The Obesity Epidemic and

The Government’s Response

Karyl Thomas Rattay MD, MSKaryl Thomas Rattay MD, MSOffice of Disease Prevention Office of Disease Prevention

and Health Promotionand Health PromotionOctober 15, 2003October 15, 2003

Chronic Disease Epidemic

Obesity Trends* Among U.S. Adults BRFSS, 1991, 1995 and 2000

(*BMI 30, or ~ 30 lbs overweight)

1991 1995

2000

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

A Real and Consequential Epidemic

Overweight Facts

• 64% adults are overweight or obese (BMI> 25)

• 15% children & adolescents (aged 6 to 19) are overweight (> 95th percentile)

• associated with many chronic diseases, especially type 2 diabetes

• $117 billion total cost (2000)• 300,000 deaths a year may be

attributable to obesity

Overweight Trends

• Obesity (BMI> 30) in adults has nearly doubled

• Overweight in children has doubled

• Overweight in adolescents has tripled

• Increases across all ages, racial and ethnic groups, both genders

• If not arrested will account for more m&m than tobacco

Eat, Drink and be Merry?

• premature death• type 2 diabetes• heart disease• stroke• hypertension• abnormal cholesterol• cancer: colon, breast• complications of

pregnancy• menstrual irregularities

• gallbladder disease• osteoarthritis• sleep apnea• increased surgical risk• asthma• hirsutism• psychological disorders• social stigmatization

Adapted from www.niddk.nih.gov/health/nutrit/pubs/statobes.htm26

Prevalence of Diagnosed Diabetes in the United StatesPrevalence of Diagnosed Diabetes in the United StatesDiagnosed cases (1960-1998) and Projected Diagnosed cases (2000-2050)

Data for 1960-1998 from the National Health Interview Survey, NCHS, CDC

Projected data for 2000-2050 from the Behavioral Risk Factor Surveillance System, Division of Diabetes Translation, CDC

0

5

10

15

20

25

3019

60

1970

1980

1990

2000

2010

2020

2030

2040

2050

Peo

ple

(m

illi

on

s)

Year

Diagnosed cases

Projected diagnosed cases

INTAKE OUTPUTMAINTAINWEIGHT

OUTPUT

INTAKE LOSEWEIGHT

INTAKE

OUTPUTGAIN

WEIGHT

Determinants of Weight Status

The Best Prescription

Rxprevention

The Call to Action to Prevent and Decrease Overweight and Obesity

The Call to Action to Prevent and Decrease Overweight and Obesity

“…it’s all about health not appearance…”

www.SurgeonGeneral.gov

A Wake Up Call

More than 1.7 million Americans die of a More than 1.7 million Americans die of a chronic disease each yearchronic disease each year

Chronic diseases account for 2/3 of years lost due to premature death

More than 125 million Americans live with chronic conditions, and millions of

new cases are diagnosed each year

Chronic diseases

account for 75% of the

$1.4 trillion we spend on

healthcare

Federal Prevention Initiatives

• New Initiatives

• HealthierUS

• Steps to a HealthierUS

• Established Programs

• Healthy People 2010

• Dietary Guidelines for Americans

HealthierUS Mission

Four Health Pillars: • Be physically active every day• Eat a nutritious diet • Get preventive screenings• Make healthy choices

Prevent a tremendous amount of disease, disability and death to help Americans lead safer, healthier, longer lives

Actions Around HealthierUS

• Reinvigoration of the President’s Council on Physical Fitness and Sports

• Partnerships within the Federal Government• HealthierChildren and Youths• Public Health and Recreation• 5 A Day

Steps to a HealthierUS

• Secretary Thompson’s

Prevention Initiative

• Envisions a nation where diseases are prevented when possible, controlled when necessary, and treated when appropriate

Steps to a HealthierUS

• Reducing Burden of Disease• Obesity• Diabetes• Asthma

• Addressing Risk Factors• Nutrition • Physical activity• Tobacco use

Steps Will Support• Community initiatives to promote and enable healthy choices

• Collaboration with the private sector, healthcare groups, and insurance systems to target reduction of risk factors and complications of chronic disease

