The State of Obesity

Better Policies for a Healthier America

Laura Segal
Director of Public Affairs

February 24, 2016

@healthyAmerica1
#StateOfObesity

Obesity Epidemic: 15 Years of Policy

In 2001, Surgeon General landmark report

recognizing obesity an epidemic.
Adult rates doubled, child rates tripled between
1980-2000. Adults inching up, children leveled?

Policy: Beyond Eat Less, Move More

Choices not made in a vacuum. Where you live,

learn, work & play impact health. Making healthy
choices easier.
Prevention is key.

It is easier to prevent in children than reverse trends

later.
Keep adults from further gains.
Healthy as can be at any weight.

Signs of Progress: Measured Declines in

Some Childhood Rates

Community Prevention Programs

CDCs Guide to Community Preventive

Services
New York Academy of Medicine Review
Local Examples
But, efforts have not matched the scale and
scope of the problem.

How to prioritize + take programs to scale?

Some Fat Factors

Food choices/changes: bigger portions, higher density food, more

prepared food, eating out/take out
Family/Friends: Screen time, influence of others
Children/Schools: Reduction/lower quality PE, more academic/less
active time, quality of food available
Work: Long hours, long commutes, desk jobs, few places to be active,
unhealthy/quick food options
Community Design: driving vs. walking/biking, lack of public transit,
limited adequate parks/rec space, fewer groceries in poorer areas
Economics: cost of healthy food, fewer/worse stocked groceries in
poorer areas, fees for rec/gym, range in quality insurance coverage, etc.
Genetics & Lifestages: Aging metabolism, childbearing
Psychology, Emotional: Marketing, body image, fad diet culture,
conflicting advice, stress eating.

Early Childhood
Food & income assistance: e.g. Special Supplemental
Nutrition Program for Women, Infants and Children
(WIC): 50%+ of infants (2m) + 4.6m kids under 5.

Promotes breastfeeding & education. Significant nutrition changes

in 2009. Rates dropped for WIC kids in 18 states 2008-11. But
rates remain at 14.7%

Child care food program/Head Start 3.3m kids.

Updated nutrition requirements passed in 2010, final regs
expected 2016. Child Care Block Grant new
nutrition/activity requirements in 2014 (to qualify for
subsidy)
Lets Move! Child Care + CDC programs.
RWJF support no sugary drinks for kids under 5.

School-Aged (55m kids)

Lots of research on healthy and school performance,
including activity & nutrition specific.
National School Lunch & Breakfast Program Healthy,
Hunger-Free Kids Act of 2010, new nutrition standards:

In 2004, only 4 states had up-to-date nutrition requirements

21.5m lunch, 14m breakfast. 51% all public school students
eligible.
2010 Healthy, Hunger-Free Kids Act up-to-date nutrition
standards. Smart Snacks in Schools standards (2014), Fruit
& Veggie Programs, Milk Program, Farm-to-School.
Community eligibility: +6m kids. Summer programs: 3.2m
kids.

School-Aged, continued

Lets Move! + CDC programs evidence-based guidance, monitoring,

prevention programs.
Local School Wellness Plans (required 2010).
Comprehensive School Physical Activity Program.

25% kids 6-15 meet national standards 60mins activity

Every Student Succeeds Act (ESSA, 2015) has Safe and Healthy
School block grants (no more stand-alone Carol M. White Physical
Education Program (PEP)).

Physical activity time during the day, breaks, before/afterschool,

Safe Routes to Schools (15,000 schools).
Expanded Medicaid coverage of school-based health services now
allowable possible (Free Care rule clarification, 2014).
Chronic Absenteeism trigger for health investigations/support.

School-Aged, continued

Key State Policy Areas:

Every state has a physical education requirement but

limited/not enforced often. Local-based.

17 states have specific physical activity and/or recess

requirements (time set aside)

28 states have Shared Use policies.

21 states have legislation requiring BMI or other

related health assessments

College Healthy Campus trend

Philadelphia: obesity -5% in school

kids 2006-2010.

