I s s u e Br i e f Bending the Obesity Cost Curve: Reducing Obesity Rates by Five Percent Could Lead to More than $29 Billion in Health Care Savings in Five Years K eeping people healthier is one of the most common sense and effective ways to reduce health care costs. Obesity is one of the biggest drivers of The Trust for America’s Health (TFAH) preventable chronic diseases and health care and Micro Health Simulations conducted an costs in the country. Two-thirds of Americans analysis to examine how much the United are either obese or overweight, and obesity is States could save in health care costs if related to more than 30 illnesses, including obesity rates were reduced by five percent. type 2 diabetes, heart disease and some The analysis found that the country could forms of cancer. save $29.8 billion in five years, $158.1 billion in 10 years and $611.7 billion in 20 years. January 2012 Preventing Epidemics. Protecting People. Body Mass Index-Related Health Costs Predicted from 2010 to 2030 Predicted BMI-related direct health costs; 0%, 1%, and 5% reduction in absolute BMI 630000 620000 610000 600000 $ million 590000 580000 570000 560000 550000 year 2012 2017 2022 2027 — 0% reduction — 1% reduction — 5% reduction Peer-Reviewed Modeling The analysis is based on a model developed by researchers at the National Heart Forum. Micro Health Simulations used the model in a peer reviewed study, “Health and Economic Burden of the Projected Obesity Trends in the [United States and the United Kingdom],” published in 2011 in The Lancet.1   The study found that if current trends continue, obesity rates could be expected to grow from 32 percent to 50-51 percent for men and from 35 percent to 45-52 percent for women by 2030. The study’s conservative estimates predict these rates of obesity could contribute to more than six million cases of type 2 diabetes, five million cases of coronary heart disease and stroke, and more than 400,000 cases of cancer in the next two decades. The combined medical costs associated with treating preventable obesity-related diseases are esti- mated to increase by $48-66 billion per year in the United States by 2030 — while experiencing a loss in economic productivity as high as $540 billion. According to a recent study in Health Affairs, current obesity-related medical costs total $147 billion a year, or nearly 10 percent of all annual medical spending, based on 2006 data.2 Obese individuals have 46 percent increased inpatient costs, 27 percent more physician visits and outpatient costs and 80 percent increased spending on prescription drugs. According to the study, of the $147 billion in obesity-related health costs, Medicare and Medicaid are responsible for $61.8 billion. More than half of Medicare ben- eficiaries are treated for five or more chronic conditions per year. The rate of obesity among Medicare patients doubled from 1987 to 2002, and spending on those individuals more than doubled. 2 Effective Ways to Reduce Obesity According to the U.S. Centers for Disease reviewed studies evaluating the effectiveness Control and Prevention (CDC), more than half of community-based disease prevention pro- of Americans live with a chronic disease, many grams.5 NYAM identified 84 articles, includ- of which are related to obesity, poor nutrition ing programs that can directly reduce obesity and physical inactivity — and a majority of and obesity-related diseases, including type 2 these diseases could be prevented.3 diabetes, heart disease, stroke, kidney disease and some forms of cancer. A wide range of evidence-based studies have found that effective disease prevention pro- n n 2011, the American Heart Association I grams in communities can reduce obesity rates, (AHA) published a review of more than 200 improve nutrition and increase physical activity. research studies and concluded that most cardiovascular disease can be prevented or at n DC’s Community Preventive Services C least delayed until old age through a combi- Taskforce conducts a systematic review and nation of direct medical care and communi- evaluation process to determine effective pro- ty-based prevention programs and policies.6 grams and policies for improving health and Some of the key findings included:7 preventing disease. The results, published in the Community Guide for Preventive s very $1 spent on building biking trails E Services, feature a series of evidence-based, and walking paths would save an estimat- community approaches to increasing physi- ed nearly $3 in medical expenses. cal activity, promoting good nutrition, low- s or every $1 spent in wellness programs, F ering diabetes rates and reducing obesity, companies would save about $3.27 in med- ranging from addressing the built environ- ical costs and $2.73 in absenteeism costs. ment, such as building sidewalks and access to parks, to workplace wellness programs to s One year interventions found that every $1 increasing physical activity in schools.4 spent targeting poor eating and poor physi- cal activity habits resulted in $1.17 of savings. n he