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10/10/2018 1 ruralhealthinfo.org

Rural Insights on Adult and Youth Obesity, a National and Community-based Perspective

Q & A to follow – Submit questions using Q&A area
Slides are available at

https://www.ruralhealthinfo.org/webinars/nchs-obesity

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Housekeeping

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10/10/2018 2 Shelby Polk DNP, APRN, FNP-BC, Associate Professor and Chair of Nursing Delta State University

Featured Speakers

Kendra B. McDow, MD, MPH, EIS Officer, Division of Health and Nutrition Examination Surveys NCHS Craig Hales, MD, MPH, Medical Epidemiologist, Division of Health and Nutrition Examination Surveys NCHS National Center for Health Statistics

The National Health and Nutrition Examination Survey (NHANES): An Overview

Kendra B. McDow, MD, MPH Rural Health Information Hub Webinar October 11, 2018

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NHANES Goals

US population-based estimates of:

– Health conditions – Awareness, treatment and control of selected diseases – Environmental exposures – Nutrition status and diet behaviors

Establish and maintain a biospecimen program

An Evolving Survey Since 1959

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History of NHANES

Survey Dates Ages NHES I 1959 – 62 18 – 79 years NHES II 1963 – 65 6 – 11 years NHES III 1966 – 70 12 – 17 years NHANES I 1971 – 75 1 – 74 years NHANES II 1976 – 80 6 months – 74 years HHANES 1982 – 84 6 months – 74 years NHANES III 1988 – 94 2 months + NHANES 1999-2018 All Ages

Nationally representative
Civilian, non-institutionalized US population
5,000 individuals examined annually
Oversampled groups:

– Non-Hispanic blacks – Non-Hispanic Asians – Hispanics – 80+ years of age – Low income whites Sampling Design

Overview

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Stage 4

Participants

Stage 1

Counties

Stage 2

Segments

Stage 3

Households

Sampling Design

Multistage Probability Sampling Design

In-person home interview
Physical assessments in Mobile Exam Centers (MEC)

– Physical exam measurements – Specialized testing – Private interviews – Lab specimen collection

Post exam assessments

Data Collection

Interviews and Physical Exams

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In-person home interview
Physical assessments in Mobile Exam Centers (MEC)

– Physical exam measurements – Specialized testing – Private interviews – Lab specimen collection

Post exam assessments

Data Collection

Interviews and Physical Exams

Demographic information
Health conditions
Health insurance and healthcare use
Prescription drugs and dietary supplements use

Data Collection

In-Home Interview

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In-person home interview
Physical assessments in Mobile Exam Centers (MEC)

– Physical exam measurements – Specialized testing – Private interviews – Lab specimen collection

Post exam assessments

Data Collection

Interviews and Physical Exams

Data Collection

MEC Physical Examinations

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10/10/2018 8 Data Collection

The MEC: A State-of-the Art Medical Facility

Configuration for NHANES 2017-2018

Data Collection

MEC Reception

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10/10/2018 9 Data Collection

Cardiovascular Health

Data Collection

Oral Health

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10/10/2018 10 Data Collection

Body Composition

Dual-energy X-ray absorptiometry (DXA)

Data Collection

Private Interviews

Dietary Recall Interviews Computer-Assisted Personal Interviews (CAPI)

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10/10/2018 11 Data Collection

MEC Laboratory

Complete Blood Count
Pregnancy test
Nutritional biomarkers
Hormone tests
Diabetes
Lipid profile
Biochemistry profile
Environmental chemicals
Infectious diseases

– Hepatitis viruses – Sexually transmitted infections Data Collection

Laboratory Tests

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10/10/2018 12 Data Collection

Anthropometry

NBA legend Dikembe Mutombo

In-person home interview
Physical assessments in Mobile Exam Centers (MEC)

– Physical exam measurements – Specialized testing – Private interviews – Lab specimen collection

Post exam assessment

Data Collection

Interviews and Physical Exams

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10/10/2018 13 Data Collection

Post Exam Assessment

Day 2 Dietary Recall

Data Release Process

– Quality Control – Editing/cleanup – Weighting – Data preparation – Documentation – Confidentiality review

Public data released in 2-year cycles

Data Release Process

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For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Thank you! Contact: Kendra B. McDow Email: omm9@cdc.gov https://www.cdc.gov/nchs/nhanes

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10/10/2018 16 National Center for Health Statistics

Prevalence of Obesity and Severe Obesity among Rural

vs. Urban Youth and Adults: U.S. 2001-2016

Craig M. Hales, MD, MPH, MS Medical Epidemiologist Division of Health and Nutrition Examination Surveys National Center for Health Statistics, CDC

Rural Health Information Hub Webinar October 11, 2018

National Health and Nutrition Examination Survey (NHANES)

Standardized measurements of height and weight

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Adult Obesity Prevalence is Lower Based on Self- reported Compared to Measured Height and Weight

39.6 29.6 5 10 15 20 25 30 35 40 45 Measured (NHANES 2015-16) Self-reported (BRFSS 2016)

Obesity Prevalence (%)

BRFSS = Behavioral Risk Factor Surveillance System

Defining Obesity

Body Mass Index (BMI) BMI =

𝑋𝑓𝑗𝑕ℎ𝑢 (𝑙𝑕) 𝐼𝑓𝑗𝑕ℎ𝑢 (𝑛2)

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Defining Obesity in Adults Aged ≥ 20 Years

Obesity: BMI ≥ 30

– For a 5’9” adult: 203 lbs or more

Severe obesity: BMI ≥ 40

– For a 5’9” adult: 271 lbs or more

Defining Obesity in Youth Aged 2-19 Years (U.S.)

