Obesity and Diabetes in California

1
Obesity and Diabetes in California

• Susan H. Babey PhDUCLA Center for Health Policy
  ResearchLos Angeles, California
• California Legislative Task Force on Diabetes and
  Obesity
• Sacramento, California
• September 22, 2007

2
Acknowledgements

• Co-authors
• Theresa Hastert, MPP
• E. Richard Brown, PhD
• Allison L. Diamant, MD, MSHS
• Major funding for data collection on obesity and
  diabetes in the 2005 California Health Interview
  Survey
• The California Endowment
• Robert Wood Johnson Foundation
• National Cancer Institute

3
Presentation Overview

• Using data from the California Health Interview
  Survey, this presentation examines
• Prevalence of adult obesity overall as well as by
  race/ethnicity and household income
• Prevalence of adolescent overweight overall as
  well as by race/ethnicity
• Prevalence of diabetes overall as well as by age,
  race/ethnicity and household income
• Examples of environmental factors associated with
  diet and activity behaviors
• Suggested strategies for improving Californians
  diet and activity behaviors

4
The California Health Interview Survey (CHIS)

• Largest state health survey and one of the
  largest health surveys in the United States
• Telephone survey of adults, adolescents and
  children from across the state conducted every
  two years
• CHIS 2005 interviewed over 43,000 households in
  California
• The data provide a representative sample of the
  states non-institutionalized population,
  including health information on the overall
  population and on many racial and ethnic groups
  as well as local-level health information for
  most counties
• Interviews are conducted in five languages
  English, Spanish, Chinese, Korean and Vietnamese

5
Background - Obesity

• Definition of Overweight and Obesity
• Body Mass Index (BMI) is defined as kg/m2
• Obese is having a BMI of 30 or higher
• Overweight among adolescents is having a BMI in
  at least the 95th percentile for age and gender
• Nationwide, the prevalence of obesity has doubled
  in the past 30 years among adults and more than
  tripled among adolescents
• Being overweight or obese increases the risk of
  conditions such as
• Type 2 diabetes
• Coronary heart disease
• Hypertension
• Stroke
• Some cancers
• In California the combined costs of obesity,
  overweight and physical inactivity were projected
  to be over 28 billion in 2005

6
Obesity in California Increased from 2001-2005
Obesity Prevalence by Year, Adults Age 18 and
Over, California, 2001-2005
Source 2001, 2003, and 2005 California Health
Interview Survey
7
Obesity Highest Among Latinos, African Americans,
American Indians and Pacific Islanders
Obesity Prevalence by Race/Ethnicity and Year,
Adults Age 18 and Over, California, 2001-2005
Source 2001 and 2005 California Health Interview
Survey
8
Obesity Highest among Low-Income Californians

• Prevalence of Obesity by Household Income, Adults
  Age 18 and Over, California, 2005

Source 2005 California Health Interview Survey
9
Adolescent Overweight in California Increased
from 2001-2005

• Prevalence of Overweight by Year, Adolescents
  Ages 12-17, California, 2001-2005

Source 2001, 2003, and 2005 California Health
Interview Survey
10
Overweight Highest among Latino and African
American Teens

• Prevalence of Overweight by Race/Ethnicity,
  Adolescents Ages 12-17, California, 2005

Source 2005 California Health Interview Survey
11
Summary of Obesity Findings

• The prevalence of obesity is increasing in
  California
• 5.6 million California adults are obese and an
  additional half million adolescents are
  overweight or obese
• Obesity rates are higher among Latinos, African
  Americans, American Indians and Pacific Islanders
  than whites or Asians
• Obesity rates increased from 2001 among whites,
  Latinos, Asians and African Americans
• Obesity prevalence is higher among lower-income
  adults
• Overweight prevalence among teens is higher among
  Latinos and African Americans than whites

12
Background - Diabetes

• Diabetes is a chronic medical condition in which
  the body does not produce or properly use
  insulin, a hormone needed to convert
  carbohydrates into energy.
• Risk factors for type 2 diabetes include
• A family history of the condition
• Age
• Obesity
• Diabetes is the fifth leading cause of death by
  disease in the U.S.
• Complications include
• Heart disease
• Blindness
• Kidney failure
• Limb disease requiring amputations
• The economic cost of diabetes in 2002 was an
  estimated 132 billion, or one out of every 10
  health care dollars spent in the United States.
• Approximately 1.8 million Californians (7) have
  diabetes. This includes 300,000 with type 1
  diabetes and more than 1.5 million with type 2
  diabetes.

