1. Obesity. Why should we care?

2. What is Obesity? Obesity is considered 30 pounds overweight. Today’s children weigh 10 pounds more than the children did 10 years ago.

3. Obesity Trends* Among U.S. Adults, BRFSS 1990 (1) (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data< 10%10%-14% Source: Behavioral Risk Factor Surveillance System, CDC

4. Obesity Trends* Among U.S. Adults, BRFSS 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Source: Behavioral Risk Factor Surveillance System, CDC no data< 10%10%-14%15%-19%

5. Obesity Trends* Among U.S. Adults, BRFSS 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data< 10%10%-14%15%-19% Source: Behavioral Risk Factor Surveillance System, CDC

6. Obesity Trends* Among U.S. Adults, BRFSS 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data< 10%10%-14%15%-19% Source: Behavioral Risk Factor Surveillance System, CDC

7. Obesity Trends* Among U.S. Adults, BRFSS 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data< 10%10%-14%15%-19% Source: Behavioral Risk Factor Surveillance System, CDC

8. Obesity Trends* Among U.S. Adults, BRFSS 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data< 10%10%-14%15%-19% Source: Behavioral Risk Factor Surveillance System, CDC

9. Obesity Trends* Among U.S. Adults, BRFSS 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data< 10%10%-14%15%-19% Source: Behavioral Risk Factor Surveillance System, CDC

10. Obesity Trends* Among U.S. Adults, BRFSS 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data10%-14%15%-19% Source: Behavioral Risk Factor Surveillance System, CDC ≥20%< 10%

11. Obesity Trends* Among U.S. Adults, BRFSS 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data< 10%10%-14%15%-19% Source: Behavioral Risk Factor Surveillance System, CDC ≥20%

12. Obesity Trends* Among U.S. Adults, BRFSS 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data< 10%10%-14%15%-19% Source: Behavioral Risk Factor Surveillance System, CDC ≥20%

13. Obesity Trends* Among U.S. Adults, BRFSS 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data< 10%10%-14%15%-19% Source: Behavioral Risk Factor Surveillance System, CDC ≥20%

14. Obesity Trends* Among U.S. Adults, BRFSS 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data< 10%10%-14%15%-19% Source: Behavioral Risk Factor Surveillance System, CDC 20%-24% ≥25%

15. Obesity Trends* Among U.S. Adults, BRFSS 2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data10%-14%15%-19% Source: Behavioral Risk Factor Surveillance System, CDC 20%-24% ≥25%< 10%

16. Obesity Trends* Among U.S. Adults, BRFSS 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data15%-19% Source: Behavioral Risk Factor Surveillance System, CDC 20%-24% ≥25%< 10%10%-14%

17. Obesity Trends* Among U.S. Adults, BRFSS 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data Source: Behavioral Risk Factor Surveillance System, CDC 20%-24% ≥25%< 10%10%-14%15%-19%

18. Obesity Trends* Among U.S. Adults, BRFSS 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data Source: Behavioral Risk Factor Surveillance System, CDC 20%-24%25%-29%< 10%10%-14%15%-19% ≥30%

19. Obesity Trends* Among U.S. Adults, BRFSS 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data Source: Behavioral Risk Factor Surveillance System, CDC 20%-24%25%-29%< 10%10%-14%15%-19% ≥30%

20. Obesity Trends* Among U.S. Adults, BRFSS 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data Source: Behavioral Risk Factor Surveillance System, CDC 20%-24%25%-29%< 10%10%-14%15%-19% ≥30%

21. Obesity Trends* Among U.S. Adults, BRFSS 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data Source: Behavioral Risk Factor Surveillance System, CDC 20%-24%25%-29%< 10%10%-14%15%-19% ≥30%

22. Obesity Trends* Among U.S. Adults, BRFSS 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) no data Source: Behavioral Risk Factor Surveillance System, CDC 20%-24%25%-29%< 10%10%-14%15%-19% ≥30%

24. Prevalence and Trends Data OBESITY RATES IN FLORIDA In 1995In 2011In 2030 if we continue In 2030 if BMI Decreases by 5% 23.3%26.6%58.6%51.1% Obesity-Related Health Care Costs in Florida Potential Savings by 2020 if BMI is Reduced by 5% (cumulative) Potential Savings by 2030 if BMI is Reduced by 5% (cumulative) $12,541,000,000$34,436,000,000 REDUCING THE AVERAGE BODY MASS INDEX (BMI) IN FLORIDA BY 5% COULD LEAD TO HEALTH CARE SAVINGS OF MORE THAN $12 BILLION IN 10 YEARS AND $34 BILLION IN 20 YEARS

25. Top Obesity Related Health Problems 2010 # of Cases Potential Cases Avoided by 2020 if BMI is Reduced by 5% (cumulative)* Potential Cost Savings by 2020, if BMI is Reduced by 5% (cumulative) Potential Cases Avoided by 2030 if BMI is Reduced by 5% (cumulative) Potential Cost Savings by 2030, if BMI is Reduced by 5% (cumulative) Type 2 Diabetes 1,722,671260,135*$4,459,000,000501,976$14,074,000,000 Obesity Related Cancers 352,18324,965$328,000,00043,451$656,000,000 Coronary Heart Disease & Stroke 1,412,354234,408$5,913,000,000465,385$14,684,000,000 Hypertension 4,372,354235,932$827,000,000401,924$2,175,000,000 Arthritis 4,225,434117,776$1,013,000,000218,399$2,849,000,000 2010 baseline for potential cases, costs and savings * National Heart Forum provided the total cases and cases avoided per 100,000 people, and TFAH used the state’s 2011 census data to translate to the full population-based estimates. ^Top obesity-related cancers include endometrial (uterine), esophageal, kidney, colon and post- menopausal breast cancer.

