  decreased and underweight rates increased in the
  1990s.4

3 Luo J et al, Int J Obes Relat Metab Disord.
200226553-558. 4 Wang et al, Am J Clin Nutr.
200275971-977.
17
Impact of Childhood Overweight (BMI gt 95th
percentile) on Adult Obesity (BMI gt 30)

• Bogalusa Heart Study
• Onset at less than 8 years of age is associated
  with being more severely obese as adults (BMI
  41.7 versus 34.0)
• 25 obese adults were overweight children

Freedman et al, Bogalusa Heart Study. Pediatrics
108 (3), 712718
18
The Health Costs Associated with Obesity are High
and Growing

• Direct health costs attributable to obesity
• 52 billion in 1995
• 75 billion in 2003
• (Medicare/Medicaid pays half of these costs)
• Private health insurance spending on
  obesity-related illnesses
• 3.6 billion in 1987
• 36.5 billion in 2002

19
Businesses Also Must Deal With The Significant
Indirect Costs Of Obesity

• 30 of obesity-related costs to business are from
  absenteeism
• 3 of employees with severe obesity (BMI 40)
  account for 21 of costs

20
What contributes to overweight and obesity?

• In addition to other factors, behavior and
  environment play a large role in causing people
  to be overweight and obese.
• These are the greatest areas for prevention and
  treatment actions.
• Adapted from U.S. Surgeon Generals Call to
  Action to Prevent and Decrease Overweight and
  Obesity, 2001

21
Prevention of Chronic Disease through Nutrition
and Physical Activity
Diabetes
Obesity
Cancer
CVD
Tobacco
Elderly
Nutrition
Adults
Physical Activity
Adolescents
Infants and Children
22
Settings for the Prevention and Treatment of
Obesity - Places where people live, learn, work
and play

• Industry
• Medical Settings
• School
• Work Site
• Community

23
Program strategy Widespread change

• Increased physical activity
• Reduced television time
• Reduced soft drink consumption
• Increased breastfeeding
• Improved fruit and vegetable consumption
• Control of portion size
• Balance caloric intake and expenditure

24
strategies
policies
environments
individuals
Theory of Change

• Strategies and interventions across settings
• Policy change
• Improved environments
• Improved behavior and health status

25
Reversing the Obesity Epidemic is a Shared
ResponsibilitySocial and environmental changes
are influenced by the efforts of many
26
CDC Vision Promote Healthy Weight Throughout
the Lifecycle

• CDC envisions a nation in which all people can
  reach and maintain a healthy weight and achieve
  their optimal lifespan with the best possible
  quality of health in every stage of life.

27
How long will it take?
28
Adult per Capita Cigarette Consumption and Major
Environmental and Policy Changes in the US
1900-1990
Thousands per year
Fairness Doctrine messages on radio and
television
Nonsmokers rights movement begins
First Medical reports linking smoking and cancer
US Surgeon Generals first report
Broadcast advertising ban
End of WW II
Federal cigarette tax doubles
Great Depression
Year
29
Websites for more information about CDC sponsored
programs

• cdc.gov/nccdphp/dnpa
• cdc.gov/5aday
• cdc.gov/nccdphp/dash
• cdc.gov/youthcampaign
• healthierus.gov/steps

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Contact InformationDivision of Nutrition and
Physical Activity (DNPA)

• Susan M. Anderson, MS, RD
• Email SAnderson_at_cdc.gov
• Phone [phone]
• www.cdc.gov/nccdphp/dnpa

31
Erin Peterson Program Manager State of Alaska
Obesity Program
The Burdon of Obesity in Alaska
32
Trends

• During the past 20 years there has been a
  dramatic increase in obesity in the United
  States.
• In 1985 only a few states were participating in
  CDC's BRFSS and providing obesity data.
• In 1991, four states had obesity prevalence rates
  of
• 15-19 percent and no states had rates at or
  above 20 percent.
• In 2004, seven states had obesity prevalence
  rates of
• 1519 percent 33 states had rates of 2024
  percent and 9 states had rates more than 25
  percent.

