STATE OF CHILDHOOD
OBESITY IN MISSOURI
Shumei Yun, MD, PhD
Eduardo Simoes, MD, MSc, DLSHTM, MPH
Outline of the Presentation




Prevalence of obesity among adults, adolescents,
and children in Missouri
Factors associated with childhood obesity
Health and economic impact of obesity
Missouri’s strategies for obesity prevention
Prevalence of Obesity among Adults Age
18 or Older
BRFSS, CDC & DHSS
Prevalence of Obesity among High
School Students
YRBS, CDC & DHSS
Prevalence of Obesity among High
School Students, Missouri, 2003-2013
50
45
40
Prevalence
(%)
35
30
25
20
15
10
12.1
14.3
13.8
15.4
14.9
11.9
5
0
2003
2005
2007
YRBS, YTS for 2011 data, DHSS
2009
2011
2013
Prevalence of Obesity/overweight among High School
Students by Race/ethnicity, Missouri, 2013
50
Obesity
45
Overweight
40
Prevalence (%)
35
30
16.2
25
18.3
14.9
14.5
15.5
15
Overall
non-Hispanic White
20
15
10
18.8
15.2
5
0
YRBS, DHSS
non-Hispanic Black
Hispanics
Prevalence of Obesity Among Middle
School Students, Missouri, 2003-2013
50
45
40
Prevalence (%)
35
30
25
20
15
16.5
13.4
13
11.4
10
11.3
8.6
5
0
2003
2005
2007
2009
YTS, DHSS
2011
2013
Prevalence of Obesity/overweight among Middle
School Students by Race/ethnicity, Missouri, 2013
50
Prevalence (%)
45
40
Obesity
35
Overweight
30
25
20
15
8.6
7.9
8.7
9.3
Overall
non-Hispanic White
11.4
10
5
10.2
7.4
6.8
non-Hispanic Black
Hispanics
0
YTS, DHSS
Prevalence of Obesity/overweight among Secondary
School Students, by Grades, Missouri, 2013
40
35
Prevalence
(%)
30
19.1
25
13.1
16.3
20
10.5
Obesity
Overweight
15
10
7.3
10.3
8.2
5
16.8
10.7
10.1
7th
8th
16
17
11th
12th
12.6
4.9
0
6th
9th
YRBS & YTS, DHSS
10th
Prevalence of Obesity among Children
age 10-17
NSCH
Prevalence of Obesity among WIC
Children Age 2-4
WIC
Obesity among WIC Children Age 2-4, Missouri,
2000-2013
30
Prevalence (%)
25
20
15.2
15
13.2
13.3
15.8
15.6
15.7
15.5
15.9
16.1
16
15.1
14
14.9
14.4
10
5
0
2000
2001
2002
2003
2004
2005
2006
2007
WIC, DHSS
2008
2009
2010
2011
2012
2013
Obesity among WIC Children Age 2-5 by
Race/ethnicity, Missouri, 2000-2013
50
45
Prevalence (%)
40
35
30
NH-White
NH-Black
25
Hispanic
20
HP 2020
15
10
5
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
WIC, DHSS
Prevalence of Obesity among WIC
Children Age 2-4, MO, 2012
Social Determinants of Health



Education
Poverty
Environment and policy
Obesity among Children age 2-18 by Head of
Household’s Education, US, 1999-2010
25
21
Prevalence (%)
20
19
15
11
10
9
5
0
Girls
Boys
CDC, http://www.cdc.gov/obesity/data/childhood.html
<HS
College+
Obesity among Children age 2-18 by Head of
Household’s Education, US
25
23
Prevalence (%)
20
17
15
<HS
11
College+
10
7
5
0
1999-2002
2007-2010
CDC, http://www.cdc.gov/obesity/data/childhood.html
Percent of Adults Age 25 or Older with
Less than a High School Education, Missouri
Obesity/overweight among Children Age 10-17 by
Poverty Level, Missouri, 2007
100
90
80
Prevalence (%)
70
60
50
46.6
40
30
21.5
20
10
0
<100 FPL
>400 FPL
NSCH
Poverty Rate in Missouri, 2008-2013
30.0%
25.0%
20.0%
15.0%
14.6%
15.3%
15.8%
16.2%
15.8%
13.4%
10.0%
5.0%
0.0%
2008
2009
2010
US Census Bureaus
2011
2012
2013
Percent of Population in Poverty by County,
Missouri, 2013
Soda Sales Tax in Retail Stores, 2014
Missouri 1.23%
National Max 7%
Average 3.55%
Availability and access to
grocery stores, farmers markets,
Recreation & Fitness Facilities
Fast-food restaurants,
Maternal and Early Childhood Factors



