Georgia epidemiology report, Vol. 21, no. 9 (Sept. 2005)

September 2005

volume 21 number 09

Obesity In Georgia

Introduction Obesity is an epidemic in Georgia, affecting all segments of the population. Excess body fat is associated with increased mortality. An estimated 6,700 Georgians died in 2003. Approximately 10% of all deaths in Georgia.1 The causes of the deaths are heart disease, some cancers, stroke, type 2 diabetes, and other medical conditions that arise from the metabolic and mechanical abnormalities induced by excess body fat.2 Obesity-related diseases occur most often in adults, but overweight children and adolescents can develop type 2 diabetes, high blood lipids, hypertension, asthma, sleep apnea, early maturation, and orthopedic problems. Psychosocial consequences of excess body fat are particularly common in children.3,4 The medical costs of obesity in the U.S. have been estimated at $75 - $100 billion per year.5,6 The estimate for Georgia is about $2.1 billion per year, or $250 per Georgian per year.5 Excess body fat is associated with both direct costs such as diagnostic and treatment services related to overweight and obesity, and indirect costs such as lost wages and reduced productivity due to illness, disability, and premature death.
The adverse health and economic effects of obesity can be reduced by preventing excess fat gain in the general population and by reducing fat among the obese and overweight. Normal body weight is maintained by balancing energy intake and energy expenditure. Although body weight is the relationship between "energy in" and "energy out", the amount of food we eat and how we live are influenced by a complex combination of biological, lifestyle, socio-economic, cultural and environmental factors. Current nutritional recommendations include eating a variety of fruits and vegetables, whole grains and fat-free or low-fat milk products, and striving for a total fat intake between 25% and 35% of total calories.7 Physical activity recommendations encourage children and adolescents to accumulate at least 60 minutes of age- and developmentally appropriate physical activity from a variety of physical activities on most days of the week.8 Adults should accumulate at least 30 minutes of moderateintensity physical activity (such as brisk walking, bicycling, or gardening) on at least five, preferably all, days of the week.7
This report describes the prevalence of overweight and obesity among children served by the Women, Infants, and Children (WIC) program, middle school students, high school students, and adults in Georgia and also highlights contributing factors to overweight and obesity. In addition, this report describes the status of selected Healthy People 2010 objectives relating to obesity, nutrition, and physical activity in Georgia. Healthy People 2010 is a document published by U.S. Department of Health and Human Services containing goals and objectives to guide the efforts of health workers this decade.9
Methods Data on overweight and obesity in Georgia were collected by three statewide surveillance systems. Measured height and weight for children ages 2 through 4 years in WIC was obtained from the Pediatric Nutrition Surveillance System (PedNSS).10 Self-reported height and weight were collected for a representative sample of middle and high school students from the Georgia Student Health Survey11 and adults through the Georgia

Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a telephone survey of a random sample of adults ages 18 years and older.12 Data on contributing factors to overweight and obesity for adolescents and adults were collected by YRBSS and BRFSS, respectively. Information on policies and environments supporting healthful behaviors in Georgia were obtained from the School Health Education Profile13 and Georgia Worksite Health Promotion, Policies, and Practices surveys.14
The prevalence of overweight and obesity was estimated through the calculation of Body Mass Index (BMI) from the height and weight of an individual. BMI was calculated by dividing a person's weight in kilograms by height in meters squared. Overweight was defined in children and adolescents using standard BMI-for-age growth charts. Children and adolescents are classified as overweight if their BMI-forage is in the 95th percentile or higher.15 For adults, overweight was defined as a BMI of at least 25.0, but less than 30.0. Adults with a BMI of 30.0 or greater are considered obese.16

Figure 1. Percent of overweight children and adolescents in Georgia compared to Healthy People 2010 Objectives for the United States

20

Georgia

National Objective

Percent

15 12
10
5

14 5

11 5

0 WIC Children ages 2-4*

Middle School

High School

Sources: *Pediatric Nutrition Surveillance System 2003 Georgia Student Health Survey 2003

