1. Adults and obesity: a growing problem with solutions Jeffrey Levi, PhD Executive Director, TFAH Grantmakers in Health Webinar September 14, 2009

2. F as in Fat 2009

3. Key Findings: F as in Fat, 2009  Adult obesity continue to rise in 23 states with no states experiencing a decrease.  Four states have rates above 30 percent -- Mississippi, Alabama, West Virginia, and Tennessee.  More than 25 percent of adults are obese in 32 states, an increase from 28 states last year.  More than 20 percent of adults are obese in every state except Colorado.  Type 2 diabetes rates increased in 19 states in the past year. In seven states, more than 10 percent of adults now have Type 2 diabetes.  Seven of the top 10 states with the highest obesity rates are also in the top 10 for highest poverty rates.

4. Key Findings: Heaviest States RankStatePercentage of Adult Obesity (2006-2008) 1Mississippi32.5% (+/-0.9) 2Alabama31.2% (+/-1.1) 3West Virginia31.1% (+/-1.0) 4Tennessee30.2% (+/-1.3) 5South Carolina29.7% (+/-0.8)

5. Key Findings: Least Heavy States RankStatePercentage of Adult Obesity (2006-2008) 51Colorado18.9% (+/- 0.6) 50Massachusetts21.2% (+/- 0.6) 49Connecticut21.3% (+/- 0.8) 48Rhode Island21.7% (+/- 0.9) 47Hawaii21.8% (+/- 0.9)

6. States with the Highest Rates of Physical Inactivity RankStatePercentage of Adult Physical Inactivity (2006-2008) Obesity Ranking 1Mississippi31.8% (+/-0.9)1 2Kentucky30.4% (+/-1.0)7 3 (tie)Louisiana30.3% (+/-0.9)8 3 (tie)Oklahoma30.3% (+/-0.8)6 5Tennessee29.8% (+/-1.2)4

7. States with the Lowest Rates of Physical Inactivity RankStatePercentage of Adult Physical Inactivity (2006-2008) Obesity Ranking 51Minnesota16.3% (+/-0.9)31 50Oregon17.6% (+/-0.8)28 48 (tie)Colorado17.9% (+/-0.6)51 48 (tie)Washington18.1% (+/-0.4)28 47Vermont18.5% (+/-0.7)46

8. Disparities in U.S. Obesity Rates, 2006--2008  Overall, 25.6% of U.S. adults were obese; however, there were significant differences among racial/ethnic groups. African Americans -- 35.7% Hispanics -- 28.7% Whites -- 23.7%  This pattern was consistent across most U.S. states. However, state obesity rates varied substantially. Obesity rates for: African Americans ranged from 23.0% in New Hampshire to 45.1% in Maine Hispanics ranged from 21.0% in Maryland to 36.7% in Tennessee Whites ranged from 9.0% in the District of Columbia to 30.2% in West Virginia Source: CDC. “Differences in Prevalence of Obesity Among Black, White, and Hispanic Adults --- United States, 2006—2008.” MMWR 58, no. 27 (2009): 740-744.

9. Health Impact of Obesity, Physical Inactivity, and Poor Nutrition  More than 80 percent of people with type 2 diabetes are overweight. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) found that a seven percent weight loss together with moderate levels of physical activity (walking 30 minutes a day, five days a week) decreased the number of new type 2 diabetes cases by 58 percent among people at-risk for diabetes.  People who are overweight are more likely to suffer from high blood pressure, high levels of blood fats, and LDL, or bad cholesterol, which are all risk factors for heart disease and stroke. Physically inactive people are twice as likely to develop coronary heart disease as regularly active people  Approximately 20 percent of cancer in women and 15 percent of cancer in men is attributable to obesity  Among individuals who have received a doctor’s diagnosis of arthritis 68.8 percent are overweight or obese

10. Obesity and Baby Boomers  Alabama has the highest rate of obese 55- to 64-year-olds at 38.7%; Colorado the lowest at 21.8%  As the Baby Boomers age, the percentage of obese individuals age 65 and older could increase significantly, from 5.2% in New York to 16.3% in Alabama  Health care costs for obese seniors (65+) are an additional $1,400 to $6,100 per year compared to non-obese individuals  Medicare spending is projected to triple from 3% of U.S. GDP in 2007 to 10% by 2057 – much of the growth is driven by treatment for obesity-related conditions

