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ASTHPHND Federal Update: Centers for Disease Control and Prevention
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Transcript of ASTHPHND Federal Update: Centers for Disease Control and Prevention
ASTHPHND Federal Update: Centers for Disease Control and Prevention
ASTHPHND Federal Update: Centers for Disease Control and Prevention
William H. Dietz, MD, PhDDirector of the Division of Nutrition, Physical
Activity, and ObesityCenters for Disease Control and Prevention
Changes in Obesity Prevalence by Race/ethnicity Boys 2-19 Years
0
10
20
30
40
50
1999-2000 2001-2002 2003-2004 2005-2006 2007-2008
Perc
en
t
Non-Hispanic White Non-Hispanic Black Mexican American
Ogden CL et al. JAMA 2008;299:2401; Ogden CL et al. JAMA. 2010 303(3):242-9.
Changes in Obesity Prevalence by Race/ethnicity Girls 2-19 Years
0
10
20
30
40
50
1999-2000 2001-2002 2003-2004 2005-2006 2007-2008
Perc
en
t
Non-Hispanic White Non-Hispanic Black Mexican American
Ogden CL et al. JAMA 2008;299:2401; Ogden CL et al. JAMA. 2010 303(3):242-9.
Flegal KM et al. JAMA 2010;303:235
Changes in Prevalence of Obesity in Men 1999-2008
05
10152025303540
1999-2000 2001-2002 2003-2004 2005-2006 2007-2008
WhiteBlackM-A
Prevalence
Year
Flegal KM et al. JAMA 2010;303:235
Changes in Prevalence of Obesity in Women 1999-2008
0
10
20
30
40
50
60
1999-2000
2001-2002
2003-2004
2005-2006
2007-2008
WhiteBlackM-A
Prevalence
Year
Costs of Adult Obesity – 1998 vs 2008Costs of Adult Obesity – 1998 vs 2008
1998 2008 Total costs $78.5 B/y $147 B/yMedical costs 6.5% 9.1%
Increased prevalence, not increased per capita costs, was the main driver of the increase in costs
Finkelstein et al. Health Affairs 2009; 28:w822
New OpportunitiesNew Opportunities
Let’s MoveEmpower parentsHealthier foods in schoolsPhysical activityAccess to affordable healthy food
Childhood Obesity Task ForceHHS Healthy Weight Task ForceNational Action Plan for Physical ActivityDietary Guidelines for AmericansChild Nutrition ReauthorizationSurgeon General’s Call to Action on Breastfeeding
CPPW Initiatives$650 million
805 also with CPPW
CPPW comp I
States Funded for Nutrition and Physical Activity
CPPW comp II
Trans Fatty Acid and Sodium in the U.S. Diet
• Major source produced by partially hydrogenating vegetable oil Reducing TFA intake from 2.5% to 0.5% of energy intake could prevent 12,000-82,000 deaths per year
• 77% sodium from processed foods. Salt reduction to 3gm/d may reduce new CHD by 60,000-120,000/y, stroke by 32,000-66,000/y, and deaths by 44,000-92,000/y. Savings projected at $10-24 billion/y.
Average Daily Energy Gap (kcal/day) Between 1988-94 and 1999-2002
Excess Weight Gained(Lb)
Daily Energy Gap (kcal/day)
All Teens 10 110 -165
Overweight Teens 58 678 -1,017
Sugar-sweetened beverages (SSBs) = 250 Kcal/dOnly 21-50 Kcal/d of calories from SSBs consumed in schools
Healthy Weight Commitment – 1.5 trillion Kcal reduction12.5 Kcal per capita
Principal Targets for Obesity Prevention and Control
Pregnancy: pre-pregnant weight, weight gain, diabetes, smoking
Reduce energy intake
Decrease high and increase low ED foods
Increase fruit and vegetable intake
Reduce sugar-sweetened beverages
Decrease television time
Breastfeeding
Increase energy expenditure
Increase daily physical activity
MAPPS Strategies
• MMediaedia• AAccessccess• PPoint of Purchase / Promotionoint of Purchase / Promotion• PPricerice• SSocial Support & Servicesocial Support & Services
MAPPS
• Media– FTC/CDC/FDA/USDA Working Group– Promote physical activity and healthy food/drink choices– Counter-advertising for unhealthy choices
MAPPS
• Access– Food/drink availability – Fresh Food Financing Initiative– Regulatory standards for sodium and trans fat– Procurement policies and practices– Farm to Institution– Safe, attractive, accessible activity– Planning and zoning– Daily quality PE in schools
MAPPS
• Point of Purchase/Promotion– Signage– Product placement– Menu labeling– Front of Pack labeling
MAPPS
• Price– Competitive pricing– Incentives– Subsidies
MAPPS
• Social Support and Services– Support Breastfeeding– Activity groups
City planning, zoning and transportation
11%
Other PA Access Strategies
3%
Promote active transportation
3%
Promote increased physical activity
4%
Require daily PA in afterschool/childcare
15%
Require daily PE in school14%
Restrict screentime 5%
Safe routes to schools7%
Safe, attractive, accessible places for
physical activity31%
Signage for neighborhood destinations in
walkable/mixed-use areas
4%Signage for public
transportation, bike lanes, boulevards
1%
Subsidized memberships to
recreational facilities1%
Workplace, faith, park, neighborhood activity
groups1%
Physical Activity MAPPS StrategiesAcross All States and Territories
N=85
Multiple Evaluation Components
MAPPS Strategies
Risk Behavior and Risk Factor Change
Policy and/or Environmental Changes
Improved Health Outcomes
Activities and Milestones
ARRA Output Measure
ARRA OutcomeMeasure
Cost studyCase study
BRFSS, YRBSImpact(Biometric)evaluation
Systemdynamicmodeling
Potential New PartnersPotential New Partners
• American Academy of Pediatrics • Business community • Food retailers• Fruit and vegetable growers • Grain industry
U.S. State Regulations for Obesity Prevention in Child Care: Findings
IndicatorChild Care Centers (# of states)
Family Child Care Homes (# of states)
Water freely available 41 34
Limit SSB 7 7
Limit low nutr. foods 9 7
No forcing to eat 32 32
No food as rewards 10 5
Support BF 9 3
Limit screen time 17 15
Required PA 3 3