1. Obesity, Nutrition, and
Physical 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. Youth
NHANES 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 Decreased
Mode 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
1998 2006
(in 2008 dollars) (in 2008 dollars)
Total Costs $75 billion/yr $147 billion/yr
% of U.S.
6.5% 9.1%
Medical Costs
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 Reduce
High 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 Reduce
High 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
1. 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
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention