Obesity: States Working to Slow the Epidemic

1. Obesity: States Working to Slow the Epidemic Kathleen Nolan Health Division Director National Governors Association Center for Best Practices Thank you Sec Woods for your kind introductionThank you Sec Woods for your kind introduction

2. Obesity Epidemic Rates of obesity have risen in every state and in every sub-group. In children In adults In minorities In elderly Increased obesity results in increases in diabetes, heart diseases, some cancer, and arthritis I know you heard from Dr. Lavisso-Mourey of RWJF yesterday about the impact of the rise in obesity in this country. Today, I want to talk to you about what states are doing to address stem the tide and how together we might begin to reverse it. I don�t want to overburden you with statistics. I�m sure you have all seen the maps of the spread of the epidemic. This increased rate of obesity has resulted in increases in I know you heard from Dr. Lavisso-Mourey of RWJF yesterday about the impact of the rise in obesity in this country. Today, I want to talk to you about what states are doing to address stem the tide and how together we might begin to reverse it. I don�t want to overburden you with statistics. I�m sure you have all seen the maps of the spread of the epidemic. This increased rate of obesity has resulted in increases in

4. Obesity in Children

5. If We Don�t Make Change Overweight children often become overweight adults. The risk for developing diabetes for children born in 2000: Boys 32.8% Girls 38.5% Hispanic boys 45.4% Hispanic girls 52.5% The epidemic is both more striking and more disturbing when we discuss our children. These are not retired factory workers with middle-aged bulge. These are children who will face the potential for a life-time of disability, chronic disease, and ill-health if they cannot change. Because habits of nutrition and physical activity are set early, many children who are overweight today will become overweight and obese adults. This statistic is a little confusing: not that they will develop diabetes as children, but at some point The epidemic is both more striking and more disturbing when we discuss our children. These are not retired factory workers with middle-aged bulge. These are children who will face the potential for a life-time of disability, chronic disease, and ill-health if they cannot change. Because habits of nutrition and physical activity are set early, many children who are overweight today will become overweight and obese adults. This statistic is a little confusing: not that they will develop diabetes as children, but at some point

6. Virginia versus US Overall Virginia is far from the worst: 58.8% of VA�s adults are overweight (58.7%--US) 72% of adults report eating fewer than 5 servings of fruits/veggies a day (76%--US) Deaths due to diabetes and heart disease in VA are slightly lower than the national averages. But it is difficult to look at these numbers and think �only�But it is difficult to look at these numbers and think �only�

7. The National Costs of Obesity It is estimated that overweight and obesity costs the United States as much as $117 billion dollars each year $61 billion in direct costs $56 billion for indirect costs Virginia annually spends an estimated $374 million (13.1%) of its Medicaid dollars on obesity related costs. Obese people cost 36% more for health svcs and 77% more for pharmaceuticals. Increased health care utilization Chronic diseases and their related costs (diabetes, arthritis) Pharmaceutical costs increase to address both obesity and the chronic conditions it causes and exacerbates Indirect costs (lost work time, disability, and out-of-pocket expenses for the individual and the society) Increased health care utilization Chronic diseases and their related costs (diabetes, arthritis) Pharmaceutical costs increase to address both obesity and the chronic conditions it causes and exacerbates Indirect costs (lost work time, disability, and out-of-pocket expenses for the individual and the society)

8. Why States Must Act Costs for health care rising Responsibility for public employees Private sector investment slowed or damaged Communities, Schools, health care providers, and agencies overburdened STRATEGIC ACTION REQUIRED ON ALL FRONTS But despite the slight preference by comparison, Virginia, like every other state in the nation, must face and meet the challenges of obesity prevention and control. Here are some of the costs that burden states (maid) and other health insurance costs for public and private sector. Crowd out, rising rates of uninsured and underinsured (states employ many, from teachers, to policemen to state health department staff) (lost work days, high health insurance costs)But despite the slight preference by comparison, Virginia, like every other state in the nation, must face and meet the challenges of obesity prevention and control. Here are some of the costs that burden states (maid) and other health insurance costs for public and private sector. Crowd out, rising rates of uninsured and underinsured (states employ many, from teachers, to policemen to state health department staff) (lost work days, high health insurance costs)

