William H. Dietz, MD, PhD Division of Nutrition, Physical Activity, and Obesity Centers for Disease Control and Prevention Planning for Success.

William H. Dietz, MD, PhDDivision of Nutrition, Physical Activity, and

ObesityCenters for Disease Control and Prevention

Planning for Success

Changes in Obesity Prevalence by Race/ethnicity Boys 2-19 Years

Ogden CL et al. JAMA 2008;299:2401; Ogden CL et al. JAMA. 2010 303(3):242-9.

Changes in Obesity Prevalence by Race/ethnicity

Girls 2-19 Years

Ogden CL et al. JAMA 2008;299:2401; Ogden CL et al. JAMA. 2010 303(3):242-9.

Flegal KM et al. JAMA 2010;303:235

Changes in Prevalence of Obesity in Women 1999-2008

Prevalence

Year

Flegal KM et al. JAMA 2010;303:235

Changes in Prevalence of Obesity in Men 1999-2008

Prevalence

Year

1998 2008 Total costs $78.5 B/y $147 B/yMedical costs 6.5% 9.1%

Increased prevalence, not increased per capita costs, was the main driver of the increase in costs

Finkelstein et al. Health Affairs 2009; 28:w822

Costs of Obesity – 1998 vs. 2008

Average Daily Energy Gap (kcal/day): 1988-1994 to 1999-2002

Excess Weight Gained

(Lb)Daily Energy Gap

(kcal/day)

All Teens 10 110 -165

Overweight Teens 58 678 -1,017

Behavioral implications of 150 kcal:Replacing 1 can of soda (12 oz) with water (140 kcal)Reducing TV watching by an hour (167 kcal/day)1

Walking 1.9 hours instead of sitting (for a 30-kg boy) Increasing PE from 1 to 3 times/week (240 kcal)

Wang YC et al. Pediatrics 2006;118:e1721Wiecha et al. 2006; Arch Pediatric Adolesc Med 160:436

Principal TargetsPrenatal periodReduce energy intake

Decrease high and increase low ED foods Increase fruit and vegetable intakeReduce sugar-sweetened beveragesDecrease television time

BreastfeedingIncrease energy expenditure

Increase daily physical activity

Priority Strategies to Address Target Behaviors

Priority Strategies to Address Target Behaviors

Energy densityApply nutrition standards in child care and schoolsPromote menu labeling in states and communitiesIncrease retail food stores in underserved areas

Fruits and vegetablesIncrease access through retail storesFarm to where you are policiesFood policy councils

Sugar-sweetened beveragesEnsure access to safe and good tasting waterLimit accessDifferential pricing strategies

Priority Strategies to Address Target Behaviors

Priority Strategies to Address Target Behaviors

Television viewingRegulations to limit TV time in child care settingsLimit food advertising directed at children

BreastfeedingPolicies and environmental supports in maternity carePolicy and environmental supports in worksites State and national coalitions to support breastfeeding

Physical activityCommunity-wide campaignsIncrease access with informational outreachIncrease opportunities for PA in school settings

New Focus Areas

Trans fatSodiumMenu labeling Point of purchaseFood marketing to children

- Media: promotional campaigns, advertising standards- Access: restricted access to less healthful products,

improved food availability in rural and urban settings- Price: competitive pricing, crop subsidies- Promotion/Point of purchase: front of pack labels- Social support: food policy councils

MMWR 2009;58: RR7

MAPPS Strategies to Improve Nutrition and Increase Physical Activity to

Prevent and Control Obesity

• Medical settings

• Child care

• School

• Worksite

• Community

• Medical settings

• Child care

• School

• Worksite

• Community

Settings for the Prevention and Settings for the Prevention and Treatment of ObesityTreatment of Obesity

Fast Food and Children’s Hospitals

Fast Food and Children’s Hospitals

200 pediatric residency programs59 (29.5%) had fast food restaurants

- 17 (8.5%) McDonalds alone- 5 (2.5%) McDonalds and others- 37 (18.5%) other

Sahud HB et al. Pediatrics 2006;118:2290

Environment

Family

School

Worksite

Community

Chronic Care Model

Medical System

Information Systems

Decision Support

Delivery System Design

Self Management Support

Family/PatientSelf-Management

Dietz WH et al. Health Affairs 2007;26:430

Settings for the Prevention and Treatment of Obesity

Settings for the Prevention and Treatment of Obesity

• Medical settings• Child care• School• Worksite• Community

• Medical settings• Child care• School• Worksite• Community

Childcare InitiativesChildcare Initiatives

Focus on state polices related to nutrition, physical activity, and obesity Identification of model policiesDevelopment of a surveillance system to assess state progress

Georgia’s Nutrition and Physical Activity Regulations in Child Care Centers (1998)Georgia’s Nutrition and Physical Activity Regulations in Child Care Centers (1998)

+ Water freely available+ Sugar-sweetened beverages limited+ Foods of low nutritional value limited+ Children not forced to eat+ Screen time limited- Food not used as a reward- Support provided for breastfeeding-Physical activity required

Benjamin SE et al. BMC Public Health 2009;8:188

School Health Profiles; MMWR 2009;58:1102

Median % Changes in Schools in which Students Could not Buy Unhealthy Snack Foods and

Beverages: 2002-2008

%

Settings for the Prevention and Treatment of Obesity

Settings for the Prevention and Treatment of Obesity

• Medical settings• Child care• School• Worksite• Community

• Medical settings• Child care• School• Worksite• Community

Strategies for Community Interventions

Strategies for Community Interventions

Recommended Community Strategies and Measurements to Prevent Obesity in the United States; MMWR 2009;58:RR-7

Local Government Actions to Prevent Childhood Obesity. www.nap.edu

National Physical Activity PlanNational Physical Activity Plan

• Establishes physical activity as a priority• Plan and framework for action• Describes government, non-government, and private sector actions to increase physical activity• Defines accountability

Sectors in National Physical Activity Plan

Sectors in National Physical Activity Plan

• Mass media• Public health• Education• Healthcare• Volunteer and non-profit organizations• Transportation, urban design and city planning • Business and industry• Parks, recreation, fitness and sports

National Initiatives National Initiatives

Let’s MoveChildhood Obesity Interdepartmental Task on Childhood ObesityHHS Task Force on Obesity

Pillars of Let’s MovePillars of Let’s Move

Helping parents make healthy choicesServing healthier foods in schoolsAccessing healthy affordable food Increasing physical activity

Upcoming EventsUpcoming EventsMarch 17 – Release of 4/6 guidance documentsApril 22 – Release of the IOM Report on SodiumApril 28 - National Nutrition SummitMay 2 - Release of the NAP for Physical ActivityMay – Release of PA State Indicator ReportMay – FDA release of FOP researchJune – Release Dietary Guidelines for AmericansJuly – Submission of recommendations for voluntary standards for food marketed to childrenAugust - 2010 Surgeon General’s CTA on Breastfeeding

National Nutrition SummitNational Nutrition Summit

Event co-sponsored by HHS and USDA to highlight progress in changing the food environment- Changes in federal food policy- Progress in schools- Progress in consumer information - Criteria for sodium reduction in selected food categories

Upcoming EventsUpcoming Events

March 17 – Release of 4/6 guidance documentsApril 22 – Release of the IOM Report on SodiumApril 28 - National Nutrition SummitMay 2 - Release of the NAP for Physical ActivityMay – Release of PA State Indicator ReportMay – FDA release of FOP researchJune – Release Dietary Guidelines for AmericansJuly – Submission of recommendations for voluntary standards for food marketed to childrenAugust - 2010 Surgeon General’s CTA on Breastfeeding