Obesity: Myths, Challenges, and Successes William H. Dietz MD, PhD Former Director Division of Nutrition Physical Activity, and Obesity Centers for Disease Control and Prevention

Obesity Trends Among U.S. Adults BRFSS, 1991

Obesity Trends Among U.S. Adults BRFSS, 1993

Obesity Trends Among U.S. Adults BRFSS, 1995

Obesity Trends Among U.S. Adults BRFSS, 1997

Obesity Trends Among U.S. Adults BRFSS, 1999

Obesity Trends Among U.S. Adults BRFSS, 2001

No Data 25% Obesity Trends Among U.S. Adults BRFSS, 2003

Obesity Trends Among U.S. Adults BRFSS, 2005 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends Among U.S. Adults BRFSS, 2007 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends Among U.S. Adults BRFSS, 2009 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends Among U.S. Adults BRFSS, 2010 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends Among U.S. Adults BRFSS, 2010 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Ogden et al. 2012, NCHS data brief. Adults 20+ years Obesity Trends in Adults over the Past 12 Years

Prevalence of Obesity in Boys NHANES Ogden et al; JAMA 2012; 307:483-90

Prevalence of Obesity in Girls NHANES Ogden et al; JAMA 2012; 307:483-90

Prevalence of Obesity in Girls NHANES Ogden et al; JAMA 2012; 307:

Obesity Trends in Youth over the Past 12 Year s Ogden et al. 2012, NCHS data brief

Year Thousands per year Great Depression End of WW II 1st Surgeon General’s report 1st Surgeon General’s report Broadcast advertising ban Federal cigarette tax doubles Federal cigarette tax doubles Fairness Doctrine messages on TV and radio Fairness Doctrine messages on TV and radio Nonsmoker’s rights movement begins Nonsmoker’s rights movement begins 1st smoking cancer concern 1st smoking cancer concern Surgeon General’s report on environmental Tobacco smoke Surgeon General’s report on environmental Tobacco smoke Master settlement agreement Master settlement agreement Nicotine medications Available over the counter Nicotine medications Available over the counter 1st World Conference on smoking and health 1st World Conference on smoking and health st Great American smokeout 1st Great American smokeout Annual Adult per Capita Cigarette Consumption and Major Smoking and Health Events- US

Myths and Misconceptions

Shifts in Food Practices in the United States  Increased cost of healthful foods  Decreased cost and increased caloric density of processed foods  Increased portion size  Widespread availability  Increased variety  Designed for palatability and shelf-life

Changes in Dietary Habits and Weight Change Weight Change over Years Mozaffarian D et al. NEJM :2392

Evidence-based Community Design Street- and community-scale urban design and land use

Strategies for a Health Care System

Social Ecological Model t lll Individual Federal and State Community Interpersonal Greatest Impact Smallest Impact Institutions Federal, state and local policies to regulate and support healthy actions Knowledge, attitudes, beliefs and behaviors Family, peers, social networks Policy, regulations and informal structures Policies, standards, social networks

Let’s Move Initiatives Let’s Move Outside (Parks and Recreation) Let’s Move Cities and Towns Chefs Move to Schools Let’s Move Salad Bars to Schools Let’s Move Child Care Challenge Let’s Move in Indian Country

Nutrition and Physical Activity Targets for a Health Care System Reduce energy intake Decrease high and increase low energy dense foods Increase fruit and vegetable intake Reduce sugar drinks Decrease television time (advertising time) Breastfeeding Increase energy expenditure Increase daily physical activity

Healthy Kids Out of School: Drink Right, Snack Smart, Move More

So How Do We Get from Here to There?

Panel Discussion