4%4-6%6% n/a Source: Mokdad et al., Diabetes Care 2000;23: Prevalence of Diabetes among U.S. Adults, BRFSS, 1990

4%4-6%6% n/a Source: Mokdad et al., Diabetes Care 2000;23: Prevalence of Diabetes among U.S. Adults, BRFSS,

4%4-6%6% n/a Source: Mokdad et al., Diabetes Care 2000;23: Prevalence of Diabetes among U.S. Adults, BRFSS,

4%4-6%6% n/a Source: Mokdad et al., Diabetes Care 2000;23: Prevalence of Diabetes among U.S. Adults, BRFSS,

4%4-6%6% n/a Source: Mokdad et al., Diabetes Care 2000;23: Prevalence of Diabetes among U.S. Adults, BRFSS,

Prevalence of Obesity* among U.S. Adults BRFSS, 1985 (*Approximately 30 pounds overweight)

Prevalence of Obesity* among U.S. Adults BRFSS, 1986 (*Approximately 30 pounds overweight)

Prevalence of Obesity* among U.S. Adults BRFSS, 1987 (*Approximately 30 pounds overweight)

Prevalence of Obesity* among U.S. Adults BRFSS, 1988 (*Approximately 30 pounds overweight)

Prevalence of Obesity* among U.S. Adults BRFSS, 1989 (*Approximately 30 pounds overweight)

Prevalence of Obesity* among U.S. Adults BRFSS, 1990 (*Approximately 30 pounds overweight)

Prevalence of Obesity* among U.S. Adults BRFSS, 1991 (*Approximately 30 pounds overweight)

Prevalence of Obesity* among U.S. Adults BRFSS, 1992 (*Approximately 30 pounds overweight)

Prevalence of Obesity* among U.S. Adults BRFSS, 1993 (*Approximately 30 pounds overweight)

Prevalence of Obesity* among U.S. Adults BRFSS, 1994 (*Approximately 30 pounds overweight)

Prevalence of Obesity* among U.S. Adults BRFSS, 1995 (*Approximately 30 pounds overweight)

Prevalence of Obesity* among U.S. Adults BRFSS, 1996 (*Approximately 30 pounds overweight)

Prevalence of Obesity* among U.S. Adults BRFSS, 1997 (*Approximately 30 pounds overweight)

Prevalence of Obesity* among U.S. Adults BRFSS, 1998 (*Approximately 30 pounds overweight)

Prevalence of Obesity* among U.S. Adults BRFSS, 1999 (*Approximately 30 pounds overweight) Source: Mokdad A H, et al. Am Med Assoc 2000;284:13

Changes in the Prevalence of Obesity (BMI > 95th Percentile) Among U.S. Female Children and Adolescents Changes in the Prevalence of Obesity (BMI > 95th Percentile) Among U.S. Female Children and Adolescents

Consequences of Childhood and Adolescent Obesity Growth Psychosocial Hyperlipidemia Hepatic steatosis Abnormal glucose metabolism Persistence into adulthood Growth Psychosocial Hyperlipidemia Hepatic steatosis Abnormal glucose metabolism Persistence into adulthood Hypertension Sleep apnea Pseudotumor PCOD Cholelithiasis Orthopedic Hypertension Sleep apnea Pseudotumor PCOD Cholelithiasis Orthopedic Common Uncommon

Consequences of Adult Obesity Psychosocial Cardiovascular – Hyperlipidemia – Diabetes mellitus – Hypertension – Respiratory – Cardiac Psychosocial Cardiovascular – Hyperlipidemia – Diabetes mellitus – Hypertension – Respiratory – Cardiac Medical – Polycystic ovary disease – Gall bladder disease – Osteoarthritis – Cancer Pregnancy and the postpartum Mortality Medical – Polycystic ovary disease – Gall bladder disease – Osteoarthritis – Cancer Pregnancy and the postpartum Mortality

Annual Direct and Indirect Costs Attributable to Obesity in the United States (Billions of 1995 Dollars) Type 2 DM CHD Hypertension Gallbladder Breast Ca Endometrial Ca Colon Ca Osteoarthritis Total Type 2 DM CHD Hypertension Gallbladder Breast Ca Endometrial Ca Colon Ca Osteoarthritis Total Disease Direct Costs Indirect Costs $32.4 $ 7.0 $ 3.2 $ 2.6 $ 0.8 $ 0.3 $ 1.0 $ 4.3 $51.6 $32.4 $ 7.0 $ 3.2 $ 2.6 $ 0.8 $ 0.3 $ 1.0 $ 4.3 $51.6 $30.7 $ NA $ 0.1 $ 1.5 $ 0.5 $ 1.8 $ 12.9 $47.5 $30.7 $ NA $ 0.1 $ 1.5 $ 0.5 $ 1.8 $ 12.9 $47.5 Wolf and Colditz, Ob Res 1998;6:97

