Life-course Perspectives for Health
Promotion and Obesity Prevention
Pan American Conference on Obesity III
June 2013
Speakers
Marcia Ory-Texas A&M
Tom Best-The Ohio State University
Roberto Lobelo-CDC
John Duperly-Universidad de los Andes
Life-course Perspectives for Health
Promotion and Obesity Prevention
Workshop Goals and Structure
• Introduce the life-course perspective –why we are
connecting children and older adults in obesity prevention
• Describe the prevalence, risk factors and consequences of
childhood obesity and identify intervention strategies for
childhood obesity prevention
• Identify aging facts and stereotypes, key determinants of
healthy aging, strategies for promoting healthy aging; and
the role of physical activity in healthy living
Life-course Perspectives for Health
Promotion and Obesity Prevention
Goals and structure, cont
• Solicit international perspectives from the audience
on what works/doesn’t work in obesity prevention
across the life-course
• Discuss cross cutting issues in risk factors and
solutions and roles of different key stakeholders in
formulating solutions;
• Mobilize action by having each participant identify
two concrete actions for preventing childhood
obesity and promoting healthy aging.
Welcome and Introductions
• What are your affiliations?
Professional backgrounds?
• What responsibility for obesity
prevention?
• Do you work with children,
older adults, or all populations
• What do you hope to get out of
today’s workshop?
Life-Course Perspectives
• Aging is from birth to death
• The past shapes the present and
future too
– Social conditions experienced in early
life influence life choices and
opportunities
– Health behaviors adopted in
childhood influence later life
– Health in childhood influences health
in later life
• It’s never to soon to adopt healthy
behaviors and never to late
Life-Course Themes
• Each life transition presents a unique
opportunity for interventions to inform policy
and practice that can improve health and
quality of life
• Interventions can be focused on particular
stages or on the entire life-course
• Chronic diseases likely result from the
complex interplay of critical and sensitive
period, and trajectory and accumulation
processes
Life-Course Perspective –
Epidemiological Approach
• Provides a way to conceptualize how underlying socioenvironmental determinants of health, experienced at
different life course stages, can differentially influence the
development of chronic diseases
• Life course epidemiology examines a range of potential
processes through which exposures acting at different stages
of life can, singly or in combination, influence disease risk
• The importance of timing is illustrated by knowledge that the
particular stage of life when an exposure occurs can be
important in understanding its later effects
Case Scenarios—How typical is Each ?
What are the Causes and Solutions
• A child is normal
weight in primary
school and remains
normal weight
throughout life
• A child is obese in
primary school and
remains obese
• A child is normal
weight in primary
school but becomes
obese as an older adult
• A child is obese in
primary school but
becomes normal
weight in mid and
later life
Hold for Childhood Obesity
Slides
Obesity Prevention Across the LifeCourse = Healthy Aging!
Marcia Ory, PhD, MPH
Regents and Distinguished Professor
Health Promotion and Community
Health Sciences
Texas A&M Health Science Center
USA
Questions for Reflection
• What does aging mean to you?
• At what age does someone become “old”?
• What can you do to age more successfully?
• How can you help others age more successfully?
Behavioral & Social Principles of Aging
• Aging as a life-course process
• Heterogeneity of the older population
• Aging and the social context
• Aging as malleable
• Potential for intervention
How Long Will The Average
American Live?
