OBESITY:
Halting the Epidemic by Making Health Easier

The Obesity Epidemic

More than one third of U.S. adults—more than 72 million people—and 16% of U.S. children are obese. Since 1980, obesity rates for adults have doubled and rates for children have tripled. Obesity rates among all groups in society—irrespective of age, sex, race, ethnicity, socioeconomic status, education level, or geographic region—have increased markedly.

Obesity has physical, psychological, and social consequences in adults and children. Children and adolescents are developing obesity-related diseases, such as type 2 diabetes, that were once seen only in adults. Obese children are more likely to have risk factors for cardiovascular disease, including high cholesterol levels, high blood pressure, and abnormal glucose tolerance. One study of 5- to 17-year-olds found that 70% of obese children had at least one risk factor for cardiovascular disease and 39% of obese children had at least two risk factors.

• In 2000, obesity-related health care costs totaled an estimated $117 billion.
   
• Between 1987 and 2001, diseases associated with obesity account for 27% of the increases in medical costs.
   
• Medical expenditures for obese workers, depending on severity of obesity and sex, are between 29%–117% greater than expenditures for workers with normal weight.
   
• From 1979–1981 to 1997–1999, annual hospital costs related to obesity among children and adolescents increased, rising from $35 million to $127 million.

The determinants of obesity in the United States are complex, numerous, and operate at social, economic, environmental, and individual levels. American society has become ‘obesogenic,' characterized by environments that promote increased food intake, nonhealthful foods, and physical inactivity. Public health approaches that affect large numbers of different populations in multiple settings—communities, schools, work sites, and health care facilities—are needed. Policy and environmental change initiatives that make healthy choices in nutrition and physical activity available, affordable, and easy will likely prove most effective in combating obesity.

The Health Consequences of Obesity Coronary heart disease Type 2 diabetes Cancer (endometrial, breast, and colon) Hypertension (high blood pressure) Dyslipidemia (high total cholesterol or high levels of triglycerides) Stroke Liver and gallbladder disease Sleep apnea and respiratory problems Osteoarthritis (degeneration of cartilage and underlying bone within a joint) Gynecological problems (abnormal menses, infertility)

[A text description of this map is also available.]

CDC's Division of Nutrition, Physical Activity, and Obesity (DNPAO) is working to reduce obesity and obesity-related conditions through state programs, technical assistance and training, leadership, surveillance and research, intervention development and evaluation, translation of practice-based evidence and research findings, and partnership development.

Currently, 23 states are funded through CDC's Nutrition and Physical Activity and Obesity (NPAO) Cooperative Agreement Program that coordinates statewide efforts with multiple partners to address obesity.

The program's focus is on policy and environmental change initiatives directed towards increasing physical activity; consumption of fruits and vegetables; breastfeeding initiation, duration, and exclusivity; and decreasing television viewing and consumption of sugar-sweetened beverages and high-energy dense foods (foods high in calories). The program seeks to address health disparities and requires a comprehensive state plan.

CDC provides technical assistance to all states to develop comprehensive state plans, community interventions, and leadership capacity to address obesity. Our new Program Technical Assistance Manual provides a one-stop reference for NPAO program guidance. CDC also provides training to public health practitioners. In 2008, CDC cosponsored an obesity prevention course focused on policy and environmental change strategies with the Center of Excellence for Training and Research Translation at the University of North Carolina.

CDC is leading the development of the National Roadmap for Obesity Prevention and Control, expected in 2010. Two conferences convened in 2008 were stepping stones toward the Roadmap: the National Summit on Legal Preparedness for Obesity Prevention and Control and Community Approaches to Address Obesity. These conferences also laid the groundwork for the Weight of the Nation Conference, scheduled for summer 2009, which will highlight progress in obesity prevention and control and identify actions needed to reverse the epidemic.

CDC monitors obesity trends and conducts and supports research on obesity prevention and control strategies. Through our research activities, we do the following:

• Identify, translate, implement, and evaluate effective or promising interventions for obesity prevention and control.
   
• Describe and track priority policy, environmental, behavioral, and demographic correlates of obesity and overweight.
   
• Identify the measures of obesity that best characterize children and adults with increased risk for adverse health outcomes.

Progress in Obesity: Recent Findings Early signs of success in the prevention and control of obesity—at both state and national levels—are now emerging. Major CDC surveys have found no significant increase in obesity prevalence among children, adolescents, women or men between 2003–2004 and 2005–2006. Also, obesity rates appear to be leveling among children in some states such as Arkansas. CDC's efforts have helped increase awareness of obesity as a national public health problem. During 2000–2007, media coverage on obesity in national print and newswires increased from about 8,000 to more than 28,000 articles. A variety of innovative policy and environmental changes in communities, work sites, and schools are likely contributing to this progress.

Developing Innovative Partnerships

CDC is making progress in halting the obesity epidemic through innovative partnerships.

• The Healthy Eating Active Living Convergence Partnership (CP) seeks to foster policy and environmental change through innovative partnerships with others from fields not traditionally involved in public health. CP is currently focused on transportation and food systems to develop active living environments and improve access to healthy foods. (Partners: California Endowment, Kaiser Permanente, Nemours, Robert Wood Johnson Foundation, W.K. Kellogg Foundation, PolicyLink, Prevention Institute)
   
• Common Community Measures for Obesity Prevention (Measures Project) fills two crucial gaps hindering obesity efforts—the absence of standard measures for community-level policy and environmental change initiatives and a tool for monitoring these initiatives. The project developed 26 measures and a Web-based tool that local governments can use to assess them. Following pilot testing in 20 communities, the measures will be available nationwide. (Partners: Robert Wood Johnson Foundation, W.K. Kellogg Foundation, Kaiser Permanente, CDC Foundation, International City/County Management Association, Macro International Inc.)
   
