1. Nutrition and Physical Activity Iowans will enjoy balanced nutrition, lead physically active lives and live in healthy communities

2. Obesity Trends Among U.S. Adults between 1985 and 2004 Source of the data: The data shown in these maps were collected through CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Each year, state health departments use standard procedures to collect data through a series of monthly telephone interviews with U.S. adults. Prevalence estimates generated for the maps may vary slightly from those generated for the states by BRFSS (http://aps.nccd.cdc.gov/brfss) as slightly different analytic methods are used. Source of the data: The data shown in these maps were collected through CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Each year, state health departments use standard procedures to collect data through a series of monthly telephone interviews with U.S. adults. Prevalence estimates generated for the maps may vary slightly from those generated for the states by BRFSS (http://aps.nccd.cdc.gov/brfss) as slightly different analytic methods are used.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

21. 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%

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

23. The Epidemic The prevalence of obesity among Iowa adults has increased by 84% from 1990 to 2004 (Behavioral Risk Factor Surveillance System BRFSS). The 2004 BRFSS data indicates 37.4% of adult Iowans are overweight, and 23.5% are obese (for a total of 61% of Iowa adults compared to the national average of 59.9%)

24. Disparities 31% of low-income children between 2 and 5 years of age in Iowa are overweight or at risk of becoming overweight. (CDC PedNSS, 2003) Overweight and obesity prevalence rises with increasing age in Iowa up to age 64. Obesity prevalence is highest (28.2%) in those with income less than $15,000. Ethnicity data not available for Iowa

25. Obj. 19-2 Total White Female Male Black Female Male Mexican American Female Male 2010 Target National Data on Adult Obesity: 1988-94 to 1999-2000 0 10 20 30 40 50 Note: Data are for ages 20 years and over, age adjusted to the 2000 standard population. Obesity is defined as BMI >= 30.0. Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Percent 1988-94

26. Children and Adolescents

27. Childhood obesity has been declared “the most pressing health concern in the country” (American Heart Association, American Stroke Association, Robert Wood Johnson Foundation, 2005)

28. Obesity in children and adolescents is associated with significant health problems such as high blood cholesterol, high blood pressure, hypertension, diabetes, and depression (American Academy of Pediatrics, 2003).

29. If current trends continue it is estimated that over one-third of the children born in the year 2000 will go on to develop diabetes (K.M. Venkat Narayan, MD, Chief of the Diabetes Epidemiology Section, Center for Disease Control and Prevention).

30. Risk of Overweight and Obesity 1 in 4 children is at risk for overweight. More than 60 percent of young people eat too much fat. Less than 20 percent of children eat the recommended 5 or more servings of fruits and vegetables each day. -Centers for Disease Control and Prevention, 2004

31. Childhood Obesity Since the 1970s, obesity prevalence has: – Doubled for preschool children aged 2-5 years – Doubled for adolescents aged 12-19 years – Tripled for children aged 6-11 years More than 9 million children and youth over 6 years are obese Similar trends in U.S. adults and adults internationally -IOM, 2004

32. Percent 1963-671971-741976-801988-94 Obj. 19-2 Percent Males 12-19 Females 12-19 National Trends in Child and Adolescent Overweight Note: Overweight is defined as BMI >= gender- and weight-specific 95th percentile from the 2000 CDC Growth Charts for the United States. Source: National Health Examination Surveys II (ages 6-11) and III (ages 12-17), National Health and Nutrition Examination Surveys I, II, III and 1999-2000, NCHS, CDC. 1999-2000 1966-70 Females 6-11 Males 6-11

33. Prevalence of Overweight Among Children and Adolescents Ages 6-19 Years - Centers for Disease Control and Prevention, 2004

34. Obj. 19-3c Total Female Male White Black Mexican American 0 10 20 30 Percent National Child and Adolescent Overweight by Race: 1988-94 to 1999-2000 Note: Overweight is defined for ages 6-19 years as BMI >= gender- and weight-specific 95th percentile from the 2000 CDC Growth Charts for the United States Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. 2010 Target 1988-94

35. Early Childhood Iowa PedNSS 2003 31% of low-income children 2-5 years of age in Iowa are overweight or at risk of becoming overweight. Overweight: 13.6% vs. 14.7% U.S. Ever Breastfed: 60% vs. 53.2% U.S. Breastfed 6 months: 27.5% vs. 21.5% U.S.

36. Prevalence of Overweight of 4th, 5th, and 6th grade youth in the UNI PANARY surveillance project Measured BMI of 2,740 4 th – 6 th grade children 60% were in the normal weight zone (70% U.S.) 20% were in the “at risk for overweight” zone (16% U.S.) 20% were in the “overweight” zone (15% U.S.) Joens-Matre, Welk, Russell, Nicklay, & Hensley (2005). Medicine and Science in Sports and Exercise. May Supplement.

