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The State of Obesity 2015
Better Policies for a Healthier America
Richard Hamburg
Deputy Director
October 23, 2015
Overview
o  Adult rates are stabilizing at high rates overall, with
only a handful of increases
o  Significant disparities persist
o  Prevention is key
n  It is easier to prevent in children than reverse trends
later.
o  Future progress will require we examine what is
working and bring these efforts to scale nationwide.
Adult Obesity Trends in 2014
o  Rates increased in five states
n  Kansas, Minnesota, New Mexico, Ohio, Utah
o  Adult obesity (BMI > 30) now exceeds 35% in
three
n  Considerable variation (Arkansas, 35.9%; Colorado
21.3%)
n  In 1991, no state exceeded 20%
n  In 1980, no state exceeded 15%
Adult Obesity Rates (2014)
States With The Highest Obesity Rates
o  7 of the 10 states with the highest rates of adult/childhood
obesity are in the South.
Persisting Disparities in 2014 data
o  23 of the 25 states with the highest rates are in the South and
Midwest
o  9 out of 10 states with highest rates of diabetes are in the South
o  American Indian/American Natives have highest adult
obesity rate (54 percent) of any racial or ethnic group
Childhood Obesity Trends
o  2011 Pediatric Nutrition Surveillance Survey (PedNSS) of
documented slight net decrease in obesity rates among 2-
to-4 year olds participating in certain federally-funded health
programs
n  Documented in all subgroups, except AI/AN kids
Physical Activity and Obesity
o  Being physically inactive is responsible for one in 10 deaths
among U.S. adults.
o  A 10-year study of children found that physical activity
lowers risk for becoming overweight or obese and higher TV
time increases it.
Food Deserts and Healthy Weight
o  More than 29 million Americans live in “food deserts.”
o  Families in predominantly minority and low-income
neighborhoods have limited access to supermarkets and fresh
produce. Greater accessibility to supermarkets is consistently
linked to lower rates of overweight and obesity.
Income, Education Effects
o  More than 33% of adults who earn less than $15,000 per year
are obese
n  Compared with 24.6 percent of those who earn at least $50,000.
o  33% of adults who don’t finish high school are obese
n  Versus obesity rate of 21.5 percent of those who finish college or
technical college
o  Protective effect of education
extends to their children
Why are we still concerned?
o  Despite signs of stabilizing, rates are dangerously
high
o  Obesity increases the risk for dozens of health
comorbidities
n  Including type 2 diabetes, various types of cancer,
cardiovascular disease, arthritis, etc.
o  Baby Boomers coming on to Medicare will further
exacerbate our long-term fiscal outlook
Diabetes and Obesity
o  More than 80 percent of people with diabetes are overweight or obese.
o  Diabetes is the seventh leading cause of death in the United States, and
costs the country around $245 billion in medical costs and lost
productivity each year.
Poor Health, Increased Care Spending
o  Current rates put 78 million Americans at increased risk of
health problems
n  Cardiovascular disease, diabetes, cancer, arthritis and
many more
o  Obese adults spend 42 percent more on direct healthcare costs
Co-Morbidities
o  Type-2 diabetes rates have doubled in the past
20 years
n  One-in-three adults will have diabetes by 2050.
Yet why are we still concerned? (cont’d)
o  Obesity carries national security risks. It has
negative implications for the education,
agricultural, and transportation sectors.
o  Public health and prevention funding remains
inadequate.
n  CDC funding has seesawed but has experienced a net
cut ($6.93 billion for FY2015 vs. $7.31 billion in
FY2005).
n  33 states and DC cut their public health budgets from
FY11-12 to FY12-13
Yet why are we still concerned? (cont’d)
Bringing Initial Steps to Scale
o  Obesity prevention should be
considered a major priority for
reducing related health care
spending and overall health care
costs
n  Community-based,
comprehensive approaches (like
CDC chronic disease prevention
programs) seem to work best.
o  ROI is critical.
