Presenter Disclosure Information

1. Presenter Disclosure Information In compliance with the accrediting board policies, the American Diabetes Association requires the following disclosure to the participants: NAME OF PRESENTER: Mary Guzman, BS, RD, LD Disclosed no conflict of interest

2. Obesity Prevention in Texas:Policy and Environmental Change for Diabetes Care and Control 6th Annual Diabetes Summit: Innovations and Quality Care April 3 & 4, 2009 Mary Guzman Nutrition, Physical Activity & Obesity Prevention Program Texas Department of State Health Services

3. Indiana Vermont Hawaii N Dakota Delaware S Dakota Wyoming Maryland W Virginia Mississippi Nevada Population Served by DSHS Health Services Regions 2006 Texas Population, 23,500,000 Source: Center for Health Statistics, Population Estimates for Counties, 2003

4. Ten Fastest Growing States 2000-2007

5. Percent of Growth Due to Each Ethnicity in Texas • 2007 • 23,904,380 total • 8,791,986 Latino/a • 2040 (Projected) • 34,433,790 total • 19,281,932 Latino/a 19,281,932 8,791,986 36.8% 55.9% Sources: U.S. Census Counts, and State Data Center Projection

6. Obese or Overweight Adults 1995-2007 Source: Centers for Disease Control, BRFSS

7. Projected Increase in Number of Obese* Adults in Texas, 2006-2040 14,656,539 9,407,802 Source: Office of State Demographer, Moderate Projection *BMI>=30

8. Obesity in Adults by Race/Ethnicity 2006 2040 Source: Office of State Demographer, “Moderate” Projection *BMI>=30

9. Obesity & Adult Latinos: Key Findings • Heavier • 71.4% versus 62.9% • Eat poorer quality diets • 76.9% versus 73.4% • Less physically active • 55.7% versus 50.3% • Higher risk for Diabetes • 12.3% versus 8.5% • Will be majority in all state areas • MSA/Urban (triple) • Rural (double) • Will account for most of the projected changes in obesity

10. Social Ecological Model Social Norms and Values • Home and Family • School • Community • Work Site • Healthcare • Food and Beverage Industry • Agriculture • Education • Media • Government • Public Health Systems • Healthcare Industry • Business and Workers • Land Use and Transportation • Leisure and Recreation Sectors of Influence Behavioral Settings • Genetics • Psychosocial • Other Personal Factors Individual Factors Food and Beverage Intake Physical Activity Energy Intake Energy Expenditure Energy Balance Note: Adapted from “Preventing Childhood Obesity.” Institute of Medicine, 2005. Prevention of Overweight and Obesity Among Children, Adolescents, and Adults

11. Increase breastfeeding initiation, duration, and exclusivity Increase physical activity Increase consumption of fruits and vegetables CDC Targets

12. Target Areas • Decrease consumption of sugar-sweetened beverages • Reduce consumption of high-energy-dense foods • Decrease television viewing

13. Healthy Eating • Preserve farmland for local farmers • Provide farmers with a reliable market year round • Help small farms create marketing and business plans • Provide grants, free marketing opportunities in non-traditional sites • Create grant programs, economic incentives for construction & renovation • Develop affordable, available food processing/kitchen space • Provide refunds, discounts, voucher/coupon systems using WIC, food stamps & other programs MALLF 2.12.09

14. Healthy Eating Price reductions Paying farmers for surplus produce Providing coupons/discounts to low-income Create economic stimulus programs & public/private partnerships Developing land-use policies and joint-use agreements MALLF 2.12.09

15. Active Living Establishing collaboration between public/private-sector departments Supporting school facilities & policies that promote active living • Improving streets, sidewalks & street-crossings for safer routes to school • Supporting safe, pedestrian-oriented transportation • Supporting land-use planning & development that encourage active living MALLF 2.12.09

16. Active Living Identifying & creating funding sources for active living initiatives Publicizing the availability of active living resources in the community Supporting parks, trails & recreation facilities Creating tax and other incentives to promote active living in workplaces, communities and households MALLF 2.12.09

17. DSHS Obesity Prevention Funded Projects 1 Dallas 3 2 4 El Paso Fort Worth/Pantego 9 10 5 7 Austin 8 San Antonio 11 Brownsville

18. Healthy Eating in Texas Communities: Farmers’ Markets, Community Gardens Brownsville “Del Campo a Su Mesa” Farmers’ Market San Antonio Food Bank Community Garden MALLF 2.12.09

19. Healthy Eating in Texas: Hospitals, Worksites The Baby Café - El PasoCommunity Breastfeeding Center Family Connections, Inc. Austin Breastfeeding Project MALLF 2.12.09

20. DSHS Main Campus Howard Lane WIC Farmers Markets (summer) Austin State Hospital Robert E. Johnson Building State Auditor’s Office Sunset Commission Legislative Budget Board Texas Legislative Council Stephen F. Austin Building Texas Department of Agriculture Comptroller of Public Accounts General Land Office Office of Rural Community Affairs Texas Water Development Board* Healthy Eating in Texas: Worksites MALLF 2.12.09

21. Resources Division of Nutrition, Physical Activity & Obesity State Legislative Database http://apps.nccd.cdc.gov/DNPALeg/index.asp National Conference of State Legislatures: Healthy Eating, Physical Activity & Food Systems to Support Healthy Communities www.ncsl.org/programs/health/KelloggHealthOverview.htm National Association of Counties' Healthy Counties Database www.naco.org National Association of State Boards of Education www.nasbe.org Strategic Alliance (California) ENACT Local Policy Database www.preventioninstitute.org/sa/policies/ Texas School Nutrition Policy www.squaremeals.org DSHS Building Healthy Texans website www.wellness.state.tx.us/

22. Contact us for more information • Barbara Keir, 512-458-7111 x2610 Acting Director, Health Promotion & Chronic Disease Prevention Section Barbara.Keir@dshs.state.tx.us • Mary Guzman 512-458-7111 x6525 Manager, NPAO Program Maria.Guzman@dshs.state.tx.us