1. Update on the Obesity Epidemic
William H. Dietz MD, PhD
Chair, Redstone Global
Center for Prevention and Wellness

2. Changes in the Prevalence of Obesity among Youth yo and Adults > 20 yo NHANES –
40%
35% %
17%
Shows plateau in 2-19 yomore clearly. If we disaggregate data, 2-5 yo decrease, 6-11 yo flat yo continue to increase
Year

3. Recent Changes in Prevalence among 2-5 yo NHANES Data
(%)
Detail on 2-5 yo
Years

4. Obesity Prevalence in 2-4 yo WIC Participants 2000 - 2014%
Changes similar to 0-23mo.
Year
Pan L et al. MMWR 2016; 65:1256

5. Changes in Obesity Prevalence among 2 - 4 yo – WIC 2010-2014
Group Change
AI/AN % 18.0% %
Hispanics % 17.3% %
Asian/Pacific Islanders 12.5% 11.1% %
Non-Hispanic Blacks % 11.9% %
Non-Hispanic Whites % % %
Pan L et al. MMWR 2016; 65:1256

6. Changes in Prevalence of Obesity in Michigan 2-4 yo%
Pan L et al. MMWR 2016; 65:1256

7. States and Communities Reporting Decreases in the Prevalence of Childhood Obesity
Portland, ME
King
County
Kearney, NE
DuPage County, IL
Cambridge, MA
Somerville, MA
Fitchburg, MA MA
New York
City OH
Philadelphia, PA WV CA
Vance, NC
Granville, NC
San Diego, CA
Multiple states and communities report decreases – ages and strategies differ NM MS
Chula Vista, CA
El Paso, TX
Anchorage, AK

8. Changes in the Prevalence of Severe Obesity (BMI >120% of 95th Percentile) in 2-19 yo Youth NHANES – 9% 8% %
Remaining concern is that severe obesity continues to increase, at same time there is progress in 2-5 yo and plateau in 6-11 yo. This means distribution of obesity is skewing to more severe obesity
Year
Skinner AC et al. Obesity 2106;24:1116

9. Changes in the Prevalence of Severe Obesity (BMI > 40) in Adults NHANES 1999-2000 – 2013-2014
10% 6% %
Year

10. Medical Complications of Obesity
Source: Rudd Center for Food Policy and Obesity

11. Adverse Childhood Experiences (ACEs)
Victimized or witnessed abuse
Verbal
Sexual
Physical
Exposures
Hunger
Homelessness
Incarceration
Household instability – divorce, separation, death
Mental illness or maternal depression
Drug or alcohol abuse

13. Frequency of Exposure within Households to Adverse Childhood Experiences: BRFSS Results from 5 States (AR, TN, LA, WA, NM)
# Aces %
MMWR 2010; 59:1609

14. Consequences of Exposure to ACES
Smoking
Illicit drug use
Adult alcohol abuse
Unintended pregnancy
Sexually transmitted diseases
Attempted suicide
Depression
Severe obesity and other chronic diseases

15. Framework for Integrated Clinical and Community Systems of Care
Care Delivery
Information Systems
Decision Support
Delivery System Design
Self Management Support
Local patient environment
Clinicians
Community
Systems
Economic Resource
Social resources
Community capacity
Healthy options
Social norms
Equity
Training & Education
Metrics
Integration
Convener, Advocacy, Data Exchange, Financing, Governance/Regulation, Referral Processes, Communications
Family & Individual Empowerment and Engagement
Note changes on community systems to align with equity framework
Population Health

16. Supportive Community Environments
Equitable Opportunity
Economic and
Educational Environment
Wealth building efforts
Employment
Jobs
Connected networks
Collective efficacy
Political efficacy
People
Socio-cultural
Environment
Place
Physical/built
Environment
Community environments stated positively
Desirable housing
Safe public spaces
Healthy products

17. Targets for Obesity Prevention and Control
Reduce stigma and bias
Reduce energy intake
Reduce sugar drinks
Decrease high ED foods – pizza, fast food
Decrease television time
Increase daily physical activity
Pregnancy: pre-pregnant weight, weight gain, diabetes, smoking
Breastfeeding
Sleep 2 17 17

18. Strategies to Address Childhood Obesity
Early childhood
Breastfeeding Baby Friendly Hospitals
Worksite lactation support in ACA
ECE Child care & Head Start standards
PHA agreement with ECE centers Empowering caregivers Menu labeling in ACA
Revision of nutrition facts panel
Healthcare PHA’s Healthy Hospital initiative
Use of EHRs to monitor progress
Healthy food in schools Healthy Hunger-free Kids Act
Competitive food standards

19. Strategies to Address Childhood Obesity
Access to healthy affordable food
Physical access to food Healthy Food Financing Initiative
Drink up! Campaign
Food reformulation Institute standards in public institutions –hospitals, city government
Tax sugar drinks
Increasing physical activity Increase PE/PA in schools
Engage Parks and Recreation Departments

20. Prevalence of Obesity – NHANES 2013-2014%
Age

21. Prevalence of Excessive 10 Year Weight Gain (> 20Kg) between 1985-86 and 1995-1996 (CARDIA)%
Lewis CE et al. Am J Epidemiol 2000;151:1172

22. Strategies to Prevent and Mitigate Transgenerational Obesity
Prenatal: pre-pregnant weight, weight gain during pregnancy, gestational diabetes, tobacco use
Postnatal: Breastfeeding, WIC, Early Head Start, Maternal, Infant, and Early Childhood Home Visiting program
Community infrastructure for physical transport
Worksite initiatives
Technology
Reimbursement – focus on family care