A person born today will live almost 78 years (vs 75.28 ys in Aruba)
A person who is 65 will live an average of 18.5 longer
A woman who is 85 will live an average of 6.8 years longer
A person 100 years will live an average of 2.3 years longer
Going Beyond Ageist Stereotypes
 Ageist stereotypes are still part
of cultural landscape
 Ageist stereotypes are health
hazards
 Age and functional status must
be considered in designing and
evaluating health promotion
programs
 We need to continually confront
ageism
Ageism is Universal
Experience with Ageism
Someone assumed I could not
understand because of my age
Someone told me “you’re too old
for that”
I was treated with less dignity
and respect because of my age
A doctor or nurse assumed my
ailments were caused by my age
Age-Biases in Health Care
• Older adults get less aggressive
treatments
• Older adults not seen as
“candidates” for health promotion
programs
• Older adults often excluded from
health studies
Old people are sick and frail
Old people are set in their ways
It’s too late to see gains
Physical activity is harmful to older
people
Keys to Healthy Aging*
Positive attitude about aging
Keep mind active
Be physically active
Eat healthy
Stay socially engaged
Manage stress
Live in Healthy Communities
*Based on years of behavioral and social research
Active Living is Seen as Essential to
Good Health
The Community Guide:
Physical Activity
• Campaigns and
Informational
Approaches
• Behavioral and
Social Approaches
• Environmental and
Policy Approaches
http://www.thecommunityguide.org/pa/index.html
• Staying active — walking, wheeling,
and getting moderate regular exercise —
helps with both our physical and mental
well-being
• Staying connected with friends, family,
and community is critical to remaining
healthy, vital, and active, and is easier if
our neighborhood is designed to support
interactions.
• Staying engaged also benefits the
community at large.
www.epa.gov/aging/bhc/guide/index.html
USA
National Blueprint:
Increasing Physical
Activity Among
Adults Aged 50 and
Older
National Blueprint
Increasing Physical
Activity Among Adults
Age 50 and Older
Participating Organizations
50 National Organizations
including…
• The National Institute on
Aging
• Centers for Disease Control
and Prevention
• AARP
• National Council on Aging
• American College of Sports
Medicine
• American Geriatrics Society
• Administration on Aging
1st Message – The Population is Aging
•
•
•
•
2000 - 35 million 65+ yrs.
2011- 41.4 million
By 2030, 70 million over 65 yrs.
Every day 10,000 Americans
turn 60
• Aging is a world wide
phenomenon
2nd Message – Chronic Conditions
• Over 90% of adults 65
or older have at least
one chronic health
condition
• 73% of older adults
have multiple
comorbidities
• 21% of over 65 have
chronic disabilities
3rd Message – Prevention
• Preventative
•Primary Prevention
•Secondary Prevention
•Rehabilitative
•Acute conditions
•Chronic disease
•Palliative
•Quality of Life
4th Message - Physical Inactivity
•
38% of USA population age 55 and
older is sedentary
•
50% of women age 75 and older
engage in no physical activity
•
Fewer than 50% of older adults ever
receive a suggestion to exercise from
their physicians
2002- 2012: Strategies to Increase Physical Activity
CROSS-CUTTING
RESEARCH
MARKETING
HOME/
COMMUNITY
PUBLIC
POLICY
MEDICAL
SYSTEMS
Strategies – Cross-Cutting
• Develop National
Clearinghouse (AFL-NPO)
• Public Information
Campaign (AARP)
• Training Standards
(ACSM)
Cross-Cutting Strategy 2
Develop a populationsegmented mass-marketing
campaign to increase
knowledge and awareness
levels related to physical
activity and fitness among the
50+ population. (AARP)
Go4Life-an exercise and
physical activity campaign is
designed to help you fit
exercise and physical activity
into your daily life (NIH)
www.nia.nih.gov/Go4Life
Strategies – Home and Community
• Identify community
resources (ACSM)
• Encourage nontraditional
partnerships (NBO)
• Identify models of
best practice (NCOA)
Strategies – Medical Systems
• Develop physical
activity toolkit (AGS)
• Develop local referral
networks (ACSM)
AGS/ACSM/AAFP
Theraband
• Disseminate
guidelines and best
practices (CDC & ACSM)
Medical Systems Strategy 3
Develop resources for
clinicians to use in making
personalized physical activity
recommendations/
prescriptions for their
patients.