Results Prevalence Twelve percent of children aged 2 through 4 years participating in the WIC program in 2003 were overweight (Figure 1). This is two and a half times higher than the percentage of children expected in this category (5%). There has been a steady increase in the prevalence of overweight in this population, rising from 7% in 1992 to 12% by 2003. This represents an average relative increase of 6% per year in the prevalence of overweight over the past decade.10
Fourteen percent of middle school students and 11 percent of high school students were overweight (Figure 1).11 The percentage of overweight students is over two-fold higher than the Healthy People 2010 objective (5%) for this age group.9 The prevalence of overweight was consistently higher than the national objective across all sex, race, and grade groups except white female high school students.11

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Figure 2. Percent of overweight or obese adults by health district, Georgia

1993-1996

1997-1999

2000-2002

< 50 %

50% -<55%

Source: Georgia Behavioral Risk Factor Surveillance System

55% -<60%

60 % or more

Sixty-one percent of adults over the age of 18 years were overweight (35%) or obese (25%) in 2003.12 The percent of adults who are overweight or obese has been increasing since the BRFSS data were first collected, rising from 37% in 1984 to 61% in 2003, representing an average relative increase of 3% per year. This rise has occurred in all regions of the state (Figure 2).1
Contributing factors According to results from the YRBSS and BRFSS, adolescents and adults in Georgia have not made significant progress in reducing their risk for overweight and obesity. Only 68% of middle and 59% of high school students engaged in vigorous activity, 17% of high school students consumed five or more servings of fruits and vegetables per day, and approximately half of middle (52%) and high (42%) school students watched at least 3 hours of television per school day (Figure 3).11 Similar to adolescents, far too many adults do not engage in health promoting behavior. Only 42% of adults were regularly active and 23% consumed five or more servings of fruits and vegetables per day in 2003 (Figure 3).12
Policies and environments supporting healthful behaviors Schools are one of the most effective intervention settings to reduce and prevent some of the most serious public health problems in children and adolescents.17 Results from the 2002 School Health Education Profile13 showed few middle (6%) and high (11%) schools in Georgia had a policy to offer fruits and vegetables at school settings. While most middle (62%) and high (94%) schools required students to take at least one course in physical education, less than one-third (29%) of students attended daily physical education class in 2003.11 The Healthy People 2010 goal for daily school physical education participation is 50%.9
With the majority of adults not getting enough physical activity or proper nutrition, worksites provide an opportune setting to address behavior change by creating or modifying policies and environments supporting healthy behaviors.18 According to the 2002 Georgia Worksite Health Promotion, Policies, and Practices

Survey14, few worksites offered programs to promote physical activity (17%) or healthy eating (10%) to employees. These percentages were well below the goals set in Healthy People 2010 (75%).9 In addition, few worksites had policies supporting physical activity through offering flextime for physical activity (17%) or subsidizing rates of health club memberships (23%).14

Percent

Figure 3. Prevalence of physical activity, fruits and vegetables consumption, and TV viewing among adolescents and adults,
Georgia, 2003

Middle School 80

70

68

59 60

50 42
40

High School

Adults

52 42

30

23

20

17

10

0

Vigorously active

5+ Fruits &

3+ hrs TV/school

(youth)* and regularly

Vegetables/day*

day*

active (adults)

Sources: *Georgia Student Health Survey Behavior Risk Factor Surveillance System

Discussion
Overweight and obesity are a growing public health problem in Georgia. The consequences of the epidemic have a severe health and economic impact on the state. Since many Georgians do not engage in healthy behaviors, strategies aimed at reducing the burden of overweight and obesity must target change at the individual-, organizational-, community- and societal-levels.

