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1<?xml version="1.0" encoding="ISO-8859-1"?>
2
3<HTML_CONTENT xmlns:ibis="http://www.ibisph.org">
4
5        <ibis:doc>
6                <name>topic/Obesity</name>
7                <summary>Topic Page</summary>
8                <description>
9                </description>
10
11                <author>Paul Leo</author>
12                <company>Software Technology Group</company>
13        </ibis:doc>
14
15        <TITLE>Obesity and Related Factors</TITLE>
16
17        <CONTENT>
18                <ibis:ExpandableContent titleLevel="2">
19                        <TITLE>Description</TITLE>
20                        <CONTENT>
21                                Achieving and sustaining appropriate body weight across the lifespan is vital to maintaining good health and quality of life.
22                                Many behavioral, environmental, and genetic factors have been shown to affect a person's body weight. Calorie balance over time
23                                is the key to weight management. Calorie balance refers to the relationship between calories consumed from foods and beverages
24                                and calories expended in normal body functions and through physical activity. People cannot control the calories expended in
25                                metabolic processes, but they can control what they eat and drink, as well as how many calories they use in physical activity.
26                                <br/><br/>
27                                Maintaining a healthy body weight and preventing excess weight gain throughout the lifespan are highly preferable to losing weight
28                                after weight gain. Once a person becomes obese, reducing body weight back to a healthy range requires significant effort over a span
29                                of time, even years. People who are most successful at losing weight and keeping it off do so through continued attention to calorie
30                                balance.
31                                <br/><br/>
32                                The prevalence of overweight and obesity in the United States is dramatically higher now than it was a few decades ago. This is true
33                                for all age groups. One of the largest changes has been an increase in the number of Americans in the obese category. In the 1970s,
34                                the prevalence of obesity was 5% for children ages 2 to 5 years, 4% for children ages 6 to 11 years, 6% for adolescents ages 12 to
35                                19 years, and 15% for adults. As of 2015-16, the prevalence of obesity has reached 14% for children 2 to 5 years, 18% for children
36                                6 to 11 years, 21% for adolescents 12 to 19 years, and 40% for adults. In the early 1990s, no state had more than 25% of adults with
37                                obesity. As of 2017, 47 states have an adult obesity prevalence of 25% or higher and in 29 states 30% of adults have obesity.
38                        </CONTENT>
39                </ibis:ExpandableContent>
40
41                <ibis:ExpandableContent titleLevel="2">
42                        <TITLE>Why It's Important</TITLE>
43                        <CONTENT>
44                                People who have obesity, compared to those with a normal or healthy weight, are at increased risk for many serious diseases and health
45                                conditions, including the following:
46                                <br/>
47                                <ul class="Indent">
48                                        <li>All-causes of death (mortality)</li>
49                                        <li>High blood pressure (hypertension)</li>
50                                        <li>High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (dyslipidemia)</li>
51                                        <li>Type 2 diabetes</li>
52                                        <li>Coronary heart disease</li>
53                                        <li>Stroke</li>
54                                        <li>Gallbladder disease</li>
55                                        <li>Osteoarthritis (a breakdown of cartilage and bone within a joint)</li>
56                                        <li>Sleep apnea and breathing problems</li>
57                                        <li>Some cancers (endometrial, breast, colon, kidney, gallbladder, and liver)</li>
58                                        <li>Low quality of life</li>
59                                        <li>Mental illness such as clinical depression, anxiety, and other mental disorders</li>
60                                        <li>Body pain and difficulty with physical functioning</li>
61                                </ul>
62                                <br/>
63                                The medical care costs of obesity in the United States are high. In 2008 dollars, these costs were estimated to be $147 billion.
64                                The annual nationwide productive costs of obesity-related absenteeism range between $3.38 billion ($79 per obese individual) and
65                                $6.38 billion ($132 per obese individual).
66                        </CONTENT>
67                </ibis:ExpandableContent>
68
69                <ibis:ExpandableContent titleLevel="2">
70                        <TITLE>What Is Known</TITLE>
71                        <CONTENT>
72                                During the past 20 years, there has been a dramatic increase in obesity in the United States and rates remain high. In 2015-2016,
73                                almost 2 in 5 U.S. adults (39.8%) and 18.5% of children and adolescents aged 2-19 years were obese (NHANES).
