CDC Division of Nutrition, Physical Activity and Obesity Activities

ASNNA Annual MeetingFebruary 16, 2010

Christa Essig, MPH

Division of Nutrition, Physical Activity and ObesityCenters for Disease Control and Prevention

FNCS/USDA Detail

The findings and conclusions herein are those of the author(s) and do not necessarily represent the official position of

the Centers for Disease Control and Prevention

1998

Obesity Trends Among U.S. AdultsBRFSS, 1990, 1998, 2006

2006

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity negatively impacts the nation’s economy

Medical costs associated with obesity for the United States have risen to

$147 billion in 2008 dollars.

Finkelstein et al., 2009

F&V Consumption

U.S. Fruit and Vegetable ConsumptionDaily Frequency Among Adults and Adolescents

27.4

14.0

32.8

13.2 9.5

32.2

Healthy People 2010 Fruit

Healthy People 2010 Vegetable

0

25

50

75

100

≥2 Fruit ≥3 Vegetables Both ≥2 Fruit and≥3 Vegetables

Pre

va

len

ce

Adults

Adolescents

2007 BRFSS and YRBS data

Only 1 in 10 youth eat enough F&V

Division of Adult and Community HealthAction Institutes and Training

Tools for Community Action • Community Health Resources Database• Community Health Assessment and Group Evaluation (CHAN

GE) Tool• Action Guides

Evaluation and Innovation • Program Monitoring and Evaluation • Program Success Stories • Journal Articles on Program Successes

http://www.cdc.gov/healthycommunitiesprogram/

Division of Adolescent and School Health

DASH State Programs: Coordinated School Health (22 states)

http://www.cdc.gov/HealthyYouth/partners/funded/cshp.htm

http://www.cdc.gov/HealthyYouth/about/index.htm

Division of Nutrition, Physical Activity and Obesity

DNPAO State Programs: Nutrition, PA, and Obesity (25 states)

www.cdc.gov/nccdphp/dnpa/obesity/state_programs

DNPAO Goals

• Increase health-related physical activity through population-based approaches.

• Improve those aspects of dietary quality most related to population burden of chronic disease and unhealthy child development.

• Decrease prevalence of obesity through prevention of excess weight gain and maintenance of healthy weight loss.

Activities SupportPrinciple Target Areas

• Environments/policies that foster - Physical activity

- Consumption of fruits and vegetables

- Breastfeeding

• Environments/policies that discourage

- Television viewing - Consumption of sugar-sweetened beverages

- Consumption of high-energy dense foods

(high calorie/low nutrient foods)

Strategies to Support Behavior TargetsTo Decrease Consumption of High Energy Dense Diets

Apply nutrition standards in childcare, school, and workplace settings

Promote menu labeling in states and communities Support interventions for retail food in underserved areas

To Decrease Consumption of Sugar-Sweetened BeveragesEnsure ready access to safe and palatable (quality) drinking water Limit access to sugar-sweetened beverages Decrease relative cost of healthy beverages through

differential pricing and/or taxation of sugar-sweetened beverages

To Increase Fruit and Vegetable ConsumptionEstablish food policy councils Support farm-to-where-you-are programs Improve access to retail food stores that provide fruits and vegetables

Story, M., K. M. Kaphingst, et al. (2008). "Creating healthy food and eating environments: policy and environmental approaches." Annual Rev Public Health 29: 253-72, Figure 1.

Why Focus on Policy & Environment?

High

Low

CostHigh

Low

Reach

Policies

Health Communication Environment/ecological approaches

Activities no feedbackHealth Systems

Activities w/ feedback, follow-up

SpecialtyCare

Community &Neighborhood Collaboration

Primary Care

CDC Supports State-Based Nutrition, Physical Activity, and Obesity Programs

• Currently funds 25 states, with a total of $16.1 million a year – average of $700,000 per state award

• CDC contributes to the development of state obesity programs by providing states with:

- program funding - training - technical assistance - program oversight

• For more information:Claire HeiserDivision of Nutrition, Physical Activity, and ObesityE-mail: cheiser@cdc.govWeb site: http://www.cdc.gov/obesity/stateprograms/index.html

Community Guide

Promoting Physical Activity: • Environmental and policy approaches are designed to provide

environmental opportunities, support, and cues to help people be more physically active.

