Progress and Challenges in the Prevention and Control of Obesity

Progress and Challenges in the Prevention and Control of Obesity William H. Dietz, MD, PhD Former Director of the Division of Nutrition, Physical Activity, and Obesity Centers for Disease Control and Prevention

Changes in Prevalence of Obesity in US Men 1999-2010 Prevalence 45 40 35 30 25 20 15 10 5 0 1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-2010 NHW NHB M-A Year Flegal KM et al. JAMA 2010;303:235; and JAMA 2012;307:491

Changes in Prevalence of Obesity in US Women 1999-2010 70 60 Prevalence (%) 50 40 30 20 10 NHW NHB M-A 0 1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-2010 Year Flegal KM et al. JAMA 2010;303:235 and JAMA 2012; 307: 491

Severe Obesity Trends in US Adults

Obesity Trends in Children < 5yo Pediatric Nutrition Surveillance System

Obesity Trends in US Youth over the Past 12 Years Ogden et al. 2012, NCHS data brief

Declines in Obesity Prevalence Location Ages Baseline FU % Change Philadelphia K - 12 2006-7 2009-10 - 4.7% New York City K 8 2006-7 2010-11 - 5.5% Mississippi K 5* 2005 2011* - 13.3% California G 5-9 2005** 2010** - 1.1% West Virginia K 2010-11 2011-12 - 3.9% *Spring; **CA Fitness Test Robert Wood Johnson Issue Brief, September 2012

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

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

Energy Deficits Necessary to Achieve the HP 2010 Goals (Prevalence = 5%) by 2020 Age Deficit 2-5 yo 33 Kcal/d 6-11 yo 149 Kcal/d 12-19 yo 177 Kcal/d Wang YC et al. Am J Prev Med 2012; 42:437

Principal Targets for Obesity Prevention and Control Pregnancy: pre-pregnant weight, weight gain, diabetes, smoking Reduce energy intake Decrease high energy dense foods Increase low energy dense foods - fruits and vegetables Reduce sugar drinks Decrease television time Breastfeeding Increase energy expenditure Increase daily physical activity Sleep

Best Investments Disparities Continued focus on evidence Move from what to how Remain assertive regarding policy solutions Procurement policies Parenting Early care and education Clinical care and management

Evidence Integration Triangle to Align Science with Policy and Practice Intervention program or policy Participatory implementation process Evidence Stakeholders Multilevel Context Intrapersonal Policy Interpersonal Community Organizational Social Glasgow RE et al. Am J Prev Med 2012;42:646 Practical measures of progress

Key Process Strategies Multi-component with local repackaging Multi-sectoral - focus on settings with specific objectives Evidence base build academic and community bridges Create public awareness of risks and benefits Find co-benefits of obesity prevention and control Assess dose of interventions (Reach X Strength = Dose)

CDC s Food and Sustainability Policy Trans fat, saturated fat and sodium No added sweeteners to fruits Daily at least one raw and one prepared vegetable Whole grain default for bread and pasta All milk < 2% fat Low fat protein entrees; vegetarian entrée twice/week 50% beverages other than < 40Kcal/serving Deep fried options limited to one choice/day www.cdc.gov/chronicdisease/resources/guidelines/food-service-guidelines.htm

Changes in the Frequency of of Multiple Complications among Obese Adults % with > 6 Complications 1987 2002 Obese 8.7% 15.5% Severely obese 14% 25% Thorpe KE et al. Health Affairs 2005:W5-317

Percentage of Costs Attributable to Overweight and Obesity (2000 MEPS Sample) Grade III (3%) Overweight (36%) 20% 31% Grade II (5%) 20% 29% Grade I (15%) Arterburn DE et al. Int J Obesity 2005;29:334

Clinical Strategies for the Prevention and Management of Obesity Interprofessional education Bias Innovative approaches Provider and institutional role models Clinical : community partnerships

PHA s Hospital Healthy Food Commitment Nutrition labeling Market healthful foods Healthy checkout Children and adult wellness meals Standards for overall cafeteria and general menu offerings Remove all fryers and deep fat fried products by 2016 Increase fruit and vegetable purchases by 20% annually Increase healthy beverage purchases to 80% total

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

Best Investments Sugar drinks - industry co-optation, addictive properties Pizza Physical activity Reframe screen time as advertising time Clinical prevention and management Invest in strategies with co-benefits Communication Metrics

Percentage Contribution of Pizza to Caloric Intake Age group Rank % Kcal #1 source 2-18 yo 2 nd 6.7% Grain-based desserts (6.8%) 2-3 yo 7 th 3.2% Reduced-fat milk (6.2%) 4-8 yo 5 th 5.3% Grain-based desserts (7.6%) 9-13 yo 2 nd 6.3% Grain-based desserts (7.1%) 14-18 yo 2 nd 8.8% Soda/sports drinks (9.3%) From http://riskfactor.cancer.gov/diet/foodsources/energy/table1a.html

Elements Common to Social Movements Shared and personalized perception of a threat Grass roots commitment Social network focused on collective action against a common target Local nodes with dense social ties, linked to other groups with weak bridging ties (rapid diffusion of innovation) Sustained action