74                                <br/><br/>
75                                Obesity affects some groups more than others.
76                                <br/>
77                                <ul class="Indent">
78                                        <li>Nationally, Hispanics (47.0%) and non-Hispanic blacks (46.8%) have the highest age-adjusted rate of obesity followed by non-Hispanic whites (37.9%) and non-Hispanic Asians (12.7%). Obesity is higher among middle age adults, 40-59 years old (42.8%) than among younger adults, age 20-39 (35.7%).</li>
79                                        <li>In Hawai'i, while 24.4% of adults have obesity, prevalence is significantly higher among Other Pacific Islanders (59.8%) and Native Hawaiians (42.8%) and lowest among Chinese (11.8%) and other Asians (18.8%) (BRFSS). While roughly 16% of adults aged 18-24 years and 75 years and older have obesity, 29.3% of those 45-54 years and 28.5% of those 35-44 years have obesity.</li>
80                                </ul>
81                        </CONTENT>
82                </ibis:ExpandableContent>
83
84                <ibis:ExpandableContent titleLevel="2">
85                        <TITLE>Who Is at Risk</TITLE>
86                        <CONTENT>
87                                A high amount of body fat can lead to weight-related diseases and other health issues and being underweight can also put one at risk
88                                for health issues. Body mass index (BMI) and waist circumference are two measures that can be used as screening tools to estimate weight
89                                status in relation to potential disease risk. However, BMI and waist circumference are not diagnostic tools for disease risks. A trained
90                                healthcare provider should perform other health assessments in order to evaluate disease risk and diagnose disease status.
91                                <br/><br/>
92                                BMI is a person's weight in kilograms divided by the square of height in meters. A high BMI can be an indicator of high body fatness and
93                                having a low BMI can be an indicator of having too low body fatness.
94                                <br/>
95                                <ul class="Indent">
96                                        <li><span class="Bold">If BMI is less than 18.5,</span> it falls within the underweight range.</li>
97                                        <li><span class="Bold">If BMI is 18.5 to 24.9,</span> it falls within the normal or Healthy Weight range.</li>
98                                        <li><span class="Bold">If BMI is 25.0 to 29.9,</span> it falls within the overweight range.</li>
99                                        <li><span class="Bold">If BMI is 30.0 or higher,</span> it falls within the obese range.</li>
100                                </ul><br/>
101                                Another way to estimate potential disease risk is to measure waist circumference. Excessive abdominal fat may be serious because it places
102                                a person at greater risk for developing obesity-related conditions, such as type 2 diabetes, high blood pressure, and coronary artery
103                                disease. Waistlines that are associated with a higher risk of developing obesity-related conditions include:
104                                <ul class="Indent">
105                                        <li>Waist circumference of more than 40 inches among men</li>
106                                        <li>Waist circumference of more than 35 inches  among non-pregnant women</li>
107                                </ul><br/>
108                                As with BMI, waist circumference can be used as a screening tool but is not diagnostic of the body fatness or health of an individual. A
109                                trained healthcare provider should perform appropriate health assessments in order to evaluate an individual's health status and risks.
110                        </CONTENT>
111                </ibis:ExpandableContent>
112
113                <ibis:ExpandableContent titleLevel="2">
114                        <TITLE>How To Reduce Risk</TITLE>
115                        <CONTENT>
116                                There is no single or simple solution to the obesity epidemic. It's a complex problem which will require a multifaceted approach for a
117                                solution. Policy makers, state and local organizations, business and community leaders, school, childcare and healthcare professionals,
118                                and individuals must work together to create an environment that supports a healthy lifestyle.
