Nutrition and Physical Activity

1. Nutrition and Physical Activity Iowans will enjoy balanced nutrition, lead physically active lives and live in healthy communities

2. Obesity Trends Among U.S. Adults between 1985 and 2004 • Source of the data: • The data shown in these maps were collected through CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Each year, state health departments use standard procedures to collect data through a series of monthly telephone interviews with U.S. adults. • Prevalence estimates generated for the maps may vary slightly from those generated for the states by BRFSS (http://aps.nccd.cdc.gov/brfss) as slightly different analytic methods are used.

3. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1985 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

4. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1986 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

5. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1987 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

6. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1988 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

7. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1989 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

8. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

9. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1991 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

10. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1992 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

11. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1993 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

12. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1994 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

13. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

14. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1996 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

15. No Data <10% 10%–14% 15%–19% ≥20 Obesity Trends* Among U.S. AdultsBRFSS, 1997 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

16. No Data <10% 10%–14% 15%–19% ≥20 Obesity Trends* Among U.S. AdultsBRFSS, 1998 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

17. No Data <10% 10%–14% 15%–19% ≥20 Obesity Trends* Among U.S. AdultsBRFSS, 1999 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

18. No Data <10% 10%–14% 15%–19% ≥20 Obesity Trends* Among U.S. AdultsBRFSS, 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

19. Obesity Trends* Among U.S. AdultsBRFSS, 2001 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

20. Obesity Trends* Among U.S. AdultsBRFSS, 2002 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

21. Obesity* Trends Among U.S. AdultsBRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

22. Obesity* Trends Among U.S. AdultsBRFSS, 2004 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

23. The Epidemic • The prevalence of obesity among Iowa adults has increased by 84% from 1990 to 2004 (Behavioral Risk Factor Surveillance System BRFSS). • The 2004 BRFSS data indicates 37.4% of adult Iowans are overweight, and 23.5% are obese (for a total of 61% of Iowa adults compared to the national average of 59.9%)

24. Disparities • 31% of low-income children between 2 and 5 years of age in Iowa are overweight or at risk of becoming overweight. (CDC PedNSS, 2003) • Overweight and obesity prevalence rises with increasing age in Iowa up to age 64. • Obesity prevalence is highest (28.2%) in those with income less than $15,000. • Ethnicity data not available for Iowa

25. National Data on Adult Obesity: 1988-94 to 1999-2000 2010 Target 1988-94 Total White Female Male Black Female Male Mexican American Female Male 0 10 20 30 40 50 Percent Note: Data are for ages 20 years and over, age adjusted to the 2000 standard population. Obesity is defined as BMI >= 30.0. Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Obj. 19-2

26. Children and Adolescents

27. Childhood obesity • has been declared “the most pressing health concern in the country” (American Heart Association, American Stroke Association, Robert Wood Johnson Foundation, 2005)

28. Obesity in children and adolescents • is associated with significant health problems such as high blood cholesterol, high blood pressure, hypertension, diabetes, and depression (American Academy of Pediatrics, 2003).

29. If current trends continue • it is estimated that over one-third of the children born in the year 2000 will go on to develop diabetes (K.M. Venkat Narayan, MD, Chief of the Diabetes Epidemiology Section, Center for Disease Control and Prevention).

30. Risk of Overweight and Obesity • 1 in 4 children is at risk for overweight. • More than 60 percent of young people eat too much fat. • Less than 20 percent of children eat the recommended 5 or more servings of fruits and vegetables each day. -Centers for Disease Control and Prevention, 2004

31. Childhood Obesity • Since the 1970s, obesity prevalence has: • Doubled for preschool children aged 2-5 years • Doubled for adolescents aged 12-19 years • Tripled for children aged 6-11 years • More than 9 million children and youth over 6 years are obese • Similar trends in U.S. adults and adults internationally -IOM, 2004

32. National Trends in Child and Adolescent Overweight Percent Percent Males 12-19 Males 6-11 Females 12-19 Females 6-11 1963-67 1971-74 1976-80 1988-94 1999-2000 1966-70 Note: Overweight is defined as BMI >= gender- and weight-specific 95th percentile from the 2000 CDC Growth Charts for the United States. Source: National Health Examination Surveys II (ages 6-11) and III (ages 12-17), National Health and Nutrition Examination Surveys I, II, III and 1999-2000, NCHS, CDC. Obj. 19-2

33. Prevalence of Overweight Among Children and Adolescents Ages 6-19 Years -Centers for Disease Control and Prevention, 2004

34. National Child and Adolescent Overweight by Race: 1988-94 to 1999-2000 2010 Target 1988-94 Total White Black Mexican American Female Male 0 10 20 30 Percent Note: Overweight is defined for ages 6-19 years as BMI >= gender- and weight-specific 95th percentile from the 2000 CDC Growth Charts for the United States Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Obj. 19-3c

35. Early ChildhoodIowa PedNSS 2003 • 31% of low-income children 2-5 years of age in Iowa are overweight or at risk of becoming overweight. • Overweight: 13.6% vs. 14.7% U.S. • Ever Breastfed: 60% vs. 53.2% U.S. • Breastfed 6 months: 27.5% vs. 21.5% U.S.

