minnesota studies of health education and environmental
TRANSCRIPT
Minnesota Studies of Health Education and Environmental
Approaches to Obesity Treatment and Prevention
Minnesota Studies of Health Education and Environmental
Approaches to Obesity Treatment and Prevention
Robert W. Jeffery, Ph.D.University of Minnesota
USA
Robert W. Jeffery, Ph.D.University of Minnesota
USA
Prevalence of Obesity (BMI ≥ 30) in US Adults, 1960-2000
Flegel et al., 2002
05
101520253035
1960 1970 1980 1990 2000
MenWomen
Perc
ent
Perc
ent
Prevalence of Obesity (BMI ≥ 30) in US Adults, 1960-2000 by Age
Flegel et al., 2002
0
10
20
30
40
1960 1970 1980 1990 2000
20-39 yrs40-59 yrs60-74 yrs
Perc
ent
Perc
ent
Prevalence of Overweight in US Children, 1970-2000
Ogden et al., 2002
0
5
10
15
20
1970 1980 1990 2000
2-5 yrs6-11 yrs12-19 yrs
Perc
ent
Perc
ent
05
1015202530
1970 1980 1990 1999
Total energyTotal fatTotal CHO
From USDA
Percent change in per capita disappear-ance of total energy, total fat, and total CHO in the US, 1970-99.
Percent change in per capita disappear-ance of total energy, total fat, and total CHO in the US, 1970-99.
% C
hang
e
What Can Be Done About the Obesity Epidemic?
What Can Be Done About the Obesity Epidemic?
! Better education about eating and exercise.
! Reduce environmental exposures that promote overeating and under-exercising.
The Healthy Worker Project (HWP)
The Healthy Worker Project (HWP)
A randomized trial of worksite interventions for
weight loss.
Jeffery et al, 1993
-1.00-0.75-0.50-0.250.000.250.500.751.00
Baseline Follow-up
Treatment
Control
HWP: Mean change in BMI over 2 years.HWP: Mean change in BMI over 2 years.
Controlling for age, sex, and education.Jeffery et al, 1993
BM
I cha
nge
Minnesota Heart Health Program (MHHP)
Minnesota Heart Health Program (MHHP)
A 10-year research and demonstration project to evaluate the
effectiveness of multicomponentinterventions to reduce CVD
incidence and mortality
Luepker et al, 1994
25.0025.2525.5025.7526.0026.2526.5026.7527.00
-3 -2 -1 0 1 2 3 4 5 6 7
ComparisonEducation
Mean BMI in MHHP education and comparison communities by year: Cross-sectional surveys.Mean BMI in MHHP education and comparison communities by year: Cross-sectional surveys.
BM
IB
M I
B(3) B(2) B(1) B0 E1 E2 E3 E4 E5 E6 E7B(3) B(2) B(1) B0 E1 E2 E3 E4 E5 E6 E7
B and E YearsB and E YearsJeffery et al, 1995
Pound of Prevention (POP)
Pound of Prevention (POP)
Randomized trial evaluating the effectiveness of a low-cost
educational approach in reducing the rate of weight
gain with age.Jeffery et al, 1999
Weight change (lb) by treatment group by year.Weight change (lb) by treatment group by year.
0
1
2
3
4
5
Baseline Year 1 Year 2 Year 3
ControlNewsletterNewsletter + Incentive
Adjusted means, controlling for age, sex, type, education, and ∆ smoking. Jeffery et al, 1999
Weigh-To-BeWeigh-To-Be
A randomized trial of mail and phone interventions for
weight loss in a managed care setting.
