For additional information, see  A NNRHN Area Percent of adults that report a BMI >= 30

Obesity

It might be said that obesity is both a health factor, as noted in County Health Rankings, for example,  and an outcome, as in the Nebraska 2017-2021 State Health Improvement Plan. 

While there are limitations to BMI as a diagnostic criteria for obesity (Minelli and Inungu 198), it is still a useful indicator on a population level as well as in treating individual patients.  BMI, or Body Mass Index, is a measure calculated for each individual using their weight and height.   While there is more focus on obesity (BMI equal to or greater than 30) because of the increased health risks, the risks actually start to accumulate when people are overweight (BMI >=25).Percent of adults that have a BMI of 25 or above, are commonly referred to as overweight versus obese. While the local rate (70.5%) was experiencing a drop from 2018 to 2019, it was still higher than the state average (69%).

While only three percent of community survey respondents confessed being worried about their weight,   four percent expressed concern about the very related issue of diabetes.  While it was one of the top issues chosen in a list of community concerns in the 2019 survey, obesity was not listed as a choice on the close-ended question in the survey completed in 2022.  However, two of the top six choices (coming in only after mental health, COVID-19, cancer and access to healthcare) were: “Challenges getting healthy and affordable food” and “Getting enough exercise”.  In addition, this issue along with the related issues of physical activity and nutrition came up in Listening Sessions. 

Percent of adults that report a BMI >= 30 is also higher in this health district than the state (36.075%  versus 33.3%)  In the state of Nebraska, American Indian and African American populations had the highest numbers of individuals who were obese.  Hispanics were most likely to be overweight (NE DHHS, 2021). In this health district, Thurston County showed 41.5% obesity in 2019 versus Cedar (34.0%), Dixon (35.0%) and Wayne 33.8%. 

Figure 36: National Center for Chronic Disease Prevention and Health Promotion (Sparkmap, December 28, 2021)

The rate for youth 10 to 17 in Nebraska was on its way back up in 2019-2020.  The Network plans to work with NNPHD and local schools to gather data to see if the local trend is similar.

Figure 37: U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, National Survey of Children’s Health. For more information on the NSCH, see http://childhealthdata.org/learn/NSCH  April 13, 2022

Contributing factors to such a large portion of our health district being overweight or obese are not unique to our area.  “Jobs have become less strenuous and people must pay a high price for exercise, arenas, or equipment.  Calories have become relatively cheaper and exercise has become relatively more expensive.”  loc 411 of The Economics of Obesity)  Rural areas such as ours face more obstacles, however.  The new neighborhood markets, “Dollar stores are especially dense in regions of the country where childhood obesity rates are the highest.  The question of how dollar stores could contribute to dietary health should be considered in efforts to combat childhood obesity” (Alavi Hojjat and Hojjat 440) COVID-19 Self-quarantine and Weight Gain Risk Factors in Adults - PMC (nih.gov) A 12-year study found that working aged men who were unemployed gained weight. Other studies have found correlation between income inequality and obesity. (Alavi Hojjat and Hojjat 1149)

The risks of obesity are many. People with high BMI are less likely to get screenings for breast, cervical, and colorectal cancers among others (Alavi Hojjat and Hojjat 561). “Adults with excess weight are at even greater risk during the COVID-19 pandemic:  Having obesity increases the risk of severe illness from COVID-19. Having obesity may triple the risk of hospitalization due to a COVID-19 infection. Obesity is linked to impaired immune function. Obesity decreases lung capacity and reserve and can make ventilation more difficult. The increased risk for hospitalization or death was particularly pronounced in those under age 65.”   Obesity, Race/Ethnicity, and COVID-19 | Overweight & Obesity | CDC

Obesity was identified as a priority in the last Community Health Improvement Plan, and promoting quality measures and interventions regarding obesity were written into a funded HRSA proposal which is now in the process of being implemented after a delay caused by COVID-19. Facilitating increased emphasis on obesity among the area’s providers would likely fit in well with increased emphasis on chronic care management and integrated behavioral health care, especially Patient Centered Medical Home (PCMH) initiatives.

Community fitness programs | County Health Rankings & Roadmaps Fitness programs can be offered in a variety of public settings including community, senior, fitness, and community wellness centers and outdoor settings such as parks. Program offerings vary by location, but often include exercise classes such as aerobic dance classes, Zumba, Pilates, yoga, Tai Chi, and spinning/indoor cycling.

• Community Activity Center | Wayne, NE - Official Website (cityofwayne.org)
• Providence Medical Wellness Center
• Pender Community Center
• Laurel is working on building a new center.

• Wellness coalitions that address the whole person including promoting physical activity and good nutrition. 

...

Another source for strategies is County Health Rankings and Roadmaps (CHR).  CHR maintains online database of strategies that have been identified as "What Works for Health" for the Health Factors that they measure.  "What Works for Health provides communities with information to help select and implement evidence-informed policies, programs, and system changes that will improve the variety of factors we know affect health."  Strategies for this indicator can be found at Adult obesity in Nebraska | County Health Rankings & Roadmaps. Particular strategies that are either being implemented or looked at for this area include: 

• Activity programs for older adults | County Health Rankings & Roadmaps
• Fruit & vegetable incentive programs | County Health Rankings & Roadmaps
• Community-based social support for physical activity | County Health Rankings & Roadmaps
• Competitive pricing for healthy foods | County Health Rankings & Roadmaps

Weight Loss to Prevent Obesity-Related Morbidity and Mortality in Adults: Behavioral Interventions