Bulletin 05-10 Legislative Committee on Health Care’s ...

January 2005

Legislative Committee on Health Care’s Subcommittee to Study

Medical and Societal Costs andImpacts of Obesity

Legislative Counsel Bureau

Bulletin No.05-10

LEGISLATIVE COMMITTEE ON HEALTH CARE SUBCOMMITTEE TO STUDY MEDICAL AND SOCIETAL COSTS

AND IMPACTS OF OBESITY

BULLETIN NO. 05-10

JANUARY 2005

TABLE OF CONTENTS

Page Summary of Recommendations............................................................................... iii Report of the Nevada Legislature’s Committee on Health Care Subcommittee to Study Medical and Societal Costs and Impacts of Obesity to the Members of the 73rd Session of the Nevada Legislature ................................................................1 I. Introduction.............................................................................................1 II. Review of Senate Concurrent Resolution No. 13 (File No. 89,

Statutes of Nevada 2003) .............................................................................2 III. Background .............................................................................................2 IV. Subcommittee Activities ..............................................................................3 V. Discussion of Recommendations....................................................................4 VI. Conclusion ..............................................................................................11 VII. Appendices..............................................................................................13

Appendix A S.C.R. No. 13 (File No. 89, Statutes of Nevada 2003) ................................15 Appendix B The Surgeon General’s Call to Action to Prevent and Decrease

Overweight and Obesity......................................................................19 Appendix C School Food and Beverage Study Results ...............................................61 Appendix D Obesity Resource List .......................................................................81

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SUMMARY OF RECOMMENDATIONS

This summary presents the recommendations approved by the Legislative Committee on Health Care’s Subcommittee to Study Medical and Societal Costs and Impacts of Obesity (Senate Concurrent Resolution No. 13, File No. 89, Statutes of Nevada 2003) at its March 22, 2004, meeting. The Subcommittee submits the following proposals to the 73rd Session of the Nevada Legislature: Statewide Plan and Resource List Concerning Obesity

1. Recognizing both that obesity is a major public health issue and that the Health Division in the state’s Department of Human Resources serves as the state’s leader in public health, the Division was asked to continue the work of the Subcommittee. The Subcommittee approved two primary requests for the Division: (a) convene a planning group or steering committee to develop a Statewide Strategic Plan concerning the prevention of obesity; and (b) maintain and update the “Obesity Resource List” that the Subcommittee developed during the course of its study.

Letters Additionally, the members authorized the Subcommittee chairwoman to send the following letters on behalf of the Subcommittee:

2. A letter to Nevada’s Congressional representatives urging them to enact legislation, such as the Improved Nutrition and Physical Activity (IMPACT) Act, which was referred to the House Committee on Energy and Commerce on January 20, 2004. This legislation will provide more funding to states to help them pursue initiatives to reduce the prevalence of obesity.

3. A letter to the United States Food and Drug Administration and the U.S. Department of Agriculture urging these agencies to simplify the nation’s food labeling system and to undertake a more comprehensive promotional effort to educate consumers about the use of the Nutrition Facts Panel and its application to their daily diet and the Food Pyramid.

4. A letter to billboard companies in Nevada urging them to allow obesity prevention advertising without charging a fee whenever a billboard is not in use.

5. A letter to Nevada’s Department of Transportation urging the department to find grant funding to develop safe biking and walking routes to schools.

6. A letter to representatives of the nation’s packaged foods industry urging them to package snack foods in single serve packages and to include labeling that reflects the packaging.

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7. A letter to the superintendent of the State Department of Education asking him to request information from the state’s school districts about their use of vending machines, snack boxes, and candy stores in each of their respective schools. The request should ask for the amount of funding that is raised from vending machines in each school, an identification of the contract requirements for each school, and information identifying how the money is used by each school.

8. A letter to the chancellor of the University and Community College System of Nevada (UCCSN) urging the UCCSN to include obesity training in the health curriculums of the medical school and for teachers who instruct in nutrition and health at elementary, middle, and high schools.

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REPORT BY THE LEGISLATIVE COMMITTEE ON HEALTH CARE SUBCOMMITTEE TO STUDY MEDICAL AND SOCIETAL COSTS AND IMPACTS OF OBESITY BY THE TO THE 73rd SESSION OF THE NEVADA LEGISLATURE

I. INTRODUCTION

The Legislative Committee on Health Care’s Subcommittee to Study Medical and Societal Costs and Impacts of Obesity was established by Senate Concurrent Resolution No. 13, File No. 89, Statutes of Nevada 2003. The Subcommittee met three times. All public hearings were conducted through simultaneous videoconferences between Carson City and Las Vegas, Nevada. The Subcommittee considered a number of significant issues related to obesity prevention. The Subcommittee did not adopt any recommendations for legislation, but it did adopt one recommendation that was forwarded to the Health Division in Nevada’s Department of Human Resources (DHR) for its consideration. In addition, the Subcommittee authorized the chairwoman to send seven letters to various parties about the activities of the Subcommittee and the desire of members to see certain changes related to obesity prevention.

Although no formal recommendations for legislation were adopted by the Subcommittee, this bulletin provides background information concerning the activities of the Subcommittee.

. Senator Valerie Wiener served as the Chair of the Subcommittee. Other legislative members of the Subcommittee during the 2003-2004 interim included: Senator Barbara Cegavske Assemblyman Kelvin Atkinson Assemblyman Garn Mabey, M.D. Additionally, the following representative of the Health Division, DHR, and the Department of Education served as voting members of the Subcommittee: Keith Rheault, Ed.D., Superintendent, Nevada Department of Education Richard Whitley, Chief, Bureau of Community Health, Health Division, DHR Legislative Counsel Bureau staff services were provided by:

Marsheilah D. Lyons, Senior Research Analyst Marla McDade Williams, Former Senior Research Analyst Leslie K. Hamner, Principal Deputy Legislative Counsel Kennedy, Senior Research Secretary

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II. REVIEW OF SENATE CONCURRENT RESOLUTION 13 (File No. 89, Statutes of Nevada 2003)

Senate Concurrent Resolution No. 13 directs the Legislative Committee on Health Care to conduct an interim study of the medical and societal costs and impacts of obesity in Nevada. The measure requires that a subcommittee be formed to conduct the study, consisting of four legislators, one representative from the Health Division of the DHR, and one representative from the Department of Education. Further, the bill sets forth the topics for evaluation during the study. The study must include:

1. An analysis of the fiscal impact of obesity on health care costs and productivity in Nevada and a determination of possible savings in health care costs resulting from the prevention and proper treatment of obesity;

2. The identification of programs and practices that have been established in Nevada and

other states which are cost-effective and could be implemented throughout Nevada; 3. Recommendations for programs to increase public awareness regarding the causes,

prevention, risks, and treatment of obesity; 4. An examination of the particular effects of the 24-hour lifestyle and transient nature of

some of the population of this state on obesity; 5. Recommendations for programs and practices that encourage healthy and balanced

fitness and nutritional choices; and 6. Any other proposals for legislation relating to health care for obesity that the

Subcommittee may receive or develop.

III. BACKGROUND In 2001, the United States Surgeon General David Satcher released a report outlining the problem of obesity in America. The report, The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity, outlined strategies that communities can use in helping to address the problems. Those options included requiring physical education at all school grades, providing more healthy food options on school campuses, and providing safe and accessible recreational facilities for residents of all ages. According to information provided in the Surgeon General’s Report, approximately 300,000 U.S. deaths a year currently are associated with obesity and overweight (compared to more than 400,000 deaths a year associated with cigarette smoking). The total direct and indirect costs attributed to overweight and obesity amounted to $117 billion in the year 2000.

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Additionally the report indicated, in 1999, an estimated 61 percent of U.S. adults were overweight, along with 13 percent of children and adolescents. Obesity among adults has doubled since 1980, while overweight among adolescents has tripled. Only 3 percent of all Americans meet at least four of the five federal Food Guide Pyramid recommendations for the intake of grains, fruits, vegetables, dairy products, and meats. And less than one-third of Americans meet the federal recommendations to engage in at least 30 minutes of moderate physical activity at least five days a week, while 40 percent of adults engage in no leisure-time physical activity at all. While the prevalence of overweight and obesity has increased for both genders and across all races, ethnic and age groups, disparities exist. According to information gathered by Dr. Satcher, in women, overweight and obesity are higher among members of racial and ethnic minority populations than in non-Hispanic white women. In men, Mexican-Americans have a higher prevalence of overweight and obesity than non-Hispanic men, while non-Hispanic white men have a greater prevalence than non-Hispanic black men. Members of lower-income families generally experience a greater prevalence than those from higher-income families. These trends are associated with dramatic increases in several health conditions, such as asthma and Type 2 diabetes among children. Dr. Satcher indicates that failure to address overweight and obesity “could wipe out some of the gains we [have] made in areas such as heart disease, several forms of cancer, and other chronic health problems.” Following the release of Surgeon Generals’ Report, many states began to address the issue of obesity prevention. The 72nd Session of Nevada’s Legislature was presented with many of the findings from this report and the efforts of other states seeking to develop comprehensive plans to study the impact of obesity on the health and well being of Nevadans. Following deliberations on this issue, the Nevada Legislature directed the Legislative Committee on Health Care to establish an interim subcommittee to study the medical and societal costs and impacts of obesity.

IV. SUBCOMMITTEE ACTIVITIES

The Legislative Committee on Health Care’s Subcommittee to Study Medical and Societal Costs and Impacts of Obesity held three meetings, including a work session. During the course of the interim study, the Subcommittee reviewed a variety of issues related to obesity. The Subcommittee received testimony from diverse sources, including representatives of state agencies, local government agencies, health care organizations, private citizens, advocacy and support groups, food manufacturers, health care professionals, and National organizations. Following are summaries of the Subcommittee’s deliberations and activities at each of the three meetings:

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1. November 3, 2004, Meeting in Las Vegas The Subcommittee heard presentations concerning the incidence of obesity, the health effects of the condition, and the costs to certain sectors of the health care delivery system of obesity-related diseases. The Subcommittee also heard a presentation summarizing a study in the Washoe County School District, which analyzed the foods and beverages available to students. 2. January 14, 2004, Meeting in Las Vegas The Subcommittee heard a number of presentations concerning ways to combat obesity in Nevada. Representatives from the Center for Science in the Public Interest, the National Conference of State Legislatures (NCSL), and the Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, discussed legislative and policy efforts that have been considered and implemented in other states. Other speakers addressed proactive efforts by companies that sell snack food products to bring awareness to the need for nutrition awareness and physical fitness to consumers. Representatives of the Nevada Alliance for Chronic Disease Prevention outlined ways that cooperative efforts can be undertaken in Nevada to increase awareness of issues related to the prevention of obesity and the promotion of healthy lifestyles. 3. March 22, 2004, Meeting in Las Vegas The Subcommittee heard presentations concerning the ability of private fitness clubs to assist in the prevention of obesity, activities undertaken in California related to obesity prevention in schools, and activities of the Clark County School District concerning obesity prevention and recess periods in schools, as well as the District’s intention to improve its nutrition policies and standards for school meals and snacks. The Subcommittee also heard a recommendation to require physicians to take continuing medical education units related to obesity screening and to establish a committee on obesity prevention and treatment. Members concluded the meeting by considering recommendations for legislation. Although the Subcommittee did not officially adopt any recommendations for legislation, it agreed to send seven letters from the Subcommittee to various interests.

V. DISCUSSION OF RECOMMENDATIONS

At its work session in Las Vegas, the Subcommittee considered several recommendations relating to the impact and prevention of obesity. The Subcommittee authorized the drafting of seven letters on its behalf to be sent to various interests, including the Health Division, DHR, the state’s Congressional representatives, the U.S. Food and Drug Administration (FDA) and

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the U.S. Department of Agriculture, the state’s billboard companies, the state’s Department of Transportation, the packaged foods industry, the state’s Department of Education, and the UCCSN. This section provides brief background regarding the Subcommittee’s request for drafting these letters. Testimony indicated that weight gain is a direct function an imbalance between the amount of calories consumed (nutrition) and the amount of calories expended by an individual (physical activity). The letters are divided based on the subject area they most closely address toward meeting the goal of preventing obesity. A. DEVELOPMENT OF HEALTHY EATING HABITS (NUTRITION) Food Labels

In mid-March of 2004, the U. S. Department of Health and Human Services released a new FDA report, entitled Calories Count: Report of the Working Group on Obesity, which outlines an additional component in HHS’ strategy for combating the growing obesity epidemic. The FDA report included recommendations on revamping food labels, educating consumers about maintaining a healthy diet and weight, and encouraging restaurants to voluntarily provide calorie and nutrition information. The report also recommended increasing FDA enforcement of food labels to more accurately inform consumers about serving sizes. With regard to food labels the report recommends that FDA take the following actions:

1. Publish an advance notice of proposed rulemaking (ANPRM) to seek comment on

how to give more prominence to calories on the food label (e.g., increasing the font size for calories, including a percent Daily Value column for total calories, and eliminating the listing for calories from fat).

2. Publish an ANPRM to seek comment on authorizing health claims on certain foods

that meet FDA's definition of “reduced” or “low” calorie. An example of a health claim for a “reduced” or “low” calorie food might be: “Diets low in calories may reduce the risk of obesity, which is associated with Type 2 diabetes, heart disease, and certain cancers.”

3. Publish an ANPRM to seek comment on whether to require additional columns on

the NFP to list quantitative amounts and percent Daily Value of an entire package on those products/package sizes that can reasonably be consumed at one eating occasion (or declare the whole package as single serving).

4. Publish an ANPRM to seek comment on which, if any, reference amounts

customarily consumed of food categories appear to have changed the most over the past decade and require updating.

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5. File petitions the FDA has received that ask the agency to define terms such as “low,” “reduced,” and “free” carbohydrate; and provide guidance for the use of the term “net” in relation to carbohydrate content of food.

6. Encourage manufacturers to use dietary guidance statements, an example of which

would be, “To manage your weight, balance the calories you eat with your physical activity.”

7. Encourage manufacturers to take advantage of the flexibility in current regulations

on serving sizes to label as a single-serving those food packages where the entire contents of the package can reasonably be consumed as a single serving.

8. Encourage manufacturers to use appropriate comparative labeling statements that

make it easier for consumers to make healthy substitutions.

The Subcommittee specifically addressed the issue of food labels during discussions regarding the Kraft Foods Obesity Initiative. After considering testimony on this issue the Subcommittee authorized the drafting of:

A letter to the U.S. FDA and the U.S. Department of Agriculture urging these agencies to simplify the nation’s food labeling system and to undertake a more comprehensive promotional effort to educate consumers about the use of the Nutrition Facts Panel and its application to their daily diet and the Food Pyramid.

Additionally, the Subcommittee asked for the drafting of:

A letter to representatives of the nation’s packaged foods industry urging them to package snack foods in single serve packages and to include labeling that reflects the packaging.

Nutrition at School A recent study conducted by the Food and Beverage Study Committee for the Washoe County School District (WCSD) indicted the following key findings from the study that involved 75 of the 86 schools open during School Year (SY) 2001-2002: • Competitive foods (foods offered at school, other than meals served through

USDA’s school meal programs—school lunch, school breakfast, and after-school snack programs) are widely available in WCSD.

1. Ninety-one percent of schools reportedly sell competitive foods.

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1. Competitive foods are available to students at school before school (32 percent), during school hours when school meals are not being served (43 percent), during lunch (65 percent), and after school (64 percent).

• Net revenue from competitive foods in SY 2001-2002 was estimated at $1,147,491.

1. Sixty-three percent of net revenue was generated from a la carte sales and was paid to

Nutrition Services to support the operating and personnel costs associated with the School Breakfast and School Lunch Programs.

2. The remaining revenues were generated from vending machines (18 percent),

fundraising efforts (12 percent), and school stores (6 percent) to support a wide variety of student activities, programs, and school necessities.

3. Fifty-six percent of net revenue was generated from sales at high schools, 34 percent

from middle schools, and 10 percent from elementary schools. 4. A high proportion of schools were unable to account for both gross and net revenues

from vending machines (39 percent), school stores (20 percent), and fundraising efforts (36 percent) making profitability difficult to determine.

5. Overhead costs of selling competitive foods were unaccounted for here. For example,

energy costs related to the 128 chilled beverage machines are estimated at $45,000 per year.

• The nutritional quality of the foods and beverages most commonly available is poor.

1. Sugary drinks (i.e., soft drinks, sports drinks, and juice drinks—not 100 percent juice) were available at 73 percent of the schools.

2. Baked goods—not low fat (i.e., cookies, crackers, cakes, pastries) were available at

63 percent of the schools. 3. Salty snacks—not low fat were available at 59 percent of the schools. 4. Candy was available at 44 percent of the schools. 5. Bottled waters and plain milk were also widely available, which suggests there is a

market for more healthful choices. • Student access to foods of low nutritional quality may be undermining the National School

Breakfast and School Lunch Programs. Sugary drinks, candy, high-fat baked goods, and salty snacks are available at times when school meals are offered. Some students may choose

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choose to purchase these items in place of, or in addition, to a school meal that meets federal nutrition standards.

• Many schools are out of compliance with existing WCSD policy regarding competitive foods. Policies adopted by the Washoe County Board of Trustees (1988) restrict student access to competitive foods at specific times of the school day. School practices reported here indicate that these policies are not consistently followed.

Testimony based on anecdotal evidence suggested that such challenges related to providing healthy foods at school are seen throughout the state and the nation. To encourage a review of this issue, the Subcommittee moved to request the drafting of:

A letter to the superintendent of the State Department of Education asking him to request information from the state’s school districts about their use of vending machines, snack boxes, and candy stores in each of their respective schools. The request should ask for the amount of funding that is raised from vending machines in each school, an identification of the contract requirements for each school, and information identifying how the money is used by each school.

Additionally, the Subcommittee requested the drafting of:

A letter to the chancellor of the University and Community College System of Nevada (UCCSN) urging the UCCSN to include obesity training in the health curriculums of the medical school and for teachers who instruct in nutrition and health at elementary, middle, and high schools.

B. DEVELOPMENT OF HEALTHY ENVIRONMENTS AND PHYSICAL FITNESS Testimony provided by a representative of the National Conference of State Legislators outlined a variety of ways that the Federal government and other states have addressed obesity. Federal legislation, entitled Improved Nutrition and Physical Activity Act or the IMPACT Act amends the Public Health Service Act, to include in the training grant program for health profession students the treatment of persons (including children) who are overweight or obese and at risk for serious medical conditions, as well as persons who suffer from eating disorders. Additionally, the measure authorizes health professional training grant appropriations through Fiscal Year 2007. The measure authorizes the Secretary of Health and Human Services to make grants to train primary care physicians and other health professionals in obesity and eating disorder identification, treatment, and prevention. This bill also amends the Public Health Service Act to direct the CDC to make grants (four-year maximum) to eligible entities to promote increased physical activity and improved nutrition through: (1) community-based activities; (2) school-based activities; and (3) health care delivery systems. The measure permits grant targeting to at-risk populations, including

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youth, adolescent girls, and health disparity and underserved populations. It also authorizes grant priority for entities that provide matching contributions. The measure allows the National Center for Health Statistics to: (1) provide for collection and analysis of data to determine child and youth fitness and energy expenditure levels, including data collected as part of the National Health and Nutrition Examination Survey; (2) make grants to States, public entities, and nonprofits to further such data collection and analysis; and (3) provide grantees with technical assistance. The measure also establishes reporting requirements respecting: (1) health disparities; (2) obesity research; and (3) the national campaign to change children’s health behaviors and reduce obesity. Finally the measure permits the use of preventive health and health services block grants for healthy eating and exercise education programs. To demonstrate support for the concepts presented through this legislation the Subcommittee asked for the drafting of:

A letter to Nevada’s Congressional representatives urging them to enact legislation such as the Improved Nutrition and Physical Activity (IMPACT) Act, which was referred to the House Committee on Energy and Commerce on January 20, 2004. This legislation will provide more funding to states to help them pursue initiatives to reduce the prevalence of obesity.

Testimony by NCSL indicated that other states were encouraging communities to promote active living and address obesity through exercise. Certain states were looking at planning dynamics to determine how effectively they supported activities such as walking and biking. Additionally, states were looking at advertising campaigns to support active living and healthy nutritional choices. Following testimony on these issue the Subcommittee moved to request the drafting of:

A letter to Nevada’s Department of Transportation urging the department to find grant funding to develop safe biking and walking routes to schools. A letter to billboard companies in Nevada urging them to allow obesity prevention advertising without charging a fee whenever a billboard is not in use.

C. STATEWIDE STRATEGIC PLAN FOR THE PREVENTION OF OBESITY Testimony indicated that to adequately address the challenge of obesity in Nevada, the work of the Subcommittee needed to continue beyond the parameters established for the interim study. Additionally, testimony indicated that the primary funding source for obesity prevention efforts is the CDC. It was further indicated that the CDC prefers to make funding awards from strategic plans that have been developed by states, and Nevada does not currently have a strategic plan in place. Advocates testified to the need for a Planning Group and Statewide Strategic Plan to address obesity in Nevada.

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The following recommendations, which related to the development and potential work of a Planning Group and the development of the strategic plan, were presented to the Subcommittee:

1. In determining membership of the planning group, be inclusive to ensure it represents the interests of Nevadans. As such, work with representatives of the State Department of Education, the UCCSN, including the School of Medicine, representatives of the state’s Cooperative Extension offices, representatives of the Nevada Dietetic Association, and representatives of private industry.

2. In working with private industry representatives, consider including each chamber of

commerce in Nevada, each Better Business Bureau in the state, the Retail Association of Nevada, the Nevada Restaurant Association, and any other identified employer group to encourage their employer-members to develop: (a) targeted intervention programs that are based on identified health risks and interests; (b) focused education programs that support individuals throughout the process of lifestyle change; (c) smoking cessation, weight management, nutrition and cholesterol management, and fitness activities; (d) integrated one-stop workshops that include multi-session classes, individual counseling, and self-directed modules; and (e) maintenance strategies that include ongoing awareness, interactive campaigns, and group support with on-site services. Additionally, a resource that may be used in this regard is the Nevada Cooperative Extension, which has developed a worksite wellness program.

3. In cooperation with health districts in Nevada, seek ways to establish state initiatives

that support: promoting weight maintenance as well as weight loss; preventing weight gain as well as weight regain; preventing obesity and/or exacerbation of the obese state; decreasing or delaying morbidity and mortality; improving health profiles and reducing risk; developing long-term strategies; enacting smaller, simpler interventions; establishing incremental, additive steps; and providing appropriate reimbursement for interventions and documented outcomes.

4. Develop methods to encourage restaurants in Nevada to identify menu items served that

are high-fat, high carbohydrate, and high-calorie foods. 5. Leverage money received from federal sources for programs that promote physical

activity in Nevada. 6. Develop nutrition standards and guidelines to control the sale of competitive foods

in schools and determine which organizations should be responsible for developing and enforcing the standards and rules.

7. Implement methods to provide nutritional training for families enrolled in the state’s

Temporary Assistance for Needy Families program, the state’s Food Stamps program,

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and any other public assistance food programs, including the Women, Infant, and Children’s program.

8. Encourage education in reading nutrition labels on packaged foods. 9. Develop methods to establish a fitness and wellness program for state employees, which

might include cooperating with the Department of Personnel and the Public Employees’ Benefits Program.

10. Use existing tools, such as the training kit from the Center for Weight and Health,

University of California, Berkeley, to help local communities prevent obesity in children.

11. Develop ways to encourage school districts in Nevada to work with health coordinators

who will develop curricula to promote physical activity and healthy nutrition in schools in the district; ensure the availability of tobacco education programs; and engage parents in providing healthy environments for kids at home.

12. Develop methods to ensure that after-school programs promote physical education in

their activities. 13. Consider adopting strategies to ensure that schools provide to children, aged five years

and older, the recommended amount of activities for cardiovascular fitness.

Additionally, to assist in coordinating services the Subcommittee created the “Obesity Resource List.” This list was available to the public during the course of the study. Recognizing both that obesity is a major public health issue and that the Health Division serves as the state’s leader in public health, the Division was asked to continue the work of the Subcommittee. The Subcommittee approved two primary requests.

Convene a planning group or steering committee to develop a Statewide Strategic Plan concerning the prevention of obesity; and Maintain and update the “Obesity Resource List” that the Subcommittee developed during the course of its study.

VI. CONCLUDING REMARKS

This report presents a summary of the recommendations requested by the Subcommittee for discussion before the 2005 Nevada Legislature. Persons wishing to have more specific information concerning these documents may find it useful to review the meeting minutes and exhibits for each of the meetings of the Subcommittee.

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VI. APPENDICES

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Appendix A Senate Concurrent Resolution No. 13, (File No. 89, Statutes of Nevada 2003) Subcommittee to Study Medical and Societal Costs and Impacts of Obesity ...................................................................... 15

Appendix B Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity ................................................................ 19 Appendix C School Food and Beverage Study Results Submitted to the Board of Trustees, Washoe County School District............................... 61 Appendix D Obesity Resource List .................................................................. 81

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APPENDIX A

Senate Concurrent Resolution No. 13 (File No. 89, Statutes of Nevada 2003)

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Senate Concurrent Resolution No. 13 File No. 89

Statutes of Nevada 2003 SENATE CONCURRENT RESOLUTION—Directing the Legislative Committee on Health Care to conduct an interim study concerning the medical and societal costs and impacts of obesity in Nevada.

WHEREAS, Obesity manifests itself as one of our nation’s most significant public health concerns as proven by recent statistics from the Centers for Disease Control and Prevention which reveal that in the United States, approximately 38.8 million adults, 19.8 percent of adults in the United States, are classified as obese, and an estimated 9 million children and adolescents between the ages of 6 and 19 years, 15 percent of that age group, are categorized as overweight; and WHEREAS, These statistics represent such an extremely rapid rise of obesity in our society over the last decade that members of the medical profession attach the word “epidemic” to the problem, a word usually reserved for massive outbreaks of infectious disease; and WHEREAS, Obesity is a chronic disease, and studies show that about one half of children who are overweight by the time they are 6 or 7 years of age remain overweight as adults and 75 percent of adolescents who are overweight will remain overweight as adults; and WHEREAS, Research has established that there is a direct causal relationship between obesity and heart disease, hypertension, stroke, elevated cholesterol, type 2 diabetes, gallbladder disease, arthritis, breathing problems, gout, and forms of cancer such as uterine, cervical, ovarian, breast, gallbladder, colorectal and prostate; and WHEREAS, Statistics for the year 2000 from the Centers for Disease Control and Prevention disclose that 4,089 deaths in Nevada were the result of heart disease and that 3,763 deaths were caused by cancer, and obesity almost assuredly played a role in many of these deaths; and WHEREAS, Not only does obesity affect physical health, but obese persons may also experience low self-esteem, social stigmatism, discrimination, poor body image and increased risk of emotional problems, and disorders such as chronic depression, anxiety and obsessive compulsive disorder have commonly been linked to obesity; and WHEREAS, According to The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity, issued in 2001, an estimated 300,000 people die each year from illnesses directly WHEREAS, In 2000, the total costs of this epidemic in the United States rose to an estimated $117 billion per year, consisting of $61 billion in direct costs for preventive, diagnostic and treatment services for medical care and $56 billion in losses relating to productivity in the workforce and the value of future earnings lost by premature death; and WHEREAS, There is a compelling need for an aggressive program of prevention and treatment because the direct and indirect costs resulting from obesity are expected to

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increase rapidly as the problem worsens and because the prevention and amelioration of obesity could have a significantly positive impact on health care costs in this state; and WHEREAS, Conquering the problem of obesity must begin with the process of accumulating sound scientific data as a foundation for fostering awareness of the role that genetics, behavior and environment play in obesity and finding solutions to improve the quality of life; now, therefore, be it RESOLVED BY THE SENATE OF THE STATE OF NEVADA, THE ASSEMBLY CONCURRING, That the Legislative Committee on Health Care is hereby directed to conduct a study of the medical and societal costs and impacts of obesity on the State of Nevada; and be it further RESOLVED, That a subcommittee must be appointed for the study consisting of one Legislator appointed by the Majority Leader of the Senate, one Legislator appointed by the Minority Leader of the Senate, one Legislator appointed by the Speaker of the Assembly and one Legislator appointed by the Minority Leader of the Assembly, all of whom must have served on the Senate Standing Committee on Human Resources and Facilities or the Assembly Standing Committee on Health and Human Services during the 2003 Legislative Session; and be it further RESOLVED, That one person assigned by the Health Division of the Department of Human Resources and one person assigned by the Department of Education shall also serve as voting members of the subcommittee; and be it further RESOLVED, That the Legislative Commission shall appoint a chairman of the subcommittee from among the members of the subcommittee; and be it further RESOLVED, That the study must include, without limitation: 1. An analysis of the fiscal impact of obesity on health care costs and productivity in Nevada and a determination of possible savings in health care costs resulting from the prevention and proper treatment of obesity; 2. The identification of programs and practices that have been established in Nevada and other states which are cost-effective and could be implemented throughout Nevada; 3. Recommendations for programs to increase public awareness regarding the causes, prevention, risks and treatment of obesity; 4. An examination of the particular effects of the 24-hour lifestyle and transient nature of some of the population of this state on obesity; 5. Recommendations for programs and practices that encourage healthy and balanced fitness and nutritional choices; and 6. Any other proposals for legislation relating to health care for obesity that the committee may receive or develop; and be it further RESOLVED, That any recommended legislation proposed by the subcommittee must be approved by a majority of the members of the Senate and a majority of the members of the Assembly appointed to the subcommittee; and be it further RESOLVED, That the Legislative Committee on Health Care shall submit a report of the results of the study and any recommendations for legislation to the 73rd Session of the Nevada Legislature.

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APPENDIX B

Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity United States Department of Health and Human Services

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ase

was

a c

ritic

al f

orce

in th

e de

velo

pmen

t of

this

doc

umen

t.

�

Off

ice

of D

isea

se P

reve

ntio

n an

d H

ealth

Pro

mot

ion

C

ente

rs fo

r Dis

ease

Con

trol

and

Pre

vent

ion

Nat

iona

l Ins

titut

es o

f Hea

lth

Thi

s pu

blic

atio

n is

ava

ilabl

e on

the

Wor

ld W

ide

Web

at

http

://w

ww

.sur

geon

gene

ral.g

ov/li

brar

y

Sugg

este

d ci

tatio

n:U

.S. D

epar

tmen

t of H

ealth

and

Hum

an S

ervi

ces.

The

Sur

geon

Gen

eral

’s c

all

to a

ctio

n to

pre

vent

and

dec

reas

e ov

erw

eigh

t and

obe

sity

. [R

ockv

ille,

MD

]: U

.S.

Dep

artm

ent o

f Hea

lth a

nd H

uman

Ser

vice

s, P

ublic

Hea

lth S

ervi

ce, O

ffic

e of

the

Surg

eon

Gen

eral

; [20

01].

Ava

ilabl

e fr

om: U

.S. G

PO, W

ashi

ngto

n.

For s

ale

by th

e Su

peri

nten

dent

of D

ocum

ents

, U.S

. Gov

ernm

ent P

rint

ing

Off

ice,

Inte

rnet

: ht

tp://

book

stor

e.G

PO.g

ovPh

one:

Tol

l Fre

e 1

(866

) 512

-180

0; D

C a

rea

(202

) 512

-180

0Fa

x: 1

(202

) 512

-225

0M

ail:

Sto

p SS

OP,

Was

hing

ton,

D.C

., 20

402-

0001

Nat

iona

l Lib

rary

of

Med

icin

e C

atal

ogin

g in

Pub

licat

ion

The

Sur

geon

Gen

eral

's ca

ll to

act

ion

to p

reve

nt a

nd d

ecre

ase

over

wei

ght a

ndob

esity

/ O

ffic

e of

Dis

ease

Pre

vent

ion

and

Hea

lth P

rom

otio

n; C

ente

rs fo

rD

isea

se C

ontr

ol a

nd P

reve

ntio

n, N

atio

nal I

nstit

utes

of H

ealth

. - -

Roc

kvill

e,M

D: U

.S. D

ept.

of H

ealth

and

Hum

an S

ervi

ces,

Pub

lic H

ealth

Ser

vice

, Off

ice

ofth

e Su

rgeo

n G

ener

al; W

ashi

ngto

n, D

.C. :

For

sal

e by

the

Supt

. of D

ocs.

, U.S

.G

.P.O

., 20

01.

Incl

udes

bib

liogr

aphi

cal r

efer

ence

s.A

lso

avai

labl

e on

the

inte

rnet

.

1. O

besi

ty--

prev

entio

n &

con

trol

. 2. W

eigh

t Gai

n. I.

Uni

ted

Stat

es.

Publ

ic H

ealth

Ser

vice

. Off

ice

of th

e Su

rgeo

n G

ener

al. I

I. U

nite

d St

ates

.O

ffic

e of

Dis

ease

Pre

vent

ion

and

Hea

lth P

rom

otio

n. II

I. C

ente

rs fo

r Dis

ease

Con

trol

and

Pre

vent

ion

(U.S

.) IV

. Nat

iona

l Ins

titut

es o

f Hea

lth (U

.S.)

02N

LM

: WD

210

S95

93 2

001

D.C

., 20

402-

0001

22

VIV

A C

all T

o A

ctio

n To

Pre

vent

and

Dec

reas

e O

verw

eigh

t and

Obe

sity

PR

INC

IPL

ES:

Ove

rwei

ght a

nd o

besi

ty h

ave

reac

hed

natio

nwid

e ep

idem

ic p

ropo

rtio

ns. B

oth

the

prev

entio

n an

d tr

eatm

ent o

f ove

rwei

ght a

nd o

besi

ty a

nd th

eir a

ssoc

iate

d he

alth

prob

lem

s ar

e im

port

ant p

ublic

hea

lth g

oals

. To

ach

ieve

thes

e go

als,

The

Sur

geon

Gen

eral

’s C

all

To A

ctio

n To

Pre

vent

and

Dec

reas

e O

verw

eigh

t an

d O

besi

ty i

s

com

mitt

ed to

five

ove

rarc

hing

pri

ncip

les:

•Pr

omot

e th

e re

cogn

ition

of

over

wei

ght a

nd o

besi

ty a

s m

ajor

pub

lic h

ealth

prob

lem

s.

•A

ssis

t Am

eric

ans

in b

alan

cing

hea

lthfu

l eat

ing

with

regu

lar p

hysi

cal a

ctiv

-

ity to

ach

ieve

and

mai

ntai

n a

heal

thy

or h

ealth

ier b

ody

wei

ght.

•Id

entif

y ef

fect

ive

and

cultu

rally

app

ropr

iate

int

erve

ntio

ns t

o pr

even

t an

d

trea

t ove

rwei

ght a

nd o

besi

ty.

•E

ncou

rage

env

iron

men

tal

chan

ges

that

hel

p pr

even

t ov

erw

eigh

t an

d

obes

ity.

•D

evel

op a

nd e

nhan

ce p

ublic

-pri

vate

par

tner

ship

s to

hel

p im

plem

ent

this

visi

on.

23

VII

VI

Sour

ce: B

ehav

iora

l Ris

k F

acto

r Su

rvei

llanc

e Sy

stem

(BR

FSS

)

Not

e: B

FR

SS u

ses

self-

repo

rted

hei

ght a

nd w

eigh

t to

calc

ulat

e ob

esity

;se

lf-re

port

ed d

ata

may

und

eres

timat

e ob

esity

pre

vale

nce.

The

se tw

o fig

ures

dem

onst

rate

the

incr

easi

ngpr

eval

ence

of o

besi

ty*

amon

g U

.S. a

dults

*App

roxi

mat

ely

30 p

ound

s ov

erw

eigh

t

24

IX

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

Y

VII

I

Tabl

e of

Con

tent

sM

essa

ge F

rom

the

Sec

reta

ry,

U.S

. D

epar

tmen

t of

Hea

lth

and

Hum

an S

ervi

ces.

......

......

......

......

......

......

......

......

......

......

......

......

......

......

XI

For

ewor

d F

rom

the

Sur

geon

Gen

eral

, U

.S.

Dep

artm

ent

of H

ealt

han

d H

uman

Ser

vice

s....

......

......

......

......

......

......

......

......

......

......

......

......

......

..X

III

Sect

ion

1: O

verw

eigh

t and

Obe

sity

as

Publ

ic H

ealth

Pro

blem

s in

Am

eric

a....

...1

Mea

suri

ng O

verw

eigh

t and

Obe

sity

......

......

......

......

......

......

......

......

......

......

..4

Hea

lth R

isks

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.8E

cono

mic

Con

sequ

ence

s...

......

......

......

......

......

......

......

......

......

......

......

......

...9

Epi

dem

iolo

gy...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

10D

ispa

ritie

s in

Pre

vale

nce

......

......

......

......

......

......

......

......

......

......

......

......

.....

11H

ealth

Ben

efits

of W

eigh

t Los

s....

......

......

......

......

......

......

......

......

......

......

...14

Sect

ion

2: P

osin

g Q

uest

ions

and

Dev

elop

ing

Stra

tegi

es...

......

......

......

......

......

.15

Dev

elop

ing

a Pu

blic

Hea

lth R

espo

nse

......

......

......

......

......

......

......

......

......

...15

CA

RE

to A

ddre

ss O

verw

eigh

t and

Obe

sity

......

......

......

......

......

......

......

......

.16

Setti

ng 1

: Fam

ilies

and

Com

mun

ities

......

......