Bringing Initial Steps to Scale
o  Addressing primary risk factors
n  Poor Nutrition
n  Inadequate Physical Activity
o  Broad, sustainable funding of evidence-based
interventions, environmental, and systems changes
n  Investments in Partnerships to Improve Community Health—will not
reach all Americans. Funding is in danger for FY 2016.
n  Expanded diabetes and heart disease funding
o  Connecting all Americans to preventive services and
a variety of treatments
Making Obesity a Priority: Robert Wood
Johnson Foundation’s “Five Big Bets”
o  RWJF announced it will commit an additional $500 million
over the next 10 years to expand efforts to help all children
grow up at a healthy weight. The new commitment will focus
on five big bets.
n  1) Ensure that all children enter kindergarten at a healthy weight.
n  2) Make a healthy school environment the norm and not the exception across
the United States.
n  3) Eliminate the consumption of sugar sweetened beverages among 0- to 5-
year-olds.
n  4) Make physical activity a part of the everyday experience for children and
youth.
n  5) Make healthy foods and beverages the affordable, available and desired
choice in all neighborhoods and communities.
Systematic Federal Review
2015 report reviews federal policies and programs in
five key areas:
o  Early Childhood
o  Schools
o  Communities
o  Nutrition Assistance and Education
o  Quality, Affordable Healthcare
Federal Policy Successes
o  More than 31 million students participate in the National School Lunch
and Breakfast Program each school day.
o  More than 95 percent of schools report meeting the updated nutrition
standards required by the Healthy, Hunger-Free Kids Act of 2010 for
school meals.
o  The Healthy, Hunger-Free Kids Act of 2010 strengthened the
requirements for school districts to develop and implement local wellness
plans
o  Community Eligibility Provision- allows qualifying low-income schools
can provide free meals to all students without cumbersome paperwork.
o  Safe Routes to Schools programs operate in all 50 states, benefiting close
to 15,000 schools.
More Federal Policy Successes
o  The Fresh Fruit and Vegetable Program (FFVP) is a federal program that
provides free fruits and vegetables to participating elementary schools
during the school day, outside of the school meal programs. Started as a
pilot program it is now a permanent program in all 50 states.
o  The Department of Defense Fresh Fruit and Vegetable program was
started in 1994 as part of an effort to find ways to provide more fresh
produce to schools. At least 48 states, Washington, D.C., Puerto Rico, the
Virgin Islands and Guam participate in the program using commodity
entitlement funds.
o  USDA awards up to $5 million in competitive grants annually for
training, supporting operations, planning, purchasing equipment,
developing school gardens, developing partnerships and implementing
farm-to-school programs. Forty states have also adopted such programs.
Progress at the State Level
o  Many states have physical education requirements
for students, and 17 states require schools to provide
physical activity or recess during the school day.
o  28 States have laws supporting shared use of
facilities
o  21 States have legislation that requires BMI
screening or other weight-related assessments
o  40 States have enacted farm-to-school programs
o  48 States require schools to provide health education
For Further Information
o  The full text of The State of
Obesity and many other interactive
features are available at:
http://www.StateofObesity.org
o  Please contact Richard Hamburg,
Deputy Director,
rhamburg@tfah.org, if you have
any further questions
State of Obesity:
Increasing Physical Activity, Improving
Nutrition, and Preventing Obesity for a
Healthier America
Capt Heidi Blanck, PhD
Chief, Obesity Prevention and Control Branch
Division of Nutrition, Physical Activity and Obesity
National Center for Chronic Disease Prevention & Health Promotion
Centers for Disease Control & Prevention
October 23, 2015
The findings and conclusions in this presentation are
those of the author and not necessarily the CDC
Who We are:
Department of Health & Human Services
Centers for Disease Control & Prevention
CDC
Division of Nutrition, Physical
Activity, and Obesity
Who We Are: Primary Federal Public Health Division
focused on improving nutrition, increasing physical
activity, and preventing obesity through population-
based work.
