1. The Burden of Obesity in North Carolina Obesity in Adults

3. The Behavioral Risk Factor Surveillance System (BRFSS) Established in 1984 by the Centers for Disease Control and Prevention Established in 1984 by the Centers for Disease Control and Prevention State-based system of health surveys that collect information on: State-based system of health surveys that collect information on: health risk behaviors health risk behaviors preventive health practices preventive health practices health care access health care access Random-digit dialing, individuals age 18 years and older are randomly selected from each household called Random-digit dialing, individuals age 18 years and older are randomly selected from each household called Largest telephone health survey in the world Largest telephone health survey in the world

5. The National Burden of Obesity 2 out of 3 adults are overweight or obese 2 out of 3 adults are overweight or obese None of the states have experienced a decrease in obesity for 16 years None of the states have experienced a decrease in obesity for 16 years In the past year, 31 states experienced an increase in obesity In the past year, 31 states experienced an increase in obesity

6. 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% Source: Behavioral Risk Factor Surveillance System, CDC

7. The National Health and Nutrition Examination Survey (NHANES) Designed to assess the health and nutritional status of adults and children Designed to assess the health and nutritional status of adults and children Combines personal interviews and physical examinations Combines personal interviews and physical examinations Used to determine the basis for national standards for such measurements as height, weight and blood pressure. Used to determine the basis for national standards for such measurements as height, weight and blood pressure.

8. The entire adult population is heavier, and the heaviest have become much heavier since 1980. Changes in the Distribution of BMI between 1976-1980 and 2005-2006, United States Adults Aged 20-74 Years

9. Adult Obesity in N.C. 65.7% of N.C. adults are overweight or obese, above the national average. 65.7% of N.C. adults are overweight or obese, above the national average. 56% are not meeting the physical activity recommendation 56% are not meeting the physical activity recommendation 78% are not meeting the fruits or vegetables recommendation 78% are not meeting the fruits or vegetables recommendation

10. Adult Obesity in N.C. Physical inactivity and unhealthy eating combined are the 2nd leading preventable cause of death in N.C., and both increase the risk of: Physical inactivity and unhealthy eating combined are the 2nd leading preventable cause of death in N.C., and both increase the risk of: Heart diseaseHeart disease Certain types of cancerCertain types of cancer DiabetesDiabetes High blood pressureHigh blood pressure StrokeStroke ObesityObesity

11. N.C. Adults, BMI Trends

12. Healthy People 2010 Launched in January 2000, by The Department of Health and Human Services Launched in January 2000, by The Department of Health and Human Services A comprehensive, nationwide health promotion and disease prevention agenda A comprehensive, nationwide health promotion and disease prevention agenda Contains objectives to increase quality and years of healthy life and to eliminate health disparities by the year 2010 Contains objectives to increase quality and years of healthy life and to eliminate health disparities by the year 2010

13. By 2010, increase the percentage of adults who are at a healthy weight to 60%.

14. By 2010, reduce the percentage of adults (20 years old or older) who are obese to 15%.

15. N.C. Adults Who Were Overweight or Obese, by Gender

16. N.C. Adults Who Were Overweight or Obese, by Age Group

17. N.C. Adults Risk Factors, by Race/Ethnicity

18. N.C. Adults who were Overweight or Obese by Income

20. The Burden of Obesity in North Carolina Special Populations & Obesity

21. Special Populations in North Carolina Life expectancy for North Carolinas minority population is almost five years less than the white population. Life expectancy for North Carolinas minority population is almost five years less than the white population. African Americans are the largest minority group, accounting for 21 percent of the population. African Americans are the largest minority group, accounting for 21 percent of the population. Hispanics now comprise approximately seven percent of the population, six times the percentage in 1990. Hispanics now comprise approximately seven percent of the population, six times the percentage in 1990. About one percent of North Carolinians are American Indian. About one percent of North Carolinians are American Indian.

