The State of Obesity Better Policies for a Healthier America

Laura SegalDirector of Public Affairs

@healthyAmerica1February 24, 2016 #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 CDC’s 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)

Let’s 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 Let’s 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 restaurants—to 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 that’s 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-to-table” 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.

Understanding Community Needs

Understanding Community Assets and Resources

Exploring All Possible Funding Streams

NECESSARY COMPONENTS within each COMMUNITY

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)

• 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

Utilize Community Needs Assessments (CNAs)conducted by various groups: • Nonprofit (e.g., community

centers, hospitals)• Public Health Departments • Education and Health (ESSA

requirement) • Community Services Block

Grant • Child Welfare

Leverage and 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• Community engagement

Capitalize on all possible sources of 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• Government grants (across departments;

across federal/state/local levels)

POTENTIAL MANAGER

ORGANIZATIONS

STATE SUPPORT CENTER

STATE SUPPORT CENTER ROLE

• 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.

One State Support Center provides support to all local managers within a

state.

One Local Manager in each community manages

community health efforts of a multi-sector collaborative.

LOCAL MANAGER FOR EACH

COMMUNITY

Education Housing &Transportation

Public Health

Local Businesses

Healthcare

Social Services

Hospitals

Community Development

For Further Information

The full text of The State of Obesity and many other interactive features are available at:

http://www.StateofObesity.orgOr

www.healthyamericans.org

County Health Rankings: http://www.countyhealthrankings.org/