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Diabetes and Obesity in NYC: Shadi Chamany, MD, MPH New York City Department of Health and Mental Hygiene November 7, 2013 Edelstein.

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Presentation on theme: "Diabetes and Obesity in NYC: Shadi Chamany, MD, MPH New York City Department of Health and Mental Hygiene November 7, 2013 Edelstein."— Presentation transcript:

1 Diabetes and Obesity in NYC: Shadi Chamany, MD, MPH New York City Department of Health and Mental Hygiene November 7, 2013 Edelstein Diabetes Conference

2 General information about obesity and diabetes Epidemiology of obesity and diabetes in NYC Ways to approach obesity and diabetes General resources Overview

3 Diabetes—What is It? A condition where the body either does not make enough insulin or the insulin it has does not work as well as it should (insulin resistance) Insulin moves sugar from the blood into the cells for energy If there isn’t enough of it or it doesn’t work right, too much sugar in the blood Sugar in the blood comes from food, your body changing other types of nutrients into sugar, and stores your body has

4 Diabetes—What Are the Complications?

5 High sugar damages the blood vessels to certain parts of the body Eye disease and blindness Nerve damage Infections and amputations Kidney disease which may require dialysis Diabetes also increases the risk of heart disease and stroke and has been linked to some cancers Adults with diabetes have heart disease deaths rate~ 2-4 times higher than those without Diabetes—What Are the Complications?

6 Type 1 Usually starts in childhood Body attacks itself, damaging cells in the pancreas that make insulin Always requires insulin Type 2 Usually starts in adulthood but see in children now May or may not need insulin Gestational diabetes Comes during pregnancy and goes away but increases risk of type 2 diabetes down the road Common Types of Diabetes

7 Type 1 Environmental exposure?? Type 2 –Overweight/obesity - Age –Physical inactivity- Family history –High blood pressure- Race/ethnicity –High triglycerides - Hx gestational DM –Low HDL (bad cholesterol) Gestational diabetes Overweight/obesity, certain race/ethnic groups, older age Risk Factors for Diabetes

8 Type 1 Environmental exposure?? Type 2 –Overweight/obesity - Age –Physical inactivity- Family history –High blood pressure- Race/ethnicity –High triglycerides - Hx gestational DM –Low HDL (bad cholesterol) Gestational diabetes Overweight/obesity, certain race/ethnic groups, older age Risk Factors for Diabetes

9 Prevalence of Self-Reported Diabetes Among NYC Adults Source: Behavioral Risk Factor Survey System , NYC Community Health Survey (CHS) ; Gupta and Olson. NYC DOHMH. Diabetes in New York City Epi Data Brief, April 2013, no. 26 and https://a816- healthpsi.nyc.gov/epiquery/https://a816- healthpsi.nyc.gov/epiquery/

10 Level of Control Among Adults with Diagnosed Diabetes (NYC data 2004) Source: Thorpe LE et al. Diabetes Care 2009;32: *includes individuals who were undiagnosed with HTN or hyperlipidemia

11 Level of Control Among Adults with Diagnosed Diabetes (national data ) Casagrande, Sarah Stark, et al. "The prevalence of meeting A1C, blood pressure, and LDL goals among people with diabetes, 1988–2010." Diabetes Care (2013).

12 Obesity—What is It? A condition where a person has excess adipose tissue Defined using height and weight in the form is the body mass index (BMI) which works for most 1 Overweight in adults kg/m 2 Obese in adults 30+ kg/m 2 Obesity is associated with increased risk of certain conditions and mortality 1 –Coronary heart disease, stroke, hypertension, dyslipidemia –Type 2 diabetes (increases insulin resistance) 2 –Cancer (endometrial, breast, colon) –Sleep apnea –Osteoarthritis 1. From CDC website 2. Steinberger and Daniels. Circulation 2003;107: http://www.cdc.gov/obesity/adult/causes/index.html

13 Obesity—How Does It Happen? Energy in > energy used → adipose tissue –Genetic factors –Physical inactivity and sedentary behavior Possibly 2 minutes of stair climbing could prevent 1 lb/yr weight gain 1 –Increased consumption of food Degree of accessibility to certain types of food Increasing portions sizes Sugary drinks increase risk of weight gain in children/adults with growing evidence of downstream effects (diabetes & heart disease) Zimring AJPM Malik AJCN Malik Circulation Fung ACJN 2009.