22. N.C. Risk Factor Percentages by Race/Ethnicity Behavioral Risk Factors * (percentages) 2007: White, Non- Hispanic African American, Non- Hispanic American Indian, Non- Hispanic Other Races, Non- Hispanic Latino/ Hispanic TOTAL Adults with high blood pressure28.239.729.316.712.728.8 Adults who smoke23.223.332.918.819.222.9 Adults who are obese26.439.226.722.925.428.7 Adults with no leisure time physical activity21.228.736.620.540.624.3 Percent of adults in fair/poor health16.621.826.814.629.718.7 * N.C. Behavioral Risk Factor Surveillance System (BRFSS), State Center for Health Statistics. BRFSS is an ongoing, monthly telephone survey through which data are collected from randomly selected, non-institutionalized N.C. adults (age 18 and older) in households with telephones. Survey responses are weighted to represent the demographics of all adults in the state.

23. Racial & Ethnic Disparities and Obesity African Americans were more likely than whites to be obese, have high blood pressure, be physically inactive, and have inadequate fruit and vegetable consumption. African Americans were more likely than whites to be obese, have high blood pressure, be physically inactive, and have inadequate fruit and vegetable consumption.

24. N.C. Adults by Race

25. Older Adults and Obesity In 2008,72.3% of adults in the 55-64 age group were overweight or obese. In 2008, 72.3% of adults in the 55-64 age group were overweight or obese.

26. Older U.S. Adults and Obesity Health Behaviors %C.I.*YearRank No Leisure-Time Physical Activity 30.4(28.6 - 32.4)200419 Eating 5 Fruits and Vegetables Daily 27.9(25.3 - 30.7)200337 Obesity22.0(20.3 - 23.8)2004 37 *A confidence interval (CI) describes the level of uncertainty of an estimate and specifies the range in which the true value is likely to fall. The State of Aging and Health in America online report uses a 95 percent level of significance, which means that 95 percent of the time, the true value falls within these boundaries. Rankings are based on the relative numeric scores for each indicator, with a ranking of "1" indicating the highest rank. [i] [i] Centers for Disease Control and Prevention and The Merck Company Foundation. The State of Aging and Health in America 2007. Whitehouse Station, NJ: The Merck Company Foundation; 2007. www.cdc.gov/aging/saha.htmwww.cdc.gov/aging/saha.htm

27. Educational and Socio-economic Disparities and Obesity In general, among white children, obesity typically declines as income and parental education increase. Only rates of obesity for white girls decrease as family income rises. In general, among white children, obesity typically declines as income and parental education increase. Only rates of obesity for white girls decrease as family income rises. Obesity rates for African American girls are higher in the lowest and highest income ranges than in the in-between bracket. Obesity rates for African American girls are higher in the lowest and highest income ranges than in the in-between bracket.

28. Educational Disparities N.C. Children and Youth who are Overweight or Obese

29. Economic Constraints In 2007, nearly 5% of N.C. primary caregivers cut the size of their childs meals because there was not enough money for food. In 2007, nearly 5% of N.C. primary caregivers cut the size of their childs meals because there was not enough money for food.

30. Economic Constraints Food insecurity and obesity are linked: Food insecurity and obesity are linked: Low-income families may consume lower-cost foods with relatively higher levels of calories per dollar, Low-income families may consume lower-cost foods with relatively higher levels of calories per dollar, Families sacrifice food quality for food quantity to stretch limited resources, Families sacrifice food quality for food quantity to stretch limited resources, Mothers in particular sacrifice their own nutrition to feed their children, yet may overeat when food is available again, and Mothers in particular sacrifice their own nutrition to feed their children, yet may overeat when food is available again, and The body may store fat more efficiently to conserve energy when there are periods of food deprivation. The body may store fat more efficiently to conserve energy when there are periods of food deprivation.

31. Rural Areas and Obesity Nationally, rural areas have higher rates of adult obesity than urban areas. Nationally, rural areas have higher rates of adult obesity than urban areas. Nearly 14% of children in rural N.C. had early risk factors for diabetes and heart disease. Nearly 14% of children in rural N.C. had early risk factors for diabetes and heart disease. In N.C., the odds of being obese were 50% higher for rural children. In N.C., the odds of being obese were 50% higher for rural children.

32. Environmental Factors Keeping adolescents in their same environments and changing only family income and parental education had a limited effect on the disparities in obesity prevalence. Keeping adolescents in their same environments and changing only family income and parental education had a limited effect on the disparities in obesity prevalence. Efforts to reduce obesity disparities between ethnic groups should look at other factors, such as environmental, contextual, biological, and socio-cultural factors. Efforts to reduce obesity disparities between ethnic groups should look at other factors, such as environmental, contextual, biological, and socio-cultural factors.