The Evolution of Strategies for the
Prevention and Control of Obesity
William H. Dietz, MD, PhD
Director
Division of Nutrition, Physical Activity, and Obesity
Centers for Disease Control and Prevention
Obesity Trends Among U.S. Adults
BRFSS, 1992
Obesity Trends Among U.S. Adults
BRFSS, 1994
Obesity Trends Among U.S. Adults
BRFSS, 1996
Obesity Trends Among U.S. Adults
BRFSS, 1998
Obesity Trends Among U.S. Adults
BRFSS, 2000
Obesity Trends Among U.S. Adults
BRFSS, 2002
(*BMI 30, or ~ 30 lbs overweight for 5’4” person)
No Data
<10%
10%–14%
15%–19%
20%-24%
25%
Obesity Trends Among U.S. Adults
BRFSS, 2004
No Data
<10%
10%–14%
15%–19%
20%-24%
25%
Obesity Trends Among U.S. Adults
BRFSS, 2006
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends Among U.S. Adults
BRFSS, 2007
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends Among U.S. Adults
BRFSS, 2008
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends Among U.S. Adults
BRFSS, 2009
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends Among U.S. Adults
BRFSS, 2010
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Prevalence of Obesity Among U.S.
Children and Adolescents
Aged 6-11 years
16
Aged 12-19 years
14
12
10
8
6
4
2
0
1963-70
NHES II & III
1971-74
NHANES I
1976-80
NHANES II
1988-94
NHANES III
1999-2000
NHANES
Standardized Share of Mode for Trips to School –
National Personal Transportation Survey
60
Car
% of Trips
50
40
Bus
30
20
Walk/bike
Public transit
10
0
1969
1977
1983
1990
1995
2001
Year
McDonald NC. Am J Prev Med 2007;32:509
Shifts in Food Practices in the United States
 Increased cost of healthful foods
 Decreased cost of junk foods
 Increased portion size
 Increased variety
 Increased school vending and
carte foods
17
a la
Changes in Dietary Habits and Weight Change
Weight Change over 12-20 Years
Mozaffarian D et al. NEJM 2011364:2392
Obesity Trends in Adults over the Past 12 Years
Source: CDC/NCHS, NHANES; Ogden et al. 2012, NCHS data brief. Adults 20+ years; Significant increasing trend in men
Severe Obesity Trends over Past 12 Years
Source: CDC/NCHS, NHANES; significant trends for both men and women
Obesity Trends in Youth over the Past 12 Years
Source: CDC/NCHS, NHANES; Ogden et al. 2012, NCHS data brief. Significant increasing trend in boys
Costs of Obesity – 1998 vs 2008
Total costs
Medical costs
1998
$78.5 B/y
6.5%
2008
$147 B/y
9.1%
Finkelstein et al. Health Affairs 2009; 28:w822
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
Broadcast advertising 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
Energy Deficits Necessary to Achieve by 2020 the HP 2010
(Prevalence = 5%) or HP2020 Goals (10% Decrease) *
Age
2-5 yo
6-11 yo
12-19 yo
•
•
•
•
HP2010
33 Kcal/d
149 Kcal/d
177 Kcal/d
HP2020
5 Kcal/d
40 Kcal/d
31 Kcal/d
Sugar drinks = 250 Kcal/d (21-50 Kcal/d consumed in schools)
Healthy Weight Commitment – 1.5 trillion Kcal reduction (12.5 Kcal/capita)
Quality PE = 35 Kcal/d
Switch sugared for non-sugared breakfast cereal – 8-80 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 and increase low ED foods
Increase fruit and vegetable intake
Reduce sugar drinks
Decrease television time
Breastfeeding
Increase energy expenditure
Increase daily physical activity
Social Ecological Model
Greatest
Impact
Federal and State
Community
Institutions
Interpersonal
t
lll
Individual
Smallest
Impact
Federal, state and local
policies to regulate and
support healthy actions
Policies, standards,
social networks
Policy, regulations
and informal structures
Family, peers, social
networks
Knowledge, attitudes,
beliefs and behaviors
National Initiatives
Let’s Move
Partnership for a Healthier America
Child Nutrition Reauthorization – Healthy Hunger-free Kids Act
Healthy Food and Sustainability Policy
National Action Plan for Physical Activity
Community-level Interventions (CPPW and CTGs)
Surgeon General’s Call to Action on Breastfeeding