119                                <br/>
120                                <ul class="Indent">
121                                        <li>Personal efforts--Knowing your body mass index (BMI), achieving and maintaining a healthy weight, and getting regular physical
122                                        activity are all actions you can take for yourself to combat obesity.</li>
123                                        <li>Community efforts--should focus on supporting healthy eating and active living in a variety of settings. Learn about different
124                                        efforts that can be used in <a href="https://www.cdc.gov/obesity/strategies/childcareece.html">early childhood care,</a> <a href="https://www.cdc.gov/obesity/strategies/healthy-hospital-env.html">hospitals,</a> <a href="https://www.cdc.gov/obesity/strategies/saladbars2schools.html">schools,</a> and <a href="https://www.cdc.gov/obesity/strategies/food-serv-guide.html">food service venues.</a></li>
125                                </ul><br/>
126                                The key to achieving and maintaining a healthy weight isn't about short-term dietary changes. It's about a lifestyle that includes healthy
127                                eating, regular physical activity, and balancing the number of calories consumed with the number of calories used by the body.
128                                <br/><br/>
129                                Tips for individuals:
130                                <ul class="Indent">
131                                        <li>Stay in control of your weight. This contributes to good health now and as you age.</li>
132                                        <li>Prevent and/or reduce overweight and obesity through improved eating and physical activity behaviors.</li>
133                                        <li>Control total calorie intake to manage body weight. For people who are overweight or obese, this will mean consuming fewer calories from foods and beverages.</li>
134                                        <li>Increase physical activity and reduce time spent in sedentary behaviors.</li>
135                                </ul><br/>
136                                Maintain appropriate calorie balance during each stage of life-childhood, adolescence, adulthood, pregnancy and breastfeeding, and older age.
137                        </CONTENT>
138                </ibis:ExpandableContent>
139
140                <ibis:ExpandableContent titleLevel="2">
141                        <TITLE>How It's Tracked</TITLE>
142                        <CONTENT>
143                                Self-reported weight status is tracked at the national and state levels primarily through two surveys:
144                                <br/>
145                                <ul class="Indent">
146                                        <li><a href="https://www.cdc.gov/healthyyouth/data/yrbs/index.htm">Youth Risk Behavior Surveillance System (YRBSS)</a>, U.S. Centers for Disease Control and Prevention, Adolescent and School Health.</li>
147                                        <li><a href="https://www.cdc.gov/brfss/index.html">Behavioral Risk Factor Surveillance System (BRFSS)</a>, U.S. Centers for Disease Control and Prevention, Office of Surveillance, Epidemiology, and Laboratory Services.</li>
148                                </ul>
149                                <br/>
150                                National information based on clinical measurements is also tracked through the <a href="https://www.cdc.gov/nchs/nhanes/index.htm">National Health And Nutrition Examination Survey (NHANES)</a> and the <a href="https://www.cdc.gov/nchs/nhis/index.htm">National Health Interview Survey (NHIS)</a>, CDC/NCHS.
151                                <br/><br/>
152                                For more information on tracking nutrition health objectives, please visit the Nutrition and Weight Status topic at <a href="https://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status">https://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status.</a>
153                        </CONTENT>
154                </ibis:ExpandableContent>
155
156                <ibis:ExpandableContent titleLevel="2"><SHOW/>
157                        <TITLE>Indicator Reports</TITLE>
158                        <CONTENT>
159                                <h3>Hawai'i IBIS Indicator Reports</h3>
160                                <ibis:SelectionsList id="IndicatorList">
161                                        <SELECTION>
162                                                <TITLE>BMI - obesity (BMI GE 30), adult</TITLE>
163                                                <LOCAL_URL>indicator/view/BMIAdultAnyCatAA.RacEthDOH.html</LOCAL_URL>