Maternal obesity and diabetes
Excessive weight gain during pregnancy
Breastfeeding
Maternal Pre-pregnancy Obesity, Missouri,
1990-2013
50
45
40
Prevalence (%)
35
30
25
20
15
10
10.7
12
13.1 13.8
14.6
15.4
16.5
17.4 18.1
19.1
20
20.7 21.3 21.3
23.3 23.9 23.8 24
22.2 22.4 22.6 22.9
24.6 24.9
5
0
1990
1995
2000
Birth records, MICA, DHSS
2005
2010
2015
Pre-pregnancy and Gestational Diabetes among
Pregnant Women, Missouri, 2009-2012
30
25
Pre-pregnancy
Prevalence (%)
Gestational
20
15
10
8.8
7.7
6.9
7.5
7.1
7.6
2.8
2.7
2.2
2.6
5
2.1
2.7
0
2007
2008
2009
2010
2011
2012
PRAMS, DHSS
Questions in 2007 & 2008 are slightly different from the other years
Excessive Weight Gain during Pregnancy & Macrosomia

In 2012, 54% pregnant women gained more
weight than that recommended by IOM
 58.2%

among obese women
1.2% babies born in 2013 had a birthweight
>=4,500 g
Breastfeeding Initiation
100.0
90.0
81.7
80.0
Prevalence (%)
70.0
71.6
73.1
75.4
80.3
76.1
60.0
50.0
40.0
30.0
20.0
10.0
0.0
2007
2008
2009
PRAMS, DHSS
2010
2011
2012
Breastfeeding at Six Months
100
US
90
Missouri
80
HP 2020
Prevalence (%)
70
60.6
60
50
40
34.2
30
20
36.9
37.6
39.1
31.8
32.3
32.2
42.1
42.9
43.5
44.4
43.8
32.9
49
39.3
38.2
34.7
47.2
43.1
49.4
42.1
35.1
33
21.7
10
0
2002
2003
2004
2005
2006
2007
2008
2009
2010
National Immunization Survey, CDC
2011
2012
2013
Behaviors Related to Obesity

Risk Behaviors
 Diet
 Fruit
and vegetable consumption
 Sugar-added drinks or non-diet soda consumption
 Milk consumption
 Physical
 Meet
activity
physical activity recommendations
 Physical inactivity
 Screen time
Sugar-added Drinks or Non-diet Soda Consumption
1+ Times per Day*, Missouri 2007-2013
100
90
80
70
Prevalence (%)
60
MS
50
HS
40
30
33.4
30.8
26.9
22.8
20
10
0
2007
2009
* In the past 7 days, YRBS, DHSS
2011
2013
Physically Active for 60+ Minutes per Day on 5+
Days of the Past 7 Days, Missouri 2005-2013
100
90
MS
80
HS
70
Prevalence (%)
60
51.6
48.3
50
43.5
40
30
52.3
48.4
36
30.3
45.4
33.8
*
*
20
53.4
10
0
2005
2007
2009
2011
• Moderate physical activity for 30+ minutes on 5 or more days of past 7 days
YRBS, DHSS
2013
Daily Physical Education among Middle and High
School Students, Missouri, 2003-2013
100
90
MS
80
Prevalence (%)
HS
70
60
50
41
40
30
33.2
25.5
31.1
27.4
33.4
33.1
32.3
29.9
30.9
26.2
24.1
20
10
0
2003
2005
2007
YRBS, DHSS
2009
2011
2013
TV Viewing 3+hours per Day on an Average School
Day, Missouri, 2003-2013
100
90
80
MS
Prevalence (%)
70
HS
60
50
40
30
43.7
32.4
40.4
33.9
36.9
29.6
33.2
32.4
32.3
29.9
30.9
25.6
20
10
0
2003
2005
2007
YRBS, DHSS
2009
2011
2013
Playing Video or Computer Games or Using Computers for
Other than School Work 3+ Hours per Day in an Average
School Day
50
45
Prevalence (%)
40
35
32.7
30
29.8
25.9
25
20
21.5
22.9
27.1
24.8
MS
HS
15
10
5
0
2007
2009
2011
YRBS, DHSS
2013
Data Gap

