1. Setting Up Camp: How Do We Improve Nutrition, Increase Physical Activity and Prevent and Control Obesity?
William H. Dietz, MD, PhD
Division of Nutrition, Physical Activity, and Obesity
Centers for Disease Control and Prevention 2

2. DNPAO Functional Model
Leadership, Management & Accountability
Long-Range
Planning
Policy Analysis
Admin./ Clerical Services
Partnerships and External Relations
Research
Surveillance
Training
Translation & Dissemination
Program Development and Technical Assistance

3. Division of Nutrition, Physical Activity, and Obesity Proposed October-2008
Office of the Director
Bill Dietz
Laurie Johnson
Program Resource Management
Associate Director for Translation and Dissemination
Jude McDivitt
Associate Director for Science
Deb Galuska
Associate Director for Policy , Partnerships, and Communication
Vacant
Nutrition Branch
Larry Grummer-Strawn
Paulette Murphy
Research & Surveillance Team
Surveillance Systems Team
Guidelines Development & Recommendations Team
International Unit (M/M)
Physical Activity and Health Branch
Mike Pratt (Acting)
Lisa Kimbrough
Research Team
Surveillance Team
Guidelines Development & Recommendations Team
Obesity Prevention & Control Branch
Bill Dietz (Acting)
Tonya Ross)
Research & Surveillance Team
Guidelines Development and Recommendations Team
Program Development & Evaluation Branch
Rosanne Farris
Becky Payne
Program Advancement Team
Program Development and Translation Team
Evaluation Team

4. Office of Policy, Partnerships, and Communications
Associate Director for Policy,
Partnerships,
And Communications
Vacant, GS
Policy and Partnerships Team
Casey Hannan, Team Leader (GS )
Primary Team Functions:
Coordination - legislative/policy issues
Long-range planning
Materials development: position papers, briefings,
testimony, Q/A documents, etc.
Inquiry response (policymakers/partners)
FOIA
Controlled correspondence
Issues management
Partnership development
Communications Team
Vacant, Team Leader (GS )
Primary Team Functions:
Strategic communication plan
Coordination - communication activities
Audience research
Message/materials development
Web design/maintenance
Inquiry response (media/public)
Media relations
Media training & TA
Issues management

5. Overview of Efforts to Control Obesity
Problem definition
Strategy development
- Targets
- Strategies: policy and environmental change
Implementation
- Multi-sectoral
- Evaluation
Social movements 2

6. Overweight Prevalence by Race/Ethnicity
for Boys Aged Years
Prevalence (%)
Source: Ogden CL et al.JAMA. 2008;299:2401-5; MMWR 1997; 46:

7. Overweight Prevalence by Race/Ethnicity
for Girls Aged Years
Prevalence (%)
Source: Ogden CL et al. JAMA. 2008;299:2401-5; ;MMWR. 1997:46:

8. Changes in Obesity Prevalence by Race/ethnicity, Boys 2-19 Years
Ogden CL et al. JAMA 2008;299:2401

9. Broadcast advertising ban
Annual Adult per Capita Cigarette Consumption and Major Smoking and Health Events – US
Thousands per year
1st World Conference
on smoking and health
Broadcast advertising ban
1st Surgeon
General’s report
1st Great
American smokeout
End of WW II
Nicotine medications
Available over
the counter
Fairness Doctrine
messages on
TV and radio
Master
settlement
agreement
1st smoking
cancer concern
Surgeon
General’s
report on
environmental
Tobacco smoke
Nonsmoker’s
rights
movement
begins
Federal cigarette
tax doubles
Great Depression
1900
1910
1920
1930
1940
1950
1960
1970
1980
1990
1998
Year 2

10. Average Daily Energy Gap (kcal/day)
Excess Weight Gained
(Lb)
Daily Energy Gap
(kcal/day)
All Teens 10
Overweight Teens 58
678 -1,017
Behavioral implications of 150 kcal:
Replacing 1 can of soda (12 oz) with water (140 kcal)
Reducing TV watching by an hour (167 kcal/day)1
Walking 1.9 hours instead of sitting (for a 30-kg boy)
Increasing PE from 1 to 3 times/week (240 kcal)
Wang YC et al. Pediatrics 2006;118:e1721
Wiecha et al. 2006; Arch Pediatr Adolesc Med 160:436 10

11. Principal Targets Reduce energy intake
Decrease high and increase low ED foods
Increase fruit and vegetable intake
Reduce sugar-sweetened beverages
Decrease television time
Breastfeeding
Increase energy expenditure
Increase daily physical activity 2

12. Policy
Laws, regulations, formal and informal rules that are adopted on a collective basis to guide individual and collective behavior 2

14. Strategies to Increase Fruit and Vegetable Consumption
Access – supermarkets
School and community gardens
Competitive pricing
Packaging
Stealth interventions (Garden Market) 2