What our work does:
q  Assists mothers who want to breastfeed
q  Helps People Stay Active
q  Ensure healthier foods are available for children in
education settings and for consumers who want to
eat better to maintain health
What We Do: Making Healthy Choices Easier
Environment
• Access, Availability, Quality
• Affordability & Price
• Information & Marketing
• Social
• Skills, Knowledge
• Time, resources
• Parenting styles/rules
Individual/Family
Healthy
eating &
physical
activity
Environment
Where We Work:
Social Ecological Model
t
lll
Individual
Federal and State
Community
Interpersonal
Greatest
Reach*
Smallest
reach
Institutions
Federal, state and local
policies to regulate and
support healthy actions
Knowledge, attitudes,
beliefs and behaviors
Family, peers, social
networks
Policy, regulations
and informal structures
Policies, standards,
social networks
* $45M Budget, 100 staff
Where We Work:
§  States, Indian Country, local Counties, and US
territories – we provide technical assistance,
training, resources, and grants
§  In hospitals, worksites, and communities we
promote breastfeeding
§  In early care and education (child care), and
schools we promote good nutrition & physical
activity
§  In workplaces we encourage physical activity
and nutrition standards for cafeterias/snack
shops
§  In neighborhoods, we help local govts support
healthier retail offerings & walkability
How We Do It:
§  Surveillance –-Monitor trends in behaviors,
obesity
§  Applied research, evaluation & translation –-
understand what works to promote health
§  Training, tools, guidance -- for grantees and
partners to stay up-to-date on key strategies and
best practices
§  Strategic communications and partnerships -- to
build networks of support and change social
norms
Partnerships Health Equity
Breastfeeding Support Strategies
§  Maternity care practices in hospitals
§  Support from health care
professionals
§  Support for breastfeeding in
communities, workplaces,
and childcare
State and National Coalitions
The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies
http://www.cdc.gov/breastfeeding
Early Care and Education (ECE)
§  Provide nutritious meals/snacks.
§  Adequate, age-appropriate
physical activity.
§  Limit screen time.
§  Support breastfeeding mothers
and babies.
http://www.cdc.gov/obesity/strategies/childcareece.html
http://www.letsmove.gov/
State Licensing, QRIS, CACFP, Professional
Development Learning Collaborative, $4M , 9 states -
Nemours
Healthy Eating Playbook
§  Better for Us Foods:
•  Implement nutrition standards in worksites,
schools, ECE, recreation centers
•  Increase affordable, healthy options in retail in
underserved areas including rural
•  Engagement of food advisory coalitions
§  Beverages
•  Ensure access to safe and good-tasting water
http://www.cdc.gov/healthyyouth/npao/pdf/Water_Access_in_Schools.pdf
§  Fruits and vegetables
•  Install salad bars in schools, worksites
•  Support USDA efforts – markets, Farm to
Institution
Facility level intervention supported by District
Wellness Policy, PTA Promotions
Salad Bar
in School
Efforts
Food Service Guidelines
Find the Health and Sustainable Guidelines at:
www.cdc.gov/chronicdisease/pdf/guidelines_for_federal_concessions_and
_vending_operations.pdf
http://www.cdc.gov/obesity/strategies/food-serv-guide.html Case Studies,
State Success Stories
Promoting Walking and Walkable
Communities
§  Support a national
movement on walking
§  Increase opportunities and
incentives for physical
activity
§  Make communities more
walkable through
transportation and
community design.
Step it Up!
6 Sections of the Call to Action
1.  Physical Activity: An Essential
Ingredient for Health
2.  Why Focus on Walking as a Public
Health Strategy?
3.  Why Don’t People Walk More?
4.  How to Increase Walking and
Improve Walkability
5.  Gaps in Surveillance, Research,
and Evaluation
6.  The Call to Action
www.surgeongeneral.gov/stepitup
Goals of the Call to Action
1.  Make walking a national priority.
2.  Design communities that make it safe and easy
to walk for people of all ages and abilities.
3.  Promote programs and policies to support
walking where people live, learn, work, and play.
4.  Provide information to encourage walking
and improve walkability.
5.  Fill surveillance, research, and
evaluation gaps related to walking
and walkability.
