Active and Eating Smart Iowans Fit for Life Active and Eating Smart Julie McMahon, Director Division of Health Promotion and Chronic Disease Prevention Iowa Department of Public Health

Obesity Trends* Among U.S. Adults BRFSS, 1991, 1996, 2003 (*BMI 30, or about 30 lbs overweight for 5’4” person) 1996 1991 2003 Obesity rates are soaring in America. About 60 million adults, or 30 percent of the adult population, are now obese, a rate that has doubled since 1980. According to the Behavioural Risk Factors Surveillance System (BRFSS), obesity has increased continuously in the last 20 years. Just in the last 10 years Iowa has changed from 10-14% range to 20-24%. Similar trends have been seen nationally. That is at the rate of 5% every 5 years. No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Stats An estimated 61% of Iowa adults are overweight (BMI > 25) or obese (BMI > 30)--BRFSS (2002) An estimated 16 percent of children and adolescents ages 6 –19 years are overweight—based on BMI, (1999 –2002 National Health and Nutrition Examination Survey (NHANES) 61% of Iowans adults are now overweight or obese. Obesity is based on BMI. BMI stands for Body Mass Index. It is a number that shows body weight adjusted for height. It is tool for used for adults. BMI of (greater or equal to) > 25 is overweight and (greater or equal to) >30 is obese. The higher the BMI the greater the health risks. Nationally estimated 16 percent of children and adolescents ages 6 –19 years are overweight. In children and teens, body mass index is used to assess underweight, overweight, and risk for overweight. Children's body fatness changes over the years as they grow. Also, girls and boys differ in their body fatness as they mature. This is why BMI for children, also referred to as BMI-for-age, is gender and age specific. At risk of overweight: BMI-for-age 85th percentile to < 95th percentile Overweight: BMI-for-age > 95th percentile  (BMI-for-age is plotted on gender specific growth charts. These charts are used for children and teens 2 – 20 years of age) (> Greater or equal to)

BRFSS: Percent Obesity by Gender The next few graphs indicate that there is a rate of increase in Obesity across the gender, across all ages, across all economic levels and education levels. It is not just an issue for the poor, the uneducated or the middle age. IT IS ACROSS GENDER, men and women are both gaining weight over the years. By Gender

BRFSS: Percent Obesity by Age By age, Young adults from age 18 to older adults are gaining weight within their age category. Age Groups

BRFSS: Percent Obesity by Educational Level Although less educated weigh more but obesity is increasing over the years in each education level. Educational Level

BRFSS: Percent Obesity by Income Level As you see it is not just an issue for the poor, the uneducated or the middle age. WITHIN each income level the RATE of obesity has increased over the years. Julie these are just research notes for you. Obesity has long been a problem mostly of the poor, but new research shows that the more affluent are catching up fast. The prevalence of obesity is growing three times faster among Americans who make more than $60,000 a year than it is among their low-income neighbors, said a study being presented Monday at a meeting of the American Heart Association. "This is a very surprising finding," said the lead researcher, Dr. Jennifer Robinson of the University of Iowa. It's paradoxical, but for years doctors have known that the people most likely to be overweight have the lowest incomes. That's because fresh produce and other healthy fare are more expensive and less accessible in low-income neighborhoods than are fast food and other high-fat options. In the early 1970s, 22.5 percent of people with incomes below $25,000 were obese. By 2002, 32.5 percent of the poor were. By comparison, just 9.7 percent of people with incomes above $60,000 were obese in the 1970s - a figure that jumped to 26.8 percent in 2002. The poor still are the most likely to be fat, said Dr. Adam Drewnowski of the University of Washington, a prominent expert on the problem. "I would caution against any attempts to interpret these data to say social differences have disappeared," he stressed. "It just shows that obesity is a general problem and it's now affecting pretty much everybody. ... But it would be very shortsighted to stop paying attention to the people who are most vulnerable." Robinson agreed. "I don't want to take focus away from the serious racial and ethnic disparities," she said. Income Level