164                                        </SELECTION>
165                                        <SELECTION>
166                                                <TITLE>BMI - obesity (BMI GE 95%ile), high school</TITLE>
167                                                <LOCAL_URL>indicator/view/OvrWgt_HS_ST.RacEthDOH.html</LOCAL_URL>
168                                        </SELECTION>
169                                        <SELECTION>
170                                                <TITLE>BMI - overweight (25 LE BMI LT 30), adult</TITLE>
171                                                <LOCAL_URL>indicator/view/BMIAnyCatAA_Ovrwt.RacEthDOH.html</LOCAL_URL>
172                                        </SELECTION>
173                                        <SELECTION>
174                                                <TITLE>BMI - overweight (BMI GE 85%ile and LT 95%ile), high school</TITLE>
175                                                <LOCAL_URL>indicator/view/OvrWgt_Risk_HS.RacEthDOH.html</LOCAL_URL>
176                                        </SELECTION>
177                                </ibis:SelectionsList>
178
179                                <h3>Hawai'i Health Matters Indicator Dashboards (Note: leaving IBIS site)</h3>
180                                <ibis:SelectionsList id="IndicatorList">
181                                        <SELECTION>
182                                                <TITLE>Physical Activity and Nutrition Plan Tracker</TITLE>
183                                                <URL>http://www.Hawaiihealthmatters.org/index.php?module=indicators&amp;controller=index&amp;action=dashboard&amp;id=83016762130277974</URL>
184                                        </SELECTION>
185                                        <SELECTION>
186                                                <TITLE>Obesity prevalence</TITLE>
187                                                <URL>http://www.Hawaiihealthmatters.org/indicators/index/indicatorsearch?doSearch=1&amp;grouping=1&amp;subgrouping=1&amp;ordering=1&amp;resultsPerPage=150&amp;l=14&amp;showSubgroups=0&amp;showOnlySelectedSubgroups=1&amp;primaryTopicOnly=&amp;sortcomp=0&amp;sortcompIncludeMissing=0&amp;showOnlySelectedComparisons=1&amp;showComparisons=1&amp;i=54_1213_1219_2089_2088_1312_1313_1321&amp;handpicked=1&amp;requireSubgroups=0&amp;handpickedItems%5B0%5D=54&amp;handpickedItems%5B1%5D=1213&amp;handpickedItems%5B2%5D=1219&amp;handpickedItems%5B3%5D=2089&amp;handpickedItems%5B4%5D=2088&amp;handpickedItems%5B5%5D=1312&amp;handpickedItems%5B6%5D=1313&amp;handpickedItems%5B7%5D=1321&amp;card=0</URL>
188                                        </SELECTION>
189                                        <SELECTION>
190                                                <TITLE>Healthy eating</TITLE>
191                                                <URL>http://www.Hawaiihealthmatters.org/indicators/index/indicatorsearch?doSearch=1&amp;grouping=1&amp;subgrouping=1&amp;ordering=1&amp;resultsPerPage=150&amp;l=14&amp;showSubgroups=0&amp;showOnlySelectedSubgroups=1&amp;primaryTopicOnly=&amp;sortcomp=0&amp;sortcompIncludeMissing=0&amp;showOnlySelectedComparisons=1&amp;showComparisons=1&amp;i=7559_3007_3009_1852_1311_1314_1853&amp;handpicked=1&amp;requireSubgroups=0&amp;handpickedItems%5B0%5D=7559&amp;handpickedItems%5B1%5D=3007&amp;handpickedItems%5B2%5D=3009&amp;handpickedItems%5B3%5D=1852&amp;handpickedItems%5B4%5D=1311&amp;handpickedItems%5B5%5D=1314&amp;handpickedItems%5B6%5D=1853&amp;card=0</URL>
192                                        </SELECTION>
193                                        <SELECTION>
194                                                <TITLE>Institutional support</TITLE>
195                                                <URL>http://www.Hawaiihealthmatters.org/indicators/index/indicatorsearch?doSearch=1&amp;grouping=1&amp;subgrouping=1&amp;ordering=1&amp;resultsPerPage=150&amp;l=14&amp;showSubgroups=0&amp;showOnlySelectedSubgroups=1&amp;primaryTopicOnly=&amp;sortcomp=0&amp;sortcompIncludeMissing=0&amp;showOnlySelectedComparisons=1&amp;showComparisons=1&amp;i=3505_3507_6169_2222_1858&amp;handpicked=1&amp;requireSubgroups=0&amp;handpickedItems%5B0%5D=3505&amp;handpickedItems%5B1%5D=3507&amp;handpickedItems%5B2%5D=6169&amp;handpickedItems%5B3%5D=2222&amp;handpickedItems%5B4%5D=1858&amp;card=0</URL>
196                                        </SELECTION>
197                                        <SELECTION>
198                                                <TITLE>Physical activity</TITLE>
