CDC Division of Nutrition, Physical Activity and Obesity Activities ASNNA Annual Meeting February 16, 2010 Christa Essig, MPH Division of Nutrition, Physical Activity and Obesity Centers for Disease Control and Prevention FNCS/USDA Detail The findings and conclusions herein are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention

Obesity negatively impacts the nation’s economy Medical costs associated with obesity for the United States have risen to $147 billion in 2008 dollars. Finkelstein et al., 2009

Division of Adult and Community Health Action Institutes and Training Tools for Community Action Community Health Resources Database Community Health Assessment and Group Evaluation (CHANGE) ToolCommunity Health Assessment and Group Evaluation (CHANGE) Tool Action Guides Evaluation and Innovation Program Monitoring and Evaluation Program Success Stories Journal Articles on Program Successes

Division of Adolescent and School Health

Division of Nutrition, Physical Activity and Obesity

DNPAO Goals Increase health-related physical activity through population-based approaches. Improve those aspects of dietary quality most related to population burden of chronic disease and unhealthy child development. Decrease prevalence of obesity through prevention of excess weight gain and maintenance of healthy weight loss.

Activities Support Principle Target Areas Environments/policies that foster - Physical activity - Consumption of fruits and vegetables - Breastfeeding Environments/policies that discourage - Television viewing - Consumption of sugar-sweetened beverages - Consumption of high-energy dense foods (high calorie/low nutrient foods)

Strategies to Support Behavior Targets To Decrease Consumption of High Energy Dense Diets Apply nutrition standards in childcare, school, and workplace settings Promote menu labeling in states and communities Support interventions for retail food in underserved areas To Decrease Consumption of Sugar-Sweetened Beverages Ensure ready access to safe and palatable (quality) drinking water Limit access to sugar-sweetened beverages Decrease relative cost of healthy beverages through differential pricing and/or taxation of sugar-sweetened beverages ToIncrease Fruit and Vegetable Consumption Establish food policy councils Support farm-to-where-you-are programs Improve access to retail food stores that provide fruits and vegetables

Story, M., K. M. Kaphingst, et al. (2008). "Creating healthy food and eating environments: policy and environmental approaches." Annual Rev Public Health 29: , Figure 1.

CDC Supports State-Based Nutrition, Physical Activity, and Obesity Programs Currently funds 25 states, with a total of $16.1 million a year – average of $700,000 per state award CDC contributes to the development of state obesity programs by providing states with: - program funding - training - technical assistance - program oversight For more information: Claire Heiser Division of Nutrition, Physical Activity, and Obesity Web site:

Community Guide Promoting Physical Activity : Environmental and policy approaches are designed to provide environmental opportunities, support, and cues to help people be more physically active. The physical environment Social networks Organizational norms and policies Laws Public health professionals, community organizations, legislators, departments of parks, recreation, transportation, and planning, and the media

CDC Recommended Community Strategies and Measurements to Prevent Obesity in the US

Promote the Availability of Affordable Health Foods and Beverages Communities should: Increase availability of healthier food and beverage choices in public service venues Improve availability of affordable healthier food and beverage choices in public service venues Improve geographic availability of supermarkets in underserved areas Provide incentives to food retailers to locate in and/or offer healthier food and beverage choices in underserved areas Improve availability of mechanisms for purchasing foods from farms Provide incentives for the production, distribution, and procurement of foods from local farms

American Recovery and Reinvestment Act Prevention and Wellness Initiative Emphasis on policy and environmental change at state and local levels: - Increase levels of physical activity; - Improve nutrition; - Decrease obesity rates; and - Decrease smoking prevalence, teen smoking initiation, and exposure to second-hand smoke.

Examples of Policies and Programs –Improving access to healthy foods in schools through changes in school meal planning and purchasing across the state. –Increasing physical activity among school children by implementing improvements to physical education programs and expanding the number of minutes students are physically active. –Promoting breastfeeding through hospital and workplace policies to support initiation and continuation of breastfeeding. –Reducing exposure to secondhand tobacco smoke through statewide policies limiting smoking in public and work places.

MAPPS - Nutrition Media Access Point of Purchase/ Promotion Price Social Support and Services

Media Media and advertising restrictions consistent with federal law Promote healthy food/drink choices Counter-advertising for unhealthy choices

Access Healthy food/drink availability (e.g., incentives to food retailers to locate/offer healthier choices in underserved areas, healthier choices in child care, schools, worksites) Limit unhealthy food/drink availability (whole milk, sugar sweetened beverages, high-fat snacks) Reduce density of fast food establishments Eliminate transfat through purchasing actions, labeling initiatives, restaurant standards Reduce sodium through purchasing actions, labeling initiatives, restaurant standards Procurement policies and practices Farm to institution, including schools, worksites, hospitals and other community institutions

Point of Purchase/Promotion Signage for healthy vs. less healthy items Product placement & attractiveness Menu labeling Price Changing relative prices of healthy vs. unhealthy items (e.g. through bulk purchase/procurement/competitive pricing). Social Support & Services Support breastfeeding through policy change and maternity care practices

Quality Control Project officer oversight, provide tools, guidance and TA Monitor performance and outcomes Ongoing feedback to maximize health impact of projects CDC and HHS will use the lessons learned from the initiative to improve the design and delivery of their state and local health promotion and disease prevention programs

Final Award Amounts for State and Territory Component CDC received 58 applications—from all 50 states All applicants receive funding for efforts in nutrition, physical activity, and tobacco control. TOTAL AWARD AMOUNT $119,067,687 ention_and_wellness_ARRA_awards_fact_sheet.pdf ention_and_wellness_ARRA_awards_fact_sheet.pdf

Economic development Healthy individuals Small & medium scale farm viability Community & social vitality Jobs Farmland preservation Environmental stewardship Growing food Distributing Retailing Eating Preparing (e.g., restaurants) Processing Community- based food system

CDC Resources Community Recommendations: The State Indicator Report on Fruits and Vegetables, 2009: DNPAO State Legislation Database: ARRA State Programs