State of Obesity 2015

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The State of Obesity 2015 Better Policies for a Healthier America Richard Hamburg Deputy Director October 23, 2015

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Overview o  o  o  Adult rates are stabilizing at high rates overall, with only a handful of increases Significant disparities persist Prevention is key n  o  It is easier to prevent in children than reverse trends later. Future progress will require we examine what is working and bring these efforts to scale nationwide.

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Adult Obesity Trends in 2014 o  Rates increased in five states n  o  Kansas, Minnesota, New Mexico, Ohio, Utah Adult obesity (BMI > 30) now exceeds 35% in three n  n  n  Considerable variation (Arkansas, 35.9%; Colorado 21.3%) In 1991, no state exceeded 20% In 1980, no state exceeded 15%

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Adult Obesity Rates (2014)

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States With The Highest Obesity Rates o  7 of the 10 states with the highest rates of adult/childhood obesity are in the South.

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Persisting Disparities in 2014 data o  23 of the 25 states with the highest rates are in the South and Midwest o  o  9 out of 10 states with highest rates of diabetes are in the South American Indian/American Natives have highest adult obesity rate (54 percent) of any racial or ethnic group

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Childhood Obesity Trends o  2011 Pediatric Nutrition Surveillance Survey (PedNSS) of documented slight net decrease in obesity rates among 2to-4 year olds participating in certain federally-funded health programs n  Documented in all subgroups, except AI/AN kids

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Physical Activity and Obesity o  o  Being physically inactive is responsible for one in 10 deaths among U.S. adults. A 10-year study of children found that physical activity lowers risk for becoming overweight or obese and higher TV time increases it.

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Food Deserts and Healthy Weight o  o  More than 29 million Americans live in “food deserts.” 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.

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Income, Education Effects o  More than 33% of adults who earn less than $15,000 per year are obese n  o  33% of adults who don’t finish high school are obese n  o  Compared with 24.6 percent of those who earn at least $50,000. Versus obesity rate of 21.5 percent of those who finish college or technical college Protective effect of education extends to their children

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Why are we still concerned? o  o  Despite signs of stabilizing, rates are dangerously high Obesity increases the risk for dozens of health comorbidities n  o  Including type 2 diabetes, various types of cancer, cardiovascular disease, arthritis, etc. Baby Boomers coming on to Medicare will further exacerbate our long-term fiscal outlook

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Diabetes and Obesity o  o  More than 80 percent of people with diabetes are overweight or obese. 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.

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Poor Health, Increased Care Spending o  o  Current rates put 78 million Americans at increased risk of health problems n  Cardiovascular disease, diabetes, cancer, arthritis and many more Obese adults spend 42 percent more on direct healthcare costs

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Co-Morbidities o  Type-2 diabetes rates have doubled in the past 20 years n  One-in-three adults will have diabetes by 2050.

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Yet why are we still concerned? (cont’d) o  o  Obesity carries national security risks. It has negative implications for the education, agricultural, and transportation sectors. Public health and prevention funding remains inadequate. n  n  CDC funding has seesawed but has experienced a net cut ($6.93 billion for FY2015 vs. $7.31 billion in FY2005). 33 states and DC cut their public health budgets from FY11-12 to FY12-13

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Yet why are we still concerned? (cont’d)

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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  o  Community-based, comprehensive approaches (like CDC chronic disease prevention programs) seem to work best. ROI is critical.

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Bringing Initial Steps to Scale o  Addressing primary risk factors n  n  o  Broad, sustainable funding of evidence-based interventions, environmental, and systems changes n  n  o  Poor Nutrition Inadequate Physical Activity Investments in Partnerships to Improve Community Health—will not reach all Americans. Funding is in danger for FY 2016. Expanded diabetes and heart disease funding Connecting all Americans to preventive services and a variety of treatments

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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  n  n  n  n  1) Ensure that all children enter kindergarten at a healthy weight. 2) Make a healthy school environment the norm and not the exception across the United States. 3) Eliminate the consumption of sugar sweetened beverages among 0- to 5year-olds. 4) Make physical activity a part of the everyday experience for children and youth. 5) Make healthy foods and beverages the affordable, available and desired choice in all neighborhoods and communities.