199                                                <URL>http://www.Hawaiihealthmatters.org/indicators/index/indicatorsearch?doSearch=1&amp;grouping=1&amp;subgrouping=1&amp;ordering=1&amp;resultsPerPage=150&amp;l=14&amp;showSubgroups=0&amp;showOnlySelectedSubgroups=1&amp;primaryTopicOnly=&amp;sortcomp=0&amp;sortcompIncludeMissing=0&amp;showOnlySelectedComparisons=1&amp;showComparisons=1&amp;i=1873_2034_1876_1315_1850_1327_1851&amp;handpicked=1&amp;requireSubgroups=0&amp;handpickedItems%5B0%5D=1873&amp;handpickedItems%5B1%5D=2034&amp;handpickedItems%5B2%5D=1876&amp;handpickedItems%5B3%5D=1315&amp;handpickedItems%5B4%5D=1850&amp;handpickedItems%5B5%5D=1327&amp;handpickedItems%5B6%5D=1851&amp;card=0</URL>
200                                        </SELECTION>
201                                        <SELECTION>
202                                                <TITLE>Sedentary behavior</TITLE>
203                                                <URL>http://www.Hawaiihealthmatters.org/indicators/index/indicatorsearch?doSearch=1&amp;grouping=1&amp;subgrouping=1&amp;ordering=1&amp;resultsPerPage=150&amp;l=14&amp;showSubgroups=0&amp;showOnlySelectedSubgroups=1&amp;primaryTopicOnly=&amp;sortcomp=0&amp;sortcompIncludeMissing=0&amp;showOnlySelectedComparisons=1&amp;showComparisons=1&amp;i=57_1869_1844_1870_1845_1239_1235&amp;handpicked=1&amp;requireSubgroups=0&amp;handpickedItems%5B0%5D=57&amp;handpickedItems%5B1%5D=1869&amp;handpickedItems%5B2%5D=1844&amp;handpickedItems%5B3%5D=1870&amp;handpickedItems%5B4%5D=1845&amp;handpickedItems%5B5%5D=1239&amp;handpickedItems%5B6%5D=1235&amp;card=0</URL>
204                                        </SELECTION>
205                                </ibis:SelectionsList>
206
207                        </CONTENT>
208                </ibis:ExpandableContent>
209
210                <ibis:ExpandableContent titleLevel="2"><SHOW/>
211                        <TITLE>Queryable Datasets</TITLE>
212                        <CONTENT>
213                                <h3>Behavioral Risk Factor Surveillance System (BRFSS)</h3>
214                                <ibis:SelectionsList>
215                                        <SELECTION>
216                                                <TITLE>Body Mass Index (BMI) - status (4 levels)</TITLE>
217                                                <LOCAL_URL>query/result/brfss/BMI4Cat/BMI4CatCrude11_.html</LOCAL_URL>
218                                        </SELECTION>
219                                        <SELECTION>
220                                                <TITLE>BMI - Choose any one category</TITLE>
221                                                <LOCAL_URL>query/result/brfss/BMIAnyCat/BMIAnyCatCrude11_.html</LOCAL_URL>
222                                        </SELECTION>
223                                        <SELECTION>
224                                                <TITLE>BMI - expanded status (6 levels)</TITLE>
225                                                <LOCAL_URL>query/result/brfss/BMI6Cat/BMI6CatCrude11_.html</LOCAL_URL>
226                                        </SELECTION>
227                                        <SELECTION>
228                                                <TITLE>BMI - overweight or obese</TITLE>
229                                                <LOCAL_URL>query/result/brfss/BMIOverWtOb/BMIOverWtObCrude11_.html</LOCAL_URL>
230                                        </SELECTION>
231                                        <SELECTION>
232                                                <TITLE>Obese/overweight - doctor advised about weight, past 12 months</TITLE>
233                                                <LOCAL_URL>query/result/brfss/HCPAdvWeight/HCPAdvWeightCrude11_.html</LOCAL_URL>
234                                        </SELECTION>
235                                </ibis:SelectionsList>
236                                <br/>
237                                <h3>Pregnancy Risk Assessment Monitoring System (PRAMS)</h3>
238                                <ibis:SelectionsList>
239                                        <SELECTION>
240                                                <TITLE>Weight - BMI status before pregnancy, State-level</TITLE>
241                                                <LOCAL_URL>query/result/prams/BMIStatusBefPregCat/BMIStatusBefPregCat_ST.html</LOCAL_URL>
242                                        </SELECTION>
243                                        <SELECTION>
244                                                <TITLE>Weight - BMI status before pregnancy, County-level</TITLE>
245                                                <LOCAL_URL>query/result/prams/BMIStatusBefPregCat/BMIStatusBefPregCat_CNTY.html</LOCAL_URL>
246                                        </SELECTION>
247                                        <SELECTION>
248                                                <TITLE>Gained recommended amount of weight during pregnancy, State-level</TITLE>