13
Diabetes Prevalence Increased from 2001-2005
Diabetes Prevalence by Year, Adults Age 18 and
Over, California, 2001-2005
Source 2001, 2003, and 2005 California Health
Interview Survey
14
Diabetes Prevalence Higher among Latinos, African
Americans and American Indians
Diabetes Prevalence by Race/Ethnicity and Year,
Adults Age 18 and Over, California, 2001-2005
Source 2001 and 2005 California Health Interview
Survey
15
Adjusting for Age Emphasizes Disparities by
Race/Ethnicity
Diabetes Prevalence by Race and Age, Adults Age
18 and Over, California, 2005
Source 2005 California Health Interview Survey
16
Diabetes Prevalence is Highest among Low-Income
Californians
Diabetes Prevalence by Household Income, Adults
Age 18 and Over, California, 2005
Source 2005 California Health Interview Survey
17
Summary of Diabetes Findings

• The prevalence of diabetes is increasing in
  California
• 1.8 million adults have been diagnosed with
  diabetes
• Diabetes rates are higher among Latinos, African
  Americans and American Indians than whites
• Diabetes prevalence increased significantly from
  2001 for all racial/ethnic groups except African
  Americans
• Diabetes prevalence is higher among low-income
  adults

18
Reducing the Prevalence of Obesity and Diabetes

• Overweight and obesity result from an energy
  imbalance eating too many calories and not
  getting enough physical activity
• Obesity is a major risk factor for type 2
  diabetes
• Preventing diabetes is closely tied to reducing
  the prevalence of obesity
• Promoting and encouraging physical activity and
  healthy eating are important in preventing and
  reducing obesity as well as in preventing
  diabetes
• Eating and activity behaviors are influenced by
  our environment

19
Physical Education at School Related to Teen
Physical Activity

• Percent of Adolescents Engaging in Regular
  Physical Activity and No Physical Activity by
  Physical Education (PE) Requirements at School,
  Ages 12-17, California, 2003

Source 2003 California Health Interview Survey
20
Availability of Safe Parks Related to Teen
Physical Activity

• Percent of Adolescents Engaging in Regular
  Physical Activity and No
• Physical Activity by Availability of a Safe Park,
  Ages 12-17, California, 2003

Source 2003 California Health Interview Survey
21
Availability of Safe Parks Related to Adult
Walking

• Prevalence of Walking by Availability of a Safe
  Park,
• Adults Age 18 and Over, California, 2003

Source 2003 California Health Interview Survey
22
Teen Soda Consumption Related to Availability in
School Vending Machines

• Average Daily Soda Consumption by the
  Availability of Soda in School Vending Machines,
  Adolescents Ages 12-17, California, 2003

Source 2003 California Health Interview Survey
23
Teen Soda Consumption Related to Fast Food

• Average Daily Soda Consumption by Fast Food
  Consumption,
• Adolescents Ages 12-17, California, 2003

Source 2003 California Health Interview Survey
24
Teen Fruit and Vegetable Consumption Related to
Fast Food

• Percent of Adolescents Eating at Least Five
  Servings of Fruits and Vegetables per Day by Fast
  Food Consumption, Ages 12-17, California, 2003

Source 2003 California Health Interview Survey
25
How can we promote physical activity and healthy
eating?

• Recognize that behavior is influenced by our
  environment
• Cost and geographic availability are associated
  with consumption of fresh fruits and vegetables,
  sodas, fast foods, etc.
• Availability of sodas in vending machines is
  associated with drinking more soda
• Safe parks and neighborhoods encourage walking
• School PE requirements are associated with
  physical activity
• Important to shape environments to encourage
  healthy behaviors and to discourage unhealthy
  behaviors
• Improving access to healthy foods and decreasing
  access to junk foods
• Improving access to facilities and opportunities
  to be physically active

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Conclusions RecommendationsHealthy Eating

• Improve environments to encourage healthy eating
  (at school, work and home)
• Specific suggestions include
• Menu labeling
• Promoting availability of healthy food outlets,
  particularly in underserved areas
• Consider zoning requirements that improve the
  food environment around schools (limiting access
  to and marketing of junk foods)
• Limiting or eliminating availability of junk food
  in schools and public buildings
• California has already taken steps to improve the
  food available in schools, but what about
  implementation?

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Conclusions RecommendationsPhysical Activity

• Improve our environment to encourage a physically
  active lifestyle
• Specific suggestions include
• Daily high-quality physical education in school
• Safe environments for walking and other physical
  activity
• Worksite programs to encourage and facilitate
  physical activity