• Cooperation among policy makers to invest in disease prevention and health promotion

• Health promotion programs to motivate and support responsible health choices

• State and federal policies that invest in the promise of prevention of all Americans

HHS Agencies Involved With Steps

• Administration on Aging

• Administration for Children and Families

• Agency for Healthcare Research and Quality

• Centers for Disease Control and Prevention

• Centers for Medicare and Medicaid Services

• Food and Drug Administration

• Health Resources and Services Administration

• Indian Health Service

• National Institutes of Health

• Office of Disease Prevention and Health Promotion

• Substance Abuse and Mental Health Services Administration

National Prevention Summit 2003

• Steps to a HealthierUS Launched• Putting Prevention First

• Secretary Thompson • Laid-out priorities and program

• Over 1000 attendees• Every facet of the health industry represented

Steps Prevention Portfolio

Available at www.healthierus.gov/steps

Power of Prevention

Prevention Strategies that

Work

Prevention Programs in

Action

Steps Grants Program - RFA

• 5-year cooperative agreement program

• Sponsored by HHS, acting through CDC and

combining strengths and resources of all relevant

HHS agencies and programs

• Innovative and effective community-based chronic

disease prevention and control programs

Steps RFA – Community Interventions

• Engage community members in assessments, planning, delivery, and evaluation

• Improve strategic communication through media and IT

• Develop supportive environments and social support to sustain individual change efforts

• Improve access to and utilization of quality health care services

Steps RFA – School Interventions

• Establish fulltime school health coordinator or council

• Provide adequate physical education for all students

• Implement professional development and staff wellness programs

• Ensure healthy choices wherever food and drinks are provided in schools

• Establish tobacco-free school environments

Steps RFA - TimelineMay 9 May 9

RFA Published in the Federal Register

May 22 May 22 Pre-Application Broadcast

June 2 June 2 Letters of Intent Due

July 15 July 15 Applications Due

September 18 September 18 Awards Made

Visit www.HealthierUS.Gov for More Visit www.HealthierUS.Gov for More InformationInformation

STEPS Awardees Representing 23 Communities

State-coordinated Small Cities/Rural Communities

WA — 4 countiesAZ — 3 countiesCO — 4 countiesNY — 4 counties

Tribes/Tribal Entities

Intertribal CouncilOf Michigan

Large Cities/Urban Communities

Seattle-King County, WASalinas-Monterey County, CAAustin-Travis County, TXNew Orleans, LASt. Petersburg-Pinellas County, FLBoston, MAPhiladelphia, PA

Snapshot of Steps Interventions

• New Orleans – Develop bicycle/pedestrian plans for individual

neighborhoods

• Boston – Implement changes to improve delivery of preventive

services like interactive risk assessment tools, patient registries and provider reminders

• Philadelphia – Develop a comprehensive system of after-school health

clubs, nutrition education programs, and physical education to promote wellness

Other Steps Activities

• Reach out to private partners • Business summit and industry specific

roundtables

• Launch National Diabetes Initiative• 5.9 million undiagnosed

• 2nd Annual Prevention Summit

2nd National Summit

Steps to A HealthierUS

April 28 – 29, 2004

Baltimore Marriott Waterfront

Baltimore, MD

Contact Information

Office of Disease Prevention and Health Promotion

202-401-6295

SAVE THE DATE

Healthy People 2010

• A comprehensive set of national health objectives

• Developed as a ten-year plan

www.healthypeople.gov

Healthy People 2010

• 2 Goals:

– Increase Quality and Years of Healthy Life

– Eliminate Health Disparities

• 467 specific objectives grouped into 28 focus areas

• The result of an extensively

collaborative scientific process

Overweight and ObesityOverweight and obesity, United States,1988–94

*In those aged 6 to 19 years, overweight or obesity is defined as at or above the sex- and age-specific 95th percentile of Body Mass Index (BMI) based on CDC Growth Charts: United States.

**In adults, obesity is defined as a BMI of 30 kg/m2 or more; overweight is a BMI of 25 kg/m2 or more.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics. National Health and Nutrition Examination Survey. 1988–94.