Percentage of Overweight U.S. Children and Adolescents is Soaring* 18 Ages 12-19 Ages 6-11 5 4 16 2 6 8 10 12 14 1963- 70** 1971-74 1976-80 1988-94 1999- 2002 We are also very concerned about the impact that the rapid increase in childhood- onset obesity is likely to have on disease rates. The number of overweight children is higher than ever before. More than 16 percent of children aged 6 to 19 are overweight, a rate that has doubled since 1980. * >95th percentile for BMI by age and sex based on 2000 CDC BMI-for-age growth charts **Data from 1963-65 for children 6-11 years of age and from 1966-70 for adolescents 12-17 years of age Source: National Center for Health Statistics

Overweight Has Important Health Consequences in Children 70% chance of being overweight as adults Childhood onset of Type 2 diabetes Face future risk of serious complications: kidney disease, blindness, amputations People born in 2000 have a high risk of getting diabetes in their lifetimes: 33% of males 39% of females Risk factors for heart disease 60% of 5-10-year olds have at least one 25% have two or more And, because children make lifestyle decisions that can last a lifetime, overweight children have a 70 percent chance of being overweight as adults. Besides, overweight children have their own health problems. We’re seeing children suffering from so-called “adult diseases” tied to overweight, such as Type 2 diabetes. That puts them at risk of suffering the serious complications of diabetes as adults, such as kidney disease, blindness, and amputations. In fact, more than one out of three people born in 2000 – 33% of boys and 39% of girls – are estimated to get diabetes in their lifetimes. Just as striking, 61 percent of overweight 5-to-10-year-olds already have risk factors for heart disease, and 26 percent have two or more risk factors. CDC Data

There is some thought that obesity gains on tobacco as the top death factor. The media, the cartoonists, are all talking about it and it is becoming a national issue.

Costs Associated with Obesity are High and Growing 2000 estimated cost: $117 billion: $61 billion direct medical costs $56 billion for indirect costs Iowan’s spent estimated $783 million $363 million paid by taxpayers (Medicare and Medicaid) Hospital costs related to childhood overweight have tripled in last 20 years The costs to society of obesity and overweight are significant. Based on figures from 2000, the problems cost American society an estimated $117 billion a year due to direct health care costs as well as the indirect economic costs of lost productivity. According to an article in the Obesity Reseach (Jan. 2004) Iowan’s spent $783 million in obesity related medical expenditures in 1998. About half of that cost $363 million is directly paid by the taxpayers through medicare and medicaid. Hospital costs related to childhood obesity alone have tripled in the last 20 years.

Three Key Factors are Related to the Onset of Obesity Poor dietary practices Decreased physical activity Increased inactivity There are three key reasons for today’s obesity epidemic: Poor dietary practices Decreased physical activity Increased inactivity (CDC)

Americans’ Food Practices are Shifting Dramatically Reduced frequency of family meals Increased fast food consumption Increased portion size Increased consumption of soft drinks (from 27 to 44 gallons/year from 1972-1992) Restrained eating, meal skipping 30,000 products in supermarkets Americans’ food practices are shifting dramatically: Reduced frequency of family meals Increased fast food consumption Increased portion size Increased consumption of soft drinks – from 27 to 44 gallons per year from 1972 to 1992 Restrained eating, meal skipping Increased food products in supermarkets – about 30,000 now (CDC)

Physical Education in Schools is on the Decline Participation in daily P.E. classes, 9-12th graders: 1991 42% 1999 29% Physical education in the schools is on the decline. Participation in daily P.E. classes has fallen dramatically over the past decade: 42% in 1991 29% in 1999 (CDC)

As TV Time Increases, So Does Rate of Overweight in Teenagers Research shows that as TV time increases, so do rates of overweight in teenagers. It’s not clear whether this effect is due to TV taking the place of physical activity, or teens eating more while watching TV, or both. (0-1) (1-2) (3-4) (4-5) (>5) (2-3) TV Hours Per Day (Youth Report) (NHES Youth Aged 12-17 in 1967-70 and NLSY Youth Aged 10-15 in 1990)

Iowa is very aware of the problem. This is a map of Iowa counties Iowa is very aware of the problem. This is a map of Iowa counties. According to the Community Health Needs Assessment and Health Improvement Plans for 2005, 74 counties out of 99 (75%) have identified overweight/obesity related health priorities.

