Ch. 8 - Addressing the Obesity Epidemic

OBESITY DRIVERS

What are the 7 environmental factors that are obesity drivers?

1) Innovations in food production (packaged/processed foods)

2) Increased portion sizes

3) Increased consumption of meals away from home

4) Sedentary lifestyle

5) Media Influences

6) Social inequities

7) Urban sprawl

OBESITY DRIVERS

What population are food marketers interested in most? and Why?

YOUTH, because of their:

- spending power

- purchasing influence

- and as future adult consumers

OBESITY DEFINITION

a) What is the most common criterion for screening and monitoring obesity at the population level?

b) Why can it sometimes be inaccurate?

c) What does it not take into consideration?

a) BMI

b) Inaccurate for ppl w/ large muscle mass or low muscle mass such as older adults

c) Doesn't take into consideration Body fat distribution

OBESITY DEFINITION - CHILDREN

What are the BMI percentiles for children

- Underweight <5th percentile

- Healthy > or = 5th - 85th

- Overweight > or = 85th - 95th

- Obese > 95th

EPIDEMIOLOGY OF OBESITY

What two systems/surveys are utilized to obtain data about obesity?

1) National Health and Nutrition Examination Survey (NHANES)

2) Behavioral Risk Factor Surveillance System (BRFSS)

MEDICAL & SOCIAL COSTS

a) Based on 2005 dollars, what is the total spending for obesity per year in? What percent of all medical costs is it?

b) In 2001, Compared to people of normal weight, people with obesity spent how much on health care costs, diabetes, hyperlipidemia, and heart disease?

c) Obesity is costly to society because it is associated with what 3 things?

a) 190 billion/year. Approx. 21% of all medical costs

b) - 37% more on health care costs

- 38% for diabetes

- 22% for hyperlipidemia

- 41% for heart disease

c) 1. Chronic disease - it is associated with an increased risk of metabolic syndrome

2. Poor quality of life

3. Self-esteem issues

Persons with obesity have societal costs that are $92,235 more than a person w/out obesity

DETERMINANTS OF OBESITY (From Picture)

What are the 11 Determinants of Obesity for Children?

1) Food Production

2) Governmental, School, and Organizational Policies

3) Economic Influences

4) Food & Physical Environments

5) Community Policy & Practices

6) Media, Advertising, & Promotions

7) Cultural factors

8 Behavioral factors

9) Personal factors

10) Family & Peer Factors

11) Biologic & Genetic Factors

DETERMINANTS OF OBESITY

(As listed on Outline)

What are the MAIN 4 Determinants of Overweight & Obesity in both adults & children

1) Genetic Factors

2) Pyschosocial Factors

3) Behavioral/Lifestyle Factors

4) Environmental Factors

GENETIC & BIO FACTORS

a) What are the two genetic/biological factors to consider with obesity?

b) What are the the two types of mutations?

c) Is there one single gene that is associated with an obesity phenotype?

a) 1. Mutations

2. Epigenetic influences (a change in gene expression that occurs w/out changing the heritability of the gene)

b)

1. Monogenic

- Mutation in the gene that codes for leptin the satiety hormone

- mutation of the leptin receptor gene, the melanocortin 4 receptor gene (MC4R)

2. Polygenic forms

- Presence of Single Nucelotide Polymorphisms (SNPs) associated w/various outcomes such as obesity, or CVD risk factors

c) NO

PSYCHOSOCIAL RISK FACTORS

What are 3 psychosocial risk factors?

1) Stress

2) Depression

3) Comfort Eating

BEHAVIORAL RISK FACTORS

What are the 3 Behavioral risk factors associated with obesity?

1) DIET

- Dietary energy density: energy dense, low fiber, high fat diet = higher fat mass & excess adiposity in children

- Sugar sweetened beverages: single most important strategy for decreasing risk of obesity

2) PHYSICAL INACTIVITY

3) OTHER FACTORS = TV, Video games, meal frequency, sleep duration

ENVIRONMENTAL FACTORS

The current environment is obesogenic due to what 7 things?

1) Media Use - Long hours of electronic media exposure. Each hour of TV a child consumes 167 extra calories

2) Food production & transportation - Agricultural tech = large scale production of highly processed foods

3) Portion sizes

4) Food available in restaurants

5) Social environment - Parents overweight, maternal smoking when pregnant, cumulative stress experienced by a child's mother, parental depression, low rates of breast feeding

6) Urban sprawl & the build environment - large percentage of population live in lower density residential areas

7) Poverty - inexpensive energy-dense processed foods & food deserts. Low income, ethnic/racial minority, & rural neighborhoods most affected

OBESITY PREVENTION & TX

What are the recommendations for adults?

1) Lifestyle changes - dietary, PA

2) Pharmacotherapy - only if BMI is >30

3) Bariatric surgery - >40 BMI or BMI b/t 35-40 with hypertension & type 2 diabetes

4) Adult intervention

- Individual lifestyle changes

- Worksite-based weight loss programs

- Community based interventions like WHOLE (Wholeness, Oneness, Righteousness, Deliverance)*

CHILDREN OBESITY PREVENTION

What are 9 ways to prevent obesity in children?

1) School-based programs that increase PA

2) Limit screen time (TV, phones)

3) Promoting diet with no sugary beverages

4) Increasing fruit & vegetable intake while limiting low nutrient foods

5) Nutrition education

6) Family outreach (accelerated BMI increase during summer has been noted)

7) Avoid telling your child "Clean your plate"

8) Encourage mothers to breastfeed

9) Health care professionals now measure weight, height, length in a standard way & also pay attention to obesity risk factors, such as weight gain

RACIAL & ETHNIC DISPARITIES

a) Obesity rates are high among which two communities?

b) What 5 main strategies can be utilized to decrease these rates of obesity?

a) Black & Hispanic communities

b) 1. Partnering with community to determine priorities

2. Using culturally sensitive community-based obesity prevention strategies

3. Increasing grant programs to encourage minority business owners to open grocery stores in low-income areas

4. Limit advertising of unhealthy foods & encourage policies that increase marketing of healthful foods & beverages

5. Increase access & use of promotore (community health workers, peer leaders, & health advocates)

POLICY OBESITY OPTIONS

What are the 5 Goals within the IOM report: "Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation (2012)"

1) Make physical activity an integral & routine part of life

2) Promote an environment that ensures healthful food & beverages

3) Transform messages about PA and nutrition

4) Expand the role of healthcare providers, insurers, & employers in obesity PREVENTION

5) Make schools the national focal point for obesity prevention

What are the 4 Overall Strategies for tackling obesity?

1) Obesity surveillance & monitoring

2) Awareness building, education, & research

3) Regulating Environments such as the food environment, early care & education environment, school environment, worksite environment, and the built environment

4) Pricing policies: subsidies, taxation