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The Georgia Division of Public Health has worked to address the problem of overweight and obesity by convening stakeholders to lead the development and implementation of a 10-year nutrition and physical activity plan for Georgia. The statewide collaborative group, Take Charge of Your Health, Georgia!, includes Department of Human Resources, Division of Public Health staff; state departments of education, transportation, and parks and recreation staff; leaders from faith- and community-based organizations; health care professionals; universities; and statewide coalitions. Take Charge of Your Health, Georgia! is also working in partnership with Governor Perdue's Live Healthy Georgia to promote healthy eating and physical activity. The plan targets nutrition, physical activity, television viewing, and breastfeeding behavior modification in the school, worksite, health care, faith-based, and community settings.
Health care providers have an important role in the prevention, control, and treatment of obesity. The nutrition and physical activity plan encourages providers to expand partnerships for referrals between providers, offer continuing education on obesity treatment and weight management, and managed care organizations to reimburse providers for prevention and treatment of obesity. Health care providers are encouraged to take training in the areas of healthy eating, breastfeeding, physical activity, and behavior change as well as routinely assess and monitor BMI among patients while providing appropriate nutrition and physical activity counseling.
Links to reports highlighting the prevalence of, contributing factors to, and strategies to address overweight and obesity by can be found on the Georgia Department of Human Resources, Division of Public Health website: www.health.state.ga.us.
Acknowledgements The authors would like to thank all of the contributors to the Overweight and Obesity in Georgia, 2005 report as well as members of the Take Charge of Your Health, Georgia! Task Force for their role in the development and implementation of the nutrition and physical activity plan for Georgia. Funding for the Task Force is provided through a Cooperative Agreement (U58/CCU422817-01) between the Georgia Department of Human Resources, Division of Public Health and the Centers for Disease Control and Prevention, Division of Nutrition and Physical Activity.
Authors: Matthew Falb, M.H.S. and Dafna Kanny, Ph.D. Please send correspondence to: Matthew Falb, Georgia Department of Human Resources, Division of Public Health 2 Peachtree St. NW, Suite 14-476 Phone: 404-651-9524 Fax: 404-463-0780
References 1. Georgia Department of Human Resources, Division of Public
Health. Overweight and Obesity in Georgia, 2005. April, 2005. Publication number: DPH05.023HW. 2. U.S. Department of Health and Human Services. The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. Rockville, MD: U.S. Department of Health and Human

Services, Public Health Service, Office of the Surgeon General; 2001. 3. World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation on Obesity, Geneva, 3-5 June 1997. WHO Technical Report Series, No. 894, 2000. 4. American Academy of Pediatrics. Type 2 Diabetes in Children and Adolescents. Pediatrics 2000;105:671-680. 5. American Academy of Pediatrics. Finkelstein EA, Fiebelkorn IC, Wang Guijing. State-level Estimates of Annual Medical Expenditures Attributable to Obesity. Obes Res 2004;12:18-24. 6. Wolf AM, Colditz GA. Current Estimates of the Economic Costs of Obesity in the United States. Obes Res 1998; 6(2):97-106. 7. United States Department of Agriculture, U.S. Department of Health and Human Services, Dietary Guidelines for Americans, 2005, Sixth Edition, 2005. 8. Strong WB, Malina RM, Blimkie CJ, Daniels SR, Dishman RK, Gutin B, et al. Evidence based physical activity for school-age youth. Pediatrics 2005;146(6):732-7. 9. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd Edition. Washington, DC: U.S. Government Printing Office, November 2000. 10. Pediatric Nutrition Surveillance System: Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 11. Kanny D, Powell KE. 2003 Georgia Student Health Survey Report. Georgia Department of Human Resources, Division of Public Health, November 2003. Publication Number: DPH03/ 144. 12. Behavioral Risk Factor Surveillance System: Atlanta, GA. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 13. Kanny D, Choi H, Hammand DA. School Health Education in Georgia: Results from the 2002 School Health Education Profile (SHEP) Survey. Georgia Department of Human Resources, Division of Public Health, February 2004. Publication Number DPH04.181HW. 14. Choi HS, Bricker SK, Troy K, Kanny D, Powell KE. Worksite Health Promotion Policies and Practices in Georgia: 2002 Georgia Worksite Survey. Georgia Department of Human Resources, Division of Public Health, January 2004. Publication Number DPH03/156HW. 15. Kuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC growth charts for the United States: Methods and development. National Center for Health Statistics. Vital Health Stat 2002; 11(246). 16. National Institutes of Health. Clinical Guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. National Institutes of Health, 1998, Publication Number 98-4083. 17. Institute of Medicine. Schools and Health: Our Nation's Investment. Washington, DC: National Academy Press, 1997. 18. Centers for Disease Control and Prevention. Promising Practices in Chronic Disease Prevention and Control: A Public Health Framework for Action. Atlanta, GA: Department of Health and Human Services, 2003.