......

......

......

......

......

......

......

16Se

tting

2: S

choo

ls...

......

......

......

......

......

......

......

......

......

......

......

......

......

...19

Setti

ng 3

: Hea

lth C

are

......

......

......

......

......

......

......

......

......

......

......

......

.....

21Se

tting

4: M

edia

and

Com

mun

icat

ions

......

......

......

......

......

......

......

......

....2

3Se

tting

5: W

orks

ites.

......

......

......

......

......

......

......

......

......

......

......

......

......

..24

Sect

ion

3: T

he P

ower

of P

eopl

e an

d Id

eas

......

......

......

......

......

......

......

......

......

27C

reat

ing

Nat

iona

l Act

ion

......

......

......

......

......

......

......

......

......

......

......

......

....2

9Su

stai

ning

Nat

iona

l Act

ion

......

......

......

......

......

......

......

......

......

......

......

......

.30

Sect

ion

4: V

isio

n fo

r the

Fut

ure

......

......

......

......

......

......

......

......

......

......

......

....3

3Su

rgeo

n G

ener

al’s

Pri

oriti

es f

or A

ctio

n...

......

......

......

......

......

......

......

......

....3

3C

oncl

usio

n...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

....3

5

Ref

eren

ces

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

......

.....

37

Ack

now

ledg

men

ts...

......

......

......

......

......

......

......

......

......

......

......

......

......

......

..41

Stee

ring

Com

mitt

ee R

oste

r...

......

......

......

......

......

......

......

......

......

......

......

......

.43

App

endi

x A

: E

xam

ples

of F

eder

al P

rogr

ams

and

Initi

ativ

es...

......

......

......

.....

45

App

endi

x B

: Fe

dera

l Pro

gram

Res

ourc

e L

ist

......

......

......

......

......

......

......

......

53

25

XI

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

Y

X

Mes

sage

Fro

m th

e Se

cret

ary

U.S

. Dep

artm

ent o

f Hea

lth a

ndH

uman

Ser

vice

s

The

20t

h ce

ntur

y sa

w r

emar

kabl

e an

d un

prec

eden

ted

impr

ovem

ents

in

the

lives

of

the

peop

le o

f ou

r co

untr

y. W

e sa

w th

e in

fant

mor

talit

y ra

te p

lum

met

and

life

expe

ctan

cy i

ncre

ase

by 3

0 ye

ars.

D

eath

s fr

om i

nfec

tious

dis

ease

s dr

oppe

d

trem

endo

usly

, and

impr

ovem

ents

in m

edic

al c

are

allo

wed

man

y in

divi

dual

s w

ith

chro

nic

dise

ase

to le

ad lo

nger

, ful

ler

lives

. Y

et d

espi

te th

ese

and

othe

r su

cces

ses,

com

plex

new

hea

lth c

halle

nges

con

tinue

to c

onfr

ont u

s.

Ove

rwei

ght

and

obes

ity a

re a

mon

g th

e m

ost

impo

rtan

t of

the

se n

ew h

ealth

chal

leng

es.

Our

mod

ern

envi

ronm

ent h

as a

llow

ed th

ese

cond

ition

s to

incr

ease

at

alar

min

g ra

tes

and

beco

me

high

ly p

ress

ing

heal

th p

robl

ems

for o

ur N

atio

n. A

t the

sam

e tim

e, b

y co

nfro

ntin

g th

ese

cond

ition

s, w

e ha

ve tr

emen

dous

opp

ortu

nitie

s to

prev

ent t

he u

nnec

essa

ry d

isea

se a

nd d

isab

ility

that

they

por

tend

for o

ur fu

ture

.

As

we

mov

e to

ack

now

ledg

e an

d un

ders

tand

thes

e co

nditi

ons,

it is

impo

rtan

t

to r

emem

ber

that

they

are

as

sens

itive

for

eac

h of

us

as th

ey a

re c

halle

ngin

g an

d

impo

rtan

t fo

r ou

r co

untr

y’s

heal

th.

Thi

s is

tru

ly t

he t

ime

for

a C

all

To A

ctio

n,

beca

use

each

one

of u

s as

an

indi

vidu

al m

ust u

nder

stan

d th

at w

e ar

e ca

lled

upon

to

act,

just

as

our i

nstit

utio

ns a

re c

alle

d up

on to

con

side

r how

they

can

hel

p co

nfro

nt

this

new

epi

dem

ic.

Thi

s Su

rgeo

n G

ener

al’s

Cal

l To

Act

ion

repr

esen

ts a

n op

port

unity

for i

ndiv

idu-

als

to m

ake

heal

thy

lifes

tyle

cho

ices

for t

hem

selv

es a

nd th

eir f

amili

es.

It e

ncou

r-

ages

hea

lth c

are

prov

ider

s to

hel

p in

divi

dual

s pr

even

t and

trea

t the

se c

ondi

tions

.

At a

bro

ader

leve

l, it

prom

pts a

ll co

mm

uniti

es to

mak

e ch

ange

s tha

t pro

mot

e he

alth

-

ful e

atin

g an

d ad

equa

te p

hysi

cal a

ctiv

ity.

It c

alls

for

sci

entis

ts to

pur

sue

new

re-

sear

ch.

Abo

ve a

ll, i

t ca

lls u

pon

indi

vidu

als,

fam

ilies

, co

mm

uniti

es,

scho

ols,

wor

ksite

s, o

rgan

izat

ions

, and

the

med

ia t

o w

ork

toge

ther

to

build

sol

utio

ns t

hat

will

bri

ng b

ette

r hea

lth to

eve

ryon

e in

this

cou

ntry

.

I w

hole

hear

tedl

y su

ppor

t Th

e Su

rgeo

n G

ener

al’s

Cal

l To

Act

ion

To P

reve

nt

and

Dec

reas

e O

verw

eigh

t an

d O

besi

ty, a

nd I

urg

e al

l of

us

to w

ork

toge

ther

to

achi

eve

its a

mbi

tious

and

ess

entia

l vis

ion.

26

XII

I

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

Y

XII

Fore

wor

d Fr

om th

eSu

rgeo

n G

ener

alU

.S. D

epar

tmen

t of H

ealth

and

Hum

an S

ervi

ces

Ove

rwei

ght a

nd o

besi

ty m

ay n

ot b

e in

fect

ious

dis

ease

s, b

ut th

ey h

ave

reac

hed

epid

emic

pro

port

ions

in th

e U

nite

d St

ates

. O

verw

eigh

t and

obe

sity

are

incr

easi

ng

in b

oth

gend

ers

and

amon

g al

l pop

ulat

ion

grou

ps.

In 1

999,

an

estim

ated

61

per-

cent

of U

.S. a

dults

wer

e ov

erw

eigh

t or o

bese

, and

13

perc

ent o

f chi

ldre

n an

d ad

o-

lesc

ents

wer

e ov

erw

eigh

t. T

oday

ther

e ar

e ne

arly

twic

e as

man

y ov

erw

eigh

t chi

l-

dren

and

alm

ost t

hree

tim

es a

s man

y ov

erw

eigh

t ado

lesc

ents

as t

here

wer

e in

198

0.

We

alre

ady

are

seei

ng t

ragi

c re

sults

fro

m t

hese

tre

nds.

A

ppro

xim

atel

y 30

0,00

0

deat

hs a

yea

r in

this

cou

ntry

are

cur

rent

ly a

ssoc

iate

d w

ith o

verw

eigh

t and

obe

sity

.

Lef

t una

bate

d, o

verw

eigh

t and

obe

sity

may

soo

n ca

use

as m

uch

prev

enta

ble

dis-

ease

and

dea

th a

s ci

gare

tte s

mok

ing.

Ove

rwei

ght a

nd o

besi

ty h

ave

been

gro

uped

as o

ne o

f the

Lea

ding

Hea

lth In

di-

cato

rs in

Hea

lthy

Peo

ple

2010

, the

Nat

ion'

s hea

lth o

bjec

tives

for t

he fi

rst d

ecad

e of

the

21st

cen

tury

. T

he L

eadi

ng H

ealth

Ind

icat

ors

refl

ect

the

maj

or p

ublic

hea

lth

conc

erns

and

opp

ortu

nitie

s in

the

Uni

ted

Stat

es.

Whi

le w

e ha

ve m

ade

dram

atic

prog

ress

ove

r th

e la

st f

ew d

ecad

es in

ach

ievi

ng s

o m

any

of o

ur h

ealth

goa

ls, t

he

stat

istic

s on

over

wei

ght a

nd o

besi

ty h

ave

stea

dily

hea

ded

in th

e w

rong

dir

ectio

n. I

f

this

situ

atio

n is

not

rev

erse

d, it

cou

ld w

ipe

out t

he g

ains

we

have

mad

e in

are

as

such

as

hear

t dis

ease

, dia

bete

s, s

ever

al f

orm

s of

can

cer,

and

othe

r ch

roni

c he

alth

prob

lem

s.

Unf

ortu

nate

ly,

exce

ssiv

e w

eigh

t fo

r he

ight

is

a ri

sk f

acto

r fo

r al

l of

thes

e co

nditi

ons.

Man

y pe

ople

bel

ieve

that

dea

ling

with

ove

rwei

ght a

nd o

besi

ty is

a p

erso

nal

resp

onsi

bilit

y. T

o so

me

degr

ee th

ey a

re ri

ght,

but i

t is

also

a c

omm

unity

resp

onsi

-

bilit

y. W

hen

ther

e ar

e no

saf

e, a

cces

sibl

e pl

aces

for

chi

ldre

n to

pla

y or

adu

lts to

wal

k, jo

g, o

r ri

de a

bik

e, th

at is

a c

omm

unity

res

pons

ibili

ty.

Whe

n sc

hool

lunc

h-

room

s or

off

ice

cafe

teri

as d

o no

t pro

vide

hea

lthy

and

appe

alin

g fo

od c

hoic

es, t

hat

is a

com

mun

ity r

espo

nsib

ility

. W

hen

new

or

expe

ctan

t mot

hers

are

not

edu

cate

d

Lik

e m

any

acro

ss th

e N

atio

n, th

e D

epar

tmen

t of H

ealth

and

Hum

an S

ervi

ces

was

rem

inde

d ho

w s

mal

l the

wor

ld is

whe

n, o

n Se

ptem

ber 1

1, w

e lo

st o

ne o

f our

own,

Pau

l Am

bros

e, M

.D.,

M.P

.H.

He

had

just

fini

shed

the

fina

l edi

ts o

n th

e C

all

To A

ctio

n an

d w

as o

n hi

s w

ay to

a c

onfe

renc

e in

Cal

ifor

nia

on c

hild

hood

obe

sity

whe

n tr

aged

y st

ruck

. Pa

ul w

as a

man

of g

reat

com

pass

ion

and

hear

t, co

mm

itted

to

help

ing

peop

le in

rur

al A

mer

ica

obta

in b

ette

r he

alth

car

e an

d im

prov

ing

prev

en-

tion

mea

sure

s fo

r all

Am

eric

ans.

He

care

d de

eply

for t

he is

sues

he

wor

ked

on b

ut

even

mor

e fo

r the

peo

ple

affe

cted

. W

hile

we

will

mis

s Pa

ul’s

ene

rgy

and

dedi

ca-

tion,

we

will

mis

s hi

s hu

man

ity e

ven

mor

e.

Tom

my

G. T

hom

pson

27

XV

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

Y

XIV

achi

evin

g a

heal

thy

body

wei

ght a

nd b

egan

a n

atio

nal d

ialo

gue

on st

rate

gies

for t

he

prev

entio

n of

ove

rwei

ght a

nd o

besi

ty.

Fina

lly, a

Sur

geon

Gen

eral

's L

iste

ning

Ses

-

sion

, he

ld i

n la

te 2

000,

and

a r

elat

ed p

ublic

com

men

t pe

riod

, ge

nera

ted

man

y

usef

ul id

eas

for p

reve

ntio

n an

d tr

eatm

ent s

trat

egie

s an

d he

lped

forg

e an

d re

info

rce

an i

mpo

rtan

t co

aliti

on o

f st

akeh

olde

rs.

Par

ticip

ants

in

thes

e ev

ents

con

side

red

man

y pr

even

tion

and

trea

tmen

t str

ateg

ies,

incl

udin

g su

ch n

atio

nal p

rior

ities

as

en-

suri

ng d

aily

phy

sica

l edu

catio

n in

sch

ools

, inc

reas

ing

rese

arch

on

the

beha

vior

al

and

envi

ronm

enta

l cau

ses

of o

besi

ty, a

nd p

rom

otin

g br

east

feed

ing.

The

se a

ctiv

ities

are

just

a b

egin

ning

, how

ever

. E

ffec

tive

actio

n re

quir

es th

e

clos

e co

oper

atio

n an

d co

llabo

ratio

n of

a v

arie

ty o

f or

gani

zatio

ns a

nd in

divi

dual

s.

Thi

s C

all

To A

ctio

n se

rves

to

recr

uit

your

tal

ent

and

insp

irat

ion

in d

evel

opin

g

natio

nal a

ctio

ns to

pro

mot

e he

alth

y ea

ting

habi

ts a

nd a

dequ

ate

phys

ical

act

ivity

,

begi

nnin

g in

chi

ldho

od a

nd c

ontin

uing

acr

oss

the

lifes

pan.

I a

ppla

ud y

our i

nter

est

in th

is im

port

ant p

ublic

hea

lth c

halle

nge.

Dav

id S

atch

er, M

.D.,

Ph.D

.

For

ewor

d F

rom

the

Surg

eon

Gen

eral

abou

t the

ben

efits

of b

reas

tfee

ding

, tha

t is

a co

mm

unity

resp

onsi

bilit

y. W

hen

we

do n

ot r

equi

re d

aily

phy

sica

l edu

catio

n in

our

sch

ools

, tha

t is

also

a c

omm

unity

resp

onsi

bilit

y. T

here

is m

uch

that

we

can

and

shou

ld d

o to

geth

er.

Taki

ng a

ctio

n to

add

ress

ove

rwei

ght a

nd o

besi

ty w

ill h

ave

prof

ound

eff

ects

on

incr

easi

ng th

e qu

ality

and

yea

rs o

f he

alth

y lif

e an

d on

elim

inat

ing

heal

th d

ispa

ri-

ties

in th

e U

nite

d St

ates

. W

ith th

is o

utco

me

in m

ind,

I as

ked

the

Off

ice

of D

isea

se

Prev

entio

n an

d H

ealth

Pro

mot

ion,

alo

ng w

ith o

ther

age

ncie

s in

the

Dep

artm

ent o

f

Hea

lth a

nd H

uman

Ser

vice

s, t

o as

sist

me

in d

evel

opin

g th

is S

urge

on G

ener

al's

Cal

l To

Act

ion

To P

reve

nt a

nd D

ecre

ase

Ove

rwei

ght a

nd O

besi

ty.

Our

ulti

mat

e

goal

is to

set

pri

oriti

es a

nd e

stab

lish

stra

tegi

es a

nd a

ctio

ns to

red

uce

over

wei

ght

and

obes

ity.

Thi

s pr

oces

s be

gins

with

our

atti

tude

s ab

out o

verw

eigh

t and

obe

sity

.

Rec

ogni

tion

of t

he e

pide

mic

of

over

wei

ght

and

obes

ity i

s re

lativ

ely

rece

nt, a

nd

ther

e re

mai

n en

orm

ous

chal

leng

es a

nd o

ppor

tuni

ties

in f

indi

ng s

olut

ions

to

this

publ

ic h

ealth

cri

sis.

Ove

rwei

ght a

nd o

besi

ty m

ust b

e ap

proa

ched

as

prev

enta

ble

and

trea

tabl

e pr

oble

ms

with

real

istic

and

exc

iting

opp

ortu

nitie

s to

impr

ove

heal

th

and

save

live

s. T

he c

halle

nge

is to

cre

ate

a m

ultif

acet

ed p

ublic

hea

lth a

ppro

ach

capa

ble

of d

eliv

erin

g lo

ng-t

erm

red

uctio

ns i

n th

e pr

eval

ence

of

over

wei

ght

and

obes

ity.

Thi

s ap

proa

ch s

houl

d fo

cus

on h

ealth

rat

her

than

app

eara

nce

and

em-

pow

er b

oth

indi

vidu

als

and

com

mun

ities

to

addr

ess

barr

iers

, red

uce

stig

mat

iza-

tion,

and

mov

e fo

rwar

d in

add

ress

ing

over

wei

ght

and

obes

ity i

n a

posi

tive

and

proa

ctiv

e fa

shio

n.

Seve

ral e

vent

s hav

e dr

awn

atte

ntio

n to

ove

rwei

ght a

nd o

besi

ty a

s pub

lic h

ealth

prob

lem

s. I

n 19

98, t

he N

atio

nal H

eart

, Lun

g, a

nd B

lood

Ins

titut

e in

coo

pera

tion

with

the

Nat

iona

l Ins

titut

e of

Dia

bete

s an

d D

iges

tive

and

Kid

ney

Dis

ease

s of

the

Nat

iona

l Ins

titut

es o

f Hea

lth re

leas

ed th

e C

linic

al G

uide

lines

on

the

Iden

tific

atio

n,

Eva

luat

ion,

and

Tre

atm

ent o

f Obe

sity

in A

dults

: Evi

denc

e R

epor

t. T

his

repo

rt w

as

the

resu

lt of

a th

orou

gh s

cien

tific

rev

iew

of

the

evid

ence

rel

ated

to th

e ri

sks

and

trea

tmen

t of

ove

rwei

ght

and

obes

ity,

and

it pr

ovid

ed e

vide

nce-

base

d tr

eatm

ent

guid

elin

es fo

r hea

lth c

are

prov

ider

s. I

n ea

rly

2000

, the

rele

ase

of H

ealth

y P

eopl

e

2010

iden

tifie

d ov

erw

eigh

t and

obe

sity

as

maj

or p

ublic

hea

lth p

robl

ems

and

set

natio

nal o

bjec

tives

for r

educ

tion

in th

eir p

reva

lenc

e. T

he N

atio

nal N

utri

tion

Sum

-

mit

in M

ay 2

000

illum

inat

ed th

e im

pact

of d

ieta

ry a

nd p

hysi

cal a

ctiv

ity h

abits

on

28

1

SEC

TIO

N 1

:

Ove

rwei

ght a

nd O

besi

ty a

s Pu

blic

Hea

lth P

robl

ems

in A

mer

ica

Thi

s Su

rgeo

n G

ener

al’s

Cal

l To

Act

ion

To P

reve

nt a

nd D

ecre

ase

Ove

rwei

ght

and

Obe

sity

see

ks to

eng

age

lead

ers

from

div

erse

gro

ups

in a

ddre

ssin

g a

publ

ic

heal

th is

sue

that

is a

mon

g th

e m

ost b

urde

nsom

e fa

ced

by th

e N

atio

n: th

e he

alth

cons

eque

nces

of

over

wei

ght a

nd o

besi

ty.

Thi

s bu

rden

man

ifes

ts it

self

in p

rem

a-

ture

dea

th a

nd d

isab

ility

, in

hea

lth c

are

cost

s, i

n lo

st p

rodu

ctiv

ity,

and

in s

ocia

l

stig

mat

izat

ion.

The

bur

den

is n

ot tr

ivia

l. S

tudi

es s

how

that

the

risk

of d

eath

rise

s

with

inc

reas

ing

wei

ght.

Eve

n m

oder

ate

wei

ght

exce

ss (

10 t

o 20

pou

nds

for

a

pers

on o

f av

erag

e he

ight

) in

crea

ses

the

risk

of

deat

h, p

artic

ular

ly a

mon

g ad

ults

aged

30

to 6

4 ye

ars.

1

Ove

rwei

ght

and

obes

ity a

re c

ause

d by

man

y fa

ctor

s.

For

each

ind

ivid

ual,

body

wei

ght

is d

eter

min

ed b

y a

com

bina

tion

of g

enet

ic,

met

abol

ic,

beha

vior

al,

envi

ronm

enta

l, cu

ltura

l, an

d so

cioe

cono

mic

infl

uenc

es.

Beh

avio

ral a

nd e

nvir

on-

men

tal

fact

ors

are

larg

e co

ntri

buto

rs t

o ov

erw

eigh

t an

d ob

esity

and

pro

vide

the

grea

test

opp

ortu

nity

for a

ctio

ns a

nd in

terv

entio

ns d

esig

ned

for p

reve

ntio

n an

d tr

eat-

men

t. For t

he v

ast m

ajor

ity o

f ind

ivid

uals

, ove

rwei

ght a

nd o

besi

ty re

sult

from

exc

ess

calo

rie

cons

umpt

ion

and/

or in

adeq

uate

phy

sica

l act

ivity

. U

nhea

lthy

diet

ary

habi

ts

and

sede

ntar

y be

havi

or to

geth

er a

ccou

nt fo

r app

roxi

mat

ely

300,

000

deat

hs e

very

year

.2,3

Thu

s, a

hea

lthy

diet

and

reg

ular

phy

sica

l act

ivity

, con

sist

ent w

ith th

e D

i-

etar

y G

uide

lines

for

Am

eric

ans,

sho

uld

be p

rom

oted

as

the

corn

erst

one

of a

ny

prev

entio

n or

trea

tmen

t eff

ort.4,

5 Acc

ordi

ng to

the

U.S

. Dep

artm

ent o

f Agr

icul

ture

’s

1994

–199

6 C

ontin

uing

Sur

vey

of F

ood

Inta

kes

by I

ndiv

idua

ls, v

ery

few

Am

eri-

cans

mee

t th

e m

ajor

ity o

f th

e Fo

od G

uide

Pyr

amid

rec

omm

enda

tions

. O

nly

3

perc

ent o

f all

indi

vidu

als

mee

t fou

r of t

he fi

ve re

com

men

datio

ns fo

r the

inta

ke o

f

grai

ns, f

ruits

, veg

etab

les,

dai

ry p

rodu

cts,

and

mea

ts.6

Muc

h w

ork

need

s to

be d

one

to e

nsur

e th

e nu

trie

nt a

dequ

acy

of o

ur d

iets

whi

le a

t the

sam

e tim

e av

oidi

ng e

xces

s

calo

ries

. D

ieta

ry a

dequ

acy

and

mod

erat

ion

in e

nerg

y co

nsum

ptio

n ar

e bo

th im

-

port

ant f

or m

aint

aini

ng o

r ach

ievi

ng a

hea

lthy

wei

ght a

nd fo

r ove

rall

heal

th.

29

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YSe

ctio

n 1:

Ove

rwei

ght a

nd O

besi

ty a

s P

ubli

c H

ealt

h P

robl

ems

in A

mer

ica

23

Man

y ad

ult A

mer

ican

s ha

ve n

ot b

een

mee

ting

Fede

ral p

hysi

cal a

ctiv

ity r

ec-

omm

enda

tions

to

accu

mul

ate

at l

east

30

min

utes

of

mod

erat

e ph

ysic

al a

ctiv

ity

mos

t da

ys o

f th

e w

eek.

4,7

In

1997

, les

s th

an o

ne-t

hird

of

adul

ts e

ngag

ed i

n th

e

reco

mm

ende

d am

ount

of p

hysi

cal a

ctiv

ity, a

nd 4

0 pe

rcen

t of a

dults

eng

aged

in n

o

leis

ure-

time

phys

ical

act

ivity

.7 A

lthou

gh n

earl

y 65

per

cent

of a

dole

scen

ts re

port

ed

part

icip

atin

g in

vig

orou

s ac

tivity

for

20

min

utes

or

mor

e on

3 o

r m

ore

out

of 7

days

, nat

iona

l da

ta a

re n

ot a

vaila

ble

to a

sses

s w

heth

er c

hild

ren

and

adol

esce

nts

mee

t the

Fed

eral

reco

mm

enda

tions

to a

ccum

ulat

e at

leas

t 60

min

utes

of m

oder

ate

phys

ical

act

ivity

mos

t day

s of

the

wee

k.4,

8 M

any

expe

rts

also

bel

ieve

that

phy

sica

l

inac

tivity

is a

n im

port

ant p

art o

f the

ene

rgy

imba

lanc

e re

spon

sibl

e fo

r the

incr

eas-

ing

prev

alen

ce o

f ove

rwei

ght a

nd o

besi

ty.

Our

soci

ety

has b

ecom

e ve

ry se

dent

ary;

for e

xam

ple,

in 1

999,

43

perc

ent o

f stu

dent

s in

gra

des

9 th

roug

h 12

vie

wed

tele

vi-

sion

mor

e th

an 2

hou

rs p

er d

ay.8

Bot

h di

etar

y in

take

and

phy

sica

l act

ivity

are

dif

ficu

lt to

mea

sure

on

eith

er a

n

indi

vidu

al o

r a p

opul

atio

n le

vel.

Mor

e re

sear

ch is

cle

arly

nec

essa

ry to

fully

und

er-

stan

d th

e sp

ecif

ic e

tiolo

gy o

f thi

s cr

isis

. H

owev

er, t

hese

sta

tistic

s an

d th

e in

crea

s-

ing

prev

alen

ce o

f ove

rwei

ght a

nd o

besi

ty h

ighl

ight

the

need

to e

ngag

e al

l Am

eri-

cans

as

we

mov

e fo

rwar

d to

ens

ure

the

qual

ity a

nd a

cces

sibi

lity

of p

reve

ntio

n an

d

trea

tmen

t pro

gram

s.

PU

BL

IC H

EA

LTH

AN

D T

HE S

UR

GE

ON G

EN

ER

AL

Thr

ough

coo

pera

tive

actio

n, p

ublic

hea

lth p

rogr

ams h

ave

succ

essf

ully

pre

-

vent

ed th

e sp

read

of i

nfec

tious

dis

ease

, pro

tect

ed a

gain

st e

nvir

onm

enta

l haz

-

ards

, red

uced

acc

iden

ts a

nd i

njur

ies,

res

pond

ed t

o di

sast

ers,

wor

ked

tow

ard

ensu

ring

the

qual

ity a

nd a

cces

sibi

lity

of h

ealth

serv

ices

, and

pro

mot

ed h

ealth

y

beha

vior

s.9

Ove

r the

pas

t 100

yea

rs, t

hank

s lar

gely

to p

ublic

hea

lth e

ffor

ts, t

he

life

expe

ctan

cy o

f Am

eric

ans

has

incr

ease

d by

app

roxi

mat

ely

50 p

erce

nt.10

Publ

ic h

ealth

suc

cess

has

tra

ditio

nally

com

e fr

om t

he r

educ

tion

in t

he

inci

denc

e of

inf

ectio

us d

isea

ses

thro

ugh

impr

oved

san

itatio

n an

d nu

triti

on,

clea

ner

air

and

wat

er, a

nd n

atio

nal

vacc

inat

ion

prog

ram

s.

As

the

thre

ats

to

Am

eric

a’s

heal

th h

ave

shif

ted,

so

too

have

pub

lic h

ealth

eff

orts

. I

n re

cent

year

s, p

ublic

hea

lth e

ffor

ts h

ave

succ

essf

ully

nav

igat

ed n

ew fr

ontie

rs s

uch

as

viol

ence

pre

vent

ion,

toba

cco

cess

atio

n, a

nd m

enta

l hea

lth. P

ublic

hea

lth o

ffi-

cial

s rem

ain

pois

ed to

add

ress

new

hea

lth c

halle

nges

thro

ugh

the

colla

bora

tive

proc

esse

s of

sci

entif

ic re

sear

ch, p

olic

y de

velo

pmen

t, an

d co

mm

unity

mob

ili-

zatio

n.

30

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YSe

ctio

n 1:

Ove

rwei

ght a

nd O

besi

ty a

s P

ubli

c H

ealt

h P

robl

ems

in A

mer

ica

45

ME

ASU

RIN

G O

VE

RW

EIG

HT A

ND O

BE

SIT

YT

he f

irst

cha

lleng

e in

add

ress

ing

over

wei

ght

and

obes

ity l

ies

in a

dopt

ing

a

com

mon

pub

lic h

ealth

mea

sure

of t

hese

con

ditio

ns.

An

expe

rt p

anel

, con

vene

d by

the

Nat

iona

l In

stitu

tes

of H

ealth

(N

IH)

in 1

998,

has

util

ized

Bod

y M

ass

Inde

x

(BM

I) f

or d

efin

ing

over

wei

ght

and

obes

ity.11

B

MI

is a

pra

ctic

al m

easu

re t

hat

requ

ires

onl

y tw

o th

ings

: ac

cura

te m

easu

res

of a

n in

divi

dual

’s w

eigh

t and

hei

ght

(fig

ure

1).

BM

I is

a m

easu

re o

f wei

ght i

n re

latio

n to

hei

ght.

BM

I is

calc

ulat

ed a

s

wei

ght i

n po

unds

div

ided

by

the

squa

re o

f the

hei

ght i

n in

ches

, mul

tiplie

d by

703

.

Alte

rnat

ivel

y, B

MI c

an b

e ca

lcul

ated

as

wei

ght i

n ki

logr

ams

divi

ded

by th

e sq

uare

of th

e he

ight

in m

eter

s.

Stud

ies

have

sho

wn

that

BM

I is

sig

nifi

cant

ly c

orre

late

d w

ith t

otal

bod

y fa

t

cont

ent f

or th

e m

ajor

ity o

f in

divi

dual

s.11

BM

I ha

s so

me

limita

tions

, in

that

it c

an

over

estim

ate

body

fat i

n pe

rson

s w

ho a

re v

ery

mus

cula

r, an

d it

can

unde

rest

imat

e

body

fat

in

pers

ons

who

hav

e lo

st m

uscl

e m

ass,

suc

h as

man

y el

derl

y.

Man

y

orga

niza

tions

, in

clud

ing

over

50

scie

ntif

ic a

nd m

edic

al o

rgan

izat

ions

tha

t ha

ve

endo

rsed

the

NIH

Clin

ical

Gui

delin

es, s

uppo

rt th

e us

e of

a B

MI

of 3

0 kg

/m2

or

grea

ter t

o id

entif

y ob

esity

in a

dults

and

a B

MI b

etw

een

25 k

g/m

2 and

29.

9 kg

/m2 t

o

iden

tify

over

wei

ght

in a

dults

.12,1

3 T

hese

def

initi

ons

are

base

d on

evi

denc

e th

at

sugg

ests

hea

lth ri

sks

are

grea

ter a

t or a

bove

a B

MI o

f 25

kg/m

2 com

pare

d to

thos

e

at a

BM

I be

low

that

leve

l.12 T

he r

isk

of d

eath

, alth

ough

mod

est u

ntil

a B

MI o

f 30

kg/m

2 is

reac

hed,

incr

ease

s w

ith a

n in

crea

sing

Bod

y M

ass

Inde

x.1

FIG

UR

E 1

: AD

ULT

BO

DY M

ASS

IN

DE

X

29

31

3

4

36

3

9

41

4

3

46

4

8

51

5

3

56

5

8

60

27

2

9

31

3

4

36

3

8

40

4

3

45

4

7

49

5

2

54

5

6

25

2

7

29

3

1

34

3

6

38

4

0

42

4

4

46

4

8

50

5

2

23

2

5

27

2

9

31

3

3

35

3

7

39

4

1

43

4

5

47

4

9

22

2

4

26

2

7

29

3

1

33

3

5

37

3

8

40

4

2

44

4

6

21

2

2

24

2

6

28

2

9

31

3

3

34

3

6

38

4

0

41

4

3

19

2

1

23

2

4

26

2

7

29

3

1

32

3

4

36

3

7

39

4

0

18

20

2

1

23

2

4

26

2

7

29

3

0

32

3

4

35

3

7

38

17

19

2

0

22

2

3

24

2

6

27

2

9

30

3

2

33

3

5

36

16

1

8

19

2

0

22

2

3

24

2

6

27

2

8

30

3

1

33

3

4

15

1

7

18

1

9

21

2

2

23

2

4

26

2

7

28

3

0

31

3

2

15

1

6

17

1

8

20

2

1

22

2

3

24

2

6

27

2

8

29

3

0

14

1

5

16

1

7

19

2

0

21

2

2

23

2

4

25

2

7

28

2

9

13

1

4

15

1

7

18

1

9

20

2

1

22

2

3

24

2

5

26

2

8

Wei

ght i

n P

ound

s12

0 13

0 14

0 15

0 16

0 17

0 18

0 19

0 20

0 21

0 22

0 23

0 24

0 25

0

4’6

4’8

4’10

5’0

5’2

5’4

5’6

5’8

5’10

6’0

6’2

6’4

6’6

6’8

Height in Feet and Inches

31

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YSe

ctio

n 1:

Ove

rwei

ght a

nd O

besi

ty a

s P

ubli

c H

ealt

h P

robl

ems

in A

mer

ica

67

In c

hild

ren

and

adol

esce

nts,

ove

rwei

ght h

as b

een

defi

ned

as a

sex

- an

d ag

e-

spec

ific

BM

I at o

r abo

ve th

e 95

th p

erce

ntile

, bas

ed o

n re

vise

d C

ente

rs fo

r Dis

ease

Con

trol

and

Pre

vent

ion

(CD

C)

grow

th c

hart

s (f

igur

es 2

and

3).14

Nei

ther

a s

epa-

rate

def

initi

on f

or o

besi

ty n

or a

def

initi

on f

or o

verw

eigh

t ba

sed

on h

ealth

out

-

com

es o

r ris

k fa

ctor

s is

def

ined

for c

hild

ren

and

adol

esce

nts.

15

FIG

UR

E 2

: BO

DY M

ASS

IN

DE

X-F

OR-A

GE P

ER

CE

NT

ILE

S:B

OY

S A

GE

D 2

TO

20

YE

AR

S

FIG

UR

E 3

: BO

DY M

ASS

IN

DE

X-F

OR-A

GE P

ER

CE

NT

ILE

S:G

IRL

S A

GE

D 2

TO

20

YE

AR

S

Sour

ce:

Dev

elop

ed b

y th

e N

atio

nal C

ente

r fo

r H

ealth

Sta

tistic

s in

col

labo

ratio

n w

ith th

eN

atio

nal C

ente

r fo

r C

hron

ic D

isea

se P

reve

ntio

n an

d H

ealth

Pro

mot

ion

(200

0)

Sour

ce:

Dev

elop

ed b

y th

e N

atio

nal C

ente

r fo

r H

ealth

Sta

tistic

s in

col

labo

ratio

n w

ith th

eN

atio

nal C

ente

r fo

r C

hron

ic D

isea

se P

reve

ntio

n an

d H

ealth

Pro

mot

ion

(200

0)

32

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YSe

ctio

n 1:

Ove

rwei

ght a

nd O

besi

ty a

s P

ubli

c H

ealt

h P

robl

ems

in A

mer

ica

89

The

se d

ata

on t

he m

orbi

dity

and

mor

talit

y as

soci

ated

with

ove

rwei

ght

and

obes

ity d

emon

stra

te th

e im

port

ance

of t

he p

reve

ntio

n of

wei

ght g

ain,

as w

ell a

s the

role

of o

besi

ty tr

eatm

ent,

in m

aint

aini

ng a

nd im

prov

ing

heal

th a

nd q

ualit

y of

life

.

TA

BL

E 1

: HE

ALT

H R

ISK

S A

SSO

CIA

TE

D W

ITH

OB

ESI

TY

EC

ON

OM

IC C

ON

SEQ

UE

NC

ES

Ove

rwei

ght a

nd o

besi

ty a

nd th

eir a

ssoc

iate

d he

alth

pro

blem

s ha

ve s

ubst

antia

l

econ

omic

con

sequ

ence

s fo

r th

e U

.S.

heal

th c

are

syst

em. T

he i

ncre

asin

g pr

eva-

lenc

e of

ove

rwei

ght a

nd o

besi

ty is

ass

ocia

ted

with

bot

h di

rect

and

indi

rect

cos

ts.

Dir

ect h

ealth

car

e co

sts

refe

r to

pre

vent

ive,

dia

gnos

tic, a

nd tr

eatm

ent s

ervi

ces

re-

late

d to

ove

rwei

ght

and

obes

ity (

for

exam

ple,

phy

sici

an v

isits

and

hos

pita

l an

d

nurs

ing

hom

e ca

re).

Ind

irec

t cos

ts r

efer

to th

e va

lue

of w

ages

lost

by

peop

le u

n-

able

to w

ork

beca

use

of il

lnes

s or

dis

abili

ty, a

s w

ell a

s th

e va

lue

of fu

ture

ear

ning

s

lost

by

prem

atur

e de

ath.

27

HE

ALT

H R

ISK

SE

pide

mio

logi

cal s

tudi

es s

how

an

incr

ease

in m

orta

lity

asso

ciat

ed w

ith o

ver-

wei

ght a

nd o

besi

ty.

Indi

vidu

als

who

are

obe

se (

BM

I > 3

0) h

ave

a 50

to 1

00 p

er-

cent

inc

reas

ed r

isk

of p

rem

atur

e de

ath

from

all

caus

es c

ompa

red

to i

ndiv

idua

ls

with

a B

MI i

n th

e ra

nge

of 2

0 to

25.