9. Ways to think of this issue The Individual needs to eat less and exercise more We in Government need to help them Focus on policy�make it easier for people to do this Focus on the environment Focus on support Focus on systems Focus on data Now that I�ve given you the bad news, let�s turn to the good news. Which is that there is a role (and hopefully a manageable one) for states to work in communion with public and private partners at a broad policy level, and in supporting local action. And it isn�t as if we don�t have the medical science to tell us what we need to do: eat less and exercise more. Take in fewer calories, and expend more in activity What is the states role Who are some state leaders/innovators: Arkansas�Healthy Arkansas Florida�Obesity taskforce Michigan�Prescription for Health Texas�Children�s Nutrition Now that I�ve given you the bad news, let�s turn to the good news. Which is that there is a role (and hopefully a manageable one) for states to work in communion with public and private partners at a broad policy level, and in supporting local action. And it isn�t as if we don�t have the medical science to tell us what we need to do: eat less and exercise more. Take in fewer calories, and expend more in activity What is the states role Who are some state leaders/innovators: Arkansas�Healthy Arkansas Florida�Obesity taskforce Michigan�Prescription for Health Texas�Children�s Nutrition

10. Opportunities for Prevention with Children Implementing enhanced Phys. Educ. Promoting breast-feeding Reducing television time Improving school-nutrition and nutrition education Increasing after-school programs and access to school facilities after hours So what can states and their community partners do to alter the course of this epidemic. Evidence has shown efforts aimed at some of these areas have succeeded in reducing obesity. Intervention begins early in life, and should follow the child through their school and community life to form those important habits of healthy and active lifestyles. For children, much of the focus is on the school environment as a good opportunity and an important role in children�s lives. And this is not our PE, folks. This is new, evidence-based efforts to get all kids active. Different from competitive sports to which children choose to participate So what can states and their community partners do to alter the course of this epidemic. Evidence has shown efforts aimed at some of these areas have succeeded in reducing obesity. Intervention begins early in life, and should follow the child through their school and community life to form those important habits of healthy and active lifestyles. For children, much of the focus is on the school environment as a good opportunity and an important role in children�s lives. And this is not our PE, folks. This is new, evidence-based efforts to get all kids active. Different from competitive sports to which children choose to participate

11. Opportunities for Prevention with All Virginians Community/State-wide education campaigns Promoting the use of stairs in the workplace and in public spaces Support groups and tailored programs Disease management with a focus on weight control Provide opportunities in the community for physical activity So what can states and their community partners do to alter the course of this epidemic. Much of the focus is on prevention of children from becoming overweight children and obese adults. Intervention begins early in life, and should follow the child through their school and community life to form those important habits of healthy and active lifestyles. For children, much of the focus is on the school environment as a good opportunity For adults, the focus is more on So what can states and their community partners do to alter the course of this epidemic. Much of the focus is on prevention of children from becoming overweight children and obese adults. Intervention begins early in life, and should follow the child through their school and community life to form those important habits of healthy and active lifestyles. For children, much of the focus is on the school environment as a good opportunity For adults, the focus is more on

12. Arkansas Multi-pronged approach launched by Gov. Mike Huckabee Children in schools Medicaid population focus Adults in the workplace Aging citizens Personal story that drove his public passion for improving the health of Arkansans. Medicaid population Data collection efforts to determine baseline and success. Improve access to an coverage for preventive services and disease management Reward healthy behaviors Simplify health messages Work across public and private sectorsPersonal story that drove his public passion for improving the health of Arkansans. Medicaid population Data collection efforts to determine baseline and success. Improve access to an coverage for preventive services and disease management Reward healthy behaviors Simplify health messages Work across public and private sectors

13. AR Innovations with Children BMI assessment in schools Year 1 results: 345,000 students assessed throughout the state 38 percent were obese or overweight Demographic breakdown of obesity/overweight: 40 percent of African American children 46 percent of Hispanic children 36percent of white (non-Hispanic) children

14. AR Innovations with Medicaid Recipients Offers comprehensive smoking cessation services Worked with major company in state to pilot a diabetes self-management course including weight control Developing a health risk assessment to identify people in need of intervention to prevent chronic diseases Nicotine patch, counseling, and therapy referrals Worked with Eli Lilly to develop and implement a pilot project for disease management that could be tailored (go back to the evidence idea) similar to the newly initiated Medicare assessment designed ALSO exploring incentive opportunities.Nicotine patch, counseling, and therapy referrals Worked with Eli Lilly to develop and implement a pilot project for disease management that could be tailored (go back to the evidence idea) similar to the newly initiated Medicare assessment designed ALSO exploring incentive opportunities.