How: 1305 State Funding for Nutrition,
Physical Activity and Obesity Prevention
Strategies
Average Award Per State: Basic $135,000; Enhanced $433,000
State	Indicator	Reports	
Policy,	Envt,	Behavior	
•  State	Indicator	Report	on	FV,	2009,	2013	
				School,	childcare,	community	
•  BreasEeeding	Report	Card,	2007-2014	
•  State	Indicator	Report	on	Physical	AcKvity,	2010,	2014			
									School,	community	(parks/playgrounds),	child	care	
~Healthy	People	2020	objec2ves	
h5p://www.cdc.gov/obesity/resources/reports.html
Vital Signs: Oct 6, 2015 -- Percent of hospitals implementing
more than half of the Ten Steps of Baby Friendly to
Support Breastfeeding
<20%	 20–	<40%	 40	–	<60%	 ≥60%	
DC
PR
DC
PR
IT
DC
PR
IT
DC
PR
IT
2007	 2009	
2011	 2013
Community Programs to Reduce Obesity
in High-Obesity Areas, FY15, 3 yr
States with a program
Eligible states: have
counties with >40%
obesity
Ineligible states
“Alabama will not look the same in 3 years as it does today; in part due
to CDC’s efforts and those of the ALProHealth team and their
Community Coalition members. Thanks for this win-win collaboration,
especially for Alabama citizens. “ Barb Struempler Auburn University
Principal Investigator
States and Communities Reporting Decreases in the
Prevalence of Childhood Obesity
El Paso, TX
NM
CA
MS
Anchorage, AK
Chula Vista, CA
Kearney, NE
WV
Vance, NC
Granville, NC
Philadelphia, PA
New York
City
Fitchburg, MA
Somerville, MA
Cambridge, MA
Portland, ME
DuPage County, IL
OH
San Diego, CA
MA
Source: Adapted from Dietz, 2014
KP:
SoCA
State of Obesity 2015
Prevention Matters
Energy Deficits Necessary to Achieve the Healthy
People 2010 Goal (Prevalence = 5%) by 2020
Age HP2010
2-5 y 33 Kcal/day
6-11 y 149 Kcal/day
12-19 y 177 Kcal/day
Wang YC, Orleans CT, Gortmaker SL. Reaching the Healthy People
Goals for Reducing Childhood Obesity Closing the Energy Gap. Am
J Prev Med. May 2012;42(5):437-444.
•  Mean kilocalories from sugary drinks for ages 2 and over, United
States 2005-2008 (NHANES)
NCHS
According to 2007-2010 NHANES data
6 in 10 children don’t eat enough fruit
9 in 10 children don’t eat enough vegetables
Example:	CORD	
3	sites,	2-12	yo	
children	Medicaid/
CHIP	
Supplement:	
Childhood	Obesity,	
2015
Popula1on-Level	Interven1on	Strategies	&	
Examples:	Child	Care/ECE	
	
	
Research	Tested	IntervenKons:	
•  Hip-Hop	to	Health	Jr.	(Fitzgibbon	et	al.,	2005)	
•  Israel	IntervenKon	(Eliakim	et	al.,	2007)		
				
PracKce	Tested	IntervenKons:	
•  NAP	SACC:	Assessment	of	policies/pracKces		
•  Color	Me	Healthy,	Eat	Well	Play	Hard	
•  CATCH	Early	Childhood		
•  State	&	Local	Policy:		New	York	City	ECE	RegulaKons
Early	CORD	Findings	
ECE,	Schools	
–  Policy	plaEorm	&	Replica1on	of	evidence-based	programs	
–  Paid	Wellness	Coordinator/Integrator	(Dietz	et	al.	2015)			
Healthcare:	Supports	needed	for	both	preven1on	&	
management	of	childhood	obesity	(USPSTF	B/AAP)	
•  Training;	Payment	Models	for	obesity	management	
•  Electronic	health	records	-	hXp://www.cdc.gov/nccdphp/dnpao/division-informa1on/
programs/cord/emr.html	
Sustainability	via	Linkages	with	State	and	Local	Govt	Depts/
Programs	(e.g.	NPAO	Staff,	WIC,	SNAP-ED,	USDA	Extension)		
Community	Coali1on	Input
Why We Do it: Policy and Systems create
Healthy Environments that reach People
DOH Land Use Guidelines 2.1 Million Residents
DOH Vending Guidelines 2.1 Million Residents
Business Worksite Food Service
Guidelines (Hospitals, City Govt)
5 major worksites (University,
Hospitals, Industry): 110,000
employees
Healthy Churches 9,500 Congregation Members
Farmers Market WIC Access 38,500 Participants
Physical Activity/Nutrition Schools 6 School Districts: 124,400
Students; 6,000 staff
Healthy Childcare 1,800 Childcare Facilities: 26,000
preschoolers
Why	We	Do	It
Resources:
www.surgeongeneral.gov/stepitup
Resources	
www.cdc.gov/nccdphp/dnpao	
www.cdc.gov/obesity	
hXp://www.cdc.gov/obesity/resources/index.html	--	Including	
Reports,	Guidelines,	&	Social	Media		
-State	Policy	searchable	database:	
hXp://nccd.cdc.gov/CDPHPPolicySearch/Default.aspx	
-DNPAO	Interac1ve	data,	trends,	maps:		
hXp://nccd.cdc.gov/NPAO_DTM/	
For	Informa1on:	dnpaopolicy@cdc.gov

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State of Obesity 2015

  • 1. The State of Obesity 2015 Better Policies for a Healthier America Richard Hamburg Deputy Director October 23, 2015
  • 2. Overview o  Adult rates are stabilizing at high rates overall, with only a handful of increases o  Significant disparities persist o  Prevention is key n  It is easier to prevent in children than reverse trends later. o  Future progress will require we examine what is working and bring these efforts to scale nationwide.