16 A

n es

timat

ed 3

00,0

00 d

eath

s a

year

may

be

attr

ibut

able

to o

besi

ty.3

Mor

bidi

ty fr

om o

besi

ty m

ay b

e as

gre

at a

s fr

om p

over

ty, s

mok

ing,

or p

robl

em

drin

king

.17 O

verw

eigh

t and

obe

sity

are

ass

ocia

ted

with

an

incr

ease

d ri

sk fo

r cor

o-

nary

hea

rt d

isea

se;

type

2 d

iabe

tes;

end

omet

rial

, co

lon,

pos

tmen

opau

sal

brea

st,

and

othe

r can

cers

; and

cer

tain

mus

culo

skel

etal

dis

orde

rs, s

uch

as k

nee

oste

oart

hri-

tis (

tabl

e 1)

.18

Bot

h m

odes

t an

d la

rge

wei

ght

gain

s ar

e as

soci

ated

with

sig

nifi

-

cant

ly in

crea

sed

risk

of

dise

ase.

For

exa

mpl

e, a

wei

ght g

ain

of 1

1 to

18

poun

ds

incr

ease

s a

pers

on’s

risk

of d

evel

opin

g ty

pe 2

dia

bete

s to

twic

e th

at o

f ind

ivid

uals

who

hav

e no

t gai

ned

wei

ght,

whi

le th

ose

who

gai

n 44

pou

nds

or m

ore

have

fou

r

times

the

risk

of t

ype

2 di

abet

es.19

A g

ain

of a

ppro

xim

atel

y 10

to 2

0 po

unds

resu

lts in

an

incr

ease

d ri

sk o

f cor

o-

nary

hea

rt d

isea

se (

nonf

atal

myo

card

ial

infa

rctio

n an

d de

ath)

of

1.25

tim

es i

n

wom

en20

and

1.6

tim

es in

men

.21 H

ighe

r lev

els

of b

ody

wei

ght g

ain

of 2

2 po

unds

in m

en a

nd 4

4 po

unds

in w

omen

resu

lt in

an

incr

ease

d co

rona

ry h

eart

dis

ease

risk

of 1

.75

and

2.65

, res

pect

ivel

y.20

,21

In w

omen

with

a B

MI o

f 34

or g

reat

er, t

he ri

sk

of d

evel

opin

g en

dom

etri

al c

ance

r is

inc

reas

ed b

y m

ore

than

six

tim

es.22

O

ver-

wei

ght a

nd o

besi

ty a

re a

lso

know

n to

exa

cerb

ate

man

y ch

roni

c co

nditi

ons

such

as

hype

rten

sion

and

ele

vate

d ch

oles

tero

l.23

Ove

rwei

ght a

nd o

bese

indi

vidu

als

also

may

suf

fer

from

soc

ial s

tigm

atiz

atio

n, d

iscr

imin

atio

n, a

nd p

oor

body

imag

e.24

Alth

ough

obe

sity

-ass

ocia

ted

mor

bidi

ties

occu

r mos

t fre

quen

tly in

adu

lts, i

m-

port

ant

cons

eque

nces

of

exce

ss w

eigh

t as

wel

l as

ant

eced

ents

of

adul

t di

seas

e

occu

r in

ove

rwei

ght c

hild

ren

and

adol

esce

nts.

O

verw

eigh

t chi

ldre

n an

d ad

oles

-

cent

s ar

e m

ore

likel

y to

bec

ome

over

wei

ght o

r obe

se a

dults

; thi

s co

ncer

n is

gre

at-

est

amon

g ad

oles

cent

s.

Type

2 d

iabe

tes,

hig

h bl

ood

lipid

s, a

nd h

yper

tens

ion

as

wel

l as

earl

y m

atur

atio

n an

d or

thop

edic

pro

blem

s al

so o

ccur

with

incr

ease

d fr

e-

quen

cy in

ove

rwei

ght y

outh

. A

com

mon

con

sequ

ence

of c

hild

hood

ove

rwei

ght i

s

psyc

hoso

cial

—sp

ecif

ical

ly d

iscr

imin

atio

n.25

Obe

sity

is A

ssoc

iate

d w

ith a

n In

crea

sed

Ris

k of

:

•pr

emat

ure

deat

h

•ty

pe 2

dia

bete

s

•he

art d

isea

se

•st

roke

•hy

pert

ensi

on

•ga

llbla

dder

dis

ease

•os

teoa

rthr

itis

(deg

ener

atio

n of

car

-

tilag

e an

d bo

ne in

join

ts)

•sl

eep

apne

a

•as

thm

a

•br

eath

ing

prob

lem

s

•ca

ncer

(end

omet

rial

, col

on, k

idne

y,

gallb

ladd

er,

and

post

men

opau

sal

brea

st c

ance

r)

•hi

gh b

lood

cho

lest

erol

•co

mpl

icat

ions

of p

regn

ancy

•m

enst

rual

irre

gula

ritie

s

•hi

rsut

ism

(pre

senc

e of

exc

ess b

ody

and

faci

al h

air)

•st

ress

inco

ntin

ence

(ur

ine

leak

age

caus

ed b

y w

eak

pelv

ic-f

loor

mus

cles

)

•in

crea

sed

surg

ical

ris

k

•ps

ycho

logi

cal

diso

rder

s su

ch a

s

depr

essi

on

•ps

ycho

logi

cal

diff

icul

ties

due

to

soci

al s

tigm

atiz

atio

n

Ada

pted

from

ww

w.n

iddk

.nih

.gov

/hea

lth/n

utri

t/pub

s/st

atob

es.h

tm26

33

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YSe

ctio

n 1:

Ove

rwei

ght a

nd O

besi

ty a

s P

ubli

c H

ealt

h P

robl

ems

in A

mer

ica

1011

The

mos

t rec

ent d

ata

(199

9) e

stim

ate

that

13

perc

ent o

f chi

ldre

n ag

ed 6

to 1

1

year

s an

d 14

per

cent

of a

dole

scen

ts a

ged

12 to

19

year

s ar

e ov

erw

eigh

t.33 D

urin

g

the

past

two

deca

des,

the

perc

enta

ge o

f ch

ildre

n w

ho a

re o

verw

eigh

t has

nea

rly

doub

led

(fro

m 7

to 1

3 pe

rcen

t), a

nd th

e pe

rcen

tage

of

adol

esce

nts

who

are

ove

r-

wei

ght h

as a

lmos

t tri

pled

(fro

m 5

to 1

4 pe

rcen

t) (f

igur

e 5)

.33

FIG

UR

E 5

: PR

EV

AL

EN

CE O

F O

VE

RW

EIG

HT*

AM

ON

G U

.S.

CH

ILD

RE

N A

ND

AD

OL

ESC

EN

TS

*Gen

der-

and

age

-spe

cific

BM

I >

the

95th

per

cent

ileSo

urce

: C

ente

rs fo

r D

isea

se C

ontr

ol a

nd P

reve

ntio

n (C

DC

), N

atio

nal C

ente

r fo

r H

ealth

Stat

istic

s (N

CH

S) N

atio

nal

Hea

lth E

xam

inat

ion

Surv

ey (

NH

ES)

, N

atio

nal

Hea

lth a

ndN

utri

tion

Exa

min

atio

n Su

rvey

(NH

AN

ES)

DIS

PAR

ITIE

S IN

PR

EV

AL

EN

CE

Bet

wee

n th

e se

cond

and

thi

rd N

atio

nal

Hea

lth a

nd N

utri

tion

Exa

min

atio

n

Surv

eys

(NH

AN

ES

II a

nd II

I), t

he p

reva

lenc

e of

ove

rwei

ght a

nd o

besi

ty (B

MI

>

25 f

or a

dults

and

> 9

5th

perc

entil

e fo

r ag

e an

d ge

nder

in

child

ren)

inc

reas

ed i

n

both

gen

ders

, acr

oss

all r

aces

and

eth

nici

ties,

and

acr

oss

all a

ge g

roup

s.15

,30

Dis

-

pari

ties

in o

verw

eigh

t and

obe

sity

pre

vale

nce

exis

t in

man

y se

gmen

ts o

f the

pop

u-

latio

n ba

sed

on r

ace

and

ethn

icity

, ge

nder

, ag

e, a

nd s

ocio

econ

omic

sta

tus.

Fo

r

exam

ple,

ove

rwei

ght a

nd o

besi

ty a

re p

artic

ular

ly c

omm

on a

mon

g m

inor

ity g

roup

s

and

thos

e w

ith a

low

er fa

mily

inco

me.

In 1

995,

the

tota

l (di

rect

and

indi

rect

) cos

ts a

ttrib

utab

le to

obe

sity

am

ount

ed to

an e

stim

ated

$99

bill

ion.

27 I

n 20

00, t

he to

tal c

ost o

f ob

esity

was

est

imat

ed to

be

$117

bill

ion

($61

bill

ion

dire

ct a

nd $

56 b

illio

n in

dire

ct).28

Mos

t of t

he c

ost a

ssoc

i-

ated

with

obe

sity

is d

ue to

type

2 d

iabe

tes,

cor

onar

y he

art d

isea

se, a

nd h

yper

ten-

sion

.29

EP

IDE

MIO

LO

GY

The

Uni

ted

Stat

es is

exp

erie

ncin

g su

bsta

ntia

l inc

reas

es in

ove

rwei

ght a

nd o

be-

sity

(as

defi

ned

by a

BM

I > 2

5 fo

r adu

lts) t

hat c

ut a

cros

s al

l age

s, ra

cial

and

eth

nic

grou

ps, a

nd b

oth

gend

ers.

30

Acc

ordi

ng t

o se

lf-r

epor

ted

mea

sure

s of

hei

ght

and

wei

ght,

obes

ity (

BM

I >

30)

has

been

inc

reas

ing

in e

very

Sta

te i

n th

e N

atio

n.31

Bas

ed o

n cl

inic

al h

eigh

t an

d w

eigh

t m

easu

rem

ents

in

the

1999

Nat

iona

l H

ealth

and

Nut

ritio

n E

xam

inat

ion

Surv

ey (N

HA

NE

S), 3

4 pe

rcen

t of U

.S. a

dults

age

d 20

to 7

4 ye

ars

are

over

wei

ght

(BM

I 25

to

29.9

), an

d an

add

ition

al 2

7 pe

rcen

t ar

e

obes

e (B

MI

> 30

).32

Thi

s co

ntra

sts

with

the

lat

e 19

70s,

whe

n an

est

imat

ed 3

2

perc

ent o

f adu

lts a

ged

20 to

74

year

s w

ere

over

wei

ght,

and

15 p

erce

nt w

ere

obes

e

(fig

ure

4).30

FIG

UR

E 4

: AG

E-A

DJU

STE

D P

RE

VA

LE

NC

E O

F O

VE

RW

EIG

HT A

ND

OB

ESI

TY

AM

ON

G U

.S. A

DU

LTS

AG

ED

20

TO

74

YE

AR

S

Sour

ce:

Cen

ters

for

Dis

ease

Con

trol

and

Pre

vent

ion

(CD

C),

Nat

iona

l Cen

ter

for

Hea

lthSt

atis

tics

(NC

HS)

, Nat

iona

l Hea

lth a

nd N

utri

tion

Exa

min

atio

n Su

rvey

(NH

AN

ES)

Prevalence (%)

Prevalence (%)

34

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YSe

ctio

n 1:

Ove

rwei

ght a

nd O

besi

ty a

s P

ubli

c H

ealt

h P

robl

ems

in A

mer

ica

1213

FIG

UR

E 6

: AG

E-A

DJU

STE

D P

RE

VA

LE

NC

E O

F O

VE

RW

EIG

HT O

R

OB

ESI

TY

IN S

EL

EC

TE

D G

RO

UPS

(NH

AN

ES

III

, 198

8–19

94)

Sour

ce:

Cen

ters

for

Dis

ease

Con

trol

and

Pre

vent

ion

(CD

C),

Nat

iona

l Cen

ter

for

Hea

lthSt

atis

tics

(NC

HS)

, Nat

iona

l Hea

lth a

nd N

utri

tion

Exa

min

atio

n Su

rvey

(NH

AN

ES)

Rac

ial

and

ethn

ic d

ispa

ritie

s in

ove

rwei

ght

may

als

o oc

cur

in c

hild

ren

and

adol

esce

nts.

D

ata

for

yout

h fr

om N

HA

NE

S II

I sh

owed

a s

imila

r pa

ttern

to th

at

seen

am

ong

adul

ts.

Mex

ican

Am

eric

an b

oys t

ende

d to

hav

e a

high

er p

reva

lenc

e of

over

wei

ght t

han

non-

His

pani

c bl

ack

and

non-

His

pani

c w

hite

boy

s. N

on-H

ispa

nic

blac

k gi

rls

tend

ed t

o ha

ve a

hig

her

prev

alen

ce o

f ov

erw

eigh

t co

mpa

red

to n

on-

His

pani

c w

hite

and

Mex

ican

Am

eric

an g

irls

.15

The

Nat

iona

l H

eart

, L

ung,

and

Blo

od In

stitu

te G

row

th a

nd H

ealth

Stu

dy o

n ov

erw

eigh

t in

child

ren

foun

d a

high

er

mea

n B

MI f

or b

lack

gir

ls a

ged

9 an

d 10

yea

rs, c

ompa

red

to w

hite

gir

ls o

f the

sam

e

ages

.35 T

his

raci

al d

iffe

renc

e in

BM

I wid

ened

and

was

eve

n gr

eate

r at a

ge 1

9.36

In a

dditi

on to

raci

al a

nd e

thni

c an

d ge

nder

dis

pari

ties,

the

prev

alen

ce o

f ove

r-

wei

ght a

nd o

besi

ty a

lso

vari

es b

y ag

e. A

mon

g bo

th m

en a

nd w

omen

, the

pre

va-

lenc

e of

ove

rwei

ght a

nd o

besi

ty in

crea

ses

with

adv

anci

ng a

ge u

ntil

the

sixt

h de

-

cade

, aft

er w

hich

it s

tart

s to

dec

line.

30

SOC

IOE

CO

NO

MIC

STA

TU

S

Dis

pari

ties

in t

he p

reva

lenc

e of

ove

rwei

ght

and

obes

ity a

lso

exis

t ba

sed

on

soci

oeco

nom

ic s

tatu

s. F

or a

ll ra

cial

and

eth

nic

grou

ps c

ombi

ned,

wom

en o

f low

er

soci

oeco

nom

ic s

tatu

s (i

ncom

e <

130

perc

ent

of p

over

ty t

hres

hold

) ar

e ap

prox

i-

RA

CE A

ND E

TH

NIC

ITY

, GE

ND

ER, A

ND

AG

E

In g

ener

al, t

he p

reva

lenc

e of

ove

rwei

ght a

nd o

besi

ty is

hig

her i

n w

omen

who

are

mem

bers

of r

acia

l and

eth

nic

min

ority

pop

ulat

ions

than

in n

on-H

ispa

nic

whi

te

wom

en. A

mon

g m

en, M

exic

an A

mer

ican

s hav

e a

high

er p

reva

lenc

e of

ove

rwei

ght

and

obes

ity th

an n

on-H

ispa

nic

whi

tes

or n

on-H

ispa

nic

blac

ks.

For n

on-H

ispa

nic

men

, the

pre

vale

nce

of o

verw

eigh

t an

d ob

esity

am

ong

whi

tes

is s

light

ly g

reat

er

than

am

ong

blac

ks.30

With

in ra

cial

gro

ups,

gen

der d

ispa

ritie

s ex

ist,

alth

ough

not

alw

ays

in th

e sa

me

dire

ctio

n. B

ased

on

NH

AN

ES

III

(198

8–19

94),30

the

prop

ortio

n of

non

-His

pani

c

blac

k w

omen

who

wer

e ov

erw

eigh

t or

obes

e (B

MI

> 25

; 69

perc

ent)

was

hig

her

than

the

prop

ortio

n of

non

-His

pani

c bl

ack

men

(58

per

cent

) (f

igur

e 6)

. Fo

r no

n-

His

pani

c w

hite

s, o

n th

e ot

her h

and,

the

prop

ortio

n of

men

who

wer

e ov

erw

eigh

t or

obes

e (B

MI

> 25

; 62

per

cent

) ex

ceed

ed t

he p

ropo

rtio

n of

wom

en (

47 p

erce

nt).

How

ever

, whe

n lo

okin

g at

obe

sity

alo

ne (B

MI

> 30

), th

e pr

eval

ence

was

slig

htly

high

er in

non

-His

pani

c w

hite

wom

en c

ompa

red

to n

on-H

ispa

nic

whi

te m

en (

23

perc

ent a

nd 2

1 pe

rcen

t, re

spec

tivel

y).30

The

pre

vale

nce

of o

verw

eigh

t or

obes

ity

(BM

I > 2

5) w

as a

bout

the

sam

e in

Mex

ican

Am

eric

an m

en a

nd w

omen

(69

perc

ent

and

70 p

erce

nt, r

espe

ctiv

ely)

.30 A

lthou

gh s

mal

ler s

urve

ys in

dica

te a

hig

her p

reva

-

lenc

e of

ove

rwei

ght a

nd o

besi

ty in

Am

eric

an In

dian

s, A

lask

a N

ativ

es, a

nd P

acif

ic

Isla

nder

Am

eric

ans

and

a lo

wer

pre

vale

nce

in A

sian

Am

eric

ans

com

pare

d to

the

gene

ral p

opul

atio

n, th

e nu

mbe

r sur

veye

d in

NH

AN

ES

III w

as to

o sm

all t

o re

liabl

y

repo

rt p

reva

lenc

e co

mpa

riso

ns o

f ove

rwei

ght a

nd o

besi

ty fo

r the

se p

opul

atio

ns.34

35

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

Y

1415

SEC

TIO

N 2

:

Posi

ng Q

uest

ions

and

Dev

elop

ing

Stra

tegi

es

Cur

rent

kno

wle

dge

is c

lear

on

man

y is

sues

: the

pre

vale

nce

of o

verw

eigh

t and

obes

ity is

hig

h, a

nd th

at o

f obe

sity

is in

crea

sing

rapi

dly;

ado

lesc

ents

who

are

ove

r-

wei

ght a

re a

t hig

h ri

sk o

f be

com

ing

over

wei

ght o

r ob

ese

adul

ts; o

verw

eigh

t and

obes

ity in

crea

se th

e ri

sk fo

r ser

ious

dis

ease

s su

ch a

s ty

pe 2

dia

bete

s, h

yper

tens

ion,

and

high

blo

od c

hole

ster

ol; a

nd o

verw

eigh

t and

obe

sity

are

ass

ocia

ted

with

pre

ma-

ture

dea

th a

nd d

isab

ility

. It

is a

lso

know

n th

at a

hea

lthy

diet

and

ade

quat

e ph

ysic

al

activ

ity a

id in

mai

ntai

ning

a h

ealth

y w

eigh

t and

, am

ong

over

wei

ght o

r obe

se p

er-

sons

, can

pro

mot

e w

eigh

t los

s.

Kno

wle

dge

is le

ss c

lear

, how

ever

, on

som

e ve

ry im

port

ant q

uest

ions

. H

ow

can

over

wei

ght a

nd o

besi

ty b

e pr

even

ted?

Wha

t are

the

mos

t eff

ectiv

e pr

even

tion

and

treat

men

t stra

tegi

es?

How

can

the

envi

ronm

ent b

e m

odifi

ed to

pro

mot

e he

alth

ier

eatin

g an

d in

crea

sed

phys

ical

act

ivity

? D

eter

min

ing

the

answ

ers

to t

hese

que

s-

tions

dem

ands

a n

atio

nal p

ublic

hea

lth r

espo

nse.

Ass

embl

ing

the

com

pone

nts

of

this

resp

onse

has

beg

un.

DE

VE

LO

PIN

G A

PU

BL

IC H

EA

LTH

RE

SPO

NSE

In D

ecem

ber 2

000,

the

Surg

eon

Gen

eral

hos

ted

a pu

blic

Lis

teni

ng S

essi

on o

n

over

wei

ght a

nd o

besi

ty.

The

mee

ting—

Tow

ard

a N

atio

nal A

ctio

n Pl

an o

n O

ver-

wei

ght

and

Obe

sity

: T

he S

urge

on G

ener

al’s

Ini

tiativ

e—be

gan

a de

velo

pmen

tal

proc

ess

that

led

to th

is S

urge

on G

ener

al’s

Cal

l To

Act

ion

To P

reve

nt a

nd D

ecre

ase

Ove

rwei

ght a

nd O

besi

ty.

A m

enu

of im

port

ant a

ctiv

ities

has

bee

n as

sem

bled

from

com

men

ts re

ceiv

ed d

urin

g th

e Su

rgeo

n G

ener

al’s

Lis

teni

ng S

essi

on, a

pub

lic c

om-

men

t per

iod,

and

the

Nat

iona

l Nut

ritio

n Su

mm

it. T

he m

enu,

whi

ch is

pre

sent

ed in

the

follo

win

g se

ctio

n, h

ighl

ight

s ar

eas

that

rec

eive

d si

gnif

ican

t at

tent

ion

duri

ng

one

or m

ore

of t

hese

eve

nts.

A

lthou

gh n

ot m

eant

to

be p

resc

ript

ive,

the

men

u

shou

ld e

stab

lish

usef

ul s

tart

ing

poin

ts a

s in

divi

dual

s an

d gr

oups

foc

us th

eir

own

skill

s, c

reat

ivity

, an

d in

spir

atio

n on

the

nat

iona

l ep

idem

ic o

f ov

erw

eigh

t an

d

obes

ity.

mat

ely

50 p

erce

nt m

ore

likel

y to

be

obes

e th

an th

ose

with

hig

her

soci

oeco

nom

ic

stat

us (i

ncom

e >

130

perc

ent o

f pov

erty

thre

shol

d).

Men

are

abo

ut e

qual

ly li

kely

to b

e ob

ese

whe

ther

they

are

in a

low

or h

igh

soci

oeco

nom

ic g

roup

.37

Am

ong

child

ren,

the

rela

tions

hip

betw

een

soci

oeco

nom

ic st

atus

and

ove

rwei

ght

in g

irls

is w

eake

r tha

n it

is in

wom

en; t

hat i

s, g

irls

from

low

er in

com

e fa

mili

es h

ave

not

cons

iste

ntly

bee

n fo

und

to b

e ov

erw

eigh

t co

mpa

red

to g

irls

fro

m h

ighe

r in

-

com

e fa

mili

es.

Am

ong

Mex

ican

Am

eric

an a

nd n

on-H

ispa

nic

blac

k ch

ildre

n an

d

adol

esce

nts,

fam

ily in

com

e do

es n

ot re

liabl

y pr

edic

t ove

rwei

ght p

reva

lenc

e. H

ow-

ever

, no

n-H

ispa

nic

whi

te a

dole

scen

ts f

rom

low

er i

ncom

e fa

mili

es e

xper

ienc

e a

grea

ter p

reva

lenc

e of

ove

rwei

ght t

han

thos

e fr

om h

ighe

r inc

ome

fam

ilies

.15

HE

ALT

H B

EN

EF

ITS

OF W

EIG

HT L

OSS

The

rec

omm

enda

tions

to

trea

t ov

erw

eigh

t an

d ob

esity

are

bas

ed o

n tw

o ra

-

tiona

les.

Fir

st,

over

wei

ght

and

obes

ity a

re a

ssoc

iate

d w

ith a

n in

crea

sed

risk

of

dise

ase

and

deat

h, a

s pr

evio

usly

dis

cuss

ed.3,

16,1

8 S

econ

d, r

ando

miz

ed c

ontr

olle

d

tria

ls h

ave

show

n th

at w

eigh

t lo

ss (

as m

odes

t as

5 t

o 15

per

cent

of

exce

ss t

otal

body

wei

ght)

red

uces

the

risk

fac

tors

for

at l

east

som

e di

seas

es, p

artic

ular

ly c

ar-

diov

ascu

lar d

isea

se, i

n th

e sh

ort t

erm

. W

eigh

t los

s re

sults

in lo

wer

blo

od p

ress

ure,

low

er b

lood

sug

ar, a

nd im

prov

ed li

pid

leve

ls.38

Whi

le fe

w p

ublis

hed

stud

ies

have

exam

ined

the

link

betw

een

wei

ght l

oss

and

redu

ced

dise

ase

or d

eath

in th

e lo

ng-

term

,39 c

urre

nt d

ata

as w

ell a

s sc

ient

ific

pla

usib

ility

sug

gest

this

link

.

Stud

ies

have

sho

wn

that

redu

cing

risk

fact

ors

for h

eart

dis

ease

, suc

h as

blo

od

pres

sure

and

blo

od c

hole

ster

ol le

vels

, low

ers

deat

h ra

tes

from

hea

rt d

isea

se a

nd

stro

ke.

The

refo

re,

it is

hig

hly

prob

able

tha

t w

eigh

t lo

ss t

hat

redu

ces

thes

e ri

sk

fact

ors

will

red

uce

the

num

ber

of d

eath

s fr

om h

eart

dis

ease

and

str

oke.

Tr

ials

exam

inin

g th

e di

rect

eff

ects

of

wei

ght l

oss

on d

isea

se a

nd d

eath

are

cur

rent

ly u

n-

der

way

.40,4

1 F

or e

xam

ple,

one

tria

l sho

ws

that

wei

ght l

oss,

a h

ealth

ful d

iet,

and

exer

cise

pre

vent

the

deve

lopm

ent o

f typ

e 2

diab

etes

am

ong

pers

ons

who

are

ove

r-

wei

ght

or o

bese

.42

The

rec

ently

com

plet

ed D

iabe

tes

Prev

entio

n Pr

ogra

m f

rom

NIH

als

o co

nfir

med

sig

nifi

cant

redu

ctio

ns in

the

risk

for d

evel

opin

g ty

pe 2

dia

be-

tes a

mon

g ob

ese

subj

ects

with

impa

ired

glu

cose

tole

ranc

e th

roug

h si

mila

r lif

esty

le

inte

rven

tions

.43

36

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YSe

ctio

n 2:

Pos

ing

Que

stio

ns a

nd D

evel

opin

g St

rate

gies

1617

habi

ts r

egar

ding

a h

ealth

y di

et a

nd p

hysi

cal

activ

ity w

ith t

heir

chi

ldre

n, f

rien

ds,

and

othe

r co

mm

unity

mem

bers

. E

mph

asis

sho

uld

be p

lace

d on

fam

ily a

nd c

om-

mun

ity o

ppor

tuni

ties

for c

omm

unic

atio

n, e

duca

tion,

and

pee

r sup

port

sur

roun

ding

the

mai

nten

ance

of h

ealth

y di

etar

y ch

oice

s an

d ph

ysic

al a

ctiv

ity p

atte

rns.

CO

MM

UN

ICA

TIO

N

•R

aise

con

sum

er a

war

enes

s ab

out t

he e

ffec

t of

bein

g ov

erw

eigh

t on

over

all

heal

th.

•In

form

com

mun

ity le

ader

s abo

ut th

e im

port

ance

of d

evel

opin

g he

alth

y co

m-

mun

ities

.

•H

ighl

ight

pro

gram

s tha

t sup

port

hea

lthfu

l foo

d an

d ph

ysic

al a

ctiv

ity c

hoic

es

to c

omm

unity

dec

isio

n m

aker

s.

•R

aise

pol

icy

mak

ers’

aw

aren

ess

of th

e ne

ed to

dev

elop

soc

ial a

nd e

nvir

on-

men

tal p

olic

y th

at w

ould

hel

p co

mm

uniti

es a

nd fa

mili

es b

e m

ore

phys

ical

ly

activ

e an

d co

nsum

e a

heal

thie

r die

t.

•E

duca

te i

ndiv

idua

ls, f

amili

es, a

nd c

omm

uniti

es a

bout

hea

lthy

diet

ary

pat-

tern

s and

regu

lar p

hysi

cal a

ctiv

ity, b

ased

on

the

Die

tary

Gui

delin

es fo

r Am

eri-

cans

.

•E

duca

te p

aren

ts a

bout

the

need

to s

erve

as

good

rol

e m

odel

s by

pra

ctic

ing

heal

thy

eatin

g ha

bits

and

eng

agin

g in

reg

ular

phy

sica

l ac

tivity

in

orde

r to

inst

ill li

felo

ng h

ealth

y ha

bits

in th

eir

child

ren.

•R

aise

con

sum

er a

war

enes

s abo

ut re

ason

able

food

and

bev

erag

e po

rtio

n si

zes.

•E

duca

te e

xpec

tant

par

ents

and

oth

er c

omm

unity

mem

bers

abo

ut th

e po

ten-

tially

pro

tect

ive

effe

ct o

f bre

astf

eedi

ng a

gain

st th

e de

velo

pmen

t of o

besi

ty.

AC

TIO

N

•Fo

rm c

omm

unity

coa

litio

ns to

sup

port

the

deve

lopm

ent o

f inc

reas

ed o

ppor

-

tuni

ties

to e

ngag

e in

lei

sure

tim

e ph

ysic

al a

ctiv

ity a

nd t

o en

cour

age

food

outle

ts to

incr

ease

ava

ilabi

lity

of lo

w-c

alor

ie, n

utri

tious

food

item

s.

•E

ncou

rage

the

food

indu

stry

to p

rovi

de r

easo

nabl

e fo

od a

nd b

ever

age

por-

tion

size

s.

•In

crea

se a

vaila

bilit

y of

nut

ritio

n in

form

atio

n fo

r fo

ods

eate

n an

d pr

epar

ed

away

from

hom

e.

The

dis

cuss

ions

at t

he S

urge

on G

ener

al’s

Lis

teni

ng S

essi

on c

ente

red

on a

c-

tiviti

es a

nd in

terv

entio

ns in

fiv

e ke

y se

tting

s: f

amili

es a

nd c

omm

uniti

es, s

choo

ls,

heal

th c

are,

med

ia a

nd c

omm

unic

atio

ns, a

nd w

orks

ites.

The

key

act

ions

dis

cuss

ed

are

pres

ente

d fo

r eac

h of

thes

e se

tting

s. M

any

of th

ese

actio

ns o

verl

ap th

e di

ffer

-

ent s

ettin

gs a

nd c

an b

e ap

plie

d in

sev

eral

or a

ll en

viro

nmen

ts.

CA

RE

TO

AD

DR

ESS

OV

ER

WE

IGH

T A

ND O

BE

SIT

YT

he k

ey a

ctio

ns a

re o

rgan

ized

by

setti

ng in

a fr

amew

ork

calle

d C

AR

E: C

om-

mun

icat

ion,

Act

ion,

and

Res

earc

h an

d E

valu

atio

n.

Com

mun

icat

ion:

Pro

visi

on o

f in

form

atio

n an

d to

ols

to m

otiv

ate

and

em-

pow

er d

ecis

ion

mak

ers

at t

he g

over

nmen

tal,

orga

niza

tiona

l, co

mm

unity

, fam

ily,

and

indi

vidu

al le

vels

who

will

cre

ate

chan

ge to

war

d th

e pr

even

tion

and

decr

ease

of

over

wei

ght a

nd o

besi

ty.

Act

ion:

Inte

rven

tions

and

act

iviti

es th

at a

ssis

t dec

isio

n m

aker

s in

pre

vent

ing

and

decr

easi

ng o

verw

eigh

t and

obe

sity

, ind

ivid

ually

or c

olle

ctiv

ely.

Res

earc

h an

d E

valu

atio

n: In

vest

igat

ions

to b

ette

r und

erst

and

the

caus

es o

f

over

wei

ght a

nd o

besi

ty, t

o as

sess

the

effe

ctiv

enes

s of i

nter

vent

ions

, and

to d

evel

op

new

com

mun

icat

ion

and

actio

n st

rate

gies

.

With

in th

e C

AR

E fr

amew

ork,

eff

ectiv

e ac

tions

mus

t occ

ur a

t mul

tiple

leve

ls.

Obv

ious

ly, i

ndiv

idua

l beh

avio

ral c

hang

e lie

s at

the

core

of a

ll st

rate

gies

to re

duce

over

wei

ght a

nd o

besi

ty.

Succ

essf

ul e

ffor

ts, h

owev

er, m

ust f

ocus

not

onl

y on

indi

-

vidu

al b

ehav

iora

l cha

nge,

but

als

o on

gro

up in

flue

nces

, ins

titut

iona

l and

com

mu-

nity

infl

uenc

es, a

nd p

ublic

pol

icy.

Act

ions

to re

duce

ove

rwei

ght a

nd o

besi

ty w

ill

fail

with

out

this

mul

tidim

ensi

onal

app

roac

h.

Indi

vidu

al b

ehav

iora

l ch

ange

can

occu

r on

ly i

n a

supp

ortiv

e en

viro

nmen

t w

ith a

cces

sibl

e an

d af

ford

able

hea

lthy

food

cho

ices

and

opp

ortu

nitie

s fo

r reg

ular

phy

sica

l act

ivity

. Fu

rthe

rmor

e, a

ctio

ns

aim

ed e

xclu

sive

ly a

t ind

ivid

ual b

ehav

iora

l cha

nge,

whi

le n

ot c

onsi

deri

ng s

ocia

l,

cultu

ral,

econ

omic

, and

env

iron

men

tal i

nflu

ence

s, a

re li

kely

to re

info

rce

attit

udes

of s

tigm

atiz

atio

n ag

ains

t the

ove

rwei

ght a

nd o

bese

.

SET

TIN

G 1

: FA

MIL

IES

AN

D C

OM

MU

NIT

IES

Fam

ilies

and

com

mun

ities

lie

at th

e fo

unda

tion

of th

e so

lutio

n to

the

prob

lem

s

of o

verw

eigh

t and

obe

sity

. Fa

mily

mem

bers

can

sha

re th

eir

own

know

ledg

e an

d

37

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YSe

ctio

n 2:

Pos

ing

Que

stio

ns a

nd D

evel

opin

g St

rate

gies

1819

•C

ondu

ct b

ehav

iora

l res

earc

h to

iden

tify

how

to m

otiv

ate

peop

le to

incr

ease

and

mai

ntai

n ph

ysic

al a

ctiv

ity a

nd m

ake

heal

thie

r foo

d ch

oice

s.

•E

valu

ate

the

feas

ibili

ty o

f inc

entiv

es th

at su

ppor

t hea

lthfu

l die

tary

and

phy

si-

cal a

ctiv

ity p

atte

rns.

•Id

entif

y te

chni

ques

tha

t ca

n fo

ster

com

mun

ity m

otiv

atio

n to

red

uce

over

-

wei

ght a

nd o

besi

ty.

•E

xam

ine

the

mar

ketin

g pr

actic

es o

f th

e fa

st f

ood

indu

stry

and

the

fac

tors

dete

rmin

ing

cons

truc

tion

of n

ew fo

od o

utle

ts.

SET

TIN

G 2

: S

CH

OO

LS

Scho

ols

are

iden

tifie

d as

a k

ey s

ettin

g fo

r pu

blic

hea

lth s

trat

egie

s to

pre

vent

and

decr

ease

the

pre

vale

nce

of o

verw

eigh

t an

d ob

esity

. M

ost

child

ren

spen

d a

larg

e po

rtio

n of

tim

e in

sch

ool.

Sch

ools

pro

vide

man

y op

port

uniti

es t

o en

gage

child

ren

in h

ealth

y ea

ting

and

phys

ical

act

ivity

and

to r

einf

orce

hea

lthy

diet

and

phys

ical

act

ivity

mes

sage

s.

Publ

ic h

ealth

app

roac

hes

in s

choo

ls s

houl

d ex

tend

beyo

nd h

ealth

and

phy

sica

l edu

catio

n to

incl

ude

scho

ol p

olic

y, th

e sc

hool

phy

sica

l

and

soci

al e

nvir

onm

ent,

and

links

bet

wee

n sc

hool

s an

d fa

mili

es a

nd c

omm

uniti

es.

Scho

ols

and

com

mun

ities

tha

t ar

e in

tere

sted

in

redu

cing

ove

rwei

ght

amon

g th

e

youn

g pe

ople

they

serv

e ca

n co

nsid

er o

ptio

ns li

sted

bel

ow.

Dec

isio

ns a

bout

whi

ch

optio

ns to

sel

ect s

houl

d be

mad

e at

the

loca

l lev

el.

CO

MM

UN

ICA

TIO

N

•B

uild

aw

aren

ess

amon

g te

ache

rs, f

ood

serv

ice

staf

f, co

ache

s, n

urse

s, a

nd

othe

r sc

hool

sta

ff a

bout

the

con

trib

utio

n of

pro

per

nutr

ition

and

phy

sica

l

activ

ity to

the

mai

nten

ance

of l

ifel

ong

heal

thy

wei

ght.

•E

duca

te te

ache

rs, s

taff

, and

par

ents

abo

ut th

e im

port

ance

of s

choo

l phy

sica

l

activ

ity a

nd n

utri

tion

prog

ram

s an

d po

licie

s.

•E

duca

te p

aren

ts, t

each

ers,

coa

ches

, sta

ff, a

nd o

ther

adu

lts in

the

com

mun

ity

abou

t the

impo

rtan

ce th

ey h

old

as ro

le m

odel

s fo

r chi

ldre

n, a

nd te

ach

them

how

to b

e m

odel

s fo

r hea

lthy

eatin

g an

d re

gula

r phy

sica

l act

ivity

.

•E

duca

te s

tude

nts,

teac

hers

, sta

ff, a

nd p

aren

ts a

bout

the

impo

rtan

ce o

f bod

y

size

acc

epta

nce

and

the

dang

ers

of u

nhea

lthy

wei

ght c

ontr

ol p

ract

ices

.

•C

reat

e m

ore

com

mun

ity-b

ased

obe

sity

pre

vent

ion

and

trea

tmen

t pro

gram

s

for c

hild

ren

and

adul

ts.

•E

mpo

wer

fam

ilies

to

man

age

wei

ght

and

heal

th t

hrou

gh s

kill

build

ing

in

pare

ntin

g, m

eal p

lann

ing,

and

beh

avio

ral m

anag

emen

t.

