1. Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley An Overview of the Obesity Epidemic in California Senate Committee on Health February 12, 2014

2. Synthesizing the science Atkins Center for Weight & Health Funded in 1999 Evaluating programs and policies Conducting research to answer critical questions Working in partnerships with communities, government and organizations Translation and dissemination

3. 3 Rates of obesity/overweight Context of rates

4. Obesity Trends* Among U.S. Adults BRFSS, 1985 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

5. Obesity Trends* Among U.S. Adults BRFSS, 1986 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

6. Obesity Trends* Among U.S. Adults BRFSS, 1987 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

7. Obesity Trends* Among U.S. Adults BRFSS, 1988 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

8. Obesity Trends* Among U.S. Adults BRFSS, 1989 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

9. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

10. Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

11. 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%

12. 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%

13. 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%

14. 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%

15. 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%

16. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

17. 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% ≥20%

18. 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% ≥20%

19. 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% ≥20%

20. 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% 20%–24% ≥25%

21. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

22. Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

23. Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

24. Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

25. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

26. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

27. Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

28. Obesity Trends* Among U.S. Adults BRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

29. Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

32. * Obesity defined as Body Mass Index wt(kg)/m 2 > 30 ** 2001-20—24% *** Methodological changes make comparisons not possible with those before 2011 Ref: BRFSS, 1985-2012

33. Ref: BRFSS, 2012

36. Ref: PedNSS, 2011 Note: Hispanic rate of obesity 50% higher

37. Ref: PedNSS, 2011

38. * Ages 2-19 Ref: Ogden, NHANES, 2012

39. Adults*United StatesCalifornia Total population316,128,83938,332,521 % White78%74% % African- American 13%7% % Hispanic17%38% Children+United StatesCalifornia % White52%27% % African- American 14%6% % Hispanic24%52% Race/Ethnicity – US vs. CA *U.S. Census Bureau: State and County QuickFacts. + kidsdata.org

40. Adults*United StatesCalifornia % Below federal poverty level 14.9%15.3% Children+United StatesCalifornia % Below federal poverty level 22.6%23.8% Poverty level – US vs. CA *U.S. Census Bureau: State and County QuickFacts. + kidsdata.org

41. Fitnessgram testing

52. Policy Evaluation in Student BMI Ref: Sanchez-Vaznaugh, Crawford, 2010

53. Ref: CCPHA

54. Annualize the adjusted decrease in prevalence from peak to 2008 Assume that annual decrease continues until 2015 Apply this to ALL kids in CA ~ 100,000 kids DROP OUT of the obese category Assuming a savings of $220 per child** Savings of about $20 million Medical cost savings per child* * Madsen K, UC Berkeley, personal communication **(based on MEPS data from 2001 to 2003, as reported in NY state comptroller report from Oct 2012)

55. GIRLS Remission 2008 to 2015 SAVINGS White 11,024 $2,425,337 African American - - Latina 8,772 $1,929,798 Asian 2,443 $537,360 American Indian - - TOTAL (By race) 22,239 $4,892,495

56. BOYS Remission: 2008 to 2015 Savings* White 27,165 $5,976,209 African American 7,971 $1,753,643 Latino 30,373 $6,682,012 Asian 4,419 $972,107 American Indian 3,881 $853,816 TOTAL (By race) 73,808 $16,237,787

57. The human cost of obesity: diabetes and pre-diabetes in adolescence

58. Human cost - Adult

59. or pictorially Now Then

60. Key messages Invest in prevention Create a culture of health Utilize the resources of the University THANK YOU