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Cancer Plan: Overweight/obesity, nutrition, and physical activity
Obesity is best measured by the body mass index (BMI), which is a formula that takes into account one’s weight and height. An adult is defined as overweight if his/her body mass index falls between 25-30 and is defined as obese if it is 30 or above. A body mass index over 25 is closely associated with increased morbidity and mortality.
While tobacco addiction is the leading underlying cause of cancer, recent studies indicate that obesity has become a major risk factor. it. Unfortunately, obesity is the leading risk factor for non-smokers. It is estimated that obesity, which is related to physical inactivity and poor nutrition, kills about six Maine people every day. Obesity costs $0.5-1.0 billion in health care dollars every year, or roughly $400-$800 per capita per year.
A 2003 study from the New England Journal of Medicine showed that being overweight or obese is associated with increased risk of death from all cancers, as well as many specific cancers. It is estimated that 90,000 deaths due to cancer could be prevented each year in the United States if men and women maintained normal weight. Overweight and obesity were found to account for an estimated 14% of all deaths from cancer in men and 20% of those in women.
Overweight and Obesity in Adults
Obesity rates have risen 75% from about one in ten Mainers in 1990 to more than one in five in 2002. Today, 59% of Maine adults are either overweight or obese. Moreover, available adult data in Maine are self-reported, and according to national, directly measured surveys, the proportion of overweight and obese adults in Maine and in the United States is probably closer to 61%. Further, although Maine’s rates of overweight and obese adults are comparable to national rates, Maine has the highest rate of adult obesity in New England.
Overweight and At Risk for Overweight in Youth
The trends among youth are equally alarming. Overweight among children is defined as being at or above the 95th percentile BMI for age and gender; and at risk for overweight is defined as being between the 85th and 94th percentile BMI for age and gender. About one-third of Maine youth are either overweight or at risk of becoming overweight. Even more alarming, a 2004 survey found that 33% of entering Maine kindergarteners were overweight or at risk for becoming overweight.
Like adult rates, youth rates have increased to epidemic proportions. For instance, in just 20 years, the national rate of overweight children has doubled, while the rate of overweight teens has tripled. The most currently available comparable data suggest this is true in Maine as well (Figure 10).
Child and Youth Overweight and Risk for Overweight, Maine
At Risk for Overweight |
Overweight |
|
High School |
15% |
13% |
Middle School |
18% |
13% |
Kindergarten |
18% |
15% |
Adult Physical Activity
One of the major factors to obesity/overweight prevention is physical activity. National recommendations for adults include 30 minutes or more of moderate activity for five or more days per week or 20 minutes or more of vigorous activity for three or more days per week. In Maine, however, only three-quarters of adults engage in physical activity at the recommended levels.
Increasingly, workers today are employed in jobs that require very little physical labor. Additionally, many people cite lack of time as a barrier for being physically active. The societal trends of working many hours, commuting long distances, and working multiple jobs restrict the amount of leisure time available.
The rural nature of Maine has a significant impact on the capacity to improve physical activity. Limited sidewalks, walking trails, bicycle paths, and other resources for physical activity in rural areas are important environmental barriers. Access to facilities for physical activity is a major hurdle for many Mainers. Additionally, climate and limited daylight also impact the opportunity to be active outdoors year round.
Youth Physical Activity
Today’s society has become very sedentary, and this has impacted the well-being of our youth. Increased rates of overweight in children have coincided with a nationwide declining trend in walking and biking. Most children in Maine are bused or driven to school. Additionally, physical activity continues to be displaced with television, electronic games, and computers.
According to a 1999 Kaiser Family Foundation study, American children ages 2-18 spend an average of four hours per day watching television or videotapes, playing video games, or using a computer. Maine data also confirm this proliferation of screen use. For instance, on an average school day, one in four (26.8%) Maine high school students watch three or more hours of television, and one in five (21%) use a computer for fun or play video games for at least one hour per day.
School budget cuts to physical education programs have also contributed to the decrease in youth physical activity rates (Figure 11). The Maine Youth Risk Behavior Surveillance System indicates that 36% of Maine high school students participated in an insufficient amount of physical activity.
