Those diseases include heart disease, stroke, cancer, diabetes, high The average healthcare costs for a person with diabetes are more than $13,000 …
NANA National Alliance for Nutrition and Activity
National Health Priorities: Reducing Obesity, Heart Disease, Cancer, Diabetes and Other Diet- and Inactivity-Related Diseases, Costs and Disabilities
Strengthen the Centers for Disease Control and Preventions Division of Nutrition and Physical Activity
2007
For more information, contact Dr Margo Wootan or Mia Dell at 202-777-8308 or mdell@cspinetorg
NANA National Alliance for Nutrition and Activity
The National Alliance for Nutrition and Activity NANA advocates national policies and programs to promote healthy eating and physical activity to help reduce the illnesses, disabilities, premature deaths, and costs caused by diet- and inactivity-related diseases Those diseases include heart disease, stroke, cancer, diabetes, high blood pressure, and obesity
The Problem: Two-thirds of premature deaths in the US are due to poor nutrition, physical inactivity and tobacco use Federal and state governments conduct effective programs to reduce tobacco use, but programs to reduce obesity and promote healthy eating and physical activity to the general public are limited Over the last 25 years, obesity rates doubled among US adults and tripled
in children and teens Overweight and obesity affect the majority of American adults 66 Diet and inactivity are cross-cutting risk factors, contributing significantly to four out of the six leading causes of death ie, heart disease, cancer, stroke, and diabetes The Costs: According to the US Department of Agriculture, healthier diets could prevent at least 71 billion per year in medical costs, lost productivity, and lost lives The Centers for Disease Control and Prevention CDC estimates that if all physically inactive Americans became active, we would save 77 billion in annual medical costs What Congress Can Do: Provide a FY 2008 appropriation of 65 million for the CDCs Division of Nutrition and Physical Activity to promote healthy eating and physical activity and reduce obesity This level of funding would allow the CDC to fund all states, with 24 funded at a basic implementation level For FY 2006, funding is 415 million, allowing CDC to fund 28 states AZ, AR, CO, FL, GA, IL, IA, KY, ME, MD, MA, MI, MO, MT, NM, NY, NC, OK, OR, PA, RI, SC, SD, TX, VT, WA, WV, and WI, seven those in bold at a basic implementation level Of this amount, 5 million should go to implement the CDCs National
Fruit and Vegetable Nutrition Program IN 2005, CDC became the lead federal agency this program
National investment in disease prevention is inconsistent with current health concerns
Over 75 of deaths in the US are due to chronic diseases Yet, the budget for CDCs National Center for Chronic Disease Prevention and Health Promotion represents only 11 of CDCs overall budget
Chronic Diseases
Leading Causes of Death1
75
19 6
Other
Chron ic D is ease Pr ev Health P rom
Infectious Diseases
11
89
CDC FY 2006 Spending for Chronic Disease Prevention and Health Promotion
CDC T otal A ppropriation
This refers only to spending on chronic disease within the CDC
Strengthen the CDCs Division of Nutrition and Physical Activity
While 1/3 of premature deaths in the US are attributable to poor nutrition and physical inactivity, funding for the CDCs Division of Nutrition and Physical Activity DNPA represents just of the CDCs total budget and is 5 of the CDCs chronic disease budget Support a FY 2008 appropriation of 65 million for the CDC to promote healthy eating and physical activity and to reduce obesity For FY 2006, funding is 415 million, allowing CDC to fund 28 states AZ, AR, CO,
FL, GA, IL, IA, KY, ME, MD, MA, MI, MO, MT, NM, NY, NC, OK, OR, PA, RI, SC, SD, TX, VT, WA, WV, and WI, seven those in bold at a basic implementation level 65 million would allow the CDC to fund all states, 24 of those at a basic implementation level 5 million of that money should be dedicated to expanding CDCs Fruit and Vegetable Program The average award for the planning level grants is 400,000 per state, which supports the development of a state-wide plan for physical activity, nutrition and obesity, partnerships, and implementation and evaluation of demonstration projects The basic implementation grants enable states to expand their efforts to conduct effective programs and to provide mini-grants for community-level programs Funding is also needed to further develop, test, and disseminate practical interventions and effective policies, to conduct surveillance and communications campaigns, and to strengthen the Fruit and Vegetable Program, which has recently been moved from the National Cancer Institute to CDC 85 of DNPA funded states have leveraged additional funds from private foundations, businesses, states and other sources to supplement DNPA funding, with leveraged amounts
