Fall 2008 Obesity
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Multnomah County Health Department Community Health Promotion, Partnerships and Planning Office of Health Assessment And Evaluation
Community Health Assessment Quarterly Volume 3, Issue 3
Fall 2008
Overweight and Obesity Over the past 25 years the proportion of overweight and obese persons in this country increased steadily in all states, but in recent years this number appears to have leveled off. In 2007, 26% of adult Americans over the age of 18 years were obese and an additional 37% were overweight1. The Healthy People 2010 target for obesity is a prevalence of 15% or less.2
creased productivity, restricted activity, absenteeism, and the value of future income lost by premature death.
Individuals who are overweight or obese are at increased risk for a number of chronic diseases including type 2 diabetes, hypertension, high cholesterol, coronary heart disease, stroke and certain types of cancer (e.g. breast and colon cancer). These health problems will have an adverse impact on quality of life and increase the risk of premature mortality. In economic terms, it is estimated that in Oregon in 1998-2000 obesity and overweight and the associated health problems cost $781 million in direct and indirect medical costs.3 This includes preventive, diagnostic, and treatment services related to obesity as well as income lost from de-
Since the early 1990s there has been a steady rise in the total proportion of obese and overweight adults in Multnomah County (body mass index greater than 25). In 2006, 53% of residents over the age of 18 (approximately 239,000 adults) in the county were either overweight or obese. The prevalence of obesity has been rising since the early 1990s while the overweight prevalence has remained relatively stable.
Obesity and overweight defined In this report obesity and overweight in adults are defined by body mass index (BMI) which is calculated using a person’s height and weight. Healthy weight is defined as a BMI between 18.5 and 24.9. Overweight is defined as a BMI between 25 and 29.9. An adult is considered obese if his or her BMI is greater than 30.
60%
Over half the adults in Multnomah County are either overweight or obese.
In 2006, the overall proportion of overweight and obese adults in Oregon and the U.S. was 61% and 63% respectively.
Overw eight and Obesity Prevalence in Multnom ah County Adults 1993-2006
50% 40%
34%
32%
30% 21% 20% 11%
Data on height and weight are collected at the county level through a telephone survey of a sample of Multnomah County residents. The survey is called the Behavioral Risk Factor Surveillance System (BRFSS).
10% 0% 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Total Overweight/Obese BMI>=25 Overweight (BMI >=25 and < 30) Obese (BMI >= 30) Source: Behavioral Risk Factor Surveillance System.
V OLU ME 3, ISSUE 3
CO M MUNI TY HE AL TH A SSESSME N T QUA RTE RLY
PAGE 2
Males and older adults are more likely to be overweight or obese in Multnomah County In 2006, approximately 61% of adult males were overweight or obese (40% overweight, 21% obese) compared with 44% of adult females (26% overweight, 19% obese). The occurrence of overweight and obesity also differs by age group. Adults between the ages of 55 and 74 years were more likely to be overweight or obese (almost 70% were either overweight or obese) while 18 to 34 year-olds were less likely to be over a healthy weight (47% overweight or obese).4
80%
Overweight and obesity by gender, Multnomah County, 2006 Obese
70%
Overweight 60% 50%
70%
21%
Overweight
60%
27%
26%
21% 20%
40% 19%
30%
26%
13%
20%
30% 20%
40%
10%
Obese
50%
40%
20%
80%
Overweight and obesity by age-group, Multnomah County, 2006
10%
27%
35%
40%
42%
45-54 yrs
55-64 yrs
43%
35%
0% 0% Male
18-34 yrs
Female
Adults 45 years and older who are over the healthy weight range are more likely to suffer from diabetes, high blood pressure and high cholesterol Analysis of data for 2002 through 2005 for Multnomah County shows that chronic diseases including diabetes, high blood pressure and high cholesterol are associated with overweight and obesity in adults 45 years and older. One out of four obese adults in this age group were diagnosed with diabetes. Further, over a third of overweight adults and about half of obese adults in this age group were diagnosed with high blood pressure while 46% of overweight adults and 55% of obese adults were diagnosed with high cholesterol. Obese and overweight adults are also at greater risk for coronary heart disease.