Percentage of Maine Middle and High School Students Who Attend Physical Education Class One or More Days During an Average School Week by Grade, 2003
Figure 11: Percentage of Maine Middle and High School Students Who Attended Physical Education Class One Or More Days During An Average School Week By Grade, 2003
Source: Maine Youth Risk Behavior Surveillance System, Maine Department of Education
Nutrition
Mainers are consuming too many calories. In just 13 years (1984-1997), calories consumed in the United States increased 15% on a per capita per day basis, with a concurrent decrease in physical activity. In Maine, data indicates that almost three-quarters of adults and high school students do not eat the recommended five servings of fruits and vegetables each day.
Soda consumption is another factor that has been studied and appears to be a contributing factor to poor nutrition, especially among youth. In the United States, the largest source of added sugars is non-diet soda.52 According to the U.S. Department of Agriculture, 69% of American boys between ages 12-19 consume soda on a given day. Among those who drink soda, an average of 868 cans per year is consumed, 95% of which is non-diet. Among the 62% of girls in this age group who drink soft drinks, an average of 627 cans per year is consumed, 90% of which is non-diet.
Goal: To reduce and prevent adult risk of colorectal and other cancers through healthful eating habits and physical activity.
Objective 1: Increase to 30% the proportion of adults who consume five or more servings of fruits and vegetables every day by 2010.
Baseline: 27% of adults, BRFSS, 2003, Maine CDC/PTM Outcome Survey, 2005.
Objective 2: Reduce the proportion of adults that are overweight to 35% or obese to 20% by 2010.
Baseline: 38% overweight; 23% obese, BRFSS, 2004.
Objective 3: Increase to 80% the proportion of adults who participate in any physical activities in the past month.
Baseline: 78.4%, BRFSS, 2004.
Objective 4: Increase to 55% the proportion of adults who participate in 30 minutes of moderate physical activity five or more days per week OR vigorous physical activity three or more days per week.
Baseline: 53.1%, BRFSS, 2003.
Strategies:
- Encourage restaurants to display nutrition information at point of contact.
- Encourage at least three Maine insurers to reimburse preventive nutrition services for adults.
- Promote adequate nutrition intake for adults through culturally and linguistically appropriate education.
- Advocate for ongoing implementation of the Physical Activity & Nutrition Plan.
- Increase the number of communities with walk/bike paths or trails.
- Encourage at least three Maine insurers to provide financial incentives for member’s participation in fitness programs.
- Increase the number of employers with environments and policies that support physical activity and improved nutrition for their employees.
Goal: To reduce risk of colorectal and other cancers through healthful eating habits and physical activity beginning as a child.
Objective 1: Increase to 35% the proportion of youth who consume five or more servings of fruits and vegetables per day by 2010.
Baseline: 23% of high school students, MYRBS, 2003.
Objective 2: Reduce the proportion of youth who are overweight to 5% or at risk for being overweight to 10% by 2010.
Baseline: High school: 13% overweight/15% at risk for overweight and Middle school: 13% overweight and 18% at risk for overweight, MYRBS, 2003.
Objective 3: Reduce the proportion of kindergarten students who are overweight to 5% or at risk for being overweight to 10% by 2010.
Baseline: 15% overweight and 18% at risk for overweight, Maine Child Health Survey, 2004.
Objective 4: Increase to 80% the proportion of youth who engage in vigorous physical activity three or more days per week for 20 minutes or more each time by 2010.
Baseline: 61% high school, 72% middle school, MYRBS 2003.
Strategies:
- Encourage restaurants to display nutrition information at point of decision.
- Encourage at least three Maine insurers to reimburse nutrition services for youth.
- Promote adequate nutrition intake for youth through culturally and linguistically appropriate education.
- Provide advocacy for ongoing implementation of the Physical Activity and Nutrition Plan.
- Advocate for all school districts to comply with USDA PL-108-265 Wellness Policy implementation.
- Increase the number of community opportunities for youth to be physically active.
- Increase the number of schools offering scheduled and supervised physical activity during the school day.
- Increase to 100% the number of Maine schools who have implemented Comprehensive School Health Education and have a Coordinated School Health Program.
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