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Obesity, Nutrition, and

Physical 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.

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
consumption of
processed foods
typically higher in
Increased schools
vending and a la carte

Active Transportation by Youth has

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

NHES: National Household Education Surveys.

NLSY: National Longitudinal Survey of Youth.

$1.6 billion/year spent

on marketing of foods
and beverages to youth
$745 million on
Television viewing
associated with
consumption of foods
advertised on
70% children 8-18
years and 30% children
<3 year old have TVs in

Costs of Adult Obesity Are


Total Costs



(in 2008 dollars)

(in 2008 dollars)





% of U.S.

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

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

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

systolic/diastolic blood pressure by 5.02.7 mmHg in persons with hypertension

Reduce systolic/diastolic blood pressure by 2.01.0 mmHg in non-hypertensives

Incremental rise in blood pressure with age

Prevalence of hypertension across

Reducing salt intake could save

tens of thousands of lives annually2

1. 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
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
American Journal
of Health Promotion.
of hypertension by 16 million
Save $26 billion in health care costs

Principal Winnable Battle

Improve dietary quality

Increase fruit and vegetable intake

Decrease intake of high-energy, lownutrient foods
Reduce consumption of sugar sweetened
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

Priority Strategies to Address

Select Winnable Battle Initiatives
Energy density

Apply nutrition standards in child care and

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

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

Reduce accessibility of sugared drinks in

Priority Strategies to Address

Select Winnable Battle Initiatives

Policy and environmental supports in

maternity care facilities
Policy and environmental supports in
State and national coalitions to support

Physical activity

Joint use agreements for after-hours

access to school facilities
Increase access to parks and recreational
Increase opportunities for physical activity

Priority Strategies to Address

Select Winnable Battle Initiatives
Sodium reduction

Establish sodium reduction standards in

government facilities and educational

Promote innovative restaurant initiatives

to reduce sodium content of restaurant

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, MPH
Director, Centers for Disease Control and Prevention,
Administrator, Agency for Toxic Substances and Disease

For more information please contact Centers for Disease Control

and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348

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.

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention