The Obesity Pandemic: the

Next Global Health

Challenge

William H. Dietz MD, PhD

Chair, Redstone Global
Center for Prevention and Wellness
 Measurement of Obesity in Children and
Adults

Body mass index (wt in kg/height in m2)

Overweight: BMI = 25-29.9
Obesity: BMI > 30
Severe obesity: BMI >40
Fat distribution - waist circumference
Children and adolescents percentiles
Overweight: BMI = 85th-95th %tile
Obesity: > 95th %tile
Severe obesity: 120% of 95th percentile
Obesity Trends Among U.S. Adults
BRFSS, 1995
Obesity Trends Among U.S. Adults
BRFSS, 1997
Obesity Trends Among U.S. Adults
BRFSS, 1999
Obesity Trends Among U.S. Adults
BRFSS, 2001
 Obesity Trends Among U.S. Adults
BRFSS, 2003

No Data <10% 10%14% 15%19% 20%-24% > 25%

 Obesity Trends Among U.S. Adults
BRFSS, 2005

No Data <10% 10%14% 15%19% 20%24% 25%29% 30%

 Obesity Trends Among U.S. Adults
BRFSS, 2007

No Data <10% 10%14% 15%19% 20%24% 25%29% 30%

 Obesity Trends Among U.S. Adults
BRFSS, 2009

No Data <10% 10%14% 15%19% 20%24% 25%29% 30%

 Obesity Trends Among U.S. Adults
BRFSS, 2010

No Data <10% 10%14% 15%19% 20%24% 25%29% 30%

Changes in the Prevalence of Obesity among Youth 2-
19 yo and Adults > 20 yo
NHANES 1999-2000 2013-2014
40

35

%
17

Year
Childhood Obesity Trends Over Time in 2-5
Year-Old U.S. Children
States and Communities Reporting Decreases in the Prevalence of
Childhood Obesity
Portland, ME

King Kearney, NE Cambridge, MA

DuPage County,
County Somerville, MA
IL
Fitchburg, MA

MA

New York
City
OH
Philadelphia, PA
WV

CA
Vance, NC
Granville, NC
San Diego, CA
NM
MS
Chula Vista, CA

El Paso, TX

Anchorage, AK
Changes in the Prevalence of Severe Obesity*
in 2-19 yo Youth
NHANES 1999-2000 2013-2014

9%

8%

Year
* Severe obesity: BMI >120% of 95th Percentile
Changes in the Prevalence of Severe Obesity
(BMI > 40) in Adults
NHANES 1999-2000 2013-2014

10%

6%
%

Year
 Medical Complications of Obesity

Source: Rudd Center for Food Policy and Obesity

 Distribution of Adults and Youth with Severe
Obesity among Primary Care Physicians
Adult physicians include family practitioners,
general practice, internal medicine, and ob/gyn
(n = 197,853)
BMI > 35 - 164 people/practitioner
BMI > 40 - 89 people/practitioner

Pediatric physicians include pediatricians and

family practitioners (n = 125,000)
BMI > 120% 95th %tile 50 youth/practitioner
 Targets for Obesity Prevention and Control in
Children and Adolescents

Reduce stigma and bias

Reduce energy intake
Reduce sugar drinks
Decrease high ED foods pizza, fast food
Increase fruit and vegetable intake
Decrease television time
Increase daily physical activity
Sleep
 People First Language

Overweight is a description
An obese person is an identity he or she
is obese, not a father, mother, or a person
characterized by their achievements
An obese person is more likely to be held
responsible tor their weight
Obesity is a disease
Describing a person with obesity focuses
attention on cause
 Targets for Obesity Prevention and Control in
Children and Adolescents

Reduce stigma and bias

Reduce energy intake
Reduce sugar drinks
Decrease high ED foods pizza, fast food
Increase fruit and vegetable intake
Decrease television time
Increase daily physical activity
Sleep
Physiologic Factors That Regulate Satiety

Factor Strategy
Volume Low energy density
Fruits and vegetables
Protein Low fat sources meat,
poultry, fish, soy
Fiber Fruits and vegetables
Whole grains
Sensory- specific satiety Repetition
 Childhood Obesity Task Force Report

