William H. Dietz, MD, PhD Division of Nutrition, Physical Activity, and Obesity Centers 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 (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 (3):242-9.

Flegal KM et al. JAMA 2010;303:235 Changes in Prevalence of Obesity in Women Prevalence Year

Flegal KM et al. JAMA 2010;303:235 Changes in Prevalence of Obesity in Men Prevalence Year

Total costs$78.5 B/y $147 B/y Medical 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): to Excess Weight Gained (Lb) Daily Energy Gap (kcal/day) All Teens Overweight Teens ,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:e1721 Wiecha et al. 2006; Arch Pediatric Adolesc Med 160:436

Principal Targets Prenatal period Reduce energy intake Decrease high and increase low E D foods Increase fruit and vegetable intake Reduce sugar-sweetened beverages Decrease television time Breastfeeding Increase energy expenditure Increase daily physical activity

Priority Strategies to Address Target Behaviors Energy density Apply nutrition standards in child care and schools Promote menu labeling in states and communities Increase retail food stores in underserved areas Fruits and vegetables Increase access through retail stores Farm to where you are policies Food policy councils Sugar-sweetened beverages Ensure access to safe and good tasting water Limit access Differential pricing strategies

Priority Strategies to Address Target Behaviors Television viewing Regulations to limit TV time in child care settings Limit food advertising directed at children Breastfeeding Policies and environmental supports in maternity care Policy and environmental supports in worksites State and national coalitions to support breastfeeding Physical activity Community-wide campaigns Increase access with informational outreach Increase opportunities for PA in school settings

New Focus Areas Trans fat Sodium Menu labeling Point of purchase Food 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 Settings for the Prevention and Treatment of Obesity

Fast Food and Children’s Hospitals 200 pediatric residency programs 59 (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/Patient Self-Management Dietz WH et al. Health Affairs 2007;26:430

Settings for the Prevention and Treatment of Obesity Medical settings Child care School Worksite Community

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

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: %

Settings for the Prevention and Treatment of Obesity Medical settings Child care School Worksite Community

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.

National 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 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 Let’s Move Childhood Obesity Interdepartmental Task on Childhood Obesity HHS Task Force on Obesity

Pillars of Let’s Move Helping parents make healthy choices Serving healthier foods in schools Accessing healthy affordable food Increasing physical activity

Upcoming Events March 17 – Release of 4/6 guidance documents April 22 – Release of the IOM Report on Sodium April 28 - National Nutrition Summit May 2 - Release of the NAP for Physical Activity May – Release of PA State Indicator Report May – FDA release of FOP research June – Release Dietary Guidelines for Americans July – Submission of recommendations for voluntary standards for food marketed to children August Surgeon General’s CTA on Breastfeeding

National 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 Events March 17 – Release of 4/6 guidance documents April 22 – Release of the IOM Report on Sodium April 28 - National Nutrition Summit May 2 - Release of the NAP for Physical Activity May – Release of PA State Indicator Report May – FDA release of FOP research June – Release Dietary Guidelines for Americans July – Submission of recommendations for voluntary standards for food marketed to children August Surgeon General’s CTA on Breastfeeding