Compendium of Proven Community- T Based Prevention Programs by The New York s ifestyle changes in nutrition and activity L Academy of Medicine (NYAM) includes a reduced the incidence of type 2 diabetes by summary and examples from an extensive lit- 58 percent compared to drug therapy, which erature review that NYAM conducted of peer only reduced the incidence by 31 percent. Return on Investment for Prevention A 2008 study, Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, by TFAH, the Urban Institute, NYAM and The Prevention Institute found that an investment of $10 per person per year in proven community-based programs to increase physical activity, improve nutrition and prevent smoking and other tobacco use could save the country more than $16 billion annually within five years.  This is a return of $5.60 for every $1.80. Out of the $16 billion, Medicare could save more than $5 billion, Medicaid could save more than $1.9 billion and private payers could save more than $9 billion. 3 Community Transformation Grants: Disease Prevention Programs Can Cut Costs for Communities The Affordable Care Act (ACA) authorized a One of the performance measures of the CTGs new investment in community prevention with is to reduce the rate of obesity by five percent the creation of Community Transformation through nutrition and physical activity pro- Grants (CTGs). grams or interventions. CDC scientists have identified many of the The communities receiving CTGs stand to top evidence-based approaches to preventing substantially reduce health care costs — includ- disease, including ways to reduce obesity rates. ing costs covered by Medicaid — by reducing Communities receiving CTGs are required to rates of obesity and other health problems. base their efforts on one or more of these prov- Conversely, however, states that do not receive en approaches and meet measurable, achiev- these funds do not have the same opportunity able outcomes. to improve health and lower costs. Community Transformation Grant Awardees 2011 CTGs are financed by the Prevention and ity system for the grants, including defining Public Health Fund of the ACA. and achieving concrete measurable outcomes and comprehensive and frequent evaluations. In 2011, in the first round of CTG grants, The requirement that grantees base efforts CDC provided $103 million to 61 communities on evidence-based, proven programs and the around the country to concentrate on their top accountability system will ensure a return on community prevention priorities and needs. investment for prevention dollars. CDC has developed a rigorous accountabil- 2011 COMMUNITY TRANSFORMATION GRANT AWARDEES Implementation State Community Transformation Grant Program Description9 Grant or Capacity Building Grant Alaska The Southeast Alaska Regional Health Consortium is receiving $499,588 to serve an Implementation estimated population of 72,000 within the state of Alaska. Work will focus on expand- ing efforts in tobacco-free living, active living and healthy eating, and quality clinical and other preventative services. The Yukon-Kushokwin Health Corporation is receiving a $193,340 planning award Capacity Building to build capacity to support healthy lifestyles among an estimated tribal population of 25,000 within the state of Alaska. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, and healthy and safe physical environments. California The Los Angeles County Department of Public Health in California is receiving Implementation $9,848,011 to serve the large county of Los Angeles, an estimated population of 10,400,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, social and emotional well- ness, and healthy and safe physical environments. The Public Health Institute in California is receiving $5,926,365 to serve the state of Implementation California minus large counties, an estimated population of 5,900,000 including a rural population of over 833,000. Work will focus on expanding efforts in tobacco-free living; active living and healthy eating, quality clinical and other preventive services, and healthy and safe physical environments. The County of San Diego Health and Human Services Agency in California is receiv- Implementation ing $3,053,793 to serve the large county of San Diego, an estimated population of over 3,095,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, social and emotional well- ness, and healthy and safe physical environments. 