36. Prevalence of Overweight of 4th, 5th, and 6th grade youth in the UNI PANARY surveillance project • Measured BMI of 2,740 4th – 6th grade children • 60% were in the normal weight zone (70% U.S.) • 20% were in the “at risk for overweight” zone (16% U.S.) • 20% were in the “overweight” zone (15% U.S.) Joens-Matre, Welk, Russell, Nicklay, & Hensley (2005). Medicine and Science in Sports and Exercise. May Supplement.

37. Prevalence of Overweight of 4th, 5th, and 6th grade youth from Urban, Small Cities, and Rural areas in the PANARY surveillance project (Joens-Matre, Welk, Russell, Nicklay, & Hensley, 2005)

38. Iowa 2003-Consumption of Fruits and Vegetables Consume 5 or more servings per day • 17% of Iowa adults • 23.6% of older adults • 19% of adults with income < $15,000 • 11.3% of adults without a HS/GED degree • 22% of US adults

39. Fried potatoes Fried potatoes 22% Other 46% Tomatoes potatoes 11% 13% Tomatoes Legumes Other Dark green/ 9% 8% potatoes orange 10% Legumes Dark 11% 6% All others All others green/ 22% 35% orange 8% National Proportion of Vegetable Servings 1999-2000 Children 2-19 years Adults 20 years and over Target = At least 1/3 dark green/orange Note: Data are age adjusted to the 2000 standard population for adults 20 years and over. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Obj. 19-6

40. Fruits and Vegetables: U.S. Average Number of Daily Servings by Race: 1999-2000 White Black Mexican American Average number of servings Total Minimum Recommended Vegetables Fruits Note: Data are age-adjusted to the 2000 standard population for ages 2 years and over. Black and white exclude persons of Hispanic origin. Persons of Mexican-American origin may be any race. Source: National Health and Nutrition Examination Survey, NCHS, CDC. Objs. 19-5 19-6

41. Moderate Physical Activity for U.S. Adults by Race/Ethnicity 2010 Target American Indian 1999 Asian 2002 Black White Hispanic 30 0 10 20 40 50 Age-adjusted percent Note: Data are for ages 18 years and over, age adjusted to the 2000 standard population. Moderate physical activity is regular leisure-time physical activity (moderate activity 30+ minutes/5+ times a week or vigorous activity 20+ minutes/3+ times a week). American Indian includes Alaska Native. Black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. I = 95% confidence interval. Source: National Health Interview Survey, NCHS, CDC. Obj. 22-2

42. Iowa 2003-Meet the recommended amount of physical activity • 43% of Iowa adults (Men- 45%; Women- 42%) • 32% of older adults • 38% of adults with income < $15,000 • 36% of adults without a HS/GED degree • 47% of U.S. adults meet the recommended amount of physical activity

43. Vigorous Physical Activity for U. S. Adolescents by Grade Level: 2001 Percent 10th 9th 11th 12th Note: Vigorous physical activity is activity that made students in grades 9-12 sweat or breathe hard for 20+ minutes on 3+ of the past 7 days. I = 95% confidence interval. Source: Youth Risk Behavior Surveillance System, NCCDPHP, CDC. Obj. 22-7

44. Benefits of Proper Nutrition and Physical Activity • Increased bone density • Enhanced cardiac wellness • Longer-term reductions in weight and cholesterol levels • Improvements in body composition • Lower risk for many chronic diseases • Support of child growth and development • Improved grades in school • Decreased incidents of tobacco and alcohol use -Centers for Disease Control and Prevention, 2004

45. Cost of Overweight • Today’s children will be the first generation in memory to have a shorter life span than their parents. - Sir John Krebs, Chairman of the United Kingdom’s Food Standards agency • Iowans pay $783 million in health care costs for problems associated with obesity - ~17% is covered by Medicaid & Medicare (Finkelstein, Fiebelkorn, & Wang, 2004) • Overweight children report lower quality of life than children with cancer.

46. Promoting Nutrition & Physical Activity CDC Planning Grant

47. CDC’s Charge • Write a comprehensive state plan, involving a wide range of community partners • Describe the plan in terms of the social-ecological model • Base plan on science-based interventions or promising interventions

48. Scope of Activities • Conduct Community Forums • Visit with professionals at conferences & meetings • Invite partners to a Kick Off Summit to begin process of writing a plan • Form Channel Work Groups to write portions of the plan

49. Iowans Fit for Life Work Groups • Early Childhood • Educational Settings • Older Iowans • Health Care • Community • Business and Agriculture

50. Comprehensive State Plan Goals • Prevent and reduce the level of obesity in Iowans through improved nutrition, physical activity and supportive environments. • Reduce obesity through integration, coordination, and collaboration among organizations and entities that share expertise and maximize resources of existing programs and partnerships.