Some ethnic and racial groups have a higher proportion of persons who are overweight or obese Data from the 2004-05 Behavioral Risk Factor Surveillance System (BRFSS) show disparities in the prevalence of overweight and obesity among adults in Multnomah County. Asian Americans had the lowest proportion of overweight and obesity while those identifying themselves as Native Americans/Alaska Natives or Hispanics had the highest proportions of overweight and obesity. The prevalence of obesity and overweight in
35-44 yrs
65-74 75+ yrs yrs
Prevalence of High Blood Pressure & High Cholesterol by Weight in Adults 45 years and older, Multnomah County, 2002-05 70% 60%
High Blood Pressure
High Cholesterol
50% 40% 30%
49%
20% 10%
36%
35%
46%
55%
23%
0%
Healthy weight
Overweight
Obese
various racial and ethnic groups in Multnomah County did not always reflect national data. Some of the more notable differences are as follow: •
The prevalence of obesity in Multnomah County in 2004-05 among African Americans was lower than the prevalence in the same population nationwide in 2005 ( 28% countywide vs. 34% nationally);
•
The proportion of Asian Americans who were obese was higher in Multnomah County in 2004-05 compared with the same population nationwide;
V OLU ME 3, ISSUE 3
•
CO M MUNI TY HE AL TH A SSESSME N T QUA RTE RLY
The proportion of obese Hispanic residents in Multnomah County in 2004-05 was higher than the proportion in the same population nationwide in 2005 (30% countywide vs. 24% nationally ).
Most adults do not meet nutrition and physical activity recommendations The most important factors in maintaining a healthy weight are nutrition and physical activity. The BRFSS data for 2005 indicates that only 26% of overweight and 27% of obese adults in Multnomah County met the recommended 5 daily servings of fruits and vegetables. In comparison, over 31% of residents within the healthy weight range met this nutritional recommendation. Regardless of weight status, most of the survey respondents did not eat the recommended amount of fruits and vegetables. Multnomah County residents at a healthy weight were more likely to meet recommendations for moderate or vigorous physical activity than overweight and obese individuals. In 2005, 48% of those in the healthy weight range met the physical activity recommendation while only 32% of overweight individuals and 17% of obese individuals met the recommendation.
PAGE 3
Public Health efforts to combat overweight and obesity include actions focused on individuals and the social environment Public health education efforts at national, state, and local levels have encouraged individuals to increase their intake of fruits and vegetables and to adopt an exercise regimen that meets the Centers for Disease Control and Preventions (CDC) recommendation of 30 minutes of moderate physical activity most days of the week. CDC’s website provides suggestions for ways to incorporate healthy diets and regular physical activity in our daily lives.6 Other public health efforts focus on changing our living environment, such as encouraging walking and bicycling friendly communities. Multnomah County Health Department has adopted a chain restaurant nutrition labeling policy that will require larger restaurant chains to list the nutritional content of their menu items. By providing nutrition information to customers at the time of ordering, restaurants will enable the public to make informed choices about what they eat. The rules to implement this policy are expected to take effect in January 2009. Multnomah County became the fifth jurisdiction in the United States to adopt menu labeling requirements. Similar laws are already in effect in New York City, San Francisco, and Seattle/King County.
Overweight youth are also a concern According to data from the 2005-06 Oregon Healthy Teen survey, about 10% of Multnomah County 8th grade and 11th grade students were overweight. An additional 15% of 8th graders and 13% of 11th graders were at risk for becoming overweight.5 The county and statewide prevalence of overweight youth and those at risk of becoming overweight are very similar. When asked about soda consumption, 84% of 8th graders and 78% of 11th grade students reported that they had consumed a soft drink at least once during the previous week; approximately 10% of students in both grades had consumed a soda at least once a day during the previous week. During the same period, 55% of 8th graders and 40% of 11th graders reported engaging in 60 minutes of physical activity on 5 or more days in the previous week (the recommended amount of activity for adolescents). Comparable national data are available from a similar survey known as the Youth Risk Behavior Survey (YRBS) which is administered to a sample of high school students. The 2007 YRBS data indicate that about 35% of students meet the recommended level of physical activity nationwide.
