James S. Marks, M.D., M.P.H. Senior Vice President The Robert Wood Johnson Foundation

1. Trends Summit on Obesity Chicago, ILJuly 20 - 22, 2005 James S. Marks, M.D., M.P.H.Senior Vice PresidentThe Robert Wood Johnson Foundation

2. 20 15 10 5 Ages 2-5 years Ages 6-11 years 0 1976-80 1988-94 1963-67 1966-70 1971-74 1999-2000 Preventing Childhood Obesity Percent Percentage of children with BMI at or above theage- and gender-specific 95th percentile. Institute of Medicine; Preventing Childhood Obesity, 2005

4. How many deaths? • 365,000 vs. 112,000 • Differences in scientific methodology • Better Treatments • Still a very large number

5. Estimated Adult Obesity-Attributable Medical Expenditures 2003 – Dollars in millions State costs related to obesity Obesity Research, January 2004

6. Both Sides of the Energy Balance Equation Energy Balance Calories In Calories Out Food Environment Activity Environment < > = Gain weight Maintain weight Lose weight

7. Interventions • School-based approaches • Community-based approaches • Public education campaigns

8. The Guide to Community Preventive Services: Recommended Physical Activity Interventions • Point-of-decision prompts • Community-wide campaigns • School-based PE • Social support interventions in community settings • Individually adapted health behavior change programs • Creation of or enhanced access to places for physical activity combined with informational outreach activities www.thecommunityguide.org

9. Brownson et al., Amer. J. Preventive Med., 2000, 18(3): 235-241

10. Paid media campaign to promote walking among sedentary older adults in Wheeling, WV Results 90% of area residents exposed to campaign 14% net rise in number of residents increasing their walking compared to control group Wheeling Walks • www.wheelingwalks.org/results.asp

11. Child and Adolescent Trial for Cardiovascular Health (CATCH) • Program included educational, behavioral and school environment components. • Results: • Less total and saturated fat • More physical activity • Effects still found 3 years after intervention ended • www.childtrends.org

12. Planet Health • Two-year intervention aimed at decreasing TV viewing and high-fat foods, and increasing activity and fruit and vegetable consumption • Results: • Obesity prevalence among girls was reduced • Decreased TV viewing seemed most important • No differences found among boys • Gortmaker et al, Arch Pediatr. Adolesc. Med., 1999; 153: 409-418

13. 30 25 20 15 Christchurch Obesity Prevention Project Control boys Control girls Prevalence (%) Intervention boys Intervention girls Baseline 12 months • Mean change in % of overweight and obese children age 7-11 after education program to decrease sugared soda consumption • James et al; BMJ 2004; 328: 1237-9

14. Safe Routes to School (SR2S) • 30 yrs. ago, 66% of kids walked or biked to school; today, roughly 13% do • In first 2 years of Marin County SR2S program: • 64% rise in number of kids walking to school 114% increase in number of kidsbiking • States passing SR2S legislation • CA - $20 million/yr. set aside • WA – all school districts must have SR2S route plans for elem. schools CDC, KidsWalk-to-School: A Guide to Promote Walking to School; Staunton et al, Amer. J. Pub. Health, 2003; 93(9): 1431-34

15. Access to Supermarkets • 3x as many supermarkets in wealthier neighborhoods1 • 4x as many in white neighborhoods as in African-American neighborhoods1 • Fruit and vegetable consumption increased by 1/3 for each additional supermarket in the community. • African-American women in Detroit who shop at supermarkets consume more fresh fruit • and vegetables than women who shop • at independent neighborhood markets. Morland et al. “Neighborhood Characteristics Associated with the Location of Food Stores and Food Service Places.” Amer. J. . Preven. Medicine, 2002; 22(1): 23-29. Morland et al. “The Contextual Effect of the Local Food Environment on Residents’ Diets: The Artherosclerosis Risk in Communities Study.” Amer. J. Pub. Health, 2002; 92(11): 1761-1767.

16. Over the 2-year period between the first and third surveys, current cigarette usedeclined by 40% among middle school students andby 18% among high school students. Bauer et al, JAMA, 2000; 284: 723-28

17. VERB™ Youth Media Campaign • Paid media campaign to get kids age 9-13 to become more active • Cutting-edge TV, Web, concerts and more • Longitudinal survey results: • 22% increase in free-time activity sessions/week • Kids exposed to campaign had more favorable attitudes about being active • Activity levels of unexposed children decreased • Highlights of the Year Two Evaluation Findings, April 2005

18. What Can Policymakers Do? • Restrict / eliminate junk foods in schools • Improve access to healthy foods in schools • Improve health education curricula to provide information on nutrition • Link school food policies with nutrition curricula • Increase physical education instruction • Improve health education classes Wisconsin Public Health & Health Policy Institute; An Ounce of Prevention: What Can Policymakers Do About the Obesity Epidemic?

19. What Can Policymakers Do? (cont’d) • Eliminate sales tax exemptions on unhealthy foods and dedicate the money to health programs • Promote policies that encourage walking and bicycling • Maximize state receipt of federal money • Improve workplace wellness programs • Improve counseling by medical professionals on diet and physical activity Wisconsin Public Health & Health Policy Institute; An Ounce of Prevention: What Can Policymakers Do About the Obesity Epidemic?

20. RWJF Active Living Programs

21. Focusing on issues that demand attention Supporting programs that create meaningful and timely change – helping Americans lead healthier lives Making a difference in your lifetime…and theirs