26. The Problem: And that’s risky and expensive. Chronic Diseases related to obesity is a leading cause of death Obesity related diseases costs the U.S. $270 billion a year We’re too sedentary We don’t eat well

27. Financial Work Related Cost of Obesity Indirect Costs:  Value of Lost Work  Insurance Premiums and Compensations  Lower Wages Obesity-related absenteeism costs employers as much as $6.4 billion a year The annual cost of obesity-related loss of productivity is as much as $30 billion each year. (Forbes 2013)

28. Starts at Childhood  Today, one in three American kids and teens are overweight or obese, nearly triple the rate in 1963.  Childhood obesity is now the No. 1 health concern among parents in the United States, topping drug abuse and smoking Source: Centers for Disease Control and Prevention

29. The Food Environment  Increased number of fast food establishments in the U.S.  Lack of access to full service grocery stores selling affordable healthful foods  Less healthy food & beverage advertising aimed at children

30. Dietary Behaviors  Increased consumption of sugar sweetened beverages  Continued low consumption of fruits and vegetables

31. Factors of Obesity  Hectic/busy schedules turn to fast food turn to fast food  Children watching more TV/video games Less active Less active Likely to consume more soda and junk food Likely to consume more soda and junk food Parents and children forgot how to “play” Parents and children forgot how to “play”  Poor neighborhoods and lack of physical activity May not have easy access to nutritional food May not have easy access to nutritional food May not be as safe for walking and playing May not be as safe for walking and playing Source: Stanford Prevention Research Center

32. Physical Activity  76.4% of adults in Pinellas County did not meet the weekly recommendation for leisure-time aerobic or muscle strengthening physical activity in the 30 days.  74% of white adults in Pinellas County had not met the weekly recommendation compared to 93% of blacks.  22.4% of adults were sedentary overall, but it jumps to 35% for adults who made less than $25,000 Even though a recent grant that ended, Communities Putting Prevention to Work, helped to increase opportunities for physical activity, the data still shows significant disparities. (Centers for Disease Control and Prevention BRFSS 2012)

33. Community Design & the Built Environment Standardized Share of Mode for Trips to School: National Personal Transportation Survey Car Bus Walk/bike Public Transit McDonald NC. Am J Prev Med 2007;32:509

34. Children Walking to School  1969 – 50%  Now – 14%

35. Challenges   Environmental factors beyond the control of individuals contribute to increased obesity rates by reducing the likelihood of healthy eating and active living behaviors.   Environmental factors that influence physical activity behavior (26, 27): Lack of infrastructure supporting active modes of transportation, i.e. sidewalks & bike facilities Access to safe places to play and be active Access to public transit Mixed use & Transit Oriented Developments

36. WHY? Does the current environment inadvertently encourage this? How can we incentivize healthier behaviors? How can we incentivize healthier behaviors? Pre- contemplation “Never ” Contemplation “Maybe” Preparation “Soon” Action “Now” Maintenance “Always”

37. Take Ownership. The obesity epidemic The obesity epidemicIS everyone’s problem. It will take EVERYONE to solve it.

38. What we DON’T need to do  Tell people how to find fruits and veggies near their home (They know how)  Tell people parks are nearby (They know)  Tell them to get healthy (They think they are fairly healthy)  Tell them exercise and physical activity are good for their health (We all know this already)

39. Thinking In New Ways  The choice to sustain good health must be supported by the environment we live in.  Leaders must make decisions that impact the environment in healthy ways.  Leaders must make decisions in ways they have not thought of previously in community planning. Employee Wellness Policies Employee Wellness Policies Healthy Vending Policies Healthy Vending Policies Fitness Zones Fitness Zones Added bike racks Added bike racks Farmers Markets/Produce Stands Farmers Markets/Produce Stands

40. The Focus:  Change systems, infrastructure and policies so they encourage – not discourage – healthy eating and physical activity.  Broad leadership team that includes elected officials, non-profit organization and the private sector.  Partner with local governments, transportation authorities, schools, Early Childhood programs/organizations, after school programs, local businesses, community and faith-based groups in partnerships.

41. Making Healthy Living Easier

42. QUESTIONS? Megan Carmichael Healthy Pinellas Program Manager Florida Department of Health - Pinellas (727) 588-4040 x3118 Megan.Carmichael@flhealth.gov