•E

xpan

d ef

fort

s to

enc

oura

ge h

ealth

y ea

ting

patte

rns,

con

sist

ent w

ith th

e D

i-

etar

y G

uide

lines

for

Am

eric

ans,

by

nutr

ition

ass

ista

nce

reci

pien

ts.

•Pr

ovid

e de

mon

stra

tion

gran

ts to

add

ress

the

lack

of a

cces

s to

and

ava

ilabi

l-

ity o

f hea

lthy

affo

rdab

le fo

ods

in in

ner c

ities

.

•Pr

omot

e he

alth

ful

diet

ary

patte

rns,

inc

ludi

ng c

onsu

mpt

ion

of a

t le

ast

five

serv

ings

of f

ruits

and

veg

etab

les

a da

y.

•C

reat

e co

mm

unity

env

iron

men

ts th

at p

rom

ote

and

supp

ort b

reas

tfee

ding

.

•D

ecre

ase

time

spen

t wat

chin

g te

levi

sion

and

in s

imila

r sed

enta

ry b

ehav

iors

by c

hild

ren

and

thei

r fa

mili

es.

•Pr

ovid

e de

mon

stra

tion

gran

ts to

add

ress

the

lack

of p

ublic

acc

ess t

o sa

fe a

nd

supe

rvis

ed p

hysi

cal a

ctiv

ity.

•C

reat

e an

d im

plem

ent

publ

ic p

olic

y re

late

d to

the

pro

visi

on o

f sa

fe a

nd

acce

ssib

le s

idew

alks

, wal

king

and

bic

ycle

pat

hs, a

nd s

tair

s.

RE

SEA

RC

H A

ND E

VA

LU

AT

ION

•C

ondu

ct r

esea

rch

on o

besi

ty p

reve

ntio

n an

d re

duct

ion

to c

onfi

rm th

eir

ef-

fect

s on

impr

ovin

g he

alth

out

com

es.

•D

eter

min

e th

e ro

ot c

ause

s, b

ehav

iors

, and

soci

al a

nd e

colo

gica

l fac

tors

lead

ing

to o

besi

ty a

nd h

ow su

ch fo

rces

var

y by

race

and

eth

nici

ty, g

ende

r, an

d so

cio-

econ

omic

sta

tus.

•A

sses

s the

fact

ors c

ontr

ibut

ing

to th

e di

spro

port

iona

te b

urde

n of

ove

rwei

ght

and

obes

ity in

low

-inc

ome

and

min

ority

raci

al a

nd e

thni

c po

pula

tions

.

•D

evel

op a

nd e

valu

ate

prev

entiv

e in

terv

entio

ns th

at ta

rget

infa

nts

and

chil-

dren

, esp

ecia

lly th

ose

who

are

at h

igh

risk

of b

ecom

ing

obes

e.

•C

oord

inat

e re

sear

ch a

ctiv

ities

to re

fine

risk

ass

essm

ent,

to e

nhan

ce o

besi

ty

prev

entio

n, a

nd to

sup

port

app

ropr

iate

con

sum

er m

essa

ges

and

educ

atio

n.

•St

udy

the

cost

-eff

ectiv

enes

s of

com

mun

ity-d

irec

ted

stra

tegi

es d

esig

ned

to

prev

ent t

he o

nset

of o

verw

eigh

t and

obe

sity

.

38

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YSe

ctio

n 2:

Pos

ing

Que

stio

ns a

nd D

evel

opin

g St

rate

gies

2021

RE

SEA

RC

H A

ND E

VA

LU

AT

ION

•C

ondu

ct re

sear

ch o

n th

e re

latio

nshi

p of

hea

lthy

eatin

g an

d ph

ysic

al a

ctiv

ity

to s

tude

nt h

ealth

, lea

rnin

g, a

ttend

ance

, cla

ssro

om b

ehav

ior,

viol

ence

, and

othe

r so

cial

out

com

es.

•E

valu

ate

scho

ol-b

ased

beh

avio

ral h

ealth

inte

rven

tions

for t

he p

reve

ntio

n of

over

wei

ght i

n ch

ildre

n.

•D

evel

op a

n on

goin

g, s

yste

mat

ic p

roce

ss to

ass

ess

the

scho

ol p

hysi

cal a

ctiv

-

ity a

nd n

utri

tion

envi

ronm

ent,

and

plan

, im

plem

ent,

and

mon

itor

impr

ove-

men

ts.

•C

ondu

ct re

sear

ch to

stu

dy th

e ef

fect

of s

choo

l pol

icie

s su

ch a

s fo

od s

ervi

ces

and

phys

ical

act

ivity

cur

ricu

la o

n ov

erw

eigh

t in

child

ren

and

adol

esce

nts.

•E

valu

ate

the

fina

ncia

l and

hea

lth im

pact

of s

choo

l con

trac

ts w

ith v

endo

rs o

f

high

-cal

orie

food

s an

d be

vera

ges

with

min

imal

nut

ritio

nal v

alue

.

SET

TIN

G 3

: H

EA

LTH C

AR

E

The

hea

lth c

are

syst

em p

rovi

des

a po

wer

ful s

ettin

g fo

r int

erve

ntio

ns a

imed

at

redu

cing

the

pre

vale

nce

of o

verw

eigh

t an

d ob

esity

and

the

ir c

onse

quen

ces.

A

maj

ority

of A

mer

ican

s in

tera

ct w

ith th

e he

alth

car

e sy

stem

at l

east

onc

e du

ring

any

give

n ye

ar.

Rec

omm

enda

tions

by

pedi

atri

c an

d ad

ult h

ealth

car

e pr

ovid

ers

can

be

infl

uent

ial i

n pa

tient

die

tary

cho

ices

and

phy

sica

l act

ivity

pat

tern

s. I

n co

llabo

ra-

tion

with

sch

ools

and

wor

ksite

s, h

ealth

car

e pr

ovid

ers

and

inst

itutio

ns c

an r

ein-

forc

e th

e ad

optio

n an

d m

aint

enan

ce o

f he

alth

y lif

esty

le b

ehav

iors

. H

ealth

car

e

prov

ider

s al

so c

an s

erve

as

effe

ctiv

e pu

blic

pol

icy

advo

cate

s an

d fu

rthe

r ca

taly

ze

inte

rven

tion

effo

rts

in th

e fa

mily

and

com

mun

ity a

nd in

the

med

ia a

nd c

omm

uni-

catio

ns s

ettin

gs.

CO

MM

UN

ICA

TIO

N

•In

form

hea

lth c

are

prov

ider

s an

d ad

min

istr

ator

s of

the

trem

endo

us b

urde

n

of o

verw

eigh

t and

obe

sity

on

the

heal

th c

are

syst

em in

term

s of

mor

talit

y,

mor

bidi

ty, a

nd c

ost.

•D

evel

op s

ensi

tivity

of s

taff

to th

e pr

oble

ms

enco

unte

red

by th

e ov

erw

eigh

t

child

.

AC

TIO

N

•Pr

ovid

e ag

e-ap

prop

riat

e an

d cu

ltura

lly s

ensi

tive

inst

ruct

ion

in h

ealth

edu

ca-

tion

that

hel

ps s

tude

nts

deve

lop

the

know

ledg

e, a

ttitu

des,

ski

lls, a

nd b

ehav

-

iors

to

adop

t, m

aint

ain,

and

enj

oy h

ealth

y ea

ting

habi

ts a

nd a

phy

sica

lly

activ

e lif

esty

le.

•E

nsur

e th

at m

eals

off

ered

thro

ugh

the

scho

ol b

reak

fast

and

lunc

h pr

ogra

ms

mee

t nut

ritio

n st

anda

rds.

•A

dopt

pol

icie

s en

suri

ng t

hat

all

food

s an

d be

vera

ges

avai

labl

e on

sch

ool

cam

puse

s an

d at

sch

ool

even

ts c

ontr

ibut

e to

war

d ea

ting

patte

rns

that

are

cons

iste

nt w

ith th

e D

ieta

ry G

uide

lines

for

Am

eric

ans.

•Pr

ovid

e fo

od o

ptio

ns th

at a

re lo

w in

fat,

calo

ries

, and

add

ed s

ugar

s, s

uch

as

frui

ts, v

eget

able

s, w

hole

gra

ins,

and

low

-fat

or n

onfa

t dai

ry fo

ods.

•E

nsur

e th

at h

ealth

y sn

acks

and

foo

ds a

re p

rovi

ded

in v

endi

ng m

achi

nes,

scho

ol s

tore

s, a

nd o

ther

ven

ues

with

in th

e sc

hool

’s c

ontr

ol.

•Pr

ohib

it st

uden

t acc

ess

to v

endi

ng m

achi

nes,

sch

ool s

tore

s, a

nd o

ther

ven

-

ues

that

com

pete

with

hea

lthy

scho

ol m

eals

in e

lem

enta

ry s

choo

ls a

nd r

e-

stri

ct a

cces

s in

mid

dle,

juni

or, a

nd h

igh

scho

ols.

•Pr

ovid

e an

ade

quat

e am

ount

of

time

for

stud

ents

to e

at s

choo

l mea

ls, a

nd

sche

dule

lunc

h pe

riod

s at

reas

onab

le h

ours

aro

und

mid

day.

•Pr

ovid

e al

l ch

ildre

n, f

rom

pre

kind

erga

rten

thr

ough

gra

de 1

2, w

ith q

ualit

y

daily

phy

sica

l edu

catio

n th

at h

elps

dev

elop

the

know

ledg

e, a

ttitu

des,

ski

lls,

beha

vior

s, a

nd c

onfi

denc

e ne

eded

to b

e ph

ysic

ally

act

ive

for l

ife.

•Pr

ovid

e da

ily re

cess

per

iods

for e

lem

enta

ry s

choo

l stu

dent

s, fe

atur

ing

time

for u

nstr

uctu

red

but s

uper

vise

d pl

ay.

•Pr

ovid

e ex

trac

urri

cula

r ph

ysic

al a

ctiv

ity p

rogr

ams,

esp

ecia

lly in

clus

ive

in-

tram

ural

pro

gram

s an

d ph

ysic

al a

ctiv

ity c

lubs

.

•E

ncou

rage

the

use

of s

choo

l fac

ilitie

s fo

r phy

sica

l act

ivity

pro

gram

s of

fere

d

by th

e sc

hool

and

/or c

omm

unity

-bas

ed o

rgan

izat

ions

out

side

of s

choo

l hou

rs.

39

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YSe

ctio

n 2:

Pos

ing

Que

stio

ns a

nd D

evel

opin

g St

rate

gies

2223

SET

TIN

G 4

: M

ED

IA A

ND C

OM

MU

NIC

AT

ION

S

The

med

ia c

an p

rovi

de e

ssen

tial f

unct

ions

in o

verw

eigh

t and

obe

sity

pre

ven-

tion

effo

rts.

Fro

m a

pub

lic e

duca

tion

and

soci

al m

arke

ting

stan

dpoi

nt, t

he m

edia

can

diss

emin

ate

heal

th m

essa

ges

and

disp

lay

heal

thy

beha

vior

s ai

med

at c

hang

ing

diet

ary

habi

ts a

nd e

xerc

ise

patte

rns.

In

addi

tion,

the

med

ia c

an p

rovi

de a

pow

erfu

l

foru

m fo

r com

mun

ity m

embe

rs w

ho a

re a

ddre

ssin

g th

e so

cial

and

env

iron

men

tal

infl

uenc

es o

n di

etar

y an

d ph

ysic

al a

ctiv

ity p

atte

rns.

CO

MM

UN

ICA

TIO

N

•E

mph

asiz

e to

med

ia p

rofe

ssio

nals

that

the

prim

ary

conc

ern

of o

verw

eigh

t

and

obes

ity is

one

of h

ealth

rath

er th

an a

ppea

ranc

e.

•E

mph

asiz

e to

med

ia p

rofe

ssio

nals

the

disp

ropo

rtio

nate

bur

den

of o

verw

eigh

t

and

obes

ity in

low

-inc

ome

and

raci

al a

nd e

thni

c m

inor

ity p

opul

atio

ns a

nd

the

need

for c

ultu

rally

sen

sitiv

e he

alth

mes

sage

s.

•C

omm

unic

ate

the

impo

rtan

ce o

f pre

vent

ion

of o

verw

eigh

t thr

ough

bal

anc-

ing

food

inta

ke w

ith p

hysi

cal a

ctiv

ity a

t all

ages

.

•Pr

omot

e th

e re

cogn

ition

of

inap

prop

riat

e w

eigh

t cha

nge.

•B

uild

aw

aren

ess

of th

e im

port

ance

of

soci

al a

nd e

nvir

onm

enta

l inf

luen

ces

on m

akin

g ap

prop

riat

e di

et a

nd p

hysi

cal a

ctiv

ity c

hoic

es.

•Pr

ovid

e pr

ofes

sion

al e

duca

tion

for

med

ia p

rofe

ssio

nals

on

polic

y ar

eas

re-

late

d to

die

t and

phy

sica

l act

ivity

.

•E

mph

asiz

e to

med

ia p

rofe

ssio

nals

the

need

to d

evel

op u

nifo

rm h

ealth

mes

-

sage

s ab

out p

hysi

cal a

ctiv

ity a

nd n

utri

tion

that

are

con

sist

ent w

ith th

e D

i-

etar

y G

uide

lines

for

Am

eric

ans.

AC

TIO

N

•C

ondu

ct a

nat

iona

l cam

paig

n to

fos

ter

publ

ic a

war

enes

s of

the

heal

th b

en-

efits

of r

egul

ar p

hysi

cal a

ctiv

ity, h

ealth

ful d

ieta

ry c

hoic

es, a

nd m

aint

aini

ng

a he

alth

y w

eigh

t, ba

sed

on th

e D

ieta

ry G

uide

lines

for

Am

eric

ans.

•E

ncou

rage

trut

hful

and

reas

onab

le c

onsu

mer

goa

ls fo

r wei

ght l

oss p

rogr

ams

and

wei

ght m

anag

emen

t pro

duct

s.

•In

form

and

edu

cate

the

hea

lth c

are

com

mun

ity a

bout

the

im

port

ance

of

heal

thy

eatin

g, c

onsi

sten

t with

the

Die

tary

Gui

delin

es f

or A

mer

ican

s, a

nd

phys

ical

act

ivity

and

fitn

ess

for t

he p

rom

otio

n of

hea

lth.

•E

duca

te h

ealth

car

e pr

ovid

ers

and

adm

inis

trat

ors

to id

entif

y an

d re

duce

the

barr

iers

invo

lvin

g pa

tient

s’ la

ck o

f acc

ess

to e

ffec

tive

nutr

ition

and

phy

sica

l

activ

ity in

terv

entio

ns.

•In

form

and

edu

cate

the

heal

th c

are

com

mun

ity a

bout

ass

essm

ent o

f wei

ght

stat

us a

nd th

e ri

sk o

f ina

ppro

pria

te w

eigh

t cha

nge.

•E

duca

te h

ealth

car

e pr

ovid

ers

on e

ffec

tive

way

s to

pro

mot

e an

d su

ppor

t

brea

stfe

edin

g.

AC

TIO

N

•Tr

ain

heal

th c

are

prov

ider

s an

d he

alth

pro

fess

ion

stud

ents

in e

ffec

tive

pre-

vent

ion

and

trea

tmen

t tec

hniq

ues

for o

verw

eigh

t and

obe

sity

.

•E

ncou

rage

par

tner

ship

s be

twee

n he

alth

car

e pr

ovid

ers,

sch

ools

, fai

th-b

ased

grou

ps, a

nd o

ther

com

mun

ity o

rgan

izat

ions

in p

reve

ntio

n ef

fort

s ta

rget

ed a

t

soci

al a

nd e

nvir

onm

enta

l cau

ses

of o

verw

eigh

t and

obe

sity

.

•E

stab

lish

a di

alog

ue to

con

side

r cla

ssif

ying

obe

sity

as

a di

seas

e ca

tego

ry fo

r

reim

burs

emen

t cod

ing.

•E

xplo

re m

echa

nism

s th

at w

ill p

artia

lly o

r ful

ly c

over

reim

burs

emen

t or i

n-

clud

e as

a m

embe

r ben

efit

heal

th c

are

serv

ices

ass

ocia

ted

with

wei

ght m

an-

agem

ent,

incl

udin

g nu

triti

on e

duca

tion

and

phys

ical

act

ivity

pro

gram

s.

RE

SEA

RC

H A

ND E

VA

LU

AT

ION

•D

evel

op e

ffec

tive

prev

entiv

e an

d th

erap

eutic

pro

gram

s fo

r obe

sity

.

•St

udy

the

effe

ct o

f wei

ght r

educ

tion

prog

ram

s on

hea

lth o

utco

mes

.

•A

naly

ze th

e co

st-e

ffec

tiven

ess

data

on

clin

ical

obe

sity

pre

vent

ion

and

trea

t-

men

t eff

orts

and

con

duct

furt

her r

esea

rch

whe

re th

e da

ta a

re in

conc

lusi

ve.

•Pr

omot

e re

sear

ch o

n th

e m

aint

enan

ce o

f wei

ght l

oss.

•Pr

omot

e re

sear

ch o

n br

east

feed

ing

and

the

prev

entio

n of

obe

sity

.

•R

evie

w a

nd e

valu

ate

the

reim

burs

emen

t pol

icie

s of p

ublic

and

pri

vate

hea

lth

insu

ranc

e pr

ovid

ers

rega

rdin

g ov

erw

eigh

t and

obe

sity

pre

vent

ion

and

trea

t-

men

t eff

orts

.

40

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YSe

ctio

n 2:

Pos

ing

Que

stio

ns a

nd D

evel

opin

g St

rate

gies

2425

CO

MM

UN

ICA

TIO

N

•In

form

em

ploy

ers

of th

e di

rect

and

indi

rect

cos

ts o

f obe

sity

.

•C

omm

unic

ate

to e

mpl

oyer

s the

retu

rn-o

n-in

vest

men

t (R

OI)

dat

a fo

r wor

ksite

obes

ity p

reve

ntio

n an

d tr

eatm

ent s

trat

egie

s.

AC

TIO

N

•C

hang

e w

orkf

low

pat

tern

s, in

clud

ing

flex

ible

wor

k ho

urs,

to c

reat

e op

por-

tuni

ties

for r

egul

ar p

hysi

cal a

ctiv

ity d

urin

g th

e w

orkd

ay.

•Pr

ovid

e pr

otec

ted

time

for

lunc

h, a

nd e

nsur

e th

at h

ealth

y fo

od o

ptio

ns a

re

avai

labl

e.

•E

stab

lish

wor

ksite

exe

rcis

e fa

cilit

ies

or c

reat

e in

cent

ives

for

em

ploy

ees

to

join

loca

l fitn

ess

cent

ers.

•C

reat

e in

cent

ives

for w

orke

rs to

ach

ieve

and

mai

ntai

n a

heal

thy

body

wei

ght.

•E

ncou

rage

em

ploy

ers

to r

equi

re w

eigh

t man

agem

ent a

nd p

hysi

cal a

ctiv

ity

coun

selin

g as

a m

embe

r ben

efit

in h

ealth

insu

ranc

e co

ntra

cts.

•C

reat

e w

ork

envi

ronm

ents

that

pro

mot

e an

d su

ppor

t bre

astf

eedi

ng.

•E

xplo

re w

ays t

o cr

eate

Fed

eral

wor

ksite

pro

gram

s pro

mot

ing

heal

thy

eatin

g

and

phys

ical

act

ivity

that

will

set

an

exam

ple

to th

e pr

ivat

e se

ctor

.

RE

SEA

RC

H A

ND E

VA

LU

AT

ION

•E

valu

ate

best

pra

ctic

es in

wor

ksite

ove

rwei

ght a

nd o

besi

ty p

reve

ntio

n an

d

trea

tmen

t eff

orts

, and

dis

sem

inat

e re

sults

of

stud

ies

wid

ely.

•E

valu

ate

econ

omic

dat

a ex

amin

ing

wor

ksite

obe

sity

pre

vent

ion

and

trea

t-

men

t eff

orts

.

•C

ondu

ct c

ontr

olle

d w

orks

ite s

tudi

es o

f th

e im

pact

of

over

wei

ght a

nd o

be-

sity

man

agem

ent p

rogr

ams

on w

orke

r pro

duct

ivity

and

abs

ente

eism

.

•In

corp

orat

e m

essa

ges

abou

t pro

per

nutr

ition

, inc

ludi

ng e

atin

g at

leas

t fiv

e

serv

ings

of f

ruits

and

veg

etab

les a

day

, and

regu

lar p

hysi

cal a

ctiv

ity in

you

th-

orie

nted

TV

pro

gram

min

g.

•Tr

ain

nutr

ition

and

exe

rcis

e sc

ient

ists

and

spe

cial

ists

in

med

ia a

dvoc

acy

skill

s th

at w

ill e

mpo

wer

the

m t

o di

ssem

inat

e th

eir

know

ledg

e to

a b

road

audi

ence

.

•E

ncou

rage

com

mun

ity-b

ased

adv

ertis

ing

cam

paig

ns t

o ba

lanc

e m

essa

ges

that

may

enc

oura

ge c

onsu

mpt

ion

of e

xces

s cal

orie

s and

inac

tivity

gen

erat

ed

by fa

st fo

od in

dust

ries

and

by

indu

stri

es th

at p

rom

ote

sede

ntar

y be

havi

ors.

•E

ncou

rage

med

ia p

rofe

ssio

nals

to u

tiliz

e ac

tors

’ in

flue

nces

as

role

mod

els

to d

emon

stra

te e

atin

g an

d ph

ysic

al a

ctiv

ity li

fest

yles

for

hea

lth r

athe

r th

an

for

appe

aran

ce.

•E

ncou

rage

med

ia p

rofe

ssio

nals

to e

mpl

oy a

ctor

s of

div

erse

siz

es.

RE

SEA

RC

H A

ND E

VA

LU

AT

ION

•E

valu

ate

the

impa

ct o

f com

mun

ity m

edia

adv

ocac

y ca

mpa

igns

des

igne

d to

achi

eve

publ

ic p

olic

y an

d he

alth

-rel

ated

goa

ls.

•C

ondu

ct c

onsu

mer

rese

arch

to e

nsur

e th

at m

edia

mes

sage

s ar

e po

sitiv

e, re

-

alis

tic, r

elev

ant,

cons

iste

nt, a

nd a

chie

vabl

e.

•In

crea

se re

sear

ch o

n th

e ef

fect

s of p

opul

ar m

edia

imag

es o

f ide

al b

ody

type

s

and

thei

r pot

entia

l hea

lth im

pact

, par

ticul

arly

on

youn

g w

omen

.

SET

TIN

G 5

: W

OR

KSI

TE

S

Mor

e th

an 1

00 m

illio

n A

mer

ican

s spe

nd th

e m

ajor

ity o

f the

ir d

ay a

t a w

orks

ite.

Whi

le a

t wor

k, e

mpl

oyee

s ar

e of

ten

aggr

egat

ed w

ithin

sys

tem

s fo

r co

mm

unic

a-

tion,

edu

catio

n, a

nd p

eer s

uppo

rt.

Thu

s, w

orks

ites

prov

ide

man

y op

port

uniti

es to

rein

forc

e th

e ad

optio

n an

d m

aint

enan

ce o

f hea

lthy

lifes

tyle

beh

avio

rs. P

ublic

hea

lth

appr

oach

es in

wor

ksite

s sh

ould

ext

end

beyo

nd h

ealth

edu

catio

n an

d aw

aren

ess

to

incl

ude

wor

ksite

pol

icie

s, th

e ph

ysic

al a

nd s

ocia

l env

iron

men

ts o

f w

orks

ites,

and

thei

r lin

ks w

ith th

e fa

mily

and

com

mun

ity s

ettin

g.

41

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

Y

2627

SEC

TIO

N 3

:

The

Pow

er o

f Peo

ple

and

Idea

s

Publ

ic h

ealth

eff

orts

are

car

ried

by

the

forc

e of

ide

as a

nd b

y th

e po

wer

of

com

mitm

ent.

Hea

lthy

Peo

ple

2010

iden

tifie

s goa

ls to

impr

ove

the

coun

try’

s hea

lth

stat

us, i

nclu

ding

redu

cing

the

prev

alen

ce o

f ove

rwei

ght a

nd o

besi

ty.

Thi

s Su

rgeo

n

Gen

eral

’s C

all

To A

ctio

n To

Pre

vent

and

Dec

reas

e O

verw

eigh

t an

d O

besi

ty a

d-

dres

ses t

he H

ealth

y P

eopl

e 20

10 o

bjec

tives

to re

duce

the

prev

alen

ce o

f ove

rwei

ght

and

obes

ity a

nd p

rese

nts

man

y id

eas

by w

hich

this

can

be

done

. Tr

ansl

atin

g th

ese

idea

s in

to m

eani

ngfu

l act

ion

will

req

uire

a g

reat

com

mitm

ent.

We

mus

t col

lec-

tivel

y bu

ild o

n ex

istin

g su

cces

sful

pro

gram

s in

bot

h th

e pu

blic

and

pri

vate

sec

tors

,

iden

tify

curr

ent g

aps

in a

ctio

n, a

nd d

evel

op a

nd in

itiat

e ac

tions

to f

ill th

ose

gaps

.

Publ

ic-p

riva

te w

orki

ng g

roup

s sh

ould

be

form

ed a

roun

d ke

y th

emes

or a

roun

d th

e

maj

or se

tting

s in

whi

ch o

besi

ty p

reve

ntio

n an

d tr

eatm

ent e

ffor

ts n

eed

to ta

ke p

lace

.

Whi

le t

he m

agni

tude

of

the

prob

lem

is

grea

t, th

e ra

nge

of p

oten

tial

solu

tions

is

even

gre

ater

. T

he d

esig

n of

suc

cess

ful

inte

rven

tions

and

act

ions

for

pre

vent

ion

and

man

agem

ent

of o

verw

eigh

t an

d ob

esity

will

req

uire

the

car

eful

atte

ntio

n of

man

y in

divi

dual

s an

d or

gani

zatio

ns w

orki

ng to

geth

er th

roug

h m

ultip

le s

pher

es o

f

infl

uenc

e.

IND

IVID

UA

LS

Indi

vidu

als

lie a

t the

foun

datio

n of

the

solu

tion

to th

e pr

oble

ms

of o

verw

eigh

t

and

obes

ity.

Indi

vidu

als

can

shar

e th

eir

own

know

ledg

e an

d ha

bits

reg

ardi

ng a

heal

thy

diet

and

phy

sica

l act

ivity

with

thei

r chi

ldre

n, o

ther

fam

ily m

embe

rs, f

rien

ds,

and

co-w

orke

rs.

Thr

ough

fra

nk d

ialo

gue

rega

rdin

g th

e m

etho

ds, c

halle

nges

, and

bene

fits

of a

dopt

ing

a he

alth

y lif

esty

le, i

ndiv

idua

ls c

an m

ake

the

effo

rt to

com

bat

the

obes

ity e

pide

mic

bot

h pe

rson

al a

nd re

leva

nt.

OR

GA

NIZ

AT

ION

S

Org

aniz

atio

ns r

epre

sent

indi

vidu

als

who

hav

e co

mm

on g

oals

and

pur

pose

s.

Org

aniz

atio

ns c

an in

itiat

e di

scus

sion

s on

obes

ity a

nd o

verw

eigh

t with

in th

eir m

em-

bers

hip

and

can

esta

blis

h w

eigh

t and

life

styl

e go

als.

O

rgan

izat

ions

can

dev

elop

prog

ram

s tha

t edu

cate

mem

bers

on

food

cho

ices

and

app

ropr

iate

leve

ls o

f phy

sica

l

42

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YSe

ctio

n 3:

The

Pow

er o

f Peo

ple

and

Idea

s

2829

amon

g at

-ris

k po

pula

tions

. G

over

nmen

ts c

an a

lso

prov

ide

supp

ort f

or p

ublic

edu

-

catio

n, p

ublic

aw

aren

ess c

ampa

igns

, and

trea

tmen

t ser

vice

s. F

inal

ly, g

over

nmen

ts

can

crea

te a

nd p

rom

ote

polic

ies

that

pro

mot

e an

env

iron

men

t in

whi

ch h

ealth

y

diet

ary

and

phys

ical

act

ivity

opt

ions

are

read

ily a

cces

sibl

e.

CR

EA

TIN

G N

AT

ION

AL A

CT

ION

Inte

rven

tions

and

act

ions

in

the

fund

amen

tal

area

s of

the

CA

RE

app

roac

h

shou

ld c

atal

yze

a pr

oces

s of

nat

iona

l, St

ate,

and

loca

l act

ion

to a

ddre

ss o

verw

eigh

t

and

obes

ity.

Whi

le s

trat

egie

s an

d ac

tion

step

s w

ill v

ary,

all

who

take

act

ion

shou

ld

ackn

owle

dge

and

embr

ace

the

follo

win

g pr

inci

ples

:

•A

ctio

ns b

y di

vers

ifie

d an

d co

oper

ativ

e gr

oups

are

des

irab

le. W

orki

ng g

roup

s

may

form

aro

und

setti

ngs

or a

roun

d cr

ossc

uttin

g th

emes

, as

appr

opri

ate,

to

best

lev

erag

e th

eir

tale

nts

and

reso

urce

s ag

ains

t ov

erw

eigh

t an

d ob

esity

.

Part

ners

hips

am

ong

all

leve

ls o

f go

vern

men

t; pu

blic

and

pri

vate

nat

iona

l,

Stat

e, T

riba

l, an

d lo

cal o

rgan

izat

ions

; and

faith

-bas

ed a

nd o

ther

com

mun

ity

grou

ps w

ill in

crea

se th

e lik

elih

ood

that

true

gap

s in

actio

n w

ill b

e ad

dres

sed.

Part

ners

hips

als

o m

ay f

oste

r le

arni

ng, s

hari

ng o

f re

sour

ces,

div

isio

n of

la-

bor,

and

cons

iste

ncy

in th

e m

essa

ge to

the

publ

ic.

Add

ition

ally

, the

y m

ay

enha

nce

med

ia p

rom

inen

ce a

nd th

e so

cial

cre

dibi

lity

of a

ctio

ns to

add

ress

over

wei

ght a

nd o

besi

ty.

•A

ctio

ns re

quir

e vi

goro

us, d

edic

ated

com

mitm

ent.

The

soc

ial,

envi

ronm

en-

tal,

and

beha

vior

al f

acto

rs r

espo

nsib

le f

or th

e ep

idem

ic o

f ov

erw

eigh

t and

obes

ity a

re f

irm

ly e

ntre

nche

d in

our

soc

iety

. I

dent

ifyi

ng a

nd d

islo

dgin

g

thes

e fa

ctor

s w

ill r

equi

re d

elib

erat

e, p

ersi

sten

t ac

tion

and

a de

gree

of

pa-

tienc

e.

•A

ctio

ns s

houl

d st

rive

to h

elp

all A

mer

ican

s m

aint

ain

a he

alth

y or

hea

lthie

r

wei

ght

thro

ugh

bala

ncin

g ca

lori

c in

take

and

ene

rgy

expe

nditu

re.

Act

ions

shou

ld fo

cus

at m

ultip

le le

vels

, tar

getin

g th

e en

viro

nmen

t, be

havi

or c

hang

e,

and

polic

y.

•A

ctio

ns s

houl

d be

car

eful

ly p

lann

ed.

The

cho

ice

of a

ctio

ns s

houl

d be

bas

ed

on t

he r

elat

ive

feas

ibili

ty, e

ffec

tiven

ess,

and

sui

tabi

lity

of a

ll po

tent

ial

ac-

tions

, and

all

part

ners

sho

uld

have

a c

lear

ly d

efin

ed ro

le in

the

actio

n.

activ

ity a

nd e

ngag

e m

embe

rs i

n th

ese

heal

thy

habi

ts.

Usi

ng t

heir

lin

ks t

o an

d

infl

uenc

e w

ithin

the

broa

der c

omm

unity

, org

aniz

atio

ns c

an sh

are

thei

r exp

erie

nces

in w

eigh

t man

agem

ent a

nd th

us s

erve

as

an im

port

ant p

ublic

reso

urce

.

IND

UST

RY

Indu

stry

has

a v

ital r

ole

in th

e pr

even

tion

of o

verw

eigh

t and

obe

sity

. Thr

ough

the

prod

uctio

n an

d di

stri

butio

n of

foo

d an

d ot

her

cons

umer

pro

duct

s, i

ndus

try

exer

ts a

trem

endo

us im

pact

on

the

nutr

ition

al q

ualit

y of

the

food

we

eat a

nd th

e

exte

nt o

f ph

ysic

al a

ctiv

ity in

whi

ch w

e en

gage

. In

dust

ry c

an u

se th

at le

vera

ge to

crea

te a

nd su

stai

n an

env

iron

men

t tha

t enc

oura

ges i

ndiv

idua

ls to

ach

ieve

and

mai

n-

tain

a h

ealth

y or

hea

lthie

r bod

y w

eigh

t.

CO

MM

UN

ITIE

S

Com

mun

ities

con

sist

of

mul

tiple

com

pone

nts,

inc

ludi

ng i

ndiv

idua

ls,

faith

-

base

d an

d ot

her c

omm

unity

org

aniz

atio

ns, w

orks

ites,

and

gov

ernm

ents

. A

foru

m

shou

ld b

e pr

ovid

ed in

whi

ch a

ll co

mm

unity

mem

bers

can

dis

cuss

the

scop

e of

the

prob

lem

of

over

wei

ght a

nd o

besi

ty w

ithin

the

com

mun

ity.

Als

o, th

e na

ture

and

adeq

uacy

of

avai

labl

e re

sour

ces

for

publ

ic e

duca

tion

and

trea

tmen

t, as

wel

l as

curr

ent a

nd f

utur

e po

licie

s an

d pr

ogra

ms

to r

educ

e th

e bu

rden

of

over

wei

ght a

nd

obes

ity w

ithin

the

com

mun

ity, m

ust b

e ad

dres

sed.

Cle

arly

, the

dis

cuss

ions

and

the

stra

tegi

es a

dopt

ed w

ill v

ary

depe

ndin

g on

the

prev

alen

ce o

f obe

sity

and

ove

rwei

ght

with

in e

ach

com

mun

ity.

GO

VE

RN

ME

NT

Loc

al g

over

nmen

ts c

an w

ork

toge

ther

with

org

aniz

atio

ns a

nd c

omm

uniti

es to

faci

litat

e go

als

for r

educ

ing

over

wei

ght a

nd o

besi

ty.

Loc

al g

over

nmen

ts c

an a

ssis

t

with

pro

vidi

ng s

ervi

ces

to i

ncre

ase

phys

ical

act

ivity

and

im

prov

e nu

triti

onal

in-

take

. St

ate,

Tri

bal,

and

loca

l gov

ernm

ents

can

col

labo

rate

mor

e w

ith F

eder

al n

utri

-

tion

assi

stan

ce p

rogr

ams t

hat p

rovi

de se

rvic

es p

rom

otin

g he

alth

y ea

ting

and

phys

ical

activ

ity.

Stat

es c

an fo

rm ta

sk fo

rces

, ste

erin

g co

mm

ittee

s, o

r adv

isor

y co

mm

ittee

s

and

can

also

dev

elop

Sta

te s

trat

egic

pla

ns.

Stat

e an

d na

tiona

l go

vern

men

ts c

an

prov

ide

fund

ing

for

rese

arch

on

the

effe

cts

of i

nter

vent

ions

on

over

wei

ght

and

obes

ity p

reva

lenc

e, p

reve

ntio

n, a

nd tr

eatm

ent,

and

on tr

ends

in d

iet a

nd e

xerc

ise

43

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YSe

ctio

n 3:

The

Pow

er o

f Peo

ple

and

Idea

s

3031

Info

rmat

ion

Gat

heri

ng

•U

pdat

e on

the

bio

logi

cal,

epid

emio

logi

cal,

and

psyc

holo

gica

l as

pect

s of

obes

ity a

nd o

verw

eigh

t.

•R

evie

w o

f sur

veill

ance

dat

a sy

stem

s to

trac

k ov

erw

eigh

t and

obe

sity

.

•U

pdat

e on

the

late

st b

ehav

iora

l and

pha

rmac

olog

ical

inte

rven

tions

for o

ver-

wei

ght a

nd o

besi

ty.

•D

iscu

ssio

n of

new

idea

s an

d go

als

for c

ontin

ued

natio

nal a

ctiv

ity.

Rep

ortin

g

•R

epor

ting

on p

rogr

ess

base

d on

mea

sura

ble

obje

ctiv

es, s

uch

as th

ose

out-

lined

in H

ealth

y P

eopl

e 20

10.

•D

iscu

ssio

n of

the

prog

ress

ach

ieve

d th

roug

h ac

tions

und

erta

ken

with

in th

e

vari

ous

setti

ngs.

•R

epor

ting

on th

e st

atus

of c

urre

nt p

olic

ies,

pro

gram

s, a

nd in

terv

entio

ns.

•C

reat

ion

and

diss

emin

atio

n of

a li

brar

y of

bes

t pra

ctic

es b

ased

on

evid

ence

-

base

d pr

ogra

ms.

•R

ecog

nitio

n of

exe

mpl

ary

inte

rven

tion

prog

ram

s, f

or e

xam

ple,

thro

ugh

an

awar

ds p

rogr

am.