Healthy weight in 8th and 11th graders Multnomah County 2005-06 and Oregon 2006 80% 70% 60% 50% 40% 30% 20% 10% 0%
77%
74%
75%
74%
26%
23%
26%
25%
8th grade
11th grade
8th grade
11th grade
Multnomah County Healthy weight
Oregon
Overweight & at risk for overweight
Source: Oregon Healthy Teen survey, 2005-06
V OLU ME 3, ISSUE 3
CO M MUNI TY HE AL TH A SSESSME N T QUA RTE RLY
PAGE 4
References 1. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System fact sheet on obesity prevalence in the United States in 2007. Online: http://apps.nccd.cdc.gov/BRFSS/list.asp?cat=OB&yr=2007&qkey=4409&state=UB. Accessed on 09/15/2008. 2. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Healthy People 2010. Online: http://www.healthypeople.gov/Document/HTML/Volume2/19Nutrition.htm#_Toc490383123. Accessed on 09/15/2008. 3. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Overweight and obesity. Online: http://www.cdc.gov/nccdphp/dnpa/obesity/economic_consequences.htm. Accessed on 09/15/2008. 4. Oregon Department of Human Services, Public Health Division, Center for Health Statistics. Behavioral Risk Factor Surveillance System data for 1993 through 2006. 5. Oregon Department of Human Services, Public Health Division, Center for Health Statistics. Oregon Healthy Teen 2007 tables. Online: http://www.dhs.state.or.us/dhs/ph/chs/youthsurvey/ohtdata.shtml#2007. Accessed on 09/15/2008. 6. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Division of Nutrition and Physical Activity. Online: http://www.cdc.gov/nccdphp/dnpa/index.htm. Accessed 09/15/2008.
Note: All graphs in this report are based on BRFSS data collected between 1993 and 2006 except as noted.
Community Health Assessment Quarterly is published four times per year, by Multnomah County Health Department Health Assessment and Evaluation Office 426 SW Stark St 9th Floor, Portland OR 97204. If you have questions or comments, please email Maya Bhat at maya.bhat@ co.multnomah.or.us or by phone at 503-988-3663 x29055. This publication is available online at: http://www.mchealth.org/hra/haq/
Community Health Assessment Quarterly Volume 3, Issue 3
Fall 2008
Overweight and Obesity Over the past 25 years the proportion of overweight and obese persons in this country increased steadily in all states, but in recent years this number appears to have leveled off. In 2007, 26% of adult Americans over the age of 18 years were obese and an additional 37% were overweight1. The Healthy People 2010 target for obesity is a prevalence of 15% or less.2
creased productivity, restricted activity, absenteeism, and the value of future income lost by premature death.
Individuals who are overweight or obese are at increased risk for a number of chronic diseases including type 2 diabetes, hypertension, high cholesterol, coronary heart disease, stroke and certain types of cancer (e.g. breast and colon cancer). These health problems will have an adverse impact on quality of life and increase the risk of premature mortality. In economic terms, it is estimated that in Oregon in 1998-2000 obesity and overweight and the associated health problems cost $781 million in direct and indirect medical costs.3 This includes preventive, diagnostic, and treatment services related to obesity as well as income lost from de-
Since the early 1990s there has been a steady rise in the total proportion of obese and overweight adults in Multnomah County (body mass index greater than 25). In 2006, 53% of residents over the age of 18 (approximately 239,000 adults) in the county were either overweight or obese. The prevalence of obesity has been rising since the early 1990s while the overweight prevalence has remained relatively stable.
Obesity and overweight defined In this report obesity and overweight in adults are defined by body mass index (BMI) which is calculated using a person’s height and weight. Healthy weight is defined as a BMI between 18.5 and 24.9. Overweight is defined as a BMI between 25 and 29.9. An adult is considered obese if his or her BMI is greater than 30.
60%
Over half the adults in Multnomah County are either overweight or obese.
In 2006, the overall proportion of overweight and obese adults in Oregon and the U.S. was 61% and 63% respectively.
Overw eight and Obesity Prevalence in Multnom ah County Adults 1993-2006
50% 40%
34%
32%
30% 21% 20% 11%
Data on height and weight are collected at the county level through a telephone survey of a sample of Multnomah County residents. The survey is called the Behavioral Risk Factor Surveillance System (BRFSS).