Affordable Care Act
Food, Farm, and Jobs Bill
Transportation Reauthorization
HBO’s Weight of the Nation
IOM Report “Accelerating Progress in Obesity Prevention”
Institutional Progress towards Obesity
Prevention and Control
Food industry
Healthy Weight Commitment
Product reformulation
Early care and education
Let’s Move Child Care
Schools
Healthy Hunger-free Kids Act
Joint use agreements
Safe Routes to School
Children in Early Care and Education Programs
In 2001, 73% of preschool children ages 3-5 years old (8.6 million
children) participated in at least one weekly non-parental care
arrangement
Nearly 60% of children 3-4 years with employed mothers
participate in center-based care
41% of preschool children are in child care for 35 or more
hours/week
Capizzano J et al. www.urban .org/url.cfm?ID=309438; www.urban .org/url.cfm?ID=309439
Let’s Move Child Care Challenge
Physical activity: 1-2h/d, outside play when possible
Screen time: None for <2yo; 30’/w during child care
Food: Fruits or vegetables at every meal, no fried foods, family
style
Beverages: Water access at meals and throughout day; no
sugar drinks; for > 3yo, LF or NF milk; limit juice to 4-6 oz
100% juice/d
Infant feeding: Support breastfeeding for mothers who want to
continue during the child care day
Institutional Progress towards Obesity
Prevention and Control
Worksites
Nutrition and PA strategies in large businesses
Medical settings
Healthy Baby Friendly hospitals
Clinical:community partnerships
Communities and states – CPPW and CTG
Healthy food financing initiatives
Procurement policy
Parks and Recreation facilities
Chronic Care Model
Environment
Medical System
Family
School
Worksite
Community
Information Systems
Family/Patient
Self-Management
Decision Support
Delivery System Design
Self Management Support
Dietz WH et al. Health Affairs 2007;26:430
Community Transformation Grants
Goal: Decrease death or disabilities through changes in weight,
proper nutrition, physical activity, tobacco use, emotional wellbeing and overall mental health
Priorities:
Tobacco-free living
Active living and healthful eating
High impact quality clinical preventive services – BP,
cholesterol
May also address
Social and emotional wellness
Healthy and safe physical environment
Elements Common to Social Movements
Shared and personalized perception of a threat
Mobilizing frame
- Narrative fidelity
- Emotional engagement - moral imperative
Collective identity and solidarity
Network focused on collective action against a common
target
Communication channels
- Rapid diffusion of innovation
Sustained action
Opportunities
• Connect existing efforts
• Identify and mobilize the passionately committed
• Use the HBO Weight of the Nation documentary to build
grass roots support for community-based strategies
• Build on the IOM report “Accelerating Progress in Obesity
Prevention
• Identify targets that address the triple bottom line
- Capitalize on oil dependency to promote physical transport
- Use the foreclosure crisis to restructure communities
GOALS
1.Make physical activity an integral and
routine part of life.
2.Create food and beverage
environments that ensure that healthy
food and beverage options are the
routine, easy choice.
3.Transform messages about physical
activity and nutrition.
4.Expand the role of health care
providers, insurers, and employers in
obesity prevention.
5.Make schools a national focal point for
obesity prevention.
Opportunities
• Connect existing efforts
• Identify and mobilize the passionately committed
• Use the HBO Weight of the Nation documentary to build
grass roots support for community-based strategies
• Build on the IOM report “Accelerating Progress in Obesity
Prevention
• Identify targets that address the triple bottom line
- Capitalize on oil dependency to promote physical transport
- Use the foreclosure crisis to restructure communities