Mon

itori

ng w

ill e

nsur

e th

at a

ll m

embe

rs o

f the

var

ious

set

tings

can

com

mun

i-

cate

thei

r ide

as a

nd s

trat

egie

s. M

onito

ring

will

allo

w p

lann

ers

to s

ee w

hich

obj

ec-

tives

are

reac

hed

or e

xcee

ded

as w

ell a

s th

ose

that

fall

shor

t of e

xpec

tatio

ns.

PRO

MO

TIO

N

In a

dditi

on t

o st

rong

lea

ders

hip

and

regu

lar

eval

uatio

n, a

suc

cess

ful

publ

ic

heal

th e

ffor

t req

uire

s ac

tive

prom

otio

n. C

ontin

uous

pub

lic e

duca

tion

on th

e m

ag-

nitu

de o

f th

e pr

oble

m o

f ov

erw

eigh

t an

d ob

esity

will

rei

nfor

ce t

he g

oals

of

the

natio

nal

effo

rt a

nd w

ill e

ncou

rage

pub

lic p

artic

ipat

ion.

T

here

fore

, th

e na

tiona

l

actio

n to

com

bat o

verw

eigh

t and

obe

sity

sho

uld:

•Fo

ster

a c

onsi

sten

t mes

sage

to th

e pu

blic

rega

rdin

g th

e ri

sks

of o

verw

eigh

t

and

obes

ity a

s wel

l as t

he m

echa

nism

s by

whi

ch a

per

son

can

adop

t a h

ealth

y

lifes

tyle

.

•Ta

rget

hig

h-ri

sk g

roup

s fo

r edu

catio

n on

ove

rwei

ght a

nd o

besi

ty.

•A

ctio

ns s

houl

d be

sen

sitiv

e to

the

need

s of

min

ority

pop

ulat

ions

and

to th

e

soci

al s

tigm

atiz

atio

n th

at c

an s

urro

und

over

wei

ght a

nd o

besi

ty.

•A

ctio

ns a

nd t

heir

out

com

es s

houl

d be

eva

luat

ed.

Whi

le i

mpl

emen

ting

a

syst

em to

mon

itor

outc

omes

sho

uld

not s

tand

as

a ba

rrie

r to

act

ion,

gro

ups

that

are

abl

e sh

ould

mon

itor

and

docu

men

t th

e sh

ort-

term

and

lon

g-te

rm

effe

cts

of t

he a

ctio

ns t

hey

take

. T

his

type

of

trac

king

pro

vide

s im

port

ant

info

rmat

ion

for

the

next

rou

nd o

f ac

tions

and

inc

reas

es t

he l

ikel

ihoo

d of

succ

ess.

D

evel

opin

g a

conc

rete

eva

luat

ion

plan

ear

ly m

ay h

elp

focu

s th

e

goal

s fo

r ac

tion.

SUST

AIN

ING

NA

TIO

NA

L A

CT

ION

Eff

ectiv

enes

s of

the

publ

ic h

ealth

resp

onse

to o

verw

eigh

t and

obe

sity

requ

ires

stro

ng le

ader

ship

, reg

ular

mon

itori

ng, a

nd c

omm

itted

supp

ort o

f all—

gove

rnm

ent;

indu

stry

; pu

blic

, pr

ivat

e, a

nd p

rofe

ssio

nal

orga

niza

tions

; co

mm

uniti

es;

scho

ols;

fam

ilies

; and

indi

vidu

als.

The

se fe

atur

es w

ill e

nsur

e su

stai

ned

actio

n, p

rodu

ctiv

e

colla

bora

tion,

and

ong

oing

pro

gres

s to

war

d th

e vi

sion

of t

his

Cal

l To

Act

ion.

LE

AD

ER

SHIP

A n

etw

ork

of le

ader

ship

acr

oss

the

coun

try

need

s to

be

esta

blis

hed

to e

nsur

e

that

act

ions

are

em

ploy

ed i

n th

e ap

prop

riat

e se

tting

s na

tionw

ide.

T

his

netw

ork

shou

ld b

e st

ruct

ured

at t

he o

rgan

izat

iona

l, in

dust

rial

, Sta

te, a

nd c

omm

unity

leve

ls.

The

cre

atio

n of

a p

ublic

-pri

vate

par

tner

ship

in th

e fo

rm o

f a n

atio

nal s

teer

ing

com

-

mitt

ee c

ould

pro

vide

an

over

arch

ing

pers

pect

ive

and

a m

ore

cent

raliz

ed le

ader

ship

to s

uch

effo

rts.

A

dia

logu

e am

ong

all

thes

e sp

here

s of

lea

ders

hip

is e

ssen

tial.

Seve

ral

key

func

tions

of

this

lea

ders

hip

stru

ctur

e ar

e de

scri

bed

in t

he f

ollo

win

g

sect

ion.

MO

NIT

OR

ING

The

eff

ectiv

enes

s of

a C

AR

E a

ppro

ach

to o

verw

eigh

t an

d ob

esity

mus

t be

asse

ssed

at r

egul

ar in

terv

als.

Mon

itori

ng s

houl

d in

clud

e ga

ther

ing

new

info

rma-

tion

on o

verw

eigh

t and

obe

sity

as

wel

l as

repo

rtin

g on

the

stat

us o

f cu

rren

t int

er-

vent

ions

.

44

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

Y

3233

SEC

TIO

N 4

:

Vis

ion

for t

he F

utur

e

Thi

s Su

rgeo

n G

ener

al’s

Cal

l To

Act

ion

To P

reve

nt a

nd D

ecre

ase

Ove

rwei

ght

and

Obe

sity

und

ersc

ores

the

trem

endo

us h

ealth

impa

ct th

at o

verw

eigh

t and

obe

-

sity

hav

e on

the

Uni

ted

Stat

es. T

hrou

gh w

ides

prea

d ac

tion

on th

e pa

rt o

f all

Am

eri-

cans

, thi

s C

all T

o A

ctio

n ai

ms

to c

atal

yze

a pr

oces

s th

at w

ill re

duce

the

prev

alen

ce

of o

verw

eigh

t and

obe

sity

on

a na

tionw

ide

scal

e. W

ithou

t sup

port

and

inve

stm

ent

from

a b

road

arr

ay o

f pu

blic

and

pri

vate

par

tner

s, th

ese

effo

rts

will

not

suc

ceed

.

With

suc

h su

ppor

t, ho

wev

er,

ther

e ex

ist

few

lim

itatio

ns o

n th

e po

tent

ial

of t

his

effo

rt to

impr

ove

the

heal

th o

f ind

ivid

uals

, fam

ilies

, com

mun

ities

, and

, ulti

mat

ely,

the

Nat

ion

as a

who

le.

SUR

GE

ON G

EN

ER

AL’S

PR

IOR

ITIE

S F

OR

AC

TIO

NT

he p

revi

ousl

y di

scus

sed

CA

RE

fra

mew

ork

pres

ents

a m

enu

of i

mpo

rtan

t

activ

ities

for

the

pre

vent

ion

and

trea

tmen

t of

ove

rwei

ght

and

obes

ity.

Bui

ldin

g

from

this

men

u, t

he S

urge

on G

ener

al id

entif

ies

the

follo

win

g 15

act

iviti

es a

s na

-

tiona

l pri

oriti

es fo

r im

med

iate

act

ion.

Ind

ivid

uals

, fam

ilies

, com

mun

ities

, sch

ools

,

wor

ksite

s, h

ealth

car

e, m

edia

, ind

ustr

y, o

rgan

izat

ions

, and

gov

ernm

ent m

ust d

eter

-

min

e th

eir r

ole

and

take

act

ion

to p

reve

nt a

nd d

ecre

ase

over

wei

ght a

nd o

besi

ty.

CO

MM

UN

ICA

TIO

N

The

Nat

ion

mus

t ta

ke a

n in

form

ed, s

ensi

tive

appr

oach

to

com

mun

icat

e

with

and

edu

cate

the

Am

eric

an p

eopl

e ab

out

heal

th i

ssue

s re

late

d to

ove

r-

wei

ght a

nd o

besi

ty.

Eve

ryon

e m

ust w

ork

toge

ther

to:

•C

hang

e th

e pe

rcep

tion

of o

verw

eigh

t and

obe

sity

at a

ll ag

es. T

he p

rim

ary

conc

ern

shou

ld b

e on

e of

hea

lth a

nd n

ot a

ppea

ranc

e.

•E

duca

te a

ll ex

pect

ant p

aren

ts a

bout

the

man

y be

nefi

ts o

f bre

astf

eedi

ng.

-B

reas

tfed

infa

nts

may

be

less

like

ly to

bec

ome

over

wei

ght a

s th

ey g

row

olde

r.

-M

othe

rs w

ho b

reas

tfee

d m

ay re

turn

to p

re-p

regn

ancy

wei

ght m

ore

quic

kly.

•E

duca

te h

ealth

car

e pr

ovid

ers

and

heal

th p

rofe

ssio

n st

uden

ts in

the

prev

en-

tion

and

trea

tmen

t of o

verw

eigh

t and

obe

sity

acr

oss

the

lifes

pan.

•Pr

omot

e in

terv

entio

ns th

at a

ddre

ss d

ispa

ritie

s in

the

prev

alen

ce o

f ove

rwei

ght

and

obes

ity.

•Se

ek to

impr

ove

the

gene

ral s

ensi

tivity

to th

e so

cial

stig

ma

of o

verw

eigh

t

and

obes

ity.

CO

MM

ITT

ED

GO

VE

RN

ME

NT S

UPP

OR

T

Loc

al, S

tate

, Tri

bal,

and

natio

nal g

over

nmen

ts h

ave

prev

ious

ly d

ecla

red

thei

r

supp

ort o

f eff

orts

to m

aint

ain

and

impr

ove

Am

eric

a’s

heal

th.

Such

gov

ernm

enta

l

back

ing

may

be

enha

nced

thro

ugh

the

follo

win

g:

•C

reat

ion

of la

ws

and

polic

ies

that

sup

port

a h

ealth

y ph

ysic

al a

nd n

utri

tiona

l

envi

ronm

ent f

or th

e pu

blic

.

•A

lloca

tion

of r

esou

rces

to

both

gov

ernm

ent

and

priv

ate

orga

niza

tions

to

carr

y ou

t nat

iona

l act

ion

to p

reve

nt a

nd d

ecre

ase

over

wei

ght a

nd o

besi

ty.

•Pr

ovis

ion

of a

utho

rity

to s

peci

fic

Fede

ral a

nd S

tate

age

ncie

s to

enf

orce

pol

i-

cies

aim

ed a

t red

ucin

g ov

erw

eigh

t and

obe

sity

.

ON

GO

ING

DIA

LO

GU

E

At a

min

imum

, a n

atio

nal s

teer

ing

com

mitt

ee sh

ould

con

vene

an

annu

al m

eet-

ing

mod

eled

aft

er t

he S

urge

on G

ener

al’s

Lis

teni

ng S

essi

on.

Thi

s ev

ent

wou

ld

prov

ide

lead

ers

with

a u

sefu

l for

um f

or in

form

atio

n ex

chan

ge a

nd e

nhan

ce th

eir

abili

ties

to c

arry

out

the

func

tions

list

ed a

bove

.

45

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YSe

ctio

n 4:

Vis

ion

for

the

Fut

ure

3435

-A

dopt

ing

polic

ies s

peci

fyin

g th

at a

ll fo

ods a

nd b

ever

ages

ava

ilabl

e at

scho

ol

cont

ribut

e to

war

d ea

ting

patte

rns t

hat a

re c

onsi

sten

t with

the

Die

tary

Gui

de-

lines

for

Am

eric

ans.

-Pr

ovid

ing

mor

e fo

od o

ptio

ns th

at a

re lo

w in

fat,

calo

ries

, and

add

ed su

gars

such

as

frui

ts, v

eget

able

s, w

hole

gra

ins,

and

low

-fat

or n

onfa

t dai

ry fo

ods.

-R

educ

ing

acce

ss t

o fo

ods

high

in

fat,

calo

ries

, and

add

ed s

ugar

s an

d to

exce

ssiv

e po

rtio

n si

zes.

•C

reat

e m

echa

nism

s fo

r ap

prop

riat

e re

imbu

rsem

ent f

or th

e pr

even

tion

and

trea

tmen

t of o

verw

eigh

t and

obe

sity

.

RE

SEA

RC

H A

ND E

VA

LU

AT

ION

The

Nat

ion

mus

t in

vest

in r

esea

rch

that

impr

oves

our

und

erst

andi

ng o

f

the

caus

es, p

reve

ntio

n, a

nd tr

eatm

ent o

f ove

rwei

ght a

nd o

besi

ty.

A c

once

rted

effo

rt s

houl

d be

mad

e to

:

•In

crea

se r

esea

rch

on b

ehav

iora

l an

d en

viro

nmen

tal

caus

es o

f ov

erw

eigh

t

and

obes

ity.

•In

crea

se re

sear

ch a

nd e

valu

atio

n on

pre

vent

ion

and

trea

tmen

t int

erve

ntio

ns

for o

verw

eigh

t and

obe

sity

, and

dev

elop

and

dis

sem

inat

e be

st p

ract

ice

guid

e-

lines

.

•In

crea

se re

sear

ch o

n di

spar

ities

in th

e pr

eval

ence

of o

verw

eigh

t and

obe

sity

amon

g ra

cial

and

eth

nic,

gen

der,

soci

oeco

nom

ic, a

nd a

ge g

roup

s, a

nd u

se

this

rese

arch

to id

entif

y ef

fect

ive

and

cultu

rally

app

ropr

iate

inte

rven

tions

.

CO

NC

LU

SIO

NT

his

Cal

l To

Act

ion

is f

or a

ll w

ho c

an h

ave

an i

mpa

ct o

n ov

erw

eigh

t an

d

obes

ity in

the

Uni

ted

Stat

es to

take

act

ion

to c

reat

e a

futu

re w

here

:

•It

is w

idel

y re

cogn

ized

that

ove

rwei

ght a

nd o

besi

ty c

an r

educ

e th

e le

ngth

and

qual

ity o

f lif

e.

•T

he e

tiolo

gy o

f th

is c

ompl

ex p

robl

em o

f ov

erw

eigh

t and

obe

sity

is b

ette

r

unde

rsto

od.

•Pr

ovid

e cu

ltura

lly a

ppro

pria

te e

duca

tion

in s

choo

ls a

nd c

omm

uniti

es a

bout

heal

thy

eatin

g ha

bits

and

reg

ular

phy

sica

l ac

tivity

, ba

sed

on t

he D

ieta

ry

Gui

delin

es fo

r Am

eric

ans,

for p

eopl

e of

all

ages

. E

mph

asiz

e th

e co

nsum

er’s

role

in m

akin

g w

ise

food

and

phy

sica

l act

ivity

cho

ices

.

AC

TIO

N

The

Nat

ion

mus

t ta

ke a

ctio

n to

ass

ist A

mer

ican

s in

bal

anci

ng h

ealth

ful

eatin

g w

ith r

egul

ar p

hysi

cal a

ctiv

ity.

Indi

vidu

als

and

grou

ps a

cros

s al

l set

-

tings

mus

t wor

k in

con

cert

to:

•E

nsur

e da

ily, q

ualit

y ph

ysic

al e

duca

tion

in a

ll sc

hool

gra

des.

Suc

h ed

uca-

tion

can

deve

lop

the

know

ledg

e, a

ttitu

des,

ski

lls, b

ehav

iors

, and

con

fide

nce

need

ed to

be

phys

ical

ly a

ctiv

e fo

r lif

e.

•R

educ

e tim

e sp

ent

wat

chin

g te

levi

sion

and

in

othe

r si

mila

r se

dent

ary

be-

havi

ors.

•B

uild

phy

sica

l act

ivity

into

reg

ular

rou

tines

and

pla

ytim

e fo

r ch

ildre

n an

d

thei

r fam

ilies

. Ens

ure

that

adu

lts g

et a

t lea

st 3

0 m

inut

es o

f mod

erat

e ph

ysi-

cal a

ctiv

ity o

n m

ost d

ays

of th

e w

eek.

Chi

ldre

n sh

ould

aim

for

at l

east

60

min

utes

.

•C

reat

e m

ore

oppo

rtun

ities

for

phy

sica

l act

ivity

at w

orks

ites.

Enc

oura

ge a

ll

empl

oyer

s to

mak

e fa

cilit

ies

and

oppo

rtun

ities

ava

ilabl

e fo

r phy

sica

l act

iv-

ity fo

r all

empl

oyee

s.

•M

ake

com

mun

ity fa

cilit

ies

avai

labl

e an

d ac

cess

ible

for p

hysi

cal a

ctiv

ity fo

r

all p

eopl

e, in

clud

ing

the

elde

rly.

•Pr

omot

e he

alth

ier f

ood

choi

ces,

incl

udin

g at

leas

t fiv

e se

rvin

gs o

f fru

its a

nd

vege

tabl

es e

ach

day,

and

rea

sona

ble

port

ion

size

s at

hom

e, i

n sc

hool

s, a

t

wor

ksite

s, a

nd in

com

mun

ities

.

•E

nsur

e th

at s

choo

ls p

rovi

de h

ealth

ful f

oods

and

bev

erag

es o

n sc

hool

cam

-

puse

s an

d at

sch

ool e

vent

s by

:

-E

nfor

cing

exi

stin

g U

.S. D

epar

tmen

t of A

gric

ultu

re r

egul

atio

ns th

at p

ro-

hibi

t ser

ving

food

s of m

inim

al n

utri

tiona

l val

ue d

urin

g m

ealti

mes

in sc

hool

food

ser

vice

are

as, i

nclu

ding

in v

endi

ng m

achi

nes.

46

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

Y

3637

Ref

eren

ces

1.C

alle

EE

, Thu

n M

J, P

etre

lli J

M, R

odri

guez

C, H

eath

CW

. Bod

y m

ass

inde

x

and

mor

talit

y in

a p

rosp

ectiv

e co

hort

of

U.S

. adu

lts. N

Eng

l J M

ed 1

999

Oct

7;34

1(15

):10

97-1

05.

2.M

cGin

nis

JM, F

oege

WH

. Act

ual c

ause

s of

dea

th in

the

Uni

ted

Stat

es. J

AM

A

1993

Nov

10;

270(

18):

2207

-12.

3.A

lliso

n D

B, F

onta

ine

KR

, Man

son

JE, S

teve

ns J,

Van

Ital

lie T

B. A

nnua

l dea

ths

attri

buta

ble

to o

besi

ty in

the

Uni

ted

Stat

es. J

AM

A 1

999

Oct

27;

282(

16):1

530-

8.

4.U

nite

d St

ates

Dep

artm

ent o

f Agr

icul

ture

(U

SDA

) an

d U

nite

d St

ates

Dep

art-

men

t of

Hea

lth a

nd H

uman

Ser

vice

s (H

HS)

. Die

tary

gui

delin

es f

or A

mer

i-

cans

, 5th

ed.

USD

A; 2

000.

Hom

e an

d G

arde

n B

ulle

tin N

o. 2

32. p

. 10-

12.

5.H

HS.

Hea

lthy

Peop

le 2

010.

2nd

ed.

With

und

erst

andi

ng a

nd im

prov

ing

heal

th

and

obje

ctiv

es fo

r im

prov

ing

heal

th. W

ashi

ngto

n (D

C):

U.S

. Gov

ernm

ent P

rint

-

ing

Off

ice

(GPO

); 2

000.

2 v

ol. p

. 19-

3.

6.U

SDA

. U

SDA

con

tinui

ng s

urve

y of

foo

d in

take

s by

ind

ivid

uals

, 19

94-9

6.

USD

A; 1

998.

7.H

HS.

Hea

lthy

Peop

le 2

010,

2nd

ed.

With

und

erst

andi

ng a

nd im

prov

ing

heal

th

and

obje

ctiv

es fo

r im

prov

ing

heal

th. W

ashi

ngto

n (D

C):

GPO

; 200

0. 2

vol

. p.

22-8

, 22-

9 (U

pdat

ed d

ata

base

d on

new

def

initi

on o

f mod

erat

e ph

ysic

al a

ctiv

-

ity w

ill b

e po

sted

on

http

://w

onde

r.cdc

.gov

/dat

a201

0/).

8.H

HS.

Hea

lthy

Peop

le 2

010,

2nd

ed.

With

und

erst

andi

ng a

nd im

prov

ing

heal

th

and

obje

ctiv

es fo

r im

prov

ing

heal

th. W

ashi

ngto

n (D

C):

GPO

; 200

0. 2

vol

. p.

22-1

9 th

roug

h 22

-23.

9.C

ente

rs f

or D

isea

se C

ontr

ol a

nd P

reve

ntio

n (

CD

C).

Ten

grea

t pub

lic h

ealth

achi

evem

ents

—U

nite

d St

ates

, 190

0-19

99. M

MW

R 1

999;

48(5

0):1

141.

10.

Guy

er B

, Fre

edm

an M

A, S

trob

ino

DM

, Son

dik,

EJ.

Ann

ual s

umm

ary

of v

ital

stat

istic

s: T

rend

s in

the

heal

th o

f Am

eric

ans

duri

ng th

e 20

th c

entu

ry. P

edia

t-

rics

200

0 D

ec;1

06(6

):13

07-1

7.

11.

Nat

iona

l Ins

titut

es o

f Hea

lth (N

IH),

Nat

iona

l Hea

rt, L

ung,

and

Blo

od In

stitu

te

(NH

LB

I). C

linic

al g

uide

lines

on

the

iden

tific

atio

n, e

valu

atio

n, a

nd tr

eatm

ent

of o

verw

eigh

t and

obe

sity

in a

dults

. HH

S, P

ublic

Hea

lth S

ervi

ce (P

HS)

; 199

8.

p. x

xiii.

•E

ffec

tive

and

prac

tical

pre

vent

ion

and

trea

tmen

t ar

e w

idel

y av

aila

ble

and

inte

grat

ed in

hea

lth c

are

syst

ems.

•E

nvir

onm

ents

hav

e be

en m

odif

ied

to p

rom

ote

heal

thy

eatin

g an

d in

crea

sed

phys

ical

act

ivity

.

•D

ispa

ritie

s in

over

wei

ght a

nd o

besi

ty p

reva

lenc

e ba

sed

on ra

ce a

nd e

thni

city

,

soci

oeco

nom

ic s

tatu

s, g

ende

r, an

d ag

e ar

e el

imin

ated

.

•T

he h

ealth

con

sequ

ence

s of

ove

rwei

ght a

nd o

besi

ty a

re re

duce

d.

•T

he s

ocia

l stig

mat

ism

ass

ocia

ted

with

ove

rwei

ght a

nd o

besi

ty is

era

dica

ted.

Thi

s vi

sion

sho

uld

be a

ppro

ache

d vi

goro

usly

and

opt

imis

tical

ly b

ut w

ith p

a-

tienc

e.

The

re is

no

sim

ple

or q

uick

ans

wer

to th

is m

ultif

acet

ed c

halle

nge.

Thi

s

Surg

eon

Gen

eral

’s C

all T

o A

ctio

n To

Pre

vent

and

Dec

reas

e O

verw

eigh

t and

Obe

-

sity

cal

ls u

pon

indi

vidu

als,

fam

ilies

, com

mun

ities

, sch

ools

, wor

ksite

s, o

rgan

iza-

tions

, gov

ernm

ent,

and

the

med

ia to

wor

k to

geth

er to

bui

ld so

lutio

ns th

at w

ill b

ring

bette

r he

alth

to

ever

yone

in

this

cou

ntry

. W

orki

ng t

oget

her,

we

can

mak

e th

is

visi

on b

ecom

e a

real

ity.

47

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YR

efer

ence

s

3839

25.

Die

tz W

H.

Hea

lth c

onse

quen

ces

of o

besi

ty in

you

th: C

hild

hood

pre

dict

ors

of

adul

t dis

ease

. Ped

iatr

ics

1998

Mar

;101

(3)

Supp

l:518

-525

.

26.

Nat

iona

l Ins

titut

e of

Dia

bete

s an

d D

iges

tive

and

Kid

ney

Dis

ease

s (N

IDD

K).

Stat

istic

s re

late

d to

obe

sity

and

ove

rwei

ght [

Inte

rnet

]. [B

ethe

sda

(MD

)]: N

IH;

1996

July

[cite

d 20

01 O

ct 3

1]. (

NIH

Pub

licat

ion

No.

96-

4158

). A

vaila

ble

from

:

ww

w.n

iddk

.nih

.gov

/hea

lth/n

utri

t/pub

s/st

atob

es.h

tm

27.

Wol

f AM

, Col

ditz

GA

. Cur

rent

est

imat

es o

f th

e ec

onom

ic c

ost o

f ob

esity

in

the

Uni

ted

Stat

es. O

bes

Res

199

8 M

ar;6

(2):

97-1

06.

28.

Wol

f A. P

erso

nal c

omm

unic

atio

n. 2

001

Nov

embe

r 26.

29.

Wol

f A

. W

hat

is t

he e

cono

mic

cas

e fo

r tr

eati

ng o

besi

ty?

Obe

s R

es

1998

;6(S

1):2

S-7S

.

30.

Ebe

rhar

dt M

S, In

gram

DD

, Mak

uc D

M, e

t al.

Urb

an a

nd ru

ral h

ealth

cha

rtboo

k.

Hea

lth, U

nite

d St

ates

, 200

1. H

yatts

ville

(MD

): N

CH

S; 2

001.

p. 2

56.

31.

Mok

dad

AH

, Ser

dula

MK

, Die

tz W

H, B

owm

an B

A, M

arks

JS,

Kop

lan

JP.

The

spr

ead

of th

e ob

esity

epi

dem

ic in

the

Uni

ted

Stat

es, 1

991-

1998

. JA

MA

1999

Oct

27;

282(

16):

1519

-22.

32.

NC

HS,

CD

C.

Prev

alen

ce o

f ov

erw

eigh

t an

d ob

esity

am

ong

adul

ts:

Uni

ted

Stat

es, 1

999

[Int

erne

t]. [

Hya

ttsvi

lle (M

D)]

: NC

HS

[cite

d 20

01 O

ct 3

1]. A

vail-

able

fro

m: w

ww

.cdc

.gov

/nch

s/pr

oduc

ts/p

ubs/

pubd

/hes

tats

/obe

se/o

bse9

9.ht

m

33.

NC

HS,

CD

C. P

reva

lenc

e of

ove

rwei

ght a

mon

g ch

ildre

n an

d ad

oles

cent

s: U

nite

d

Stat

es, 1

999

[Int

erne

t]. [

Hya

ttsvi

lle (M

D)]

: NC

HS

[cite

d 20

01 O

ct 3

1]. A

vail-

able

fro

m: w

ww

.cdc

.gov

/nch

s/pr

oduc

ts/p

ubs/

pubd

/hes

tats

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r99f

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34.

NIH

, NH

LB

I. C

linic

al g

uide

lines

on

the

iden

tific

atio

n, e

valu

atio

n, a

nd tr

eat-

men

t of o

verw

eigh

t and

obe

sity

in a

dults

. HH

S, P

HS;

199

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. 8-9

.

35.

Cam

paig

ne B

N, M

orri

son

JA, S

chum

ann

BC

, Fau

lkne

r F, L

akat

os E

, Spr

eche

r

D, S

chre

iber

GB

. Ind

exes

of o

besi

ty a

nd c

ompa

riso

ns w

ith p

revi

ous

natio

nal

surv

ey d

ata

in 9

- and

10-

year

old

bla

ck a

nd w

hite

gir

ls: N

atio

nal H

eart

, Lun

g,

and

Blo

od I

nstit

ute

Gro

wth

and

Hea

lth S

tudy

. J P

edia

tr 1

994

May

;124

:675

-

80.

36.

Kim

m S

, B

arto

n B

, O

barz

anek

E,

McM

ahon

R,

Sabr

y Z

, W

acla

wiw

M,

Schr

eibe

r G

, Mor

riso

n J,

Sim

ilo S

, Dan

iels

S. R

acia

l div

erge

nce

in a

dipo

sity

duri

ng a

dole

scen

ce:

the

NH

LB

I G

row

th a

nd H

ealth

Stu

dy. P

edia

tric

s 20

01

Mar

;107

(3):

E34

-E40

.

12.

NIH

, NH

LB

I. C

linic

al g

uide

lines

on

the

iden

tific

atio

n, e

valu

atio

n, a

nd tr

eat-

men

t of o

verw

eigh

t and

obe

sity

in a

dults

. HH

S, P

HS;

199

8. p

. 1.

13.

USD

A, H

HS.

Die

tary

gui

delin

es fo

r Am

eric

ans,

5th

ed.

USD

A; 2

000.

Hom

e

and

Gar

den

Bul

letin

No.

232

. p. 7

.

14.

Nat

iona

l C

ente

r fo

r H

ealth

Sta

tistic

s (N

CH

S), C

DC

. CD

C G

row

th C

hart

s:

Uni

ted

Stat

es [I

nter

net]

. [H

yatts

ville

(MD

)]: N

CH

S [c

ited

2001

Oct

31]

. Ava

il-

able

from

: http

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ww

.cdc

.gov

/gro

wth

char

ts/.

15.

Troi

ano

RP,

Fle

gal

KM

. Ove

rwei

ght

child

ren

and

adol

esce

nts:

Des

crip

tion,

epid

emio

logy

, and

dem

ogra

phic

s. P

edia

tric

s 19

98 M

ar;1

01(3

):49

7-50

4.

16.

NIH

, NH

LB

I. C

linic

al g

uide

lines

on

the

iden

tific

atio

n, e

valu

atio

n, a

nd tr

eat-

men

t of o

verw

eigh

t and

obe

sity

in a

dults

. HH

S, P

HS;

199

8. p

. 23.

17.

Stur

m R

, Wel

ls K

B. D

oes

obes

ity c

ontr

ibut

e as

muc

h to

mor

bidi

ty a

s po

vert

y

or s

mok

ing?

Pub

lic H

ealth

200

1 M

ay;1

15(3

):22

9-35

.

18.

NIH

, NH

LB

I. C

linic

al g

uide

lines

on

the

iden

tific

atio

n, e

valu

atio

n, a

nd tr

eat-

men

t of o

verw

eigh

t and

obe

sity

in a

dults

. HH

S, P

HS;

199

8. p

. 12-

19.

19.

Ford

ES,

Will

iam

son

DF,

Liu

S. W

eigh

t cha

nge

and

diab

etes

inci

denc

e: F

ind-

ings

fro

m a

nat

iona

l co

hort

of

US

adu

lts.

Am

J E

pide

mio

l 19

97 A

ug

1;14

6(3)

:214

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20.

Will

ett W

C, M

anso

n JE

, Sta

mpf

er M

J, C

oldi

tz G

A, R

osne

r B

, Spe

izer

FE

,

Hen

neke

ns C

H. W

eigh

t, w

eigh

t cha

nge,

and

cor

onar

y he

art d

isea

se in

wom

en.

Ris

k w

ithin

the

‘nor

mal

’ wei

ght r

ange

. JA

MA

199

5 Fe

b 8;

273(

6):4

61-6

5.

21.

Gal

anis

DJ,

Har

ris T

, Sha

rp D

S, P

etro

vitc

h H

. Rel

ativ

e w

eigh

t, w

eigh

t cha

nge,

and

risk

of

coro

nary

hea

rt d

isea

se i

n th

e H

onol

ulu

Hea

rt P

rogr

am. A

m J

Epi

dem

iol 1

998

Feb

15;1

47(4

):37

9-86

.

22.

Wei

derp

ass

E, P

erss

on I

, Ada

mi H

O, M

agnu

sson

C, L

indg

ren

A, B

aron

JA

.

Bod

y si

ze in

dif

fere

nt p

erio

ds o

f lif

e, d

iabe

tes

mel

litus

, hyp

erte

nsio

n, a

nd ri

sk

of p

ostm

enop

ausa

l en

dom

etri

al c

ance

r. C

ance

r C

ause

s C

ontr

ol 2

000

Feb;

11(2

):18

5-92

.

23.

NIH

, NH

LB

I. C

linic

al g

uide

lines

on

the

iden

tific

atio

n, e

valu

atio

n, a

nd tr

eat-

men

t of o

verw

eigh

t and

obe

sity

in a

dults

. HH

S, P

HS;

199

8. p

. 12-

13.

24.

NIH

, NH

LB

I. C

linic

al g

uide

lines

on

the

iden

tific

atio

n, e

valu

atio

n, a

nd tr

eat-

men

t of o

verw

eigh

t and

obe

sity

in a

dults

. HH

S, P

HS;

199

8. p

. 20-

23.

48

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

Y

4041

Ack

now

ledg

men

ts

The

Sur

geon

Gen

eral

’s C

all T

o A

ctio

n To

Add

ress

Ove

rwei

ght a

nd O

besi

ty is

part

of a

nat

iona

l com

mitm

ent t

o co

mba

t the

epi

dem

ic o

f ove

rwei

ght a

nd o

besi

ty

in th

e U

nite

d St

ates

, led

by

the

U.S

. Dep

artm

ent o

f H

ealth

and

Hum

an S

ervi

ces

(HH

S).

Lea

ders

hip

and

dire

ctio

n w

ere

prov

ided

by

Surg

eon

Gen

eral

Dav

id S

atch

er

and

Dep

uty

Surg

eon

Gen

eral

Ken

neth

Mor

itsug

u.

Dev

elop

men

t of

the

Cal

l To

Act

ion

was

coo

rdin

ated

by

the

HH

S O

ffic

e of

Dis

ease

Pre

vent

ion

and

Hea

lth P

rom

otio

n (O

DPH

P),

unde

r th

e le

ader

ship

of

Ran

dolp

h W

ykof

f. P

rinc

ipal

resp

onsi

bilit

y fo

r edi

ting

the

Cal

l To

Act

ion

was

car

-

ried

out

by

Paul

Am

bros

e, w

ith p

roje

ct m

anag

emen

t ca

rrie

d ou

t by

Kat

hryn

McM

urry

. Tec

hnic

al a

nd e

dito

rial

sup

port

wer

e pr

ovid

ed b

y th

e m

embe

rs o

f th

e

HH

S St

eeri

ng C

omm

ittee

(see

pag

e 43

). C

ritic

al sc

ient

ific

ove

rsig

ht w

as p

rovi

ded

by W

illia

m D

ietz

and

Van

Hub

bard

.

Res

earc

h, a

naly

sis,

and

wri

ting

supp

ort

wer

e pr

ovid

ed b

y O

DPH

P m

edic

al

resi

dent

s an

d fe

llow

s:

Sajid

a C

haud

ry,

Joan

Dav

is,

Che

ryl

Iver

son,

Mw

ango

Kas

hoki

, Dav

id M

eyer

s, S

tace

y Sh

erid

an, L

isa

Stol

l, an

d K

aryl

Tho

mas

.

Log

istic

al s

uppo

rt a

nd c

oord

inat

ion

with

the

Off

ice

of t

he S

urge

on G

ener

al

was

pro

vide

d by

Ann

Eld

erki

n.

Subs

tant

ial p

ublic

inpu

t was

sou

ght a

nd re

ceiv

ed a

t mul

tiple

ste

ps in

the

pro-

cess

of

deve

lopi

ng t

he C

all

To A

ctio

n.

Sinc

ere

grat

itude

is

exte

nded

to

all

who

cont

ribu

ted

to th

e na

tiona

l dia

logu

e on

ove

rwei

ght a

nd o

besi

ty in

the

Uni

ted

Stat

es:

•D

iscu

ssio

n le

ader

s and

par

ticip

ants

at t

he M

ay 2

000

Nat

iona

l Nut

ritio

n Su

m-

mit.

•Pa

nelis

ts a

nd p

artic

ipan

ts a

t the

Dec

embe

r 200

0 Su

rgeo

n G

ener

al’s

Lis

ten-

ing

Sess

ion.

•A

ll w

ho p

rovi

ded

wri

tten

publ

ic c

omm

ents

.

In a

dditi

on, a

dvan

ce g

ratit

ude

is e

xten

ded

to a

ll in

tere

sted

sta

keho

lder

s w

ho

will

resp

ond

to th

e C

all T

o A

ctio

n an

d be

gin

or c

ontin

ue to

take

act

ion

to a

llevi

ate

the

criti

cal p

ublic

hea

lth p

robl

em o

f ove

rwei

ght a

nd o

besi

ty.

37.

HH

S. H

ealth

y Pe

ople

201

0, 2

nd e

d. W

ith u

nder

stan

ding

and

impr

ovin

g he

alth

and

obje

ctiv

es fo

r im

prov

ing

heal

th. 2

vol

. Was

hing

ton

(DC

): G

PO; 2

000.

p.

19-1

2.

38.

NIH

, NH

LB

I. C

linic

al g

uide

lines

on

the

iden

tific

atio

n, e

valu

atio

n, a

nd tr

eat-

men

t of o

verw

eigh

t and

obe

sity

in a

dults

. HH

S, P

HS;

199

8. p

. 29-

41.

39.

NIH

, NH

LB

I. C

linic

al g

uide

lines

on

the

iden

tific

atio

n, e

valu

atio

n, a

nd tr

eat-

men

t of o

verw

eigh

t and

obe

sity

in a

dults

. HH

S, P

HS;

199

8. p

. 25-

26.

40.

NIH

, NH

LB

I. C

linic

al g

uide

lines

on

the

iden

tific

atio

n, e

valu

atio

n, a

nd tr

eat-

men

t of o

verw

eigh

t and

obe

sity

in a

dults

. HH

S, P

HS;

199

8. p

. 26.

