A Growing Epidemic

By: Jennifer Brierley

Section One

Developing a Thesis and Finding Data

What is obesity?

What is diabetes?

How are obesity and diabetes related?

Obesity by definition is an increase body weight caused by excessive accumulation of fat.

How do you know if someone is obese?

A person is obese when their Body Mass Index (BMI) exceeds 30 and a person is considered overweight when their Body Mass Index is between 25 and 30.

What is a Body Mass Index?

A Body Mass Index commonly known as your BMI is a common measure expressing the relationship of weight-to-height. BMI = mass (kg) (height (m)) 2

Quick Data Fact • The Body Mass Index Formula is a Mathematical Index • A mathematical index is an arbitrarily defined number that provides a measure of scale.

• It is determined by a mathematical calculation that combines various attributes of each case in order to make comparisons.

• Mathematical Indices are found in Unit 3 (Tools for Analyzing Data) Jen Brierley’s BMI Weight = 52 kilograms Height = 1.57 meters I am not obese!  BMI = mass (kg) height (m) 2 BMI = 52 (1.57) 2 BMI =21

There are 3 types of diabetes: 1. Type 1 Diabetes 2. Type 2 Diabetes 3. Gestational Diabetes Quick Fact!

Type 2 Diabetes is one of the fastest growing diseases in Canada with more than 60,000 new cases yearly. Diabetes is a chronic, metabolic condition that results from the body’s inability to sufficiently produce and/or properly use insulin

Type 2 Diabetes

can

be prevented!

I researched the risk factors, health risks, symptoms, and prevention methods for obesity and diabetes.

I then drew a mind map in order to examine how obesity and diabetes are related.

Breathing Problems Gallbladder disease Types of Cancer Unusual thirst Frequent Urination Fatigue Sleeping Problems Osteoarthritis Reduced blood Supply to limbs Blindness Health Risks Unexplained weight loss Symptoms Nerve damage Health Risks Erectile dysfunction Heart disease stroke African Aboriginal Asian South Asian Hispanic Socioeconomic influences Metabolic Cultural Environmental Behavioral Date of birth Age Body weight Factors Obesity Type 2 Diabetes Causes (risk factors) Adult Child BMI Non-abdominal obesity Abdominal obesity Height Prevention Causes Imbalance involving Excessive calorie consumption Inadequate Physical activity Inadequate Energy expenditure Be physically active Achieve healthy weight And maintain it Limit intake of Fat and sugar Maintain normal Blood pressure Eat regular, Balanced meals (include Four food groups) Don’t smoke Keep cholesterol And other fats Within target level Hispanic Given birth to A baby > 9 lb Have had gestational diabetes Genetics African Sex Being age 40 + Female High blood pressure High Cholesterol/other fats in the body High risk ethnic groups Aboriginal Asian South Asian

MIND MAP

Male

After analyzing the connections I was interested in whether or not Canadians could reduce the risk of diabetes if in fact they started to live a healthy lifestyle.

Thesis Question

What effect do Canadian’s knowledge, attitudes and behaviors concerning obesity have on type 2 diabetes?

•The better Canadian’s knowledge, attitudes and behaviors are concerning obesity, the lower the chance of developing type 2 diabetes will be •Obesity and diabetes are directly correlated •As the population as a whole becomes healthier, the prevalence of type 2 diabetes will decrease among Canadians What do knowledge, attitudes and behavior mean?

•Knowledge is if the population knows the facts and the statistics related to the topic •Attitude is how much the population care about the issue and whether they are willing to engage in the topic.

•Behavior is what the population is doing. Are they dealing with the topic issue? Are they putting their knowledge and attitudes into effect?

Objectives: •Will examine Canadian’s knowledge, attitudes, and behaviors related to obesity in order to determine what type of intervention would lead to reducing obesity. •Will examine Canadian’s knowledge concerning the health factors related to obesity and whether or not Canadian’s are aware of the effect obesity has on developing type 2 diabetes.

Section Two

Using Diagrams to find Connections and Organize Ideas

Cause and Effect

Diet’s Role in Developing Diabetes No Does a person have knowledge about diet?

Yes No Does the person have poor diet?

Yes unhealthy Does a person have a good attitude towards their diet?

No Yes No Does a person have good behaviors towards their diet?

healthy No Is the person overweight?