• The physical environment • Social networks • Organizational norms and policies • Laws • Public health professionals, community organizations, legislators,

departments of parks, recreation, transportation, and planning, and the media

http://www.thecommunityguide.org/pa/environmental-policy/index.html

CDC Recommended Community Strategies and Measurements to

Prevent Obesity in the US

http://www.cdc.gov/obesity/downloads/community_strategies_guide.pdf

Promote the Availability of Affordable Health Foods and Beverages

Communities should: • Increase availability of healthier food and beverage

choices in public service venues• Improve availability of affordable healthier food and

beverage choices in public service venues • Improve geographic availability of supermarkets in

underserved areas • Provide incentives to food retailers to locate in and/or

offer healthier food and beverage choices in underserved areas

• Improve availability of mechanisms for purchasing foods from farms

• Provide incentives for the production, distribution, and procurement of foods from local farms

American Recovery and Reinvestment Act

Prevention and Wellness Initiative• Emphasis on policy and environmental

change at state and local levels:

- Increase levels of physical activity; - Improve nutrition; - Decrease obesity rates; and - Decrease smoking prevalence, teen smoking initiation, and exposure to

second-hand smoke.

www.cdc.gov/chronicdisease/recovery

Examples of Policies and Programs

– Improving access to healthy foods in schools through changes in school meal planning and purchasing across the state.

– Increasing physical activity among school children by implementing improvements to physical education programs and expanding the number of minutes students are physically active.

– Promoting breastfeeding through hospital and workplace policies to support initiation and continuation of breastfeeding.

– Reducing exposure to secondhand tobacco smoke through statewide policies limiting smoking in public and work places.

MAPPS - Nutrition

• Media• Access• Point of Purchase/ Promotion• Price• Social Support and Services

http://www.cdc.gov/chronicdisease/recovery/

Media

• Media and advertising restrictions consistent with federal law

• Promote healthy food/drink choices

• Counter-advertising for unhealthy choices

Access• Healthy food/drink availability (e.g., incentives to food

retailers to locate/offer healthier choices in underserved areas, healthier choices in child care, schools, worksites)

• Limit unhealthy food/drink availability (whole milk, sugar sweetened beverages, high-fat snacks)

• Reduce density of fast food establishments• Eliminate transfat through purchasing actions, labeling

initiatives, restaurant standards• Reduce sodium through purchasing actions, labeling

initiatives, restaurant standards• Procurement policies and practices• Farm to institution, including schools, worksites,

hospitals and other community institutions

Point of Purchase/Promotion• Signage for healthy vs. less healthy items• Product placement & attractiveness• Menu labeling

Price• Changing relative prices of healthy vs. unhealthy

items (e.g. through bulk purchase/procurement/competitive pricing).

Social Support & Services• Support breastfeeding through policy change

and maternity care practices

Quality Control

• Project officer oversight, provide tools, guidance and TA

• Monitor performance and outcomes• Ongoing feedback to maximize health impact of

projects

• CDC and HHS will use the lessons learned from the initiative to improve the design and delivery of their state and local health promotion and disease prevention programs

Final Award Amounts for State and Territory Component

• CDC received 58 applications—from all 50 states • All applicants receive funding for efforts in nutrition, physical

activity, and tobacco control.

• TOTAL AWARD AMOUNT $119,067,687

http://www.cdc.gov/chronicdisease/recovery/docs/State_prevention_and_wellness_ARRA_awards_fact_sheet.pdf

Lessons from Previous Health Promotion

Merzel C. D’Afflitti, J. Reconsidering community-based health promotion: Promise, performance, and potential. American Journal of Public Health. 2003; 93(4):557-574.

Modest impact is due in part to:

•Addressing few ecological levels

•Insufficient tailoring to community

Economic development

Healthy individuals

Small & medium scale farm viability

Community & social vitality

Jobs

Farmland preservation

Environmental stewardship

Growing food

Distributing

Retailing

Eating

Preparing (e.g., restaurants)

Processing

Community- based

food system

CDC Resources

• Community Recommendations:www.cdc.gov/obesity/downloads/community_strategies_guide.pdf

• The State Indicator Report on Fruits and Vegetables, 2009: http://www.fruitsandveggiesmatter.gov/indicatorreport

• DNPAO State Legislation Database: http://apps.nccd.cdc.gov/DNPALeg/

• ARRAwww.cdc.gov/chronicdisease/recovery

• State Programs www.cdc.gov/obesity/stateprograms/index.html

• http://www.cdc.gov/nccdphp/dnpao• http://www.cdc.gov/healthyyouth/