14 People Eat Out More 14

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16 Portion Size Influences Consumption Numerous studies show people given larger portions eat more, without recognizing it 1-8 –People given beverages 50% larger consumed 20% (women) to 33% (men) more, with no decrease in food eaten 9 –People given larger portion sizes of food eat ~20- 50% more, without completely reducing intake at subsequent meals 4 1. Wansink and Cheney. JAMA 2005;293(14): Wansink B. Ann Review Nutr 2004;24: Rolls BJ et al. J Amer Diet Assoc 2006;106(4): Ledikwe JH et al. J Nutr 2005;135(4): Diliberti N et al. Obes Rsrch 2004;12(3): Rolls BJ et al. AJCN 2002;76(6): Wansink B et al. Obes Rsrch 2005;13(1): Flood JE et al. J Amer Diet Assoc 2006;106: Rolls BJ et al. Obesity 2007; 15:

17 Sugary Drink Consumption Among NYC Adults NYC CHS

18 Obesity contributes to conditions with significant years of “healthy” life lost DALYS or disability adjusted life years (years life lost + years lived w/ disability) YLLYLD Ischemic Heart Disease89,48181,2788,203 Major Depression42,1100 HIV37,49528,1309,365 Alcohol Use35,0504,47530,575 Osteoarthritis29, ,236 Asthma27,7452,97424,771 Diabetes26,55712,69013,867 Lung Cancer25,07423,9361,138 Cerebrovascular Disease24,25812,59511,663 Hypertension21,80417,7754,029 Source: Perlman and Driver. Disability adjusted life years in New York City. New York City Department of Health and Mental Hygiene

19 Obesity contributes to conditions with significant years of “healthy” life lost DALYS or disability adjusted life years (years life lost + years lived w/ disability) YLLYLD Ischemic Heart Disease89,48181,2788,203 Major Depression42,1100 HIV37,49528,1309,365 Alcohol Use35,0504,47530,575 Osteoarthritis29, ,236 Asthma27,7452,97424,771 Diabetes26,55712,69013,867 Lung Cancer25,07423,9361,138 Cerebrovascular Disease24,25812,59511,663 Hypertension21,80417,7754,029 Source: Perlman and Driver. Disability adjusted life years in New York City. New York City Department of Health and Mental Hygiene

20 Pre-diabetes is a condition where blood sugar is elevated but not high enough to be considered to be diabetes Increased risk of developing diabetes—over 5 years, 15-30% will develop diabetes 1 In NYC, 1.3 million adults in NYC have pre-diabetes 2 72% (960,000) are overweight or obese Pre-Diabetes 1.CDC. Pre-diabetes. 2.NYC DOHMH. NYC HANES 2004 data analyzed by Bureau of Epidemiology Services Jan 2012.

21 Weight gain contributes to type 2 diabetes 1 For each 1 kg increase, there was a 4.5% increase in the risk of diabetes Intensive lifestyle modification has been shown to reduce the risk of developing T2DM in people who are overweight and have pre- diabetes 2 Excess weight can make diabetes harder to manage Modest weight loss in people who are overweight with T2DM can improve insulin resistance, CVD risk factors, and can decrease number of medications 3 Weight, Pre-Diabetes, and Type 2 Diabetes 1. Ford et al, AJE 1997;146: DPP Research Group, NEJM ADA. Standards of Medical Care in Diabetes 2013.

22 Prevalence of Self-Reported Overweight/Obesity Among NYC Adults Source: NYC CHS (age-adjusted)

23 Prevalence of Self-Reported Overweight/Obesity Among NYC Adults Source: NYC CHS (age-adjusted)

24 Prevalence of Self-Reported Overweight/Obesity Among NYC Adults Source: NYC CHS (age-adjusted)

25 Shift in the Distribution of Body Mass Index Among Adults (nat’l data) Adapted from : Ogden Cl et al. Obesity among adults in the United States. NCHS Data Brief No. 1, November 2007 Obese Over-weight

26 Prevalence of Self-Reported Obesity 2002 vs in Adults NYC CHS 2002 & 2012 age-adjusted; * denotes differences where confidence interval do not overlap

27 Prevalence of Overweight/Obesity in Public School K-8 Source: NYC FITNESSGRAM data, school years , , and for NYC public schools students in districts 1-32, grades K-8, and ages Prepared by: NYC Department of Health and Mental Hygiene, Bureau of Epidemiology Services

28 Prevalence of Overweight/Obesity in Public School K-8 Source: NYC FITNESSGRAM data, school years , , and for NYC public schools students in districts 1-32, grades K-8, and ages Prepared by: NYC Department of Health and Mental Hygiene, Bureau of Epidemiology Services

29 Physical Inactivity Adults with no physical activity in past 30 days NYC CHS age adjusted; * no data collected for that year

30 So Now What?

31 Decrease access & consumption of unhealthy food Increase access & consumption of healthy food Increase physical activity and decrease sedentary behavior Ensure effective quality of care for diabetes and obesity Four Goals to Address Obesity and Diabetes

32 Decrease access & consumption of unhealthy food Increase access & consumption of healthy food Increase physical activity and decrease sedentary behavior Ensure effective quality of care for diabetes and obesity 1. Maintain healthy weight 2. Modest weight loss if overweight; at a minimum, don’t gain more weight 3. Benefits of physical activity regardless of weight Four Goals to Address Obesity and Diabetes

33 NYC DOHMH Activities and Programs We Promote

34 Promoting Healthier Eating Decreasing access to unhealthy food Trans Fat Restriction –Food service establishments National Salt Reduction Initiative –Packaged & restaurant foods –90+ partners and nearly 30 companies have committed to targets New York City Food Standards City agencies and daycare centers required; other institutions and organizations are adopting on voluntary basis (hospitals, CBOs, FBOs) Portion cap rule –Sugary drinks in food service establishments