ranging from 100,000 to over 1 million With grants from DNPA, funded states have developed and implemented programs to address poor diets and physical inactivity Examples include: Iowas Pick A Better Snack PABS social marketing campaign raised fruit and vegetable intake 25 among low-income groups and elementary school students using strategic placement of simple messages with colorful fruit and vegetable graphics on billboards, bus signs and local shopper newspapers Pennsylvanias Keystone Healthy Zone Schools Campaign has increased the number of schools reporting they have a School Health Council by 84, making schools more likely to have written policies about nutrition, make improvements to nutrition environments, and offer more minutes of physical education and more opportunities for physical activity As a result of this initiative, there also has been a 47 increase in the number of schools which are making attempts to correct hazards so children who live within a mile of school can walk or bike to school Nebraskas Work Well Council provides materials and assistance to businesses in developing a wellness plan for their employees After seven years of the program, appraisals
indicate that participating Work Well employees have an obesity rate less than half the comparable state and local rates in the general population
National Fruit and Vegetable Program
The National Fruit and Vegetable Nutrition Program was developed in 1991 to encourage and support people to eat more fruits and vegetables to promote health The 2005 transfer of federal leadership for the National Fruit and Vegetable Nutrition Program from the National Cancer Institute NCI to the Centers for Disease Control and Prevention CDC provides an opportunity to strengthen and reinvigorate this important nutrition initiative Just one in five Americans eat at least five daily servings of fruits and vegetables In fact, the average fruit and vegetable consumption has remained relatively flat for more than 10 years: 36 servings of fruits and vegetables a day The USDA recommends 10 daily servings of fruits and vegetables People who consume recommended amounts of fruits and vegetables have reduced risk of chronic diseases, including stroke and other cardiovascular diseases, type 2 diabetes, and certain types of cancer Creating partnerships from a broad coalition of educators, health organizations,
food producers and retailers, researchers, and government agencies, the Fruit and Vegetable Program includes a diverse spectrum of successful programs: from books for preschoolers and incentive programs for employees, to community gardens and farmers markets, to interventions in restaurants, schools and churches Here are three examples of this program at work in our communities: Wisconsin The Veggin Out Program seeks to increase fruit and vegetable consumption among low-income people by providing food and cooking demonstrations at local farmers markets Since its inception in 2002, it has reached over 3,000 adults and almost 800 children Over 90 percent of the participants said they planned to eat more fruits and vegetables because of the program Texas In 2004, about 2,000 children and their parents attended the 4th Annual Childrens Nutrition Expo at the Houston Childrens Museum, an event created to help make families more aware of the importance of healthy nutrition and physical activity through hands-on, interactive learning experiences Through efforts like these, the percentage of adults who eat fruits and vegetables 5 or more times a day doubled from 12 percent to 23 percent
in five years Arizona The Arizona Community Nutrition Program offers classroom sessions that promote 5 A Day messages and a tour of the produce section of the local grocery store to thousands of low-income third graders each year In 2003, surveys of participating children indicated a sharp increase from 57 percent to 95 percent in the percentage who knew how many servings of fruits and vegetables they should eat each day In addition, 87 percent learned how to make a fruit or vegetable snack by themselves
Obesity is one of the greatest health challenges of our time
Obesity rates have doubled in adults and tripled in children and adolescents over the last two decades Two-thirds 66 of American adults are seriously overweight or obese2 One in six young people are obese and one in three are overweight2