37. Prevalence of Overweight of 4th, 5th, and 6th grade youth from Urban, Small Cities, and Rural areas in the PANARY surveillance project Urban Small Cities Rural Normal weight 62.8%62.9%53.1% At-Risk for Overweight 17.8%19.5%21.8% Overweight 19.4%17.6%25.1% (Joens-Matre, Welk, Russell, Nicklay, & Hensley, 2005)

38. Iowa 2003- Consumption of Fruits and Vegetables Consume 5 or more servings per day 17% of Iowa adults 23.6% of older adults 19% of adults with income < $15,000 11.3% of adults without a HS/GED degree 22% of US adults

39. National Proportion of Vegetable Servings 1999-2000 Obj. 19-6 Note: Data are age adjusted to the 2000 standard population for adults 20 years and over. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Children 2-19 yearsAdults 20 years and over Dark green/ orange 8% Tomatoes 9% Legumes 6% All others 22% Other potatoes 10% Fried potatoes 46% Dark green/ orange 11% Tomatoes 11% Legumes 8% All others 35% Other potatoes 13% Fried potatoes 22% Target = At least 1/3 dark green/orange

40. Average number of servings Objs. 19-5 19-6 Fruits and Vegetables: U.S. Average Number of Daily Servings by Race: 1999- 2000 Minimum Recommended Note: Data are age-adjusted to the 2000 standard population for ages 2 years and over. Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Fruits Vegetables Total WhiteBlackMexican American

41. 0 Age-adjusted percent 2010 Target 30 401020 1999 2002 50 Obj. 22-2 Moderate Physical Activity for U.S. Adults by Race/Ethnicity Note: Data are for ages 18 years and over, age adjusted to the 2000 standard population. Moderate physical activity is regular leisure-time physical activity (moderate activity 30+ minutes/5+ times a week or vigorous activity 20+ minutes/3+ times a week). American Indian includes Alaska Native. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. I = 95% confidence interval. Source: National Health Interview Survey, NCHS, CDC. White American Indian Hispanic Asian Black

42. Iowa 2003- Meet the recommended amount of physical activity 43% of Iowa adults (Men- 45%; Women- 42%) 32% of older adults 38% of adults with income < $15,000 36% of adults without a HS/GED degree 47% of U.S. adults meet the recommended amount of physical activity

43. Vigorous Physical Activity for U. S. Adolescents by Grade Level: 2001 11th 10th Obj. 22-7 9th Percent 12th Note: Vigorous physical activity is activity that made students in grades 9-12 sweat or breathe hard for 20+ minutes on 3+ of the past 7 days. I = 95% confidence interval. Source: Youth Risk Behavior Surveillance System, NCCDPHP, CDC.

44. Benefits of Proper Nutrition and Physical Activity Increased bone density Enhanced cardiac wellness Longer-term reductions in weight and cholesterol levels Improvements in body composition Lower risk for many chronic diseases Support of child growth and development Improved grades in school Decreased incidents of tobacco and alcohol use -Centers for Disease Control and Prevention, 2004

45. Cost of Overweight Today’s children will be the first generation in memory to have a shorter life span than their parents. - Sir John Krebs, Chairman of the United Kingdom’s Food Standards agency Iowans pay $783 million in health care costs for problems associated with obesity - ~17% is covered by Medicaid & Medicare (Finkelstein, Fiebelkorn, & Wang, 2004) Overweight children report lower quality of life than children with cancer.

46. Promoting Nutrition & Physical Activity CDC Planning Grant

47. CDC’s Charge Write a comprehensive state plan, involving a wide range of community partners Describe the plan in terms of the social- ecological model Base plan on science-based interventions or promising interventions

48. Scope of Activities Conduct Community Forums Visit with professionals at conferences & meetings Invite partners to a Kick Off Summit to begin process of writing a plan Form Channel Work Groups to write portions of the plan

49. Iowans Fit for Life Work Groups Early Childhood Educational Settings Older Iowans Health Care Community Business and Agriculture

50. Comprehensive State Plan Goals Prevent and reduce the level of obesity in Iowans through improved nutrition, physical activity and supportive environments. Reduce obesity through integration, coordination, and collaboration among organizations and entities that share expertise and maximize resources of existing programs and partnerships.

51. Social-Ecological Model

52. Target Audience PolicyEnvironmental Support Venue for Message Delivery Child Healthy lifestyles modeled in home All children have access to healthy foods, physical activity and a nurturing environment Alternatives to TV After school programs School meals Schools & child care Media WIC Individual Level of the Social Ecological Model Other Target Audiences: Adolescents, young adults, middle aged, elderly, persons with disabilities

53. Behavior Change Strategies Increase breastfeeding initiation and duration Reduce TV viewing Increase physical activity Increase fruit and vegetable consumption Other dietary changes such as decreasing soft drink intake or reducing portion sizes Increase parental involvement, but not parental control

54. Child Care and Afterschool Settings: The Perfect Venue to Promote Healthy Lifestyles Dietary behaviors and habits of physical activity have their origins in early childhood. Child care serves many of the specific groups of children—minorities and those in poverty—most at risk for being overweight. School-age children are likely to be sedentary in the afterschool hours if not given active options. Providers act as liaisons to parents who make critical nutrition and fitness decisions for their children.

55. Strategies to Promote Nutrition and Physical Activity Program Policy Funding

56. Program Strategies Games and Activities Curricula and Lesson Plans Engaging Parents

57. Policy Strategies Develop physical activity and nutrition guidelines for child care and afterschool programs Provide physical activity and nutrition training for child care and afterschool providers Help child care and afterschool programs access food nutrition entitlement programs

58. Creative Finance Strategies Make better use of existing resources Create more flexibility in existing categorical funding Build public-private partnerships

59. Today’s Activity Identify potential partners. Identify potential resources. Identify existing efforts that relate to the focus areas of nutrition, physical activity, breastfeeding, and/or screen time.