15. Agreement between the Alliance for a Healthier Generation and the Soft Drink Companies
Elementary schools
H2O
8 oz juice without added sweeteners
FF and LF regular and flavored milk
Middle schools
Same standards, 10 oz portions
High schools
No and low kcal drinks, light juices, sports drinks
50% must be H2O and no or low Kcal; 100Kcal/container 2

16. NYCDHMH, Amend Article 47, NYC Health Code; Applies to Group Day Care in NYC
Television, video and other visual viewing
Cannot be used for children <2 yo
Limited 60 minutes per day of educational programs or programs that actively engage child movement for children 2+ yo
60’ physical activity required
Eliminate sugar-sweetened beverages
Provide 1% or no-fat milk

17. Principal Targets Reduce energy intake
Decrease high and increase low ED foods
Increase fruit and vegetable intake
Reduce sugar-sweetened beverages
Decrease television time
Breastfeeding
Increase energy expenditure
Increase daily physical activity 2

18. Strategies to Increase Rates of Breastfeeding
Maternity care practices
Prenatal counseling
Baby-friendly hospitals
Workplace support for breastfeeding
Peer support – peer counseling
Professional support and education
Public acceptance 2

19. Role of Physical Activity in Weight Control
Dose to prevent obesity unknown
Dose to maintain weight after loss ~ 1 hr/d
Relatively modest impact on weight loss
Reduces obesity associated comorbidities 2

20. Effective Interventions to Promote Physical Activity
Informational
Community-wide education
Point of decision prompts
Behavioral and social
School-based PE
Non-family social support
Individually adapted behavior change
Environmental and policy
Enhanced access with outreach
Urban design and land use

21. The RE-AIM Framework R Reach E Effectiveness A Adoption
I Implementation
M Maintenance
Glasgow RE et al. Ann Behav Med 2004;27:3-12 2

22. “To obtain more evidence-based practice we need more practice-based evidence”
Green L, Ottoson JM. In Hiss et al, From Clinical Trials to Community: the Science of Translating Diabetes and Obesity Research, NIH, 2004.

23. Settings for the Prevention and Treatment of Obesity
Medical Settings
School
Work Site
Community

24. Chronic Care Model Environment Medical System
Family/Patient
Self-Management
Family
School
Worksite
Community
Information Systems
Decision Support
Delivery System Design
Self Management Support
Dietz WH et al. Health Affairs 2007;26:430

26. Pediatric Initiatives
Expert committee recommendations
Maine and Massachusetts collaboratives
NICHQ Network (NICHQ.org)
NCQA – HEDIS measures
AAP priority – Jeanne Lindros 2

27. Chronic Care Model Environment Medical System
Family/Patient
Self-Management
Family
School
Worksite
Community
Information Systems
Decision Support
Delivery System Design
Self Management Support
Dietz WH et al. Health Affairs 2007;26:430

28. Settings for the Prevention and Treatment of Obesity
Medical Settings
School
Work Site
Community

29. Priority Physical Activity and Nutrition Actions for Schools
Coordinated school health program and school health council
Assessment and planning (School Health Index)
Quality health education
Staff wellness programs
Additional opportunities for physical activity (e.g., recess, after school, walk to school)
Quality PE
Healthy school nutrition environment

30. % of Schools in Which Students Could Purchase Selected Food and Beverages From Vending Machines, School Store, Canteen, or Snack Bar, 2000 and 2006

31. Settings for the Prevention and Treatment of Obesity
Medical Settings
School
Work Site
Community

33. Model Worksite Interventions
DNPAO Stairwells
Sprint campus
KP farmers’ markets and commissary policy
NYC purchasing policy 2

34. Settings for the Prevention and Treatment of Obesity
Medical Settings
School
Work Site
Community

35. The Somerville, MA Intervention
Increased low ED foods
Discouraged high fat and sugar foods
School wellness policy
Enhanced school food service
Healthy meeting and event policy
Expanded pedestrian safety policies
Walk to school campaign
City employee fitness benefit
Local physician training
Economos et al. Obesity 2007;15:1325 2

36. Needs Identified at the CDC’s Community Meeting
Development of a national strategic plan
Clearinghouse for obesity prevention and control programs
Evidence-based and promising interventions
Training in HEAL for policymakers
Standardized evaluation tools
Flexible comprehensive funding 2

37. Largest Connected Subcomponent in Framingham Heart Study
Christakis and Fowler. NEJM 2007;357:370

38. A National Convergence Around Healthy Eating, Active Living
Steps to a
Healthier US

39. Elements Common to Social Movements
Shared and personalized perception of a threat
Common frame
Grass roots commitment
Social network focused on collective action
Local nodes with dense social ties, linked to other groups with weak bridging ties (rapid diffusion of innovation)
Organizational structure 2

40. Paul Revere’s Ride by
David Hackett Fischer