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The Obesity Epidemic and
The Government’s Response
Karyl Thomas Rattay MD, MSKaryl Thomas Rattay MD, MSOffice of Disease Prevention Office of Disease Prevention
and Health Promotionand Health PromotionOctober 15, 2003October 15, 2003
Chronic Disease Epidemic
Obesity Trends* Among U.S. Adults BRFSS, 1991, 1995 and 2000
(*BMI 30, or ~ 30 lbs overweight)
1991 1995
2000
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.
No Data <10% 10%-14% 15-19% 20%
A Real and Consequential Epidemic
Overweight Facts
• 64% adults are overweight or obese (BMI> 25)
• 15% children & adolescents (aged 6 to 19) are overweight (> 95th percentile)
• associated with many chronic diseases, especially type 2 diabetes
• $117 billion total cost (2000)• 300,000 deaths a year may be
attributable to obesity
Overweight Trends
• Obesity (BMI> 30) in adults has nearly doubled
• Overweight in children has doubled
• Overweight in adolescents has tripled
• Increases across all ages, racial and ethnic groups, both genders
• If not arrested will account for more m&m than tobacco
Eat, Drink and be Merry?
• premature death• type 2 diabetes• heart disease• stroke• hypertension• abnormal cholesterol• cancer: colon, breast• complications of
pregnancy• menstrual irregularities
• gallbladder disease• osteoarthritis• sleep apnea• increased surgical risk• asthma• hirsutism• psychological disorders• social stigmatization
Adapted from www.niddk.nih.gov/health/nutrit/pubs/statobes.htm26
Prevalence of Diagnosed Diabetes in the United StatesPrevalence of Diagnosed Diabetes in the United StatesDiagnosed cases (1960-1998) and Projected Diagnosed cases (2000-2050)
Data for 1960-1998 from the National Health Interview Survey, NCHS, CDC
Projected data for 2000-2050 from the Behavioral Risk Factor Surveillance System, Division of Diabetes Translation, CDC
0
5
10
15
20
25
3019
60
1970
1980
1990
2000
2010
2020
2030
2040
2050
Peo
ple
(m
illi
on
s)
Year
Diagnosed cases
Projected diagnosed cases
INTAKE OUTPUTMAINTAINWEIGHT
OUTPUT
INTAKE LOSEWEIGHT
INTAKE
OUTPUTGAIN
WEIGHT
Determinants of Weight Status
The Best Prescription
Rxprevention
The Call to Action to Prevent and Decrease Overweight and Obesity
The Call to Action to Prevent and Decrease Overweight and Obesity
“…it’s all about health not appearance…”
www.SurgeonGeneral.gov
A Wake Up Call
More than 1.7 million Americans die of a More than 1.7 million Americans die of a chronic disease each yearchronic disease each year
Chronic diseases account for 2/3 of years lost due to premature death
More than 125 million Americans live with chronic conditions, and millions of
new cases are diagnosed each year
Chronic diseases
account for 75% of the
$1.4 trillion we spend on
healthcare
Federal Prevention Initiatives
• New Initiatives
• HealthierUS
• Steps to a HealthierUS
• Established Programs
• Healthy People 2010
• Dietary Guidelines for Americans
HealthierUS Mission
Four Health Pillars: • Be physically active every day• Eat a nutritious diet • Get preventive screenings• Make healthy choices
Prevent a tremendous amount of disease, disability and death to help Americans lead safer, healthier, longer lives
Actions Around HealthierUS
• Reinvigoration of the President’s Council on Physical Fitness and Sports
• Partnerships within the Federal Government• HealthierChildren and Youths• Public Health and Recreation• 5 A Day
Steps to a HealthierUS
• Secretary Thompson’s
Prevention Initiative
• Envisions a nation where diseases are prevented when possible, controlled when necessary, and treated when appropriate
Steps to a HealthierUS
• Reducing Burden of Disease• Obesity• Diabetes• Asthma
• Addressing Risk Factors• Nutrition • Physical activity• Tobacco use
Steps Will Support• Community initiatives to promote and enable healthy choices
• Collaboration with the private sector, healthcare groups, and insurance systems to target reduction of risk factors and complications of chronic disease
• Cooperation among policy makers to invest in disease prevention and health promotion
• Health promotion programs to motivate and support responsible health choices