Implementation, application to CDC CDC-funded State Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases Capacity building 2004-2005-current 2005-2006-applied Implementation, application to CDC 2006…. Iowa Department of Public Health has recently received CDC grant to address this overwhelming problem. The grant is divided into two stages. Capacity building and Implementation stage. We are currently in the capacity building stage which basically implies writing the comprehensive state plan that is unique and addresses the needs of Iowans. Once the state plan is written and pilot intervention has been approved and implemented we are eligible to apply to become an implementation state.

CDC-funded NPA Program Year 1-2: Bring together partners to write the State Comprehensive Plan. Implement a pilot intervention Submit the State Plan and application to become an implementation state. CDC has developed a State Plan Index to provide guidance in writing of the State Plan. Some of the key components of the plan include Bringing together partners that actively participate throughout the planning process. Implement a pilot intervention in the community that identifies barriers and provide solutions to build model healthy community. The State Plan to be completed by November 2005 will then be submitted to CDC.

Vision Iowans Fit for Life Iowans will enjoy balanced nutrition, lead physically active lives and live in healthy communities Iowans Fit for Life, Active and Eating Smart is the name this program. The long term vision of the program is “Iowans will enjoy good nutrition, have active lives and live in healthy communities”. This is what we vision will happen 10-20 years from now.

Mission Iowans Fit for Life Develop and strengthen partnerships that prevent and reduce obesity in Iowa To make the vision a reality we know that it will take partnerships from all of you as the key leaders in Iowa working together for this very important goal.

Goals/Outcomes Iowans Fit for Life Prevent and reduce obesity in Iowans through improved nutrition, physical activity and supportive environments. Reduce obesity through integration, coordination and collaboration among organizations and entities that share expertise and maximize resources of existing programs and partnerships. There two major goals to ultimately reach our vision The goal is the prevention of obesity through lifestyle changes of improving nutrition and increasing physical activity through supportive environments. To achieve this we need to integrate, coordinate and collaborate with all of you to maximize resources.

Strategies Iowans Fit for Life Develop and support partnerships that implement obesity prevention programs The main strategy of the program is to develop and support partnerships. Partnerships represent a balance among academics, government, public health, non profit, and advocacy organizations that represent people affected by obesity.

Strategies Iowans Fit for Life Create and sustain model healthy communities around nutrition and physical activity. According to the CDC guidelines, we are implementing a pilot intervention. The goal of the pilot intervention is to build a model schools and communities that enjoy balanced nutrition and leads physically active lives.

Strategies Iowans Fit for Life Collect and analyze data that drives decisions about program needs and effectiveness Data on effectiveness of the program, the pilot intervention and the partnerships will be collected and analyzed. This will help drive the program in a more effective and efficient manner.

What needs to be done to develop the Comprehensive State Plan? Develop Partnerships at the local and state level Share expertise and maximizes resources of existing programs and partnerships. Use Iowa-specific data to identify issues and maximize existing public and private resources Build model healthy community—pilot intervention Partnerships represent a balance among academics, government, public health, non profit, and advocacy organizations that represent people affected by obesity.

Partnerships Work Groups: Educational Setting Early Childhood Older Iowans Business and Agriculture Health Care Community For the development of the state plan the Partners will provide expertise in the following work groups. All work groups will address the four focus areas of the CDC grant, to balance caloric intake and expenditure; increasing physical activity; improving nutrition through increased consumption of fruits and vegetables; reducing screen time; and increasing breastfeeding. Public relations and Special populations will be addressed in each work group. Please see partnership form for more details. The information that we collected from the community forums, WIC agencies and today will all be given to the work groups and incorporated in the Comprehensive State Plan.

For more Information: www.iowa.gov/iowansfitforlife Here’s how you can make a difference and get involved… Today will be just the beginning as you provide your expertise in the work groups. At the end of today you will be asked to provide your commitment for the program. Please feel free to contact us at any time… The website listed will be ready soon. For more information and regular updates you will be able to find it on the website. For more Information: www.iowa.gov/iowansfitforlife