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[Dr. Carney] Welcome to
"Controversies in Public Health,"

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Module 3 lecture.

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Module 3 is "Preventing Obesity."

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This is Dr. Jan Carney.

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Our learning objectives are to
describe the data and trends

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in obesity in children,
adolescents, and adults

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in the United States.

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Discuss the variation in obesity

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according to demographic
factors in geographic regions.

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To evaluate the overall public
health impact of obesity

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in the United States.

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To summarize evidence-based approaches

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for clinical and community prevention.

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To discuss the relationship
between the consumption

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of sugar-sweetened beverages and obesity,

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and to review the evidence

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that raising the price of sugary drinks

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will limit consumption.

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First, the public health impact.

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This is from CDC, "Why it Matters."

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Children with obesity

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are more likely to have obesity as adults.

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Adults with obesity

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have higher risk for
developing chronic conditions

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such as heart disease, type 2 diabetes,

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and some types of cancer.

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Obesity costs the U.S. healthcare system

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nearly $173 billion each year.

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Americans don't eat healthy enough

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or get the right amount
of physical activity.

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Fewer than one in 10 children and adults

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eat the recommended daily
amounts of vegetables.

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Fewer than one in four young people

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get enough aerobic physical activity,

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and just one in four adults

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meet physical activity guidelines.

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And we know that the reasons
behind these statistics

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are complicated,

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and there's much variation
in geographic regions

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and according to demographic factors.

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And let's delve into this just a bit more.

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If you go onto the CDC website,

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one of the things that you'll notice

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is a wide geographic variation

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in self-reported obesity among U.S. adults

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by state and territory.

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This is from 2021, and this information

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is from the Behavioral Risk
Factor Surveillance System,

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which is self-reported data

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that's been done consistently over time.

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And if you look at the
map, the darkest levels,

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for example the dark red from 45

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to half the population in that area,

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reporting obesity,

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you'll see those in
Kentucky and West Virginia,

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and a wide range of states

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who have in excess of 35 and
40% reported rates of obesity.

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That's overall. Let's break this down.

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First, among non-Hispanic Asian adults.

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And if you look at this,

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what is noticeably different
from the previous map

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is that there are many states

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who have less than 20%
self-reported obesity.

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Let's look at non-Hispanic white adults.

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And in this, we see more variation,

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and you can see a wide
swath of our country

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reporting in excess of 30 and 40%.

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This is the prevalence
of self-reported obesity

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among Hispanic adults.

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And again, you can see how
with the exception of Vermont,

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the vast majority of states in the U.S.

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have self-reported obesity rates

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that are in excess of 30%.

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These are the self-reported rates

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among non-Hispanic American
Indian or Alaska Native adults.

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And you can see in Arizona,
North Dakota, and Pennsylvania,

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some of the highest
rates that we have seen.

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And these are reports from
non-Hispanic black adults,

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the prevalence of self-reported obesity,

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and again our southern
states and Wisconsin

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are extremely high.

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What are some of our
takeaways from those maps?

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Is, first, how common this is.

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And in terms of those trends,
if you look on the CDC website

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and see the trends starting earlier,

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you'll see how much darker
the maps have gotten.

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And when we look at
different demographic factors

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and geographic areas,

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there are mark differences.

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How does this help us?

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This helps us with setting priorities

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and making sure that we are cognizant

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of cultural differences.

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We develop programs that may be effective

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in different areas of the country

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and among different individuals.

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So in the areas of
prevention and practice,

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there are evidence-based recommendations.

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You can focus on individual behaviors,

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for example, in a clinical setting,

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and environmental strategies

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as well as policy changes.

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A couple of important
distinctions I would make

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is between community prevention
and clinical prevention.

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Community prevention are
those public health strategies

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that may work in an entire population

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or an entire geographic area.

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And clinical prevention,

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we're talking about those interventions

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that might be

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in terms of talking with
a health professional,

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what are the kinds of things
that might help people

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in terms of dietary change
or physical activity?