• State and federal policies that invest in the promise of prevention of all Americans
HHS Agencies Involved With Steps
• Administration on Aging
• Administration for Children and Families
• Agency for Healthcare Research and Quality
• Centers for Disease Control and Prevention
• Centers for Medicare and Medicaid Services
• Food and Drug Administration
• Health Resources and Services Administration
• Indian Health Service
• National Institutes of Health
• Office of Disease Prevention and Health Promotion
• Substance Abuse and Mental Health Services Administration
National Prevention Summit 2003
• Steps to a HealthierUS Launched• Putting Prevention First
• Secretary Thompson • Laid-out priorities and program
• Over 1000 attendees• Every facet of the health industry represented
Steps Prevention Portfolio
Available at www.healthierus.gov/steps
Power of Prevention
Prevention Strategies that
Work
Prevention Programs in
Action
Steps Grants Program - RFA
• 5-year cooperative agreement program
• Sponsored by HHS, acting through CDC and
combining strengths and resources of all relevant
HHS agencies and programs
• Innovative and effective community-based chronic
disease prevention and control programs
Steps RFA – Community Interventions
• Engage community members in assessments, planning, delivery, and evaluation
• Improve strategic communication through media and IT
• Develop supportive environments and social support to sustain individual change efforts
• Improve access to and utilization of quality health care services
Steps RFA – School Interventions
• Establish fulltime school health coordinator or council
• Provide adequate physical education for all students
• Implement professional development and staff wellness programs
• Ensure healthy choices wherever food and drinks are provided in schools
• Establish tobacco-free school environments
Steps RFA - TimelineMay 9 May 9
RFA Published in the Federal Register
May 22 May 22 Pre-Application Broadcast
June 2 June 2 Letters of Intent Due
July 15 July 15 Applications Due
September 18 September 18 Awards Made
Visit www.HealthierUS.Gov for More Visit www.HealthierUS.Gov for More InformationInformation
STEPS Awardees Representing 23 Communities
State-coordinated Small Cities/Rural Communities
WA — 4 countiesAZ — 3 countiesCO — 4 countiesNY — 4 counties
Tribes/Tribal Entities
Intertribal CouncilOf Michigan
Large Cities/Urban Communities
Seattle-King County, WASalinas-Monterey County, CAAustin-Travis County, TXNew Orleans, LASt. Petersburg-Pinellas County, FLBoston, MAPhiladelphia, PA
Snapshot of Steps Interventions
• New Orleans – Develop bicycle/pedestrian plans for individual
neighborhoods
• Boston – Implement changes to improve delivery of preventive
services like interactive risk assessment tools, patient registries and provider reminders
• Philadelphia – Develop a comprehensive system of after-school health
clubs, nutrition education programs, and physical education to promote wellness
Other Steps Activities
• Reach out to private partners • Business summit and industry specific
roundtables
• Launch National Diabetes Initiative• 5.9 million undiagnosed
• 2nd Annual Prevention Summit
2nd National Summit
Steps to A HealthierUS
April 28 – 29, 2004
Baltimore Marriott Waterfront
Baltimore, MD
Contact Information
Office of Disease Prevention and Health Promotion
202-401-6295
SAVE THE DATE
Healthy People 2010
• A comprehensive set of national health objectives
• Developed as a ten-year plan
www.healthypeople.gov
Healthy People 2010
• 2 Goals:
– Increase Quality and Years of Healthy Life
– Eliminate Health Disparities
• 467 specific objectives grouped into 28 focus areas
• The result of an extensively
collaborative scientific process
Overweight and ObesityOverweight and obesity, United States,1988–94
*In those aged 6 to 19 years, overweight or obesity is defined as at or above the sex- and age-specific 95th percentile of Body Mass Index (BMI) based on CDC Growth Charts: United States.
**In adults, obesity is defined as a BMI of 30 kg/m2 or more; overweight is a BMI of 25 kg/m2 or more.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics. National Health and Nutrition Examination Survey. 1988–94.