Low risk of developing diabetes High risk of developing diabetes

Network Diagram Genetics Had gestational diabetes High cholesterol Obesity High blood pressure High risk ethnic groups Given birth to a baby >9 lb’s Being age 40 +

Network Diagram

Causes of type 2 diabetes that relate to each other Obesity Had gestational diabetes Gave birth to a baby > 9lb’s High blood pressure High cholesterol High risk ethnic groups Genetics Being age 40 + Obesity

----------- + + -

Had gestational diabetes

------------------

Gave birth to a baby > 9lb’s

+ + -------------- -

High blood pressure

+ ------------ + -

High cholesterol

+ ------------ -

High risk ethnic groups

+ + + + ------------ _ _

Genetics

+ + + + ---------- -

Being age 40 +

+ + + + ---------- Table that corresponds with network diagram. + represents a relationship -represents no relationship ------ represents that there is no relationship with itself

Organization Chart Canada Ontario

Sex

Male

Age

Quebec Female 14 and under 15 - 25 26 - 49 50 + Elementary school

Level of education obtained

High school College University Post graduate

Tree Diagram

Diabetes

Type 1 Does not apply to project Type 2 Prevention Causes (risk factors) Abdominal

Obesity

Genetics Non abdominal Does not apply to project High risk ethnic groups High cholesterol Had gestational diabetes High blood pressure Being age 40+ Given birth to a baby > 9 lb’s Be physically active Achieve healthy weight and maintain it Don’t smoke Maintain normal blood pressure Limit intake of fat and sugar Keep cholesterol and other fats within target level Eat regular, balanced meals (include 4 food groups)

Section Three

Part One: Obesity in Canada Part Two: Diabetes in Canada Part Three: Effects of Obesity on Diabetes (correlation between the two)

Obesity Rates in 1978/79 and 2004 by Age Group •The distribution of this graph is left skewed because the greatest frequencies are near the right end of the bar graph, although the 2004 data could be viewed as a mound shaped distribution.

•The greatest obesity rates occur among adults ages 45 to 64.

•This is accurate as the onset of type two diabetes is around age 40

Mean 1978/79 = 6+9+13+17+20+20+11 7 =13.7

Mean 2004 = 11+21+20+30+30+25+24 7 = 23.0

23.0 –13.7 = 9.3

This is showing that the average percent of obese people in Canada has risen about 9% since 1980.

Median 1978/79 = 17 Median 2004 = 30 30 –17 = 13 The median and mode also display the increase in obesity rates since 1980. The median increase by 13 % and the mode by 10%.

Mode 1978/79 = 20 Mode 2004 = 30

Calculation: Coefficient of determination (r 2 ) = 0.8296

83% of the variation in the percentage of obese people is due to the variation of the year.

Trends in Obesity Rates This graph clearly and effectively shows that Canadians need to pay attention to their weight because since 1991 obesity rates have increased by rapidly compared to the obesity rates from 1978 to 1991.

Obesity Prevalence in 2000/01 of the population ages 20 to 64 (in this graph obesity is measured by someone with a BMI>27)

Prevalence of Obesity in Canada from 1985 to 1998

Percentage distribution of body mass index (BMI) by sex (2004)

Mound Shaped Distribution This shows that obesity is a rising problem in Canada because in men the percentage of obesity is only 10% below the percentage of the population with a normal weight and in women it is only 20% below.

Obesity Rates by Fruit and Vegetable Consumption (2004)

MMMM M Left Skewed Distribution

Obesity Rates by Physical Activity Level (2004)

Left Skewed Distribution

Obesity Rates by Level of Education Obtained (2004)

Prevalence Rate of Diagnosed Diabetes by Age and Sex (1998/99)

2 0 8 6 4 18 16 14 12 10

Prevalence Rate of Diagnosed Diabetes by Age and Sex

20 - 39 20 - 59

Age Group

60 - 74 75 + Percentage(%) Both Percentage (%) Women Percentage (%) Men

Trends in the prevalence of diabetes (1994 to 2002)

Coefficient of determination (r 2 ) = 0.974

Did you know that diabetes is the 7 th leading cause of death in Canada!!!!

This graph evidently displays the increase in the prevalence of diabetes over the years.

Mortality Rates due to Diabetes Estimated Future Deaths from Diabetes (Number of actual and projected deaths due to diabetes by sex, Canada, 1970 - 2050)

Prevalence of Diabetes by Body Mass Index (BMI) Category

Relative Risk for Comorbidities in Obese Subjects (1997)

Observations and Conclusions based on Secondary Data

•Obesity is an rapidly increasing health risk in Canadian society •Obesity and diabetes are directly correlated.

•Obesity is a modifiable risk factor of diabetes •Diet and Physical Exercise prevent both diseases •Diabetes prevalence in Canada is on the rise. It is already the 7 th leading cause of death. If it continues to increase it will produce a major health epidemic in our society.

How can we fix this fast approaching epidemic?

What effect do Canadian’s knowledge, attitudes, and behaviors concerning obesity have on type two diabetes?

