ASTHPHND Federal Update: Centers for Disease Control and Prevention

ASTHPHND Federal Update: Centers for Disease Control and Prevention

William H. Dietz, MD, PhDDirector of the Division of Nutrition, Physical

Activity, and ObesityCenters for Disease Control and Prevention

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

0

10

20

30

40

50

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008

Perc

en

t

Non-Hispanic White Non-Hispanic Black Mexican American

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

0

10

20

30

40

50

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008

Perc

en

t

Non-Hispanic White Non-Hispanic Black Mexican American

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 Men 1999-2008

05

10152025303540

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008

WhiteBlackM-A

Prevalence

Year

Flegal KM et al. JAMA 2010;303:235

Changes in Prevalence of Obesity in Women 1999-2008

0

10

20

30

40

50

60

1999-2000

2001-2002

2003-2004

2005-2006

2007-2008

WhiteBlackM-A

Prevalence

Year

Costs of Adult Obesity – 1998 vs 2008Costs of Adult Obesity – 1998 vs 2008

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

New OpportunitiesNew Opportunities

Let’s MoveEmpower parentsHealthier foods in schoolsPhysical activityAccess to affordable healthy food

Childhood Obesity Task ForceHHS Healthy Weight Task ForceNational Action Plan for Physical ActivityDietary Guidelines for AmericansChild Nutrition ReauthorizationSurgeon General’s Call to Action on Breastfeeding

CPPW Initiatives$650 million

805 also with CPPW

CPPW comp I

States Funded for Nutrition and Physical Activity

CPPW comp II

Trans Fatty Acid and Sodium in the U.S. Diet

• Major source produced by partially hydrogenating vegetable oil Reducing TFA intake from 2.5% to 0.5% of energy intake could prevent 12,000-82,000 deaths per year

• 77% sodium from processed foods. Salt reduction to 3gm/d may reduce new CHD by 60,000-120,000/y, stroke by 32,000-66,000/y, and deaths by 44,000-92,000/y. Savings projected at $10-24 billion/y.

Average Daily Energy Gap (kcal/day) Between 1988-94 and 1999-2002

Excess Weight Gained(Lb)

Daily Energy Gap (kcal/day)

All Teens 10 110 -165

Overweight Teens 58 678 -1,017

Sugar-sweetened beverages (SSBs) = 250 Kcal/dOnly 21-50 Kcal/d of calories from SSBs consumed in schools

Healthy Weight Commitment – 1.5 trillion Kcal reduction12.5 Kcal per capita

Principal Targets for Obesity Prevention and Control

Pregnancy: pre-pregnant weight, weight gain, diabetes, smoking

Reduce energy intake

Decrease high and increase low ED foods

Increase fruit and vegetable intake

Reduce sugar-sweetened beverages

Decrease television time

Breastfeeding

Increase energy expenditure

Increase daily physical activity

MAPPS Strategies

• MMediaedia• AAccessccess• PPoint of Purchase / Promotionoint of Purchase / Promotion• PPricerice• SSocial Support & Servicesocial Support & Services

MAPPS

• Media– FTC/CDC/FDA/USDA Working Group– Promote physical activity and healthy food/drink choices– Counter-advertising for unhealthy choices

MAPPS

• Access– Food/drink availability – Fresh Food Financing Initiative– Regulatory standards for sodium and trans fat– Procurement policies and practices– Farm to Institution– Safe, attractive, accessible activity– Planning and zoning– Daily quality PE in schools

MAPPS

• Point of Purchase/Promotion– Signage– Product placement– Menu labeling– Front of Pack labeling

MAPPS

• Price– Competitive pricing– Incentives– Subsidies

MAPPS

• Social Support and Services– Support Breastfeeding– Activity groups

City planning, zoning and transportation

11%

Other PA Access Strategies

3%

Promote active transportation

3%

Promote increased physical activity

4%

Require daily PA in afterschool/childcare

15%

Require daily PE in school14%

Restrict screentime 5%

Safe routes to schools7%

Safe, attractive, accessible places for

physical activity31%

Signage for neighborhood destinations in

walkable/mixed-use areas

4%Signage for public

transportation, bike lanes, boulevards

1%

Subsidized memberships to

recreational facilities1%

Workplace, faith, park, neighborhood activity

groups1%

Physical Activity MAPPS StrategiesAcross All States and Territories

N=85

Multiple Evaluation Components

MAPPS Strategies

Risk Behavior and Risk Factor Change

Policy and/or Environmental Changes

Improved Health Outcomes

Activities and Milestones

ARRA Output Measure

ARRA OutcomeMeasure

Cost studyCase study

BRFSS, YRBSImpact(Biometric)evaluation

Systemdynamicmodeling

Potential New PartnersPotential New Partners

• American Academy of Pediatrics • Business community • Food retailers• Fruit and vegetable growers • Grain industry

U.S. State Regulations for Obesity Prevention in Child Care: Findings

IndicatorChild Care Centers (# of states)

Family Child Care Homes (# of states)

Water freely available 41 34

Limit SSB 7 7

Limit low nutr. foods 9 7

No forcing to eat 32 32

No food as rewards 10 5

Support BF 9 3

Limit screen time 17 15

Required PA 3 3