4 2011 COMMUNITY TRANSFORMATION GRANT AWARDEES Implementation State Community Transformation Grant Program Description9 Grant or Capacity Building Grant California The San Francisco Department of Public Health in California is receiving $815,358 to Implementation serve the large county of San Francisco, an estimated population of 805,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, and healthy and safe physical environments. The County of Kern’s Public Health Services Department in California is receiving Capacity Building a $416,577 planning award to build capacity to support healthy lifestyles in the large county of Kern (including the city of Bakersfield), an estimated population of over 839,000. Work will target tobacco-free living, active living and healthy eating, and healthy and safe physical environments. The Fresno County Department of Public Health in California is receiving a $499,695 Capacity Building planning award to build capacity to support healthy lifestyles in the large county of Fresno, an estimated population of over 930,000. Work will target tobacco-free liv- ing, active living and healthy eating, quality clinical and other preventive services, and healthy and safe physical environments. The Sierra Health Foundation in California is receiving a $499,229 planning award to Capacity Building build capacity to support healthy lifestyles in the large county of Sacramento, an esti- mated population of 1,400,000. Work will target tobacco-free living, active living and healthy eating, quality clinical and other preventive services, healthy and safe physical environments, and social and emotional wellness. The Stanislaus County Health Services Agency in California is receiving a $293,899 Capacity Building planning award to build capacity to support healthy lifestyles in the large county of Stanislaus (including the city of Modesto), an estimated population of over 500,000. Work will target tobacco-free living, active living and healthy eating, quality clinical and other preventive services, and healthy and safe physical environments. The Toiyabe Indian Health Project is receiving a $500,000 planning award to build Capacity Building capacity to support healthy lifestyles among an estimated tribal population of 3,000 within the state of California. Work will target tobacco-free living, active living and healthy eating, quality clinical and preventive services, social and emotional wellness, and healthy and safe physical environments. Ventura County Public Health in California is receiving a $481,036 planning award to Capacity Building build capacity to support healthy lifestyles in the large county of Ventura (including the city of Oxnard), an estimated population of 823,000. Work will target tobacco-free liv- ing, active living and healthy eating, quality clinical and other preventive services, social and emotional wellness, and healthy and safe physical environments. Colorado The Denver Health & Hospital Authority in Colorado is receiving $610,345 to serve Implementation the large county of Denver, an estimated population of over 600,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clini- cal and other preventive services, and healthy and safe physical environments. Connecticut The Connecticut Department of Public Health is receiving a $493,891 planning award Capacity Building to build capacity to support healthy lifestyles in the state of Connecticut minus large counties, an estimated population of over 889,000 including a rural population of 306,000. Work will target tobacco-free living, active living and healthy eating, quality clinical and other preventive services, healthy and safe physical environments, and social and emotional wellness. Florida The Broward Regional Health Planning Council in Florida is receiving $1,766,476 to Implementation serve the large county of Broward (including the city of Fort Lauderdale), an estimated population of 1,700,000. Work will focus on expanding efforts in tobacco-free liv- ing, active living and healthy eating, quality clinical and other preventive services, and healthy and safe physical environments. 5 2011 COMMUNITY TRANSFORMATION GRANT AWARDEES Implementation State Community Transformation Grant Program Description9 Grant or Capacity Building Grant Georgia Cobb Public Health in Georgia is receiving a $499,000 planning award to build capacity Capacity Building to support healthy lifestyles in the large county of Cobb (including the city of Marietta), an estimated population of over 688,000. Work will target tobacco-free living, active living and healthy eating, quality clinical and other preventive services, social and emo- tional wellness, and healthy and safe physical environments. Illinois The Illinois Department of Public Health is receiving $4,781,121 to serve the state Implementation of Illinois minus large counties, an estimated population of 4,800,000 including a rural population of over 1,600,000. Work will focus on expanding efforts in tobacco-free liv- ing, active living and healthy eating, quality clinical and other preventive services, social and emotional wellness, and healthy and safe physical environments. Iowa The Iowa Department of Public Health is receiving $3,007,856 to serve the entire Implementation state of Iowa, an estimated population of over 3,000,000 including a rural population of over 1,300,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, and quality clinical and other preventive services. Kentucky The Louisville Metro Department of Public Health and Wellness in Kentucky is receiving Implementation $721,594 to serve the large county of Jefferson, an estimated population of over 