18 15 12
Percentage of young people who are obese2
percent
9 6
Obesity increases the risk of heart disease, high blood pressure, diabetes, arthritis-related disability, and cancer 3
3 0 1963-65, 1971-74 1976-80 1988-94 1966-70 19992000
6-11 year olds
12-19 year olds
Data for 1966-70 are based on adolescents ages 12-17
Obesity remains a serious public health threat and a leading
cause of death A 2005 CDC study recalculated the number of deaths due to obesity, given more recent data CDC estimated that approximately 112,000 deaths are associated with obesity each year in the United States4 That makes obesity the second leading contributor to premature death the first is tobacco It is equivalent to a jetliner full of 300 people crashing every day Obesity is not the only adverse outcome from poor nutrition and physical inactivity Even people with normal weights die from heart disease, cancer, and other diseases caused by poor diet and/or physical inactivity
Unhealthy eating and physical inactivity cause 1/3 of premature deaths
Americans are eating more calories According to national surveys, men on average consumed 168 more calories per day in 2000 than in 1971 2,618 kcal per day in 2000 compared to 2,450 kcal in 1971 and women consumed 335 more calories per day in 2000 than in 1971 1,877 kcal per day in 2000 compared to 1,542 kcal in 19716 50 of American adults do not get the recommended amount of physical activity9 Regular physical activity helps to prevent heart disease, colon cancer, obesity, diabetes, and high blood pressure
Much of our nations disease
burden is preventable Approximately 70 of premature deaths are caused by poor nutrition, physical inactivity, and tobacco use7,8
Only 12 of Americans eat a healthy diet consistent with federal nutrition recommendations10 The typical American diet is too high in saturated and trans fat, salt, and refined sugars and too low in fruits, vegetables, whole grains, calcium, and fiber
Diet and inactivity are cross-cutting risk factors, contributing significantly to four out of the six leading causes of death Leading Causes of Death1
Diet and inactivity are leading risk factors for causes of death shown in orange
1 Heart Disease 2 Cancer 3 Stroke 4 Chronic Lower Respiratory Diseases 5 Accidents 6 Diabetes 7 Pneumonia and Influenza 8 Alzheimers Disease 9 Nephritis 10 Septicemia 11 Suicide 12 Chronic Liver Disease/Cirrhosis 13 Hypertension 14 Parkinsons Disease 15 Pneumonitis
684,462 554,643 157,803 126,128 105,695 73,965 64,847 63,343 42,536 34,243 30,642 27,201 21,841 17,898 17,457
Diabetes: Obesitys Twin Epidemic
Diabetes rates have risen along with obesity rates The number of Americans with diabetes more than doubled from 58 million to 147 million between 1980 and 200411 More than 60
of people with diabetes are under 65 years old One in three Americans will develop diabetes in their lifetime12 Type 2 diabetes is no longer called adult onset diabetes because of rising rates in children In a study conducted in Cincinnati, the incidence of type 2 diabetes in adolescents increased ten-fold b 
etween 1982 and 199413 90-95 of diabetes is type 2 Between 50 and 80 of diabetes cases are associated with unhealthy eating patterns and sedentary lifestyles14
Diabetes Is on the Rise
millions of Americans
16 14 12 10 8 6 4
19 84 19 88 19 80 19 90 19 94 19 98 19 96 19 86 20 02 20 04 19 82 20 00 19 92
Through physical activity and healthy eating, the onset of type 2 diabetes was reduced by 60 in at-risk individuals 15 In comparison, the diabetes drug metformin reduced the onset of type 2 diabetes by 30 The average healthcare costs for a person with diabetes are more than 13,000 per year compared to 2,500 for a person without diabetes16 Employers pay an average of 4,410 more per year for employee beneficiaries who have diabetes than for beneficiaries who do not have diabetes17 Federal Medicare and Medicaid costs due to diabetes were 145 billion in 200018
The costs of diet-,
inactivity-, and obesity-related diseases are borne by individuals, businesses and governments
Diet- and inactivity-related diseases increase out-ofpocket costs for families For example, diabetes patients pay about 2,000 per year in drug store expenses27 Diet- and inactivity-related diseases increase costs to businesses Medical costs of General Motors employees increased from 2,225 to 3,753 per year with increasing body mass index BMI of the employee28
Costs of Diseases to which Diet- and Inactivity Are Major Contributors
Cancer19 Coronary Heart Disease20 Obesity21 Diabetes22 Stroke20 High Blood Pressure20 Osteoporosis23, 190 Billion 142 Billion 117 Billion 132 Billion 57 Billion 60 Billion 17 Billion