15. AR Innovations with Adults Developed a program with state employees Working closely with communities and private companies to promote worksite wellness programs with employees from public and private sector Exploring implementation of incentives for healthy behaviors for insurance costs. State employee programs included a competition with a major employer in Little Rock, pedometers, and BMI assessment/education campaign. State employee programs included a competition with a major employer in Little Rock, pedometers, and BMI assessment/education campaign.

16. AR Innovations for the Aging Gov. Huckabee is focusing on pilot programs to reach aging populations with healthy behavior education and messages. Identifying opportunities for improving nutrition among aging populations in the community.

17. Michigan�s Prescription for Health Gov. Jennifer Granholm appointed the nation�s first State Surgeon General Dr. Wisdom is charged with monitoring the health of Michiganders, and for promoting improved health. Serves as a convener for a broad number of stakeholders Developed a state-wide walking campaign Although Arkansas is the only major, broad state-wide campaign, we do not expect that to remain true for long. To help guide Virginia in this, I�ll mention two other examples, and then identify some suggestions for moving forward. Michigan has tried a different approach to leading the charge against obesity. Governor Jennifer Granholm has appointed Dr. Kimberlydawn Wisdom to serve as Michigan�s Surgeon General, or chief public health advocate. WHY: Healthy Michigan 2010, an evidence-based scientific report, documented Michigan's Health Status and is the foundation for this Prescription for a�Healthier Michigan. It found a number of barriers blocking progress toward improved health: lack of a common health promotion vision and values system; inconsistent and often inadequate personal and family commitment to a healthy lifestyle; unfounded beliefs, misinformation and myths about health, and fragmented health care systems within the health community and state and local government Besides Michigan�s Prescription for a Healthier Michigan, and a state-wide walking program, Michigan is leading in creating more pedestrian friendly districts and cities. My colleague from NGA, John Ratliffe will discuss this type of effort that on the next panel.Although Arkansas is the only major, broad state-wide campaign, we do not expect that to remain true for long. To help guide Virginia in this, I�ll mention two other examples, and then identify some suggestions for moving forward. Michigan has tried a different approach to leading the charge against obesity. Governor Jennifer Granholm has appointed Dr. Kimberlydawn Wisdom to serve as Michigan�s Surgeon General, or chief public health advocate. WHY: Healthy Michigan 2010, an evidence-based scientific report, documented Michigan's Health Status and is the foundation for this Prescription for a�Healthier Michigan. It found a number of barriers blocking progress toward improved health: lack of a common health promotion vision and values system; inconsistent and often inadequate personal and family commitment to a healthy lifestyle; unfounded beliefs, misinformation and myths about health, and fragmented health care systems within the health community and state and local government Besides Michigan�s Prescription for a Healthier Michigan, and a state-wide walking program, Michigan is leading in creating more pedestrian friendly districts and cities. My colleague from NGA, John Ratliffe will discuss this type of effort that on the next panel.

