ASTHPHND Federal Update: Centers for Disease Control and Prevention

1. ASTHPHND Federal Update: Centers for Disease Control and Prevention William H. Dietz, MD, PhD Director of the Division of Nutrition, Physical Activity, and Obesity Centers for Disease Control and Prevention

2. Changes in Obesity Prevalence by Race/ethnicity Boys 2-19 Years Ogden CL et al. JAMA 2008;299:2401; Ogden CL et al. JAMA. 2010 303(3):242-9.

3. Changes in Obesity Prevalence by Race/ethnicity Girls 2-19 Years Ogden CL et al. JAMA 2008;299:2401; Ogden CL et al. JAMA. 2010 303(3):242-9.

4. Changes in Prevalence of Obesity in Men 1999-2008 Prevalence Year Flegal KM et al. JAMA 2010;303:235

5. Changes in Prevalence of Obesity in Women 1999-2008 Prevalence Year Flegal KM et al. JAMA 2010;303:235

6. Costs of Adult Obesity – 1998 vs 2008 19982008 Total costs $78.5 B/y $147 B/y Medical 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

7. New Opportunities Let’s Move Empower parents Healthier foods in schools Physical activity Access to affordable healthy food Childhood Obesity Task Force HHS Healthy Weight Task Force National Action Plan for Physical Activity Dietary Guidelines for Americans Child Nutrition Reauthorization Surgeon General’s Call to Action on Breastfeeding

8. CPPW Initiatives$650 million

10. States Funded for Nutrition and Physical Activity CPPW comp I CPPW comp II 805 also with CPPW

11. 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.

12. Average Daily Energy Gap (kcal/day) Between 1988-94 and 1999-2002 Sugar-sweetened beverages (SSBs) = 250 Kcal/d Only 21-50 Kcal/d of calories from SSBs consumed in schools Healthy Weight Commitment – 1.5 trillion Kcal reduction 12.5 Kcal per capita

13. 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

14. MAPPS Strategies Media Access Point of Purchase / Promotion Price Social Support & Services

15. MAPPS • Media • FTC/CDC/FDA/USDA Working Group • Promote physical activity and healthy food/drink choices • Counter-advertising for unhealthy choices

16. 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

17. MAPPS • Point of Purchase/Promotion • Signage • Product placement • Menu labeling • Front of Pack labeling

18. MAPPS • Price • Competitive pricing • Incentives • Subsidies

19. MAPPS • Social Support and Services • Support Breastfeeding • Activity groups

22. Multiple Evaluation Components Policy and/or Environmental Changes Risk Behavior and Risk Factor Change Improved Health Outcomes MAPPS Strategies Activities and Milestones BRFSS, YRBS Impact (Biometric) evaluation System dynamic modeling ARRA Output Measure ARRA Outcome Measure Cost study Case study

23. Potential New Partners • American Academy of Pediatrics • Business community • Food retailers • Fruit and vegetable growers • Grain industry

24. U.S. State Regulations for Obesity Prevention in Child Care: Findings