Estimates of annual direct indirect costs Figure includes direct costs only
The total US healthcare costs due to obesity is 94 billion a year6 Half that cost 47 billion is paid through Medicare and Medicaid
Obesity increases inpatient and ambulatory health care costs by 395 per person per year — more than smoking and problem drinking21 Because of the extra weight that Americans gained over the last decade, the airline industry spends an additional 275 million a year on jet
fuel29
According to the USDA, healthier diets could prevent at least 71 billion per year in medical costs, lost productivity, and lost lives24
Federal Medicaid Medicare Costs, 200017 Disease Heart Disease Cancer Cost 431 billion 188 billion 145 billion 70 billion
CDC estimates that if all physically inactive Americans became active, we would save 77 billion in annual medical costs25
Health care spending is expected to rise by 25 by 2030, due to the aging of the American population Chronic diseases are responsible for 75 of health care costs26
Diabetes Stroke
Poor diet and physical inactivity contribute to the leading causes of disability among Americans
Number of Americans Affected by Diseases to which Diet and Inactivity Are Major Contributors Overweight/Obese20 High Blood Pressure20 Diabetes30 Coronary Heart Disease20 Osteoporosis23 Cancer19 Stroke20 134,750,000 65,000,000 18,200,000 13,000,000 10,000,000 9,800,000 5,400,000
Diabetes is a leading cause of serious disabilities such as blindness and amputation Each year, 12,000 to 24,000 people with diabetes become blind, almost 130,000 receive treatment for kidney failure, and 82,000 undergo diabetesrelated lower-extremity
amputations30
The leading cause of permanent, premature disability in the US labor force is coronary heart disease, which causes 19 percent of disability allowances distributed by the Social Security Administration31
Stroke is a leading cause of serious long-term disability20 22 million Americans have disabilities resulting from high blood pressure32 Most hip fractures are caused by osteoporosis23, 33 Of people over age 50 who fracture a hip, 24 die within one year and 25 require long-term care23 A broken hip is the second leading cause of admission to nursing homes
Poor diet and physical inactivity are causing adult diseases in children
Because of the rising obesity rates, this may be the first generation of children who live shorter lives than their parents34
Only 2 of children eat a healthy diet ie, a diet consistent with federal nutrition recommendations37 According to the US Department of Agriculture USDA, children 2 to 18 years consumed an average of 118 more calories per day in 1996 than they did in 197838 An extra
118 calories per day, if not compensated for through increased physical activity, translates into an average of 12 pounds of weight gain per year
35 of
children are physically inactive39 Three out of four American high school students do not eat 5 or more servings of fruits and vegetables each day40 Three out of four children consume more saturated fat than is recommended in the Dietary Guidelines for Americans41
25 of children ages 5 to 10 years have high cholesterol, high blood pressure, or other early warning sign for heart disease35 Autopsy studies of teenagers and young adults have shown that virtually all have fatty streaks in their arteries which is the first step toward clogged arteries One in ten had advanced fibrous plaques in their arteries36
As the number of young people with type 2 diabetes increases, diabetic complications like limb amputations, blindness, kidney failure, and heart disease will develop in people of younger ages likely in their 30s and 40s From 1979 to 1999, annual hospital costs for treating obesity-related diseases in children rose three-fold from 35 million to 127 million42
References
1 Hoyert DL, King HC, Smith BL Deaths: Preliminary data for 2003: National Vital Statistics Reports; vol 53, no 15 Hyattsville, MD: National Center for Health Statistics, 2005 2 Ogden C, et al Prevalence of
Overweight and Obesity in the United States, 1999-2004 Journal of the American Medical Association 2006, vol 295, pp 1549-1555 3 US Department of Health and Human Services The Surgeon Generals Call to Action to Prevent and Decrease Overweight and Obesity 2001 Rockville, MD: US Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2001 4 Flegal KM, et al Excess Deaths Associated with Underweight, Overweight, and Obesity Journal of the American Medical Association 2005, vol 293, pp 1861-1867 5 Finkelstein E, Fiebelkorn I, and Wang G State-Level Estimates of Annual Medical Expenditures Attributable to Obesity Obesity Research 2004, vol 12, pp 18-24 6 Centers for Disease Control and Prevention CDC Trends in Intake of Energy and Macronutrients United States, 1971-2000 MMWR 2004, vol 53, pp 80-82 7 McGinnis JM, Foege WH The Immediate vs the Important Journal of the American Medical Association 2004, vol 291, pp 1263-1264 8 McGinnis JM, Foege WH Actual Causes of Death in the United States Journal of the American Medical Association 1993, vol 270, pp 2207-2212 9 Centers for Disease Control and Prevention CDC, US Department of Health and Human
