California Department of Public Health Ronald W. Chapman, MD, MPH Director and State Health Officer California Department of Public Health Obesity in California “Prevention is the Best Treatment”

California Department of Public Health Obesity Rates Obesity rates nearly tripled among low-income children and teens in California over the past 30 years. 1 Nearly one in three California youth ages 10 – 17 years are overweight or obese. 2 In 1985 nearly 8% of adults in California were obese. In 2010 that tripled to almost 24%. 3

California Department of Public Health OverweightObese Children (low-income 2-4 years) 2010 United States California 95% C.I. for California 16.1% 16.0%,16.2% 17.3% 14.4% 14.3%,14.5% Youth (10-17 years) United States California 95% C.I. for California 15.3% 15.5% 10.5%,20.5% 16.4% 15.0% 9.9%,20.1% Adults 2012 United States California 95% C.I. for California 35.8% 35.3% 34.2%,36.5% 27.6% 25.0% 23.9%,26.0% Obesity Rates: US vs. CA by Age Group

California Department of Public Health Obesity rates among low-income children age 2 – 4 years in California declined Obesity Rates

California Department of Public Health In California obesity-attributable medical costs were $15.2 billion annually (2009 dollars) with 41.5% publically financed. 4 Lost productivity costs associated with overweight and obesity in California were $8.2 billion (2006 data) 5 If adult BMI was reduced by 5% California could save $81.7 billion in obesity-related health care costs by The Cost of Obesity in California

California Department of Public Health Obesity increases the risk of many health conditions: 2 – Coronary heart disease, stroke, and high blood pressure – Type 2 diabetes – Cancers, such as endometrial, breast, and colon cancer – High total cholesterol or high levels of triglycerides – Liver and gallbladder disease – Sleep apnea and respiratory problems – Degeneration of cartilage and underlying bone within a joint (osteoarthritis) – Reproductive health complications such as infertility – Mental health conditions Contributes to some of the leading causes of preventable death 3 Health Consequences of Obesity

California Department of Public Health Strategic Priorities to Prevent Obesity and Chronic Disease Increase access to and consumption of healthy foods and drink Decrease access to and consumption of less healthy foods and drinks Increase opportunities for safe physical activity through healthy community/transportation design Decrease sedentary behavior

California Department of Public Health Obesity Factors Protective Factors Risk Factors Breastfeeding 5 – Exclusive (only breast milk) for at least 6 months – Longer duration Dietary practices – Fruit and vegetable consumption 6-11  Regular physical activity Dietary practices – Sugar-sweetened beverages – High calorie, low nutrient foods 16 Screen time – Television viewing Sedentary behavior

California Department of Public Health Nearly half of the added sugars consumed by Americans come from SSB 6  Children and adolescents who consume more SSB have higher body weight compared to those who drink less, and some evidence also supports this relationship in adults Sugar-Sweetened Beverages (SSB) and Obesity

California Department of Public Health Proportion of adolescents who drank 2 or more glasses of soda or other sugary drinks per day – California target17% – California baseline 1 27% – California update 2 30% – National targetN/A – National baseline 3 20% – National update 4 19% Let’s Get Healthy California Indicator: Sugar Sweetened Beverages, Adolescents California Health Interview Survey California Health Interview Survey Youth Risk Behavior Survey, 9 th – 12 th grader students Youth Risk Behavior Survey, 9 th – 12 th grader students

California Department of Public Health Strong evidence indicates that regular PA helps people maintain a healthy weight and prevent excess weight gain 17,18 Proportion of Californians who get the recommended amount of PA – 45.6% of preschoolers 27 – 30.4% of school-age children 27 – 16.1% of adolescents 27 – 25.3% of adults 28 Physical Activity (PA) in California

California Department of Public Health Walking, bicycling, and public transit use contributes to daily physical activity, aerobic fitness, and cardiovascular health while helping to protect against obesity, diabetes, and other diseases 1–9 19 Active transportation in the US has decreased over time. Each additional hour per day spent in a car is associated with a 6% increase in the likelihood of obesity (59)59 Active Transport and Obesity

California Department of Public Health Safe Physical Activity and Active Transportation Design communities to safely accommodate pedestrians, bicyclists and public transit users as well as vehicles – complete streets Safe Routes to School Partner with transportation and traffic safety agencies on California Transportation Plan 2040 and Public Transit Plan

California Department of Public Health Proportion of children and adolescents who score 6 of 6 on the required California school Fitnessgram test Grade – California target36% 46%52% – California baseline 1 25%32%37% – California update N/AN/AN/A – National targetNCNCNC – National baseline 2 NCNCNC – National update 2 NCNCNC Let’s Get Healthy California Indicator: Fitnessgram, Youth California Fitness Report 2 NC = No comparable national data source

California Department of Public Health Living closer to healthy food retail is associated with decreased risk for obesity and other diet- related diseases 42 There are 2.2 farmers’ markets per 100,000 residents in California (vs. 2.5 nationally) 43 Nearly one-third of adults in California reported having limited access to quality, affordable, and fresh FV in their neighborhood 33 Access to Healthy Food and Obesity

California Department of Public Health Those living near an abundance of fast-food restaurants and convenience stores have a significantly higher prevalence of obesity and diabetes 44 Fast-food restaurants are often located near schools, 45 and such close proximity has been linked to increased risk of obesity in schoolchildren 46 In 2005, there were 4 times as many fast food restaurants and convenience stores than supermarkets and produce vendors in CA 47 Access to Unhealthy Food and Obesity

California Department of Public Health Proportion of adults who have consumed fruits and vegetables five or more times per day – California target34% – California baseline 1 28% – California update 2 27% – National targetN/A – National baseline 1 24% – National update 3 NC Let’s Get Healthy California Indicator: Fruits and Vegetables, Adults Behavioral Risk Factor Surveillance Survey Behavioral Risk Factor Surveillance Survey 3 NC = No comparable national data source is available – data no longer reported in the same format

California Department of Public Health Behavior Change Programs Increase referrals to, and use of, behavior change programs for people with chronic disease that increase physical activity, healthy eating and self-management Walk With Ease Chronic Disease Self-Management Program Diabetes Self-Management Education WISEWOMAN

California Department of Public Health California Wellness Plan Goals Overarching: Equity in Health and Wellness 1.Healthy Communities 2.Optimal Health Systems Linked with Community Preventive Services 3.Accessible and Usable Health Information 4.Prevention Sustainability and Capacity

California Department of Public Health Advancing Prevention in the 21 st Century February 13-14, 2014 in Sacramento Four Focus Areas with strategies and action steps for collaborative work over the next 2 years Showcase best practices Obtain commitments from partners to contribute resources to Focus Areas Keynote presentations will be available online

California Department of Public Health California Obesity Prevention Plan Developed in 2006 with extensive stakeholder input – Plan updated in 2010 – To be updated again in 2014 Current data and trends Streamline and focus strategies Used to: – Guide CDPH’s obesity prevention work – Provide background information for the public – Inform: grant proposals program strategies and policy for partners

California Department of Public Health Nutrition Education and Obesity Prevention NEOP Local assistance grants to local health departments and community organizations Training and technical assistance – Breastfeeding trainings – Local school wellness support Resources – Case studies – Toolkits – Nutrition standards – The NEOP Children’s Power Play! Campaign improved daily fruits and vegetables intake