PPrreevveennttiinngg OObbeessiittyy aanndd OOtthheerr CChhrroonniicc DDiisseeaasseess Missouri’s Nutrition and Physical Activity Plan 2005 Missouri Department of Health and Senior Services Healthy Missourians Initiative Preventing Obesity and Other Chronic Diseases Missouri’s Nutrition and Physical Activity Plan 2005 Missouri Department of Health and Senior Services Julia M. Eckstein, Director Missouri Department of Health and Senior Services Paula F. Nickelson, Director Division of Community Health Deborah Markenson, M.S., R.D., Administrator Chronic Disease Prevention and Health Promotion Janet S. Wilson, M.P.A. M.Ed., Chief Health Promotion Unit Donna Mehrle, M.P.H., R.D., L.D., Program Coordinator Health Promotion Unit This document was supported by Grant/Cooperative Agreement Number U58/CCU 722795-02 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. Alternate forms of this publication for persons with disabilities may be obtained by contacting: Missouri Department of Health and Senior Services Health Promotion Unit P.O. Box 570, Jefferson City, MO 65102 573-522-2820 Hearing impaired citizens telephone 1-800-735-2966. AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER Services provided on a nondiscriminatory basis. Dear Fellow Missourian, The health and well being of our fellow citizens is of utmost importance. Unfortunately, obesity and weight problems among children and adults have increased at astounding rates over the past decade, resulting in health problems that have adversely affected the quality of life for thousands of people and cost the state more than one and a half billion dollars annually. To help address this problem we have developed the Healthy Missourians Initiative to address our state’s obesity epidemic and to encourage healthy lifestyles for Missourians of all ages. In this report you will find strategies for preventing obesity and programs to increase physical activity and healthy eating among all Missourians, particularly children and their families. This report was developed under the guidance of the Missouri Department of Health and Senior Services by the Missouri Council on the Prevention and Management of Overweight and Obesity and hundreds of Missourians who provided input on a number of actions than can lead to a healthier Missouri. As Governor, I am pleased to share this program with employers, schools, senior centers, and other organizations who are interested in better health. I strongly encourage any interested parties to contact the Missouri Department of Health and Senior Services for more information on the Healthy Missourians Initiative. Sincerely, Matt Blunt Dear Missourians, Overweight and obesity are major concerns in our state. In Missouri more than one in five adults are considered obese, and more than half are overweight. The rates of overweight among children are also dismal. That’s why we are pleased to be working with Governor Matt Blunt on the Healthy Missourians Initiative. It was estimated in 2003 that $1.6 billion is spent annually in Missouri on obesity-attributed medical expenditures in adults with approximately half of that amount paid by Medicare and Medicaid. On an average, obese adults (18 to 65 years of age) spend 36 percent more on medical expenses annually compared with those of normal weight. These costs do not include the emotional and physical costs of this condition. Partners that have contributed to this initiative include the Missouri Council on the Prevention and Management of Overweight and Obesity and the State Physical Activity Plan Work Team. The work of these groups was presented to the public in a series of meetings throughout the state in July 2004, and many useful comments were received and incorporated into a final plan. Due to the magnitude and complexity of this disease, the members of these groups, individually and collectively, will continue to work collaboratively and creatively to positively address the risk factors of nutritional intake and physical activity. The focused work of many people working together is needed to implement this plan. This plan was designed to guide the work of a wide range of organizations and individuals to positively impact the eating habits and physical activity levels of Missourians. This plan incorporates many different levels of influence on our daily habits to encourage and support changed behaviors that are necessary to prevent and treat overweight and obesity. Additional copies of the plan may be obtained on the web site of the Missouri Department of Health and Senior Services at http://www.dhss.mo.gov/Obesity or by calling 573-522-2820. Sincerely, Julia M. Eckstein, Director Missouri Department of Health and Senior Services Table of contents The problem Overview .................................................1 Obesity defined .......................................3 Prevalence ..............................................4 Childhood obesity....................................5 Acknowledgments Grateful appreciation is extended to the members of the Health consequences ..............................6 State Physical Activity Plan Work Team and the Missouri Council on the Prevention and Management of Overweight and Obesity for their time and expertise. Their guidance The high cost of