249                                                <LOCAL_URL>query/result/prams/RecWeightGainDurPreg/RecWeightGainDurPreg_ST.html</LOCAL_URL>
250                                        </SELECTION>
251                                        <SELECTION>
252                                                <TITLE>Gained recommended amount of weight during pregnancy, County-level</TITLE>
253                                                <LOCAL_URL>query/result/prams/RecWeightGainDurPreg/RecWeightGainDurPreg_CNTY.html</LOCAL_URL>
254                                        </SELECTION>
255                                </ibis:SelectionsList>
256                                <br/>
257                                <h3>Youth Risk Behavior Survey (YRBS) - BMI and Perceived Weight</h3>
258                                <ibis:SelectionsList>
259                                        <SELECTION>
260                                                <TITLE>Overweight (&gt;=85%ile &amp; &lt;95%ile BMI for age &amp; sex), High Schools, State-level</TITLE>
261                                                <LOCAL_URL>query/result/yrbs/OvrWgtRisk/OvrWgtRisk_HS_ST.html</LOCAL_URL>
262                                        </SELECTION>
263                                        <SELECTION>
264                                                <TITLE>Overweight (&gt;=85%ile &amp; &lt;95%ile BMI for age &amp; sex), High Schools, County-level</TITLE>
265                                                <LOCAL_URL>query/result/yrbs/OvrWgtRisk/OvrWgtRisk_HS_CNTY.html</LOCAL_URL>
266                                        </SELECTION>
267                                        <SELECTION>
268                                                <TITLE>Obese (>=95%ile BMI for age &amp; sex), High Schools, State-level</TITLE>
269                                                <LOCAL_URL>query/result/yrbs/OvrWgt/OvrWgt_HS_ST.html</LOCAL_URL>
270                                        </SELECTION>
271                                        <SELECTION>
272                                                <TITLE>Obese (>=95%ile BMI for age &amp; sex), High Schools, County-level</TITLE>
273                                                <LOCAL_URL>query/result/yrbs/OvrWgt/OvrWgt_HS_CNTY.html</LOCAL_URL>
274                                        </SELECTION>
275                                        <SELECTION>
276                                                <TITLE>Overweight or obese (>=85%ile BMI for age &amp; sex), High Schools, State-level</TITLE>
277                                                <LOCAL_URL>query/result/yrbs/OvrWgtObese/OvrWgtObese_HS_ST.html</LOCAL_URL>
278                                        </SELECTION>
279                                        <SELECTION>
280                                                <TITLE>Overweight or obese (>=85%ile BMI for age &amp; sex), High Schools, County-level</TITLE>
281                                                <LOCAL_URL>query/result/yrbs/OvrWgtObese/OvrWgtObese_HS_CNTY.html</LOCAL_URL>
282                                        </SELECTION>
283                                        <SELECTION>
284                                                <TITLE>Overweight - student self described, High Schools, State-level</TITLE>
285                                                <LOCAL_URL>query/result/yrbs/OvrWgtStu/OvrWgtStu_HS_ST.html</LOCAL_URL>
286                                        </SELECTION>
287                                        <SELECTION>
288                                                <TITLE>Overweight - student self described, High Schools, County-level</TITLE>
289                                                <LOCAL_URL>query/result/yrbs/OvrWgtStu/OvrWgtStu_HS_CNTY.html</LOCAL_URL>
290                                        </SELECTION>
291                                        <SELECTION>
292                                                <TITLE>Overweight - student self described, Middle Schools, State-level</TITLE>
293                                                <LOCAL_URL>query/result/yrbs/OvrWgtStu/OvrWgtStu_MS_ST.html</LOCAL_URL>
294                                        </SELECTION>
295                                        <SELECTION>
296                                                <TITLE>Overweight - student self described, Middle Schools, County-level</TITLE>
297                                                <LOCAL_URL>query/result/yrbs/OvrWgtStu/OvrWgtStu_MS_CNTY.html</LOCAL_URL>
298                                        </SELECTION>
299                                </ibis:SelectionsList>
300                                <br/>
301                                <h3>Youth Risk Behavior Survey (YRBS) - Weight Control Practices</h3>