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Systematic Federal Review 2015 report reviews federal policies and programs in five key areas: o  o  o  o  o  Early Childhood Schools Communities Nutrition Assistance and Education Quality, Affordable Healthcare

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Federal Policy Successes o  o  o  o  o  More than 31 million students participate in the National School Lunch and Breakfast Program each school day. 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. The Healthy, Hunger-Free Kids Act of 2010 strengthened the requirements for school districts to develop and implement local wellness plans Community Eligibility Provision- allows qualifying low-income schools can provide free meals to all students without cumbersome paperwork. Safe Routes to Schools programs operate in all 50 states, benefiting close to 15,000 schools.

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More Federal Policy Successes o  o  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. 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. 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.

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Progress at the State Level o  o  o  o  o  Many states have physical education requirements for students, and 17 states require schools to provide physical activity or recess during the school day. 28 States have laws supporting shared use of facilities 21 States have legislation that requires BMI screening or other weight-related assessments 40 States have enacted farm-to-school programs 48 States require schools to provide health education

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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

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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

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Who We are: Department of Health & Human Services Centers for Disease Control & Prevention

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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 populationbased 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

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What We Do: Making Healthy Choices Easier Individual/Family Environment • Skills, Knowledge • Time, resources • Parenting styles/rules Healthy eating & physical activity • Access, Availability, Quality • Affordability & Price • Information & Marketing • Social Environment

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Where We Work: Social Ecological Model Greatest Reach* Federal and State Community Institutions Interpersonal t lll Individual Federal, state and local policies to regulate and support healthy actions Policies, standards, social networks Policy, regulations and informal structures Family, peers, social networks Knowledge, attitudes, beliefs and behaviors Smallest reach * $45M Budget, 100 staff

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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

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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

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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

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Early Care and Education (ECE) §  Provide nutritious meals/snacks. §  Adequate, age-appropriate physical activity. §  Limit screen time. §  Support breastfeeding mothers and babies. State Licensing, QRIS, CACFP, Professional Development Learning Collaborative, $4M , 9 states Nemours http://www.cdc.gov/obesity/strategies/childcareece.html http://www.letsmove.gov/

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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

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Salad Bar in School Efforts Facility level intervention supported by District Wellness Policy, PTA Promotions

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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

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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.

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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

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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.

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How: 1305 State Funding for Nutrition, Physical Activity and Obesity Prevention Strategies Average Award Per State: Basic $135,000; Enhanced $433,000

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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

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Vital Signs: Oct 6, 2015 -- Percent of hospitals implementing more than half of the Ten Steps of Baby Friendly to Support Breastfeeding 2007 2009 DC DC PR PR IT 2011 2013 DC DC PR PR IT <20% 20– <40% IT 40 – <60% ≥60%

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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

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States and Communities Reporting Decreases in the Prevalence of Childhood Obesity Portland, ME Kearney, NE DuPage County, IL Cambridge, MA Somerville, MA Fitchburg, MA MA New York City OH Philadelphia, PA WV KP: SoCA CA Vance, NC Granville, NC San Diego, CA NM MS Chula Vista, CA El Paso, TX Anchorage, AK Source: Adapted from Dietz, 2014

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Prevention Matters Energy Deficits Necessary to Achieve the Healthy People 2010 Goal (Prevalence = 5%) by 2020 Age 2-5 y HP2010 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.

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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 •  Mean kilocalories from sugary drinks for ages 2 and over, United States 2005-2008 (NHANES)

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Example: CORD 3 sites, 2-12 yo children Medicaid/ CHIP Supplement: Childhood Obesity, 2015

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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

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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

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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

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Why We Do It

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Resources: www.surgeongeneral.gov/stepitup

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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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