Early adopter: school nutrition & wellness policies. Reduced junk food,
no sugary drinks in vending, no fryers, etc.
School and community health & nutrition education (cooking classes,
information campaigns, HYPE summits).
Food Trust: 600+ corner stores, 30+ farmers markets, and nearly 200
Chinese take-out restaurantsto promote healthy food sales and better
access to healthy foods within the community; Almost $80,000 redeemed
in Philly Food Bucks, a $2 incentive for fruits and vegetables thats
offered for every $5 spent with benefits from the federal Supplemental
Nutrition Assistance Program at participating farmers markets; and
Complete Streets: Philadelphia Master Trail, mixed use housing/city
planning, walking/bike lanes, etc.

Mississippi: obesity -11% for K-5,

2008-2013

Nutrition standards in 2006 for food sold in school vending machines;

Healthy Students Act in 2007, which set specific requirements for
physical education, health education, wellness policies, and school
meals, snacks, and drinks;
Safe Routes to School. Move to Learn - short physical activity
breaks. Just Have a Ball (26,000+ kids UnitedHealth, Subway))
Partnership for a Healthy Mississippi, the National Grocers
Association, and The Food Trust convened the Mississippi Grocery
Access Task Force addressing food desserts and swamps.
Faith-based communities encourage congregations and families to
prepare healthy meals and integrate physical activity into everyday
life.

Community Focus
CDC programs & grants. Center for Chronic Disease
Prevention & Health Promotion; Division of Nutrition,
Physical Activity & Obesity (DNAPO).

DNAPO 2014 - $52m ($8m breastfeeding initiative, $4m early child

care), $5m high-risk, $35m for core activities)

Built environment, Complete Streets (665 communities,

30 states), Sustainable Communities (transportation, HUD,
community-development, etc
Local Food, Local Places 26 regions in 14 states, 6
federal agency partners.

Brownsville, Texas

Tu Salud Si Cuenta TV, radio, community education

Farmers markets + Su Clinica (Federally Qualified
Health Center). Community gardens.
Promotoras/Community health workers - vouchers &
door-to-door recruitment.
Build a Better Block Project address disrepair &
development. Belden Trail.
School of Public Health & restaurant healthy options
UT Brownsville Diabetes Prevention

CDC Chronic Disease Funding

Nutrition Programs

Supplemental Nutrition Assistance Program: 46m (15% of

Americans, 70% of recipients families with children)

SNAP-Ed in all 50 states nutrition (and physical activity)

education (expanded in 2010 as grants program). Range of
programs and models. SNAP retailers must stock healthy options,
farmers markets SNAP eligible (6,400 in 36 states) & can take
Electronic Benefit Transfer (EBT) payments.

Double value for fruits & veggies via Wholesome Wave nonprofit
effort (500+ farmers markets, 31+ states)
Healthy Food Financing, New Market Tax Credits
Dietary Guidelines (new 2015) & New Food Labels (proposed 2015)
& Restaurant Menu Labeling (Dec 2016?)
Marketing to kids voluntary guidelines ($2B a year)

In Baltimore & Tucson

Baltimarket Virtual Supermarket

East Baltimore area with six fast food restaurants, 15 corner stores,
and 40 carryouts, and no supermarkets.

Deliveries & computers covered by United Way, KFF, ShopRite

Garden Kitchen, SNAP-Ed grantee. Partnership between the City of
South Tucson, Pima County, the University of Arizona College of
Agriculture and Life Science, etc. Former Mexican restaurant >
community-based nutrition & physical education center: food
demonstrations, gardening classes, physical activity events, etc. Seed-totable nutrition education program -- from growing and/or purchasing on
a budget to preparing to storing/saving leftovers.

Healthcare
Affordable Care Act (ACA) required coverage of
preventive services, including obesity screening/counseling.
Plans & states range in coverage of obesity treatments.

Traditional Medicaid sets own policies, but incentivized.

(Medicaid: 12.7m adults (not eldery/disabled), 40m children during
a year.)
Medicaid Innovation grants for some state programs.

New healthcare models incentivizing value/quality

Accountable Care Communities, Patient-Centered Medical
Homes, nonprofit hospital Community Benefit program.
Medicare (53.6m) covers counseling less than 1% have
done, 30% obese.