Division of Public Health http://health.state.ga.us
Stuart T. Brown, M.D. Director
State Health Officer

Epidemiology Branch http://health.state.ga.us/epi
Susan Lance, D.V.M., Ph.D. Director
State Epidemiologist

Georgia Epidemiology Report Editorial Board
Carol A. Hoban, M.S., M.P.H. Editor Kathryn E. Arnold, M.D.
Cherie Drenzek, D.V.M., M.S. Susan Lance, D.V.M., Ph.D.
Stuart T. Brown, M.D. Angela Alexander - Mailing List Jimmy Clanton, Jr. - Graphic Designer
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Two Peachtree St., N.W. Atlanta, GA 30303-3186 Phone: (404) 657-2588
Fax: (404) 657-7517

Georgia Department of Human Resources
Division of Public Health

Please send comments to: Gaepinfo@dhr.state.ga.us

The Georgia Epidemiology Report Epidemiology Branch Two Peachtree St., NW Atlanta, GA 30303-3186

PRESORTED STANDARD U.S. POSTAGE
PAID ATLANTA, GA PERMIT NO. 4528

September 2005

Volume 21 Number 09

Reported Cases of Selected Notifiable Diseases in Georgia Profile* for June 2005

Selected Notifiable Diseases
Campylobacteriosis Chlamydia trachomatis Cryptosporidiosis E. coli O157:H7 Giardiasis Gonorrhea Haemophilus influenzae (invasive) Hepatitis A (acute) Hepatitis B (acute) Legionellosis Lyme Disease Meningococcal Disease (invasive) Mumps Pertussis Rubella Salmonellosis Shigellosis Syphilis - Primary Syphilis - Secondary Syphilis - Early Latent Syphilis - Other** Syphilis - Congenital Tuberculosis

Total Reported for June 2005
2005 84
2724 7 3 32
1305 6 15 14 2 0 3 0 7 0
202 49 4 15 10 37 0 49

Previous 3 Months Total

Ending in June

2003

2004 2005

174

153

181

9009

8853

7860

26

24

24

8

13

6

190

225

125

4382

3912

3492

18

36

22

131

90

30

151

115

35

12

20

9

6

4

0

7

4

5

1

0

0

12

10

14

0

0

0

388

403

420

405

190

133

31

35

17

133

139

76

223

98

55

225

213

161

5

2

0

142

159

111

Previous 12 Months Total

Ending in June

2003 2004

2005

665

605

603

35786

35094

33209

127

136

161

35

30

21

905

875

791

18576

16566

15646

76

115

108

512

689

182

552

626

330

30

41

32

11

10

4

32

27

19

1

2

3

34

32

39

0

1

0

1940

2075

1958

1980

753

562

113

141

85

435

487

382

799

543

255

849

813

756

13

5

2

553

547

471

* The cumulative numbers in the above table reflect the date the disease was first diagnosed rather than the date the report was received at the state office, and therefore are subject to change over time due to late reporting. The 3 month delay in the disease profile for a given month is designed to minimize any changes that may occur. This method of summarizing data is expected to provide a better overall measure of disease trends and patterns in Georgia.

** Other syphilis includes latent (unknown duration), late latent, late with symptomatic manifestations, and neurosyphilis.

AIDS Profile Update

Report Period
Latest 12 Months: 09/04-08/05 Five Years Ago: 09/00-08/01 Cumulative: 07/81-08/05

Total Cases Reported* <13yrs >=13yrs Total

5

1,595 1,600

10

1,210 1,220

224

28,731 28,955

Percent Female
25.2
26.3
19.3

Risk Group Distribution (%) MSM IDU MSM&IDU HS Blood Unknown

32.1

5.5

2.3

10.6

1.3

48.2

30.3

10.1

2.6

17.4

1.9

37.8

45.4

15.8

4.9

14.4

1.9

17.6

Race Distribution (%) White Black Other

22.5 75.5

2.0

20.1 75.3

4.6

31.9 65.6

2.5

MSM - Men having sex with men

IDU - Injection drug users

HS - Heterosexual

* Case totals are accumulated by date of report to the Epidemiology Section

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