Section Four Analyzing Primary Source Data

Surveyed 100 people Objectives: 1. Obtain information to back up secondary sources 2. Explore my thesis and come to some concrete conclusions

60 50 40 10 0 30 20 Gender Response Frequency

Gender Distribution of Survey Respondents

Male Female

Gender

Unknown

Age Distribution

Age Distribution of Survey Respondents

30 25 20 15 10 5 0 Under 14 14-25 26-49

Age

50+ Unknow n

Education Distribution of Survey Respondents

35 30 25 20 15 10 5 0 Elementary High School College University

Level of Education

Postgraduate Unknow n

50 45 40 35 30 25 20 15 10 5 0 0-19

Opinions on Ideal BMI

20-25

BMI Range

26-30 30+

Satisfaction with Diet and Fitness Level

45 40 35 30 25 20 15 10 5 0 Very Satisfied Satisfied Disastisfied Very Disastisfied

Level of Satisfaction

Unknow n

Pecentage of Canadians Believed to be Overweight by Survey Respondents

25 20 15 10 5 0 0-9% 10-19% 20-29% 30-39% 40-49%

Percent Range

50-59% 60% Plus Unknow n

Survey Respondent's Belief in Obesity as an Increasing Health Problem

Don't Care No Yes

Respondents' Exercise Behaviour

100% 80% 60% 40% 4 5 20% 1 0% 15 min or less 3 6 8 13 10 8 11 7 6 1 4 1 30 min 1 hour

Average Length of Exercise

5 2 2 1 1 0 More than 1 hour Response to "On average, how many times per w eek do you exercise?" 5 or More Times Per Week 4 Times Per Week 3 Times Per Week 2 Times Per Week 1 Times Per Week 0 Time Per Week

Section Five

Conclusion Data Sources and Limitations Bias

Conclusion

Obesity rates in Canada are increasing rapidly. Why? Do Canadians not know about how to live a healthy life? Do they not care? Are they just choosing not to live a healthy life? 23% of the population is obese. Obesity has many serious health consequences, one being diabetes, which is directly correlated. Diabetes in Canada is on the rise as well. Diabetes is the 7th leading cause of death in Canada at the moment. If obesity leads to the development of type two diabetes then as obesity continues to rise so will the development of diabetes and ultimately more deaths.

Conclusion Continued After many hours of research and analysis of graphs I realized that the Canadian’s knowledge about obesity and its consequences is reasonably good and their attitude towards solving the problem and reducing obesity rates is good. Then why are obesity rates still so high. The reason is behavior. Canadians are not acting upon their knowledge and attitudes toward obesity. In my survey almost 80% of the people new the correct number of servings of fruit and vegetables you need per day but in the secondary source graph 80% were not eating the correct amount. In order to solve the rising epidemic I believe that the government should develop programs to encourage the behaviors of Canadians towards a healthy living in order to reduce obesity and thus reduce diabetes.

Obesity is a modifiable risk factor for diabetes and stats show that an intensive healthy lifestyle (physical exercise) can reduce the risk of developing type two diabetes in an obese person by 58%. A person can reduce symptoms of diabetes through physical activity and proper diet. With obesity being a modifiable risk factor for diabetes, by improving Canadians behaviors towards obesity we can solve two major health issues as well as other benefits such as health care costs. If Canada could increase the number of physically active Canadians by 1% then the annual saving in the cost of treating type two diabetes would be $877,000. In conclusion obesity is a huge factor in reducing diabetes and in order to accomplish that the behaviors of Canadians need to be addressed because that is what the general population is lacking, not the knowledge, not the attitudes, but the behaviors.

Data Sources and Limitations

Data Sources The majority of my data was found using reputable statistic sources. The main two data sources I used were: Statistics Canada – I found the majority of my raw data for my secondary sources there.

Health Canada – I found many published and approved reports on obesity, diabetes , and the correlation between the two. Limitations For the obesity data there were a few limitations in the secondary sources.

•There was not a lot of available data that included the under 18 age group because the body mass index standards differ for adults and children. This was a limitation because my survey evaluated data from people under 18.

•Data was not collected from the territories.

For the diabetes data there was one big limitation and that was the fact that statistics do not differ from the various types of diabetes. The stats represented all 3 types: type 1, type 2, and gestational. Although it might have skewed the data slightly, type 2 diabetes accounts for 90% of all cases so it wasn’t too much of a problem.

sampling interval =population size sample size = 32270500 100 = 322705 I encountered a few bias in my survey. The first was a sampling bias. I sampled 100 people to represent the population of Canada. My sample didn’t accurately represent the population.

No non-response bias, which was surprising because I thought I would run into that problem.

Household bias occurred in my survey analysis because I did not survey equal amounts of males and females, and my age groups were not equally weighted. The bias did not affect my overall results.