740,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, and healthy and safe physical environments. Unlawful Narcotics Investigation Treatment Education, Inc. (UNITE) in Kentucky is Capacity Building receiving a $500,000 planning award to build capacity to support healthy lifestyles in the entire state of Kentucky minus large counties, an estimated population of over 3,500,000 including a rural population of 1,800,000. Work will target tobacco-free liv- ing, active living and healthy eating, quality clinical and other preventive services, social and emotional wellness, and healthy and safe physical environments. Louisiana The Louisiana Department of Health and Hospitals is receiving a $500,000 planning Capacity Building award to build capacity to support healthy lifestyles in the entire state of Louisiana, an estimated population of 4,500,000 including a rural population of over 1,100,000. Work will target tobacco-free living, active living and healthy eating, and quality clinical and other preventive services. Maine The Maine Department of Health and Human Services/Maine CDC is receiv- Implementation ing $1,318,301 to serve the entire state of Maine, an estimated population of over 1,300,000 including a rural population of over 545,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, and healthy and safe physical environments. Maryland The Maryland Department of Health and Mental Hygiene is receiving $1,945,289 to serve Implementation the entire state of Maryland minus large counties, an estimated population of 1,900,000 includ- ing a rural population of over 300,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, and quality clinical and other preventive services. Massachusetts The Massachusetts Department of Public Health is receiving $1,505,006 to serve the Implementation state of Massachusetts minus large counties, an estimated population of over 1,574,000 including a rural population of 27,000. Work will focus on expanding efforts in tobacco- free living, active living and healthy eating, quality clinical and other preventive services, social and emotional wellness, and healthy and safe physical environments. The Massachusetts Department of Public Health is receiving $1,574,982 to serve the Implementation large county of Middlesex (including the cities of Lowell and Cambridge), an estimated population of over 1,500,000. Work will focus on expanding efforts in tobacco-free liv- ing, active living and healthy eating, quality clinical and other preventive services, social and emotional wellness, and healthy and safe physical environments. 6 2011 COMMUNITY TRANSFORMATION GRANT AWARDEES Implementation State Community Transformation Grant Program Description9 Grant or Capacity Building Grant Michigan The Sault Ste. Marie Tribe of Chippewa Indians is receiving $500,000 to serve an esti- Implementation mated tribal population of over 176,000 within the state of Michigan. Work will target tobacco-free living, active living and healthy eating, quality clinical and other preventive services, and healthy and safe physical environments. Spectrum Health Hospitals in Michigan is receiving a $333,321 planning award to build Capacity Building capacity to support healthy lifestyles in the large county of Kent (including the city of Grand Rapids), an estimated population of over 600,000. Work will target tobacco-free living, active living and healthy eating, quality clinical and other preventive services, and social and emotional wellness. Minnesota The Hennepin County Human Services and Public Health Department in Minnesota Implementation is receiving $1,156,212 to serve the large county of Hennepin (including the city of Minneapolis), an estimated population of 1,150,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, and quality clinical and other preventive services. The Minnesota Department of Health is receiving $3,603,724 to serve the state of Implementation Minnesota minus large counties, an estimated population of over 3,600,000 including a rural population of over 1,300,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, and quality clinical and other preventive services. Mississippi My Brother’s Keeper, Inc. in Mississippi is receiving a $500,000 planning award to build Capacity Building capacity to support healthy lifestyles in the entire state of Mississippi, an estimated popu- lation of over 2,950,000 including a rural population of over 1,600,000. Work will target tobacco-free living, active living and healthy eating, quality clinical and other preventive services, social and emotional wellness, and healthy and safe physical environments. Missouri The Mid-America Regional Council Community Services Corporation in Missouri is Implementation receiving $705,708 to serve the large county of Jackson (including the city of Independence and portions of Kansas City), an estimated population of over 674,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, and healthy and safe physical environments. Montana The Montana Department of Public Health and Human Services is receiving $769,195 Implementation