Pilot diabetes prevention program, shown to reduce risk by 58%

(10,000 with prediabetes)

Healthcare
Traditional Medicaid sets own policies, but incentivized.
(Medicaid: 12.7m adults (not elderly/disabled), 40m
children during a year.)

8 states + DC cover all obesity preventive care

15 + DC cover nutrition counseling
12 + DC cover behavioral consult
14 cover obesity drugs, 36 EXCLUDE obesity drug coverage
47 cover bariatric surgery (with different requirements), 3 (MT, MS,
OH) EXCLUDE bariatric surgery

Medicaid Innovation grants for some state programs

including some community-based efforts.
NIH research

Bon Secours St. Francis Health

System, Greenville, SC.

Diabetes Integrated Practice Unit (IPU) (pre &

current diabetes)
Connect patients with community resources
Coordinated medical care team with nurse care
coordinator (+ mental health, dietician, diabetes
educator, pharmacist, exercise physiologist)
Worksite and home services. Home
assessments/counseling. Grocery shopping visits.

Accountable Health Communities

CMS 5 year pilot to 44 communities

(hub/managers) to reduce health costs,
improve health by connecting patients to
services:

Housing instability
Utility needs
Food insecurity
Interpersonal violence
Transportation

Moving Toward Change

Bring effective programs to scale (new policy

initiatives for local efforts).
Bring community & available
assets/resources together strategically. New
models for integrating community programs,
health care & social services.
Focus on early childhood.
Target communities with highest rates and
marked inequalities.

One Local Manager in

each community
manages community
health efforts of a multisector collaborative.

Public
Health

MANAGER ROLE

Convening and
managing
community
partners/stakeholders
Strategic planning/goal
setting
Managing and
integrating funding,
programs and policies
Analyzing outcomes and
shared impact (health
and economic)

Understandi
ng
Community
UtilizeNeeds
Community Needs
Assessments (CNAs)
conducted by various
groups:
Nonprofit (e.g.,
community centers,
hospitals)
Public Health
Departments
Education and Health
(ESSA requirement)

Social
Servic
es

Educati
on

STATE
SUPPORT
CENTER

Hospitals
Healthc
are

LOCAL
MANAGER
FOR EACH
COMMUNITY

Communit
y
Developm
ent

Local
Business
es

Housing &
Transporta
tion

POTENTIAL
MANAGER
ORGANIZATION
S
Integrator

Community health
trust/fund
Community
development
financial institution
(CDFI)
Public health agency
Social service agency
Nonprofit/community
organization
Hospital or local health
system
Community health
center
University
Foundations

NECESSARY COMPONENTS
within each COMMUNITY
Understanding
Community Assets
and
Leverage
andResources
analyze existing

resources in the community, including:

Underlying health system,
including Public Health Department
(with foundational services like epi
lab surveillance) and Health Care
Systems (including hospitals, public
and private payers)
Existing social service programs
Cross-sector strengths and
connections (housing,
transportation, education, etc.)
Local institutions and
business/private sector community

Exploring All
Possible Funding
Streams
Capitalize
on all possible sources of

One State Support

Center provides
support to all local
managers within a
state.
STATE
SUPPORT
CENTER ROLE

intervention support and funding, for

example:

Medicaid
New Market Tax credits
Community Development Funds/
eg. CDFIs
Community benefit (nonprofit

hospitals)
Community Health Trust (CDFI for

health)
Philanthropic investments

Reinvestment grants

Conduct or coordinate
needs assessments
Collects/connects local
data across sectors
Assists community to
define goals
Provides menu of
evidence-based
programs/policies to match
needs and goals
Provide/coordinate
technical assistance for
implementation of
programs/policies
Conduct evaluation and
quality improvement for
programs/policies
Inform advancing of
national research efforts

POTENTIAL MODELS

EPIScenter
Communities that Care
PROSPER
Build on Evidence-Banks,
e.g. Child Trends etc.

For Further Information

The full text of The State of

Obesity and many other interactive
features are available at:
http://www.StateofObesity.org
Or
www.healthyamericans.org

County Health Rankings:

http://www.countyhealthrankings.org/