Obesity, Latinos, and Diet Daniel Santibanez, MPH, University of North Florida May 27. 2005 - UNF Hispanic Health Issues Seminar This is part 4 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.

1. Obesity, Latinos, and Diet Daniel Santibanez, MPH Department of Public Health University of North Florida This is part 4 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department. For more information or register for the seminars, please call 620-1289.

7. The Increase in Overweight and Obesity Among Adults

9. 1996 2003 Obesity Trends* Among U.S. Adults BRFSS, 1991, 1996, 2003 (*BMI  30, or about 30 lbs overweight for 5’4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Source: Behavioral Risk Factor Surveillance System, CDC. 1991

10. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

11. Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

12. Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

13. Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

14. Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

15. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

16. Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

17. Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

18. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

19. Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

20. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

21. Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

22. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20

23. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20

24. Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20

25. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20

26. Obesity Trends* Among U.S. Adults BRFSS, 2001 No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

27. (*BMI  30, or ~ 30 lbs overweight for 5’4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002

28. Obesity* Trends Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

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32. Increase in Overweight and Obesity Prevalence Among U.S. Adults by Racial and Ethnic Group CDC. Center for Health Statistics. National Health and Nutrition Examination Survey. American Obesity Association Overweight Prevalence Obesity Prevalence Racial/ Ethnic Group 1988 to 1994 1999 to 2000 1988 to 1994 1999 to 2000 Mexican-American 67.4% 73.4% 28.4% 34.4% Black (non- Hispanic) 62.5% 69.6% 30.2% 39.9% White (non- Hispanic) 52.6% 62.3% 21.2% 28.7%

33. Increase in Overweight Prevalence Among U.S. Adults (Ages 20 -74) by Racial/Ethnic Group and Gender CDC. Center for Health Statistics. National Health and Nutrition Examination Survey. American Obesity Association Men Prevalence Women Prevalence Racial/ Ethnic Group 1988 to 1994 1999 to 2000 1988 to 1994 1999 to 2000 Mexican-American 69.4% 74.4% 69.6% 71.8% Black (non- Hispanic) 58.2% 60.1% 68.5% 78% White (non- Hispanic) 61.6% 67.5% 47.2% 57.5%

34. Increase in Obesity Prevalence Among U.S. Adults (Ages 20 -74) by Racial/Ethnic Group and Gender CDC. Center for Health Statistics. National Health and Nutrition Examination Survey. American Obesity Association Men Prevalence Women Prevalence Racial/ Ethnic Group 1988 to 1994 1999 to 2000 1988 to 1994 1999 to 2000 Mexican-American 24.4% 29.4% 36.1% 40.1% Black (non- Hispanic) 21.3% 28.8% 39.1% 40.1% White (non- Hispanic) 20.7% 27.7% 23.3% 30.6%

35. Increase in Severe Obesity (BMI ≥40) Prevalence Among U.S. Adults (Ages 20 and older) by Racial/Ethnic Group and Gender CDC. Center for Health Statistics. National Health and Nutrition Examination Survey. American Obesity Association Men Prevalence Women Prevalence Racial/ Ethnic Group 1988 to 1994 1999 to 2000 1988 to 1994 1999 to 2000 Mexican-American 1.1% 2.4% 4.8% 5.5% Black (non- Hispanic) 2.4% 3.5% 7.9% 15.1% White (non- Hispanic) 1.8% 3% 3.4% 4.9%

36. Source: Flegal et al. Nutrition Reviews. 2004; 62(7): S144-S148.

37. Florida: Prevalence of Overweight*, by race or ethnicity *Overweight is defined as having a body mass index of ≥ 25 and ≤ 29.9 Source: Behavioral Risk Factor Surveillance System (BRFSS), 2001. Mortality and Morbidity Weekly Report. August 23, 2003. 52(SS08); 1-80 Ethnicity % Overweight 95% CI ( ±) Hispanic 58.1 4.3 White, non-Hispanic 54.0 2.0 Black, non-Hispanic 71.8 5.3

38. Florida: Prevalence of Obesity*, by race or ethnicity *Obesity is defined as having a body mass index of ≥ 30 Source: Behavioral Risk Factor Surveillance System (BRFSS), 2001. Mortality and Morbidity Weekly Report. August 23, 2003. 52(SS08); 1-80 Ethnicity % Obese 95% CI ( ±) Hispanic 17.1 3.3 White, non-Hispanic 18.5 1.6 Black, non-Hispanic 32.8 6.1

40. Florida: 2000 BRFSS, Adults Overall Hispanic Black, non-Hispanic White, non-Hispanic % Overweight 35.2% % Obese 18.7% 20.2% 29.7% 17.0% Men: % Overweight 42.8% Men: % Obese 18.95% 17.5% 23.5% 18.9% Women: % Overweight 24.8% Women: % Obese 18.7% 22.8% 34.5% 15.3%

41. Florida: 2000 BRFSS, Adults Percent Obese Age Overall Hispanic Black, non-Hispanic White, non-Hispanic 18 – 29 years 13.8% 11.8% 20.1% 11.8% 30 – 44 years 21.2% 19.2% 31.3% 19.0% 45 – 64 years 23.9% 26.9% 37.4% 21.1% Over 65 years 15.8% 23.3% 25.2% 13.8%

45. Source: The rising tide of metabolic syndrome. Postgraduate Medicine. Dec 2004; 116(6):54-57

46. Diagnostic Criteria for Metabolic Syndrome Source: ATP III. Bethesda: National Institutes of Health, 2001 *A diagnosis of metabolic syndrome is made if a patient has three or more of the criteria listed. **The American Diabetes Association recently set a cut point of ≥ 100 mg/dL at which persons are considered to have impaired fasting glucose Feature Criterion* Abdominal Girth Men Women Waist Circumference > 102 cm (>40 in) > 88 cm (35 in) Fasting plasma HDL-C Men Women < 40 mg/dL (< 1.04 mmol/L) < 50 mg/dL (< 1.29 mmol/L) Fasting plasma triglycerides ≥ 150 mg/dL (≥ 1.69 mmol/L) Fasting blood glucose** ≥ 110 mg/L (≥ 6.1 mmol/L) Blood pressure ≥ 130/ ≥ 85 mm Hg

48. Source: The rising tide of metabolic syndrome. Postgraduate Medicine. Dec 2004; 116(6):54-57

49. Causes for Obesity Among Latinos The associations of poverty, acculturation, exercise, and diet to BMI implicate societal as well as individual contributors to obesity among U.S. Latinos.

50. Attitudes About Obesity Vary Across Cultures Where thinness is associated with extreme poverty, deprivation, or wasting diseases, obesity may be viewed as a symbol of social stature, prosperity, and robustness.

54. Florida: Prevalence of No Leisure-time Physical Activity in the Past Month Source: Behavioral Risk Factor Surveillance System (BRFSS), 2001. Mortality and Morbidity Weekly Report. August 23, 2003. 52(SS08); 1-80 Ethnicity % No Activity 95% CI ( ±) Hispanic 40.9% 4.3 White, non-Hispanic 23.1% 1.6 Black, non-Hispanic 33.2% 5.3

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