to serve the entire state of Montana, an estimated population of 974,000 including a rural population of 630,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, and quality clinical and other preventive services. Nebraska The Douglas County Health Department in Nebraska is receiving $510,199 to serve Implementation the large county of Douglas (including the city of Omaha), an estimated population of over 510,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, social and emotional wellness, and healthy and safe physical environments. New Mexico The New Mexico Department of Health is receiving $1,500,000 to serve the state of Capacity Building New Mexico minus large counties, an estimated population of 1,300,000 including a rural population of over 673,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, and quality clinical and other preventive services. The Bernalillo County Office of Environmental Health in New Mexico is receiving Implementation a $497,353 planning award to build capacity to support healthy lifestyles in the large county of Bernalillo (including the city of Albuquerque), an estimated population of over 662,000. Work will target tobacco-free living, active living and healthy eating, quality clinical and other preventive services, and healthy and safe physical environments. 7 2011 COMMUNITY TRANSFORMATION GRANT AWARDEES Implementation State Community Transformation Grant Program Description9 Grant or Capacity Building Grant New Jersey The New Jersey Prevention Network is receiving a $500,000 planning award to build Capacity Building capacity to support healthy lifestyles in the state of New Jersey minus large counties, an estimated population of 3,392,095. Work will target tobacco-free living, active living and healthy eating, quality clinical and other preventive services, social and emotional wellness, and healthy and safe physical environments. New York The Fund for Public Health in New York is receiving $8,391,881 to serve the large coun- Implementation ties that comprise the City of New York, an estimated population of 8,390,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, qual- ity clinical and other preventive services, and healthy and safe physical environments. The University of Rochester Medical Center in New York is receiving $733,703 Implementation to serve the large county of Monroe (including the city of Rochester), an estimated population of over 744,000. Work will focus on expanding efforts in tobacco-free liv- ing, active living and healthy eating, quality clinical and other preventive services, and healthy and safe physical environments. North Carolina The North Carolina Division of Public Health is receiving $7,466,092 to serve the entire Implementation state of North Carolina minus large counties, an estimated population of 7,500,000 includ- ing a rural population of over 2,700,000. Work will focus on expanding efforts in tobacco- free living, active living and healthy eating, and quality clinical and other preventive services. North Dakota The North Dakota Department of Health is receiving a $370,684 planning award to Capacity Building build capacity to support healthy lifestyles in the entire state of North Dakota, an esti- mated population of over 640,000 including a rural population of 330,000. Work will tar- get tobacco-free living, active living and healthy eating, quality clinical and other preven- tive services, healthy and safe physical environments, and social and emotional wellness. Ohio The Austen BioInnovation Institute in Ohio is receiving a $500,000 planning award to Capacity Building build capacity to support healthy lifestyles in the large county of Summit (including the city of Akron), an estimated population of over 540,000. Work will target tobacco-free living, active living and healthy eating, quality clinical and other preventive services, social and emotional wellness, and healthy and safe physical environments. Public Health — Dayton and Montgomery County in Ohio is receiving a $180,246 Capacity Building planning award to build capacity to support healthy lifestyles in the large county of Dayton, an estimated population of over 530,000. Work will target tobacco-free living, active living and healthy eating, and quality clinical and other preventive services. Oklahoma The Oklahoma City-County Health Department in Oklahoma is receiving $716,704 to Implementation serve the large county of Oklahoma, an estimated population of over 718,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, and healthy and safe physical environments. Pennsylvania The Philadelphia Department of Public Health in Pennsylvania is receiving $1,547,297 Implementation to serve the large county of Philadelphia, an estimated population of over 1,526,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eat- ing, quality clinical and other preventive services, social and emotional wellness, healthy and safe physical environments. Lancaster General Health in Pennsylvania is receiving a $233,577 planning award to Capacity Building build capacity to support healthy lifestyles in the large county of Lancaster, an estimated population of over 519,000. Work will target tobacco-free living, active living and healthy eating, quality clinical and other preventive services, and healthy and safe physi- cal environments. 