SAC360

1. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.
CHAPTER 16
Public Health Enemy
Number Two—and
Growing: Poor Diet
and Physical
Inactivity

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Health Risks of Obesity
 Cardiovascular disease
 Diabetes
 Some cancers
 Arthritis

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Epidemiology of Obesity
 Prevalence of overweight and obesity have been increasing since the 1960s in
all ages and genders.
 In the U.S., 74.6% of men and 67.4% of women are overweight or obese.
 Black women are more likely than white women to be overweight or obese.
 White men are slightly more likely than black men to be overweight or obese.
 Higher SES is associated with lower rates of overweight and obesity, especially
among women.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Measuring Health Risk
 BMI
– Calculated from height and weight
– Overweight 25–29.9 BMI, Obese >30 BMI
 Waist-to-hip ratio
– Distribution of fat on the body
– Pear-shaped versus apple-shaped bodies

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Overweight among Children
 Prevalence of overweight among 2- to 19-year-olds increased from under 10%
in 1988–1994 to >17.8% in 2013–2016.
 High prevalence exists among Black and Hispanic youth.
 Type 2 diabetes is being diagnosed in children.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Diet and Nutrition
 Federal Dietary Guidelines for Americans:
– More fruits and vegetables, whole grains, low-fat milk and dairy products
– Less refined grains, added sugar, salt, cholesterol, saturated and trans fats
– ChooseMyPlate.gov

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Dietary Surveys by USDA
 Diet of about 75% of U.S. population falls short of the federal
recommendations.
 Vegetables are the most commonly omitted item.
 Intake of sweetened beverages has increased; intake of milk has decreased.
– Sweetened beverages account for about 7% of daily calorie intake.

8. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Promoting Healthy Eating
 Many social, cultural, and economic factors contribute to dietary patterns.
 Learn from tobacco control success.
 Enhance self-efficacy and provide social support.
 Apply California’s “5-A-Day” Campaign for Better Health.
 Increase access to healthier food options.
– Restaurants, schools, worksites
 Reduce less healthy foods in public venues.
– High calorie drinks and fast food in schools
– Limit or tax sugar-sweetened beverages (SSBs) and junk food.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
What Can Be Learned from Tobacco
Control Programs?
 Provide more food labeling:
– For calories, fat, and sugar content
– In advertising and on wrappers/containers
– 2018 law to post calorie counts on menus
 Limit advertising of unhealthy options, especially those aimed at children.
 Best hope is to focus on children, starting with encouraging breast-feeding.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Physical Activity and Health
 Exercise promotes health, independent of weight control.
– Weight control works best when healthy eating is combined with physical activity.
 Epidemiologic studies have demonstrated that people who are more
physically active live longer.
– Exercise helps to prevent heart disease, high blood pressure, harmful cholesterol
levels, diabetes, and some forms of cancer.
– Exercise clearly protects against cardiovascular disease.
– Physical activity reduces colon and breast cancer risk.
– Type 2 diabetes is related to weight gain in adults.

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2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
How Much Exercise?
 Children = 60 minutes or more daily
 Adults = 150 to 300 minutes per week
 Adults = muscle strengthening twice per week
 More is better.
 Most American adults fail to meet guidelines.
 Lower SES is associated with more inactivity.
 Children get less exercise as they get older.
 Obesity in children is correlated with time using TV, computer, and video
games.

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2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Promoting Physical Activity
 Employ the ecological model, intervening at numerous levels of influence.
 Remove environmental barriers and provide places to exercise.
 Suburban lifestyle is to drive everywhere.
– Add sidewalks, walking trails, bike paths.
– Pedometers increase physical activity and reduce BMI and blood pressure.
 Develop habits of exercise in children and adolescents.
– Physical education classes should focus on activities that can be practiced
throughout one’s lifetime.

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2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Confronting the Obesity Epidemic
 Overweight and obesity could reverse public health improvements achieved in
the 20th century.
 Life expectancy will decline due to obesity.
 Overweight and obesity diseases account for 20.6% of the U.S.’s total medical
expenditures.
 Bariatric surgery helps obese people lose weight and control diabetes.
– Effective diet pills could do the same less drastically.

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Weight Loss Drugs
 Fen-phen had to be removed from the market because it caused heart valve
problems and pulmonary hypertension.
 Belviq works by activating a part of the brain that controls hunger.
 Qsymia is a combination of appetite suppressant and a drug used to treat
epilepsy and migraines.
 Orlistat works by inhibiting the absorption of dietary fats.

15. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 1
 What are some of the environmental factors that discourage Americans from
eating healthy diets?

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 2
 Referring to Table 16-2, estimate how many calories of energy you expend
each day.
 Do you achieve the minimum amount recommended by the CDC and the
ACSM?
 Can you think of two or three changes in your daily schedule that would
increase your physical activity level?

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©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 3
 Visit www.choosemyplate.gov and determine the dietary guidelines and
exercise recommendations individualized for you.
 Use the ecological model (see Chapter 14) to design a community program to
help people follow the recommendations of MyPlate.

18. Copyright
©
2021
by
Jones
&
Bartlett
Learning,
LLC
an
Ascend
Learning
Company.
www.jblearning.com
Discussion Question 4
 Visit the CDC’s Physical Activity website, www.cdc.gov/physicalactivity.
 In what ways is the CDC trying to promote more physical activity for
Americans?
 Under “Resources & Publications/Recommendations & Guidelines,” there are
links to recommendations for different groups of the population. Find one
relevant to you.
 Can you find any ideas that you want to try?