Harold W. Kohl, III, Ph.D. ILSI Center for Health Promotion Atlanta, GA USA

1. Results of Public Health Prevention Interventions Harold W. Kohl, III, Ph.D. ILSI Center for Health Promotion Atlanta, GA USA

2. Changes in prevalence of adult obesity among adult men, 7 countries. Percent Popkin and Doak, 1998

3. Changes in prevalence of adult obesity among adult women, 7 countries. Percent Popkin and Doak, 1998

4. Public health prevention of diabetes and obesity • What are we preventing/promoting? • When do we want to prevent/promote it? • In which settings should we put our efforts?

5. Public health prevention of obesity • Childhood/adolescence • overweight • obesity Prevention can mean treatment! • Adulthood • overweight • obesity

6. Public health prevention of type II diabetes • Childhood/adolescence • IFG • Diabetes Prevention can mean treatment! • Adulthood • IFG • Diabetes

7. Public health behavior promotion related to obesity and diabetes • Childhood/adolescence • Physical inactivity • Diet behaviors • Adulthood • Physical inactivity • Diet behaviors

8. Today’s goal • Attempt to summarize status of knowledge in areas of obesity and diabetes public health prevention interventions. • Provide framework for other experts on the panel as well as breakout groups. • Answer a few questions and raise more.

9. Summary of randomized, controlled studies on obesity (weight gain) prevention

10. Summary of observational studies on obesity (weight gain) prevention Cross-sectional studies suggest lower weights at higher levels of physical activity and diet ‘quality’ indicators. Longitudinal studies (n = 12) suggest an attenuation of weight gain at higher levels of physical activity. Change analyses suggest a lower risk of becoming overweight with an increase in activity

11. Mean weight change by cardiovascular fitness changes, ACLS, 1970-1994 Weight Change (kg) n=4,599 men and 724 women Mean time between fitness evaluations: 1.8 y Mean time of follow-up: 7.5 y Dipietro, et al, 1998

12. Summary of randomized, controlled studies on Type II diabetes prevention Diabetes Prevention Program (n>3,000) Diabetes Care 1999;22:623-634. Finnish Diabetes Prevention Study (n=523) Br. J. Nutrition 2000;83( Suppl. 1), s137-s142 Da Qing IGT and Diabetes Study (n=577) Diabetes Care 1997;537-544.

13. Summary of trials on diabetes prevention • All start with initial population with IFG. • Early work suggested possibility, but non-optimal study designs limited interpretation. • 2 current studies investigating solely ‘hygienic’ interventions. • Results of randomized, controlled trials suggest positive outcomes, incidence reductions of up to 30% may be possible.

14. Six-year incidence of diabetes by treatment condition and body composition: Da Qing China Percent Xiao-ren Pan, et al, 1997

15. Potential settings for health behavior interventions for children and adults School Community Provider Family

16. School-based interventions • Some have focused on obese or high-risk children (with physiologic outcomes) while most have included the entire school (behavioral outcomes) • Most have been multi-component interventions – behavioral, environmental, educational – and various risk factors • Short term results – implications for adult outcomes are unknown.

17. School-based interventions • Targeted interventions produce short-term weight loss. • Overweight children • Populations ‘at-risk’ • Curriculum and environmental changes are possible. • Changes in physical activity (PE) and food service policies are achievable as are short term changes in comprehension

18. School-based interventions • Varying “success”: changes in body composition measures not likely to follow changes in knowledge or behavior. • No approach has been tested across several ages or grades. • Few attempts for home-support of school intervention.

19. Community based interventions • Stanford Three-Community • Stanford Five-City • Minnesota Heart Health Program • Pawtucket Heart Health Program • North Karelia Project • Mauritius • Despite positive risk factor changes, no evidence of obesity-related treatment effects in 4 of 6 studies

20. Community based interventions • Pound of Prevention (only community-based study designed to prevent weight gain). • 1200 volunteers randomized to no-contact control, and education (with and without readership incentives) combined with intervention activities. • 3 year intervention • All three groups gained weight • Education alone appears insufficient on the community level. Jeffrey and French, 1999

21. What to do?

22. Current Recommendations Children should accumulate 30-60 minutes of moderate-to-vigorous physical activity each day

23. The Program • A classroom-based physical activity promotion program designed to reduce periods of inactivity during school day for elementary school children.

24. The Program • Integrates 10 minute periods of physical activity into school day combined with age-appropriate lessons of math, science, language arts, etc.

25. The Materials • Physical activity cards are linked to core academic objectives • Teacher manual coordinates the lessons • TAKE 10!™ Tracking Poster motivates kids • Teacher Training Video explains the program

26. Primary core academic curriculum objectives

27. Secondary Curriculum Objectives