1. Border Obesity Prevention (BOP): Development of a binational strategic framework Prevención de la Obesidad en la Frontera (POF): Desarrollo de un marco estratégico binacional Ronald J. Dutton, PhD and Allison Banicki, PhD

2. Obesity among adults (2012) Source: Organization for Economic Cooperation and Development (OECD) Mexico No. 2USA No. 1

3. Childhood obesity in the U.S. (2011-12) Children and adolescents aged 2-19 years, the prevalence of obesity has remained fairly stable at about 17%. The prevalence among children and adolescents was higher among Hispanics (22.4%) and non-Hispanic blacks (20.2%) than among non-Hispanic whites (14.1%). Ref: www.cdc/obesity/data/childhood.html Page 3

4. Prevalence of obesity in Mexican adults, 2012 The epidemic of overweight and obesity in Mexico is affecting men and women of all ages, regions, urban and rural areas, SES and levels of educational attainment. The prevalence of abdominal obesity was: higher in northern Mexico than in less developed areas (central and southern regions, not including Mexico city). higher in urban areas than in rural areas. higher among those of higher SES higher among those with lower educational attainment Simón Barquera, et. al., Salud Pública Méx 2013; Vol. 55(supl. 2):S151-S160 ENSANUT 2012 (Encuesta Nacional de Salud y Nutrición) Page 4

5. Burden of Obesity in Adults (Texas 2014) AreaPrevalence Texas – non-border counties 32.0% Texas – border counties39.1% US (2013) 29.4% 5 From Behavioral Risk Factor Surveillance System (BRFSS). Data are age adjusted to the 2000 standard population using age groups 18-44, 45-64 and 65 years and over.

6. Ground zero – Cameron, County, Texas? (the southern most US-Mexico Border county) Ref: Susan Fisher-Hoch, et. al., PLOS One 10(7), 2015 10 year Cameron County Cohort (2004-2014) Cohort of 2,838 adults Average Age (46 years) Overweight (33.3%) Obesity (50.9%) Diabetes (27.6%) (16.4% diagnosed + 11.2% undiagnosed) Page 6

7. Border Obesity Prevention (BOP): activities sponsored by the Commission BOP Summit held July 16-18, 2013, in McAllen, Texas. About 240 attendees from all 10 US-Mexico border states and both federal governments (U.S. DHHS, CDC, Mexico SSA, Mexico INSP). Recommendations from BOP Summit included: Continue binational sharing of best practices, information and materials for obesity prevention programs. Work to achieve border obesity prevention through public, private, non-profit and governmental partnerships on both sides of the border. Establish a Border Obesity Prevention (BOP) Technical Work Group to develop a strategic action plan. Page 7

8. BOP Workshop August 4-6, 2015, Laredo, Texas Decided to focus on the strategic map´s Strategic Objective D1: Influence Public Policies Relevant to Obesity Prevention and used the Social Ecological Model below as a conceptual framework for organizing needs & potential interventions. Formed 4 work groups: 1)Healthy eating 2)Physical activity and active living 3)Breastfeeding and 4)Communication Workshop participants identified specific recommendations within each of those four priority areas. Page 8

9. Healthy Eating Recommendations (and selected objectives and tasks) Promote healthy foods. Increase access to healthier food choices that are consistent with national dietary guidelines. Obtain baseline nutritional data for the border region. Promote healthy beverages. Improve access to clean water. Reduce the consumption of sugary beverages. Encourage soda taxes (as have been demonstrated to reduce consumption of sugary beverages in Mexico). Page 9

10. Physical Activity and Active Living Recommendations Create a border physical activity plan to inform and support community leaders to take action and make changes to increase physical activity and active living in their communities. Develop a surveillance system to assess, evaluate and monitor physical activity levels. Incorporate physical activity into the US-Mexico Border Health Commission policies and activities (“walk the walk…”). Page 10

11. Breastfeeding Recommendations (and selected objectives and tasks) Promote laws and policies supporting breastfeeding by working mothers. Develop programs that recognize employers with worksite policies and practices that are supportive of breastfeeding. Ensure a minimum 4 months maternity leave Improve Hospital Practices Ensure that maternity care practices are fully supported for breastfeeding. Page 11

12. Communication Recommendations contd. (and selected objectives and tasks) Promote effective BOP communication messages through multiple channels, audiences and time Create health communication workshops across sister cities and states annually where entities can come together to ID messages for release that year. Work with broadcast organizations and other communication entities that already promote health related topics. Use the different channels (e.g. social media, website, radio, TV, newspaper, newsletters, texting, consumer health technologies). Page 12

13. Page 13 Border Obesity Prevention (BOP): Development of a binational strategic framework

14. Thank You!! Ronald J. Dutton, Ph.D. Director, Office of Border Health www.dshs.state.tx.us/borderhealth/ www.borderhealth.org