Obesity: the Effectiveness of Prevention
and Treatment Strategies - Academy Health
William
i i
H. Dietz,
i
MD, PhD
Director of the Division of Nutrition, Physical
A i i and
Activity,
d Obesity
Ob i
Centers for Disease Control and Prevention
Changes in Obesity Prevalence by Race/ethnicity
Boys 2-19 Years
Non-Hispanic White
Non-Hispanic Black
Mexican American
50
Perrcent
40
30
20
10
0
1999-2000
2001-2002
2003-2004
2005-2006
2007-2008
Ogden CL et al. JAMA 2008;299:2401; Ogden CL et al. JAMA. 2010 303(3):242-9.
Changes in Prevalence of Obesity in Women
1999-2008
60
50
40
Prevalence
White
Black
M-A
30
20
10
0
19991999
2000
20012001
2002
20032003
2004
20052005
2006
20072007
2008
Year
Flegal KM et al. JAMA 2010;303:235
C t off Adult
Costs
Ad lt Obesity
Ob it – 1998 vs 2008
Total costs
Medical costs
1998
$$78.5 B/yy
6.5%
2008
$$147 B/yy
9.1%
Increased prevalence, not increased per capita costs,
was the main driver of the increase in costs
Finkelstein et al. Health Affairs 2009; 28:w822
Annual Adult per Capita Cigarette Consumption and Major
S
Smoking
i and Health Events – US
S 1900
1900-1998
1998
Thousands per year
1st World Conference
on smoking and health
Broadcast advertising
g ban
1st Surgeon
General’s report
1st Great
American smokeout
Nicotine medications
Available over
the counter
End of WW II
Fairness Doctrine
messages on
TV and radio
1st smoking
cancer concern
Nonsmoker’s
rights
movement
begins
1910
1920
1930
1940
Surgeon
General’s
report on
environmental
Tobacco smoke
Federal cigarette
tax doubles
Great Depression
1900
Master
settlement
agreement
1950
Year
1960
1970
1980
1990
1998
New Opportunities
pp
Let’s Move
E
Empower
parents
t
Healthier foods in schools
Physical activity
Access to affordable healthy food
y Task Force
Childhood Obesity
HHS Healthy Weight Task Force
National Action Plan for Physical Activity
Dietary Guidelines for Americans
Child Nutrition Reauthorization
Surgeon General’s Call to Action on Breastfeeding
CPPW Initiatives
$650 million
illi
States Funded for Nutrition and Physical Activity
CPPW comp I
805 also with CPPW
CPPW comp II
Average Daily Energy Gap (kcal/day) Between
1988 94 and 1999
1988-94
1999-2002
2002
Excess Weight Gained
(Lb)
Daily Energy Gap
(kcal/day)
All Teens
10
110 -165
Overweight Teens
58
678 -1,017
Sugar-sweetened beverages (SSBs) = 250 Kcal/d
Only 21-50 Kcal/d of calories from SSBs consumed in schools
Healthy Weight Commitment – 1.5 trillion Kcal reduction
12.5 Kcal per capita
Principal
p Targets
g for Obesityy Prevention and Control
Pregnancy: pre-pregnant weight, weight gain, diabetes, smoking
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
MAPPS Strategies
•
•
•
•
•
Media
Access
Point of Purchase / Promotion
Price
Social Support & Services
MAPPS
• Media
– FTC/CDC/FDA/USDA Working Group
– Promote
P
t physical
h i l activity
ti it and
dh
healthy
lth food/drink
f d/d i k choices
h i
– Counter-advertising for unhealthy choices
MAPPS
• Access
– Food/drink availability – Fresh Food Financing Initiative
– Regulatory
R l t standards
t d d for
f sodium
di and
d trans
t
f t
fat
– Procurement policies and practices
– Farm to Institution
– Safe, attractive, accessible activity
– Planning and zoning
– Daily quality PE in schools
MAPPS
• Point of Purchase/Promotion
P rchase/Promotion
– Signage
– Product
P d t placement
l
t
– Menu labeling
– Front of Pack labeling
Multiple Evaluation Components
MAPPS
Strategies
Policy and/or
Environmental
Changes
Activities and
Mil t
Milestones
ARRA Output
Measure
Cost study
Case study
ARRA Outcome
Measure
Risk Behavior
and Risk
Factor Change
Improved
Health
Outcomes
BRFSS, YRBS
BRFSS
Impact
(Biometric)
evaluation
System
S
t
dynamic
modeling
Opportunities and Challenges
• Two year time frame
• Uncertainty re: impact
• Need for local measures
• Evaluation critical
• Partnerships
Strategies for Community Interventions
Recommended Community Strategies and
Measurements to Prevent Obesity in the United States;
MMWR 2009;58:RR-7
Local Government
Go ernment Actions to Pre
Prevent
ent Childhood
Obesity. www.nap.edu