33
Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI 30, or 30 lbs overweight for 5 4
person)
34
Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs overweight for 5 4
person)
35
Obesity Trends Among U.S. AdultsBRFSS, 2004
(BMI 30, or 30 lbs overweight for 5 4
person)
36
Prevalence of Overweight (25.0 lt BMI lt 30.0),
Obesity (BMI gt30.0) and Overweight/Obesity (BMI
gt 25.0), Alaskan Adults 1991-2004
Source AK BRFSS
37
Alaskan High School Students Who are Overweight
or At-Risk for Becoming Overweight
Source Youth Risk Behavior Survey 2003
38
BMI StatusAnchorage School District
Students1998 2003
Source DHSS, Division of Public Health, Section
of Epidemiology State of Alaska, Epidemiology
Bulletin, Volume No. 8, Number 9, November 10,
2004
39
BMI Status of Kindergarten and First Grade
Students Anchorage School District 1998-2003
Source DHSS, Division of Public Health, Section
of Epidemiology State of Alaska, Epidemiology
Bulletin, Volume No. 8, Number 9, November 10,
2004
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Overweight and Obesity Health Consequences

• Adults
• Premature mortality
• Cardiovascular disease
• Type 2 Diabetes
• Musculoskeletal disorders
• Sleep apnea
• Gallbladder disease
• Certain types of cancer (endometrial, colon,
  kidney, gallbladder, postmenopausal breast)

• Youth
• Increased risk of obesity as an adult
• High blood pressure
• High cholesterol
• Orthopedic disorders
• Type 2 Diabetes
• Psychosocial disorders

41
Obesity Economic Costs

• United States
• 75 billion in annual direct medical expenditures
  
• 18 billion financed by Medicare
• 21 billion financed by Medicaid

• Alaska
• 195 million in annual direct medical
  expenditures
• 17 million financed by Medicare
• 29 million financed by Medicaid

Source State-Level Estimates of Annual Medical
Expenditures Attributable to Obesity. Obesity
Research. 2004
42
Causes of Obesity Complex Interrelated Factors

• The ideal approach to obesity control will
  address all factors

1Thomas PR, ed. Weighing the Options. Wash DC
Natl Acad Press 19952. 2Williamson DF. N Engl
J Med. 19993411140. 3Koplan JP, Dietz WH.
JAMA. 19992821579.
43

• Plan Goals
• Goal 1 Increase the percentage of Alaskans who
  recognize the need to address overweight and
  obesity
• Goal 2 Increase the percentage of Alaskans who
  are physically active
• Goal 3 Increase the percentage of Alaskans who
  make healthy food choices
• Goal 4 Increase the percentage of Alaskans who
  maintain a healthy weight

44

Settings Goals, Aims, Strategies
Mass Communication

• School Based

Healthcare

• Community

45
Obesity Prevention and Control Program

• Program Activities
• Surveillance and Evaluation
• Weight Status, Nutrition, Physical Activity
• Resource Development and Distribution
• State Physical Activity and Nutrition Plan
• School Wellness Policy Toolkit
• Head Start Training Manual

46
State of Alaska Obesity Prevention and Control
Program Activities (Continued)

• Training and Technical Assistance
• Community Groups
• Employers
• Schools
• Local Governments and Non-profits
• Statewide Coalitions
• Public and Professional Education

47
Nathan Johnson Municipality of Anchorage Health
and Human Services
48
OBESITYThe Mayors Taskforce on Obesity and
Health 10 Year Plan
2006
An overview
49
The Problem
People are consuming more calories than they
can expend.
50
Trends

• U.S. - 60 of adults are either overweight or
  obese.
• State of Alaska - 63 of adults are either
  overweight or obese.

51
Municipality of Anchorage

• 61 adults are overweight,
• 23 adults are obese.
• 36 of all ASD students were overweight or at
  risk for becoming overweight.
• 32 of kindergarten and 1st grade students were
  overweight or at risk for becoming overweight.

52
BMI
Overweight -
Obese -
Extremely Obese -
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Why do we care?

• It is an expensive epidemic.
• It contributes to many illnesses.
• It can decrease quality of life.
• It is often misunderstood.

