William H. Dietz MD, PhD Director:Redstone Global Center for
Prevention and Wellness Critical and Emerging Strategies for
Obesity Prevention and Care
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Most Recent Obesity Trends in Youth 2-19 y: 2-year surveys
Ogden et al. 2012, NCHS data brief; Ogden et al. 2014 JAMA No
significant linear trend over the last 10 years 2003-2004 to
2011-2012 overall or in boys or girls
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Childhood Obesity Trends Over Time in 2-5 Year-Old U.S.
Children
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States and Communities Reporting Decreases in the Prevalence of
Childhood Obesity El Paso, TX NM CA MS Anchorage, AK Chula Vista,
CA Kearney, NE WV Vance, NC Granville, NC Philadelphia, PA New York
City Fitchburg, MA Somerville, MA Cambridge, MA Portland, ME DuPage
County, IL OH San Diego, CA MA King County
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Adverse Childhood Experiences (ACEs) Victimized or witnessed
abuse Verbal Sexual Physical Exposures Poverty Incarceration
Homelessness Household instability divorce, separation, death
Mental illness or maternal depression Drug or alcohol abuse
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Frequency of Exposure to ACEs (n=8056) Frequency % Zero49.5%
One24.9% Two12.5% Three 6.9% Four 6.2% Fellitti VJ et al. Am J Prev
Med 1998;14:245
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Consequences of Exposure to ACES Smoking Illicit drug use Adult
alcohol abuse Unintended pregnancy Sexually transmitted diseases
Attempted suicide Depression Severe obesity
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Impact of Early Adverse Experiences on Obesity 40% increased
risk of obesity 90% increased risk of severe obesity associated
with verbal abuse Population attributable fraction of any abuse =
8% obesity and 17% severe obesity (BMI > 40)
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Changes in Physical Activity Increased use of appliances
Elimination of PE and recess Suburbanization Increased car use
Post-industrial society shift from manufacturing to service
economy
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Shifts in Food Practices in the United States Increased cost of
healthful foods Decreased cost of junk foods Increased portion size
Increased processed foods Increased variety Increased availability
Increased school vending and a la carte foods 13
Slide 14
Daily Energy Deficits Necessary to Achieve the HP 2010 Goal
(Prevalence = 5%) by 2020 Age Deficit 2-5 yo 33 kcal/d 6-11 yo149
kcal/d 12-19 yo177 kcal/d Adults220 kcal/d Wang YC et al. Am J Prev
Med 2012; 42:437 Hall KD et al. Lancet 2011;378:826
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Changes in Food Consumption in the US Between 1999-2000 &
2009-10, sugar drinks declined by 68 kcal/d in 2-19 yo* Between
2003-4 & 2007-8, fast food consumption decreased by 64 kcal/d
(25%) in 2-11 yo and 14 kcal/d (3%) in 12-19 yo** Between 2003-4
and 2009-10, pizza consumption decreased by 27 kcal/d (25%) in 2-11
yo*** Healthy Weight Commitment Foundation 78 kcal/d *Kit et al. Am
J Clin Nutr May 15, 2013;doi:103945 **Powell & Nguyen. Am J
Prev Med 2012;43:498 ***Powell et al. Pediatrics 2015; Jan 19
online release
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Social Ecological Model t lll Individual Federal and State
Community Interpersonal Greatest Impact Smallest Impact
Institutions Federal, state and local policies to regulate and
support healthy actions Knowledge, attitudes, beliefs and behaviors
Family, peers, social networks Policy, regulations and informal
structures Policies, standards, social networks
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People First Language Obese is an identity Obesity is a disease
An obese person is more likely to be held responsible tor their
weight Describing a person with obesity is more likely to focus
attention on cause
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Settings for the Prevention and Management of Obesity Early
care & education Schools Communities Medical systems Early care
& education Schools Communities Medical systems
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Strategies for Early Care and Education Regulations Standards
for PA Limits on screen time Healthful foods and beverages Training
and technical assistance Accountability Quality Improvement Rating
Systems (QRIS) Self-assessment NAP-SACC
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Strategies for Schools Nutrition Remove sugar drinks and junk
food Implement competitive food policies School wellness councils
Physical activity (PAG Mid-course review) Multicomponent programs
Physical education Activity breaks
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Opportunities for School-wide Physical Activity Kohl HW III,
Cook HC. Educating the Student Body, IOM 2013.
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Programs to Increase Physical Activity in Youth CDC funds for
comprehensive physical activity programs Lets Move Active Schools
Presidential Youth Fitness Program
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Strategies for Communities Parks and recreation Proximity
Safety Programming and promotion Healthy food and beverage
offerings Land use Safe routes to school (active transport)
Complete streets
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The Fittest American Cities (Metropolitan Statistical Areas)
CityScore 1. Washington DC 77.3 2. Minneapolis/St. Paul 73.5 3.
Portland 72.1 4. Denver 71.7 5. San Francisco 71.0 34. Kansas City
45.1 41. St. Louis 41.3 ACSM American Fitness Index 2014
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Strategies for Communities Parks and recreation Proximity
Safety Programming and promotion Healthy food and beverage
offerings Land use Safe routes to school (active transport)
Complete streets
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Environment Family School Worksite Community Chronic Care Model
Medical System Information Systems Decision Support Delivery System
Design Self Management Support Family/Patient Self-Management Dietz
WH et al. Health Affairs 2007;26:430
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Language in Obesity Counseling Terms to UseTerms to Avoid
WeightObesity Unhealthy weightHeaviness Healthier weightFat
Increased BMIUnhealthy BMI Eating habitsDiet Physical
activityExercise Puhl R et al. Int J Obesity 2013;37:612 Wadden T
& Didie E. Obesity Res 2003;11:1140
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Why Weight? www.whyweightguide.org Facilitates the initiation
of open and productive conversations about weight Assesses patient
readiness Promotes active listening Establishes realistic goals
Builds trust Addresses culture and social support
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How Can We Best Engage Families? Adverse risk factors Presence
of health effects Impaired activities of daily living Bullying
(Bully or the Bullier) Family history
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Competencies Relevant to Obesity Prevention and Control Use of
appropriate terms for obesity Sensitivity to bias and stigma
Behavior change strategies Ability to work with and within teams
Use of information technology Ability to work across sectors -
Interdisciplinary - Clinical:community Align clinical services with
severity Focus on health as well as disease
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Weigh In: Talking with your Children about Weight and Health
Free e-guide for parents of children 7-11 yo Helps parents discuss
weight and health with their children Real-world situations and
plain language responses Avoids blame; provides ways to have
conversations about the following: BMI confusion Body image
Bullying Weight bias Inter-family weight differences and parental
obesity
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Lets Move Initiatives Lets Move Outside (Parks and Recreation)
Lets Move Cities, Towns, & Counties Chefs Move to Schools Lets
Move Salad Bars to School Lets Move Child Care Challenge Lets Move
in Indian Country Lets Move Active Schools Drink Up!
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Challenges Is obesity the right frame? Healthy weight?Wellness?
Diabetes? Apply strategic thinking to choices of interventions More
practice-based evidence Evaluation if it cant be measured it wont
be done Long-term investments Uncertainty regarding the
sustainability of the federal response Importance of state and
local solutions