[Dr. Carney] Welcome to "Controversies in Public Health,"
Module 3 lecture.
Module 3 is "Preventing Obesity."
This is Dr. Jan Carney.
Our learning objectives are to describe the data and trends
in obesity in children, adolescents, and adults
in the United States.
Discuss the variation in obesity
according to demographic factors in geographic regions.
To evaluate the overall public health impact of obesity
in the United States.
To summarize evidence-based approaches
for clinical and community prevention.
To discuss the relationship between the consumption
of sugar-sweetened beverages and obesity,
and to review the evidence
that raising the price of sugary drinks
will limit consumption.
First, the public health impact.
This is from CDC, "Why it Matters."
Children with obesity
are more likely to have obesity as adults.
Adults with obesity
have higher risk for developing chronic conditions
such as heart disease, type 2 diabetes,
and some types of cancer.
Obesity costs the U.S. healthcare system
nearly $173 billion each year.
Americans don't eat healthy enough
or get the right amount of physical activity.
Fewer than one in 10 children and adults
eat the recommended daily amounts of vegetables.
Fewer than one in four young people
get enough aerobic physical activity,
and just one in four adults
meet physical activity guidelines.
And we know that the reasons behind these statistics
are complicated,
and there's much variation in geographic regions
and according to demographic factors.
And let's delve into this just a bit more.
If you go onto the CDC website,
one of the things that you'll notice
is a wide geographic variation
in self-reported obesity among U.S. adults
by state and territory.
This is from 2021, and this information
is from the Behavioral Risk Factor Surveillance System,
which is self-reported data
that's been done consistently over time.
And if you look at the map, the darkest levels,
for example the dark red from 45
to half the population in that area,
reporting obesity,
you'll see those in Kentucky and West Virginia,
and a wide range of states
who have in excess of 35 and 40% reported rates of obesity.
That's overall. Let's break this down.
First, among non-Hispanic Asian adults.
And if you look at this,
what is noticeably different from the previous map
is that there are many states
who have less than 20% self-reported obesity.
Let's look at non-Hispanic white adults.
And in this, we see more variation,
and you can see a wide swath of our country
reporting in excess of 30 and 40%.
This is the prevalence of self-reported obesity
among Hispanic adults.
And again, you can see how with the exception of Vermont,
the vast majority of states in the U.S.
have self-reported obesity rates
that are in excess of 30%.
These are the self-reported rates
among non-Hispanic American Indian or Alaska Native adults.
And you can see in Arizona, North Dakota, and Pennsylvania,
some of the highest rates that we have seen.
And these are reports from non-Hispanic black adults,
the prevalence of self-reported obesity,
and again our southern states and Wisconsin
are extremely high.
What are some of our takeaways from those maps?
Is, first, how common this is.
And in terms of those trends, if you look on the CDC website
and see the trends starting earlier,
you'll see how much darker the maps have gotten.
And when we look at different demographic factors
and geographic areas,
there are mark differences.
How does this help us?
This helps us with setting priorities
and making sure that we are cognizant
of cultural differences.
We develop programs that may be effective
in different areas of the country
and among different individuals.
So in the areas of prevention and practice,
there are evidence-based recommendations.
You can focus on individual behaviors,
for example, in a clinical setting,
and environmental strategies
as well as policy changes.
A couple of important distinctions I would make
is between community prevention and clinical prevention.
Community prevention are those public health strategies
that may work in an entire population
or an entire geographic area.
And clinical prevention,
we're talking about those interventions
that might be
in terms of talking with a health professional,
what are the kinds of things that might help people
in terms of dietary change or physical activity?
And one of the factors that it's very important
in terms of that environment is local food environments
and access to healthy foods at an affordable price.
Sugary drinks.
This is from the CDC,
and consuming too many sugary drinks
is associated with gaining weight and obesity,
type 2 diabetes,
having high blood pressure,
and of course, more common, tooth decay.
This looks at the most recent CDC information
for self-reporting intake of sugar-sweetened beverages,
which we now call sugary drinks,
at least once daily among U.S. adults in 2010 and 2015.
And you can see the darker red are the higher percentages
and the lighter colors are lower percentages.
And again, you see wide geographic variation,
but also it's very common in terms of consumption
of more than half of the adult survey
consuming at least a sugar-sweetened beverage
or sugary drink at least once per day.
This looks at adolescence, 'cause remember,
the habits and behaviors we develop
as children and adolescents
are more likely to move with us right into adulthood.
So this is from CDC,
the Youth Risk Behavior Surveillance System, YRBSS,
and from 2019,
this is the percentage of students in grades nine through 12
who drank regular soda or pop at least one time per day.
And the blue is at least 19.8%,
and the blue and green are the higher percentages.
In some states, the data is not available,
but again we can see wide geographic variation,
and often this is worse in southern states.
So what about raising the price of sugary drinks?
What do we think about that?
And this is from the World Health Organization.
Sugary drinks are a major source of sugar in the diet
and consumption is increasing in most countries,
in the United States and beyond,
especially in children and adolescents.
The World Health Organization guidelines
recommend to prevent obesity and tooth decay,
adults and children reduce their consumption of sugars
to less than 10% of their daily energy intake.
So this suggests that further reducing this below 5%
can lead to additional health benefits.
There is strong evidence
that increasing the price of sugary drinks
reduces their consumption.
A good analogy
is the efforts to increase the price of tobacco
and its positive impact in terms of prevention
or reducing tobacco use among adolescents.
One of the things important to consider
is an excise tax versus a sales tax.
So if there is an increase in the excise tax,
it impacts purchase and consumption decisions
as opposed to a sales tax increase
might have the unintended consequence
to encourage buying at larger volumes
and may not in a positive way
impact purchase and consumption decisions.
This is an important distinction.
Some of the literature suggests that a 10% excise tax
could reduce purchase by as much as 10%.
We also know that the consumption of most sugary drinks
is still at home.
So there's a large potential of public health impact
if we can reduce purchase and later consumption.
As we know,
one of the controversial areas in this discussion
is discussion of a tax,
but in this case the public support for tax is highest
when the funds are intended to be used
for obesity prevention.
This is our discussion template,
and as you read about the area of overweight and obesity
and consumption of sugary drinks
and how this relates to obesity,
please consider these different aspects of the controversy,
specifically number six,
why is this health issue so controversial?
What are the specific factors?
What about economics?
Think about where people buy sugary drinks.
What about the role of the government?
Is there scientific uncertainty?
And are there politics at play?
What do we think is the role of the media or social media?
What about advertising?
And finally, how would you respond to the controversy?
Before our specific discussion questions
that we'll discuss in Yellowdig,
please consider the following:
What is the evidence
that environmental and behavioral factors
contribute to obesity?
What specific factors play a role?
What's the evidence that a combination
of individual and population-based approaches
will reduce the health consequences of obesity
in children and adults?
What's the evidence that sugary drinks
contribute to obesity?
What is the evidence
that raising the price will limit consumption?
And finally,
is there a role or not
for the beverage industry
in helping us to create solutions?
Questions?