302                                <ibis:SelectionsList>
303                                        <SELECTION>
304                                                <TITLE>Trying to lose weight, Middle Schools, State-level</TITLE>
305                                                <LOCAL_URL>query/result/yrbs/LsWgtTrying/LsWgtTrying_MS_ST.html</LOCAL_URL>
306                                        </SELECTION>
307                                        <SELECTION>
308                                                <TITLE>Trying to lose weight, Middle Schools, County-level</TITLE>
309                                                <LOCAL_URL>query/result/yrbs/LsWgtTrying/LsWgtTrying_MS_CNTY.html</LOCAL_URL>
310                                        </SELECTION>
311                                        <SELECTION>
312                                                <TITLE>Any disordered eating behavior, ever, Middle Schools, State-level</TITLE>
313                                                <LOCAL_URL>query/result/yrbs/LsWgtDisord/LsWgtDisord_MS_ST.html</LOCAL_URL>
314                                        </SELECTION>
315                                        <SELECTION>
316                                                <TITLE>Any disordered eating behavior, ever, Middle Schools, County-level</TITLE>
317                                                <LOCAL_URL>query/result/yrbs/LsWgtDisord/LsWgtDisord_MS_CNTY.html</LOCAL_URL>
318                                        </SELECTION>
319                                        <SELECTION>
320                                                <TITLE>Any disordered eating behavior, past 30 days, High Schools, State-level</TITLE>
321                                                <LOCAL_URL>query/result/yrbs/LsWgtDisord30D/LsWgtDisord30D_HS_ST.html</LOCAL_URL>
322                                        </SELECTION>
323                                        <SELECTION>
324                                                <TITLE>Any disordered eating behavior, past 30 days, High Schools, County-level</TITLE>
325                                                <LOCAL_URL>query/result/yrbs/LsWgtDisord30D/LsWgtDisord30D_HS_CNTY.html</LOCAL_URL>
326                                        </SELECTION>
327                                        <SELECTION>
328                                                <TITLE>Weight control by fasting, ever, Middle Schools, State-level</TITLE>
329                                                <LOCAL_URL>query/result/yrbs/LsWgtFasting/LsWgtFasting_MS_ST.html</LOCAL_URL>
330                                        </SELECTION>
331                                        <SELECTION>
332                                                <TITLE>Weight control by fasting, ever, Middle Schools, County-level</TITLE>
333                                                <LOCAL_URL>query/result/yrbs/LsWgtFasting/LsWgtFasting_MS_CNTY.html</LOCAL_URL>
334                                        </SELECTION>
335                                        <SELECTION>
336                                                <TITLE>Weight control by fasting, past 30 days, High Schools, State-level</TITLE>
337                                                <LOCAL_URL>query/result/yrbs/LsWgtFasting30D/LsWgtFasting30D_HS_ST.html</LOCAL_URL>
338                                        </SELECTION>
339                                        <SELECTION>
340                                                <TITLE>Weight control by unprescribed drug use, ever, Middle Schools, State-level</TITLE>
341                                                <LOCAL_URL>query/result/yrbs/LsWgtPills/LsWgtPills_MS_ST.html</LOCAL_URL>
342                                        </SELECTION>
343                                        <SELECTION>
344                                                <TITLE>Weight control by unprescribed drug use, ever, Middle Schools, County-level</TITLE>
345                                                <LOCAL_URL>query/result/yrbs/LsWgtPills/LsWgtPills_MS_CNTY.html</LOCAL_URL>
346                                        </SELECTION>
347                                        <SELECTION>
348                                                <TITLE>Weight control by unprescribed drug use, past 30 days, High Schools, State-level</TITLE>
349                                                <LOCAL_URL>query/result/yrbs/LsWgtPills30D/LsWgtPills30D_HS_ST.html</LOCAL_URL>
350                                        </SELECTION>
351                                        <SELECTION>
352                                                <TITLE>Weight control by unprescribed drug use, past 30 days, High Schools, County-level</TITLE>
353                                                <LOCAL_URL>query/result/yrbs/LsWgtPills30D/LsWgtPills30D_HS_CNTY.html</LOCAL_URL>