  • 3. Adult Obesity Trends in 2014 o  Rates increased in five states n  Kansas, Minnesota, New Mexico, Ohio, Utah o  Adult obesity (BMI > 30) now exceeds 35% in three n  Considerable variation (Arkansas, 35.9%; Colorado 21.3%) n  In 1991, no state exceeded 20% n  In 1980, no state exceeded 15%
  • 5. States With The Highest Obesity Rates o  7 of the 10 states with the highest rates of adult/childhood obesity are in the South.
  • 6. Persisting Disparities in 2014 data o  23 of the 25 states with the highest rates are in the South and Midwest o  9 out of 10 states with highest rates of diabetes are in the South o  American Indian/American Natives have highest adult obesity rate (54 percent) of any racial or ethnic group
  • 7. Childhood Obesity Trends o  2011 Pediatric Nutrition Surveillance Survey (PedNSS) of documented slight net decrease in obesity rates among 2- to-4 year olds participating in certain federally-funded health programs n  Documented in all subgroups, except AI/AN kids
  • 8. Physical Activity and Obesity o  Being physically inactive is responsible for one in 10 deaths among U.S. adults. o  A 10-year study of children found that physical activity lowers risk for becoming overweight or obese and higher TV time increases it.
  • 9. Food Deserts and Healthy Weight o  More than 29 million Americans live in “food deserts.” o  Families in predominantly minority and low-income neighborhoods have limited access to supermarkets and fresh produce. Greater accessibility to supermarkets is consistently linked to lower rates of overweight and obesity.
  • 10. Income, Education Effects o  More than 33% of adults who earn less than $15,000 per year are obese n  Compared with 24.6 percent of those who earn at least $50,000. o  33% of adults who don’t finish high school are obese n  Versus obesity rate of 21.5 percent of those who finish college or technical college o  Protective effect of education extends to their children
  • 11. Why are we still concerned? o  Despite signs of stabilizing, rates are dangerously high o  Obesity increases the risk for dozens of health comorbidities n  Including type 2 diabetes, various types of cancer, cardiovascular disease, arthritis, etc. o  Baby Boomers coming on to Medicare will further exacerbate our long-term fiscal outlook
  • 12. Diabetes and Obesity o  More than 80 percent of people with diabetes are overweight or obese. o  Diabetes is the seventh leading cause of death in the United States, and costs the country around $245 billion in medical costs and lost productivity each year.
  • 13. Poor Health, Increased Care Spending o  Current rates put 78 million Americans at increased risk of health problems n  Cardiovascular disease, diabetes, cancer, arthritis and many more o  Obese adults spend 42 percent more on direct healthcare costs
  • 14. Co-Morbidities o  Type-2 diabetes rates have doubled in the past 20 years n  One-in-three adults will have diabetes by 2050.