• Early Assessment of Programs and Policies to Prevent Childhood Obesity is identifying a set of promising local programs and policies and determining which ones merit rigorous evaluation. Priority is placed on programs and policies implemented in community settings targeting low-income children to improve eating habits and physical activity levels. (Partners: Robert Wood Johnson Foundation, Division of Adolescent and School Health [CDC], Prevention Research Centers Program Office, CDC Foundation, Macro International Inc.)
   
• Addressing Obesity Through Commercial Health Plans. CDC is working to help public health professionals and health care plan administrators collaborate to improve obesity interventions designed for medical settings. (Partner: Deloitte Consulting)

In collaboration with the Task Force on Community Preventive Services (the Community Guide), CDC is conducting evidence-based reviews of obesity interventions in three settings—medical care, work sites, and communities.

CDC translates practice-based evidence and research findings for use by practitioners, communities, and the public. Recent translation products include the following:

• The Swift Work Site Assessment and Translation (SWAT) (http://www.cdc.gov/swat) evaluation method assesses work site health promotion programs that help employees attain or maintain a healthy body weight.
   
• Healthy Weight Web site (http://www.cdc.gov/healthyweight) includes a BMI calculator and provides consumers with relevant steps and tools to help them understand how to achieve and maintain a healthy weight for a lifetime.
   
• The Weight Management Research to Practice Series (http://www.cdc.gov/weightr2p) summarizes the science on various weight management topics, highlighting the implications of the research findings for public health and medical care professionals.

Successes and Opportunities for Population-Level Prevention and Control Success Stories

Michigan: Building Healthy Communities

Michigan's Building Healthy Communities Project is designed to improve the environment and change policies to make it easier for residents to be healthy. Local health departments were supported through funding and technical assistance to form community coalitions and develop 3-year plans for creating more opportunities for their residents to engage in healthful eating, physical activity, and tobacco-free lifestyles. Coalitions included representatives from local transportation, zoning and planning departments, law enforcement, the YMCA, hospitals, universities, nonprofit organizations, news media outlets, in addition to farmers, residents, public officials, and city engineers.

The Building Healthy Communities Project achieved significant success in making it easier for Michigan residents to be healthy by

• Creating or enhancing 11 trails covering 58.6 miles.
• Enhancing 7 parks with amenities such as new equipment, benches, and lighting.
• Providing residents with 14,000 walking maps.
• Conducting 129 community fitness classes.
• Opening 5 new farmers' market locations with the ability to process Electronic Benefit Transfer capabilities for processing for food stamps.
• Creating 7 new school and community gardens.
• Distributing 5,000 coupon books to low-income seniors to redeem for fresh fruits and vegetables.

In 2005, less than one quarter of Texas adults ate the minimum amount of fruits and vegetables recommended for good health. To increase access to fresh produce, the Texas Department of State Health Services Nutrition, Physical Activity, and Obesity Prevention Program worked with the department's Building Healthy Texans Employee Wellness Program to create a Farm to Work program. This program enables employees at 10 Austin-area work sites to purchase fresh local produce, which is delivered weekly to their work site. Coordination with local farmers is handled by the Sustainable Food Center, a nonprofit organization. Participation is easy—employees order on a week-by-week basis, with no subscription required. Orders are prepaid through a secure server so no money is handled onsite. A Farm to Work tool kit was created and disseminated. Other state agencies and private companies in Texas are now implementing similar programs.

Employees took advantage of the program and saved money. In 1 year, 1,700 employees participated; 82,000 pounds of fresh local produce were delivered; and Central Texas farmers made $160,000 in sales. An informal cost comparison showed that grocery store produce was more expensive than the Farm to Work produce.

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Modeled after the national Convergence Partnership, the California Convergence is a statewide initiative that provides a unique opportunity not only to accelerate the movement to prevent obesity in California, but to promote learning and synergy across programs by bringing together seven separate funders—The California Endowment, Kaiser Permanente, the Robert Wood Johnson Foundation, the W.K. Kellogg Foundation, the U.S. Department of Health and Human Services, the California Department of Public Health, and the Centers for Disease Control and Prevention. The California Convergence partnership strategically connects existing resources, and creates an effective learning community that can take action and share information, tools, and resources across initiatives and funding streams to create healthy environments where people can thrive.

To create healthier communities across California, the California Convergence pursues the following goals:

• Shift the public and political discussion regarding obesity prevention to emphasize improving nutrition and physical activity environments.  

• Accelerate local and state policy efforts to change nutrition and physical activity environments to improve health.  

• Strengthen the network of leaders in California that are on the front lines in developing and implementing strategies to improve food and activity environments.  

• Increase opportunities for leaders and community coalitions to build their capacity and leadership skills to support this work.

Through the California Convergence, leaders from 26 communities are working collectively to develop a common policy agenda, build a statewide communication infrastructure, influence funding strategies, and generate public revenue to support their work including the following:

• Policy Change. Convene local and state policy advocates to support local—and eventual statewide—adoption of high-impact policy strategies.
• State Conference. Bring leaders together in a statewide conference to share strategies and lessons, resources, and tools.
• Leadership Building and Peer Networking. Create opportunities for local leaders to learn from each other.
• Skill Building. Communicate policy and systems change issues to decision makers and the public.
• Growing the Movement. Prepare local leaders to participate in the 2009 Childhood Obesity Prevention Conference.

Related Materials

• Optimal Body Weight (OBW) Calculator
• Nutrition and Weight Management
• Obesity—At A Glance 2009 (PDF–3.9Mb)
• Obesity—Success Stories (PDF–2.3Mb)