Obesity:

BMI-for-age ≥ 95th percentile
Average height 10-year old boy: ≥ 98 lbs

Severe obesity:

BMI-for-age ≥ 120% of 95th percentile
Average height 10-year old boy: ≥ 118 lbs

95th percentile

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Obesity and Severe Obesity Prevalence Among U.S. Adults Continues to Increase

10 20 30 40

1960- 1962 1971- 1974 1976- 1980 1988- 1994 1999- 2000 2001- 2002 2003- 2004 2005- 2006 2007- 2008 2009- 2010 2011- 2012 2013- 2014 2015- 2016

Percent Source: National Health and Nutrition Examination Survey, Fryar et

al. Health E-Stats 2018

Obesity, women Obesity, men Severe obesity, women Severe obesity, men

Obesity and Severe Obesity Prevalence Among U.S. Youth Has Leveled Off But Continues To Be High

10 20 30

1960- 1962 1971- 1974 1976- 1980 1988- 1994 1999- 2000 2001- 2002 2003- 2004 2005- 2006 2007- 2008 2009- 2010 2011- 2012 2013- 2014 2015- 2016

Percent Source: National Health and Nutrition Examination Survey, Fryar et

al. Health E-Stats 2018

Obesity Severe obesity

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Disparities in Obesity Prevalence

Socioeconomic status
Race and ethnicity
Geographic location (state)

Source: Ogden CL, et al MMWR 2018

Obesity Prevalence Higher and Increasing Among Girls in Households with Lower Education

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Disparities in Obesity Prevalence by Race and Ethnicity Vary by Sex

Source: Hales et al. Data Brief 2017

10 20 30 40 50 60 Men Women Non-Hispanic white Non-Hispanic black Non-Hispanic Asian Hispanic

Prevalence of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2017

BRFSS = Behavioral Risk Factor Surveillance System

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Urban/Rural Disparities in Obesity and Severe Obesity Prevalence using NHANES

NCHS Urban-Rural Classification Scheme for Counties

Large MSA

MSA = Metropolitan Statistical Area NCHS = National Center for Health Statistics

Medium or Small MSA Rural (Non-MSA)

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Adults: Increasing Obesity Prevalence from Urban to Rural Areas, 2013-2016

31.8 42.4 38.9 5 10 15 20 25 30 35 40 45 50 Large MSA Medium or Small MSA Rural

Percent

Men

38.1 42.5 47.2 Large MSA Medium or Small MSA Rural

Women

Adults: Increasing Severe Obesity Prevalence from Urban to Rural Areas, 2013-2016

4.1 6.1 9.9 5 10 15 20 25 30 35 40 45 50 Large MSA Medium or Small MSA Rural

Percent

Men

8.1 11.1 13.5 Large MSA Medium or Small MSA Rural

Women

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MEN: Obesity and Severe Obesity Prevalence Increased in Urban and Rural Areas 2001-2016

5 10 15 20 25 30 35 40 45 50 2001-2004 2005-2008 2009-2012 2013-2016

Percent

Obesity Severe obesity

MEN: Obesity and Severe Obesity Prevalence Increased in Urban and Rural Areas 2001-2016

5 10 15 20 25 30 35 40 45 50 2001-2004 2005-2008 2009-2012 2013-2016

Percent

Obesity Severe obesity

Tripled from 2.8% to 9.9% in rural areas

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WOMEN: Obesity and Severe Obesity Prevalence Increased in Urban and Rural Areas 2001-2016

5 10 15 20 25 30 35 40 45 50 2001-2004 2005-2008 2009-2012 2013-2016

Percent

Obesity Severe obesity

WOMEN: Obesity and Severe Obesity Prevalence Increased in Urban and Rural Areas 2001-2016

5 10 15 20 25 30 35 40 45 50 2001-2004 2005-2008 2009-2012 2013-2016

Percent

Obesity Severe obesity

Doubled from 6.4% to 13.5% in rural areas

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Youth: Obesity Prevalence in Rural and Urban Areas, 2013-2016

17.1 17.2 21.7 5 10 15 20 25 Large MSA Medium or Small MSA Rural

Percent

Youth: Higher Severe Obesity in Rural Compared to Urban Areas, 2013-2016

5.1 5.3 9.4 5 10 15 20 25 Large MSA Medium or Small MSA Rural

Percent

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Youth: No Increasing Trends in Obesity or Severe Obesity in Urban or Rural Areas 2001-2016

5 10 15 20 25 2001-2004 2005-2008 2009-2012 2013-2016

Percent

Obesity Severe obesity

Disparities in Obesity Prevalence: Rural vs. Urban

Obesity

Higher among adults

Severe obesity

2x higher among adults and youth
2001-2016 rural trends:

– 3x ↑ in men – 2x ↑ in women

vs.

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10/10/2018 28 JAMA 2018; 319(23) June 19

See Full Reports: Acknowledgements

Cynthia L. Ogden, PhD
Cheryl D. Fryar, MSPH
Margaret D. Carroll, MSPH
David S. Freedman, PhD
Yutaka Aoki, PhD

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For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the

fficial position of the Centers for Disease Control and Prevention.

Thank you!

chales@cdc.gov

HRSA Delta State Rural Development Network Grant Program (DELTA)

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Evi Evide denc nced ed-Base Based d Pr Prog

grams

ams

Weight Loss Pilot Programs

SHAPEDOWN
10 Weeks
2 hour sessions
1 hour education
1 hour physical activity
Structured Weight Loss Program
CMS Intensive Behavioral Therapy for Obesity

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What Was Learned?

GAP GAPS

Research
Practice
Program Development

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How Do We Deepen Rural Engagement?

Communities
Change the “NORM”
Healthy Living Where We
Live, Work, Learn, & Play
Train People Living in the Community

Questions?

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