Obesity, Nutrition, and Physical Activity

1. Obesity, Nutrition, andPhysical Activity U.S. Department of Health and Human Services Centers for Disease Control and Prevention

2. Rapid Increases in Adult Obesity in the U.S.BRFSS: 1990, 1999, 2009

3. Rapid Increases in Obesity Among U.S. YouthNHANES 1963-2008 National Health Examination Surveys II (ages 6-11) and III (ages 12-17). National Health and Nutrition Examination Surveys I, II, III and 1999-2008. www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm.

4. Shifts in Dietary patterns in the United States • Relative prices of more healthful foods have increased faster than prices for less healthful foods. • Increased portion size • Increased consumption of processed foods typically higher in sodium • Increased schools vending and a la carte foods

5. Active Transportation by Youth has DecreasedMode for Trips to School – National Personal Transportation Survey McDonald NC. Am J Prev Med 2007;32:509.

6. Increased TV Viewing Increases Childhood Obesity Prevalence • $1.6 billion/year spent on marketing of foods and beverages to youth • $745 million on television • Television viewing associated with consumption of foods advertised on television • 70% children 8-18 years and 30% children <3 year old have TVs in their rooms NHES: National Household Education Surveys. NLSY: National Longitudinal Survey of Youth.

7. Costs of Adult Obesity Are Increasing Increased prevalence, not increased per capita costs, was the main driver of the increase in costs. Finkelstein et al. Health Affairs 2009; 28:w822.

8. Reductions in Salt Intake Can ReduceHigh Blood Pressure • Increased sodium in the diet = increased blood pressure = increased risk for heart attack and stroke • Generally, lower consumption of salt means lower blood pressure • Within the span of a few weeks, most people experience a reduction in blood pressure when salt intake is reduced • Even people with blood pressure in the normal range benefit from sodium reduction; there appears to be no threshold

9. Reductions in Salt Intake Can ReduceHigh Blood Pressure (continued) • Sodium intake affects • Blood pressure levels – a meta-analysis1 of trials indicates that a median reduction of urinary sodium to ≈1800 mg would • Reduce systolic/diastolic blood pressure by 5.0-2.7 mmHg in persons with hypertension • Reduce systolic/diastolic blood pressure by 2.0-1.0 mmHg in non-hypertensives • Incremental rise in blood pressure with age • Prevalence of hypertension across populations • Reducing salt intake could save tens of thousands of lives annually2 J Hum Hypertens. 2002; 16: 761-770. 2. PloS Med. 2009;6(4):e1000058., N Engl J Med. 2010;362:590-599.; Ann Intern Med. 2010;152:481-487

10. Estimated Effects of Sodium Reduction on Hypertension Prevalence and Related Costs • Reducing average population intake to 2300 mg per day (current recommended maximum) may… • Reduce cases of hypertension by 11 million • Save $18 billion in health care costs • Gain 312,000 Quality Adjusted Life Years (QALYs) • Reducing average population intake even lower – to 1500 mg per day (recommended maximum level for “specific populations” described in the Dietary Guidelines for Americans) – may… • Reduce cases of hypertension by 16 million • Save $26 billion in health care costs • Gain 459,000 Quality Adjusted Life Years (QALYs) American Journal of Health Promotion. 2009;24:49-57.

11. Principal Winnable Battle Initiatives • Improve dietary quality • Increase fruit and vegetable intake • Decrease intake of high-energy, low-nutrient foods • Reduce consumption of sugar sweetened drinks • Reduce sodium in the food supply • Eliminate industrially produced trans fat from the food supply • Increase breastfeeding • Increase physical activity • Prevent micronutrient malnutrition • Enhance state and community capacity to improve population-level health

12. Priority Strategies to Address Select Winnable Battle Initiatives • Energy density • Apply nutrition standards in child care and schools • Increase number of healthy food retail outlets in underserved areas and improve access • Fruits and vegetables • Increase access through retail stores • Support Farm to Institution policies • Leverage food policy councils • Sugared drinks • Ensure access to safe and good-tasting water • Reduce accessibility of sugared drinks in child care and schools

13. Priority Strategies to Address Select Winnable Battle Initiatives • Breastfeeding • Policy and environmental supports in maternity care facilities • Policy and environmental supports in worksites • State and national coalitions to support breastfeeding • Physical activity • Joint use agreements for after-hours access to school facilities • Increase access to parks and recreational facilities • Increase opportunities for physical activity in youth-serving settings

14. Priority Strategies to Address Select Winnable Battle Initiatives • Sodium reduction • Establish sodium reduction standards in government facilities and educational institutions • Promote innovative restaurant initiatives to reduce sodium content of restaurant meals • Increase availability of lower-sodium processed and restaurant food products

15. “Obesity continues to be a major public health problem. We need intensive, comprehensive and ongoing efforts to address obesity. If we don't, more people will get sick and die from obesity-related conditions, such as heart disease, stroke, type 2 diabetes and certain types of cancer – some of the leading causes of death.” – Thomas R. Frieden, MD, MPH Director, Centers for Disease Control and Prevention, Administrator, Agency for Toxic Substances and Disease Registry

16. www.cdc.gov/winnablebattles U.S. Department of Health and Human Services Centers for Disease Control and Prevention