Jeffery, 2003
Weigh-To-Be Participant Characteristics
Weigh-To-Be Participant Characteristics
! 1801 MCO members with BMI ≥ 27.0
! Recruited by direct mail, clinic flyers, and physician referral
! 72% women
! Mean BMI = 33.6
Weigh-To-Be TreatmentsWeigh-To-Be Treatments
! Usual care
! 10 phone counseling lessons
! 10 interactive lessons by mail
Weigh-To-Be EvaluationWeigh-To-Be Evaluation
! Clinic visits at baseline and 24 months
! Mailed surveys at 6, 12, and 18 months
Weigh-To-Be Weight Loss ResultsWeigh-To-Be Weight Loss Results
-4
-3
-2
-1
0
1
2
Baseline 6 months 12 months 24 months
ControlMailPhone
Wei
ght l
oss
(kg)
Wei
ght l
oss
(kg)
Cafeteria Study of Price and Availability Influences on Fruit and
Salad Consumption
Cafeteria Study of Price and Availability Influences on Fruit and
Salad Consumption
! Three (3) weeks baseline observation! Three (3) weeks interventions
" 50% price reduction" increased choices
! Three (3) weeks return to baseline
Jeffery et al, 1994
0
10
20
30
40
50
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45
DayDay
BaselineBaseline InterventionIntervention Follow-upFollow-up
X = 11X = 11 X = 31X = 31 X = 14X = 14Num
ber o
f Fru
it Pu
rcha
ses
Num
ber o
f Fru
it Pu
rcha
ses
Jeffery et al, 1994
0
10
20
30
40
50
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45
DayDay
Poun
ds o
f Sal
ad
Purc
hase
dPo
unds
of S
alad
Pu
rcha
sed
BaselineBaseline InterventionIntervention Follow-upFollow-up
X = 8X = 8 X = 24X = 24 X = 12X = 12
Jeffery et al, 1994
020406080
100
Average School 1urban
School 2Suburban
Baseline 1Low priceBaseline 2
Fruit Sales as a Function of PriceFruit Sales as a Function of Price
Average versus each school
French et al, 1997
Mea
n w
eekl
y fr
uit s
ales
01020304050
%
Same price 50% low-fat
discount
Same price
Low-Fat Snack Sales in Vending Machines (%) as a Function of PriceLow-Fat Snack Sales in Vending
Machines (%) as a Function of Price
French et al, 1997
Equal -10% -25% -50%Equal -10% -25% -50%
WorksiteWorksiteSchoolSchool
NoneNone
Low-FatLabel
Low-FatLabel
Label +Sign
Label +Sign
Prom
otio
n
Price
Setti
ng
CHIPS Study DesignCHIPS Study Design
0
5
10
15
20
25
No Label Label Label & Sign
PromotionPromotion
% S
ales
LF
Snac
ksEffect of Health Promotion on
Low-Fat Snack SalesEffect of Health Promotion on
Low-Fat Snack Sales
% Increase in sales: 1% 8%
French et al, 2001
05
10152025
Equal -Ź10% -Ź25% -Ź50%% S
ales
LF
Snac
ks
Price% Increase in sales: 9% 39% 93%
Effect of Price on Low-Fat Snack Sales
Effect of Price on Low-Fat Snack Sales
French et al, 2001
1. Free gym membership to University employees: NO EFFECT!
2. Free gym membership to 616 weight gain prevention study participants: 2 USED THEM�!
Results of Two Studies on the Effects of Price on the Use of Exercise Facilities
Results of Two Studies on the Effects of Price on the Use of Exercise Facilities
French, et al 1994
Sherwood, et al 1998
13.8c15.5b
12.7a
11.1a
0
5
10
15
20
NoIntervention
Signs Signs +Music +Artwork
NoIntervention
% P
eopl
e U
s in g
th
e S t
a irs
Percentage of People Using the Stairs During Each Phase of the Study
Percentage of People Using the Stairs During Each Phase of the Study
NOTE: Percentages with unshared superscripts differ significantly, p < .05 Boutelle et al, 2002
TACOSTACOS
A two-year group randomized trial evaluating the effects of environmental and promotional interventions on student purchases of lower fat food served a la carte and in vending machines.
French 2003
TACOS SchoolsTACOS Schools
! 10 treatment, 10 control
! Median students/school: 1,731
TACOS InterventionTACOS Intervention
! Increase offerings of lower fat a la carte foods.
! Student led promotions for lower fat foods.
TACOS: Most commonly available a la carte foods.
TACOS: Most commonly available a la carte foods.
% of total Number of Category food item schoolsChips/crackers 11.5 19Entrees 10.0 14Ice cream 9.9 20Cookies (packaged) 8.7 18Pastry (school prepared) 5.5 16Pastry (packaged) 5.4 17Cookies (school prepared) 5.3 17Candy 4.8 10Fruits/vegetables 4.5 1735.4% of products low fat (5.5 gm per serving)
TACOS: Vending MachinesTACOS: Vending Machines
Median per school
Total 12Snack 2Soft drink 4Others 5
35.0% of products low fat (5.0 gm per serving)
ConclusionsConclusions! Nutrition education is not a very effective
method for reducing population obesity.
! Behavior changes associated with environmental approaches are encouraging.
! Effectiveness of environmental interventions in changing weight need experimental study.
! Ignorance: We�re not sure how we got here and thus aren�t sure how to get back.
! Value Conflicts: Social and economic consequence of solutions won�t please everyone.
! Lack of Social Consensus:" On the urgency of the problem." On necessary steps towards its resolution.
Obstacles to Effective Public PolicyObstacles to Effective Public Policy
Public Opinion on Who Is Responsible for Today�s Diet-Related Problems
(n = 821)
Public Opinion on Who Is Responsible for Today�s Diet-Related Problems
(n = 821)
! Individuals 80%
! Stores 2%
! Manufacturers 14%
Jeffery et al, 1990