  • 15. Yet why are we still concerned? (cont’d) o  Obesity carries national security risks. It has negative implications for the education, agricultural, and transportation sectors. o  Public health and prevention funding remains inadequate. n  CDC funding has seesawed but has experienced a net cut ($6.93 billion for FY2015 vs. $7.31 billion in FY2005). n  33 states and DC cut their public health budgets from FY11-12 to FY12-13
  • 16. Yet why are we still concerned? (cont’d)
  • 17. Bringing Initial Steps to Scale o  Obesity prevention should be considered a major priority for reducing related health care spending and overall health care costs n  Community-based, comprehensive approaches (like CDC chronic disease prevention programs) seem to work best. o  ROI is critical.
  • 18. Bringing Initial Steps to Scale o  Addressing primary risk factors n  Poor Nutrition n  Inadequate Physical Activity o  Broad, sustainable funding of evidence-based interventions, environmental, and systems changes n  Investments in Partnerships to Improve Community Health—will not reach all Americans. Funding is in danger for FY 2016. n  Expanded diabetes and heart disease funding o  Connecting all Americans to preventive services and a variety of treatments
  • 19. Making Obesity a Priority: Robert Wood Johnson Foundation’s “Five Big Bets” o  RWJF announced it will commit an additional $500 million over the next 10 years to expand efforts to help all children grow up at a healthy weight. The new commitment will focus on five big bets. n  1) Ensure that all children enter kindergarten at a healthy weight. n  2) Make a healthy school environment the norm and not the exception across the United States. n  3) Eliminate the consumption of sugar sweetened beverages among 0- to 5- year-olds. n  4) Make physical activity a part of the everyday experience for children and youth. n  5) Make healthy foods and beverages the affordable, available and desired choice in all neighborhoods and communities.
  • 20. Systematic Federal Review 2015 report reviews federal policies and programs in five key areas: o  Early Childhood o  Schools o  Communities o  Nutrition Assistance and Education o  Quality, Affordable Healthcare
  • 21. Federal Policy Successes o  More than 31 million students participate in the National School Lunch and Breakfast Program each school day. o  More than 95 percent of schools report meeting the updated nutrition standards required by the Healthy, Hunger-Free Kids Act of 2010 for school meals. o  The Healthy, Hunger-Free Kids Act of 2010 strengthened the requirements for school districts to develop and implement local wellness plans o  Community Eligibility Provision- allows qualifying low-income schools can provide free meals to all students without cumbersome paperwork. o  Safe Routes to Schools programs operate in all 50 states, benefiting close to 15,000 schools.
  • 22. More Federal Policy Successes o  The Fresh Fruit and Vegetable Program (FFVP) is a federal program that provides free fruits and vegetables to participating elementary schools during the school day, outside of the school meal programs. Started as a pilot program it is now a permanent program in all 50 states. o  The Department of Defense Fresh Fruit and Vegetable program was started in 1994 as part of an effort to find ways to provide more fresh produce to schools. At least 48 states, Washington, D.C., Puerto Rico, the Virgin Islands and Guam participate in the program using commodity entitlement funds. o  USDA awards up to $5 million in competitive grants annually for training, supporting operations, planning, purchasing equipment, developing school gardens, developing partnerships and implementing farm-to-school programs. Forty states have also adopted such programs.