obesity ...........................9 and thoughtful contributions provided direction for the nutrition and physical activity programs to prevent obesity Quality of life ..........................................10 and related chronic diseases in Missouri. The names of these individuals are listed in Appendices C and D. Data compilation and analysis: The plan Shumei Yun, M.D., Ph.D. Public Health Epidemiologist, Office of Surveillance, Overview ...............................................11 Evaluation, Planning and Health Information Missouri Department of Health and Senior Services A healthier lifestyle .................................13 Editing: Janet Wilson, Chief Goals, strategies, actions ......................15 Health Promotion Unit Missouri Department of Health and Senior Services Implementation and evaluation...............20 Donna Mehrle, Coordinator Health Promotion Unit Missouri Department of Health and Senior Services Writing and design: Data sources ..............................................21 Liz Coleman, Public Information Coordinator Office of Surveillance, Evaluation, Planning and References .................................................22 Health Information Missouri Department of Health and Senior Services Appendices ................................................23 Overview-The problem 1 Obesity is one of the most serious health issues facing society today. In the past two decades, the problem has grown at such an alarming rate, obesity is considered a national epidemic.1,2,3 In Missouri, more than one in five adults are obese, and more than half of adults are overweight, which can lead to obesity. In 2002, more than 23 percent of Missourians over the age of 18 were obese (Figure 1). Obesity attacks the well-being of millions of people every year. It is a contributing factor in some of the most devastating and disabling diseases – diabetes, heart disease, arthritis and several types of cancer. Obesity is a leading cause of preventable death in the United States. The stark reality is excess weight means an increase in the risk of premature death. Obesity is a complex problem with numerous causes and consequences: -It is an expensive epidemic. Overweight and obesity costs Missouri thousands of lives and well over a billion dollars every year. -It contributes to many illnesses. People who are overweight or obese are frequently plagued by serious and long-lasting health concerns. Both physical and mental health are adversely affected.4 “Taking action to address overweight and obesity will have -It can decrease quality of life. In some cases, profound effects on increasing overweight and obese people have a diminished quality of life due to health concerns, discrimination and the quality and years of healthy difficulty or inability to participate in certain activities. life and on eliminating health -It is often misunderstood. Overweight and obesity disparities in the United States.”6 are not simply a result of eating too much – although poor eating habits are often a contributing factor. The problems are caused by a number of factors that are - U.S. Surgeon General, 2001 often interrelated. According to the American Obesity Association, behavior, environment and genetics are all part of the overweight and obesity equation.5 Overview-The problem 2 The good news is obesity can be prevented and treated. This report addresses some of the most important A number of things can be done to help people adopt issues regarding obesity: a healthier lifestyle and overcome this serious health condition. Preventing and treating obesity and the • How are overweight and obesity defined? associated health problems are important public health • How many Missourians suffer from these goals. conditions? • What are the health consequences of being It is vital for health care professionals, elected officials, overweight or obese? policy makers and the general public to fully understand • What is the economic impact on the state? the obesity issue. Understanding is crucial to effectively address the problem. The answers to these questions can help Missouri work toward slowing and ending the obesity epidemic. This report provides detailed information about obesity in Missouri. The report can assist health care professionals, program managers and policy makers in evaluating the obesity burden and identifying populations at the highest risk in order to target obesity treatment and prevention programs. Obesity on the Rise lilflu~ ; Obesity. r'lil/il'alo lliMii~ am !\!ftQIW!I atiul - 990.~Q.2 Jfi.□1 !i.D ..