41.

NID

DK

. Stu

dy o

f Hea

lth O

utco

mes

of W

eigh

t-L

oss

(SH

OW

) tri

al [I

nter

net]

.

[Bet

hesd

a (M

D)]

: N

IDD

K [

cite

d 20

01 O

ct 3

1].

Ava

ilab

le f

rom

:

ww

w.n

iddk

.nih

.gov

/pat

ient

/SH

OW

/look

ahea

d.ht

m

42.

Tuom

ileht

o J,

Lin

dstr

om J

, E

riks

son

JG,

Val

le T

T, H

amal

aine

n H

, Il

anne

-

Pari

kka

P, K

eina

nen-

Kin

kaan

niem

i S,

Laa

kso

M, L

ouhe

rant

a A

, Ras

tas

M.

Prev

entio

n of

type

2 d

iabe

tes

mel

litus

by

chan

ges

in li

fest

yle

amon

g su

bjec

ts

with

impa

ired

glu

cose

tole

ranc

e. N

Eng

l J M

ed 2

001

May

3;3

44(1

8):1

343-

50.

43.

NID

DK

Dia

bete

s Pr

even

tion

Prog

ram

. Die

t and

exe

rcis

e dr

amat

ical

ly d

elay

type

2 d

iabe

tes.

Dia

bete

s m

edic

atio

n m

etfo

rmin

als

o ef

fect

ive.

NID

DK

Pre

ss

Rel

ease

; 200

1 A

ugus

t 8.

49

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

Y

4243

Stee

ring

Com

mitt

ee R

oste

r

Age

ncy

for

Hea

lthca

re R

esea

rch

and

Qua

lity

Dav

id A

tkin

s

Adm

inis

trat

ion

for

Chi

ldre

n an

d F

amili

es

Hea

d St

art B

urea

uR

obin

Bro

cato

Adm

inis

trat

ion

on A

ging

Yvo

nne

Jack

son

Cen

ters

for

Dis

ease

Con

trol

and

Pre

vent

ion

Div

isio

n of

Nut

ritio

n an

d Ph

ysic

al A

ctiv

ityW

illia

m D

ietz

Cha

rlen

e Sa

nder

s

Div

isio

n of

Ado

lesc

ent a

nd S

choo

l Hea

lthL

loyd

Kol

be

Cha

rlen

e B

urge

son

Cas

ey H

anna

n

How

ell W

echs

ler

Cen

ters

for

Med

icar

e an

d M

edic

aid

Serv

ices

John

Why

te

CA

PT D

avid

Ard

ay

Foo

d an

d D

rug

Adm

inis

trat

ion

Bru

ce S

chne

ider

Eliz

abet

h Y

etle

y

Hea

lth R

esou

rces

and

Ser

vice

s Adm

inis

trat

ion

CA

PT L

aura

McN

ally

Indi

an H

ealth

Ser

vice

Jean

Cha

rles

-Azu

re

Nat

iona

l Ins

titut

es o

f Hea

lth

Off

ice

of th

e D

irec

tor

Mar

tina

Vog

el-T

aylo

r

Div

isio

n of

Nut

ritio

n R

esea

rch

Coo

rdin

atio

nC

APT

Van

Hub

bard

Pam

ela

Star

ke-R

eed

Nat

iona

l Can

cer

Inst

itute

CD

R R

icha

rd T

roia

no

Nat

iona

l Hea

rt, L

ung,

and

Blo

od In

stitu

teK

aren

Don

ato

50

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

Y

4445

AP

PE

ND

IX A

:

Exa

mpl

es o

f Fed

eral

Pro

gram

san

d In

itiat

ives

Prog

ram

s on

ove

rwei

ght a

nd o

besi

ty s

pan

mul

tiple

dep

artm

ents

, off

ices

, and

agen

cies

in th

e Fe

dera

l Gov

ernm

ent a

nd p

rom

ote

valu

able

rese

arch

and

act

ion

in

vari

ous

setti

ngs.

The

se p

rogr

ams

are

ampl

ifie

d by

Sta

te, T

riba

l, lo

cal,

and

priv

ate-

sect

or a

ctiv

ities

. So

me

exam

ples

of F

eder

al in

itiat

ives

on

over

wei

ght a

nd o

besi

ty,

and

the

prog

ram

s th

at s

uppo

rt th

em, a

re li

sted

bel

ow. F

or m

ore

info

rmat

ion

on a

num

ber o

f the

se p

rogr

ams,

ple

ase

see

appe

ndix

B.

SET

TIN

G 1

: F

AM

ILIE

S A

ND C

OM

MU

NIT

IES

•T

he C

ente

rs f

or D

isea

se C

ontr

ol a

nd P

reve

ntio

n (C

DC

) ha

s a

com

mun

ity

plan

ning

tool

cal

led

the

Pla

nned

App

roac

h to

Com

mun

ity H

ealth

(PA

TCH

).

Thi

s to

ol c

an b

e va

luab

le in

the

proc

ess

of d

evel

opin

g an

d su

stai

ning

act

ion.

•T

he F

eder

al H

ighw

ay A

dmin

istr

atio

n, th

e E

nvir

onm

enta

l Pro

tect

ion

Age

ncy,

and

the

Geo

rgia

Dep

artm

ent

of T

rans

port

atio

n ha

ve d

evel

oped

Str

ateg

ies

for M

etro

polit

an A

tlant

a’s R

egio

nal T

rans

port

atio

n an

d A

ir Q

ualit

y, a

doc

u-

men

t tha

t pro

vide

s a

fram

ewor

k fo

r ass

essi

ng w

hich

fact

ors

of la

nd u

se a

nd

tran

spor

tatio

n in

vest

men

t pol

icie

s ha

ve th

e gr

eate

st p

oten

tial t

o re

duce

the

leve

l of a

utom

obile

dep

ende

nce,

whi

ch m

ay c

onse

quen

tly in

crea

se w

alki

ng

and

bicy

clin

g ac

tiviti

es w

hile

pro

mot

ing

the

econ

omic

and

env

iron

men

tal

heal

th o

f th

e A

tlant

a m

etro

polit

an r

egio

n.

•T

he H

ead

Star

t Bur

eau

of th

e A

dmin

istr

atio

n fo

r Chi

ldre

n an

d Fa

mili

es, i

n

conj

unct

ion

with

mem

bers

of t

he c

omm

unity

and

var

ious

Fed

eral

age

ncie

s,

will

con

vene

a fo

cus g

roup

in fa

ll 20

02 to

iden

tify

issu

es, e

ffec

tive

prac

tices

,

and

reco

mm

enda

tions

add

ress

ing

over

wei

ght i

n ch

ildre

n of

the

Hea

d St

art

Prog

ram

.

•T

he H

ead

Star

t Bur

eau

has

publ

ishe

d a

Trai

ning

Gui

de fo

r th

e H

ead

Star

t

Lear

ning

Com

mun

ity: E

nhan

cing

Hea

lth in

the

Hea

d St

art W

orkp

lace

. T

he

guid

e ad

dres

ses t

he im

port

ance

of h

ealth

in th

e w

orkp

lace

and

pre

sent

s hea

lth

Nat

iona

l Ins

titut

e of

Dia

bete

s an

d D

iges

tive

and

Kid

ney

Dis

ease

sSu

san

Yan

ovsk

i

Nat

iona

l Ins

titut

e of

Chi

ld H

ealth

and

Hum

an D

evel

opm

ent

Lynn

e H

aver

kos

Off

ice

of P

ublic

Hea

lth a

nd S

cien

ce

Off

ice

of D

isea

se P

reve

ntio

n an

d H

ealth

Pro

mot

ion

Ran

dolp

h W

ykof

f

Paul

Am

bros

e

Kat

hryn

McM

urry

Lin

da M

eyer

s

Off

ice

of th

e Su

rgeo

n G

ener

alA

nn E

lder

kin

Off

ice

of M

inor

ity H

ealth

Vio

let W

oo

Off

ice

on W

omen

’s H

ealth

Wan

da J

ones

Kat

hy M

cCar

ty

Jone

lle R

owe

Pres

iden

t’s C

ounc

il on

Phy

sica

l Fitn

ess

and

Spor

tsC

hris

tine

Spai

n

51

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YA

ppen

dix

A:

Exa

mpl

es o

f Fed

eral

Pro

gram

s an

d In

itia

tive

s

4647

•T

he I

ndia

n H

ealth

Ser

vice

and

Hea

d St

art

Bur

eau

have

par

tner

ed i

n th

e

deve

lopm

ent o

f an

initi

ativ

e, H

ealth

y C

hild

ren,

Hea

lthy

Fam

ilies

, and

Hea

lthy

Com

mun

ities

: A F

ocus

on

Dia

bete

s an

d O

besi

ty P

reve

ntio

n, w

hich

has

fo-

cuse

d on

obe

sity

and

dia

bete

s pr

even

tion

activ

ities

for H

ead

Star

t chi

ldre

n,

fam

ilies

, sta

ff, a

nd c

omm

uniti

es.

•T

he N

atio

nal I

nstit

utes

of

Hea

lth (

NIH

) Pa

thw

ays

rese

arch

fos

ters

cul

tur-

ally

app

ropr

iate

hea

lthy

eatin

g pr

actic

es a

nd i

ncre

ased

phy

sica

l ac

tivity

amon

g A

mer

ican

Indi

an c

hild

ren,

thei

r fam

ilies

, foo

d se

rvic

e st

aff,

and

phys

i-

cal e

duca

tion

and

clas

sroo

m te

ache

rs.

•N

IH a

nd th

e N

atio

nal R

ecre

atio

n an

d Pa

rk A

ssoc

iatio

n ha

ve d

evel

oped

the

Hea

rts

N’ P

arks

pro

gram

, whi

ch w

ill c

reat

e na

tiona

l dis

sem

inat

ion

mag

net

site

s fo

r im

plem

entin

g ac

tiviti

es e

ncou

ragi

ng h

ealth

y ea

ting

and

phys

ical

activ

ity.

•N

IH h

as d

evel

oped

a h

ealth

aw

aren

ess

cam

paig

n ca

lled

Sist

ers

Toge

ther

:

Mov

e M

ore,

Eat

Bet

ter t

o en

cour

age A

fric

an A

mer

ican

wom

en in

Bos

ton

to

mai

ntai

n or

ach

ieve

a h

ealth

ier

wei

ght b

y in

crea

sing

thei

r ph

ysic

al a

ctiv

ity

and

eatin

g he

alth

y fo

ods.

NIH

is c

urre

ntly

exp

andi

ng th

is p

rogr

am to

oth

er

site

s.

•T

he O

ffic

e fo

r Am

eric

an I

ndia

n, A

lask

a N

ativ

e, a

nd N

ativ

e H

awai

ian

Pro-

gram

s ha

s de

velo

ped

the

Wis

dom

Ste

ps H

ealth

Pro

mot

ion

Prog

ram

for E

l-

ders

, a p

artn

ersh

ip b

etw

een

the

Trib

es a

nd M

inne

sota

’s S

tate

Uni

t on

Agi

ng.

The

pro

gram

pro

mot

es h

ealth

aw

aren

ess,

with

maj

or e

mph

asis

on

assi

stin

g

elde

rs i

n w

eigh

t lo

ss, p

artic

ipat

ion

in e

xerc

ise

prog

ram

s, i

mpr

ovem

ent

of

diet

, and

sm

okin

g ce

ssat

ion.

•T

he O

ffic

e on

Wom

en’s

Hea

lth h

as d

evel

oped

the

Gir

ls a

nd O

besi

ty In

itia-

tive,

ser

ving

to id

entif

y ex

istin

g go

vern

men

t obe

sity

pro

gram

s an

d to

ada

pt

thes

e pr

ogra

ms

tow

ard

gend

er-s

peci

fic

guid

ance

for g

irls

.

•U

SDA

’s C

oope

rativ

e St

ate

Res

earc

h, E

duca

tion,

and

Ext

ensi

on S

ervi

ce

(CSR

EE

S) h

as d

evel

oped

a n

atio

nwid

e pr

ojec

t, R

ever

sing

Chi

ldho

od O

be-

sity

Tre

nds:

Hel

ping

Chi

ldre

n A

chie

ve H

ealth

y W

eigh

ts.

Thi

s pr

ojec

t will

achi

eve

its g

oals

thro

ugh

the

inte

grat

ion

of re

sear

ch, e

duca

tion,

and

inno

va-

tive

appr

oach

es to

hel

p ch

ildre

n ac

hiev

e he

alth

y w

eigh

ts.

The

pro

ject

will

test

a n

umbe

r of p

rogr

am in

terv

entio

ns d

esig

ned

to re

duce

the

prev

alen

ce o

f

prom

otio

n pr

inci

ples

and

act

iviti

es th

at c

an b

e ap

plie

d to

a v

arie

ty o

f wor

k-

plac

e he

alth

issu

es, i

nclu

ding

ach

ievi

ng a

nd m

aint

aini

ng a

hea

lthy

wei

ght.

•T

he H

ealth

Res

ourc

es a

nd S

ervi

ces A

dmin

istr

atio

n (H

RSA

) has

spo

nsor

ed

Stat

ewid

e Pa

rtne

rshi

ps in

Wom

en's

Hea

lth th

at h

ave

begu

n a

new

pre

ven-

tion

initi

ativ

e en

title

d W

ISE

WO

MA

N.

Thr

ee S

tate

wid

e Pa

rtne

rshi

ps i

n

Wom

en's

Hea

lth g

rant

ees

(Ala

ska,

Nor

th C

arol

ina,

and

Ver

mon

t) h

ave

WIS

EW

OM

AN

pro

gram

s in

thei

r Sta

tes.

The

se g

rant

ees

are

enco

urag

ed to

colla

bora

te w

ith th

e W

ISE

WO

MA

N p

rogr

ams i

n th

eir S

tate

s and

with

oth

er

com

mun

ity-b

ased

par

tner

s to

sup

port

car

diov

ascu

lar s

cree

ning

s fo

r wom

en

aged

40

to 6

4 ye

ars

who

then

rece

ive

nutr

ition

cou

nsel

ing

and

phys

ical

ac-

tivity

sup

port

.

•U

nder

the

Hea

lthy

Peop

le 2

010

initi

ativ

e, t

he D

epar

tmen

t of

Hea

lth a

nd

Hum

an S

ervi

ces

(HH

S) h

as p

rodu

ced

the

docu

men

t H

ealth

y P

eopl

e in

Hea

lthy

Com

mun

ities

: A C

omm

unity

Pla

nnin

g G

uide

Usi

ng H

ealth

y P

eopl

e

2010

. Thi

s do

cum

ent i

s a

guid

e to

dev

elop

ing

an a

ctio

n pl

an th

roug

h bu

ild-

ing

com

mun

ity c

oalit

ions

, cre

atin

g a

visi

on, m

easu

ring

resu

lts, a

nd c

reat

ing

part

ners

hips

. It o

utlin

es s

trat

egie

s to

hel

p st

art c

omm

unity

act

iviti

es.

•H

HS

spon

sore

d th

e de

velo

pmen

t of

a H

ealth

y P

eopl

e 20

10 T

oolk

it to

pro

-

vide

gui

danc

e, te

chni

cal t

ools

, and

reso

urce

s to

gro

ups

as th

ey d

evel

op a

nd

sust

ain

a su

cces

sful

pla

n of

act

ion.

The

Too

lkit

is o

rgan

ized

aro

und

com

mon

elem

ents

of

heal

th p

lann

ing

and

impr

ovem

ent a

nd p

rovi

des

usef

ul ti

ps f

or

getti

ng s

tart

ed.

•H

HS

has

rece

ntly

rel

ease

d a

Blu

epri

nt f

or A

ctio

n on

Bre

astfe

edin

g. T

he

Blu

epri

nt fo

r A

ctio

n, w

hich

was

dev

elop

ed b

y he

alth

and

sci

entif

ic e

xper

ts

from

14

Fede

ral

agen

cies

and

23

heal

th c

are

prof

essi

onal

org

aniz

atio

ns,

offe

rs a

ctio

n st

eps

for

the

heal

th c

are

syst

em, f

amili

es, t

he c

omm

unity

, re-

sear

cher

s, a

nd th

e w

orkp

lace

to b

ette

r fo

cus

atte

ntio

n on

the

impo

rtan

ce o

f

brea

stfe

edin

g.

•H

HS,

the

U.S

. Dep

artm

ent o

f Agr

icul

ture

(USD

A) a

nd o

ther

org

aniz

atio

ns

have

col

labo

rate

d to

form

the

Uni

ted

Stat

es B

reas

tfee

ding

Com

mitt

ee. T

hey

have

dev

elop

ed B

reas

tfeed

ing

in th

e U

nite

d St

ates

: A N

atio

nal A

gend

a, w

hich

is a

str

ateg

ic p

lan

to p

rote

ct, p

rom

ote,

and

sup

port

bre

astf

eedi

ng.

52

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YA

ppen

dix

A:

Exa

mpl

es o

f Fed

eral

Pro

gram

s an

d In

itia

tive

s

4849

•C

DC

and

USD

A a

re d

evel

opin

g a

men

tori

ng c

urri

culu

m to

pro

mot

e nu

tri-

tion

and

phys

ical

act

ivity

in 1

1- to

18-

year

-old

Afr

ican

Am

eric

an m

ales

in

an e

ffor

t to

addr

ess

raci

al d

ispa

ritie

s in

nut

ritio

n an

d ph

ysic

al a

ctiv

ity.

•C

DC

, the

Pre

side

nt’s

Cou

ncil

on P

hysi

cal F

itnes

s an

d Sp

orts

(PC

PFS)

, and

the

Dep

artm

ent

of E

duca

tion

have

dev

elop

ed a

rep

ort,

Pro

mot

ing

Bet

ter

Hea

lth f

or Y

oung

Peo

ple

Thro

ugh

Phy

sica

l A

ctiv

ity a

nd S

port

s, i

n w

hich

they

des

crib

e st

rate

gies

to in

crea

se th

e nu

mbe

r of y

outh

eng

agin

g in

phy

si-

cal a

ctiv

ity.

•PC

PFS

has

deve

lope

d th

e Pr

esid

ent’s

Cha

lleng

e Ph

ysic

al A

ctiv

ity a

nd F

it-

ness

Aw

ards

Pro

gram

, inc

orpo

ratin

g th

e Pr

esid

entia

l, N

atio

nal,

Part

icip

ant,

and

Hea

lth F

itnes

s A

war

ds, a

nd f

or th

e fi

rst t

ime

this

yea

r, th

e Pr

esid

entia

l

Act

ive

Lif

esty

le A

war

d; t

he S

tate

Cha

mpi

on A

war

d; t

he N

atio

nal

Scho

ol

Dem

onst

ratio

n Pr

ogra

m; a

nd th

e Pr

esid

entia

l Spo

rts A

war

d Pr

ogra

m a

s mea

ns

of e

ncou

ragi

ng i

ndiv

idua

l ch

ildre

n an

d sc

hool

s to

ado

pt a

nd m

aint

ain

an

activ

e, fi

t, an

d he

alth

y lif

esty

le.

•U

SDA

has

laun

ched

eff

orts

to fo

ster

hea

lthy

scho

ol e

nvir

onm

ents

that

sup

-

port

pro

per n

utri

tion

and

the

deve

lopm

ent o

f hea

lthfu

l eat

ing

habi

ts, i

nclu

d-

ing

re-e

mph

asiz

ing

regu

latio

ns th

at p

rohi

bit s

ervi

ng fo

ods

of m

inim

al n

utri

-

tiona

l val

ue in

the

food

ser

vice

are

a du

ring

mea

l per

iods

.

•U

SDA

’s T

eam

Nut

ritio

n in

clud

es a

mul

titud

e of

nut

ritio

n ed

ucat

ion

mat

eri-

als

for c

hild

ren

rang

ing

from

pre

kind

erga

rten

thro

ugh

high

sch

ool t

hat s

up-

port

con

cept

s to

mai

ntai

n a

heal

thy

wei

ght.

Tea

m N

utri

tion

prov

ides

gra

nts

to S

tate

s pr

omot

ing

the

Fede

ral D

ieta

ry G

uide

lines

for

Am

eric

ans,

hea

lthy

food

cho

ices

, and

phy

sica

l act

ivity

.

•U

SDA

’s T

eam

Nut

ritio

n re

sour

ces

incl

ude

a Fo

od a

nd N

utri

tion

Serv

ice’

s

“act

ion

kit,”

Cha

ngin

g th

e Sc

ene:

Impr

ovin

g th

e Sc

hool

Nut

ritio

n E

nvir

on-

men

t, w

hich

can

be

used

at

the

Stat

e an

d lo

cal

leve

ls t

o ed

ucat

e de

cisi

on

mak

ers

abou

t th

e ro

le s

choo

l en

viro

nmen

ts p

lay

in h

elpi

ng s

tude

nts

mee

t

the

goal

s of

the

Die

tary

Gui

delin

es fo

r A

mer

ican

s.

child

hood

ove

rwei

ght a

nd o

besi

ty in

var

ious

pop

ulat

ions

. B

oth

quan

titat

ive

and

qual

itativ

e m

etho

dolo

gies

will

be

empl

oyed

in

dete

rmin

ing

the

mos

t

appr

opri

ate

and

effe

ctiv

e pr

ogra

m in

terv

entio

n fo

r a s

peci

fic

popu

latio

n.

•C

SRE

ES

also

fun

ds W

IN t

he R

ocki

es (

Wel

lnes

s IN

the

Roc

kies

), w

hich

seek

s to

impr

ove

attit

udes

and

beh

avio

rs a

bout

foo

d, p

hysi

cal a

ctiv

ity, a

nd

body

imag

e am

ong

rura

l res

iden

ts o

f Ida

ho, M

onta

na, a

nd W

yom

ing

in o

r-

der

to r

ever

se t

he r

isin

g tid

e of

obe

sity

. Int

erve

ntio

ns w

ill b

e co

mm

unity

base

d an

d w

ill ta

rget

you

th, l

imite

d-re

sour

ce a

udie

nces

, and

ove

rwei

ght o

r

obes

e ad

ults

.

•T

he W

omen

, Inf

ants

, and

Chi

ldre

n (W

IC)

Farm

er’s

Mar

ket N

utri

tion

Pro-

gram

was

est

ablis

hed

by C

ongr

ess

to p

rovi

de f

resh

and

nut

ritio

us f

oods

from

farm

ers’

mar

kets

to lo

w-in

com

e fa

mili

es p

artic

ipat

ing

in th

e WIC

pro

gram

.

SET

TIN

G 2

: SC

HO

OL

S•

The

Ass

ista

nt S

ecre

tary

for

Hea

lth, t

he A

ssis

tant

Sec

reta

ry o

f E

lem

enta

ry

and

Seco

ndar

y E

duca

tion,

and

USD

A’s

Und

er S

ecre

tary

for

Foo

d, N

utri

-

tion,

and

Con

sum

er S

ervi

ces

co-c

hair

a F

eder

al In

tera

genc

y C

omm

ittee

on

Scho

ol H

ealth

tha

t se

rves

to

inte

grat

e ef

fort

s ac

ross

thr

ee C

abin

et d

epar

t-

men

ts to

impr

ove

the

heal

th a

nd e

duca

tion

of y

oung

peo

ple,

incl

udin

g ef

-

fort

s to

pre

vent

and

dec

reas

e ob

esity

.

•C

DC

cur

rent

ly s

uppo

rts

20 S

tate

edu

catio

n ag

enci

es fo

r coo

rdin

ated

sch

ool

heal

th p

rogr

ams

to r

educ

e th

e fo

llow

ing

chro

nic

dise

ase

risk

fac

tors

: to

-

bacc

o us

e, p

oor e

atin

g ha

bits

, phy

sica

l act

ivity

, and

obe

sity

. C

DC

als

o ha

s

deve

lope

d gu

idel

ines

for s

choo

l hea

lth p

rogr

ams

base

d on

a re

view

of p

ub-

lishe

d re

sear

ch a

nd in

put f

rom

aca

dem

ic e

xper

ts.

•Sc

hool

Hea

lth I

ndex

for

Phy

sica

l Act

ivity

and

Hea

lthy

Eat

ing:

A S

elf A

s-

sess

men

t &

Pla

nnin

g G

uide

, is

a g

uide

dev

elop

ed b

y C

DC

tha

t en

able

s

scho

ols

to id

entif

y st

reng

ths

and

wea

knes

ses

of th

eir

phys

ical

act

ivity

and

nutr

ition

pol

icie

s an

d pr

ogra

ms;

dev

elop

an

actio

n pl

an f

or im

prov

ing

stu-

dent

hea

lth; a

nd in

volv

e te

ache

rs, p

aren

ts, s

tude

nts,

and

the

com

mun

ity in

impr

ovin

g sc

hool

ser

vice

s.

53

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

RW

EIG

HT A

ND O

BE

SIT

YA

ppen

dix

A:

Exa

mpl

es o

f Fed

eral

Pro

gram

s an

d In

itia

tive

s

5051

•N

IH h

as c

olla

bora

ted

with

oth

er F

eder

al a

genc

ies

to c

ondu

ct a

nd p

rom

ote

rese

arch

on

obes

ity a

nd a

ssoc

iate

d di

seas

es. T

hese

stu

dies

focu

s on

bio

logi

c

and

envi

ronm

enta

l det

erm

inan

ts o

f hum

an o

verw

eigh

t and

obe

sity

, pre

ven-

tion

stra

tegi

es, a

nd tr

eatm

ent m

odal

ities

.

•N

IH h

as d

evel

oped

a W

eigh

t-co

ntro

l Inf

orm

atio

n N

etw

ork

to p

rovi

de h

ealth

prof

essi

onal

s and

con

sum

ers w

ith sc

ienc

e-ba

sed

mat

eria

ls o

n ob

esity

, wei

ght

cont

rol,

and

nutr

ition

.

•H

HS

has c

harg

ed m

embe

rs o

f NIH

’s N

atio

nal T

ask

Forc

e on

Pre

vent

ion

and

Trea

tmen

t of O

besi

ty to

pub

lish

evid

ence

revi

ews o

f ove

rwei

ght a

nd o

besi

ty

in l

eadi

ng m

edic

al j

ourn

als

to p

rovi

de c

linic

ians

with

the

lat

est

and

mos

t

accu

rate

info

rmat

ion.

SET

TIN

G 4

: M

ED

IA A

ND C

OM

MU

NIC

AT

ION

S•

CD

C is

usi

ng e

xist

ing

surv

eilla

nce

syst

ems

to d

evel

op b

ienn

ial r

epor

ts o

n

natio

nal,

Stat

e, a

nd lo

cal t

rend

s in

the

prev

alen

ce o

f car

diov

ascu

lar d

isea

se,

canc

er, a

nd d

iabe

tes;

the

risk

fact

ors r

elat

ed to

thes

e di

seas

es; a

nd th

e sc

hool

-

base

d pr

ogra

ms

that

may

redu

ce th

ese

risk

fact

ors.

•C

DC

, in

conj

unct

ion

with

PC

PFS

and

othe

r pri

vate

and

pub

lic a

genc

ies,

is

Pro

mot

ing

Bet

ter

Hea

lth fo

r Yo

ung

Peo

ple

Thro

ugh

Phy

sica

l Act

ivity

and

Spor

ts, a

doc

umen

t tha

t rep

orts

on

the

stra

tegi

es b

eing

use

d to

invo

lve

fam

i-

lies,

sch

ool p

rogr

ams,

rec

reat

ion

prog

ram

s, c

omm

unity

str

uctu

ral e

nvir

on-

men

t, an

d m

edia

cam

paig

ns o

n ph

ysic

al a

ctiv

ity.

•T

he P

CP

FS

Res

earc

h D

iges

t, a

quar

terl

y pu

blic

atio

n, s

ynth

esiz

es s

cien

tific

info

rmat

ion

on sp

ecif

ic to

pics

in p

hysi

cal f

itnes

s, e

xerc

ise

scie

nce,

and

spor

ts

med

icin

e fo

r di

ssem

inat

ion

to f

itnes

s pr

ofes

sion

als

and

citiz

ens.

SET

TIN

G 5

: W

OR

KSI

TE

S•

CD

C h

as d

evel

oped

the

Pers

onal

Ene

rgy

Plan

(PE

P), a

sel

f-he

lp p

rogr

am

that

pro

mot

es h

ealth

y ea

ting

and

phys

ical

act

ivity

in th

e w

orkp

lace

. Wor

ksite

s

are

enco

urag

ed to

sup

plem

ent t

he P

EP

self

-hel

p ki

ts w

ith a

dded

act

iviti

es

and

mod

ific

atio

ns to

the

nutr

ition

al a

nd p

hysi

cal e

nvir

onm

ent.

SET

TIN

G 3

: HE

ALT

H C

AR

E•

The

Age

ncy

for

Hea

lthca

re R

esea

rch

and

Qua

lity

is s

uppo

rtin

g th

e U

.S.

Prev

entiv

e Se

rvic

es T

ask

Forc

e’s

upda

te to

the

1996

Gui

de to

Clin

ical

Pre

-

vent

ive

Serv

ices

cha

pter

on

scre

enin

g fo

r ob

esity

. T

he r

epor

t w

ill b

e ex

-

pand

ed to

add

ress

scr

eeni

ng a

nd c

ouns

elin

g fo

r ove

rwei

ght a

nd o

besi

ty a

nd

will

ass

ess

the

effe

ctiv

enes

s of

pri

mar

y ca

re-b

ased

inte

rven

tions

to p

reve

nt

or tr

eat o

besi

ty.

•C

DC

has

bee

n ac

tive

in le

adin

g di

scus

sion

s ab

out r

eim

burs

emen

t, or

incl

u-

sion

as

a m

embe

r be

nefi

t, fo

r se

rvic

es r

elat

ing

to th

e pr

even

tion

and

trea

t-

men

t of o

verw

eigh

t and

obe

sity

.

•C

DC

is f

ocus

ing

on th

e pr

even

tion

of p

edia

tric

ove

rwei

ght i

n th

e pr

imar

y

care

set

ting.

•T

he D

epar

tmen

t of

Def

ense

has

dev

elop

ed th

e L

EA

N P

rogr

am, a

hea

lthy

lifes

tyle

mod

el fo

r the

trea

tmen

t of o

besi

ty a

dmin

iste

red

in th

e Tr

iple

r Arm

y

Med

ical

Cen

ter.

•H

RSA

and

oth

er p

artn

ers

incl

udin

g PC

PFS,

NIH

, and

CD

C h

ave

deve

lope

d

Bri

ght

Fut

ures

in

Pra

ctic

e: P

hysi

cal

Act

ivity

. T

hese

gui

delin

es a

nd t

ools

emph

asiz

e he

alth

pro

mot

ion,

dis

ease

pre

vent

ion,

and

ear

ly r

ecog

nitio

n of

phys

ical

act

ivity

issu

es a

nd c

once

rns

of in

fant

s, c

hild

ren,

and

ado

lesc

ents

.

•H

RSA

, in

colla

bora

tion

with

oth

er p

artn

ers,

has

dev

elop

ed B

righ

t Fut

ures

in P

ract

ice:

Nut

ritio

n. T

hese

nut

ritio

n gu

idel

ines

pro

vide

a th

orou

gh o

ver-

view

of

nutr

ition

sup

ervi

sion

dur

ing

infa

ncy,

chi

ldho

od, a

nd a

dole

scen

ce.

The

gui

delin

es a

lso

high

light

how

par

tner

ship

s am

ong

heal

th p

rofe

ssio

nals

,

fam

ilies

, and

com

mun

ities

can

impr

ove

the

nutr

ition

al st

atus

of i

nfan

ts, c

hil-

dren

, and

ado

lesc

ents

.

•H

RSA

spo

nsor

s a

Dia

bete

s an

d H

yper

tens

ion

Col

labo

rativ

e th

at i

nclu

des

nutr

ition

and

wei

ght m

anag

emen

t edu

catio

n fo

r pat

ient

s in

com

mun

ity h

ealth

cent

ers.

•N

IH h

as d

evel

oped

the

Clin

ical

Gui

delin

es o

n th

e Id

entif

icat

ion,

Eva

lua-

tion,

and

Tre

atm

ent o

f Ove

rwei

ght a

nd O

besi

ty in

Adu

lts: E

vide

nce

Rep

ort,

whi

ch h

as b

een

form

atte

d in

to v

ario

us p

rodu

cts

suita

ble

for

use

by p

hysi

-

cian

s an

d ot

her h

ealth

pro

fess

iona

ls.

54

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

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HT A

ND O

BE

SIT

Y

5253

AP

PE

ND

IX B

:

Fede

ral P

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esou

rce

Lis

t

BL

UE

PR

INT F

OR A

CT

ION O

N B

RE

AST

FE

ED

ING

Off

ice

on W

omen

's H

ealth

U.S

. Dep

artm

ent o

f Hea

lth a

nd H

uman

Ser

vice

s

200

Inde

pend

ence

Ave

nue,

SW

., R

oom

730

B

Was

hing

ton,

DC

202

01

Phon

e: (2

02) 6

90-7

650

Fax:

(202

) 205

-263

1

http

://w

ww

.4w

oman

.gov

/Bre

astf

eedi

ng/in

dex.

htm

BR

IGH

T F

UT

UR

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IN P

RA

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ICE

BR

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UT

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PRO

JEC

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HR

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340

Fax:

(301

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2

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cdeg

raw

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sa.g

ov

http

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CD

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11-3

435

•C

DC

has

a W

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CD

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Gui

de to

Pro

mot

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Mod

erat

e P

hysi

cal A

ctiv

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hich

pro

vide

s re

sour

ces

and

info

r-

mat

ion

on h

ow a

dults

can

inco

rpor

ate

phys

ical

act

ivity

into

thei

r rou

tines

at

the

wor

kpla

ce.

•C

DC

has

pro

vide

d fu

ndin

g to

Sta

te d

epar

tmen

ts o

f he

alth

in M

aine

, Mon

-

tana

, New

Yor

k, a

nd N

orth

Car

olin

a fo

r the

est

ablis

hmen

t of h

ealth

pro

mo-

tion

prog

ram

s at

mul

tiple

wor

ksite

s. T

he p

rogr

ams

are

inte

nded

to f

orm

u-

late

and

impl

emen

t pol

icy

and

envi

ronm

enta

l cha

nges

that

supp

ort i

ncre

ased

phys

ical

act

ivity

and

hea

lthy

eatin

g.

55

TH

E S

UR

GE

ON G

EN

ER

AL’S

CA

LL T

O A

CT

ION T

O P

RE

VE

NT A

ND

DE

CR

EA

SE O

VE

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BE

SIT

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Fed

eral

Pro

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Res

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5455

GIR

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AN

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omen

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ealth

U.S

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Ser

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200

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Ave

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., R

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730

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Was

hing

ton,

DC

202

01

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650

Fax:

(202

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1

http

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ww

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GU

IDA

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ung,

and

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te

P.O

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301

05

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3

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http

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203

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204

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57

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59

APPENDIX C

Food and Beverage Study Results Submitted to the Board of Trustees

Washoe County School District October 2003

61

School Food and Beverage Study Results

Submitted to The Board of Trustees

Washoe County School District

On Behalf of the Food and Beverage Study Committee:

Eddie Bonine, Director, WCSD Student Services (Co-Chair) Patricia Marble, Associate Director, WCSD Nutrition Services (Co-Chair)

Jamie Benedict, Associate Professor, University of Nevada, Reno Rick Borba, Principal, Galena High School

John Carlson, Principal, McQueen High School Pat Cook, Nutrition Consultant, Nevada Department of Education

Lisa Hill, Nutrition Consultant Mike Supple, Co-Director, WCSD Nutrition Services

October, 2003

63

Acknowledgements

The Food and Beverage Study Committee would like to acknowledge and thank the following individuals for lending their time and expertise to this effort. Debra Brus, Public Health Epidemiologist, Washoe County District Health Dept. Heidi Himler, Nutrition Student, University of Nevada, Reno Cynthia K. Mitchell, Economic Consulting Inc. Barbara Scott, Associate Professor, University of Nevada School of Medicine Gwenn Snow, Health Program Specialist, University of Nevada, Reno Krista Steele, Nutrition Student, University of Nevada, Reno

64

Table of Contents

Executive Summary……………………………………………………………………… 1 Introduction……………………………………………………………………………… 2 Methods…………………………………………………………………………………. 2 Results…………………………………………………………………………………… 2-6 Limitations………………………………………………………………………………. 6 Key Findings…………………………………………………………………………….. 6-7 Implications……………………………………………………………………….……... 7-8 Tables

Table 1. Percentage (and Number) of Participating Schools Where Students Can Purchase Competitive Foods From Each Venue………………………………… 9 Table 2. Students’ Access to Competitive Foods During the School Day (By Venue and School Level)…………………………………………………… 10 Table 3. Types of Competitive Foods Sold from Vending Machines, Schools Stores, Fundraisers and A La Carte Offerings…………………………. 11 Table 4. Part A: Reported Revenues from Competitive Food Sales by Venue and School Level for the 2001-02 School Year………………………………… 12 Table 4. Part B: Reported Revenues from Competitive Food Sales by Venue and School Level for the 2001-02 School Year………………………………… 13

Table 5. Summary of Net Revenue Sales: Total Revenues and Percent Of Total Net Revenue from Competitive Food Sales at Elementary, Middle and High Schools………………………………………………………. 14

Table 6. Percentage (and Number) of Elementary, Middle and High Schools Who Sell Select Foods and Beverages During the School Day From Vending Machines, School Stores, Fundraisers, and A La Carte Offerings……………………………………………………………………….. 15

Appendices

Appendix A: Survey Instrument Appendix B: Letter from Superintendent Hager to School Principals Appendix C: Energy cost calculations Appendix D: Washoe County School District Policy on Competitive Foods Appendix E: Verbatim Responses to Question 9: How monies from sales are used Appendix F: Verbatim Responses to Question 10: Additional comments from

respondents

65

Executive Summary

A study of the financial and nutritional impact of foods and beverages sold outside of the National School Lunch and Breakfast Programs (hereafter referred to as “competitive foods”) was conducted. The following are key findings from the study that involved 75 of the 86 schools open during the 2001-02 school year: 1. Competitive foods are widely available in WCSD.