(American Geriatrics Society)
Strategies – Public Policy
• Develop Public Policy
Agenda (RWJF)
• Educate
Policymakers (NCPPA &
SGMA)
• Cost –effectiveness
data (CDC)
Public Policy Strategy 2
Educate policymakers
about the importance of
physical activity for the
older population.
Include information that
provides examples of
effective policy in this
arena.
(National Coalition for
Promoting Physical
Activity)
Physical Activity FAQ 1
WHY SHOULD I BE PHYSICALLY
ACTIVE?
Regular physical activity can help to
improve quality of life in old age.
Physical activity can help you stay
active and engaged with your family
and community.
It can help you to manage or
postpone some of the chronic
diseases and conditions many of us
have come to expect from old age.
Physical Activity FAQ 2
HOW MUCH PHYSICAL ACTIVITY
DO I NEED?
Ideally, you should aim to do at least
150 minutes of moderate intensity
aerobic activity per week as well as
two days per week of resistance
exercises.
However, start by doing what you can,
and gradually look for ways to do
more.
If you have not been active for a while,
start out slowly. After several weeks or
months, build up your activities—do
them longer and more often.
Physical Activity FAQ 3
WHAT IS THE BEST EXERCISE
FOR OLDER ADULTS?
There is no single best exercise that
works for all persons.
Some can run marathons or compete
in triathlons, whereas others may be
more comfortable walking, gardening
or doing tai chi.
The most important thing is to do
regardless of your age is to avoid
inactivity..
Physical Activity FAQ 4
HOW MANY TIMES A WEEK
SHOULD I EXERCISE?
Generally it is better to spread
physical activity out throughout the
week with a goal of being active on at
least 3-5 days per week.
By choosing activities that you enjoy,
that are convenient and affordable,
you may be able to find a way to be
active on almost all days of the week.
Physical Activity FAQ 5
I HAVE NOT EXERCISED FOR
MANY YEARS, WHERE SHOULD I
START?
Forget the old saying “no pain, no
gain” – it is simply not true!
There are many excellent options for
those of us who cannot or do not want
to exercise vigorously.
Walking is a wonderful way to
increase your activity level.
Remember - the most important thing
is not what you do - rather - it is most
important to avoid complete inactivity.
Physical Activity FAQ 6
WILL PHYSICAL ACTIVITY HELP
TO REDUCE MY RISK FOR
SPECIFIC DISEASES AND
CONDITIONS?
Physical inactivity is a major risk
factor for many physical and
psychological conditions.
Sedentary living is associated with
heart disease, obesity, diabetes and
many other conditions.
Inactivity is also linked to low selfesteem and psychological depression.
Regular physical activity can
positively influence all of the above
conditions.
Physical Activity FAQ 7
IS EXERCISE SAFE?
Yes! Almost everyone can find a safe
and effective exercise program
tailored towards his or her health
status, physical activity goals, and
personal preferences.
It is far more risky to your health to be
sedentary than it is to begin a
program of light-to-moderate intensity
physical activity.
Physical Activity FAQ 8
AM I TOO OLD TO EXERCISE?
No! You are never too old to exercise!
Physical activity has been shown to
be of benefit for individuals of all ages
including persons as old as ninety and
one hundred years of age.
Many people just like you are active
on a daily basis. You can find a
physical activity program that you will
enjoy, that will make you feel better,
and that will increase your quality of
life.
Physical Activity FAQ 9
DO I NEED SPECIAL CLOTHING
AND EQUIPMENT?
No! Special clothing and equipment
are seldom needed.
Safe and effective physical activity
can be performed wearing
comfortable street shoes and loose
fitting everyday clothes.
Effective strength training can be
achieved with inexpensive equipment
such as elastic bands and water filled
jugs.
.
Its Simple!
Adults, get at least 30
minutes of physical activity
each day.
If it is too hard to set aside
30 minutes at one time,
break it up into 10 or 15
minute segments.