Child and Adult Obesity in Ohio: 2008 Ohio Family Health Survey

Supporting Decision-Making Through Research: Findings from the 2008 Ohio Family Health Survey

Leona Cuttler, M.D.* Lisa Simpson, MB, BCh, MPH^

JB Silvers, PhD* Andrew Gallan, PhD*Ann Nevar, MPA* Mendel Singer, PhD*

*The Center for Child Health and Policy at Rainbow Babies & Children’s Hospital, Case Western Reserve Univ.

^Child Policy Research Center, CCHMC, Univ. of Cincinnati

Thursday, Jun. 12, 2008

How America's Children Packed On the Pounds

By JEFFREY KLUGER

We hear a lot about Obesity…

…But what are the actual data??

….. impact on health during childhood? and adulthood?

….. in Ohio now? - rates of childhood & adult obesity?- policy-relevant risk factors?- impact on health? health services?- implications for policy?

Cardiovascular:• Hypertension (2.5-3.7x inc) • Dyslipidemia • Risk factors: 60% of obese 5-10 yo have > 1 risk factor• Metabolic syn (30% obese)

Sleep Apnea3x rise over 30 yrs25% obese

Asthma 2-fold rise in obese

Gallstones

Fatty LiverUp to 50% in obese

Type 2 Diabetes: up to 45% new onset pediatric diabetesBone disease

Arthritis, SCFE

Psychological poor quality of life, depression, ADHD, eating disorders (cause?)

Does Childhood Obesity Really Have an Impact? Health during childhood

Does Childhood Obesity Really Have an Impact? Health during Adulthood

Childhood obesity tends to persist into adulthood, and predisposes to:

• Diabetes• Cardiovascular disease• Cancer (colon, pancreas, breast, etc.)• and much more

Obesity: 1 of 3 Americans to develop diabetes

Childhood obesity increases the risk of adult heart disease

Obese at 7-13 y higher risk of heart disease after age 25 y

Current adolescent obesity will cause 100,000 excessive cardiac deaths by 2035

Adult obesity impacts health and costs

Medical costs of obese 37% more than normal weight

Obesity accounted for 27% of the rise in inflation-adjusted per capita spending between 1987-2001

What is the current state of child and adult obesity in Ohio?

Sponsored by:

The Ohio Family Health Survey 2008

Funded by: State of Ohio Departments of Insurance, Job and Family Services, Health, and Mental Health

Directed by: Ohio Colleges of Medicine Government Resource Center at The Ohio State University and the

Health Policy Institute of Ohio

The Ohio Family Health Survey

• Telephone interviews: 50,092 households• Adults: height, weight, health• If child between 10-17 yrs in household: child’s

height, weight, health (n= 6086) provided by adult (86% parents)

• Body Mass Index (BMI) calculated– Classification of BMI: underweight, healthy,

overweight, obese

Obesity: terminology• Body Mass Index (BMI) is used to assess

“fatness”• “Overweight” refers to individuals who are

above normal weight but not obese (children: BMI 85th-94th percentile; adults: BMI 25-29.9 kg/m²)

• “Obese” refers to individuals who are markedly above normal weight (children: BMI> 95th percentile; adults: BMI > 30 kg/m²)

How many Ohioans are overweight or obese?

Underweight Healthy weight Overweight Obese

1 in 3 Children 2 in 3 Adults

~500,000 Ohio children are overweight or obese

~5.5 million Ohio adults are overweight or obese

*Ohio Family Health Survey, 2008

Overweight and obesity in Ohio: children and adults

Children:- 2003 NSCH (10-17 y): 30.5% (vs. 30.5% US)- 2008 OFHS (10-17 y): 35.6%Kids: Ohio is 22nd fattest state,

Trust for America’s Health 2008

Adults: - 2003 BRFSS: 60.9% (vs. 59.6% US) - 2008 OFHS: 65.0%Adults: Ohio is 17th fattest state,

Trust for America’s Health 2008

• Are rates rising in Ohio?

But prevalence of childhood obesity in Ohio is uneven

across racial and demographic groups*

Obese

Overweight

Child Race/Ethnicity Child Insurance Type

*P<0.01, Ohio Family Health Survey, 2008

0

20

40

60

Medicaid Uninsured Job-basedCoverage

0

20

40

60

Black Hispanic White

0

20

40

60

< Highschool

Highschool

Somecollege

Four yearcollege +

Parent Education

% %

%

Gender: Overweight and obesity is more common in Ohio males than

females - Children*

ObeseOverweight *Ohio Family Health Survey, 2008

P < 0.01

0

10

20

30

40

50

Boys Girls

%

Gender: Overweight and obesity is more common in Ohio males than

females - Adults*

ObeseOverweight *Ohio Family Health Survey, 2008

P < 0.01

0

10

20

30

40

50

60

70

80

Men Women

%

Childhood Obesity in Ohio: Impact on Health*

Relative Risk

0 1 2 3 4 5

Healthy weight

Chronic illness

Poor mental health

Asthma

Limited ability to do things

Poor health status

Diabetes

*Ohio Family Health Survey, 2008

P < 0.05-<0.001

Adult Obesity in Ohio: Impact on Health*

0 1 2 3 4 5 6

Healthy weight

Chronic Illness

Poor mental health

Cardiovascular disease

Hypertension

Heart failure

Diabetes

*Ohio Family Health Survey, 2008

Relative RiskP <0.001

Obese Ohioans need more health services than those who are normal

weight (P<.01)

