1. Puerto Rico: Overweight and Obesity Facts Madeline Reyes, MD, MPH Deputy Secretary Secretariat for Health Promotion Puerto Rico Department of Health PACO III - June 2013

2. Objectives Consider the overweight and obesity problem in the Puerto Rican pediatric population. Introduce available statistics. Share initiatives and strategies developed and implemented in PR.

3. Obesity Prevalence in Children younger than 5 ys beneficiaries of the WIC Program, Puerto Rico 2006-10 Source: CDC-National Pediatric Nutrition Surveillance System (PedNSS) reports, 2006-2010 BMI ≥ 85% Prevalence (%)

4. Overweight and Obesity Prevalence in Second Grade Students, Puerto Rico, 2004-05 y 2008-09 Source: PR Department of Health and Alliance for Pediatric Obesity Prevention. Study to determine obesity prevalence, nutritional habits and physical activity of 2 nd grade students and families in public and private schools 2008-2009. Prevalence (%)

5. Overweight Prevalence in 9 th -12 th Grade Students, PR 2005 y 2011 ( Percentile: > 85 ta y < 95 ta ) Source: CDC-Youth Risk Behavior Surveillance System (YRBSS), 2013 Prevalence (%)

6. Overweight & Obesity Prevalence Trends, PR 1996 to 2010 Source: Puerto Rico Department of Health, PR-BRFSS, 1996-2010 HP 2010 = 40%

7. Overweight and Obesity Prevalence in Adults Older than 18 ys by Age Group, Puerto Rico 2011 Source: Behavioral Risk Factor Surveillance System, 2013 (18-24)(25-34)(35-44)(45-54)(55-64)(65+) PrevalenciaPrevalencia (Age Group

8. Obese Puerto Ricans 2011 and… Risk Factors Prevalence of Chronic Diseases Source: Puerto Rico Department of Health, PR-BRFSS, 2011

9. Overweight & Obese Prevalence by … Education PR 2011 Income PR 2011 Source: Puerto Rico Department of Health, PR-BRFSS, 2011

10. Initiatives and Strategies Secretariat for Health Promotion Communities Putting Prevention to Work 4 municipalities: Physical Activity - Milla Verde (1 mile walking trail) Nutrition – Ordinances (healthy menus in events, healthy choices in vending machines, My Plate adapted) Tobacco – Ordinance (no smoking in public bldgs. entrance and exit areas, no sales in school surroundings) Low fat Milk consumption campaign Policies: Trans fat, Healthy menus, Vending machines Educational activities

11. Initiatives and Strategies Intersectorial collaborations: – Alliance for Pediatric Obesity Prevention – Public Policy – First Lady “Proyectos de Vida”- public agencies – Department of Sports and Recreation “Actívate Puerto Rico” – Department of Education – menus served – Department of the Family - nutrition – Coamo Saludable – ACHIEVE “Health Promoters” – Foundations – Fundación El Angel, United Way…

12. Challenges Pediatric epidemiologic surveillance for PR Public health approach to our health system with accessible chronic disease prevention and health promotion services as the number one priorities Develop and implement policies, systems and environment changes – healthier lifestyles (nutrition, phys. activity, tobacco…) at a municipal/community level Funding and Resources Synchronization and integration of interagency services and resources Early interventions

13. Thanks! Madeline Reyes, MD, MPH Deputy Secretary Secretariat for Health Promotion Puerto Rico Department of Health mareyes@salud.pr.gov 787-765-2929 Ext. 4103/4113