• 91% of schools reportedly sell competitive foods. • Competitive foods are available to students at school before school (32%), during school

hours when school meals are not being served (43%), during lunch (65%), and after school (64%).

2. Net revenue from competitive foods in 2001-02 is estimated at $1,147,491. • 63% of net revenue was generated from a la carte sales and is paid to Nutrition Services

to support the operating and personnel costs associated with the School Breakfast and School Lunch Programs.

• The remaining revenues were generated from vending machines (18%), fundraising efforts (12%) and school stores (6%) to support a wide variety of student activities, programs, and school necessities.

• 56% of net revenue was generated from sales at high schools, 34% from middle schools and 10% from elementary schools.

• A high proportion of schools were unable to account for both gross and net revenues from vending machines (39%), school stores (20%) and fundraising efforts (36%) making profitability difficult to determine.

• Overhead costs of selling competitive foods are unaccounted for here. For example, energy costs related to the 128 chilled beverage machines are estimated at $45,000/yr.

3. The nutritional quality of the foods and beverages most commonly available is poor. • Sugary drinks (i.e., soft drinks, sports drinks, and juice drinks—not 100% juice) were

available at 73% of the schools. • Baked goods—not low fat (i.e., cookies, crackers, cakes, pastries) were available at 63%

of the schools. • Salty snacks—not low fat were available at 59% of the schools. • Candy was available at 44% of the schools. • Bottled waters and plain milk were also widely available and suggests there is a market

for more healthful choices. 4. Student access to foods of low nutritional quality may be undermining the National

School Breakfast and School Lunch Programs. • Sugary drinks, candy, and high-fat baked goods and salty snacks are available at times

when school meals are offered. Some students may choose to purchase these items in place of, or in addition to a school meal that meets federal nutrition standards.

5. Many schools are out of compliance with existing WCSD policy regarding competitive foods. • Policies adopted by the Washoe County Board of Trustees (1988) restrict student access

to competitive foods at specific times of the school day. School practices reported here indicate that these policies are not consistently followed.

66

Introduction

Upon the recommendation of Superintendent Jim Hager, a study of the nutritional and financial impact of foods and beverages sold outside of the National School Breakfast and School Lunch Programs (hereafter referred to as “competitive foods”) was conducted. The study committee, co-chaired by Eddie Bonine (Director, WCSD Student Services) and Patricia Marble (Associate Director, WCSD Nutrition Services) was therefore created to determine the: (1) Types of foods and beverages offered for purchase at the school sites, (2) Annual gross and net revenues, and (3) Use of these revenues.

Committee members agreed that a District-wide survey (K-12) was needed in order to obtain the desired information. Members also agreed to limit the scope of the study to student access during the school day to vending machines, student stores, fundraising and a la carte offerings. The following is a description of the survey methods employed, results, and conclusions.

Methods The survey instrument was developed by committee members and included both open-and close-ended questions related to vending machines, student stores, fundraising and a la carte sales during the 2001-02 school year. Using the Centers for Disease Control and Prevention’s School Health Policies and Programs Study (SHPPS 2000) questionnaire as a template, the survey included questions about access during the school day, types of foods and beverages sold, and gross and net revenues from each venue listed above. In addition, questions about selling foods and beverages from specific restaurant chains and contracts with food and beverage companies were included due to concerns about commercialism in schools and its effect on students’ eating habits. Questions about existing school policies related to foods and beverages were included to evaluate potential models to build upon. Pre-test results with six principals provided evidence that the survey format and questions were suitable.

The survey was sent electronically to every school principal in the District during March 2003 (Appendix A). A cover letter from Superintendent Hager was enclosed that explained the purpose of the survey, and requested that each school participate (Appendix B). Survey reminders were sent to principals approximately two weeks later.

Results Surveys were received from 75 schools in the District including 53 elementary schools, 11 middle schools and 11 high schools. This represented 87% of schools open during the 2001-02 school year. To maximize the reliability and validity of the study, principals were asked to clarify responses or provide missing information. However, it should be noted that in many cases, the information was unavailable. Survey responses were then entered into a database and tabulated.

67

Vending Machines Forty-one percent (31/75) of the responding schools reported that students could purchase

competitive foods from vending machines at school. This included 21% of elementary schools, 91% of middle schools, and 91% of high schools (Table 1). The total number of machines reported was 140; 128 for beverages and 12 for foods. (It should be noted that several schools also reported the presence of vending machines strictly for teacher use but the content and revenue from these machines is not included here.) Among schools that did have vending machines, students could purchase competitive foods before school (45%), during school hours when school meals were not being served (42%), during lunch (48%), and after school (90%). Access to vending machines at specific times of the school day among elementary, middle and high schools is shown in Table 2.

The types of competitive foods sold from vending machines are listed in Table 3. The items most commonly available were soft drinks (71%), fruit drinks—not 100% juice (68%), bottled water (68%), sports drinks (61%), and salty snacks—not low fat (26%).

Among schools that did provide gross and/or net revenues from vending machines, the totals were $316,903 and $211,269 respectively (Table 4). However, because 39% of schools could not provide a complete accounting of these revenues (i.e., either the gross or net revenues for food and/or beverages were unknown), the profitability of this venue cannot be determined. In addition, these revenues do not reflect the electric costs associated with chilled beverage machines estimated at $45,000/yr for the 128 machines (see Appendix C). The reported revenues did vary greatly by school level with high schools reporting the largest net revenue from vending machines ($162,413 or 77% of total net), followed by middle schools ($41,335 or 20%), and elementary schools ($7,520 or 3%).

School Stores

Twenty-percent (15/76) of the responding schools reported that students could purchase

competitive foods from a school store. This included 13% of elementary schools, 36% of middle schools, and 36% of high schools (Table 1). Among these schools, students could purchase competitive foods before school (27%), during school hours when school meals were not being served (27%), during lunch period (40%), and after school (40%). Access to school stores at specific times of the school day among elementary, middle and high schools is shown in Table 2. Types of competitive foods sold from school stores are listed in Table 3. The items most commonly available were non-chocolate candy (67%), bottled water (53%), salty snacks—not low fat (47%), chocolate candy (47%), soft drinks (40%) and cookies, crackers, cakes, pastries and other baked goods—not low fat (40%) (Table 3).

Reporting of gross and net revenues resulting from school stores was better, compared to

vending machines with only 20% of schools unable to provide both figures. As shown in Table 4, gross and net revenues were $199,111 and $73,667 respectively. However, because of missing information (i.e., some schools could not provide gross and net for both food and beverage sales), profitability of school stores cannot be determined.

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Net revenues from middle and high schools were similar, $30,444 (41% of total net) and $35,180 (48%) respectively, while the sales from elementary schools were relatively small ($8,043 or 11%). Fundraisers

Sixty-one percent (46/75) of the responding schools reported that students could purchase competitive foods through various fundraising efforts. This included 60% of elementary schools and 64% of both middle and high schools (Table 1). Among these schools, students could purchase competitive foods before school (24%), during school hours when school meals were not being served (52%) during lunch (22%), and after school (67%). Access to fundraising offerings at specific times of the school day among elementary, middle and high schools is shown in Table 2.

Types of foods and beverages available from fundraisers are listed in Table 3. The items

most commonly available were non-chocolate candy (63%), cookies, crackers, cakes, pastries and other baked goods—not low fat (54%), chocolate candy (50%), soft drinks (30%), and ice cream and frozen yogurt (30%).

Similar to the other venues, incomplete reporting of fundraising revenues makes it

difficult to assess the profitability of this venue; 36% of schools were unable to provide both gross and net revenues for food and beverages sales. Among schools that could provide either or both figures, the gross and net revenues were $155,770 and $138,832 respectively (Table 4). High school sales were the highest ($95,600 or 69% of total net revenues) followed by elementary ($28,339 or 20%) and middle schools ($14,893 or 11%). A La Carte Foods and Beverages

WCSD Nutrition Services sells competitive foods a la carte, in addition to school meals. A la carte here includes any food and beverages sales to students that are not considered part of a reimbursable USDA school meal. Sixty-four percent (48/75) of responding schools reported that students may purchase competitive foods through this venue, including 50% of elementary schools, and 100% of middle and high schools. However, based on the data provided by Nutrition Services, 100% of participating schools generated revenue from competitive food sales. The disparity may be due to the different interpretations of “a la carte.” In all likelihood, principals were not aware, or did not consider the sales of beverages to students who bring lunch from home. Among the schools that did report a la carte sales, students could purchase a la carte competitive foods before school (29%) and during lunch period (96%). Access to a la carte offerings among elementary, middle and high school students at these times is shown in Table 2.

Types of competitive foods available a la carte are listed in Table 3. The items most commonly available were unflavored milk (83%), sweetened/flavored milk (77%), cookies, crackers, cakes, pastries and other baked goods—not low fat (77%), sports drinks (73%) and fruit snacks (71%).

69

As shown in Table 4, the total gross and net revenues from a la carte food and beverage sales from all responding schools were $2,564,237 and $723,721 respectively. Only a very small proportion of the net revenues were from elementary schools ($68,211 or 9%), with the higher revenues generated from sales at high schools ($349,890 or 48%) and middle schools ($305,619 or 42%).

**********************************

In summary, 91% (68/75) of responding schools report the sale of competitive foods. While net revenues from these sales is conservatively estimated at $1,147,491, the incomplete accounting from schools makes it difficult to provide a full economic analysis for the District. Of total net revenues from all competitive food sales, approximately 63% were from a la carte offerings, 18% from vending machines, 12% from fundraising efforts, and 6% from school stores (see Table 5). Sales were highest among high schools generating approximately 56% of total net revenue, followed by middle schools (34%) and elementary schools (10%).

Students have access to competitive foods before school (32%), during lunch (65%),

during school hours when school meals are not being served (43%) and after school (64%). And, as shown in Table 6, foods and beverages of poor nutritional value (i.e., sugary drinks, candy, and high-fat baked goods and salty snacks) are widely available, including at times when school meals are offered. Consequently, many schools are now out of compliance with existing District policy regarding competitive foods (see Appendix D). Sale and Promotion of Specific Brands of Foods and Beverages “Branded” competitive foods from restaurants were sold by 45% (34/77) of responding schools. Twenty-seven percent (20/75) of schools also reported that they had contracted with a specific food and/or beverage company that gave the company the rights to sell their product at school. The total number of contracts was 30 and the number of contracts at each school ranged from 1 to four. Of schools who had such a contract(s); 55% (11/20) received a flat fee or incentive for agreeing to these contracts, and 50% (10/20) received a specified percentage of the sales receipts. No schools reported receiving incentives when sales reached a specific level. Thirty-percent of these schools (6/20) allowed the companies to advertise their product(s) on school grounds including inside school buildings (3 schools), and outside of school buildings, such as playing fields (3 schools). Use of Revenues from Food and Beverage Sales Respondents were asked to describe qualitatively how monies from competitive foods were used. Please see individual responses to this question as well as general comments from respondents in Appendices E and F. Competitive food revenues support a variety of student activities and programs (fieldtrips, scholarships, banquets, student awards, etc), and are also used for basic school necessities (books, paper, pencils, art supplies, custodial services, etc).

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Policies Related to Food and Beverage Sales Thirty-five percent of schools reportedly had policies regarding the types of foods and beverages that students could purchase during the school day (e.g., limited access to soft drinks, “sugary items, etc). An examination of these policies, among those that included this information, suggested that approximately half of these school policies were more closely related to when students have access to competitive foods as opposed to limiting any specific competitive food per se. In addition, 51% of schools had policies in place that prohibits the consumption of foods and beverages during instructional time.

Limitations 1. The findings do not represent 100% of WCSD schools. 2. Many schools were unable to provide the information requested. 3. Sales volume for any particular food or beverage was not measured. 4. Data are limited to the 2001-02 school year.

Key Findings

Key Finding 1. Competitive foods are widely available in WCSD. Ninety-one percent of schools who returned a survey report student access to vending machines, school stores, fundraisers and/or a la carte sales. These venues are available to students before classes start in the morning (32%), during school hours when school meals are not being served (43%), during lunch (65%), and after classes end in the afternoon (64%).

Key Finding 2. The net revenue generated from these sales is modestly estimated to be $1,147,491. The largest proportion derived from a la carte food and beverages sales (63%) that is paid to Nutrition Services and directly supports the operating and personnel costs associated with the School Breakfast and School Lunch Programs. The remaining revenues are generated from vending machines (18%), fundraising efforts (12%) and school stores (6%) and support a variety of student activities and programs, as well as school necessities. Fifty-six percent of revenues were generated from sales at high schools, 34% from middle schools and 10% from elementary schools.

A high proportion of schools were unable to account for gross and net revenues from

vending machines (39%), school stores (20%), and fundraising efforts (36%). Because of this missing information, evaluating the profitability of these venues is difficult. In addition, overhead costs of selling competitive foods unaccounted for here. For example, the energy costs associated with the 128 chilled beverage machines are estimated at $45,000/yr.

Key Finding 3. The nutritional quality of the foods and beverages most commonly available is poor. Sugary drinks (i.e., soft drinks, sports drinks, and juice drinks—not 100% juice) were available at 73% of the responding schools; cookies, crackers, cakes, pastries and other baked goods—not low fat were available at 63% of the schools; salty snacks—not low fat were available at 59% of the schools; and candy was available at 44% of the schools. Water and plain milk were also widely available suggesting there is a market for more healthful choices.

71

Key Finding 4. Student access to foods of low nutritional quality may be undermining the National School Breakfast and School Lunch Programs. Sugary drinks, candy, and high-fat baked goods and salty snacks are available at times when school meals are offered. Some students may choose to purchase these items in place of or in addition to, a school meal that meets federal nutrition standards

Key Finding 5. Many schools are out of compliance with existing WCSD policy

regarding competitive foods. The Washoe County School District Policy on Competitive Foods (adopted in 1988 by the Board of Trustees) limits the times when competitive foods may be sold to students. The practices reported here indicate that these policies are not consistently followed.

Implications

The wide availability of unhealthy foods in WCSD schools contributes to a nationwide trend in unhealthy eating patterns among children and subsequent health risks. Competitive food sales undermine the nutrition integrity and viability of the National School Lunch Program and National School Breakfast Program, which is a source of important nutrition intake for many children. Allowing access to unhealthy foods in schools overlooks a well known fact: consuming a healthy diet improves school success. As a result, school districts and states nationwide are enacting policy and statute governing all foods available to students at school. This trend is expected to continue due to overwhelming concern about the chronic disease epidemic and rising health care costs. A full summary of the background and rationale for such action can be found in the recent report to Congress “Foods Sold in Competition with USDA School Meal Programs” found at www.fns.usda.gov and the 2003 Surgeon General’s report “The Power of Prevention” available at www.healthierus.gov/steps. The following are a few highlights from these reports. Trends in Children’s Eating Behaviors

• Overweight and diabetes have skyrocketed in children. During the past two decades, the

percentage of children who are overweight has nearly doubled and the percentage of adolescents who are overweight has nearly tripled. Type II Diabetes (“adult onset”), once rare in children, has become more common. Type II Diabetes can lead to high blood pressure, heart disease, kidney failure, and blindness.

• Children are not getting the nutrition they need. Only two percent of school aged

children meet the Food Pyramid serving recommendations for all five food groups. Girls, ages 14 to 18, have especially low intakes of fruits and dairy products. Children’s diets are high in added sugar.

• Soda has replaced water, natural juices, and milk. Children are heavy consumers of

regular or diet soda. Twenty percent of one and two year-olds drink soda. Almost half of all children between the ages of 6 and 11 drink soda and consume, on average, 15 ounces per day. Overall, 56 to 85 percent of children consume soda on any given day. As children drink more soda, they drink less milk and less fruit juices.

72

They have lower intakes of important nutrients like vitamin A and calcium (from milk) and folate and vitamin C (from fruit juices). A typical 20-ounce soft drink available in school vending machines provides about 250 calories and 66 grams of sugar (16 teaspoons) and can contain up to 80 milligrams of caffeine.

Trends in the Schoolhouse • Students’ preferences. Social trends in eating along with marketing campaigns targeted at

children for foods high in fat, sugar, and salt content have contributed to an increased demand for unhealthy foods. School inadvertently contribute to targeted marketing of unhealthy foods by allowing these products in schools, through promotion of logos, sponsorship of education programs and activities, exclusive contracts, and fundraising campaigns. Research shows that the deciding factor for students given a choice between healthy or unhealthy drinks and snacks is price.

• Increased financial demands and limited resources. Financially strapped school districts

sell unhealthy foods and beverages to generate income. Recently, however, schools who change to a healthier fare have maintained profitability.

These trends are especially troubling given that the United States is in the midst of a

chronic disease epidemic of unparalleled proportions. In 2003, the Surgeon General reported: • More than 1.7 million Americans die of a chronic disease each year, accounting for 70% of

all U.S. deaths. • Two-thirds of all deaths are related to lifestyle choices such as tobacco use, poor diet, and

lack of exercise. • Each year, over $33 billion in medical costs and $9 billion in lost productivity due to heart

disease, cancer, stroke, and diabetes are attributed to poor nutrition. The Center for Health and Health Care in Schools reported, in August 2003, that parents—

regardless of income, race, or political affiliation—strongly support efforts to improve student health, including eating healthy. Over 85% of the 1,101 parents polled nationwide support programs in schools to help improve the nation’s obesity epidemic. The full report can be accessed at www.healthinschools.org.

These trends indicate that timing is opportune to evaluate and update practices related

to the nutrition quality of all foods and beverages available to Washoe County School District students.

73

Table 1. Percentage (and Number) of Responding Schools Where Students Can Purchase Competitive Foods from Each Venue Elementary

(n=53) Middle School

(n=11) High School

(n=11) All Schools

(n=75) Vending Machines 21 (11) 91 (10) 91 (10) 41 (31) School Store 13 (7) 36 (4) 36 (4) 20 (15) Fundraisers 60 (32) 64 (7) 64 (7) 61 (46) A la Carte 49 (26)1 100 (11) 100 (11) 64 (48) Any of the above 87 (46) 100 (11) 100 (11) 91 (68)

1 This represents the number of elementary schools who reported the sale of a la carte foods and beverages at their school. Actual revenues provided by Nutrition Services indicate competitive foods are sold at 100% of elementary schools (see Table 4). The disparity may be due to the interpretation of “a la carte” by respondents.

74

Table 2. Students’ Access to Competitive Foods During the School Day (By Venue and School Level)

Before School

During School When

Meals Are Not Being

Served

During Lunch

After School

Venue/School Level Percentage ( and Number) of Schools Reporting Access Vending Machines Elementary Schools (n=11) 9 (1) 18 (2) 27 (3) 73 (8) Middle Schools (n=10) 30 (3) 40 (4) 20 (2) 100 (10) High Schools (n=10) 100 (10) 70 (7) 100 (10) 100 (10) All Schools (n=31) 45 (14) 42 (13) 48 (15) 90 (28) School Stores Elementary Schools (n=7) 0 57 (4) 0 43 (3) Middle Schools (n=4) 25 (1) 0 50 (2) 25 (1) High Schools (n=4) 75 (3) 0 100 (4) 50 (2) All Schools (n=15) 27 (4) 27 (4) 40 (6) 40 (6) Fundraisers Elementary Schools (n=32) 6 (2) 53 (17) 6 (2) 56 (18) Middle Schools (n=7) 29 (2) 29 (2) 29 (2) 100 (7) High Schools (n=7) 100 (7) 71 (5) 86 (6) 86 (6) All Schools (n=46) 24 (11) 52 (24) 22 (10) 67 (31) A La Carte1 Elementary Schools (n=26)2 12 (3) -- 96 (25) -- Middle Schools (n=11) 46 (5) -- 91 (10) -- High Schools (n=11) 55 (6) -- 100 (11) -- All Schools (n=48) 29 (14) -- 96 (46) -- Any of the Above Venues (n=75) 32 (24) 43 (32) 65 (49) 64 (48) 1 A La Carte foods and beverages are only sold when school meals are offered (i.e., during School Breakfast and School Lunch). 2 This represents the number of elementary schools who reported the sale of a la carte foods and beverages at their school. Actual revenues provided by Nutrition Services indicate competitive foods are sold at 100% of elementary schools (see Table 4). The disparity may be due to interpretation of “a la carte” by respondents.

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Table 3. Types of Competitive Foods Sold from Vending Machines, Schools Stores, Fundraisers and A La Carte Offerings

Vending Machines

School Stores Fund-raisers A La Carte Sales

Number of Schools That Report Venue Access

n=31 n=15

n=46 n=48

Types of Competitive Foods Sold Percent (and Number) of Schools That Sell the Specific Type of Food or Beverage Within Each Venue

Plain bottled water 68 (21) 53 (8) 17 (8) 69 (33) Sport drinks 61 (19) 27 (4) 4 (2) 73 (35) Soft drinks 71 (22) 40 (6) 30 (14) 19 (9) Unflavored milk 3 (1) 13 (2) 2 (1) 83 (40) Sweetened or flavored milk 3 (1) 7 (1) 2 (1) 77 (37) Coffee drinks 3 (1) 13 (2) 4 (2) 4 (2) Fruit drinks—not 100% juice 68 (21) 33 (5) 6 (3) 52 (25) 100% fruit or vegetable juice 19 (6) 13 (2) 9 (4) 27 (13) Designer drinks 3 (1) 13 (2) 2 (1) 2 (1) Chocolate candy 19 (6) 47 (7) 50 (23) 17 (8) Non-chocolate candy 19 (6) 67 (10) 63 (29) 19 (9) Chewing gum 3 (1) 20 (3) 4 (2) 0 Regular cookies, crackers, cakes, pastries or other baked goods

16 (5)

40 (6)

54 (25)

77 (37)

Low-fat cookies, crackers, cakes, pastries or other baked goods

6 (2)

33 (5)

13 (6)

10 (5)

Fresh whole fruits or vegetables 0 0 2 (1) 44 (21) Regular salty snacks (e.g., chips) 26 (8) 47 (7) 24 (11) 69 (33) Low-fat salty snacks (e.g., pretzels) 13 (4) 27 (4) 20 (9) 42 (20) Meat sticks or jerky 0 27 (4) 15 (7) 10 (5) Regular ice cream and frozen yogurt 0 20 (3) 30 (14) 2 (1) Low-fat or fat-free ice cream, frozen yogurt or sherbet

0

7 (1)

9 (4)

2 (1)

Unfrozen low-fat or non-fat yogurt 0 0 2 (1) 21 (10) Chicken sandwich - - - 27 (13) Hamburgers/cheeseburgers - - - 33 (16) Burrito - - - 33 (16) Pizza by the slice - - - 48 (23) Deli sandwich - - - 38 (18) Chef salad - - - 33 (16) Nachos with cheese - - - 42 (20) Cheese sauce - - - 35 (17) Fruit Snack - - - 71 (34) Bagels and cream cheese - - - 40 (19) Fries - - - 42 (20) Note: The foods and beverages most commonly offered for sale within each venue are shown in boldface.

76

Tab

le 4

. Pa

rt A

: R

epor

ted

Rev

enue

s fro

m C

ompe

titiv

e Fo

od S

ales

by

Ven

ue a

nd S

choo

l Lev

el fo

r th

e 20

01-0

2 Sc

hool

Yea

r

Ele

men

tary

Sc

hool

s M

iddl

e Sc

hool

s H

igh

Scho

ols

All

Scho

ols3

Ven

ding

Mac

hine

s (n

=11)

(n

=10)

(n

=10)

(n

=31)

Gro

ss R

even

ues f

rom

Foo

d Sa

les

8

,865

(n =

1)

7

,540

(n =

1)

55,

945

(n =

5)

72

,350

(n =

7)

N

et R

even

ues f

rom

Foo

d Sa

les

1

,586

(n =

1)

4

,508

(n =

2)

19,

168

(n =

4)

25

,263

(n =

7 )

G

ross

Rev

enue

s fro

m B

ever

age

Sale

s

11,2

04 (n

= 4

)

56,9

50 (n

= 6

) 1

76,3

97 (n

= 9

) 2

44,5

52 (n

= 1

9)

N

et R

even

ues f

rom

Bev

erag

e Sa

les

4

,572

(n =

7)

36

,827

(n =

9)

143

,244

(n =

10)

1

84,6

45 (n

= 2

6)

C

ombi

ned

Gro

ss R

even

ues f

rom

Foo

d

a

nd B

ever

age

Sale

s1

_

____

__

____

___

____

__

____

__

C

ombi

ned

Net

Rev

enue

s fro

m F

ood

and

Bev

erag

e Sa

les1

1

,361

(n =

2)

____

___

____

__

1,36

1 (n

= 2

)

Tot

al G

ross

Rev

enue

s fro

m V

endi

ng2

20

,070

(n =

5)

64

,490

(n =

6)

232

,342

(n =

9)

316

,903

(n =

20)

Tot

al N

et R

even

ues f

rom

Ven

ding

2

7,5

20 (n

= 1

0)

41

,335

(n =

10)

1

62,4

13 (n

= 1

0)

211

,269

(n =

30)

Sc

hool

Sto

res

(n=7

) (n

=4)

(n=4

) (n

=15)

Gro

ss R

even

ues f

rom

Foo

d Sa

les

12

,670

(n =

6)

42

,231

(n =

4)

89

,950

(n =

3)

144

,851

(n =

13)

Net

Rev

enue

s fro

m F

ood

Sale

s

7,8

43 (n

= 6

)

20,4

99 (n

= 3

)

12,9

30 (n

= 3

)

41,

272

(n =

12)

Gro

ss R

even

ues f

rom

Bev

erag

e Sa

les

300

(n =

1)

19

,410

(n =

2)

34

,550

(n =

2)

5

4,26

0 (n

= 5

)

Net

Rev

enue

s fro

m B

ever

age

Sale

s

2

00 (n

= 1

)

9,9

45 (n

= 2

)

17,2

50 (n

= 2

)

27,

395

(n =

5)

C

ombi

ned

Gro

ss R

even

ues f

rom

Foo

d

a

nd B

ever

age

Sale

s1 __

____

_ __

____

_ __

____

_ __

____

_

C

ombi

ned

Net

Rev

enue

s fro

m F

ood

and

Bev

erag

e Sa

les1

____

___

____

___

5

,000

(n =

1)

5,00

0 (n

= 1

)

Tot

al G

ross

Rev

enue

s fro

m S

tore

s2

12,9

70 (n

= 6

)

61,

641

(n =

4)

124

,500

(n =

3)

199

,111

(n =

13)

Tot

al N

et R

even

ues f

rom

Sto

res2

8

,043

(n =

6)

3

0,44

4 (n

= 3

)

35,1

80 (n

= 4

)

73,

667

(n =

13)

1 S

ome

scho

ols w

ere

unab

le to

sepa

rate

food

and

bev

erag

e sa

le re

venu

es a

nd e

lect

ed to

repo

rt a

com

bine

d re

venu

e.

2 It is

impo

rtant

to n

ote

that

due

to m

issi

ng re

venu

e in

form

atio

n, th

e gr

oss a

nd n

et re

venu

es m

ay n

ot c

orre

spon

d to

the

sam

e sc

hool

s. Th

eref

ore,

pr

ofita

bilit

y ca

nnot

be

dete

rmin

ed.

3 Min

or d

iscr

epan

cies

are

due

to ro

undi

ng.

77

Tab

le 4

. Pa

rt B

: R

epor

ted

Rev

enue

s fro

m C

ompe

titiv

e Fo

od S

ales

by

Ven

ue a

nd S

choo

l Lev

el fo

r th

e 20

01-0

2 Sc

hool

Yea

r

E

lem

enta

ry

Scho

ols

Mid

dle

Scho

ols

Hig

h Sc

hool

s A

ll Sc

hool

s4

Fund

rais

ing

(n=3

2)

(n=7

) (n

=7)

(n=4

6)

G

ross

Rev

enue

s fro

m F

ood

Sale

s

43,6

05 (n

= 2

3)

3

,200

(n =

2)

93

,528

(n =

4)

140

,333

(n =

29)

Net

Rev

enue

s fro

m F

ood

Sale

s

27,1

26 (n

= 2

9)

6

,667

(n =

3)

75

,600

(n =

5)

109

,393

(n =

37)

Gro

ss R

even

ues f

rom

Bev

erag

e Sa

les

1

,166

(n =

5)

1

,100

(n =

2)

2,

266

(n =

7)

N

et R

even

ues f

rom

Bev

erag

e Sa

les

1

,213

(n =

9)

850

(n =

3)

10

,000

(n =

1)

1

2,06

3 (n

= 1

3)

C

ombi

ned

Gro

ss R

even

ues f

rom

Foo

d

and

Bev

erag

e Sa

les1

_

____

_

13,1

71 (n

= 1

)

___

___

1

3,17

1 (n

= 1

)

Com

bine

d N

et R

even

ues f

rom

Foo

d

and

Bev

erag

e Sa

les1

_

____

_

7,3

75 (n

= 1

)

10,0

00 (n

= 1

)

17,

375

(n =

2)

T

otal

Gro

ss R

even

ues f

rom

Fun

drai

sing

2

44,7

71 (n

= 2

3)

17

,471

(n =

3)

93

,528

(n =

4)

155

,770

(n =

30)

Tot

al N

et R

even

ues f

rom

Fun

drai

sing

2

28,3

39 (n

= 3

0)

14

,893

(n =

4)

95

,600

(n =

6)

138

,832

(n =

40)

A

La

Car

te F

ood

and

Bev

erag

e Sa

les3

(n=5

3)

(n=1

1)

(n=1

1)

(n=7

5)

Tota

l Gro

ss R

even

ues f

rom

Foo

d an

d B

ever

age

Sale

s 1

36,4

23 (n

= 5

3)

1,13

1,92

3 (n

= 1

1)

1,29

5,89

0 (n

= 1

1)

2,56

4,23

7 (n

= 7

5)

Tota

l Net

Rev

enue

s fro

m F

ood

and

Bev

erag

e Sa

les

6

8,21

1 (n

= 5

3)

30

5,61

9 (n

= 1

1)

34

9,89

0 (n

= 1

1)

72

3,72

1 (n

= 7

5)

Tot

al G

ross

Rev

enue

s fro

m F

ood

and

Bev

erag

e Sa

les A

mon

g al

l Ven

ues2,

4 2

14,2

35 (n

= 5

3)

1,27

5,52

6 (n

= 1

1)

1,74

6,26

0 (n

= 1

1)

3,23

6,02

2 (n

= 7

5)

Tot

al N

et R

even

ues f

rom

Foo

d an

d B

ever

age

Sale

s Am

ong

all V

enue

s2,4

112

,114

(n =

53)

392,

292

(n =

11)

643,

084

(n =

11)

1,

147,

491

(n =

75)

1 S

ome

scho

ols w

ere

unab

le to

sepa

rate

food

and

bev

erag

e sa

le re

venu

es a

nd e

lect

ed to

repo

rt a

com

bine

d re

venu

e.

2 It is

impo

rtant

to n

ote

that

due

to m

issi

ng re

venu

e in

form

atio

n, th

e gr

oss a

nd n

et re

venu

es m

ay n

ot c

orre

spon

d to

the

sam

e sc

hool

s. Th

eref

ore,

pr

ofita

bilit

y ca

nnot

be

dete

rmin

ed.

3 The

reve

nues

for a

la c

arte

sale

s wer

e pr

ovid

ed b

y N

utrit

ion

Serv

ices

and

incl

ude

any

food

or b

ever

age

sold

out

side

of t

he re

imbu

rsab

le S

choo

l B

reak

fast

and

Sch

ool L

unch

Pro

gram

s (e.

g., m

ilk sa

les t

o ch

ildre

n w

ho b

ring

lunc

h fr

om h

ome)

.

4 Min

or d

iscr

epan

cies

are

due

to ro

undi

ng.

78

Tab

le 5

. Su

mm

ary

of N

et R

even

ue S

ourc

es:

Tot

al R

even

ues a

nd P

erce

nt o

f Tot

al N

et R

even

ue fr

om C

ompe

titiv

e

Food

Sal

es A

t Ele

men

tary

, Mid

dle

and

Hig

h Sc

hool

s 1

E

lem

enta

ry S

choo

ls

Mid

dle

Scho

ols

Hig

h Sc

hool

s A

ll Sc

hool

s V

endi

ng M

achi

nes

$7,5

20

.6%

$4

1,33

5 3.

6%

$162

,413

14

.1%

$2

11,2

69

18.4

%

Scho

ol S

tore

s $8

,043

.7

%

$30,

444

2.6%

$3

5,18

0 3.

1%

$73,

667

6.4%

Fu

ndra

isin

g $2

8,33

9 2.

5%

$14,

893

1.3%

$9

5,60

0 8.

3%

$138

,832

12

.1%

A

La

Car

te

$68,

211

5.9%

$3

05,6

19

26.6

%

$349

,890

30

.5%

$7

23,7

21

63.1

%

All

Ven

ues

$112

,114

9.

8%

$392

,292

34

.2%

$6

43,0

84

56.0

%

$1,1

47,4

91

100%

1 D

iscr

epan

cies

are

due

to ro

undi

ng.

79

Tab

le 6

. Pe

rcen

tage

(and

Num

ber)

of E

lem

enta

ry, M

iddl

e an

d H

igh

Scho

ols W

ho S

ell S

elec

t Foo

ds a

nd B

ever

ages

Dur

ing

the

Scho

ol D

ay fr

om V

endi

ng M

achi

nes,

Scho

ol S

tore

s, Fu

ndra

iser

s, or

A L

a C

arte

Off

erin

gs

Scho

ol L

evel

B

efor

e Sc

hool

Dur

ing

Scho

ol H

ours

W

hen

Mea

ls

Are

Not

B

eing

Ser

ved

D

urin

g L

unch

A

fter

Sch

ool

D

urin

g A

ny

of th

e R

epor

ted

Tim

es

Elem

enta

ry S

choo

ls (n

=53)

11

(6)

26 (1

4)

47 (2

5)

36 (1

9)

M

iddl

e Sc

hool

s (n=

11)

63 (7

) 45

(5)

100

(11)

91

(10)

Hig

h Sc

hool

s (n=

11)

100

(11)

73

(8)

100

(11)

10

0 (1

1)

Spor

ts D

rink

s, So

ft

Dri

nks,

or F

ruit

Dri

nks—

not 1

00%

ju

ice

Al

l Sch

ools

(n=7

5)

32 (2

4)

36 (2

7)

63 (4

7)

53 (4

0)

73 (5

5)

Elem

enta

ry S

choo

ls (n

=53)

4

(2)

15 (8

) 17

(9)

36 (1

3)

M

iddl

e Sc

hool

s (n=

11)

45 (5

) 27

(3)

64 (7

) 64

(7)

H

igh

Scho

ols (

n=11

) 91

(10)

64

(7)

91 (1

0)

91 (1

0)

Can

dy (i

nclu

ding

ch

ocol

ate

cand

y)

Al

l Sch

ools

(n=7

5)

23 (1

7)

24 (1

8)

35 (2

6)

40 (3

0)

44 (3

3)

Elem

enta

ry S

choo

ls (n

=53)

6

(3)

30 (1

6)

36 (1

9)

21 (1

1)

Mid

dle

Scho

ols (

n=11

) 64

(7)

45 (5

) 10

0 (1

1)

91 (1

0)

Hig

h Sc

hool

s (n=

11)

91 (1

0)

73 (8

) 91

(10)

91

(10)

Coo

kies

, cra

cker

s, ca

kes,

past

ries

and

ot

her

bake

d go

ods—

not l

ow fa

t

All S

choo

ls (n

=75)

27

(20)

39

(29)

53

(40)

41

(31)

63

(47)

Elem

enta

ry S

choo

ls (n

=53)

6

(3)

21 (1

1)

28 (1

5)

19 (1

0)

M

iddl

e Sc

hool

s (n=

11)

64 (7

) 45

(5)

100

(11)

91

(10)

Hig

h Sc

hool

s (n=

11)

100

(11)

73

(8)

100

(11)

10

0 (1

1)

Salty

Sna

cks—

not

low

-fat

All S

choo

ls (n

=75)

28

(21)

32

(24)

49

(37)

41

(31)

59

(44)

80

APPENDIX D

Obesity Resource List Health Division, Nevada’s Department of Human Resources

81

OB

ESI

TY

RE

SOU

RC

E L

IST

Nev

ada’

s L

egis

lati

ve C

omm

itte

e on

Hea

lth

Car

e Su

bcom

mit

tee

to S

tudy

Med

ical

and

Soc

ieta

l Cos

ts a

nd I

mpa

cts

of O

besi

ty

Cha

irw

oman

Val

erie

Wie

ner

PR

OG

RA

M

CO

NT

AC

T

CO

NT

AC

T I

NF

OR

MA

TIO

N

CO

MM

EN

TS

AA

RP

L

arry

Spi

tler

Ass

ocia

te S

tate

Dir

ecto

r fo

r A

dvoc

acy

Bet

tye

Tho

mas

L

ead

Vol

unte

er f

or H

ealth

Car

e Is

sues

5820

Eas

tern

Ave

., S

te.

