1 The Passive Path to Physical ActivityAzPHA & Az Forward Stewardship Summit Bob England, MD, MPH April 26, 2017

2 Trends in Infectious Disease Mortality in the United States During the 20th CenturyArmstrong, GL. JAMA Jan 6;281(1):61-6. 2

3 Obesity Trends* Among U.S. Adults BRFSS, 1985(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14%

4 Obesity Trends* Among U.S. Adults BRFSS, 1986(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14%

5 Obesity Trends* Among U.S. Adults BRFSS, 1987(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14%

6 Obesity Trends* Among U.S. Adults BRFSS, 1988(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14%

7 Obesity Trends* Among U.S. Adults BRFSS, 1989(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14%

8 Obesity Trends* Among U.S. Adults BRFSS, 1990(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14%

9 Obesity Trends* Among U.S. Adults BRFSS, 1991(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14% %–19%

10 Obesity Trends* Among U.S. Adults BRFSS, 1992(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14% %–19%

11 Obesity Trends* Among U.S. Adults BRFSS, 1993(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14% %–19%

12 Obesity Trends* Among U.S. Adults BRFSS, 1994(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14% %–19%

13 Obesity Trends* Among U.S. Adults BRFSS, 1995(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14% %–19%

14 Obesity Trends* Among U.S. Adults BRFSS, 1996(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14% %–19%

15 Obesity Trends* Among U.S. Adults BRFSS, 1997(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14% %–19% ≥20%

16 Obesity Trends* Among U.S. Adults BRFSS, 1998(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14% %–19% ≥20%

17 Obesity Trends* Among U.S. Adults BRFSS, 1999(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14% %–19% ≥20%

18 Obesity Trends* Among U.S. Adults BRFSS, 2000(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14% %–19% ≥20%

19 Obesity Trends* Among U.S. Adults BRFSS, 2001(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14% %–19% %–24% ≥25%

20 Obesity Trends* Among U.S. Adults BRFSS, 2002(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14% %–19% %–24% ≥25%

21 Obesity Trends* Among U.S. Adults BRFSS, 2003(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% %–14% %–19% %–24% ≥25%

22 Obesity Trends* Among U.S. Adults BRFSS, 2004(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980. No Data <10% %–14% %–19% %–24% ≥25%

23 Obesity Trends* Among U.S. Adults BRFSS, 2005(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980. No Data <10% %–14% %–19% %–24% %–29% ≥30%

24 Obesity Trends* Among U.S. Adults BRFSS, 2006(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% %–14% %–19% %–24% %–29% ≥30%

25 Obesity Trends* Among U.S. Adults BRFSS, 2007(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% %–14% %–19% %–24% %–29% ≥30%

26 Obesity Trends* Among U.S. Adults BRFSS, 2008(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% %–14% %–19% %–24% %–29% ≥30%

27 Obesity Trends* Among U.S. Adults BRFSS, 2009(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% %–14% %–19% %–24% %–29% ≥30%

28 Obesity Trends* Among U.S. Adults BRFSS, 2010(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% %–14% %–19% %–24% %–29% ≥30%

29 So what if we’re fat? Hypertension High blood cholesterolMetabolic disorder Diabetes Coronary heart disease Congestive heart failure Stroke Gallstones Cholescystitis & cholelithiasis Gout Osteoarthritis Obstructive sleep apnea and respiratory problems Some types of cancer (e.g., endometrial, breast, prostate, and colon) Complications of pregnancy (DM, HTN, preeclampsia, c-sections) Menstrual irregularities, infertility, irregular ovulation Bladder control problems (such as stress incontinence) Uric acid nephrolithiasis Psychological disorders (e.g., depression, eating disorders, distorted body image, and low self-esteem)

30 Number and percentage of US pop with diagnosed Diabetes

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33 Sitting Kills Researchers found a strong association with daily sitting time and risk of mortality. Medicine & Science in Sports & Exercise 2009 May;41:

34 Trends in Infectious Disease Mortality in the United States During the 20th CenturyArmstrong, GL. JAMA Jan 6;281(1):61-6. 34

35 Penicillin Armstrong, GL. JAMA Jan 6;281(1):61-6. 35

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37 Deaths from Aquatically Transmitted Diseases as a Fraction of All Deaths: U.S. 1900-1967

38 Tuberculosis, All Forms, as a Fraction of All Deaths: U.S. 1900-1997Drugs

39 Public Health Successes of the 19th & 20th CenturiesHow much individual ed? How much personal effort? How much health care? Environmental, communal, passive

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