1. Child and Adult Obesity in Ohio: 2008 Ohio Family Health Survey Supporting Decision-Making Through Research: Findings from the 2008 Ohio Family Health Survey Leona Cuttler, M.D.* Lisa Simpson, MB, BCh, MPH ^ JB Silvers, PhD* Andrew Gallan, PhD* Ann Nevar, MPA* Mendel Singer, PhD* * The Center for Child Health and Policy at Rainbow Babies & Children’s Hospital, Case Western Reserve Univ. ^ Child Policy Research Center, CCHMC, Univ. of Cincinnati

2. We hear a lot about Obesity…

3. …But what are the actual data?? ….. impact on health during childhood? and adulthood? ….. in Ohio now? - rates of childhood & adult obesity? - policy-relevant risk factors? - impact on health? health services? - implications for policy?

4. Cardiovascular: Hypertension (2.5-3.7x inc) Dyslipidemia Risk factors: 60% of obese 5-10 yo have > 1 risk factor Metabolic syn (30% obese) Sleep Apnea 3x rise over 30 yrs 25% obese Asthma 2-fold rise in obese Gallstones Fatty Liver Up to 50% in obese Type 2 Diabetes : up to 45% new onset pediatric diabetes Bone disease Arthritis, SCFE Psychological poor quality of life, depression, ADHD, eating disorders (cause?) Does Childhood Obesity Really Have an Impact? Health during childhood

5. Does Childhood Obesity Really Have an Impact? Health during Adulthood Childhood obesity tends to persist into adulthood, and predisposes to: Diabetes Cardiovascular disease Cancer (colon, pancreas, breast, etc.) and much more

6. Obesity: 1 of 3 Americans to develop diabetes

7. Childhood obesity increases the risk of adult heart disease Obese at 7-13 y  higher risk of heart disease after age 25 y Current adolescent obesity will cause 100,000 excessive cardiac deaths by 2035

8. Adult obesity impacts health and costs Medical costs of obese 37% more than normal weight Obesity accounted for 27% of the rise in inflation- adjusted per capita spending between 1987-2001

9. What is the current state of child and adult obesity in Ohio? Sponsored by: The Ohio Family Health Survey 2008 Funded by: State of Ohio Departments of Insurance, Job and Family Services, Health, and Mental Health Directed by: Ohio Colleges of Medicine Government Resource Center at The Ohio State University and the Health Policy Institute of Ohio

10. The Ohio Family Health Survey Telephone interviews: 50,092 households Adults: height, weight, health If child between 10-17 yrs in household: child’s height, weight, health (n= 6086) provided by adult (86% parents) Body Mass Index (BMI) calculated – Classification of BMI: underweight, healthy, overweight, obese

11. Obesity: terminology Body Mass Index (BMI) is used to assess “fatness” “Overweight” refers to individuals who are above normal weight but not obese (children: BMI 85 th -94 th percentile; adults: BMI 25-29.9 kg/m²) “Obese” refers to individuals who are markedly above normal weight (children: BMI> 95 th percentile; adults: BMI > 30 kg/m²)

12. How many Ohioans are overweight or obese? 1 in 3 Children2 in 3 Adults ~500,000 Ohio children are overweight or obese ~5.5 million Ohio adults are overweight or obese *Ohio Family Health Survey, 2008

13. Overweight and obesity in Ohio: children and adults Children: - 2003 NSCH (10-17 y): 30.5% (vs. 30.5% US) - 2008 OFHS (10-17 y): 35.6% Kids: Ohio is 22 nd fattest state, Trust for America’s Health 2008 Adults: - 2003 BRFSS: 60.9% (vs. 59.6% US) - 2008 OFHS: 65.0% Adults: Ohio is 17 th fattest state, Trust for America’s Health 2008 Are rates rising in Ohio?

14. But prevalence of childhood obesity in Ohio is uneven across racial and demographic groups* Obese Overweight Child Race/EthnicityChild Insurance Type *P<0.01, Ohio Family Health Survey, 2008 Parent Education % %

15. Gender: Overweight and obesity is more common in Ohio males than females - Children* ObeseOverweight *Ohio Family Health Survey, 2008 P < 0.01 %

16. Gender: Overweight and obesity is more common in Ohio males than females - Adults* ObeseOverweight *Ohio Family Health Survey, 2008 P < 0.01 %

17. Childhood Obesity in Ohio: Impact on Health* Relative Risk *Ohio Family Health Survey, 2008 P < 0.05-<0.001

18. Adult Obesity in Ohio: Impact on Health* *Ohio Family Health Survey, 2008 Relative Risk P <0.001

19. Obese Ohioans need more health services than those who are normal weight (P<.01) Special health care needs: Chronic medications: Emergency room visits – Two or more: Hospitalizations – Two or more: 1.4-fold higher1.6-fold higher 1.4-fold higher 1.8-fold higher 2.1-fold higher 1.6-fold higher 1.5-fold higher ChildrenAdults

20. Therefore, obesity is currently a major public health threat to Ohio: prevalence, impact on health, use of health resources What should we do about it? Do the data help identify policy directions?

