2. Childhood Obesity: A National Focus Christopher Roller Director of Advocacy and State Health Alliances American Heart Association, Nevada Presentation to the WCHD Childhood Obesity Forum, September 15 th, 2010

3. Outline - Nature of the problem - Brief history - Causes of the epidemic - National recommendations and guidelines - Resources - Policy solutions

6. How Bad Is The Problem? - About one in three children and teens in the U.S. is overweight or obese. - Overweight kids have a 70–80 percent chance of staying overweight their entire lives. - Obese and overweight adults now outnumber those at a healthy weight; - Nearly seven in 10 U.S. adults are overweight or obese.

7. 1999 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2008 Source: CDC Behavioral Risk Factor Surveillance System 2008 1990 No Data <10% 10%–14% 1 5%–19% 20%–24% 25%–29% ≥30%

8. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

9. Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

10. Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

11. Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

12. Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

13. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

14. Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

15. Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

16. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

17. Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

18. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

19. Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

20. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

21. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

22. Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

23. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

24. Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

25. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

26. Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

27. Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

28. Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

29. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

30. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

31. Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

32. Growth in Childhood Obesity, 1971 to Present: Source: CDC, National Center for Health Statistics, National Health and Nutrition Examination Surveys

33. Causes of the Epidemic Source: American Heart Association - Growing portion sizes - Poor nutrition - Dining out more - Moving less

34. Causes of the Epidemic Growing Portion Sizes Americans are eating more Portions have grown dramatically in recent decades People eat more when served bigger portions

35. Causes of the Epidemic Less Nutrition/Poor Choices Americans are eating more and more foods that are high in calories but don’t meet their nutritional needs. A majority of Americans are not getting enough vitamins and nutrients through healthy foods, such as fat-free or low-fat dairy, whole grains, fruits and vegetables. French fries are the most common “vegetable” consumed by children

36. Causes of the Epidemic Dining Out People dine out more than ever before. When people dine out, they consume more calories than if they eat at home. Away-from-home meals contain fewer fruits, vegetables and whole grains than foods prepared at home.

37. Causes of the Epidemic Lack of Physical Activity Children are not getting enough physical activity. Fitness and physical activity habits established in childhood are key indicators for health in adulthood. Most children get more than the recommended limit of two hours of screen time per day.

38. Causes of the Epidemic Source: White House Task Force on Childhood Obesity, Report to the President Other Contributing Factors: - Pre birth and genetic - Socioeconomic - Racial and ethnic - Regional

39. Recommendations

40. - Alliance For a Healthier Generation

41. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry

42. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics

43. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics - American Heart Association

44. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics - American Heart Association - American Diabetes Association

45. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics - American Heart Association - American Diabetes Association - American Dietetic Association

46. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics - American Heart Association - American Diabetes Association - American Dietetic Association - American Medical Association

47. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics - American Heart Association - American Diabetes Association - American Dietetic Association - American Medical Association - Centers for Disease Control

48. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics - American Heart Association - American Diabetes Association - American Dietetic Association - American Medical Association - Centers for Disease Control - DHHS (synthesis of guidelines)

49. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics - American Heart Association - American Diabetes Association - American Dietetic Association - American Medical Association - Centers for Disease Control - DHHS (synthesis of guidelines) - Institute of Medicine

50. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics - American Heart Association - American Diabetes Association - American Dietetic Association - American Medical Association - Centers for Disease Control - DHHS (synthesis of guidelines) - Institute of Medicine - Johns Hopkins

51. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics - American Heart Association - American Diabetes Association - American Dietetic Association - American Medical Association - Centers for Disease Control - DHHS (synthesis of guidelines) - Institute of Medicine - Johns Hopkins - National Heart Lung and Blood Institute

52. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics - American Heart Association - American Diabetes Association - American Dietetic Association - American Medical Association - Centers for Disease Control - DHHS (synthesis of guidelines) - Institute of Medicine - Johns Hopkins - National Heart Lung and Blood Institute - National Initiative for Children’s Healthcare Quality

53. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics - American Heart Association - American Diabetes Association - American Dietetic Association - American Medical Association - Centers for Disease Control - DHHS (synthesis of guidelines) - Institute of Medicine - Johns Hopkins - National Heart Lung and Blood Institute - National Initiative for Children’s Healthcare Quality - Nemours

54. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics - American Heart Association - American Diabetes Association - American Dietetic Association - American Medical Association - Centers for Disease Control - DHHS (synthesis of guidelines) - Institute of Medicine - Johns Hopkins - National Heart Lung and Blood Institute - National Initiative for Children’s Healthcare Quality - Nemours - The Obesity Society

55. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics - American Heart Association - American Diabetes Association - American Dietetic Association - American Medical Association - Centers for Disease Control - DHHS (synthesis of guidelines) - Institute of Medicine - Johns Hopkins - National Heart Lung and Blood Institute - National Initiative for Children’s Healthcare Quality - Nemours - The Obesity Society - Robert Wood Johnson Foundation

56. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics - American Heart Association - American Diabetes Association - American Dietetic Association - American Medical Association - Centers for Disease Control - DHHS (synthesis of guidelines) - Institute of Medicine - Johns Hopkins - National Heart Lung and Blood Institute - National Initiative for Children’s Healthcare Quality - Nemours - The Obesity Society - Robert Wood Johnson Foundation - Society for Nutrition Education

57. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics - American Heart Association - American Diabetes Association - American Dietetic Association - American Medical Association - Centers for Disease Control - DHHS (synthesis of guidelines) - Institute of Medicine - Johns Hopkins - National Heart Lung and Blood Institute - National Initiative for Children’s Healthcare Quality - Nemours - The Obesity Society - Robert Wood Johnson Foundation - Society for Nutrition Education - The Surgeon General

58. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics - American Heart Association - American Diabetes Association - American Dietetic Association - American Medical Association - Centers for Disease Control - DHHS (synthesis of guidelines) - Institute of Medicine - Johns Hopkins - National Heart Lung and Blood Institute - National Initiative for Children’s Healthcare Quality - Nemours - The Obesity Society - Robert Wood Johnson Foundation - Society for Nutrition Education - The Surgeon General - USDA

59. Recommendations - Alliance For a Healthier Generation - American Academy of Child and Adolescent Psychiatry - American Academy of Pediatrics - American Heart Association - American Diabetes Association - American Dietetic Association - American Medical Association - Centers for Disease Control - DHHS (synthesis of guidelines) - Institute of Medicine - Johns Hopkins - National Heart Lung and Blood Institute - National Initiative for Children’s Healthcare Quality - Nemours - The Obesity Society - Robert Wood Johnson Foundation - Society for Nutrition Education - The Surgeon General - USDA - The U.S. Preventative Services Task Force

60. Recommendations Let’s Move Campaign www.letsmove.gov Partnership for a Healthier America www.ahealthieramerica.org

61. Recommendations White House Task Force - 70 Recommendations - Federal action - State or local action - Private sector action - Incorporates recommendations from most available sources

62. Recommendations White House Task Force - Women to be at a healthy weight at conception and avoid excess weight gain during pregnancy. - Breast-feeding to be encouraged: Studies show babies fed this way are 22 percent less likely to become obese. - Smaller restaurant portions and posting of calorie information. - Schools to serve more fruits in lunches and vending machines. - The USDA to add 2 million children to the school lunch program by 2015.

63. Recommendations White House Task Force - A 50 percent increase in high school students attending daily physical-education classes. - Recess classes in elementary schools to increase by 95 percent. - Updated federal nutrition standards for meals served at schools and more school-based nutrition education. - Pediatricians to check patients' body mass index, a height-weight calculation used to measure body fat. - A standard nutrition label on the front of packaged foods.

64. Recommendations White House Task Force - The food industry and beverage industry to limit the marketing of unhealthy products to children, with government regulation as a last resort. - Economic incentives to eradicate "food deserts," urban and rural areas with few grocery stores. - Insurance plans to cover services necessary to treat and prevent childhood obesity. - Using cartoon characters to promote only healthy food. Source: The Washington Post, May 12 th 2010

65. Recommendations Health Care Providers - In 2007 the AMA convened an expert panel consisting of representatives of 15 organizations - Tasked with developing recommendations for the assessment, prevention and treatment of childhood and adolescent obesity - Available in articles published as a supplemental issue of Pediatrics. The issue is: PEDIATRICS Vol. 120 Supplement December 2007 http://pediatrics.aappublications.org/cgi/content/full/120/Supplement_4/S229

66. Recommendations - American Academy of Pediatrics - American Dietetic Association - National Association of Pediatric Nurse Practitioners - Association of American Indian Physicians - American Heart Association - National Association of School Nurses - American College of Sports Medicine - The Obesity Society (formerly NAASO) - The Endocrine Society - American College of Preventive Medicine - American Academy of Child and Adolescent Psychiatry - National Medical Association

67. AHA Resources: - Understanding Childhood Obesity, Statistical Sourcebook - AHA Recommendations, Overweight in Children - AHA Scientific Position, Physical Activity and Children - AHA Scientific Position, Dietary Guidelines for Healthy Children - How to Raise Healthier Kids http://www.heart.org/HEARTORG/GettingHealthy/WeightManag ement/Obesity/Childhood-Obesity_UCM_304347_Article.jsp

68. How Much Do You Care?

78. So What Can I Do About It?

79. Federal Legislation - Child Nutrition Act - FIT Kids - Menu Labeling - Others (HCR, CPPW)

80. Federal Legislation Child Nutrition Act - Takes steps to improve nutrition, school wellness policies and food access in schools - Passed Senate and awaiting action in the House www.heart.org/childnutritionpetition

81. Federal Legislation FIT Kids Act - Aims to prioritize quality physical education and increase opportunities for physical activity in schools - Would amend the No Child Left Behind Act to encourage schools to provide regular, quality physical education and promote healthy lifestyles www.fitkidsact.org

82. Federal Legislation Menu Labeling - Provision included in the Patient Protection and Affordable Care Act (health care reform bill). - Requires restaurants, retail food establishments and vending machine operators with more than 20 locations nationwide to list nutrition information

83. Federal Legislation Others - Other provisions in health care reform too numerous to mention - Communities Putting Prevention to Work (CPPW) and other grants from the CDC and DHHS

84. State and Local Policies Physical Education Requirements - 150 minutes in elementary and 225 minutes in middle school - Remove exemptions, waivers and substitutions - Enhanced standards requiring PE be taught by certified/licensed PE teachers - At least 50% of class time involve activity

85. State and Local Policies Nutrition and PA Requirements - Require nutrition standards that are consistent with the Healthy Schools Program or equivalent standards - Creation and strengthening of school wellness policies - Promote policies that incorporate activity into the school day - Promote obesity prevention strategies in early childhood programs and childcare

86. You’re the Cure Network www.yourethecure.org - “Take action” on federal and state policies - Keep informed on policy solutions and the science behind them

87. Questions?