190

Las

Veg

as,

NV

89

119

Tel

epho

ne:

(70

2) 9

38-3

236

The

AA

RP

Inte

rnet

Web

site

:

ww

w.a

arp.

org

feat

ures

hea

lth

tips,

the

impo

rtan

ce o

f ch

ecku

ps

and

prev

entio

n, e

atin

g w

ell,

m

anag

ing

stre

ss,

and

stay

ing

activ

e.

Buf

fy G

ail M

artin

G

over

nmen

t Rel

atio

ns D

irec

tor

Nor

ther

n N

evad

a O

ffic

e 64

90 S

. M

cCar

ran

Blv

d.,

Ste.

40

Ren

o, N

V 89

509

Tel

epho

ne:

(77

5) 8

25-0

409

Susa

n R

obin

son

Reg

iona

l Vic

e Pr

esid

ent

Tel

epho

ne:

(77

5) 3

29-0

609

Am

eric

an C

ance

r So

ciet

y (A

CS)

Vic

tor

Esp

inoz

a Pr

ogra

m M

anag

er

Sout

hern

Nev

ada

Off

ice

1325

E.

Har

mon

Ave

. L

as V

egas

, N

V

8911

9 T

elep

hone

: (

702)

798

-687

7

The

AC

S W

eb s

ite

( ww

w.c

ance

r.or

g) o

ffer

s nu

mer

ous

reso

urce

s on

foo

d an

d fi

tnes

s.

T

he A

CS

also

has

the

follo

win

g pr

ogra

ms:

A

ctiv

e fo

r L

ife

- A

10-

wee

k pr

ogra

m to

enc

oura

ge e

mpl

oyee

s to

be

mor

e ac

tive

on a

reg

ular

ba

sis

by s

ettin

g in

divi

dual

goa

ls

and

form

ing

team

s fo

r m

otiv

atio

n an

d su

ppor

t.

Mee

ting

Wel

l - A

pro

gram

that

pr

ovid

es to

ols,

incl

udin

g a

guid

eboo

k th

at m

akes

it e

asy

to

choo

se h

ealth

y fo

od a

nd a

ctiv

ities

fo

r w

ork

even

ts a

nd m

eetin

gs.

83

http://www.aarp.org/

http://www.cancer.org/

PR

OG

RA

M

CO

NT

AC

T

CO

NT

AC

T I

NF

OR

MA

TIO

N

CO

MM

EN

TS

AC

S (c

onti

nued

)

Gen

erat

ion

Fit

- A

pro

gram

for

st

uden

ts,

ages

11

to 1

8, w

ho ta

ke

part

in c

omm

unity

ser

vice

pro

ject

s th

at p

rom

ote

mor

e ph

ysic

al

activ

ity a

nd h

ealth

ier

eatin

g.

The

A

CS

will

trai

n co

ache

s,

coun

selo

rs,

and

yout

h gr

oup

lead

ers

to r

un th

e pr

ogra

m.

Mor

e in

form

atio

n is

ava

ilabl

e by

cal

ling

(800

) AC

S-23

45.

Am

eric

an H

eart

A

ssoc

iati

on (

AH

A)

of N

evad

a

Rob

in C

amac

ho

Dir

ecto

r of

Adv

ocac

y an

d C

omm

unic

atio

n

6370

W.

Fla

min

go R

d.,

Ste.

1

Las

Veg

as,

NV

89

103

Tel

epho

ne:

(70

2) 3

67-1

366

Fax

: (

702)

367

-197

5

The

AH

A’s

Web

site

pro

vide

s in

form

atio

n on

its

“Hea

lthy

Lif

esty

le”

link

at

ww

w.a

mer

ican

hear

t.or

g

Art

hrit

is

Fou

ndat

ion

of

Nev

ada

Sloa

ne A

rnol

d E

xecu

tive

Dir

ecto

r 24

50 C

hand

ler

Ave

., S

te.

17

Las

Veg

as,

NV

89

120

Tel

epho

ne:

(70

2) 3

67-1

626

Fax

: (

702)

367

-638

1

The

Fou

ndat

ion

offe

rs e

xerc

ise

clas

ses,

sup

port

and

edu

catio

n gr

oups

, se

lf-he

lp c

ours

es,

phys

icia

n re

ferr

als,

info

rmat

iona

l bro

chur

es,

and

patie

nt/p

hysi

cian

edu

catio

n w

orks

hops

. A

lso,

the

Fou

ndat

ion

wor

ks in

pa

rtne

rshi

p w

ith th

e H

ealth

D

ivis

ion,

Dep

artm

ent o

f H

uman

R

esou

rces

(D

HR

), a

nd h

as

esta

blis

hed

a st

ate

plan

on

arth

ritis

to

dec

reas

e th

e bu

rden

of

arth

ritis

in

the

stat

e.

M

ore

info

rmat

ion

abou

t the

dis

ease

is

ava

ilabl

e at

ww

w.a

rthrit

is.o

rg a

nd

http

://h

ealth

2k.s

tate

.nv.

us/a

rthr

itis.

84

http://www.americanheart.org/

http://www.arthritis.org/

http://health2k.state.nv.us/arthritis

PR

OG

RA

M

CO

NT

AC

T

CO

NT

AC

T I

NF

OR

MA

TIO

N

CO

MM

EN

TS

Cen

ter

for

Scie

nce

in t

he P

ublic

In

tere

st (

CSP

I)

Mar

go G

. W

oota

n, D

.Sc.

D

irec

tor

Nut

ritio

n Po

licy

1875

Con

nect

icut

Ave

., N

W

Was

hing

ton,

D.C

. 2

0009

T

elep

hone

: (

202)

332

-911

0

The

CSP

I is

a n

utri

tion

advo

cacy

or

gani

zatio

n.

Man

y re

sour

ces

are

avai

labl

e at

ww

w.c

spin

et.o

rg.

Sach

iko

T.

St.

Jeor

, Ph

.D.,

R.D

. D

irec

tor

Pr

ofes

sor

and

Chi

ef

Div

isio

n of

Med

ical

Nut

ritio

n

Dep

artm

ent o

f In

tern

al M

edic

ine

Uni

vers

ity o

f N

evad

a Sc

hool

of

Med

icin

e (U

NSO

M)

153

Red

field

Bld

g., R

m. 2

49/M

S 15

3 R

eno,

NV

89

557

Tel

epho

ne:

(775

) 784

-447

4, E

xt. 1

5 F

ax:

(77

5) 7

84-4

468

The

CN

MD

off

ers

“sta

te o

f th

e ar

t” e

valu

atio

n an

d tr

eatm

ent

optio

ns a

nd c

ondu

cts

rese

arch

re

late

d to

obe

sity

issu

es.

Ray

mon

d Pl

odko

wsk

i, M

.D.

Co-

Chi

ef,

Div

isio

n of

Med

ical

N

utri

tion,

and

C

hief

of

End

ocri

nolo

gy a

nd

Met

abol

ism

, R

eno

Vet

eran

s A

ffai

rs

Med

ical

Cen

ter

Sub-

spec

ialty

, B

oard

Cer

tifie

d in

E

ndoc

rino

logy

, D

iabe

tes,

and

M

etab

olis

m

Dep

artm

ent o

f In

tern

al M

edic

ine

UN

SOM

- R

eno

1000

Loc

ust S

t.,

MS

111

Ren

o, N

V 89

502

Tel

epho

ne:

(77

5) 3

28-1

894

F

ax:

(77

5) 2

01-1

581

Dr.

Plo

dkow

ski p

erfo

rms

obes

ity

rese

arch

and

teac

hes

med

ical

re

side

nts

and

med

ical

stu

dent

s.

Cen

ter

for

Nut

riti

on a

nd

Met

abol

ic

Dis

orde

rs

(CN

MD

)

Oth

er P

hysi

cian

s at

the

Cen

ter

for

Nut

ritio

n an

d M

etab

olic

Dis

orde

rs:

Doi

na K

ulic

k, M

.D.

(Boa

rd C

ertif

ied

in G

ener

al I

nter

nal M

edic

ine)

Dia

ne C

hau,

M.D

. (B

oard

Cer

tifie

d in

Ger

iatr

ics)

Reg

iste

red

Die

titia

ns I

nvol

ved

in th

e Pr

ogra

m:

Bar

bara

Sco

tt, M

.P.H

., R

.D.

(Ped

iatr

ics

and

Fam

ily M

edic

ine)

Jess

ica

Kre

nkel

, M

.S.,

R.D

. (C

ertif

ied

in N

utri

tion

Supp

ort,

Ger

iatr

ics,

Gen

eral

Med

icin

e)

Vic

ki B

ovee

, M

.S.,

R.D

. (C

linic

Adm

inis

trat

or,

Cer

tific

ate

in A

dult

Wei

ght M

anag

emen

t)

85

http://www.cspinet.org/

PR

OG

RA

M

CO

NT

AC

T

CO

NT

AC

T I

NF

OR

MA

TIO

N

CO

MM

EN

TS

CN

MD

(c

onti

nued

) Jo

lyn

Wir

shin

g, R

.D.

(C

linic

al d

ietit

ian

and

coun

selo

r)

Hol

ly H

erzo

g, M

.S.,

R.D

. (G

ener

al M

edic

ine,

Sup

plem

ents

)

Mir

iam

Een

, M

.S.,

R.D

. (F

amily

Med

icin

e, L

as V

egas

)

Beh

avio

ral S

cien

tists

:

Tra

cy V

each

, E

d.D

., M

.F.T

. (P

rofe

ssor

of

Psyc

hiat

ry &

Beh

avio

ral S

cien

ces,

Int

erna

l Med

icin

e, S

tres

s M

anag

emen

t)

Sach

iko

T.

St.

Jeor

, Ph

.D.,

R.D

. (O

besi

ty,

Wei

ght M

anag

emen

t);

Fel

low

in th

e So

ciet

y of

Beh

avio

ral M

edic

ine

C

lark

Cou

nty

Hea

lth

Dis

tric

t (C

CH

D)

Jean

ne P

alm

er

Hea

lth E

duca

tion

Man

ager

R

ayle

en E

arne

y C

hron

ic D

isea

se H

ealth

Edu

cato

r

P.O

. B

ox 3

902

Las

Veg

as,

NV

89

127

Tel

epho

ne:

(70

2) 7

59-1

271

Fax

: (

702)

759

-141

6

The

CC

HD

is C

lark

Cou

nty’

s pu

blic

hea

lth a

genc

y.

M

ore

info

rmat

ion

abou

t the

D

istr

ict’

s pr

ogra

ms

is a

vaila

ble

at

ww

w.c

chd.

org.

Dai

ry C

ounc

il of

U

tah/

Nev

ada

Bar

bara

Pau

lsen

Pr

ogra

m D

irec

tor

Sout

hern

Nev

ada

Off

ice

5836

S.

Peco

s R

d.

Las

Veg

as,

NV

891

20

Tel

epho

ne:

(70

2) 3

15-0

520

The

Dai

ry C

ounc

il is

a r

esou

rce

to

obta

in n

utri

tion

educ

atio

n m

ater

ials

and

kits

. T

he C

ounc

il of

fers

the

follo

win

g pr

ogra

ms:

A

ctio

n fo

r H

ealth

y K

ids

- A

n in

tegr

ated

, na

tiona

l-st

ate

effo

rt to

ad

dres

s ov

erw

eigh

t,

unde

rnou

rish

ed,

and

sede

ntar

y yo

uth

by f

ocus

ing

on c

hang

e in

th

e sc

hool

env

iron

men

t.

LIF

EST

EPS

®-

A b

ehav

iora

lly-

base

d w

eigh

t man

agem

ent

prog

ram

.

86

http://www.cchd.org/

PR

OG

RA

M

CO

NT

AC

T

CO

NT

AC

T I

NF

OR

MA

TIO

N

CO

MM

EN

TS

Bra

dfor

d L

ee,

M.D

., J

.D.,

M.B

.A.

Stat

e H

ealth

Off

icer

50

5 E

. K

ing

St.,

Rm

. 20

1 C

arso

n C

ity,

NV

89

701

Tel

epho

ne:

(77

5) 6

84-4

200

Fax

: (

775)

687

-385

9

The

Hea

lth D

ivis

ion

prom

otes

and

pr

otec

ts th

e he

alth

of

Nev

adan

s an

d vi

sito

rs to

the

stat

e th

roug

h its

le

ader

ship

in p

ublic

hea

lth a

nd

enfo

rcem

ent o

f la

ws

and

regu

latio

ns

pert

aini

ng to

pub

lic h

ealth

. M

ore

info

rmat

ion

abou

t the

Div

isio

n’s

prog

ram

s an

d in

itiat

ives

is a

vaila

ble

at h

ttp:/

/hea

lth2k

.sta

te.n

v.us

.

Ric

hard

Whi

tley

Chi

ef

Bur

eau

of C

omm

unity

Hea

lth

505

E.

Kin

g St

., R

m.

103

Car

son

City

, N

V

8970

1 T

elep

hone

: (

775)

684

-599

6 F

ax:

(77

5) 6

84-5

998

The

Bur

eau

offe

rs n

umer

ous

prog

ram

s de

sign

ed to

pre

vent

, co

ntro

l, an

d er

adic

ate

com

mun

icab

le a

nd c

hron

ic d

isea

se

in N

evad

a. R

elev

ant p

rogr

ams

are:

(1

) T

obac

co C

ontr

ol;

(2)

Bre

ast a

nd

Cer

vica

l Can

cer

Prev

entio

n an

d C

ontr

ol;

(3)

Can

cer

Reg

istr

y;

(4)

Dia

bete

s C

ontr

ol;

and

(5) A

rthr

itis

Prev

entio

n an

d C

ontr

ol.

Hea

lth

Div

isio

n,

DH

R

Cha

rlen

e H

erst

M

anag

er

Chr

onic

Dis

ease

Pre

vent

ion

Prog

ram

s B

urea

u of

Com

mun

ity H

ealth

Tel

epho

ne:

(77

5) 6

84-5

914

The

Nev

ada

Alli

ance

for

Chr

onic

D

isea

se P

reve

ntio

n in

clud

es th

e fo

llow

ing

wor

k gr

oups

: (

1) d

ata

user

s; (

2) p

olic

y; (

3) b

ehav

iora

l ri

sk f

acto

rs;

(4)

envi

ronm

enta

l ris

k fa

ctor

s; a

nd (

5) p

sych

osoc

ial a

nd

gene

tic.

87

http://health2k.state.nv.us/

PR

OG

RA

M

CO

NT

AC

T

CO

NT

AC

T I

NF

OR

MA

TIO

N

CO

MM

EN

TS

Kau

fman

, D

r. F

ranc

ine

D

r. F

ranc

ine

Kau

fman

Pr

ofes

sor

of P

edia

tric

s H

ead

Div

isio

n of

End

ocri

nolo

gy

Dep

artm

ent o

f Pe

diat

rics

Chi

ldre

n’s

Hos

pita

l U

nive

rsity

of

Sout

hern

Cal

ifor

nia

4650

Sun

set B

lvd.

, M

S 61

L

os A

ngel

es,

CA

90

027

Tel

epho

ne:

(32

3) 6

69-4

606

Fax

: (

310)

701

-278

0

Dr.

Kau

fman

rec

ently

ser

ved

on a

W

hite

Hou

se S

umm

it on

Hea

lthy

Scho

ols/

Hea

lthy

Stud

ents

, an

d, a

s th

e ch

air

of a

Tas

k For

ce c

reat

ed

by th

e L

os A

ngel

es C

ount

y B

oard

of

Sup

ervi

sors

, w

as in

stru

men

tal

in b

anni

ng s

oda

vend

ing

mac

hine

s on

man

y pu

blic

sch

ool c

ampu

ses,

in

clud

ing

the

seco

nd la

rges

t sc

hool

dis

tric

t in

the

coun

try

- th

e L

os A

ngel

es U

nifi

ed S

choo

l D

istr

ict,

whi

ch is

cur

rent

ly in

the

proc

ess

of p

hasi

ng o

ut s

oda

vend

ing

mac

hine

s.

She

has

been

th

e re

cipi

ent o

f N

atio

nal I

nstit

utes

of

Hea

lth (

NIH

) fu

ndin

g si

nce

1980

, an

d m

ore

rece

ntly

cha

ired

th

e N

IH s

tudy

on

the

Prev

entio

n an

d T

reat

men

t of

Typ

e 2

Dia

bete

s in

Chi

ldre

n an

d Y

outh

.

Kra

ft F

oods

Nor

th

Am

eric

a, I

nc.

Kat

hlee

n Sp

ear

Vic

e Pr

esid

ent

Dep

uty

Gen

eral

Cou

nsel

Thr

ee L

akes

Dri

ve

Nor

thfi

eld,

IL

60

093

Tel

epho

ne:

(84

7) 6

46-2

517

Fax

: (

847)

646

-443

1

The

com

pany

laun

ched

its

Obe

sity

In

itiat

ive

on J

uly

1, 2

003,

with

the

form

atio

n of

a W

orld

wid

e H

ealth

&

Wel

lnes

s A

dvis

ory

Cou

ncil.

M

ore

info

rmat

ion

abou

t the

initi

ativ

e is

ava

ilabl

e at

http

://k

raft.

com

.

Las

Veg

as A

thle

tic

Clu

bs (

LV

AC

)

Bre

t Fitz

gera

ld

Vic

e Pr

esid

ent o

f C

orpo

rate

C

omm

unic

atio

n E

dito

r an

d Pu

blis

her

LVA

C M

agaz

ine

2655

S.

Mar

ylan

d Pk

wy.

L

as V

egas

, N

V

8910

9 T

elep

hone

: (

702)

591

-744

1

Mor

e in

form

atio

n ab

out p

rogr

ams

and

serv

ices

off

ered

by

LV

AC

is

avai

labl

e at

ww

w.l

vac.

com

.

88

http://kraft.com/

http://www.lvac.com/

PR

OG

RA

M

CO

NT

AC

T

CO

NT

AC

T I

NF

OR

MA

TIO

N

CO

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EN

TS

Lum

mis

E

lem

enta

ry S

choo

l P

TA

Ter

ri J

anis

on

Pare

nt/T

eam

Nut

ritio

n L

eade

r

9000

Hill

poin

t L

as V

egas

, N

V

8913

4 T

elep

hone

: (

702)

373

-368

3

An

elem

enta

ry s

choo

l pro

gram

to

incr

ease

the

heal

th a

nd f

itnes

s of

th

e st

uden

ts a

nd s

taff

of

the

scho

ol.

The

pro

gram

incl

udes

:

(1)

rece

ss b

efor

e lu

nch;

(2

) L

umm

is L

aser

Fitn

ess

Tea

m;

(3)

conv

ersi

on o

f lu

nch

room

to

“ser

ve u

p” lu

nche

s; a

nd

(4)

switc

hing

fro

m s

nack

bar

to

Fun

Fri

day’

s.

Mor

e in

form

atio

n is

ava

ilabl

e at

w

ww

.lum

mis

pta.

com

N

atio

nal C

ente

r fo

r C

hron

ic

Dis

ease

Pre

vent

ion

and

Hea

lth

Pro

mot

ion

How

ell W

echs

ler,

Ed.

D.,

M.P

.H.,

C

hief

R

esea

rch

App

licat

ion

Bra

nch

Div

isio

n of

Ado

lesc

ent a

nd S

choo

l H

ealth

Cen

ters

for

Dis

ease

Con

trol

and

Pr

even

tion

47

70 B

ufor

d H

ighw

ay

Atla

nta,

GA

30

341

Tel

epho

ne:

(77

0) 4

88-6

197

Obe

sity

and

juve

nile

fitn

ess

and

nutr

ition

res

ourc

es a

re a

vaila

ble

at

ww

w.c

dc.g

ov.

Nev

ada

Ass

ocia

tion

for

Hea

lth,

Phy

sica

l E

duca

tion,

R

ecre

atio

n, a

nd

Dan

ce

(NA

HP

ER

D)

Dr.

R.R

. A

pach

e Pr

esid

ent-

Ele

ct

Dep

artm

ent o

f E

duca

tiona

l L

eade

rshi

p U

nive

rsity

of

Nev

ada,

Las

Veg

as

4505

Mar

ylan

d Pk

wy.

, B

ox 4

5300

2 L

as V

egas

, N

V

8915

4 T

elep

hone

: (

702)

895

-462

9 F

ax:

(70

2) 8

95-3

492

Acc

ordi

ng to

info

rmat

ion

on th

e A

ssoc

iatio

n’s

Web

site

, th

e m

issi

on o

f th

e N

AH

PER

D is

: •

To

enco

urag

e qu

ality

el

emen

tary

, se

cond

ary,

and

co

llege

phy

sica

l edu

catio

n pr

ogra

ms

base

d up

on n

eeds

, in

tere

sts,

and

inhe

rent

ca

paci

ties

of th

e in

divi

dual

for

hi

s op

timum

dev

elop

men

t;

89

http://www.lummispta.com/

http://www.cdc.gov/

PR

OG

RA

M

CO

NT

AC

T

CO

NT

AC

T I

NF

OR

MA

TIO

N

CO

MM

EN

TS

NA

HP

ER

D

(con

tinue

d)

• T

o co

ntri

bute

to th

e in

divi

dual

’s u

nder

stan

ding

of

his

role

as

a de

moc

ratic

citi

zen

in N

evad

a, th

e U

nite

d St

ates

, an

d at

larg

e;

• T

o pr

ovid

e th

e le

ader

ship

es

sent

ial t

o th

e co

ntin

ual

deve

lopm

ent a

nd im

prov

emen

t of

pro

gram

s in

hea

lth,

phys

ical

ed

ucat

ion,

rec

reat

ion,

and

da

nce;

•

To

awak

en a

nd s

timul

ate

inte

llige

nt a

nd c

ompr

ehen

sive

in

tere

st in

hea

lth,

phys

ical

ed

ucat

ion,

rec

reat

ion

and

danc

e;

• T

o as

sist

in r

esea

rch

and

expe

rim

enta

tion

and

to

diss

emin

ate

accu

rate

in

form

atio

n in

pro

gram

s of

he

alth

, ph

ysic

al e

duca

tion,

re

crea

tion,

and

dan

ce;

and

• T

o pr

omot

e so

und

com

mun

ity

rela

tions

hips

lead

ing

to a

dequ

ate

supp

ort f

or h

ealth

, ph

ysic

al

educ

atio

n, r

ecre

atio

n, a

nd d

ance

. M

ore

info

rmat

ion

abou

t the

gro

up

is a

vaila

ble

at

ww

w.n

ahpe

rd.0

catc

h.co

m.

90

http://www.nahperd.0catch.com/

PR

OG

RA

M

CO

NT

AC

T

CO

NT

AC

T I

NF

OR

MA

TIO

N

CO

MM

EN

TS

Nev

ada

Dia

bete

s A

ssoc

iati

on f

or

Chi

ldre

n an

d A

dult

s (N

DA

CA

)

Myl

an H

awki

ns

Exe

cutiv

e D

irec

tor

Nor

ther

n N

evad

a O

ffic

e 10

05 T

erm

inal

Way

, St

e. 1

04

Ren

o, N

V 89

502

Tel

epho

ne:

(77

5) 8

56-3

839

Fax

: (

775)

348

-759

1 So

uthe

rn N

evad

a O

ffic

e 62

39 I

slan

d Pa

lm A

venu

e L

as V

egas

, N

V

8911

9 T

elep

hone

: (

800)

379

-383

9

The

ND

AC

A is

the

only

or

gani

zatio

n in

Nev

ada

that

pr

ovid

es d

irec

t ser

vice

s to

ch

ildre

n an

d su

ppor

t for

fam

ilies

de

alin

g w

ith d

iabe

tes.

Mor

e in

form

atio

n ab

out t

he

ND

AC

A is

ava

ilabl

e at

ht

tp:/

/dia

bete

snv.

org.

Mic

hele

Cow

ee

Pres

iden

t

13 C

anyo

n D

r.

Car

son

City

, N

V

8970

3

Bar

b Sc

ott

Pres

iden

t-E

lect

1840

Bre

nda

Way

C

arso

n C

ity,

NV

89

704

D

ebbi

e K

lein

L

egis

lativ

e C

hair

4843

Elk

cree

k T

rail

Ren

o, N

V 89

509

Nev

ada

Die

teti

c A

ssoc

iati

on (

ND

A)

Kay

Ori

ng

Nev

ada

Del

egat

e to

AD

A

2390

Ove

rloo

k C

t.

Ren

o, N

V 89

509

Die

tetic

pro

fess

iona

ls (

diet

itian

s an

d di

etet

ic te

chni

cian

s) p

rovi

de

expe

rtis

e in

foo

ds a

nd n

utri

tion

to

stat

e ag

enci

es a

s th

ey f

orm

ulat

e pr

ogra

ms.

T

he N

DA

has

acc

ess

to 3

00 m

embe

rs in

Nev

ada

who

ar

e av

aila

ble

for

trea

ting

pers

ons

who

are

ove

rwei

ght o

r ob

ese.

M

any

of th

e or

gani

zatio

n’s

diet

itian

s an

d di

etet

ic te

chni

cian

s ar

e in

volv

ed in

pro

gram

s fo

r w

eigh

t man

agem

ent t

hrou

ghou

t th

e st

ate.

Nev

ada

PT

A

DJ

Stut

z Pr

esid

ent

6134

W.

Cha

rles

ton

Blv

d.

Las

Veg

as,

NV

89

146

Tel

epho

ne:

(80

0) 7

82-7

201

Tel

epho

ne:

(70

2) 2

58-7

885

Fax

: (

702)

258

-783

6

The

Com

mitt

ee o

n H

ealth

and

W

elfa

re o

f th

e N

evad

a PT

A

prom

otes

sch

ool i

nitia

tives

on

nutr

ition

and

hea

lthy

choi

ces.

M

ore

info

rmat

ion

is a

vaila

ble

at

ww

w.n

evad

apta

.org

.

91

http://diabetesnv.org/

http://www.nevadapta.org/

PR

OG

RA

M

CO

NT

AC

T

CO

NT

AC

T I

NF

OR

MA

TIO

N

CO

MM

EN

TS

Nev

ada

Stat

e A

ssoc

iati

on o

f Sc

hool

Nur

ses

Vir

gini

a Sm

ith,

R.N

., M

.S.,

M.S

.N.

Dir

ecto

r

In

form

atio

n ab

out t

he r

ole

of

scho

ol n

ursi

ng is

ava

ilabl

e at

w

ww

.nas

n.or

g.

Sier

ra H

ealt

h Se

rvic

es,

Inc.

Jack

Kim

, D

irec

tor

Leg

isla

tive

Prog

ram

s G

over

nmen

t Aff

airs

& S

peci

al P

roje

cts

Jenn

ifer

Mar

tinse

n, M

.S.E

., C

.H.E

.S.

Dir

ecto

r H

ealth

Edu

catio

n an

d W

elln

ess

Col

leen

Cor

ey,

R.D

., C

.D.E

. H

ealth

Edu

cato

r H

ealth

Edu

catio

n an

d W

elln

ess

2724

N.

Ten

aya

Way

L

as V

egas

, N

V

8912

8 T

elep

hone

: (

702)

240

-889

0 F

ax:

(70

2) 2

42-7

931

Sier

ra H

ealth

Ser

vice

s, I

nc.

offe

rs:

•

15 p

rogr

ams

to a

ddre

ss a

wid

e va

riet

y of

med

ical

con

ditio

ns.

• T

wo

prog

ram

s to

add

ress

ch

ildho

od o

besi

ty,

nutr

ition

, an

d fit

ness

: C

amp

LE

AN

and

Kid

Fit.

• T

hree

pro

gram

s to

add

ress

ad

ult o

besi

ty,

nutr

ition

, an

d fi

tnes

s:

(1)

Lea

n O

n M

e;

(2)

the

Em

ploy

ee W

elln

ess

Prog

ram

; an

d (3

) th

e F

it-F

or-

Lif

e C

lub.

Susa

n L

. M

each

am,

Ph.D

., R

.D.

Cha

ir

Dep

artm

ent o

f N

utri

tion

Scie

nces

D

irec

tor

Did

actic

Pro

gram

in D

iete

tics

Scho

ol o

f H

ealth

and

Hum

an S

cien

ces

Dep

artm

ent o

f N

utri

tion

Scie

nces

D

ivis

ion

of H

ealth

Sci

ence

s

4505

S. M

aryl

and

Pkw

y.

Box

453

026

Las

Veg

as,

NV

89

154

Tel

epho

ne:

(70

2) 8

95-1

169

Fax

: (

702)

895

-261

6

Dr.

Mea

cham

pro

vide

s co

mm

unity

edu

catio

n an

d co

mm

unity

ass

essm

ent.

Sh

e m

ay

also

ass

ist w

ith o

besi

ty p

reve

ntio

n pr

ogra

ms.

Uni

vers

ity

of

Nev

ada,

L

as V

egas

Mon

ica

Lou

nsbe

ry,

Ph.D

. A

ssoc

iate

Pro

fess

or/C

oord

inat

or o

f th

e Sp

orts

Edu

catio

n an

d L

eade

rshi

p Pr

ogra

m

Dep

artm

ent o

f E

duca

tiona

l L

eade

rshi

p

4505

Mar

ylan

d Pk

wy.

, B

ox 4

5300

2 L

as V

egas

, N

V

8915

4 T

elep

hone

: (

702)

895

-462

9 F

ax:

(70

2) 8

95-3

492

The

Pla

nned

App

roac

hed

To

Hea

lthie

r Sc

hool

s (P

AT

HS)

pr

ogra

m is

a s

choo

l-ba

sed

heal

th

inte

rven

tion

prog

ram

. S

ervi

ces

incl

ude

prog

ram

dev

elop

men

t,

impl

emen

tatio

n, a

nd e

valu

atio

n.

92

http://www.nasn.org/

PR

OG

RA

M

CO

NT

AC

T

CO

NT

AC

T I

NF

OR

MA

TIO

N

CO

MM

EN

TS

Uni

vers

ity

of

Nev

ada,

Ren

o (U

NR

)

Dr.

Jam

ie B

ened

ict

Ass

ocia

te P

rofe

ssor

D

epar

tmen

t of

Nut

ritio

n

Mai

l Sto

p 14

2 R

eno,

NV

89

523

Tel

epho

ne:

(77

5) 7

84-6

445

Inst

ruct

iona

l pro

gram

s at

UN

R

conc

erni

ng n

utri

tion

incl

ude:

(1

) an

und

ergr

adua

te d

egre

e in

nu

triti

on;

(2)

a di

etet

ic in

tern

ship

; (3

) nu

triti

on c

ours

es th

at s

uppo

rt

othe

r he

alth

-rel

ated

maj

ors;

and

(4

) a

grad

uate

pro

gram

in

Nut

ritio

nal S

cien

ce.

Dr.

Ben

edic

t als

o co

nduc

ted

the

Was

hoe

Cou

nty

Scho

ol D

istr

ict

Foo

d an

d B

ever

age

Stud

y, w

hich

as

sess

ed f

ood

and

beve

rage

s so

ld

in d

istr

ict s

choo

ls.

U

NR

Coo

pera

tive

E

xten

sion

Mad

elei

ne S

igm

an-G

rant

, Ph

.D.,

R.D

. A

rea

Ext

ensi

on S

peci

alis

t

2345

Red

Roc

k St

., S

te.

100

Las

Veg

as,

NV

89

146

Tel

epho

ne:

(70

2) 2

22-3

130

Fax

: (

702)

932

-128

0

The

Coo

pera

tive

Ext

ensi

on

prov

ides

pro

gram

s fo

r ch

ildre

n,

incl

udin

g:

(1)

Chi

ld O

besi

ty

Prev

entio

n in

Nev

ada,

or

CO

PIN

; (2

) T

umm

y T

alks

; (3

) ch

ild c

are

prov

ider

trai

ning

; (4

) co

llabo

ratio

n w

ith W

omen

, In

fant

s an

d C

hild

ren

Spec

ial S

uppl

emen

tal N

utri

tion

Prog

ram

; (5

) br

east

feed

ing

prom

otio

n an

d su

ppor

t; (

6) th

e E

xpan

ded

Foo

d an

d N

utri

tion

Edu

catio

n Pr

ogra

m (

EFN

EP)

; (7

) C

hefs

for

Kid

s; a

nd (

8) te

am

nutr

ition

edu

catio

n.

93

PR

OG

RA

M

CO

NT

AC

T

CO

NT

AC

T I

NF

OR

MA

TIO

N

CO

MM

EN

TS

UN

R C

oope

rati

ve

Ext

ensi

on

(con

tinu

ed)

The

Coo

pera

tive

Ext

ensi

on

prov

ides

pro

gram

s fo

r ad

oles

cent

s, in

clud

ing:

(1

) C

alci

um -

It’

s N

ot J

ust M

ilk;

and

(2)

Nur

turi

ng P

artn

ers.

T

he C

oope

rativ

e E

xten

sion

pr

ovid

es p

rogr

ams

for

adul

ts,

incl

udin

g:

(1)

An

Oun

ce o

f Pr

even

tion

(Dia

bete

s);

(2)

Hea

lthy

Hea

rts;

(3)

EFN

EP;

and

(4

) Se

nior

s C

an.

U

NR

Sou

ther

n N

evad

a A

rea

Hea

lth

Edu

cati

on

Cen

ter

(SN

AH

EC

)

Ros

e M

. Y

uhos

E

xecu

tive

Dir

ecto

r

Scho

ol o

f M

edic

ine

1094

E.

Saha

ra A

ve.

Las

Veg

as,

NV

89

104

Tel

epho

ne:

(70

2) 3

18-8

452

Fax

: (

702)

318

-846

3

The

SN

AH

EC

has

:

• A

You

th a

nd F

amily

Ser

vice

s D

epar

tmen

t tha

t wor

ks w

ith

area

sch

ools

and

dir

ectly

with

pa

rent

s of

teen

aged

and

pr

e-te

en c

hild

ren;

• St

uden

t dev

elop

men

t pro

gram

s de

sign

ed to

inte

rest

stu

dent

s (e

lem

enta

ry th

roug

h hi

gh s

choo

l) in

hea

lth c

aree

rs.

T

hese

pro

gram

s ca

n be

ex

pand

ed to

incl

ude

units

on

nutr

ition

and

exe

rcis

e;

• A

dole

scen

t fam

ily li

fe p

rogr

ams

that

pro

mot

e “p

ositi

ve c

hoic

es

for

posi

tive

futu

res”

thro

ugh

an

outr

each

pro

gram

for

fam

ilies

w

ith te

enag

ed a

nd p

re-t

een

94

PR

OG

RA

M

CO

NT

AC

T

CO

NT

AC

T I

NF

OR

MA

TIO

N

CO

MM

EN

TS

SNA

HE

C

(con

tinu

ed)

child

ren

with

a f

ocus

on

impr

ovin

g co

mm

unic

atio

n an

d un

ders

tand

ing;

and

•

A c

ontin

uing

edu

catio

n pr

ogra

m

to a

ssis

t pro

fess

iona

ls in

the

fiel

ds o

f ed

ucat

ion

and

med

icin

e to

ach

ieve

nat

iona

l, s

tate

, an

d pr

ofes

sion

al s

tand

ards

.

Was

hoe

Cou

nty

Dis

tric

t H

ealt

h D

epar

tmen

t

Bar

bara

Hun

t D

istr

ict H

ealth

Off

icer

D

ebra

Bru

s, D

.V.M

. E

pide

mio

logi

st

P.O

. B

ox 1

1130

R

eno,

NV

89

520

Tel

epho

ne:

(77

5) 3

28-2

416

Fax

: (

775)

328

-227

9

The

Dep

artm

ent i

s th

e co

unty

’s

publ

ic h

ealth

age

ncy.

M

ore

info

rmat

ion

abou

t its

pr

ogra

ms

is a

vaila

ble

at

ww

w.c

o.w

asho

e.nv

.us/

heal

th.

W

asho

e C

ount

y Sc

hool

Dis

tric

t

Aar

on M

. H

ardy

, M

.S.

Wel

lnes

s C

oord

inat

or

Ris

k M

anag

emen

t

Scho

ol-B

ased

Wel

lnes

s Pr

ogra

m

425

Nin

th S

t.

Ren

o, N

V 89

520

Tel

epho

ne:

(77

5) 3

33-5

054

F

ax:

(77

5) 3

48-0

280

The

Wel

lnes

s Pr

ogra

m w

as c

reat

ed

in 1

994.

The

pro

gram

’s m

issi

on is

to

est

ablis

h en

viro

nmen

ts th

at

incr

ease

hea

lth a

war

enes

s, p

rom

ote

posi

tive

lifes

tyle

s, d

ecre

ase

the

risk

of

dis

ease

, an

d en

hanc

e th

e qu

ality

of

life

for

dis

tric

t per

sonn

el a

nd

retir

ees.

Mor

e in

form

atio

n ab

out t

he

prog

ram

is a

vaila

ble

at

ww

w.w

asho

e.k1

2.nv

.us/

wel

lnes

s.

M

MW

/k:W

4139

4

95

http://www.co.washoe.nv.us/health

http://www.washoe.k12.nv.us/wellness

Bulletin 05-10 Legislative Committee on Health Care’s ...

Documents