Obesity control the public health challenge

1
Obesity control the public health challenge

• Katherine Hempstead
• Center for Health Statistics
• New Jersey Department of Health and Senior
  Services
• June 25, 2007

2
Learning objectives

• 1. Understand epidemiological data on obesity
  epidemic
• 2. Review current obesity control policy
  activities
• 3. Understand challenges facing obesity control
  efforts, role of epidemiologists

3
Overview

• Background
• Current policy activities
• Obesity control vs. tobacco control
• Outlook/Assessment

4
Age pattern of obesity prevalence, 1998-2006
Source BRFSS
5
If age-specific growth rates persist
Projection 2012
Source BRFSS
6
Prevalence of overweight Children and teens
SourceNHANES
7
Obesity Trends Among U.S. AdultsBRFSS, 2005
(BMI 30, or 30 lbs overweight for 5 4
person)
1519
2024 2529 30
8
Overweight and obesity by race and ethnicity,
adults, 2006
Source BRFSS
9
Overweight by race and ethnicity, 12-19 years,
2003/4
SourceNHANES
10
Burden of obesity

• Morbidity
• Disability
• Life expectancy
• Cost

11
Public health response

• Long recognized as health problem
• Epidemic anticipated since 1970s
• Focus has been on individual behavior
• if overweight, decrease energy intake and
  increase energy expenditure Dietary Goals for
  the United States, 1977

12
More recently

• Obesity is a societal problem
• The toxic environment
• Policy focused on altering environment
• individual change will not work in isolation.
• Trust for Americas Health, 2006

13
Recent legislative activities

• Schools
• Task forces
• Insurance mandates
• Taxes/bans on food
• Menu labeling
• Improvements to the built environment

14
Enacted obesity legislation
15
Proposed obesity legislation
16
2006 State Report Card
17
Obesity control comparable to tobacco control in
some ways

• Multiple stakeholders
• States very important
• Focus on prevention
• Focus on environmental reform
• Emphasis on legislative activity

18
Tobacco control hailed as a great public health
victory

• Obesity control efforts in much earlier stage of
  development
• Is obesity control on a trajectory to be
  similarly successful?
• Unique challenges

19
1. Obesity is a more complex problem

• Food behavior affected by many factors
• Physical activity difficult to regulate

20
2. Food supply more difficult to regulate

• Food supply is decentralized
• Food industry less monolithic

21
3. More potential for backlash

• War on obesity or war on obese?
• Some say too much big brother

22
Summary

• Challenges
• Complexity of obesity
• Decentralization of food supply
• Potential for backlash
• What do we need?

23
We need epidemiological evidence

• Public intervention on the rise
• But science not driving policy
• Epidemiologists can contribute with data,
  evaluations, new outcome measures
• a necessary element of an adequate
  governmental response to the obesity epidemic is
  a robust information-gathering system to monitor
  progress and guide programs and policies. IOM

24
and appropriate expectations

• Avoid urge to rush into unsupported activities
• Toxic environment was created over several
  decades
• Consumers need to develop new lifestyle
  preferences and maintain them
• Need to de-normalize unhealthy lifestyles
• Moderate change may confer benefits

25
The problem is pervasive
26
In closing

• The 'fad diet' approach does not work for
  individuals, and it's not going to work for our
  nation's obesity crisis either.
• Trust for Americas Health, 2006