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Robert Wm. Blum MD, MPH, PhD Johns Hopkins University

Multilevel and Life Course Approaches to Obesity

My Background

  Came to the Bloomberg School in 2004 as professor and chair of the Department of Population, Family and Reproductive Health

  I love teaching this course because it provides the opportunity to merge my clinical background and academic interests

  Pediatrician by training

  Before coming to Hopkins, my clinical work was in adolescent medicine and in adolescent health

  This course looks at adolescent health within a broader context—the context of a life course perspective

  In this course, we’re aiming to ... -  Give you a framework and an understanding of major

developmental issues across the stages of human life -  Highlight measurement issues and effective interventions and

programs

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Multilevel Approaches to Obesity

Section A

Definitions

  Overweight: body mass index (BMI) between the 85th and 95th centile on growth charts

  Obesity: BMI over 30

  BMI:

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Obesity1 Trends among US Adults (BRFSS2, 1985)

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1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System Sources: Mokdad, A. H., et al. (1999, October 27). JAMA, 282, 16, 1519–1522; Mokdad, A. H., et al. (2001, September 12). JAMA, 286, 10, 1195–1200.

Obesity1 Trends among US Adults (BRFSS2, 1986)

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1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System Sources: Mokdad, A. H., et al. (1999, October 27). JAMA, 282, 16, 1519–1522; Mokdad, A. H., et al. (2001, September 12). JAMA, 286, 10, 1195–1200.

Obesity1 Trends among US Adults (BRFSS2, 1987)

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1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System Sources: Mokdad, A. H., et al. (1999, October 27). JAMA, 282, 16, 1519–1522; Mokdad, A. H., et al. (2001, September 12). JAMA, 286, 10, 1195–1200.

Obesity1 Trends among US Adults (BRFSS2, 1988)

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1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System Sources: Mokdad, A. H., et al. (1999, October 27). JAMA, 282, 16, 1519–1522; Mokdad, A. H., et al. (2001, September 12). JAMA, 286, 10, 1195–1200.

Obesity1 Trends among US Adults (BRFSS2, 1989)

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1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System Sources: Mokdad, A. H., et al. (1999, October 27). JAMA, 282, 16, 1519–1522; Mokdad, A. H., et al. (2001, September 12). JAMA, 286, 10, 1195–1200.

Obesity1 Trends among US Adults (BRFSS2, 1990)

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1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System Sources: Mokdad, A. H., et al. (1999, October 27). JAMA, 282, 16, 1519–1522; Mokdad, A. H., et al. (2001, September 12). JAMA, 286, 10, 1195–1200.

Obesity1 Trends among US Adults (BRFSS2, 1991)

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1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System Sources: Mokdad, A. H., et al. (1999, October 27). JAMA, 282, 16, 1519–1522; Mokdad, A. H., et al. (2001, September 12). JAMA, 286, 10, 1195–1200.

Obesity1 Trends among US Adults (BRFSS2, 1992)

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1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System Sources: Mokdad, A. H., et al. (1999, October 27). JAMA, 282, 16, 1519–1522; Mokdad, A. H., et al. (2001, September 12). JAMA, 286, 10, 1195–1200.

Obesity1 Trends among US Adults (BRFSS2, 1993)

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1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System Sources: Mokdad, A. H., et al. (1999, October 27). JAMA, 282, 16, 1519–1522; Mokdad, A. H., et al. (2001, September 12). JAMA, 286, 10, 1195–1200.

Obesity1 Trends among US Adults (BRFSS2, 1994)

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1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System Sources: Mokdad, A. H., et al. (1999, October 27). JAMA, 282, 16, 1519–1522; Mokdad, A. H., et al. (2001, September 12). JAMA, 286, 10, 1195–1200.

Obesity1 Trends among US Adults (BRFSS2, 1995)

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1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System Sources: Mokdad, A. H., et al. (1999, October 27). JAMA, 282, 16, 1519–1522; Mokdad, A. H., et al. (2001, September 12). JAMA, 286, 10, 1195–1200.

Obesity1 Trends among US Adults (BRFSS2, 1996)

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1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System Sources: Mokdad, A. H., et al. (1999, October 27). JAMA, 282, 16, 1519–1522; Mokdad, A. H., et al. (2001, September 12). JAMA, 286, 10, 1195–1200.

Obesity1 Trends among US Adults (BRFSS2, 1997)

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1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System Sources: Mokdad, A. H., et al. (1999, October 27). JAMA, 282, 16, 1519–1522; Mokdad, A. H., et al. (2001, September 12). JAMA, 286, 10, 1195–1200.

Obesity1 Trends among US Adults (BRFSS2, 1998)

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1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System Sources: Mokdad, A. H., et al. (1999, October 27). JAMA, 282, 16, 1519–1522; Mokdad, A. H., et al. (2001, September 12). JAMA, 286, 10, 1195–1200.

Obesity1 Trends among US Adults (BRFSS2, 1999)

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1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System Sources: Mokdad, A. H., et al. (1999, October 27). JAMA, 282, 16, 1519–1522; Mokdad, A. H., et al. (2001, September 12). JAMA, 286, 10, 1195–1200.

Obesity1 Trends among US Adults (BRFSS2, 2000)

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1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System Sources: Mokdad, A. H., et al. (1999, October 27). JAMA, 282, 16, 1519–1522; Mokdad, A. H., et al. (2001, September 12). JAMA, 286, 10, 1195–1200.

Obesity1 Trends among US Adults (BRFSS2, 2001)

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1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System Sources: Mokdad, A. H., et al. (1999, October 27). JAMA, 282, 16, 1519–1522; Mokdad, A. H., et al. (2001, September 12). JAMA, 286, 10, 1195–1200.

Obesity1 Trends among US Adults (BRFSS2, 2002)

23 1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System

Obesity1 Trends among US Adults (BRFSS2, 2003)

24 1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System

Obesity1 Trends among US Adults (BRFSS2, 2004)

25 1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System

Obesity1 Trends among US Adults (BRFSS2, 2005)

26 1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System

Obesity1 Trends among US Adults (BRFSS2, 2006)

27 1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System

Obesity1 Trends among US Adults (BRFSS2, 2007)

28 1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System

Obesity1 Trends among US Adults (BRFSS2, 2008)

29 1BMI ≥30, or ~30 lbs overweight for 5’4” woman 2CDC’s Behavioral Risk Factor Surveillance System

Why?

  What are the factors that contribute to obesity?

  Consider multilevel explanations -  Individual -  Family -  Peer -  School -  Community -  Policy

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