Early childhood
Prenatal care
Breastfeeding
Screen time
Early care and education
Chemical exposures

70 recommendations across early

childhood, empowering parents
and caregivers, healthy food in
schools, access to healthy
affordable food, and increasing
physical activity
 Legislative, Regulatory Lets Move Initiatives to
Implement the WH Task Force Report on Childhood
Obesity
Early childhood
Breastfeeding Worksite lactation support in ACA
ECE Lets Move! child care standards
WIC New WIC package

Empowering caregivers Making nutrition information useful

Menu labeling in ACA

Revision of nutrition facts panel

Healthcare AAP implements universal BMI

screening
 Obesity Prevalence in 2-4 yo WIC
Participants 2000 - 2014

Year
Pan L et al. MMWR 2016; 65:1256
Changes in Obesity Prevalence among
2 - 4 yo WIC 2010-2014

Group 2010 2014 Change

Non-Hispanic Blacks 12.7% 11.9% - 0.8%
Non-Hispanic Whites 12.8% 12.2% - 0.6%
Hispanics 19.3% 17.3% - 2.0%
Asian/Pacific Islanders 12.5% 11.1% - 1.4%
AI/AN 20.9% 18.0% - 2.9%

Pan L et al. MMWR 2016; 65:1256

Potential Impact of Changes in Calories
Available from the 2009 Revised WIC
Food Package for 2 - 4 yo*

Substitution of 16 qts 1% milk for 24 qts whole

milk = 7488 kcal/m
Decreases in orange juice from 228 fl oz to 128
fl oz/m = 1400 kcal/m
Total decrease 8888 kcal = 297 kcal/d

*www.fns.usda.gov/wic/final-rule-revisions-wic-food-packages
 Legislative, Regulatory Lets Move Initiatives to
Implement the WH Task Force Report on Childhood
Obesity
Early childhood
Breastfeeding Worksite lactation support in ACA
ECE Lets Move! child care standards
WIC New WIC package

Empowering caregivers Making nutrition information useful

Menu labeling in ACA

Revision of nutrition facts panel

Healthcare AAP implements universal BMI

screening
 Legislative, Regulatory & Voluntary Lets Move
Initiatives to Implement the WH Task Force Report on
Childhood Obesity

Healthy Food in Schools Quality school meals

Healthy Hunger-free Kids
Act
Competitive food standards

Healthy Affordable Food Access Physical access to food

Healthy Food Financing
Initiative

Increasing Physical Activity Lets Move! Active Schools

Lets Move Outside (Parks
and Recreation)
Prevalence of Obesity in Selected Age
Groups NHANES 2011-2014

Ogden CL et al. NCHS Data Brief #219, November 2015

 Adverse Childhood Experiences
(ACEs)
Victimized or witnessed abuse
Verbal
Sexual
Physical
Exposures
Poverty
Incarceration
Homelessness
Household instability divorce, separation, death
Mental illness or maternal depression
Drug or alcohol abuse
Sayer C and Lee TH. NEJM 2014; 371:14
Frequency of Exposure within Households to Adverse
Childhood Experiences: BRFSS Results from 5 States
(AR, TN, LA, WA, NM)
Exposure Prevalence
Verbal abuse 25.9%
Physical abuse 14.8%
Sexual abuse 12.2%
Mental illness 19.4%
Incarceration 7.2%
Substance abuse 29.1%
Separation/divorce 26.6%
Witnessed violence 16.3%

MMWR 2010; 59:1609

Frequency of Exposure within Households to Adverse
Childhood Experiences: BRFSS Results from 5 States
(AR, TN, LA, WA, NM)

# Aces

MMWR 2010; 59:1609

Chronic Diseases Associated with ACEs

Dose response and 2-8X increase in

Ischemic heart disease
Any cancer
Stroke
COPD
Diabetes
Severe obesity (BMI > 35)

Fellitti VJ et al. Am J Prev Med 1998;14:245

 Prevalence of Severe Obesity in Adults (BMI > 35)
after Exposure to Adverse Childhood Experiences

# Aces

Prevalence
of Obesity
(%)

Fellitti VJ et al. Am J Prev Med 1998; 14:245