1. Healthy Schools June 2011 Aruba PACO
Healthy Eating and Active Living: the CDC’s Public Health Approach to Preventing and Reducing Obesity
CDR 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 (CDC)
Healthy Schools June Aruba PACO

2. HHS HHS Healthy Weight Task Force
Department of Health & Human Services
HHS Healthy Weight Task Force
The findings presented are those of the presenter and not the official views of the CDC.

3. Division of Nutrition, Physical Activity and Obesity (DNPAO)
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

4. Obesity Trends* Among U.S. Adults BRFSS, 2000, 2005, 2009
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2000
2005
2009
$147 Billion = Obesity Associated
Health Care Spending, 2008 estimates
No Data <10% %–14% %–19% %–24% %–29% ≥30%

5. 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 data, disparities exist among youth with higher prevalence among minority racial/ethnic groups including Mexican American boys (27%) and Black girls (29%) aged y
Message: Obesity is Common, Costly, and Serious
Information on these obesity statistics, as well as state specific data, can be found on CDC’s Division of Nutrition Physical Activity and Obesity website:
Obesity Trends by State
Obesity by Race Ethnicity
County Specific Diabetes and Obesity Prevalence
Overweight Trends Among Children and Adolescents

6. Age-adjusted Percentage of U. S
Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes
Obesity (BMI ≥30 kg/m2)
1994
2000
2008
No Data <14.0% % % % >26.0%
Diabetes
1994
2000
2008
No Data <4.5% % % % >9.0%
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at

7. National news teleconference
“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.

8. 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

9. Multi-level, Multi-sector Prevention

11. Healthy eating & physical activity
Making Healthy Choices Easier
Individual
Environment
Affordability
Access, availability
Placement
Marketing
Culture
Skills
Knowledge
Time
Preferences
Healthy eating & physical activity
Environment

12. 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

13. Settings for the Prevention Childhood Obesity
Community
School
Child Care
Medical /hospitals
Worksite - family

14. CDC Guidance Documents: Policy and Environmental Strategies for State and Communities
Fruits & Vegetables
Energy Density
Sugar Sweetened Beverages
Breastfeeding
Physical Activity
Television Viewing

15. Evidence-based strategies
Promising
Emerging
Effective
Research-tested, Practice-based
Reach, impact, sustainability/maintenance

16. Strategies to Increase Fruit and Vegetable Access, Availability, and Consumption
Food Policy Coalitions as a Means to Improve the Food Environment
Access to Retail Venues that Sell Fruits and Vegetables in Underserved Communities
Farm-to-Where-You-Are Programs in All Possible Venues
Ready Access to Fruits and Vegetables in Worksite Foodservice, Meetings and Events
Community and Home Gardens
Policies to Incorporate Fruit and Vegetable Activities into Schools and Early learning centers/child care
Include Fruits and Vegetables in Emergency Food Programs 16 16 16

17. 7 Strategies: Reducing Sugar Drink Consumption
Ensure ready access to potable drinking water
Limit access to Sugar Drinks
Promote access to and consumption of more healthful alternatives to Sugar Drinks
Limit marketing of Sugar Drinks and minimize marketing’s impact on children
Decrease the relative cost of more healthful beverage alternatives through differential pricing of Sugar Drinks
Include screening and counseling about Sugar Drink consumption as part of routine medical care
Expand the knowledge and skills of medical care providers to conduct nutrition screening and counseling on Sugar Drink consumption

18. 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

19. Child Care-Based Program Example
Strategy 1: Ensure ready access to potable drinking water
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 breastmilk
Spring 2011: USDA Guidance for Schools – Compliance Fall 2011, low-fat/reduced fat milk, water during mealtime

20. School-Based Program Examples
Strategy: Promote access to and consumption of more healthful alternatives to Sugar Drinks
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

21. CDC Recommended Community Strategies and Measurements to Prevent Obesity
Increase availability of healthy, affordable food and beverage choices in public service venues.
Improve geographic availability of supermarkets in underserved areas.
Improve access to fresh fruits and vegetables by providing incentives for the production, distribution, and procurement of foods from local farms.
Limit advertisements of less-healthy foods and beverages.
• Increase support for breastfeeding.
• Promote exclusive breastfeeding and worksite accommodations to express human milk.
Improve access to outdoor recreational facilities.
• Build or enhance infrastructures to support more walking and bicycling.
• Support locating schools within easy walking distance of residential areas.
Improve access to public transportation
Participate in community coalitions or partnerships to address obesity.

22. 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 spaces
Healthy Parks, Healthy People

23. 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

24. Improving healthy eating and activity living is a shared responsibility. Social and environmental changes are influenced by the efforts of many…
There is a role for everyone in discovering ways to create supportive environments to help individuals and families to easily make healthy food choices, enjoy a physically active lifestyle, and move toward a healthy weight.

26. U.S. FTC Marketing Principles
U.S. Interagency workgroup, FTC Nutrition Marketing Principles, Voluntary
Nutrient standards for foods marketed to kids
Open comment period