Healthy Schools June 2011 Aruba PACO Healthy Eating and Active Living: the CDC’s Public Health Approach to Preventing and Reducing Obesity CDR Heidi Blanck, PhD Chief, Obesity Prevention and Control Branch Division of Nutrition, Physical Activity and Obesity National Center for Chronic Disease Prevention & Health Promotion Centers for Disease Control & Prevention (CDC) Healthy Schools June 2011 Aruba PACO

HHS HHS Healthy Weight Task Force Department of Health & Human Services HHS Healthy Weight Task Force The findings presented are those of the presenter and not the official views of the CDC.

Division of Nutrition, Physical Activity and Obesity (DNPAO) A world where regular physical activity, good nutrition, and a healthy weight are a part of everyone’s life Mission: Lead strategic public health efforts to prevent and control obesity, chronic disease and other health conditions through physical activity and good nutrition

Obesity Trends* Among U.S. Adults BRFSS, 2000, 2005, 2009 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2000 2005 2009 $147 Billion = Obesity Associated Health Care Spending, 2008 estimates No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Statistics More than one in six (17%) U.S. children is obese, three times the rate in the 1970’s (BMI at or above the 95% percentile of the sex-specific BMI-for-age growth charts) According to 2007-2008 data, disparities exist among youth with higher prevalence among minority racial/ethnic groups including Mexican American boys (27%) and Black girls (29%) aged 12-19 y http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm Message: Obesity is Common, Costly, and Serious Information on these obesity statistics, as well as state specific data, can be found on CDC’s Division of Nutrition Physical Activity and Obesity website: http://www.cdc.gov/obesity/data/trends.html#State Obesity Trends by State Obesity by Race Ethnicity County Specific Diabetes and Obesity Prevalence Overweight Trends Among Children and Adolescents

Age-adjusted Percentage of U. S Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes Obesity (BMI ≥30 kg/m2) 1994 2000 2008 No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0% Diabetes 1994 2000 2008 No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

National news teleconference “Obesity is a major public health problem. We need intensive and ongoing efforts to address obesity or more people will get sick and die from complications of obesity, such as heart disease, stroke, diabetes and cancer.” “Not only are the cost of obesity high…, but in addition, the economic cost are high. In 2008 medical dollars, medical cost associated with obesity were estimated at 147 billion.” “Six things can reduce or prevent obesity.” 1. Physical activity. 2. Increase the uptake and continuation of breast feeding. 3. Increase fruit and vegetable intake. 4. Reduce screen time. 5. Reduce high-calorie food intake, in particular, sugary drinks.

Public Health Approach: Focus On Supportive Environments Difficult to make a healthy choice in an unhealthy environment Working to support families in being able to have healthy choices

Multi-level, Multi-sector Prevention

Healthy eating & physical activity Making Healthy Choices Easier Individual Environment Affordability Access, availability Placement Marketing Culture Skills Knowledge Time Preferences Healthy eating & physical activity Environment

Principal Target Areas for Obesity Prevention Increase consumption of fruits and vegetables Increase breastfeeding initiation, duration, and exclusivity Increase physical activity Decrease television viewing and screentime Decrease consumption of high energy dense foods of low-nutrient value Decrease consumption of sugar drinks

Settings for the Prevention Childhood Obesity Community School Child Care Medical /hospitals Worksite - family

CDC Guidance Documents: Policy and Environmental Strategies for State and Communities Fruits & Vegetables Energy Density Sugar Sweetened Beverages Breastfeeding Physical Activity Television Viewing

Evidence-based strategies Promising Emerging Effective Research-tested, Practice-based www.center-trt.org Reach, impact, sustainability/maintenance

Strategies to Increase Fruit and Vegetable Access, Availability, and Consumption Food Policy Coalitions as a Means to Improve the Food Environment Access to Retail Venues that Sell Fruits and Vegetables in Underserved Communities Farm-to-Where-You-Are Programs in All Possible Venues Ready Access to Fruits and Vegetables in Worksite Foodservice, Meetings and Events Community and Home Gardens Policies to Incorporate Fruit and Vegetable Activities into Schools and Early learning centers/child care Include Fruits and Vegetables in Emergency Food Programs 16 16 16

7 Strategies: Reducing Sugar Drink Consumption Ensure ready access to potable drinking water Limit access to Sugar Drinks Promote access to and consumption of more healthful alternatives to Sugar Drinks Limit marketing of Sugar Drinks and minimize marketing’s impact on children Decrease the relative cost of more healthful beverage alternatives through differential pricing of Sugar Drinks Include screening and counseling about Sugar Drink consumption as part of routine medical care Expand the knowledge and skills of medical care providers to conduct nutrition screening and counseling on Sugar Drink consumption

Strategy : Ensure ready access to potable drinking water To promote water consumption, potable (clean, good tasting) drinking water should be easily accessible to children and adults in homes and public facilities, including parks, playgrounds, schools, child cares, public buildings, worksites, and clinics

Child Care-Based Program Example Strategy 1: Ensure ready access to potable drinking water Child Care-Based Program Example New York City’s Nutritional Standards for Child Care Code requires that potable drinking water be made easily accessible throughout the day, including at meals City code prohibits providing beverages with added sweeteners, whether artificial or natural Limit screentime/television viewing Support breastfeeding, pumping, use of breastmilk Spring 2011: USDA Guidance for Schools – Compliance Fall 2011, low-fat/reduced fat milk, water during mealtime

School-Based Program Examples Strategy: Promote access to and consumption of more healthful alternatives to Sugar Drinks School-Based Program Examples Nutrition standards, meals and snacks Water access Food and activity as rewards Candy, treats, limiting activity Joint use agreements Allow community members to take part in physical activity, school gardens, cooking/culinary training, making meals for family as part of aftercare programs Reduction in advertising on school campus

CDC Recommended Community Strategies and Measurements to Prevent Obesity Increase availability of healthy, affordable food and beverage choices in public service venues. Improve geographic availability of supermarkets in underserved areas. Improve access to fresh fruits and vegetables by providing incentives for the production, distribution, and procurement of foods from local farms. Limit advertisements of less-healthy foods and beverages. • Increase support for breastfeeding. • Promote exclusive breastfeeding and worksite accommodations to express human milk. Improve access to outdoor recreational facilities. • Build or enhance infrastructures to support more walking and bicycling. • Support locating schools within easy walking distance of residential areas. Improve access to public transportation Participate in community coalitions or partnerships to address obesity. http://www.cdc.gov/obesity/downloads/community_strategies_guide.pdf

Other Youth Settings -- National Park Service - Healthy and sustainable food guidelines Vendors contracts – canteens, vending machines, stores, restaurants Water fountains, refillable water stations Model for small, local parks and open spaces Healthy Parks, Healthy People

Multi-sector, Multi-level Actions Champions and civic engagement What can empowered youth do? What can parents do? What can teachers, coaches? What can employers, business leaders do? Making public health policy, public policy Co-benefits – improved school attendance  inproved academic, improved jobs/economy; improved mental health/self-esteem

Improving healthy eating and activity living is a shared responsibility. Social and environmental changes are influenced by the efforts of many… There is a role for everyone in discovering ways to create supportive environments to help individuals and families to easily make healthy food choices, enjoy a physically active lifestyle, and move toward a healthy weight.

www.cdc.gov/dnpao

U.S. FTC Marketing Principles U.S. Interagency workgroup, FTC Nutrition Marketing Principles, Voluntary Nutrient standards for foods marketed to kids Open comment period