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And one of the factors
that it's very important

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in terms of that environment
is local food environments

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and access to healthy foods
at an affordable price.

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Sugary drinks.

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This is from the CDC,

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and consuming too many sugary drinks

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is associated with gaining
weight and obesity,

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type 2 diabetes,

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having high blood pressure,

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and of course, more common, tooth decay.

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This looks at the most
recent CDC information

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for self-reporting intake of
sugar-sweetened beverages,

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which we now call sugary drinks,

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at least once daily among
U.S. adults in 2010 and 2015.

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And you can see the darker
red are the higher percentages

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and the lighter colors
are lower percentages.

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And again, you see wide
geographic variation,

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but also it's very common
in terms of consumption

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of more than half of the adult survey

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consuming at least a
sugar-sweetened beverage

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or sugary drink at least once per day.

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This looks at adolescence,
'cause remember,

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the habits and behaviors we develop

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as children and adolescents

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are more likely to move with
us right into adulthood.

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So this is from CDC,

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the Youth Risk Behavior
Surveillance System, YRBSS,

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and from 2019,

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this is the percentage of
students in grades nine through 12

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who drank regular soda or pop
at least one time per day.

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And the blue is at least 19.8%,

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and the blue and green are
the higher percentages.

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In some states, the data is not available,

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but again we can see wide
geographic variation,

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and often this is worse
in southern states.

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So what about raising the
price of sugary drinks?

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What do we think about that?

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And this is from the
World Health Organization.

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Sugary drinks are a major
source of sugar in the diet

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and consumption is
increasing in most countries,

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in the United States and beyond,

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especially in children and adolescents.

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The World Health Organization guidelines

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recommend to prevent
obesity and tooth decay,

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adults and children reduce
their consumption of sugars

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to less than 10% of their
daily energy intake.

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So this suggests that further
reducing this below 5%

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can lead to additional health benefits.

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There is strong evidence

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that increasing the price of sugary drinks

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reduces their consumption.

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A good analogy

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is the efforts to increase
the price of tobacco

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and its positive impact
in terms of prevention

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or reducing tobacco use among adolescents.

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One of the things important to consider

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is an excise tax versus a sales tax.

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So if there is an increase
in the excise tax,

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it impacts purchase and
consumption decisions

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as opposed to a sales tax increase

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might have the unintended consequence

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to encourage buying at larger volumes

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and may not in a positive way

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impact purchase and consumption decisions.

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This is an important distinction.

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Some of the literature
suggests that a 10% excise tax

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could reduce purchase by as much as 10%.

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We also know that the
consumption of most sugary drinks

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is still at home.

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So there's a large potential
of public health impact

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if we can reduce purchase
and later consumption.

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As we know,

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one of the controversial
areas in this discussion

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is discussion of a tax,

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but in this case the public
support for tax is highest

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when the funds are intended to be used

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for obesity prevention.

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This is our discussion template,

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and as you read about the
area of overweight and obesity

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and consumption of sugary drinks

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and how this relates to obesity,

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please consider these different
aspects of the controversy,

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specifically number six,

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why is this health issue so controversial?

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What are the specific factors?

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What about economics?

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Think about where people
buy sugary drinks.

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What about the role of the government?

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Is there scientific uncertainty?

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And are there politics at play?

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What do we think is the role
of the media or social media?

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What about advertising?

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And finally, how would you
respond to the controversy?

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Before our specific discussion questions

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that we'll discuss in Yellowdig,

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please consider the following:

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What is the evidence

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that environmental and behavioral factors

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contribute to obesity?

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What specific factors play a role?

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What's the evidence that a combination

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of individual and
population-based approaches

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will reduce the health
consequences of obesity

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in children and adults?

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What's the evidence that sugary drinks

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contribute to obesity?

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What is the evidence

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that raising the price
will limit consumption?

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And finally,

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is there a role or not

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for the beverage industry

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in helping us to create solutions?

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Questions?