8 2011 COMMUNITY TRANSFORMATION GRANT AWARDEES Implementation State Community Transformation Grant Program Description9 Grant or Capacity Building Grant Republic of Palau Ulkerreuil A Klengar is receiving a $147,106 planning award to build capacity to support Capacity Building healthy lifestyles in the territory of the Republic of Palau, an estimated population of 22,000. Work will target tobacco-free living, active living and healthy eating, quality clinical and other preventive services, healthy and safe physical environments, and social and emotional wellness. South Carolina The South Carolina Department of Health and Environmental Control is receiving Implementation $4,624,724 to serve the entire state of South Carolina, an estimated population of 4,500,000 including a rural population of over 1,050,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, and healthy and safe physical environments. South Dakota The South Dakota Department of Health is receiving $812,383 to serve the entire Implementation state of South Dakota, an estimated population of 812,000 including a rural population of 430,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, healthy and safe physical environments, and social and emotional wellness. Texas The City of Austin Health & Human Services Department in Texas is receiving Implementation $1,026,158 to serve the large county of Travis, an estimated population of over 1,000,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, social and emotional well- ness, and healthy and safe physical environments. The Texas Department of State Health Services is receiving $10,000,000 to serve the Implementation state of Texas minus large counties, an estimated population of 10,000,000 including a rural population of over 2,900,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, and quality clinical and other preventive services. The Houston Department of Health & Human Services in Texas is receiving a Capacity Building $500,000 planning award to build capacity to support healthy lifestyles in the large county of Harris, an estimated population of 4,100,000. Work will target tobacco-free living, active living and healthy eating, quality clinical and other preventive services, and social and emotional wellness. Utah The Utah Department of Health is receiving a $499,366 planning award to build capacity to Capacity Building support healthy lifestyles in the entire state of Utah minus large counties, an estimated pop- ulation of 1,200,000 including a rural population of over 300,000. Work will target tobacco- free living, active living and healthy eating, and quality clinical and other preventive services. Vermont The Vermont Department of Health is receiving $621,760 to serve the entire state of Implementation Vermont, an estimated population of 620,000 including a rural population of over 413,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, and healthy and safe physical environments. Virginia The Fairfax County Department of Neighborhood and Community Services in Virginia Capacity Building is receiving a $499,559 planning award to build capacity to support healthy lifestyles in large county of Fairfax, an estimated population of over 1,000,000. Work will target tobacco-free living, active living and healthy eating, quality clinical and other preventive services, social and emotional wellness, and healthy and safe physical environments. 9 2011 COMMUNITY TRANSFORMATION GRANT AWARDEES Implementation State Community Transformation Grant Program Description9 Grant or Capacity Building Grant Washington The Tacoma-Pierce County Health Department in Washington is receiving $796,836 Implementation to serve the large county of Tacoma, an estimated population of 814,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, and healthy and safe physical environments. The Washington State Department of Health is receiving $3,256,347 to serve the Implementation state of Washington minus large counties, an estimated population of 3,250,000 includ- ing a rural population of over 800,000. Work will focus on expanding efforts in tobacco- free living, active living and healthy eating, quality clinical and other preventive services, and healthy and safe physical environments. The Confederated Tribes of The Chehalis Reservation is receiving a $498,663 planning Capacity Building award to build capacity to support healthy lifestyles among an estimated tribal popula- tion of 1,500 within the state of Washington. Work will target tobacco-free living, active living and healthy eating, and quality clinical and other preventive services. The Sophie Trettevick Indian Health Center is receiving a $218,929 planning award Capacity Building to build capacity to support healthy lifestyles among an estimated tribal population of 2,200 