obesity: trends, impact,...
TRANSCRIPT
Obesity: Trends,
Impact, Complexity
Ross A. Hammond, Ph.D.Director, Center on Social Dynamics & Policy
Senior Fellow, Economic Studies Program
The Brookings Institution
Attorneys General Education Program
April 28th, 2011
Trends and Prevalence
Rapid growth since 1970
Since 1970, the percentage of obese
Americans has more than doubled, with 1 in
3 adults now obese and 2 in 3 overweight
0
10
20
30
40
50
60
70
%
Year
Incidence of Overweight & Obesity in United States, 1960-2006
TOTAL Overweight
TOTAL Obesity
Change in BMI Distribution
Rapid growth since 1970
Since 1970, the percentage of obese Americans has
more than doubled, with 1 in 3 adults now obese
and 2 in 3 overweight
This is a nation-wide trend in the US:
In 1989, no state had obesity prevalence higher than 15%.
In 2009, the only state with obesity prevalence lower than
20% was Colorado (18.6%)
Source: Behavioral Risk Factor Surveillance System, CDC.
1999
Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2009
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2009
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Rapid growth since 1970
Since 1970, the percentage of obese Americans has
more than doubled, with 1 in 3 adults now obese and
2 in 3 overweight
This is a nation-wide trend in the US:
In 1989, no state had obesity prevalence higher than 15%.
In 2009, the only state with obesity prevalence lower than
20% was Colorado (18.6%)
Increasingly also global problem
Similar epidemics underway in both developed and
developing countries
More than half a billion people overweight by 2002
Obesity in children may portend
accelerating future growth
Between 1980 and 2000, the prevalence of overweight in children doubled
Currently almost 1 in 3 school-age children overweight or obese in the US
Once obesity exists, entrenched behaviors and tenacious physiological processes resist weight loss
The majority of obese children (and >70% of adolescents who are overweight) become obese adults; a minority of currently obese adults were obese as children
Tip of the iceberg? Rise in
overweight among US children
Prevalence of overweight in US children and adolescents, by gender and age; SOURCE: Wang & Beydoun 2007, data from NHNES
Heterogeneity and Disparities
Substantial heterogeneity in incidence of overweight/obesity
Geographic
Age-adjusted percent
0 - 19.4
19.5 - 23.8
23.9 - 27.0
27.1 - 30.7
> 30.8
County-level Estimates of Obesity among Adults aged ≥ 20 years
United States 2008
Heterogeneity and Disparities
Substantial heterogeneity in incidence of overweight/obesity
Geographic
Gender, race, income
Heterogeneity and Disparities
Substantial heterogeneity in incidence of overweight/obesity
Geographic
Gender, race, income
Education (and gender) No significant link between obesity and education among
men
Among women, those with college degrees less likely to be obese compared with less educated women.
Impact
Public Health Impact
Coronary heart disease: 50% more likely in overweight, twice as likely for obese, three times more likely in severely obese (BMI > 33)
Type 2 diabetes: Obese women nearly twice as likely to develop Type 2 diabetes than those with BMI < 22
Hypertension risk in overweight increased 3.0 times (men) and 2.9 times (women)
Blood pressure increase of 1 mmHg (systolic) per one-unit increase BMI among healthy adults aged 20-29
Overweight and obesity also increase risks of: Cancers (endometrial, breast, and colon)
Stroke, liver and gallbladder disease
Osteoarthritis, sleep apnea, asthma
Example: Diabetes & Obesity By US County
(2008)
0
5
10
15
20
25
30
35
40
45
50
0 2 4 6 8 10 12 14 16 18 20
% Type II Diabetic
% O
bese
Economic Impact
Economic costs associated with obesity
epidemic in the United States may be as high
as $215 bn annually
At least three major sources of cost have
been well quantified:
Direct (health care) costs
Indirect (productivity) costs
Transportation costs
Some evidence for other costs as well, less
easy to measure
Direct Costs
“Obesity-attributable” medical spending already accounts for ≈10% of all US health care costs (as high as $147 bn in direct costs annually)
These have doubled in the last decade
Some projections show dramatic future increases
Private payers bear the majority of estimated costs, but public-sector spending is substantial
Medicare spending would be an estimated 8.5% lower in the absence of obesity, Medicaid 11.8% lower
Indirect Costs
Obesity-related health problems contribute to workplace absenteeism, “presenteeism”
Obesity may lead to an increase in disability payments
Indirect costs to US businesses include health insurance expenditures, paid sick leave, life insurance, and disability insurance
Premature mortality affects population productivity
Total productivity costs of obesity estimated to be as high as $66 bn annually
Transportation Costs
Significant impact on transportation costs and
environmental impact
Moving heavier passengers takes more fuel: Airlines: weight gain during the decade of the 1990s alone required
approximately 350 million extra gal of jet fuel in the year 2000 ($1.2
billion annually at today’s fuel prices)
Roads: Excess fuel consumption due to obesity by noncommercial
passenger highway travel was estimated at one billion in 2009 ($2.7
billion annually at today’s prices)
Moving more food, more waste, larger products
also takes more fuel (no estimate yet)
Increased fuel use also has environmental,
trade implications
Total Quantified Current Costs
(up to $215 bn annually)
Annual Cost Breakdown
Direct Medical Spending ($86 - $147 billion)
Indirect Productivity Costs ($5 - $66 billion)
Transportation Costs ($3.7 - $3.9 billion)
+ Other costs: Educational effects, changes in facilities, ….
Future Increases
Rapid increase in childhood obesity likely to
mean much higher costs in the future
Onset of obesity-related health problems at
younger ages means higher lifetime costs:
Costs for medical treatments start earlier
Productivity costs accumulate over longer period
Higher obesity earlier in life also means a larger
segment of the population contributing to
obesity-related transportation costs
There may be educational effects associated
especially with school-age obesity
0
10
20
30
40
50
60
1926-1935 1936-1945 1946-1955 1966-1985
Ag
e d
ecad
e b
y w
hic
h >
20%
co
ho
rt o
bese
Onset of widespread obesity at earlier ages
Complexity
The Obesity Epidemic as a
Complex System
Several characteristics make the obesity especially challenging to study, and to design interventions to slow or reverse
Many interacting factors at several levels of scale Intra-individual: genetics, neurobiology, metabolism
Social: family structure, norms, advertising, physical environment, agricultural markets, policy incentives
Multiple actors Families, schools, retailers, industry, government, media,
healthcare providers, city planners, employers, insurance
Each has different goals, incentives, and constraints; interventions affect each in a different way
Diversity Opportunities to become obese at many different ages across
lifecourse, driven by potentially different factors
Implications of complexity for
science and for policy
There may be no single explanation for what is “causing” the epidemic
There may be no single solution that “fits” all circumstances and contexts
Interventions that do not take account of complexity in system can have unanticipated consequences
Interventions that are successful in one area alone may be offset by response elsewhere in the system
The most powerful interventions may be those that simultaneously address both individuals and their environment, at multiple levels, and in an integrated way
Research, data, and policy needs
Increasing calls for new kinds of data, and “systems” research approaches that capture complexity and effectively inform policy choices 2010 IOM Report (and numerous scientific papers) calling
for “systems” perspective and tools
Newly formed research network in NIH/CDC/USDA /RWJF NCCOR for application of systems approaches to childhood obesity, discovery of novel intervention strategies
Need for engagement, discourse with policymakers; a two-way conversation
Obesity: Trends,
Impact, Complexity
Ross A. Hammond, Ph.D.Director, Center on Social Dynamics & Policy
Senior Fellow, Economic Studies Program
The Brookings Institution