F as in Fat, 2008: Why Obesity Policies are Failing in America Jeffrey Levi, PhD Executive Director Trust for America’s Health September 17, 2008

Key Findings: F as in Fat, 2008  Adult obesity rates rose for a second consecutive year in 24 states and for a third consecutive year in 19 states, with no states experiencing a decrease.  More than 25 percent of adults are obese in 28 states, an increase from 19 states last year.  More than 20 percent of adults are obese in every state except Colorado.  Rates of type 2 diabetes grew in 26 states last year.  Seven of the top 10 states with the highest obesity rates are also in the top 10 for highest poverty rates.

Key Findings: F as in Fat, 2008 RankStatePercentage of Adult Obesity (Based on combined data) 1Mississippi31.7% (+/- 1.0) 2West Virginia30.6% (+/- 1.1) 3Alabama30.1% (+/- 1.2) 4Louisiana29.5% (+/- 1.0) 5South Carolina29.2% (+/- 0.8) 6Tennessee29.0% (+/- 1.2) 7Kentucky28.4% (+/- 1.0) 8 (tie)Oklahoma28.1% (+/- 0.8) 8 (tie)Arkansas28.1% (+/- 0.9) 10Michigan27.7% (+/- 0.8)

Factors Contributing to Obesity Rates  Inadequate Physical Activity For adults, physical inactivity rates range from 15.7% (Minnesota) to 31.8% (Mississippi), with the majority of states not demonstrating any statistically significant change in their rates of physical inactivity. All 50 states and DC have laws related to physical education and physical activity in schools; only 13 include enforceability language. 30 years ago, nearly half of American children walked or biked to school; today, less than one in five either walk or bike to school.

Factors Contributing to Obesity Rates  Nutrition Higher caloric intake and higher caloric density of foods influence obesity rates – adults consumed approximately 300 more calories daily in 2002 than they did in The Dietary Guidelines for Americans were updated in 2005, but the USDA school meal program has yet to adopt them. Standards for foods sold outside the school meal program are outdated. Rising food costs are putting an economic strain on Americans, making it more difficult for schools and families to purchase costlier, more nutritious fruits and vegetables.

Factors Contributing to Obesity Rates  Barriers in the Built Environment Lack of access to grocery stores and other venues that sell healthy foods can inhibit healthy eating. Communities without well-lighted sidewalks, bicycle paths, trails, parks and other recreational sites may discourage physical activity.  Health Coverage Ten states do not include specific coverage for nutrition assessment and counseling for obese and overweight children in their Medicaid programs. Twenty states explicitly do not cover nutrition assessment and consultation for obese adults under Medicaid.

Recommendation: National Strategy to Combat Obesity  We recommend the development of a comprehensive, realistic plan that involves every department and agency of the federal government, state and local governments, businesses, communities, schools, families, and individuals.  It would outline roles and responsibilities and set national goals so that agencies, businesses, families and communities can implement policies, programs and practices in their purview that aim to curtail obesity levels.  The National Strategy for Pandemic Influenza Planning can serve as a model for this approach.

Recommendation: Increase Funding for Obesity Prevention  Many chronic disease prevention programs have been flat-funded for the past few years.  Without additional funding, CDC’s chronic disease prevention programs cannot expand to all 50 states and in some cases have had to decrease the number of grantees due to insufficient funding.

Recommendation: Increase Funding for Obesity Prevention

Prevention for a Healthier America: Financial Return on Investment? INVESTMENT:$10 per person per year HEATH CARE COST NET SAVINGS: $16 Billion annually within 5 years RETURN ON INVESTMENT (ROI): $5.60 for every $1 With a Strategic Investment in Proven Community-Based Prevention Programs to Increase Physical Activity and Good Nutrition and Prevent Smoking and Other Tobacco Use