18. Florida Gov. Bush formed a task force on Obesity A list of recommendations were forwarded to the Governor, and served as a basis for several bills: Called for the creation of standards and guidelines for school nutrition and phys ed Created a wellness program for state employees Governor Jeb Bush has also seen a need for a solution to this epidemic. On October 25, 2003, Governor Bush signed an executive agreement for a Governor�s Task Force on the Obesity Epidemic. This task force was created to review the burden of obesity on Florida, and to make recommendations by February 2004 on how Florida can combat this problem. The task force members along with the Governor convened public meetings across the state to listen to experts in the fields of nutrition, physical activity, medicine, and epidemiology. They finalized a list of recommendations based on the consensus of the task force members. After the recommendations were received by the Governor, a 2004 legislative package consisting of 3 bills was proposed. The first bill consisted of directing the Department of Education to implement guidelines relating to school nutrition and physical education (SB 354). The second bill incorporated the Department of Health to be active in promoting healthy lifestyles (HB 935). And the final bill, created a wellness program for state employees (HB 913). Governor Jeb Bush has also seen a need for a solution to this epidemic. On October 25, 2003, Governor Bush signed an executive agreement for a Governor�s Task Force on the Obesity Epidemic. This task force was created to review the burden of obesity on Florida, and to make recommendations by February 2004 on how Florida can combat this problem. The task force members along with the Governor convened public meetings across the state to listen to experts in the fields of nutrition, physical activity, medicine, and epidemiology. They finalized a list of recommendations based on the consensus of the task force members. After the recommendations were received by the Governor, a 2004 legislative package consisting of 3 bills was proposed. The first bill consisted of directing the Department of Education to implement guidelines relating to school nutrition and physical education (SB 354). The second bill incorporated the Department of Health to be active in promoting healthy lifestyles (HB 935). And the final bill, created a wellness program for state employees (HB 913).

19. A few additional examples Texas Dept of Ag requirements for school lunches CDC stairwell improvement project Promoting stairwell use with music, art, etc. California soda ban in schools No soft drink sales allowed on campuses (vending or a la carte) Another state in the South has done amazing things in regards to what is served in our children�s cafeterias. Texas Agriculture Commissioner Susan Combs is leading the charge. Texas is only one of two states that the Department of Agriculture is in charge of the school lunch and breakfast programs. (the other is NJ). Since the commissioner is elected, he/she has the authority to implement any policy decisions. A couple of things that Texas has done: School campuses may not serve or provide access for students of foods of minimal nutritional value by USDA standards at any time. French fries and other fried potato products must not exceed 3 ounces per serving, and students can only purchase one serving. It is recommended that they be baked. Schools should eliminate frying as a method of on-site preparation. All schools must be in compliance by 2009. Beginning with the 2005-2006 school year, schools should include a request for trans fat information in all product specifications. By 2006, all beverages would be milk (2%, 1%, or skim), water or 100% fruit juice. Teachers are allowed to offer snacks but they need to fall under the guidelines of foods of minimal nutrition value. This means no cookies, cupcakes, pudding, etc. Another state in the South has done amazing things in regards to what is served in our children�s cafeterias. Texas Agriculture Commissioner Susan Combs is leading the charge. Texas is only one of two states that the Department of Agriculture is in charge of the school lunch and breakfast programs. (the other is NJ). Since the commissioner is elected, he/she has the authority to implement any policy decisions. A couple of things that Texas has done: School campuses may not serve or provide access for students of foods of minimal nutritional value by USDA standards at any time. French fries and other fried potato products must not exceed 3 ounces per serving, and students can only purchase one serving. It is recommended that they be baked. Schools should eliminate frying as a method of on-site preparation. All schools must be in compliance by 2009. Beginning with the 2005-2006 school year, schools should include a request for trans fat information in all product specifications. By 2006, all beverages would be milk (2%, 1%, or skim), water or 100% fruit juice. Teachers are allowed to offer snacks but they need to fall under the guidelines of foods of minimal nutrition value. This means no cookies, cupcakes, pudding, etc.

20. So what can VA do NGA�s Suggestions: Educate people on the reasons and the how�s to eat better and be active Improve phys educe. Strategize with partners from food and fitness industries Regulate access to junk foods and sodas in schools Consider coverage enhancements for health insurance recipients

21. Things VA can do NGA�s Suggestions (cont�d): Gather economic impact and demographic data and use in setting priorities. Work with medical groups, charitable organizations, churches, and others to provide services for Virginians at high-risk for obesity. Partner with state and local agencies to promote healthy community design. Use the bully-pulpit at all levels. Challenge private sector efforts to mobilize response to obesity epidemic

22. Some other things to think about The evidence base: Guide to community preventive services Centers for Disease Control Other states and community connections Planning/strategy�breadth of issues Support communities/pilot projects Empowerment to eat less and exercise more