Healthy People 2010

• Ongoing evaluation– Progress Reviews

– Mid-Course Reviews

– Developmental Objectives

Dietary Logic?• The Japanese eat very little fat and suffer fewer heart

attacks than the British or Americans.• The French eat a lot of fat and also suffer fewer

heart attacks than the British or Americans.• The Japanese drink very little red wine and suffer

fewer heart attacks than the British or Americans.• The Italians drink excessive amounts of red wine, and

also suffer fewer heart attacks than the British or Americans.

Dietary Logic?

• Conclusion:

• Eat & drink what you like. • It's speaking English that kills

you.

Dietary Guidelines for Americans

• Science-based advice for ages 2+

• Promote health

• Prevent chronic disease

• Federal nutrition policy/ programs

• Vehicle to speak with one voice

• “Gold standard”• HHS/USDA

1980 1985 1990 1995

Figure 1. Covers of the first 4 editions of the Dietary Guidelines for Americans

Aim for Fitness

• Aim for a healthy weight

• Be physically active each day

Be physically active each day

Health benefits of physical activity Physical activity recommendations

Adults -- 30 minutes of moderate physical activity most,

preferably all, days of the weekChildren -- 60 minutes of moderate

physical activity daily

Build a Healthy Base

Let the Pyramid guide your food choices Choose a variety of grains daily, especially

whole grains Choose a variety of fruits and vegetables

daily Keep food safe to eat

Fats, Oils, & SweetsUSE SPARINGLY

Milk, Yogurt,& CheeseGroup2-3 SERVINGS

VegetableGroup3-5 SERVINGS

Meat, Poultry, FishDry Beans, Eggs

& Nuts Group2-3 SERVINGS

Fruit Group

2-4 SERVINGS

Bread, Cereal,Rice, & Pasta

Group6-11

SERVINGS

Food Guide PyramidA Guide to Daily Food Choices

Source: U.S. Department of Agriculture/U.S. Department of Health and Human Services

KEY

Fat (naturally occurring and added)

Sugars (added)

These symbols show fat andadded sugars in foods

1,600calories

2,200calories

2,800calories

Grains group 6 9 11

Veg. group 3 4 5

Fruit group 2 3 4

Milk group 2 or 3 2 or 3 2 or 3

Meat andbeans group

2(5 oz. total)

2(6 oz. total)

3(7 oz. total)

Recommended number of servings

Choose Sensibly

Choose a diet that is low in saturated fat and cholesterol and moderate in total fat

Choose beverages and foods to moderate your intake of sugars

Choose and prepare foods with less salt If you drink alcoholic beverages, do so

in moderation

Choose a diet that is low in saturated fat and cholesterol and

moderate in total fat Total fat recommendation: 30% of

calories or less Descriptions of the different types of fat Limits on saturated fat and total fat for

various calorie levels Comparison of saturated fat content of

foods

• Calories

• Total fat in grams

• Saturated fat in grams

• Cholesterol in milligrams

• Sodium in milligrams

Nutrients in one serving.

The “ % Daily Value” shows you how much of the recommended amounts the food provides in one serving,

Here is the recommended daily amount for each nutrient for two calorie levels.

Serving Number of

servings

Goal of Dietary Guidelines

IMPROVE HEALTH BY:• Increasing awareness

• Providing healthy options

• Promoting healthy choices

Consumer Understanding

“Moderate”

• ”a reasonable amount”

• “the lowest possible amount”

• “some, but not a lot”

• “a small amount”

• “limit”

• “put that 3rd donut away”

How are we doing?

• Only 3 percent of us meet 4 of the 5 recommendations for intake of grains, fruits, vegetables, dairy products, and meats

• Less than 20% teenage girls get enough calcium• 35% of adolescents don’t get enough physical

activity• 43% of high schoolers watch more than 2 hours of

TV per day

Taking Steps Together

“The function of protecting and

developing health must rank even above

that of restoring it when it is impaired. ”

Hippocrates

Karyl Thomas Rattay Karyl Thomas Rattay Kthomas@osophs.dhhs.govKthomas@osophs.dhhs.gov