1. Obesity: Myths, Challenges, and Successes William H. Dietz MD, PhD Former Director Division of Nutrition Physical Activity, and Obesity Centers for Disease Control and Prevention

2. Obesity Trends Among U.S. Adults BRFSS, 1991

3. Obesity Trends Among U.S. Adults BRFSS, 1993

4. Obesity Trends Among U.S. Adults BRFSS, 1995

5. Obesity Trends Among U.S. Adults BRFSS, 1997

6. Obesity Trends Among U.S. Adults BRFSS, 1999

7. Obesity Trends Among U.S. Adults BRFSS, 2001

8. No Data 25% Obesity Trends Among U.S. Adults BRFSS, 2003

9. Obesity Trends Among U.S. Adults BRFSS, 2005 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

10. Obesity Trends Among U.S. Adults BRFSS, 2007 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

11. Obesity Trends Among U.S. Adults BRFSS, 2009 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

12. Obesity Trends Among U.S. Adults BRFSS, 2010 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

14. Obesity Trends Among U.S. Adults BRFSS, 2010 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

15. Ogden et al. 2012, NCHS data brief. Adults 20+ years Obesity Trends in Adults over the Past 12 Years

16. Prevalence of Obesity in Boys NHANES 2009-2010 Ogden et al; JAMA 2012; 307:483-90

17. Prevalence of Obesity in Girls NHANES 2009-2010 Ogden et al; JAMA 2012; 307:483-90

18. Prevalence of Obesity in Girls NHANES 2009-2010 Ogden et al; JAMA 2012; 307:483- 90

19. Obesity Trends in Youth over the Past 12 Year s Ogden et al. 2012, NCHS data brief

20. Year Thousands per year 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 Great Depression End of WW II 1st Surgeon General’s report 1st Surgeon General’s report Broadcast advertising ban Federal cigarette tax doubles Federal cigarette tax doubles Fairness Doctrine messages on TV and radio Fairness Doctrine messages on TV and radio Nonsmoker’s rights movement begins Nonsmoker’s rights movement begins 1st smoking cancer concern 1st smoking cancer concern Surgeon General’s report on environmental Tobacco smoke Surgeon General’s report on environmental Tobacco smoke Master settlement agreement Master settlement agreement Nicotine medications Available over the counter Nicotine medications Available over the counter 1st World Conference on smoking and health 1st World Conference on smoking and health 1998 1st Great American smokeout 1st Great American smokeout Annual Adult per Capita Cigarette Consumption and Major Smoking and Health Events- US 1900-1998

21. Myths and Misconceptions

23. Shifts in Food Practices in the United States  Increased cost of healthful foods  Decreased cost and increased caloric density of processed foods  Increased portion size  Widespread availability  Increased variety  Designed for palatability and shelf-life

24. Changes in Dietary Habits and Weight Change Weight Change over 12-20 Years Mozaffarian D et al. NEJM 2011364:2392

25. Evidence-based Community Design Street- and community-scale urban design and land use

27. Strategies for a Health Care System

28. Social Ecological Model t lll Individual Federal and State Community Interpersonal Greatest Impact Smallest Impact 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

29. Let’s Move Initiatives Let’s Move Outside (Parks and Recreation) Let’s Move Cities and Towns Chefs Move to Schools Let’s Move Salad Bars to Schools Let’s Move Child Care Challenge Let’s Move in Indian Country

30. Nutrition and Physical Activity Targets for a Health Care System Reduce energy intake Decrease high and increase low energy dense foods Increase fruit and vegetable intake Reduce sugar drinks Decrease television time (advertising time) Breastfeeding Increase energy expenditure Increase daily physical activity

31. Healthy Kids Out of School: Drink Right, Snack Smart, Move More

32. So How Do We Get from Here to There?

33. Panel Discussion