&--------------------- O.l'! Source: Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention Overweight and obesity defined 3 What is considered overweight and obese? can be used to quickly determine an adult’s weight status. Through the years, that question has been answered in many different ways. Today, the most commonly used For children age 2 to 20 years old, the Centers for indicator of a person’s weight status is the body mass Disease Control and Prevention (CDC) has developed index or BMI. This number expresses a person’s ratio a definition of overweight based on the 2000 CDC of weight to height. The National Heart, Lung and growth charts. Overweight is defined as at or above Blood Institute developed this standard definition of the 95th percentile of BMI for age. At risk for overweight and obesity in 1998 based on an extensive overweight is defined as at or above the 85th percentile evidenced-based review of morbidity and mortality but less than the 95th percentile of BMI for age. related to weight. In this report, the definition of childhood obesity is Adults over age 20 with a BMI of 25 to 29.9 are equivalent to the CDC’s definition of overweight for considered overweight while those with a BMI of 30 or children. The definition of childhood overweight is more are considered obese. The BMI chart (Figure 2) equivalent to the definition of the CDC’s definition of at risk for overweight. Figure 2. Adult Body Mass Index (BMI) Chart H■lgf.11: W ght( b.~ (In.) Are you at a 58 91 '96 1100 10:5 110 91 healthy weight? 59 94 H 10-6 109 1 UI 1 2B 1S3, 138 143 98• 1 1--6-0-1,-W----_ 1,--02-'1101 11 ~ HS 1 33 138 148 14 D4 61 100 1CS ., i i is 122 . J7 1~3 14 53 - '185 il 1 To determine Body Mass ,42 '1'11,1 1 _ 58 1R4f 191 2181 Index (BMI) using the chart, find height in the left column and move 64 111a 11 12'3 134 1 · 51 157 16 5B 174 204 232 across the row to weight. &5 1'1!- , 132 i-aa I . :ss ·152 1158 , 2m 240 The number at the top of that column is the && 1,a 12 tse 142 s1 161 173 21s 241 associated BMI. 87' H 1,~ 1~, ·1:ia 144 151 ~55 1M 111 in 1&11 ~ua 101 z.m :282 • Healthy weight: 69 2e ,as1·142 149, i55 02 1139 ns 182 1as g · 200 ~slval BMI - 18.5 to 24.9 • Overweight: 7D 1~ 199 146 153 lill' 6f 1174 11H lB.Bi ills 21'12 20i7 :243 270• BMI - 25 to 29.9 11 13fi MJ so Hi7 1e 5 • r.2. 1.19 1 a-s · 93 200 20s 211s :2Ba 2aa • Obese: 12 140 14?' -" 1s2 HS9 11 184 1~1 10& "tCla 2 a 221 7.§a ~rM,1 BMI - 30 or higher 7l 4 ~51 59 166 1741182 189 197 204 212 219 227 i6~ 302 I 74, 1iffi 155116:i 111 17tll I 00 194 202 IZ1'0 :2:1 e 225 :2aa 212 J11 1 75 152 16.0 1 Bi 178 184 192 20.0 208 .Im} ll4- 23:2. !LO 219 3 9 71 "15fl H34 172 18Dil HUl Prevalence 4 Obesity has nearly doubled in Missouri in recent years. Between 1990 and 2002, the prevalence of obesity among adults in the state increased from 11.9 percent to 23.2 percent (Figure 1). (See Appendix E for county- specific prevalence rates.) Based on the national prevalence of obesity, it is estimated that more than 10 percent of Missouri’s children 0 to 5 years old were obese in 1999-2000.2 While obesity has increased in both genders and in all racial groups, research shows certain groups of people are more prone to the problem. The prevalence of Programs focusing on these specific population groups obesity in Missouri is higher among the following groups are crucial to reducing obesity in Missouri and of adults: addressing the serious health conditions that will continue to compromise the well-being of millions of • People with an annual income of less than Missourians. $15,000 (27.6 percent) • People age 50 to 64 (27.5 percent) (Figure 3) Since 1990, obesity has • African-American women (27.4 percent) nearly doubled in Missouri. • People having less than a high school education (26.6 percent) Obesity and Age in Missouri Fig1.1re 3. Obei!ilty prevalence trends ~mo11g MiH01.Hi adul , by aga. group 35 -30 - .26 .f!. s 20 C 1QJ 15 l_ 10 s a Source: Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention Childhood obesity 5 Childhood obesity has increased at a disturbing rate. From 1993 to 2002, the prevalence of obese children 2 More than 10 percent of children and adolescents in to 5 years of age participating in the Missouri Women, the United States are overweight.2 Infants and Children Supplemental Nutrition (WIC) program increased by nearly 58 percent. Being obese puts children at a greater risk for serious health problems now and in the future. Childhood obesity has increased in all racial and gender groups. Like the adult obesity problem, childhood Type II diabetes, once considered an adult disease, has overweight and obesity are also more prevalent in increased dramatically in children and adolescents. certain populations. Overweight and obesity are closely linked to this type of diabetes. Risk factors for heart disease, such as high In Missouri, African-American boys had the highest cholesterol and high blood pressure, also occur more prevalence of obesity in 2003 for middle school frequently in obese children.6 students. African-American males had the highest prevalence of obesity for high school age students in Obese adolescents have a 70 percent chance of 2003. Hispanic children had a higher prevalence of becoming overweight or obese adults.6 obesity among elementary school students participating in the Missouri School-aged Children’s Health Services The most immediate consequence of being obese, as Program during the 2001 school year, and among perceived by children themselves, is social children younger than age 5 participating in the WIC discrimination.6 program between 1993 and 2002. In the past five years in Missouri, the prevalence of Early efforts to prevent children from becoming obese middle school students increased by 75 percent, overweight and obese are key to reducing the obesity and the prevalence of obese high school students epidemic. increased by 64 percent. Adolescents who are obese are much more likely to become overweight or obese adults.6