21. Given the scope of the problem, policy is important to address obesity 1.Start young 2.Target parent + child 3.Not focus on a single geographic region 4.Multilevel approach: global + some subgroups 5.Change perceptions of health, food, activity 6.Develop policies for prevention + treatment 7.Consider defining obesity as a chronic disease

22. 1. Start Young If we want to overcome obesity in Ohio, we have to target children because: Obesity starts very young, and becomes more prevalent with advancing age

23. OHIO: Obesity (BMI>95%ile) Across the Lifespan ¹ Pediatric Nutrition Surveillance System (PedNSS), CDC and ODH, 2006 2 Ohio Family Health Survey (OFHS), ODJFS/ODH/ODI/ODMH, 2008 Newborns 2-5 yr olds 1 Adults 2 10-17 yr olds 2 <5 % 5-9.9 % 10-14.9 % 15-19.9 % 20-24.9 % 25-29.9 % ≥30 % NS

24. 1. Start Young If we want to overcome obesity in Ohio, we have to target children because: Obesity starts very young, and becomes more prevalent with advancing age Obese children generally become obese adults

25. 2. Target Parents + Children Parent obesity is a strong independent predictor of childhood obesity

26. Parent obesity is linked to childhood obesity* Children % overweight obese * P<0.01; Ohio Family Health Survey, 2008 Adults

27. 2. Target Parents + Children Parent obesity is a strong independent predictor of childhood obesity Targeting parents includes focus on their educational attainment

28. Parent education is linked to childhood obesity* % *OFHS, 2008 Children Adult Education Level obese overweight P<0.01

29. 3. We should not focus on a single geographic region Obesity is not easily targeted geographically: Child and adult obesity is widespread in OH No specific region or type of region is dominant

30. Ohio: County-by-County Rates of Obesity <5 % 5-9.9 % 10-14.9 % 15-19.9 % 20-24.9 % 25-29.9 % ≥30 % NS Children (10-17 yrs) Adults

31. 4. Consider multilevel approach, recognizing demographic subgroups Independent risk factors for obesity CHILDADULT more likely Male (vs female) 1.8x1.3x Medicaid (vs job-based) 1.3x1.3 Income 100-200% FPL (vs >300% FPL) 1.4x1.2x Black female (vs white female) 1.8x1.5x

32. In addition, other independent risk factors for childhood obesity Children: more likely to be obese – 10-11 Years-Old (vs 16-17 years-old) 2.2-fold – Adult is Obese (vs healthy weight) 1.7-fold – Adult High School (vs 4 year college) 1.4-fold

33. Other policy recommendations 5.Change perceptions of health, food, and activity 6.Develop policies that address prevention and treatment 7.Consider defining obesity as a chronic disease

34. Summary (1) In Ohio: 35.6 % of children and 65% of adults are overweight or obese Rates of obesity differ according to demographic factors (gender, race, income, insurance, and parent education) Obesity is associated with both - a substantial increase in diseases, and - marked increased use of health resources

35. Summary (2) The extent/impact of obesity suggest that policy interventions are needed. The data suggest: 1.Start young 2.Target parent + child 3.Not focus on a single geographic region 4.Multilevel approach: global + some subgroups 5.Change perceptions of health, food, activity 6.Develop policies for prevention + treatment 7.Consider defining obesity as a chronic disease

36. Summary (3) Act now. When is the evidence enough? When the problem is big enough: Get data  Act on best available evidence  Re-evaluate  Modify

37. Thank you Thanks to Ohio Dept. of Job and Family Services, Ohio Dept. of Health, Ohio Dept. of Insurance, and Ohio Dept. of Mental Health, OSU-HPIO Thanks to Rainbow Board of Trustees Research team: Leona Cuttler, A. Gallan, Ann Nevar, JB Silvers, Mendel Singer, Lisa Simpson Reviewer team: Cynthia Burnell, James Gearheart, Lorin Ranbom, Barry Jamieson