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Healthy Eating and Active Living: the CDC’s Public Health Approach to Preventing and Reducing Obesity
CDR Heidi Blanck, PhDChief, Obesity Prevention and Control Branch
Division of Nutrition, Physical Activity and ObesityNational Center for Chronic Disease Prevention & Health Promotion
Centers for Disease Control & Prevention (CDC)
Healthy Schools June 2011 Aruba PACO
HHS
The findings presented are those of the presenter and not the official views of the CDC.
Department of Health & Human Services
HHS Healthy Weight Task Force
Division of Nutrition, Physical Activity and Obesity (DNPAO)
Vision: A world where regular physical activity, good nutrition, and a healthy weight are a part of everyone’s life
Mission: Lead strategic public health efforts to prevent and control obesity, chronic disease and other health conditions through physical activity and good nutrition
2005
Obesity Trends* Among U.S. AdultsBRFSS, 2000, 2005, 2009
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
2009
2000
$147 Billion = Obesity Associated Health Care Spending, 2008 estimates
Obesity Statistics
• More than one in six (17%) U.S. children is obese, three times the rate in the 1970’s (BMI at or above the 95% percentile of the sex-specific BMI-for-age growth charts)
• According to 2007-2008 data, disparities exist among youth with higher prevalence among minority racial/ethnic groups including Mexican American boys (27%) and Black girls (29%) aged 12-19 y
http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm
Message: Obesity is Common, Costly, and Serious
2008
Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes
Obesity (BMI ≥30 kg/m2)
Diabetes
1994
1994
2000
2000
No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0%
No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0%
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics
2008
“Obesity is a major public health problem. We need intensive and ongoing efforts to address obesity or more people will get sick and die from complications of obesity, such as heart disease, stroke, diabetes and cancer.”
“Not only are the cost of obesity high…, but in addition, the economic cost are high. In 2008 medical dollars, medical cost associated with obesity were estimated at 147 billion.”
“Six things can reduce or prevent obesity.” 1. Physical activity. 2. Increase the uptake and continuation of breast feeding. 3. Increase fruit and vegetable intake. 4. Reduce screen time. 5. Reduce high-calorie food intake, in particular, sugary drinks.
National news teleconference
Public Health Approach: Focus On Supportive Environments
Difficult to make a healthy choice in an unhealthy environment
Working to support families in being able to have healthy choices
Making Healthy Choices Easier
Environment • Affordability• Access, availability• Placement • Marketing
• Culture• Skills • Knowledge• Time• Preferences
Individual
Healthy eating & physical
activity
Environment
Principal Target Areas for Obesity Prevention
• Increase consumption of fruits and vegetables• Increase breastfeeding initiation, duration, and
exclusivity• Increase physical activity
• Decrease television viewing and screentime• Decrease consumption of high energy dense foods of
low-nutrient value• Decrease consumption of sugar drinks
Settings for the Prevention Childhood Obesity• Community
• School• Child Care
• Medical /hospitals• Worksite - family
CDC Guidance Documents: Policy and Environmental Strategies for State and Communities
Guidance Documents– Fruits & Vegetables– Energy Density– Sugar Sweetened Beverages– Breastfeeding – Physical Activity– Television Viewing
Evidence-based strategies
• Promising• Emerging• Effective
• Research-tested, Practice-basedwww.center-trt.org
• Reach, impact, sustainability/maintenance
Strategies to Increase Fruit and Vegetable Access, Availability, and Consumption
1. Food Policy Coalitions as a Means to Improve the Food Environment 2. Access to Retail Venues that Sell Fruits and Vegetables in Underserved
Communities3. Farm-to-Where-You-Are Programs in All Possible Venues4. Ready Access to Fruits and Vegetables in Worksite Foodservice,
Meetings and Events5. Community and Home Gardens6. Policies to Incorporate Fruit and Vegetable Activities into Schools and
Early learning centers/child care7. Include Fruits and Vegetables in Emergency Food Programs
7 Strategies: Reducing Sugar Drink Consumption
1. Ensure ready access to potable drinking water2. Limit access to Sugar Drinks3. Promote access to and consumption of more healthful
alternatives to Sugar Drinks4. Limit marketing of Sugar Drinks and minimize marketing’s
impact on children5. Decrease the relative cost of more healthful beverage
alternatives through differential pricing of Sugar Drinks6. Include screening and counseling about Sugar Drink
consumption as part of routine medical care7. Expand the knowledge and skills of medical care providers to
conduct nutrition screening and counseling on Sugar Drink consumption
17
Strategy : Ensure ready access to potable drinking water
• To promote water consumption, potable (clean, good tasting) drinking water should be easily accessible to children and adults in homes and public facilities, including parks, playgrounds, schools, child cares, public buildings, worksites, and clinics
18
Child Care-Based Program Example
• New York City’s Nutritional Standards for Child Care– Code requires that potable drinking water be made easily
accessible throughout the day, including at meals
– City code prohibits providing beverages with added sweeteners, whether artificial or natural
– Limit screentime/television viewing– Support breastfeeding, pumping, use of breastmilkSpring 2011: USDA Guidance for Schools – Compliance Fall
2011, low-fat/reduced fat milk, water during mealtime
Strategy 1: Ensure ready access to potable drinking water
19
School-Based Program Examples• Nutrition standards, meals and snacks• Water access• Food and activity as rewards
– Candy, treats, limiting activity• Joint use agreements
– Allow community members to take part in physical activity, school gardens, cooking/culinary training, making meals for family as part of aftercare programs
• Reduction in advertising on school campus
Strategy: Promote access to and consumption of more healthful alternatives to Sugar Drinks
20
CDC Recommended Community Strategies and Measurements to
Prevent Obesity
http://www.cdc.gov/obesity/downloads/community_strategies_guide.pdf
Other Youth Settings --
National Park Service - Healthy and sustainable food guidelines Vendors contracts – canteens, vending
machines, stores, restaurants Water fountains, refillable water stations Model for small, local parks and open spacesHealthy Parks, Healthy People
Multi-sector, Multi-level Actions
• Champions and civic engagement– What can empowered youth do?– What can parents do?– What can teachers, coaches?– What can employers, business leaders do?
• Making public health policy, public policy• Co-benefits – improved school attendance
inproved academic, improved jobs/economy; improved mental health/self-esteem
Improving healthy eating and activity living is a
shared responsibility. Social and environmental
changes are influenced by the efforts of many…