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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