Obesity: States Working to Slow the Epidemic

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Obesity States Working to Slow the Epidemic

• Kathleen Nolan
• Health Division Director
• National Governors Association
• Center for Best Practices

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Obesity Epidemic

• Rates of obesity have risen in every state and in
  every sub-group.
• In children
• In adults
• In minorities
• In elderly
• Increased obesity results in increases in
  diabetes, heart diseases, some cancer, and
  arthritis

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Obesity Trends Among U.S. AdultsBRFSS, 1991,
1996, 2003
(BMI ?30, or about 30 lbs overweight for 54
person)
1996
2003
No Data
lt10
10-14
15-19
20-24
? 25
Source Behavioral Risk Factor Surveillance
System, CDC.
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Obesity in Children
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If We Dont Make Change

• Overweight children often become overweight
  adults.
• The risk for developing diabetes for children
  born in 2000
• Boys 32.8
• Girls 38.5
• Hispanic boys 45.4
• Hispanic girls 52.5

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Virginia versus US

• Overall Virginia is far from the worst
• 58.8 of VAs adults are overweight (58.7--US)
• 72 of adults report eating fewer than 5 servings
  of fruits/veggies a day (76--US)
• Deaths due to diabetes and heart disease in VA
  are slightly lower than the national averages.

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The National Costs of Obesity

• It is estimated that overweight and obesity costs
  the United States as much as 117 billion dollars
  each year
• 61 billion in direct costs
• 56 billion for indirect costs
• Virginia annually spends an estimated 374
  million (13.1) of its Medicaid dollars on
  obesity related costs.
• Obese people cost 36 more for health svcs and
  77 more for pharmaceuticals.

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Why States Must Act

• Costs for health care rising
• Responsibility for public employees
• Private sector investment slowed or damaged
• Communities, Schools, health care providers, and
  agencies overburdened
• STRATEGIC ACTION REQUIRED ON ALL FRONTS

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Ways to think of this issue

• The Individual needs to eat less and exercise
  more
• We in Government need to help them
• Focus on policymake it easier for people to do
  this
• Focus on the environment
• Focus on support
• Focus on systems
• Focus on data

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Opportunities for Prevention with Children

• Implementing enhanced Phys. Educ.
• Promoting breast-feeding
• Reducing television time
• Improving school-nutrition and nutrition
  education
• Increasing after-school programs and access to
  school facilities after hours

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Opportunities for Prevention with All Virginians

• Community/State-wide education campaigns
• Promoting the use of stairs in the workplace and
  in public spaces
• Support groups and tailored programs
• Disease management with a focus on weight control
  
• Provide opportunities in the community for
  physical activity

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Arkansas

• Multi-pronged approach launched by Gov. Mike
  Huckabee
• Children in schools
• Medicaid population focus
• Adults in the workplace
• Aging citizens

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AR Innovations with Children

• BMI assessment in schools
• Year 1 results
• 345,000 students assessed throughout the state
• 38 percent were obese or overweight
• Demographic breakdown of obesity/overweight
• 40 percent of African American children
• 46 percent of Hispanic children
• 36percent of white (non-Hispanic) children

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AR Innovations with Medicaid Recipients

• Offers comprehensive smoking cessation services
• Worked with major company in state to pilot a
  diabetes self-management course including weight
  control
• Developing a health risk assessment to identify
  people in need of intervention to prevent chronic
  diseases

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AR Innovations with Adults

• Developed a program with state employees
• Working closely with communities and private
  companies to promote worksite wellness programs
  with employees from public and private sector
• Exploring implementation of incentives for
  healthy behaviors for insurance costs.

16
AR Innovations for the Aging

• Gov. Huckabee is focusing on pilot programs to
  reach aging populations with healthy behavior
  education and messages.
• Identifying opportunities for improving nutrition
  among aging populations in the community.

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Michigans Prescription for Health

• Gov. Jennifer Granholm appointed the nations
  first State Surgeon General
• Dr. Wisdom is charged with monitoring the health
  of Michiganders, and for promoting improved
  health.
• Serves as a convener for a broad number of
  stakeholders
• Developed a state-wide walking campaign

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Florida

• Gov. Bush formed a task force on Obesity
• A list of recommendations were forwarded to the
  Governor, and served as a basis for several
  bills
• Called for the creation of standards and
  guidelines for school nutrition and phys ed
• Created a wellness program for state employees

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A few additional examples

• Texas
• Dept of Ag requirements for school lunches
• CDC stairwell improvement project
• Promoting stairwell use with music, art, etc.
• California soda ban in schools
• No soft drink sales allowed on campuses (vending
  or a la carte)

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So what can VA do

• NGAs Suggestions
• Educate people on the reasons and the hows to
  eat better and be active
• Improve phys educe.
• Strategize with partners from food and fitness
  industries
• Regulate access to junk foods and sodas in
  schools
• Consider coverage enhancements for health
  insurance recipients

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Things VA can do

• NGAs Suggestions (contd)
• Gather economic impact and demographic data and
  use in setting priorities.
• Work with medical groups, charitable
  organizations, churches, and others to provide
  services for Virginians at high-risk for
  obesity.
• Partner with state and local agencies to promote
  healthy community design.
• Use the bully-pulpit at all levels.
• Challenge private sector efforts to mobilize
  response to obesity epidemic

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Some other things to think about

• The evidence base
• Guide to community preventive services
• Centers for Disease Control
• Other states and community connections
• Planning/strategybreadth of issues
• Support communities/pilot projects
• Empowerment to eat less and exercise more