Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition...

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Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley An Overview of the Obesity Epidemic in California Senate Committee on Health February 12, 2014

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Page 1: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Pat Crawford, DrPH, RDDirector, Atkins Center for Weight &

HealthCooperative Extension Nutrition and

Obesity Specialist University of California at Berkeley

An Overview of the Obesity Epidemic in California

Senate Committee on Health February 12, 2014

Page 2: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Synthesizing the science

Atkins Center for Weight & Health Funded in 1999

Evaluating programs

and policies

Conducting research to

answer critical

questions

Working in partnerships

with communities,

government and organizations

Translation and

dissemination

Page 3: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

3

Rates of obesity/overweight

Context of rates

Page 4: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 1985

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Page 5: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 1986

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Page 6: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 1987

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Page 7: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 1988

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Page 8: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 1989

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Page 9: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 1990

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Page 10: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 1991

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Page 11: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 1992

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Page 12: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 1993

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Page 13: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 1994

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Page 14: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 1995

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Page 15: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 1996

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Page 16: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 1997

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Page 17: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 1998

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Page 18: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 1999

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Page 19: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 2000

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Page 20: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 2001

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Page 21: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 2002

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Page 22: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 2003

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Page 23: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 2004

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Page 24: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 2005

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

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

Page 25: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 2006

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

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

Page 26: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 2007

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

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

Page 27: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 2008

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

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

Page 28: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 2009

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

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

Page 29: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity Trends* Among U.S. AdultsBRFSS, 2010

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

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

Page 30: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.
Page 31: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.
Page 32: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Change in Adult Obesity* in California

Years % ObeseNumber of

years

1985-1990 < 10% 6 years

1991-1996 10-14% 6 years

1997 -2002 ** 15-19% 6 years

2003 -2011 20-24% 9 years

2012*** 25-<30% 1 year

* Obesity defined as Body Mass Index wt(kg)/m2 > 30** 2001-20—24%*** Methodological changes make comparisons not possible with those before 2011Ref: BRFSS, 1985-2012

Page 33: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity in Adults

US CA

All 28% 25%

Men 28%   26% 

Women  28% 24%

Ref: BRFSS, 2012

Page 34: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Overweight (and obesity) in adults

US CA

All 60% 64%

Men 67%   70%

Women  54% 58%

Ref: BRFSS, 2012

Page 35: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Overweight (and obesity) in adults by race

US CA

White 63% 58%

Black 71%   74%

Hispanic  67% 70%

Other 53% 40%

Ref: BRFSS, 2012

Page 36: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Obesity in low-income children

US CA

All 14% 16%

Ref: PedNSS, 2011Note: Hispanic rate of obesity 50% higher

Page 37: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Overweight (and obesity) in low-income children

US CA

All 30% 33%

Ref: PedNSS, 2011

Page 38: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Overweight (and obesity) in children by race*

All girls 30% All boys 33%

White 26% White 30%

Black 41% Black 37%

Hispanic 39% Hispanic 40%

* Ages 2-19Ref: Ogden, NHANES, 2012

Page 39: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Adults* United States California

Total population

316,128,839 38,332,521

% White 78% 74%

% African-American

13% 7%

% Hispanic 17% 38%Children+ United States California

% White 52% 27%

% African-American

14% 6%

% Hispanic 24% 52%

Race/Ethnicity – US vs. CA

*U.S. Census Bureau: State and County QuickFacts.

+ kidsdata.org 

Page 40: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Adults* United States California

% Below federal poverty level

14.9% 15.3%

Children+ United States California

% Below federal poverty level

22.6% 23.8%

Poverty level – US vs. CA

*U.S. Census Bureau: State and County QuickFacts.

+ kidsdata.org 

Page 41: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Fitnessgram testing

Page 42: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

2001 2005 2008 200910

15

20

25

30

35

All Boys BMI > 95th percentile

BMI

Page 43: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

2001 2005 2008 200910

15

20

25

30

35

Hispanic boys BMI > 95th percentile

BMI

Page 44: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

2001 2003 2008 200910

15

20

25

30

35

Asian boys BMI > 95th percentile

BMI

Page 45: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

2001 2007 2008 200910

15

20

25

30

35

American Indian boys BMI > 95th percentile

BMI

Page 46: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

2001 2005 2008 200910

15

20

25

30

35

Non-Hispanic White boys BMI > 95th percentile

BMI

Page 47: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

2001 2005 2008 200910

15

20

25

30

35

All girls BMI > 95th percentile

BMI

Page 48: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

2001 2008 2008 200910

15

20

25

30

35Black girls BMI > 95th percentile

BMI

Page 49: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

2001 2005 2008 200910

15

20

25

30

35

Hispanic girls BMI > 95th percentileBM

I

Page 50: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

2001 2008 200910

15

20

25

30

35

American Indian girls BMI > 95th percentile

BMI

Page 51: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

2001 2005 2008 200910

15

20

25

30

35

Non-Hispanic White girls BMI > 95th percentile

BMI

Page 52: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Policy Evaluation in Student BMI

Ref: Sanchez-Vaznaugh, Crawford, 2010

Page 53: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Ref: CCPHA

Page 54: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

• Annualize the adjusted decrease in prevalence

from peak to 2008

• Assume that annual decrease continues until

2015

• Apply this to ALL kids in CA

• ~ 100,000 kids DROP OUT of the obese

category

• Assuming a savings of $220 per child**

• Savings of about $20 million

Medical cost savings per child*

* Madsen K, UC Berkeley, personal communication**(based on MEPS data from 2001 to 2003, as reported in NY state comptroller report from Oct 2012)

Page 55: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

GIRLS

Remission 2008 to 2015

SAVINGS

White  11,024  $2,425,337

African American  -    -  

Latina  8,772  $1,929,798

Asian  2,443  $537,360

American Indian  -    -  

TOTAL (By race)  22,239  $4,892,495

Page 56: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

BOYSRemission: 2008 to 2015

Savings*

White  27,165  $5,976,209

African American  7,971  $1,753,643

Latino  30,373  $6,682,012

Asian  4,419  $972,107

American Indian  3,881  $853,816

TOTAL (By race)  73,808  $16,237,787

Page 57: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

The human cost of obesity: diabetes and pre-diabetes in adolescence

2001 20090

5

10

15

20

25

Page 58: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Human cost - Adult

Page 59: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

or pictorially NowThen

Page 60: Pat Crawford, DrPH, RD Director, Atkins Center for Weight & Health Cooperative Extension Nutrition and Obesity Specialist University of California at Berkeley.

Key messages

Invest in prevention

Create a culture of health

Utilize the resources of the University

THANK YOU


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