Preschool children
 Only

Elementary school children
 No

WIC data available
data
Middle and high school age children
 Data


are self-reported
Only at state level
Adults

Self-reported data
Health Consequences of Childhood
Obesity

Immediate health effects
 High
blood pressure
 Dyslipidemia
 Pre-diabetes and diabetes
 Bone and joint problems
 Sleep apnea & asthma
 Fatty liver disease & gallstones
 Social and psychological problems
CDC, http://www.cdc.gov/obesity/childhood/basics.html
Health Consequences of Childhood
Obesity

Long-term Health Effects
 Increase
the risk and severity of obesity as adults
 Heart
disease, type 2 diabetes, stroke, and osteoarthritis
 Many types of cancer– breast, colon, endometrium,
esophagus, kidney, pancreas, gall bladder, thyroid, ovary,
cervix, prostate, multiple myeloma, and Hodgkin’s lymphoma
CDC, http://www.cdc.gov/obesity/childhood/basics.html
Obesity-related Chronic Disease in
Missouri




The prevalence of diabetes, hypertension, and high
cholesterol among adult Missourians is higher than
national average
The prevalence of these chronic conditions has been
increasing overtime
Age-adjusted osteoarthritis hospitalization rate
more than doubled from 1994 to 2012
Obesity is the second leading cause of preventable
premature death, only second to tobacco use
Economic Impact of Obesity, Missouri

Thorpe, 2008, $1.9 billion, 4.8%
 2013,
$3.4 billion -- projection
 2018, $ 8.2 billion -- projection

Trogdon, et al, 2009, 3.2 $billion, 7.7%
Progress





Prevalence of obesity among WIC and middle school
children started to decrease
Prevalence of breastfeeding initiation and at six months
increased.
More middle school students participating in daily
physical education
More students meeting physical activity
recommendations
Fewer students drinking sugar sweetened beverages
one or more times per day
Challenges




Lack of data and local level data
High poverty
Obesogenic fetal environment
Obesogenic physical environment
CDC Framework for Preventing Obesity
(adapted from IOM 2005)
Social Norms
and Values
 Home and Family
 Food and
Beverage Industry
 School
 Agriculture
Sectors of
Influence
 Community
 Work Site
 Education
 Media
 Healthcare
 Government
Behavioral
Settings
 Public Health
Systems
 Healthcare
Industry
 Genetics
 Psychosocial
Individual
Factors
 Other Personal
Factors
Food and
Beverage Intake
Energy Intake
 Business and
Workers
Physical
Activity
Energy Expenditure
Energy Balance
Draft – last revised, March 24, 2005
Prevention of Overweight and Obesity
Among Children, Adolescents, and Adults
 Land Use and
Transportation
 Leisure and
Recreation
Missouri’s Strategies






Adoption of food service guidelines
Increase access to healthier foods
through small retail venues
Promote supportive nutrition
environments and comprehensive school
physical activity programs
Increase physical activity in early care
settings
Enhance access to PA and outreach
within communities—MO Livable Streets
Workplace breastfeeding support
Key Partners








University of Missouri Extension
Missouri Council for Activity and Nutrition
Local Public Health Agencies & Center for Local Public
Health
Department of Elementary and Secondary Education
Missouri Convergence Partnership
State Alliance of YMCAs
MO Association of Health, Physical Education, Recreation
and Dance
And more!
Acknowledgements
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
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
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

Noaman Kayani
Arthur Pashi
Jiaqing Li
Dave McBride
Supriya Nelluri
Mary Jo Mosley
Venkata Garikapaty
Pat Simmons
Janet Wilson
Sherri Homan
Becca Mickels
David Kelly