35 Promoting Healthier Eating Increasing access to healthy food Green Carts –Permits for mobile vendors in low- income areas, ~ 500 active permits, ~80 of which accept EBT Shop Healthy –Promote healthy food in corner stores and supermarkets/community outreach (currently in South Bronx but expanding) Farmers Markets –Nutrition workshops and cooking demos at 20 markets –Health Bucks: $2 coupons for F/V at all farmers’ markets (EBT accepted); for every $5 customer spends using SNAP, get a $2 coupon

36 Promoting Physical Activity (run by Dept of Parks and Recreation) Shape Up New York –Free aerobic classes in underserved neighborhoods in parks and community centers and schools BeFitNYC –A website with search engine to find low-cost fitness opportunities across NYC

37 Promoting Physical Activity Active Design Guidelines –Developers, city planners, and community groups can use; build places and spaces to promote activity Play Streets (community and school) –Increase the frequency of single blocks of streets being closed to cars on a daily or weekly basis for children to play Stair prompts -Facilitate stair use through outreach to building owners, stair access and signage in City Buildings, and better stair designs

38 Promoting Physical Activity Move to Improve Curriculum developed by DOHMH and Department of Education used to train K-5 teachers with goal of getting kids moving during the day and include academic integration Teachers get a manual and equipment Thousands of teachers have been trained across hundreds of schools (DOE run)

39 Promoting Physical Activity and Healthy Eating Eat Well Play Hard Nutrition workshops for children and caregivers & promotion of physical activity –Child care centers –Pre-K-1 st grade –Includes train the trainer model in child care centers Thousands reached each year

40 SOME GENERAL TIPS AND RESOURCES FOR YOU AND YOUR CLIENTS (more to come from Lorraine Drago)

41 General Guidance on Diet (assuming basic nutrition needs are met) –Little to no sugary drinks (alcohol and mixers count) –Limit fried foods, desserts, salty chips and snacks –Less red meat, more fish and chicken –Low fat dairy –Whole grains instead of refined grains –More fruits and vegetables –Avoid seconds and save “half for later”

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43 CalCutter App (FREE) CalCutter has 3 main functions: –Helps cooks figure out how many calories are in meals –Offers ways for cooks to reduce calorie counts Suggests alternative ingredients, different cooking methods and/or smaller portion sizes –Displays how many calories from their 2,000 daily allowance remain for other side dishes/meals

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48 General Guidance on Activity (assuming no medical contraindications & tailored to individual) –Some is better than none –More benefit accrues with more activity and higher intensity –Aerobic activity goals Aerobic: –Moderate activity totaling 150 min/week, such as brisk walking for 30 minutes –Vigorous activity totaling 75 min/week –In either situation, using short bouts of activity, OK if at least 10 minutes at a time –Muscle-strengthening goals –Moderate or high intensity –Involving two or more muscle groups on 2+ days/week Source: 2008 Physical Activity Guidelines for American

49 Resources

50 Healthy Diet Resources Farmers Markets https://a816-healthpsi.nyc.gov/DispensingSiteLocator/mainView.do https://a816-healthpsi.nyc.gov/DispensingSiteLocator/mainView.do (query system to find a market near you) map.pdfhttp://www.nyc.gov/html/doh/downloads/pdf/cdp/farmers-market- map.pdf (map of markets noting which have cooking demonstrations) Reading labels fact.pdf Salt and sugary drinks 07.pdf 06.pdf Green Carts Shop Healthy CalCutter app

51 Physical Activity Resources Shape Up NYC For free classes that you can join across the city, go to ape-up-nyc or call 311 and ask for locations ape-up-nyc BeFitNYC Active Design Guidelines For architects and urban designers esign.shtml For community groups nmental/active-design-community-guide.pdf

52 Medication Resource (NYC) Big Apple Rx A discount program for all New Yorkers to use regardless of insurance status tml --can save up to 47% on prescriptions tml Two steps to access this resource: 1)Find a participating pharmacy—either on the website or calling )Print out a card to use at the pharmacy—either on the website or just use this information belowhttp://www.bigapplerx.com/findpharmacy BIN:# , Group: # NYC12, Cardholder ID: 69530

53 Medication Resource (NYS) Prescription saver –A discount program if low income* AND years of age or with a disability https://nyprescriptionsaver.fhsc.com/ https://nyprescriptionsaver.fhsc.com/ –Can save up to 60% on generics and 30% on brand name –Complete an application on line, mail one in, or call *annual household income <$35,000 if single and <$50,000 if married

54 Quitting Tobacco NYS Quit line NYQUITS --Free counseling by phone --Smoking cessation medication if eligible NYC Quits website https://a816-nycquits.nyc.gov/pages/homepage.aspx

55 Contact Information: Shadi Chamany, MD, MPH


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