within the state of Washington. Work will target tobacco-free living, active living and healthy eating, and quality clinical and other preventive services. West Virginia The West Virginia Bureau for Public Health is receiving $1,883,603 to serve the entire Implementation state of West Virginia, an estimated population of 1,800,000 including a rural population of 800,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, quality clinical and other preventive services, healthy and safe physical environments, and social and emotional wellness. Wisconsin The University Health Services at the University of Wisconsin-Madison is receiving Implementation $4,695,253 to serve the entire state of Wisconsin minus large counties, an estimated population of 4,700,000 including a rural population of over 1,500,000. Work will focus on expanding efforts in tobacco-free living, active living and healthy eating, and quality clinical and other preventive services. The Great Lakes Inter-Tribal Council, Inc. is receiving a $499,982 planning award to Capacity Building build capacity to support healthy lifestyles among an estimated tribal population of over 8,000 within the state of Wisconsin. Work will target tobacco-free living, active living and healthy eating, quality clinical and other preventive services, social and emotional wellness, and healthy and safe physical environments. 10 Obesity: A Major Factor in U.S. Health In the past three decades the health of Americans has changed dramatically. Adult obesity rates have doubled since 1980, childhood obesity rates have tripled.10 Two-thirds of adults are either over- weight or obese.11 The childhood obesity epidemic is putting today’s youth on course to possibly be the first generation to live shorter, less healthy lives than their parents. n ore than one quarter of America’s health care costs are related to obesity.12, 13 Health care M costs of obese workers are up to 21 percent higher than non-obese workers.14 Obese and physi- cally inactive workers also suffer from lower worker productivity, increased absenteeism and higher workers’ compensation claims.15 n ight now, more than half of Americans live with one or more chronic disease, such as heart R disease, stroke, diabetes or cancer.16 n ne in four Americans has heart disease, one in three has high blood pressure.17 O n lmost 26 million adult Americans have type 2 diabetes, and another 79 million are pre-diabetic, A at high risk for developing type 2 diabetes.18 n bese individuals are 20 to 80 times more likely to develop type 2 diabetes, diabetic men are O two to three times more likely to develop heart disease, and diabetic women are five times more likely to develop heart disease.19 n ore than 75 percent of high blood pressure cases can be attributed to obesity.20 Many cases of M type 2 diabetes are associated with overweight or obesity. n ver time, type 2 diabetes and high blood pressure put people at increased risk for developing O compounding and even more serious conditions, including heart disease, stroke, or kidney disease (renal disease). n n estimated 30 percent of cancer deaths in the United States are due to poor nutrition and phys- A ical inactivity, including excess weight.21 n or every pound of body weight loss, there is a four-pound reduction in knee joint stress among F overweight and obese people with osteoarthritis of the knee.22 11 State-by-State Adult Obesity Rates row are noted with three asterisks (***). Additional information about methodolo- WA ND MT MN gies and confidence intervals is available in the report.  Individuals with a body mass VT ME OR SD WI index (BMI) (a calculation based on weight and height ratios) of 30 or higher are ID WY MI NY NH MA considered obese. IA NE PA RI NV UT CO IL IN OH NJ CT 1. Mississippi (34.4%); 2. Alabama (32.3%); 3. West Virginia* KS MO WV DE CA KY VA MD DC (32.2%); 4. Tennessee (31.9%); 5. Louisiana (31.6%); 6. AZ NM OK AR TN NC Kentucky** (31.5%); 7. Oklahoma** (31.4%); 8. South MS AL GA SC Carolina* (30.9%); 9. Arkansas (30.6%); 10. Michigan* LA TX (30.5%); 11. Missouri* (30.3%); 12. Texas** (30.1%); 13. FL Ohio (29.6%); 14. North Carolina (29.4%); 15. Indiana* (29.1%); 16. Kansas** (29.0%); 17. (tie) Georgia (28.7%); AK HI and South Dakota (28.7%); 19. Pennsylvania (28.5%); 20. Iowa (28.1%); 21. (tie) Delaware (28.0%); and North Dakota (28.0%); 23. Illinois** (27.7%); 24. Nebraska (27.6%); 25. <10% ≥15% and <20% ≥25% and<30% Wisconsin (27.4%); 26. Maryland (27.1%); 27. Maine** ≥10% and <15% ≥20% and <25% ≥30% (26.5%); 28. Washington (26.4%); 29. Florida** (26.1%); 30. (tie) Alaska (25.9%); and Virginia (25.9%); 32. Idaho (25.7%); 33. (tie) New Hampshire (25.6%); and New Mexico (25.6%); Note: 1 = Highest rate of adult obesity, 51 = lowest rate of adult obesity. Rankings are based on combining three years of data (2008-2010) from the U.S. 35. (tie) Arizona (25.4%); Oregon (25.4%); and Wyoming Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance (25.4%); 38. Minnesota (25.3%); 39. Nevada (25.0%); 40. System to “stabilize” data for comparison purposes. This methodology, recom- California (24.8%); 41. New York (24.7%); 42. Rhode Island** mended by the CDC, compensates for any potential anomalies or usual changes (24.3%); 43. New Jersey (24.1%); 44. Montana (23.8%); 45. due to the specific sample in any given year in any given state.  