Healthy People 2010
• Ongoing evaluation– Progress Reviews
– Mid-Course Reviews
– Developmental Objectives
Dietary Logic?• The Japanese eat very little fat and suffer fewer heart
attacks than the British or Americans.• The French eat a lot of fat and also suffer fewer
heart attacks than the British or Americans.• The Japanese drink very little red wine and suffer
fewer heart attacks than the British or Americans.• The Italians drink excessive amounts of red wine, and
also suffer fewer heart attacks than the British or Americans.
Dietary Logic?
• Conclusion:
• Eat & drink what you like. • It's speaking English that kills
you.
Dietary Guidelines for Americans
• Science-based advice for ages 2+
• Promote health
• Prevent chronic disease
• Federal nutrition policy/ programs
• Vehicle to speak with one voice
• “Gold standard”• HHS/USDA
1980 1985 1990 1995
Figure 1. Covers of the first 4 editions of the Dietary Guidelines for Americans
Aim for Fitness
• Aim for a healthy weight
• Be physically active each day
Be physically active each day
Health benefits of physical activity Physical activity recommendations
Adults -- 30 minutes of moderate physical activity most,
preferably all, days of the weekChildren -- 60 minutes of moderate
physical activity daily
Build a Healthy Base
Let the Pyramid guide your food choices Choose a variety of grains daily, especially
whole grains Choose a variety of fruits and vegetables
daily Keep food safe to eat
Fats, Oils, & SweetsUSE SPARINGLY
Milk, Yogurt,& CheeseGroup2-3 SERVINGS
VegetableGroup3-5 SERVINGS
Meat, Poultry, FishDry Beans, Eggs
& Nuts Group2-3 SERVINGS
Fruit Group
2-4 SERVINGS
Bread, Cereal,Rice, & Pasta
Group6-11
SERVINGS
Food Guide PyramidA Guide to Daily Food Choices
Source: U.S. Department of Agriculture/U.S. Department of Health and Human Services
KEY
Fat (naturally occurring and added)
Sugars (added)
These symbols show fat andadded sugars in foods
1,600calories
2,200calories
2,800calories
Grains group 6 9 11
Veg. group 3 4 5
Fruit group 2 3 4
Milk group 2 or 3 2 or 3 2 or 3
Meat andbeans group
2(5 oz. total)
2(6 oz. total)
3(7 oz. total)
Recommended number of servings
Choose Sensibly
Choose a diet that is low in saturated fat and cholesterol and moderate in total fat
Choose beverages and foods to moderate your intake of sugars
Choose and prepare foods with less salt If you drink alcoholic beverages, do so
in moderation
Choose a diet that is low in saturated fat and cholesterol and
moderate in total fat Total fat recommendation: 30% of
calories or less Descriptions of the different types of fat Limits on saturated fat and total fat for
various calorie levels Comparison of saturated fat content of
foods
• Calories
• Total fat in grams
• Saturated fat in grams
• Cholesterol in milligrams
• Sodium in milligrams
Nutrients in one serving.
The “ % Daily Value” shows you how much of the recommended amounts the food provides in one serving,
Here is the recommended daily amount for each nutrient for two calorie levels.
Serving Number of
servings
Goal of Dietary Guidelines
IMPROVE HEALTH BY:• Increasing awareness
• Providing healthy options
• Promoting healthy choices
Consumer Understanding
“Moderate”
• ”a reasonable amount”
• “the lowest possible amount”
• “some, but not a lot”
• “a small amount”
• “limit”
• “put that 3rd donut away”
How are we doing?
• Only 3 percent of us meet 4 of the 5 recommendations for intake of grains, fruits, vegetables, dairy products, and meats
• Less than 20% teenage girls get enough calcium• 35% of adolescents don’t get enough physical
activity• 43% of high schoolers watch more than 2 hours of
TV per day
Taking Steps Together
“The function of protecting and
developing health must rank even above
that of restoring it when it is impaired. ”
Hippocrates
Karyl Thomas Rattay Karyl Thomas Rattay [email protected]@osophs.dhhs.gov