  • 23. Progress at the State Level o  Many states have physical education requirements for students, and 17 states require schools to provide physical activity or recess during the school day. o  28 States have laws supporting shared use of facilities o  21 States have legislation that requires BMI screening or other weight-related assessments o  40 States have enacted farm-to-school programs o  48 States require schools to provide health education
  • 24. For Further Information o  The full text of The State of Obesity and many other interactive features are available at: http://www.StateofObesity.org o  Please contact Richard Hamburg, Deputy Director, rhamburg@tfah.org, if you have any further questions
  • 25. State of Obesity: Increasing Physical Activity, Improving Nutrition, and Preventing Obesity for a Healthier America Capt Heidi Blanck, PhD Chief, Obesity Prevention and Control Branch Division of Nutrition, Physical Activity and Obesity National Center for Chronic Disease Prevention & Health Promotion Centers for Disease Control & Prevention October 23, 2015 The findings and conclusions in this presentation are those of the author and not necessarily the CDC
  • 26. Who We are: Department of Health & Human Services Centers for Disease Control & Prevention
  • 27. CDC Division of Nutrition, Physical Activity, and Obesity Who We Are: Primary Federal Public Health Division focused on improving nutrition, increasing physical activity, and preventing obesity through population- based work. What our work does: q  Assists mothers who want to breastfeed q  Helps People Stay Active q  Ensure healthier foods are available for children in education settings and for consumers who want to eat better to maintain health
  • 28. What We Do: Making Healthy Choices Easier Environment • Access, Availability, Quality • Affordability & Price • Information & Marketing • Social • Skills, Knowledge • Time, resources • Parenting styles/rules Individual/Family Healthy eating & physical activity Environment
  • 29. Where We Work: Social Ecological Model t lll Individual Federal and State Community Interpersonal Greatest Reach* Smallest reach Institutions Federal, state and local policies to regulate and support healthy actions Knowledge, attitudes, beliefs and behaviors Family, peers, social networks Policy, regulations and informal structures Policies, standards, social networks * $45M Budget, 100 staff
  • 30. Where We Work: §  States, Indian Country, local Counties, and US territories – we provide technical assistance, training, resources, and grants §  In hospitals, worksites, and communities we promote breastfeeding §  In early care and education (child care), and schools we promote good nutrition & physical activity §  In workplaces we encourage physical activity and nutrition standards for cafeterias/snack shops §  In neighborhoods, we help local govts support healthier retail offerings & walkability
  • 31. How We Do It: §  Surveillance –-Monitor trends in behaviors, obesity §  Applied research, evaluation & translation –- understand what works to promote health §  Training, tools, guidance -- for grantees and partners to stay up-to-date on key strategies and best practices §  Strategic communications and partnerships -- to build networks of support and change social norms Partnerships Health Equity
  • 32. Breastfeeding Support Strategies §  Maternity care practices in hospitals §  Support from health care professionals §  Support for breastfeeding in communities, workplaces, and childcare State and National Coalitions The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies http://www.cdc.gov/breastfeeding
  • 33. Early Care and Education (ECE) §  Provide nutritious meals/snacks. §  Adequate, age-appropriate physical activity. §  Limit screen time. §  Support breastfeeding mothers and babies. http://www.cdc.gov/obesity/strategies/childcareece.html http://www.letsmove.gov/ State Licensing, QRIS, CACFP, Professional Development Learning Collaborative, $4M , 9 states - Nemours
  • 34. Healthy Eating Playbook §  Better for Us Foods: •  Implement nutrition standards in worksites, schools, ECE, recreation centers •  Increase affordable, healthy options in retail in underserved areas including rural •  Engagement of food advisory coalitions §  Beverages •  Ensure access to safe and good-tasting water http://www.cdc.gov/healthyyouth/npao/pdf/Water_Access_in_Schools.pdf §  Fruits and vegetables •  Install salad bars in schools, worksites •  Support USDA efforts – markets, Farm to Institution
  • 35. Facility level intervention supported by District Wellness Policy, PTA Promotions Salad Bar in School Efforts
  • 36. Food Service Guidelines Find the Health and Sustainable Guidelines at: www.cdc.gov/chronicdisease/pdf/guidelines_for_federal_concessions_and _vending_operations.pdf http://www.cdc.gov/obesity/strategies/food-serv-guide.html Case Studies, State Success Stories
  • 37. Promoting Walking and Walkable Communities §  Support a national movement on walking §  Increase opportunities and incentives for physical activity §  Make communities more walkable through transportation and community design.
  • 38. Step it Up! 6 Sections of the Call to Action 1.  Physical Activity: An Essential Ingredient for Health 2.  Why Focus on Walking as a Public Health Strategy? 3.  Why Don’t People Walk More? 4.  How to Increase Walking and Improve Walkability 5.  Gaps in Surveillance, Research, and Evaluation 6.  The Call to Action www.surgeongeneral.gov/stepitup
  • 39. Goals of the Call to Action 1.  Make walking a national priority. 2.  Design communities that make it safe and easy to walk for people of all ages and abilities. 3.  Promote programs and policies to support walking where people live, learn, work, and play. 4.  Provide information to encourage walking and improve walkability. 5.  Fill surveillance, research, and evaluation gaps related to walking and walkability.