States with statisti- Vermont** (23.5%); 46. Utah (23.4%); 47. Hawaii (23.1%); cally significant (p<0.05) increases for one year are noted with an asterisk (*), states with statistically significant increases for two years in a row are noted with 48. Massachusetts** (22.3%); 49. Connecticut (21.8%); 50. two asterisks (**), states with statistically significant increases for three years in a District of Columbia (21.7%); 51. Colorado* (19.8%). State-by-State Obese and Overweight Children Ages 10-17 Rates considered overweight. States with statistically significant (p<0.05) increases WA MT ND in combined obesity and overweight since the NSCH was last issued in 2003 MN WI VT ME are noted with an asterisk (*). SD OR ID NH WY 1. Mississippi* (44.4%); 2. Arkansas (37.5%); 3. Georgia MI NY IA MA NE PA RI NV UT CO IL IN OH NJ CT (37.3%); 4. Kentucky (37.1%) 5. Tennessee (36.5%) 6. DE Alabama (36.1%); 7. Louisiana (35.9%); 8. West Virginia KS MO WV KY VA MD DC CA NM OK AR TN NC (35.5%); 9. District of Columbia (35.4%); 10. Illinois (34.9%); AZ MS AL GA SC 11. Nevada* (34.2%); 12. Alaska (33.9%); 13. South Carolina (33.7%); 14. North Carolina (33.5%); 15. Ohio (33.3%); TX LA FL 16. Delaware (33.2%); 17. Florida (33.1%); 18. New York AK HI (32.9%); 19. New Mexico (32.7%) 20. Texas (32.2%) 21. Nebraska (31.5%); 22. Kansas (31.1%); 23. (tie) Missouri (31.0%) and New Jersey (31.0%) and Virginia (31.0%); 26. (tie) Arizona (30.6%) and Michigan (30.6%); 28. California <10% ≥15% and <20% ≥25% and<30% (30.5%); 29. Rhode Island (30.1%); 30. Massachusetts ≥10% and <15% ≥20% and <25% ≥30% (30.0%) 31. Indiana (29.9%) 32. Pennsylvania (29.7%); 33. (tie) Oklahoma (29.5%) and Washington (29.5%); 35. New Note: 1 = Highest rate of childhood overweight, 51 = lowest. Rankings are Hampshire (29.4%); 36. Maryland (28.8%); 37. Hawaii based on the National Survey of Children’s Health, a phone survey of par- (28.5%); 38. South Dakota (28.4%); 39. Maine (28.2%); 40. ents with children ages 10-17 conducted in 2007 by the U.S. Department of Wisconsin (27.9%); 41. Idaho (27.5%); 42. Colorado (27.2%); Health and Human Services. These are the most recent state-by-state data 43. Vermont (26.7%); 44. Iowa (26.5%); 45. (tie) Connecticut available. Additional information about methodologies and confidence inter- (25.7%) and North Dakota (25.7%) and Wyoming (25.7%); vals is available in the report. Children with a body mass index, a calculation based on weight and height ratios, at or above the 95th percentile for their 48. Montana (25.6%); 49. Oregon (24.3%); 50. (tie) age are considered obese and children at or above the 85th percentile are Minnesota (23.1%) and Utah (23.1%) 12 Endnotes 1 ang Y C et al. 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[Press Release]. small-weight-loss-takes-pressure-off-knee (accessed http://www.cdc.gov/nchs/pressroom/06facts/obe- January 18, 2012). sity03_04.htm, (accessed April 14, 2008). 13 ACKNOWLEDGEMENTS TFAH BOARD OF DIRECTORS Trust for America’s Health is a non-profit, non- Gail Christopher, DN partisan organization dedicated to saving lives by President of the Board, TFAH protecting the health of every community and working Vice President—Program Strategy to make disease prevention a national priority. WK Kellogg Foundation Cynthia M. Harris, PhD, DABT REPORT AUTHORS Vice President of the Board, TFAH Jeffrey Levi, PhD. Director and Professor Executive Director Institute of Public Health, Florida A&M Trust for America’s Health University and Associate Professor in the Department Theodore Spencer of Health Policy Secretary of the Board, TFAH The George Washington University Senior Advocate, Climate Center School of Public Health and Health Services Natural Resources Defense Council Laura M. Segal, MA Robert T. Harris, MD Director of Public Affairs Treasurer of the Board, TFAH Trust for America’s Health Former Chief Medical Officer and Rebecca Salay Senior Vice President for Healthcare Director of Government Relations BlueCross BlueShield of North Carolina Trust for America’s Health David Fleming, MD Director of Public Health CONTRIBUTORS AND Seattle King County, Washington TECHNICAL ANALYSIS Arthur Garson, Jr., MD, MPH Micro Health Simulations Director, Center for Health Policy, University Professor, And Professor of Public Health Services University of Virginia John Gates, JD Founder, Operator and Manager Nashoba Brook Bakery Alonzo Plough, MA, MPH, PhD Director, Emergency Preparedness and Response Program Los Angeles County Department of Public Health Eduardo Sanchez, MD, MPH Chief Medical Officer Blue Cross Blue Shield of Texas Jane Silver, MPH President Irene Diamond Fund 1730 M Street NW • Suite 900 • Washington, DC 20036 (t) 202-223-9870 • (f) 202-223-9871 www.healthyamericans.org 14