State of Health in America… Grace H. A. Thomas, MD, FACOG

Obesity One word says it all ! By definition – is an excessively high amount of body fat in relation to lean body mass Body Mass Index (BMI) is a common measure expressing the relationship of weight to height

Prevalence of Obesity Worldwide: WHO estimates more than 1 billion people are overweight – BMI 25-29 300 million of those people meet the criteria for obesity – BMI of 30 or greater

Prevalence of Obesity There are over 72 million obese adults in the U.S. Childhood obesity affects approximately 12.5 million children and teens in the U.S. In every state, more than 15% of the adults are obese In 9 states (including Alabama) more than 30% of adults are obese No state has an obesity rate of less than 15% which was the national goal for 2010

Contributing Factors to National Epidemic Higher medical costs One study estimated approximately 9% of all medical costs in 2008 were obesity related and amounted to $147 billion, compared with $78.5 billion 10 years before

Contributing Factors to National Epidemic Lower quality of life Contributes to many health problems that are the leading causes of death in the U.S.

Factors in National Epidemic Heart disease Stroke Diabetes mellitus Some types of cancer Sleep apnea / breathing problems Limited physical activity

Women and Obesity Non-Hispanic black women and Hispanic women have the highest rates of obesity 41.9% and 30.7%, respectively 1. Obesity affects fertility throughout a woman’s reproductive life – Obese women are 3 times more likely as women of normal weight to be infertile 2. Obesity during pregnancy is related to overall higher health care expenditures and contributes to many pregnancy complications including Pregnancy Induced Hypertension; preeclampsia, gestational diabetes mellitus, cesarean section and neonatal death

Women and Obesity mothers including Neural Tube Defects, 3. Rates of fetal anomalies are increased in obese mothers including Neural Tube Defects, Spina bifida, cardiovascular anomalies, cleft lip and palate 4. Strong link to gynecological cancers, particularly endometrial/uterine cancer and cervical cancer; and well established link between obesity and postmenopausal breast cancer

Why is this epidemic happening? Weight gain occurs when people eat too much food and get less physical activity Societal and community changes have accompanied the rise in obesity

The American Diet Some Americans have less access to stores providing healthy, affordable food such as fruits and vegetables, especially in rural, minority and low-income neighborhoods Restaurants, snack shops, and vending machines provide foods that are higher in calories than home cooked foods

The American Diet adults drink at least one sugary drink per day There is too much sugar in our diet – 6 out of 10 adults drink at least one sugary drink per day It is often easier and cheaper to get less healthy foods and beverages Foods high in sugar, fat and salt are highly advertised and marketed

The American Diet soft drinks – 77 gallons per person each year Alabama is among our nation’s top consumer of soft drinks – 77 gallons per person each year Residents also consume $649 per person in fast food annually Reference: 10 States With The Deadliest Eating Habits by Charles B. Stockdale

What happened to physical activity? **Many communities are built in ways that make it difficult or unsafe to be physically active: Access to parks and recreation centers may be difficult or lacking, and public transportation may not be available Safe routes for walking and biking to school, work or play may not exist Too few students get quality, daily physical education in school

Diabetes Belt mapped higher than average occurrences of diabetes The term “Diabetes Belt” was coined when researchers mapped higher than average occurrences of diabetes mellitus in an area encircling much of the Southeast Almost all of Alabama’s 67 counties are included 11% or more of a county’s residents have to be diagnosed with diabetes mellitus to be included in the “Diabetes Belt”

Diabetes Belt **In 2010, the Centers for Disease Control (CDC) reported that 11.6 % of Montgomery County’s residents have diabetes mellitus; the national median is 8.1% Only 2 Alabama counties were omitted from the “Diabetes Belt” – Baldwin and Shelby

Diabetes Belt 4 Distinguishing Factors 1) The population of the Diabetes Belt counties contained substantially more African Americans compared to the rest of the country – 23.8 % for diabetes belt, vs 8.6 % nationally 2) The prevalence of obesity was greater in the diabetes belt than in the rest of the nation 3) A sedentary lifestyle was greater in the diabetes belt 4) The proportion of people with a college education was smaller

What can be done…. Our first lady recently launched the “Let’s Move!” program, which seeks to eliminate childhood obesity within the generation It’s main points of action are; providing healthy foods in schools, increasing physical activity and improving access to healthy, affordable foods

States can… Expand programs that bring local fruits and vegetables to schools, businesses and communities Support hospital programs that encourage breastfeeding Adopt policies that promote bicycling and public transportation Provide supermarkets and farmers markets with incentives to establish their businesses in low income areas and to offer healthy foods

Everyone can… Eat more fruits and vegetables and fewer foods high in fat and sugar Drink more water instead of sugary drinks Limit TV watching in kids to less than 2 hours a day Support breast feeding Promote policies and programs at school, at work and in the community that make healthy choice the easy choice Get moving! – 10 minutes brisk walk, 3 times a day, 5 days a week

Alabama Department of Public Health State Obesity Task force – has developed a strategic plan for the prevention and control of overweight and obesity in Alabama BITE – Community Grant – 5 Alabama communities received funds to stimulate community-based physical activity and nutrition programs to reduce risk of overweight and obesity Scale Back Alabama – Statewide campaign held at the beginning of each year to encourage Alabamians to get healthier by losing weight and exercising

In Conclusion… Obesity is a complex issue that requires action on many levels A cultural shift in the way we think about food: convenience culture vs eating for good health