HPLive Webinar from 10/23/15 with Rich Hamburg from Trust for America's Health and Dr. Heidi Blanck, Centers for Disease Control and Prevention

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%

4. Adult Obesity Rates (2014)

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

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

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

52. Why We Do It

53. Resources:
www.surgeongeneral.gov/stepitup

54. 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