54
Obesity Economic Costs

• United States
• 75 billion in annual direct medical expenditures
  
• 18 billion financed by Medicare
• 21 billion financed by Medicaid

• Alaska
• 195 million in annual direct medical
  expenditures
• 17 million financed by Medicare
• 29 million financed by Medicaid

Source State-Level Estimates of Annual Medical
Expenditures Attributable to Obesity. Obesity
Research. 2004
55
Illness

• diabetes
• coronary heart disease
• high blood pressure
• high cholesterol
• osteoarthritis
• sleep disturbances
• breathing problems
• certain cancers
• to name a few

56
Causes and contributions

• Behavior
• Environment
• Genetics

57
Promoting exercise has not worked
Source Centers for Disease Control and
Prevention Behavioral Risk Factor Surveillance
System
58
Quality of Life
The National Institute of Health projects that
our next generation of children will be the first
in the history of the U.S. whose life expectancy
is shorter than their parents due to the impacts
of obesity and related health consequences.
59
Municipality of Anchorage Ten Year Plan on
Obesity and Health
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Goals and Objectives

• Goal 1 Ensure Plan Implementation, Oversight
  and Review.
• Goal 2 Improve the eating habits of the
  Municipality of Anchorage residents through
  better nutrition.
• Goal 3 Increase the number of adults,
  adolescents and children who engage in regular
  physical activity.
• Goal 4 Create a community environment that
  supports a more physically active way of life.

61
Goal 1 Ensure Plan Implementation, Oversight
and Review.

• 1.
• 1 Establish oversight of plan progress, promotion
  and review.
• 1.2 Identify an umbrella program that will assist
  in quantifying and rewarding efforts on a
  community-wide basis.

62
Goal 2 Improve the eating habits of the
Municipality of Anchorage residents through
better nutrition.

• 2.1 Improve the overall nutrition in all schools,
  public and private, within the Municipality
  of Anchorage.
• 2.2 Improve the overall nutrition of licensed
  Child Care Centers and Child Care Homes within
  the Municipality of Anchorage.
• 2.3 Improve the nutrition in the workplace.
• 2.4 Improve the availability of nutritional
  choices within the community.
• 2.5 Encourage health care providers and insurance
  carriers to promote better nutritional habits.

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Rewarding Homework with Donuts
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Goal 3 Increase the number of adults,
adolescents and children who engage in regular
physical activity.

• 3.1 Increase the number of pre-school aged
  children engaged in recommended daily physical
  activity.
• 3.2 Increase opportunities for physical activity
  in the Municipality of Anchorage schools.
• 3.3 Increase and improve workplace initiatives
  promoting physical activity.
• 3.4 Engage community organizations and recreation
  groups in developing greater options, access and
  participation in physical activity.
• 3.5 Promote public policy that supports and
  promotes physical fitness.

65
Goal 4 Create a community environment that
supports a more physically active way of life.

• 4.1 Develop safe, convenient, and attractive
  sidewalks/pathways.
• 4.2 Develop safe, convenient, and attractive
  transit facilities to include easier
  accessibility from both sides of the street.
• 4.3 Improve off-road trail system to provide
  better area wide connectivity and linkages to
  major destinations and adjoining neighborhoods.
• 4.4 Improve safety and maintenance of pedestrian
  transportation system.
• 4.5 Site public facilities, such as schools,
  parks, and public buildings in locations where
  they are readily accessible by walking, biking
  and/or public transit to the residents intended
  to be served.
• 4.6 Modify the Municipality of Anchorages land
  use regulations to encourage and facilitate
  compact mixed use and pedestrian friendly
  development, particularly in those areas so
  identified in the Municipality of Anchorages
  Comprehensive Plan.
• 4.7 Create new or remodeled buildings with
  features that support and encourage more physical
  activity.

66

• Actually, 8 million children and adolescents are
  overweight
• Over the last two decades the rates for
  overweight adolescents have tripled.

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Fulfilling Market Needs
Goliath Caskets
The owners based the casket specifications on
simple observations of the world around them.
"It's just going to local restaurants or walking
in a normal Wal-Mart - people are getting wider
and they're getting thicker."
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Co-Chairs, Sen. Donny Olson and Rep. Sharon
Cissna thank you for participating in the
Legislative Health Caucus. A copy of this
powerpoint can be found on our website
www.akdemocrats.cissna.org The audio file of
todays program can be found at
http//www.ktoo.org/gavel/audio.cfm. (type in the
date of this Caucus). For more information,
please call 1-800-922-3785