Linkages Between Medicine and Public HealthSteps to Combat the Obesity Epidemic PHGR

William H. Dietz, M.D., Ph.D.Director, Division of Nutrition, Physical Activity and Obesity

Centers for Disease Control and Prevention

Changes in Obesity Prevalence by Race/ethnicity Boys 2-19 Years

0

10

20

30

40

50

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008

Perc

ent

Non-Hispanic White Non-Hispanic Black Mexican American

Ogden CL et al. JAMA 2008;299:2401; Ogden CL et al. JAMA. 2010 303(3):242-9.

Changes in Obesity Prevalence by Race/ethnicity Girls 2-19 Years

0

10

20

30

40

50

1999-2000 2001-2002 2003-2004 2005-2006 2007-2008

Perc

ent

Non-Hispanic White Non-Hispanic Black Mexican American

Ogden CL et al. JAMA 2008;299:2401; Ogden CL et al. JAMA. 2010 303(3):242-9.

Impact of Childhood Obesity on Adult Obesity

• 25% obese adults were overweight children• 4.9 BMI unit difference in severity• Onset < 8y more severely obese as adults (BMI = 41.7 vs 34.0) • 50% of adults with BMI > 40 were obese as children

Freedman et al, Pediatrics 2001; 108: 712

Average Daily Energy Gap (kcal/day) Between 1988-94 and 1999-2002

Excess Weight Gained(Lb)

Daily Energy Gap (kcal/day)

All Teens 10 110 -165

Overweight Teens 58 678 -1,017

Principal Targets

Pregnancy: pre-pregnant weight, weight gain, diabetes, smokingReduce energy intake

Decrease high and increase low ED foods Increase fruit and vegetable intakeReduce sugar-sweetened beveragesDecrease television time

BreastfeedingIncrease energy expenditure

Increase daily physical activity

Priority Strategies to Address Target Behaviors

Energy densityApply nutrition standards in child care and schoolsPromote menu labeling in states and communitiesIncrease retail food stores in underserved areas

Fruits and vegetablesIncrease access through retail storesFarm to where you are policiesFood policy councils

Sugar-sweetened beveragesEnsure access to safe and good tasting waterLimit accessDifferential pricing strategies

Priority Strategies to Address Target Behaviors

Television viewingRegulations to limit TV time in child care settingsLimit food advertising directed at children

BreastfeedingPolicies and environmental supports in maternity carePolicy and environmental supports in worksites State and national coalitions to support breastfeeding

Physical activityCommunity-wide campaignsIncrease access with informational outreachIncrease opportunities for PA in school settings

Environment

Family

School

Worksite

Community

Chronic Care Model

Medical System

Information Systems

Decision Support

Delivery System Design

Self Management Support

Family/PatientSelf-Management

Dietz WH et al. Health Affairs 2007;26:430

Strategies for Community Interventions

Recommended Community Strategies and Measurements to Prevent Obesity in the United States; MMWR 2009;58:RR-7

Local Government Actions to Prevent Childhood Obesity. www.nap.edu

New Opportunities

Let’s MoveHealthy choicesHealthier schoolsPhysical activityAccess to affordable healthy food

Childhood Obesity Task ForceHHS Healthy Weight Task Force