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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