Obesity, Nutrition, andPhysical Activity

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

Rapid Increases in Adult Obesity in the U.S.

BRFSS: 1990, 1999, 2009

Rapid Increases in Obesity Among U.S. Youth

NHANES 1963-2008

National Health Examination Surveys II (ages 6-11) and III (ages 12-17).National Health and Nutrition Examination Surveys I, II, III and 1999-2008.www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm.

Shifts in Dietary patterns in the United States

Relative prices of more healthful foods have increased faster than prices for less healthful foods.

Increased portion size Increased

consumption of processed foods typically higher in sodium

Increased schools vending and a la carte foods

Active Transportation by Youth has Decreased

Mode for Trips to School – National Personal

Transportation Survey

McDonald NC. Am J Prev Med 2007;32:509.

Increased TV Viewing Increases Childhood Obesity Prevalence

$1.6 billion/year spent on marketing of foods and beverages to youth• $745 million on

television Television viewing

associated with consumption of foods advertised on television

70% children 8-18 years and 30% children <3 year old have TVs in their rooms

NHES: National Household Education Surveys.NLSY: National Longitudinal Survey of Youth.

Costs of Adult Obesity Are Increasing

1998 (in 2008 dollars)

2006 (in 2008 dollars)

Total Costs$75

billion/yr$147

billion/yr

% of U.S. Medical Costs

6.5% 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.

Reductions in Salt Intake Can Reduce

High Blood Pressure Increased sodium in the diet =

increased blood pressure = increased risk for heart attack and stroke • Generally, lower consumption of salt means

lower blood pressure• Within the span of a few weeks, most people

experience a reduction in blood pressure when salt intake is reduced

Even people with blood pressure in the normal range benefit from sodium reduction; there appears to be no threshold

Reductions in Salt Intake Can Reduce

High Blood Pressure (continued)

Sodium intake affects

• Blood pressure levels – a meta-analysis1 of trials indicates that a median reduction of urinary sodium to ≈1800 mg would

Reduce systolic/diastolic blood pressure by 5.0-2.7 mmHg in persons with hypertension

Reduce systolic/diastolic blood pressure by 2.0-1.0 mmHg in non-hypertensives

• Incremental rise in blood pressure with age• Prevalence of hypertension across

populations Reducing salt intake could save

tens of thousands of lives annually21. J Hum Hypertens. 2002; 16: 761-770.2. PloS Med. 2009;6(4):e1000058., N Engl J Med. 2010;362:590-599.; Ann Intern Med. 2010;152:481-487

Estimated Effects of Sodium Reduction on Hypertension

Prevalence and Related Costs

Reducing average population intake to 2300 mg per day (current recommended maximum) may…• Reduce cases of hypertension by 11 million• Save $18 billion in health care costs• Gain 312,000 Quality Adjusted Life Years

(QALYs)

Reducing average population intake even lower – to 1500 mg per day (recommended maximum level for “specific populations” described in the Dietary Guidelines for Americans) – may…• Reduce cases of hypertension by 16 million• Save $26 billion in health care costs• Gain 459,000 Quality Adjusted Life Years

(QALYs)

American Journal of Health Promotion. 2009;24:49-57.

Principal Winnable Battle Initiatives

Improve dietary quality• Increase fruit and vegetable intake• Decrease intake of high-energy, low-

nutrient foods• Reduce consumption of sugar sweetened

drinks• Reduce sodium in the food supply• Eliminate industrially produced trans fat

from the food supply Increase breastfeeding Increase physical activity Prevent micronutrient malnutrition Enhance state and community

capacity to improve population-level health

Priority Strategies to Address Select Winnable Battle Initiatives Energy density

• Apply nutrition standards in child care and schools

• Increase number of healthy food retail outlets in underserved areas and improve access

Fruits and vegetables• Increase access through retail stores• Support Farm to Institution policies• Leverage food policy councils

Sugared drinks• Ensure access to safe and good-tasting

water• Reduce accessibility of sugared drinks in

child care and schools

Priority Strategies to Address Select Winnable Battle Initiatives

Breastfeeding• Policy and environmental supports in

maternity care facilities• Policy and environmental supports in

worksites • State and national coalitions to support

breastfeeding

Physical activity• Joint use agreements for after-hours

access to school facilities • Increase access to parks and recreational

facilities• Increase opportunities for physical activity

in youth-serving settings

Priority Strategies to Address Select Winnable Battle Initiatives

Sodium reduction

• Establish sodium reduction standards in government facilities and educational institutions

• Promote innovative restaurant initiatives to reduce sodium content of restaurant meals

• Increase availability of lower-sodium processed and restaurant food products

“Obesity continues to be a major public health problem. We need intensive, comprehensive and ongoing efforts to address obesity. If we don't, more people will get sick and die from obesity-related conditions, such as heart disease, stroke, type 2 diabetes and certain types of cancer – some of the leading causes of death.”

– Thomas R. Frieden, MD, MPHDirector, Centers for Disease Control and Prevention, Administrator, Agency for Toxic Substances and Disease Registry

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

www.cdc.gov/winnablebattles

U.S. Department of Health and Human ServicesCenters for Disease Control and Prevention