ASTPHND: DNPAO Update June 8, 2008

1. ASTPHND: DNPAO UpdateJune 8, 2008 Update on the Division of Nutrition, Physical Activity, and Obesity

2. DNPAO Vision and Mission Vision: A world where regular physical activity, good nutrition, and healthy weight are part of everyone's life. Mission: Lead strategic public health efforts to prevent and control obesity, chronic disease, and other health conditions through regular physical activity and good nutrition.

3. Goals Increase health-related physical activity through population-based approaches. Improve those aspects of dietary quality most related to population burden of chronic disease and unhealthy child development. Decrease prevalence of obesity through prevention of excess weight gain and maintenance of healthy weight loss.

4. DNPAO Organizational Structure Office of the Director Program Resource Management Associate Director for Translation and Dissemination Associate Director for Science Associate Director for Policy and Planning • Nutrition Branch • Team Structure: • Research & Surveillance Team • Surveillance Systems Team • Guidelines Development & Recommendations Team • International Unit (M/M) • Physical Activity Branch • Team Structure: • Research Team • Surveillance Team • Guidelines Development & Recommendations Team • Obesity Prevention & Control Branch • Team Structure: • Research & Surveillance Team • Guidelines Development and Recommendations Team • Program Development & Evaluation Branch • Team Structure: • Technical Assistance & Consultation Team • Program Development Team • Evaluation Team

5. State Programs • 48 states, 2 territories and District of Columbia • Total funds requested ~$40m; DNPAO funds $17.4m • 32 applications rated outstanding • 15 previously funded states refunded, 8 newly funded • 16 states funded at > $700,000 • Past performance not considered in the review process

7. Principal Targets Reduce energy intake Decrease high and increase low ED foods Increase fruit and vegetable intake Reduce sugar-sweetened beverages Decrease television time Breastfeeding Increase energy expenditure Increase daily physical activity

8. Strategies to Increase Fruit and Vegetable Consumption Early exposure Access Community gardens and farmers markets Competitive pricing Stealth interventions (Garden Market)

9. Agreement between the Alliance for a Healthier Generation and the Soft Drink Companies Elementary schools H2O 8 oz juice without added sweeteners FF and LF regular and flavored milk Middle schools Same standards, 10 oz portions High schools No and low kcal drinks, light juices, sports drinks 50% must be H2O and no or low Kcal; 100Kcal/container

10. NYCDHMH, Amend Article 47, NYC Health Code; Applies to Group Day Care in NYC Television, video and other visual viewing • Cannot be used for children <2 yo • Limited 60 minutes per day of educational programs or programs that actively engage child movement for children 2+ yo 60’ physical activity required Eliminate sugar-sweetened beverages Provide 1% or no-fat milk

11. Principal Targets Reduce energy intake Decrease high and increase low ED foods Increase fruit and vegetable intake Reduce sugar-sweetened beverages Decrease television time Breastfeeding Increase energy expenditure Increase daily physical activity

12. Effective Interventions to Promote Physical Activity • Informational • Community-wide education • Point of decision prompts • Behavioral and social • School-based PE • Non-family social support • Individually adapted behavior change • Environmental and policy • Enhanced access with outreach • Urban design and land use

13. Additional Targets for Obesity Prevention and Control in Childhood • Prenatal tobacco use (Oken et al. Int J Obesity 2008;32:201) • Sleep (Chen et al. Obesity 2008;16:265)

14. Prevalence of Obesity among 6-11yo Children; NHANES 2003-2006 Ogden CL, et al. JAMA 2008;299:2401

15. Ogden CL et al. JAMA 2008;299:2401

16. Changes in the Prevalence of Adult Obesity between 1999 and 2006 Ogden CL, et al. NCHS Data Brief, November 2007

17. Other Data Sources Consistent with a Plateau in the Prevalence of Childhood Obesity YRBS 2007: no change from 2005-2007 State data Texas – 2000-02 to 2004-05 (elementary school) Arkansas – 2003-04 to 2006-07 (all students) Large samples from states Maine West Virginia

18. Obesity Trends Among U.S. AdultsBRFSS,1990, 1998, 2006 1998 1990 2006 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

19. Global Trends in Obesity-Related Media Coverage Note: Figures retrieved from Lexis-Nexis searches on “obesity or obese” in U.S. and international newspapers and newswires.

20. Annual Adult per Capita Cigarette Consumption and Major Smoking and Health Events – US 1900-1998 Thousands per year 1st World Conference on smoking and health Broadcast advertising ban 1st Surgeon General’s report 1st Great American smokeout Nicotine medications Available over the counter End of WW II Fairness Doctrine messages on TV and radio Master settlement agreement 1st smoking cancer concern Surgeon General’s report on environmental Tobacco smoke Nonsmoker’s rights movement begins Federal cigarette tax doubles Great Depression 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 1998 Year

21. % of Schools in Which Students Could Purchase Selected Food and Beverages From Vending Machines, School Store, Canteen, or Snack Bar, 2000 and 2006

22. US Physical Activity GuidelinesProposed Initial Research Questions What is the evidence that: 1. Physical activity is associated with [Outcome]? 2. The dose of physical activity that is associated with [Outcome] or precursors varies by: Differing intensities? Accumulation of multiple short periods of participation? A specific pattern of weekly regularity? Different modes (types) of physical activity? 3. Physical activity might increase the risk of a certain [Outcome]? 4. An exposure of physical activity other than 30 minutes/day on most, preferably all, days each week is associated with [Outcome]?

23. US Physical Activity Guidelines Scientific Database MEDLINE literature January 1, 1995- June 30, 2007 14,472 abstracts triaged n=1,561 papers abstracted

24. Health Outcomes Intensity Frequency Duration Pattern Type US Physical Activity Guidelines Literature Review Conceptual Framework Physical Activity; exposure Cardio-vascular/ Respiratory Health (including CHD, PVD, Stroke) Musculo-skeletal Health (including Osteoporosis) Metabolic Health (including Diabetes Mellitus and Obesity) Functional Health Cancers All-Cause Mortality Mental Health Examples Examples Examples Examples Examples Examples Examples • Dyslipidemias • Blood Pressure • Hemostatic/ • Coagulation Factors • Asthma • Fitness • Cardiac Function • Lung Function • Insulin Resistance • Insulin Sensitivity • Glucose uptake • Metabolic Syndrome • Overweight • Constipation • Fitness • Hormonal influences • Sleep quality • Bone mineralization • Flexibility • Strength • Maturation/Growth • Fitness • Motor skill development • Muscle fiber • Bowel transittime • Hormonal factors • Immune Function • Linkages with other behaviors. • Quality of life • Functional independence • Balance • Pain • Fall prevention • Cognitive Function • Anxiety • Self-concept • Sleep quality • Strength • Balance • Fitness • Previous Injury • Family history Risk Factors Caloric Expenditure Adverse events and Risks of Physical Activity All arrows will be examined for heterogeneity across demographic characteristics (eg gender, age, race/ethnicity). Evidence will also be examined for select special groups, including disabled populations.

25. The Convergence Partnership

26. Elements Common to Social Movements Shared and personalized perception of a threat Common frame Grass roots commitment Social network focused on collective action Local nodes with dense social ties, linked to other groups with weak bridging ties (rapid diffusion of innovation) Organizational structure

27. Largest Connected Subcomponent in Framingham Heart Study Christakis and Fowler. NEJM 2007;357:370