  • 40. How: 1305 State Funding for Nutrition, Physical Activity and Obesity Prevention Strategies Average Award Per State: Basic $135,000; Enhanced $433,000
  • 41. State Indicator Reports Policy, Envt, Behavior •  State Indicator Report on FV, 2009, 2013 School, childcare, community •  BreasEeeding Report Card, 2007-2014 •  State Indicator Report on Physical AcKvity, 2010, 2014 School, community (parks/playgrounds), child care ~Healthy People 2020 objec2ves h5p://www.cdc.gov/obesity/resources/reports.html
  • 42. Vital Signs: Oct 6, 2015 -- Percent of hospitals implementing more than half of the Ten Steps of Baby Friendly to Support Breastfeeding <20% 20– <40% 40 – <60% ≥60% DC PR DC PR IT DC PR IT DC PR IT 2007 2009 2011 2013
  • 43. Community Programs to Reduce Obesity in High-Obesity Areas, FY15, 3 yr States with a program Eligible states: have counties with >40% obesity Ineligible states “Alabama will not look the same in 3 years as it does today; in part due to CDC’s efforts and those of the ALProHealth team and their Community Coalition members. Thanks for this win-win collaboration, especially for Alabama citizens. “ Barb Struempler Auburn University Principal Investigator
  • 44. States and Communities Reporting Decreases in the Prevalence of Childhood Obesity El Paso, TX NM CA MS Anchorage, AK Chula Vista, CA Kearney, NE WV Vance, NC Granville, NC Philadelphia, PA New York City Fitchburg, MA Somerville, MA Cambridge, MA Portland, ME DuPage County, IL OH San Diego, CA MA Source: Adapted from Dietz, 2014 KP: SoCA
  • 46. Prevention Matters Energy Deficits Necessary to Achieve the Healthy People 2010 Goal (Prevalence = 5%) by 2020 Age HP2010 2-5 y 33 Kcal/day 6-11 y 149 Kcal/day 12-19 y 177 Kcal/day Wang YC, Orleans CT, Gortmaker SL. Reaching the Healthy People Goals for Reducing Childhood Obesity Closing the Energy Gap. Am J Prev Med. May 2012;42(5):437-444.
  • 47. •  Mean kilocalories from sugary drinks for ages 2 and over, United States 2005-2008 (NHANES) NCHS According to 2007-2010 NHANES data 6 in 10 children don’t eat enough fruit 9 in 10 children don’t eat enough vegetables
  • 49. Popula1on-Level Interven1on Strategies & Examples: Child Care/ECE Research Tested IntervenKons: •  Hip-Hop to Health Jr. (Fitzgibbon et al., 2005) •  Israel IntervenKon (Eliakim et al., 2007) PracKce Tested IntervenKons: •  NAP SACC: Assessment of policies/pracKces •  Color Me Healthy, Eat Well Play Hard •  CATCH Early Childhood •  State & Local Policy: New York City ECE RegulaKons
  • 50. Early CORD Findings ECE, Schools –  Policy plaEorm & Replica1on of evidence-based programs –  Paid Wellness Coordinator/Integrator (Dietz et al. 2015) Healthcare: Supports needed for both preven1on & management of childhood obesity (USPSTF B/AAP) •  Training; Payment Models for obesity management •  Electronic health records - hXp://www.cdc.gov/nccdphp/dnpao/division-informa1on/ programs/cord/emr.html Sustainability via Linkages with State and Local Govt Depts/ Programs (e.g. NPAO Staff, WIC, SNAP-ED, USDA Extension) Community Coali1on Input
  • 51. Why We Do it: Policy and Systems create Healthy Environments that reach People DOH Land Use Guidelines 2.1 Million Residents DOH Vending Guidelines 2.1 Million Residents Business Worksite Food Service Guidelines (Hospitals, City Govt) 5 major worksites (University, Hospitals, Industry): 110,000 employees Healthy Churches 9,500 Congregation Members Farmers Market WIC Access 38,500 Participants Physical Activity/Nutrition Schools 6 School Districts: 124,400 Students; 6,000 staff Healthy Childcare 1,800 Childcare Facilities: 26,000 preschoolers