10% 0% 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Total Overweight/Obese BMI>=25 Overweight (BMI >=25 and < 30) Obese (BMI >= 30) Source: Behavioral Risk Factor Surveillance System.
V OLU ME 3, ISSUE 3
CO M MUNI TY HE AL TH A SSESSME N T QUA RTE RLY
PAGE 2
Males and older adults are more likely to be overweight or obese in Multnomah County In 2006, approximately 61% of adult males were overweight or obese (40% overweight, 21% obese) compared with 44% of adult females (26% overweight, 19% obese). The occurrence of overweight and obesity also differs by age group. Adults between the ages of 55 and 74 years were more likely to be overweight or obese (almost 70% were either overweight or obese) while 18 to 34 year-olds were less likely to be over a healthy weight (47% overweight or obese).4
80%
Overweight and obesity by gender, Multnomah County, 2006 Obese
70%
Overweight 60% 50%
70%
21%
Overweight
60%
27%
26%
21% 20%
40% 19%
30%
26%
13%
20%
30% 20%
40%
10%
Obese
50%
40%
20%
80%
Overweight and obesity by age-group, Multnomah County, 2006
10%
27%
35%
40%
42%
45-54 yrs
55-64 yrs
43%
35%
0% 0% Male
18-34 yrs
Female
Adults 45 years and older who are over the healthy weight range are more likely to suffer from diabetes, high blood pressure and high cholesterol Analysis of data for 2002 through 2005 for Multnomah County shows that chronic diseases including diabetes, high blood pressure and high cholesterol are associated with overweight and obesity in adults 45 years and older. One out of four obese adults in this age group were diagnosed with diabetes. Further, over a third of overweight adults and about half of obese adults in this age group were diagnosed with high blood pressure while 46% of overweight adults and 55% of obese adults were diagnosed with high cholesterol. Obese and overweight adults are also at greater risk for coronary heart disease.
Some ethnic and racial groups have a higher proportion of persons who are overweight or obese Data from the 2004-05 Behavioral Risk Factor Surveillance System (BRFSS) show disparities in the prevalence of overweight and obesity among adults in Multnomah County. Asian Americans had the lowest proportion of overweight and obesity while those identifying themselves as Native Americans/Alaska Natives or Hispanics had the highest proportions of overweight and obesity. The prevalence of obesity and overweight in
35-44 yrs
65-74 75+ yrs yrs
Prevalence of High Blood Pressure & High Cholesterol by Weight in Adults 45 years and older, Multnomah County, 2002-05 70% 60%
High Blood Pressure
High Cholesterol
50% 40% 30%
49%
20% 10%
36%
35%
46%
55%
23%
0%
Healthy weight
Overweight
Obese
various racial and ethnic groups in Multnomah County did not always reflect national data. Some of the more notable differences are as follow: •
The prevalence of obesity in Multnomah County in 2004-05 among African Americans was lower than the prevalence in the same population nationwide in 2005 ( 28% countywide vs. 34% nationally);
•
The proportion of Asian Americans who were obese was higher in Multnomah County in 2004-05 compared with the same population nationwide;
V OLU ME 3, ISSUE 3
•
CO M MUNI TY HE AL TH A SSESSME N T QUA RTE RLY
The proportion of obese Hispanic residents in Multnomah County in 2004-05 was higher than the proportion in the same population nationwide in 2005 (30% countywide vs. 24% nationally ).
Most adults do not meet nutrition and physical activity recommendations The most important factors in maintaining a healthy weight are nutrition and physical activity. The BRFSS data for 2005 indicates that only 26% of overweight and 27% of obese adults in Multnomah County met the recommended 5 daily servings of fruits and vegetables. In comparison, over 31% of residents within the healthy weight range met this nutritional recommendation. Regardless of weight status, most of the survey respondents did not eat the recommended amount of fruits and vegetables. Multnomah County residents at a healthy weight were more likely to meet recommendations for moderate or vigorous physical activity than overweight and obese individuals. In 2005, 48% of those in the healthy weight range met the physical activity recommendation while only 32% of overweight individuals and 17% of obese individuals met the recommendation.