Factors Related to the Onset of Obesity Altered dietary intake Decreased physical activity Increased inactivity Altered dietary intake Decreased physical activity Increased inactivity

Shifts in Food Practices in the United States Fast food consumption Reduced frequency of family meals Restrained eating, meal skipping Consumption of soft drinks - increased from 27 to 44 gal/y from ,000 products in supermarkets 12,000 new food products/year Fast food consumption Reduced frequency of family meals Restrained eating, meal skipping Consumption of soft drinks - increased from 27 to 44 gal/y from ,000 products in supermarkets 12,000 new food products/year

Factors Related to the Onset of Obesity Altered dietary intake Decreased physical activity Increased inactivity Altered dietary intake Decreased physical activity Increased inactivity

Netherlands Germany England Italy Canada USA Netherlands Germany England Italy Canada USA Modal Travel in Urban Areas: Europe and North America Percent of Trips by Mode Modal Travel in Urban Areas: Europe and North America Percent of Trips by Mode Transportation Quarterly 1997; 51:31 Public CountryBicycleWalkingTransportCar Public CountryBicycleWalkingTransportCar

Factors Related to the Onset of Obesity Altered dietary intake Decreased physical activity Increased inactivity Altered dietary intake Decreased physical activity Increased inactivity

Distribution of Hours of TV Per Day: NHES Youth Aged in and NLSY Youth Aged in TV Hours (Youth Report)

Prevalence of Obesity by Hours of TV per Day: NHES Youth Aged in and NLSY Youth Aged in 1990

Effect of Reduced Inactivity or Exercise on Obesity Percent Overweight Change Percent Overweight Change Time (months) Exercise Sedentary Epstein et al, Health Psychol 1995; 14:109

Intervention Sites to Prevent or Treat Obesity Medical Settings School Work Site Community Medical Settings School Work Site Community

Prevalence of weight loss advice from a health care provider among obese persons: Did not receive advice 58% Receive advice 42% Galuska DA et al. JAMA 1999

Weight Loss Advice and Self-reported Attempts to Lose Weight (BRFSS, 1996) Galuska DA et al. JAMA %79.5%

Intervention Sites to Prevent or Treat Obesity Medical Settings School Work Site Community Medical Settings School Work Site Community

School-based Approaches to Treat or Prevent Obesity Physical education classes Media curricula and TV turnoffs Competitive foods and pouring contracts Comprehensive school-based interventions Physical education classes Media curricula and TV turnoffs Competitive foods and pouring contracts Comprehensive school-based interventions

Daily Physical Education Classes in School (9-12th graders) Year Year % 42% 27% % 42% 27% Source: YRBS

School-based Approaches to Treat or Prevent Obesity Physical education classes Media curricula and TV turnoffs Competitive foods and pouring contracts Comprehensive school-based interventions Physical education classes Media curricula and TV turnoffs Competitive foods and pouring contracts Comprehensive school-based interventions

Effects of Increased Choices and Reduced Price on Fruit and Vegetable Consumption Jeffery et al, Prev Med 1994; 23:788 Fruits (#/day) Fruits (#/day) Intervention Baseline Follow-up Vegetables (lbs/day) Vegetables (lbs/day)

Effects of the Promotion of Low-fat Items in Vending Machines

School-based Approaches to Treat or Prevent Obesity Physical education classes Media curricula and TV turnoffs Competitive foods and pouring contracts Comprehensive school-based interventions Physical education classes Media curricula and TV turnoffs Competitive foods and pouring contracts Comprehensive school-based interventions

Effects of Planet Health on Obesity* Prevalence *BMI and TSF> 85th percentile **p< 0.05 *BMI and TSF> 85th percentile **p< 0.05

Intervention Sites to Prevent or Treat Obesity Medical Settings School Work Site Community Medical Settings School Work Site Community

Coca Cola HealthWorks/POWERaDE

Intervention Sites to Prevent or Treat Obesity Medical Settings School Work Site Community Medical Settings School Work Site Community

Community-based Approaches Communications Community programs Environmental change – Sidewalks and bicycle trails – Access – Neighborhood safety – Building design – Urban planning Communications Community programs Environmental change – Sidewalks and bicycle trails – Access – Neighborhood safety – Building design – Urban planning

Community Structure and Physical Activity