354                                        </SELECTION>
355                                        <SELECTION>
356                                                <TITLE>Weight control by vomiting or laxatives, ever, Middle Schools, State-level</TITLE>
357                                                <LOCAL_URL>query/result/yrbs/LsWgtVomLax/LsWgtVomLax_MS_ST.html</LOCAL_URL>
358                                        </SELECTION>
359                                        <SELECTION>
360                                                <TITLE>Weight control by vomiting or laxatives, ever, Middle Schools, County-level</TITLE>
361                                                <LOCAL_URL>query/result/yrbs/LsWgtVomLax/LsWgtVomLax_MS_CNTY.html</LOCAL_URL>
362                                        </SELECTION>
363                                        <SELECTION>
364                                                <TITLE>Weight control by vomiting or laxatives, past 30 days, High Schools, State-level</TITLE>
365                                                <LOCAL_URL>query/result/yrbs/LsWgtVomLax30D/LsWgtVomLax30D_HS_ST.html</LOCAL_URL>
366                                        </SELECTION>
367                                </ibis:SelectionsList>
368                        </CONTENT>
369                </ibis:ExpandableContent>
370
371                <ibis:ExpandableContent titleLevel="2">
372                        <TITLE>Publications</TITLE>
373                        <CONTENT>
374                                <ibis:SelectionsList id="Publications">
375                                        <SELECTION>
376                                                <TITLE>Recommended Community Strategies and Measurements to Prevent Obesity in the United States</TITLE>
377                                                <URL>https://www.cdc.gov/mmwr/pdf/rr/rr5807.pdf</URL>
378                                        </SELECTION>
379                                        <SELECTION>
380                                                <TITLE>The CDC Guide to Strategies to Increase the Consumption of Fruits and Vegetables </TITLE>
381                                                <URL>https://www.cdc.gov/obesity/downloads/strategies-fruits-and-vegetables.pdf</URL>
382                                        </SELECTION>
383                                        <SELECTION>
384                                                <TITLE>The CDC Guide to Strategies to Increase Physical Activity in the Community</TITLE>
385                                                <URL>https://www.cdc.gov/obesity/downloads/PA_2011_WEB.pdf</URL>
386                                        </SELECTION>
387                                        <SELECTION>
388                                                <TITLE>Combined Built Environment Features Help Communities Get Active</TITLE>
389                                                <URL>https://www.thecommunityguide.org/content/combined-built-environment-features-help-communities-get-active</URL>
390                                        </SELECTION>
391                                        <SELECTION>
392                                                <TITLE>Step it Up! The Surgeon General's Call to Action to Promote Walking and Walkable Communities</TITLE>
393                                                <URL>https://www.cdc.gov/physicalactivity/walking/call-to-action/index.htm</URL>
394                                        </SELECTION>
395                                </ibis:SelectionsList>
396                        </CONTENT>
397                </ibis:ExpandableContent>
398
399                <ibis:ExpandableContent titleLevel="2">
400                        <TITLE>Resources</TITLE>
401                        <CONTENT>
402                                <ibis:SelectionsList id="ResourcesFAQList">
403                                        <SELECTION>
404                                                <TITLE>Hawai'i Department of Health Physical Activity and Nutrition Program</TITLE>
405                                                <URL>https://health.hawaii.gov/physical-activity-nutrition/</URL>
406                                        </SELECTION>
407                                        <SELECTION>
408                                                <TITLE>CDC - Division of Nutrition, Physical Activity and Obesity</TITLE>
409                                                <URL>https://www.cdc.gov/nccdphp/dnpao/index.html</URL>
410                                        </SELECTION>
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414
415        </CONTENT>
416</HTML_CONTENT>
417
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