• Special health care needs:

• Chronic medications:

• Emergency room visits– Two or more:

• Hospitalizations – Two or more:

1.4-fold higher 1.6-fold higher

1.4-fold higher

1.8-fold higher

2.1-fold higher

1.6-fold higher

1.5-fold higher

1.5-fold higher

Children Adults

Therefore, obesity is currently a major public health threat to Ohio:

prevalence, impact on health, use of health resources

• What should we do about it? • Do the data help identify policy directions?

Given the scope of the problem, policy is important to address obesity

1. Start young2. Target parent + child3. Not focus on a single geographic region4. Multilevel approach: global + some subgroups5. Change perceptions of health, food, activity6. Develop policies for prevention + treatment7. Consider defining obesity as a chronic disease

1. Start Young

If we want to overcome obesity in Ohio, we have to target children because:

• Obesity starts very young, and becomes more prevalent with advancing age

OHIO:Obesity (BMI>95%ile) Across the Lifespan

¹ Pediatric Nutrition Surveillance System (PedNSS), CDC and ODH, 20062 Ohio Family Health Survey (OFHS), ODJFS/ODH/ODI/ODMH, 2008

Newborns 2-5 yr olds1 Adults210-17 yr olds2

<5% 5-9.9% 10-14.9% 15-19.9% 20-24.9% 25-29.9% ≥30% NS

1. Start Young

If we want to overcome obesity in Ohio, we have to target children because:

• Obesity starts very young, and becomes more prevalent with advancing age

• Obese children generally become obese adults

2. Target Parents + Children

• Parent obesity is a strong independent predictor of childhood obesity

Parent obesity is linked to childhood obesity*

0

10

20

30

40

50

Normal weight Overweight Obese

0

10

20

30

40

50

Normal weight Overweight Obese

0

10

20

30

40

50

Normal weight Overweight Obese

0

10

20

30

40

50

Normal weight Overweight Obese

Ch

ildre

n%

overweight

obese

* P<0.01; Ohio Family Health Survey, 2008

Adults

2. Target Parents + Children

• Parent obesity is a strong independent predictor of childhood obesity

• Targeting parents includes focus on their educational attainment

Parent education is linked to childhood obesity*

0

10

20

30

40

50

60

< Highschool

High school Somecollege

Four-yearcollege +

%

*OFHS, 2008

Chi

ldre

n

Adult Education Level

obese

overweight

P<0.01

3. We should not focus on a single geographic region

Obesity is not easily targeted geographically:

• Child and adult obesity is widespread in OH• No specific region or type of region is

dominant

Ohio: County-by-County Rates of Obesity

<5% 5-9.9% 10-14.9% 15-19.9% 20-24.9% 25-29.9% ≥30% NS

Children (10-17 yrs) Adults

4. Consider multilevel approach, recognizing demographic subgroups

Independent risk factors for obesityIndependent risk factors for obesityCHILDCHILD ADULTADULT

more likely more likely

Male (vs female) 1.8x 1.3xMedicaid (vs job-based) 1.3x 1.3Income 100-200% FPL (vs >300% FPL) 1.4x 1.2xBlack female (vs white female) 1.8x 1.5x

In addition, other independent risk factors for childhood obesity

Children: more likely to be obese

– 10-11 Years-Old (vs 16-17 years-old) 2.2-fold

– Adult is Obese (vs healthy weight) 1.7-fold

– Adult High School (vs 4 year college) 1.4-fold

Other policy recommendations

5. Change perceptions of health, food, and activity

6. Develop policies that address prevention and treatment

7. Consider defining obesity as a chronic disease

Summary (1)In Ohio:• 35.6 % of children and 65% of adults are overweight

or obese• Rates of obesity differ according to demographic

factors (gender, race, income, insurance, and parent education)

• Obesity is associated with both - a substantial increase in diseases, and- marked increased use of health resources

Summary (2)• The extent/impact of obesity suggest that policy

interventions are needed. The data suggest:1. Start young2. Target parent + child3. Not focus on a single geographic region4. Multilevel approach: global + some subgroups5. Change perceptions of health, food, activity6. Develop policies for prevention + treatment7. Consider defining obesity as a chronic disease

Summary (3)

• Act now.When is the evidence enough?When the problem is big enough:

Get data Act on best available evidence Re-evaluateModify

Thank you• Thanks to Ohio Dept. of Job and Family Services,

Ohio Dept. of Health, Ohio Dept. of Insurance, and Ohio Dept. of Mental Health, OSU-HPIO

• Thanks to Rainbow Board of Trustees• Research team: Leona Cuttler, A. Gallan, Ann

Nevar, JB Silvers, Mendel Singer, Lisa Simpson• Reviewer team: Cynthia Burnell, James

Gearheart, Lorin Ranbom, Barry Jamieson