PAGE 3
Public Health efforts to combat overweight and obesity include actions focused on individuals and the social environment Public health education efforts at national, state, and local levels have encouraged individuals to increase their intake of fruits and vegetables and to adopt an exercise regimen that meets the Centers for Disease Control and Preventions (CDC) recommendation of 30 minutes of moderate physical activity most days of the week. CDC’s website provides suggestions for ways to incorporate healthy diets and regular physical activity in our daily lives.6 Other public health efforts focus on changing our living environment, such as encouraging walking and bicycling friendly communities. Multnomah County Health Department has adopted a chain restaurant nutrition labeling policy that will require larger restaurant chains to list the nutritional content of their menu items. By providing nutrition information to customers at the time of ordering, restaurants will enable the public to make informed choices about what they eat. The rules to implement this policy are expected to take effect in January 2009. Multnomah County became the fifth jurisdiction in the United States to adopt menu labeling requirements. Similar laws are already in effect in New York City, San Francisco, and Seattle/King County.
Overweight youth are also a concern According to data from the 2005-06 Oregon Healthy Teen survey, about 10% of Multnomah County 8th grade and 11th grade students were overweight. An additional 15% of 8th graders and 13% of 11th graders were at risk for becoming overweight.5 The county and statewide prevalence of overweight youth and those at risk of becoming overweight are very similar. When asked about soda consumption, 84% of 8th graders and 78% of 11th grade students reported that they had consumed a soft drink at least once during the previous week; approximately 10% of students in both grades had consumed a soda at least once a day during the previous week. During the same period, 55% of 8th graders and 40% of 11th graders reported engaging in 60 minutes of physical activity on 5 or more days in the previous week (the recommended amount of activity for adolescents). Comparable national data are available from a similar survey known as the Youth Risk Behavior Survey (YRBS) which is administered to a sample of high school students. The 2007 YRBS data indicate that about 35% of students meet the recommended level of physical activity nationwide.
Healthy weight in 8th and 11th graders Multnomah County 2005-06 and Oregon 2006 80% 70% 60% 50% 40% 30% 20% 10% 0%
77%
74%
75%
74%
26%
23%
26%
25%
8th grade
11th grade
8th grade
11th grade
Multnomah County Healthy weight
Oregon
Overweight & at risk for overweight
Source: Oregon Healthy Teen survey, 2005-06
V OLU ME 3, ISSUE 3
CO M MUNI TY HE AL TH A SSESSME N T QUA RTE RLY
PAGE 4
References 1. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System fact sheet on obesity prevalence in the United States in 2007. Online: http://apps.nccd.cdc.gov/BRFSS/list.asp?cat=OB&yr=2007&qkey=4409&state=UB. Accessed on 09/15/2008. 2. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Healthy People 2010. Online: http://www.healthypeople.gov/Document/HTML/Volume2/19Nutrition.htm#_Toc490383123. Accessed on 09/15/2008. 3. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Overweight and obesity. Online: http://www.cdc.gov/nccdphp/dnpa/obesity/economic_consequences.htm. Accessed on 09/15/2008. 4. Oregon Department of Human Services, Public Health Division, Center for Health Statistics. Behavioral Risk Factor Surveillance System data for 1993 through 2006. 5. Oregon Department of Human Services, Public Health Division, Center for Health Statistics. Oregon Healthy Teen 2007 tables. Online: http://www.dhs.state.or.us/dhs/ph/chs/youthsurvey/ohtdata.shtml#2007. Accessed on 09/15/2008. 6. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Division of Nutrition and Physical Activity. Online: http://www.cdc.gov/nccdphp/dnpa/index.htm. Accessed 09/15/2008.
Note: All graphs in this report are based on BRFSS data collected between 1993 and 2006 except as noted.
Community Health Assessment Quarterly is published four times per year, by Multnomah County Health Department Health Assessment and Evaluation Office 426 SW Stark St 9th Floor, Portland OR 97204. If you have questions or comments, please email Maya Bhat at maya.bhat@ co.multnomah.or.us or by phone at 503-988-3663 x29055. This publication is available online at: http://www.mchealth.org/hra/haq/