11. It can’t all be fixed in the doctor’s office Health Behaviors 50% Environment20% Access to Care 10% Genetics20% Prevention 4% Medical Services 96% Factors Influencing Health National Health Expenditures SOURCE: Blue Sky Initiative, University of California at San Francisco, Institute of the Future, 2000

12. Why community prevention?  Clinical interventions – one person at a time Coverage of medical treatment and counseling is critical “Prescriptions” for obesity require supportive community environment – whether improved nutrition or increased physical activity  Create the social and structural environment that makes healthy choices the easy choices  Community interventions – an entire population Addresses the needs of those already obese and those at risk – both “treatment” and “prevention” Evidence of success (and cost savings) from some population level interventions (tobacco control, helmet laws, sanitation) We can change norms and behaviors and see positive health outcomes

13. What is community prevention?  Interventions that promote healthy environments and behaviors – making it easier for people to make healthy choices, such as: Changing community norms and empowering communities  Coalition and social network building  Social marketing campaigns Changing the physical and social environments  Organizational practices and governmental policies  Facilities and programs  Walkability – lighting, sidewalks, signs;  Access to healthy foods Increasing individual knowledge and skills

14. What is a successful program?  Multi-faceted – no magic bullet to preventing or reversing obesity  Targeted at the needs of particular communities – geographic and racial/ethnic  REACH, Healthy Communities Program (formerly the Steps Program), Pioneering Healthier Communities, Shape Up Somerville, HEAC

15. Path to success – kids or adults?  Singular focus on kids can be perceived (incorrectly) as writing off adults.  Changing norms requires reaching both kids and adults – they influence each other in different ways Increasing evidence that weight of parents affects weight of kids Impact of kids on changing behavior of their parents

16. There is an evidence base….  NYAM, A Compendium of Proven Community-Based Prevention Programs  NACCD, Compendium of Successful Community Based Interventions  Healthy Eating Active Living Convergence Partnership, Promising Strategies  REACH, Steps

17. Small changes make big differences  STOP Obesity Alliance recommends a sustained weight loss of 5-10% as a measure of success and can achieve major health improvements Similar data for increased fitness (physical activity) with or without weight loss Important message for policy makers AND for communities Translates into real declines in associated diseases  Delaying costs or “compressing morbidity”?

18. Prevention for a Healthier America: Financial Return on Investment? INVESTMENT:$10 per person per year HEATH CARE COST NET SAVINGS: $16 Billion annually within 5 years RETURN ON INVESTMENT (ROI): $5.60 for every $1 With a Strategic Investment in Proven Community-Based Prevention Programs to Increase Physical Activity and Good Nutrition and Prevent Smoking and Other Tobacco Use

19. If it’s all local – where do the Feds come in?  Part of national strategy to improve health  Can change norms in state and local government by investing in these programs  Bending the cost curve Senior health care cost:  Costs among obese 36.8% to 88% higher ($1486-$6192 per person)  Those 55-64 are 7.6%-16.3% more obese than current population over 65 (range is by state) Worker productivity

20. Policy implications: A natural experiment  $650 million in stimulus bill to “carry out evidence- based clinical and community-based prevention and wellness strategies…that deliver specific, measurable health outcomes that address chronic disease rates.”  “a historic commitment to wellness initiatives will keep millions of Americans from setting foot in the doctor's office in the first place -- because these are preventable diseases and we're going to invest in prevention.” – President Barack Obama, Feb. 17, 2009

21. Policy implications: Health reform  Senate HELP bill: Community Transformation Grants  Senate Finance bill: Incentives for Healthy Lifestyles  House bill: Community-Based Prevention and Wellness Services grants Opposition CBO issues

22. Convergence Partnership Statement  “our work has demonstrated the important health impacts that community prevention efforts can provide. These examples also highlight the tremendous benefit that modest investments in underserved communities can yield in improving health outcomes. Many initiatives have included a rigorous evaluation and, in some cases, resulted in articles in peer- reviewed journals to help the field build from lessons learned. In short, this is a strong platform for the nation to build on, and with additional resources, it could bring considerable improvements in health for all Americans. It is time to scale up these efforts by including robust financial support for community prevention in any health systems reform.”

23. Links  www.healthyamericans.org www.healthyamericans.org State by state data Prevention for a Healthier America F as in Fat  www.healthyamericans.org/health-reform www.healthyamericans.org/health-reform Updates on legislation Compendia and success stories