Services Physical Activity and Good Nutrition: Essential Elements to Prevent Chronic Diseases and Obesity, At-a-Glance 2004 Atlanta: CDC, 2004 Accessed at http://wwwcdcgov/nccdphp/aag/aag_dnpahtm on March, 2005 10 Basiotis PP, et al The Healthy Eating Index: 1999-2000 Washington, DC: US Department of Agriculture, Center for Nutrition Policy and Promotion, 1992 11 Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Interview Statistics Data Trends, National Diabetes Surveillance System, Prevalence of Diabetes Accessed at http://wwwcdcgov/diabetes/statistics/prev/national/tablepersonshtm on February 28, 2006 12 Narayan KMV, et al Lifetime Risk for Diabetes Mellitus in the United States Journal of the American Medical Association 2003, vol 290, pp 1884-1890 13 Pinhas-Hamiel O, et al Increased Incidence of Non-insulin-dependent Diabetes Mellitus among Adolescents The Journal of Pediatrics 1996, vol 128, pp 608-615 14 Hu F, et al Diet, Lifestyle, and the Risk of Type 2 Diabetes Mellitus in Women The New England Journal of Medicine, 2001, vol 345, pp 790-797 15 Knowler W, et al Reduction in the Incidence of Type 2 Diabetes with Lifestyle
Intervention or Metformin The New England Journal of Medicine 2002, vol 346, pp 393-403 16 Julie Louise Gerberding, MD, MPH, Director, Centers for Disease Control Letter to Mr Eric Hargis, Chair, Research to Prevention Coalition, May 18, 2006 17 Ramsey S, et al Productivity and Medical Costs of Diabetes in a Large Employer Population Diabetes Care 2002, vol 25, pp 23-29 18 National Institutes of Health NIH, Office of the Director, US Department of Health and Human Services DiseaseSpecific Estimates of Direct and Indirect Costs of Illness and NIH Support Bethesda, MD: NIH, 2000 19 American Cancer Society ACS Cancer Facts Figures 2005 Atlanta, GA: ACS, 2005 20 American Heart Association AHA Heart Disease and Stroke Statistics — 2005 Update Dallas, TX: AHA, 2005 21 Sturm R The Effects of Obesity, Smoking, and Drinking on Medical Problems and Costs Health Affairs 2002, vol 21, pp 245-253 22 American Diabetes Association Economic Costs of Diabetes in the US in 2002 Diabetes Care 2003, vol 26, pp 917-932 23 National Osteoporosis Foundation Osteoporosis Disease Statistics: Fast Facts Accessed at http://wwwnoforg/osteoporosis/statshtm on March, 2005
References continued
24 Frazao E High
Costs of Poor Eating Patterns in the United States In Americas Eating Habits: Changes and Consequences Edited by Elizabeth Frazao Washington, DC: Economic Research Service, US Department of Agriculture, 1999 Agriculture Information Bulletin No 750, pp 5-32 25 Pratt M, Macera CA, Wang G Higher Direct Medical Costs Associated with Physical Inactivity The Physician and Sportsmedicine 2000, vol 28, pp 63-70 26 Centers for Disease Control and Prevention CDC, US Department of Health and Human Services The Promise of Prevention Atlanta: CDC, 2003 27 American Diabetes Association, 2003 28 Wang F, et al The Relationship between National Heart, Lung, and Blood Institute Weight Guidelines and Concurrent Medical Costs in a Manufacturing Population American Journal of Health Promotion 2003, vol 17, pp 183-189 29 Dannenberg AL, et al Economic and Environmental Costs of Obesity: The Impact on Airlines American Journal of Preventive Medicine 2004, vol 27, pp 264 30 Centers for Disease Control and Prevention, US Department of Health and Human Services Diabetes: Disabling, Deadly, and on the Rise, At-a-Glance 2005 Atlanta: CDC, 2005 31 American Heart Association AHA Heart Disease and Stroke
Statistics 2003 Update Dallas, TX: AHA, 2003 32 American Heart Association AHA 1998 Heart and Stroke Statistical Update Dallas, TX: AHA, 1997 33 Measured in adults over age 45 34 Olshansky SJ, et al A Potential Decline in Life Expectancy in the United States in the 21st Century New England Journal of Medicine 2005, vol 352, pp 1138-1145 35 Freedman DS, et al The Relation of Overweight to Cardiovascular Risk Factors Among Children and Adolescents: The Bogalusa Heart Study Pediatrics 1999, vol 103, pp 1175-1182 36 Pathobiological Determinants of Atherosclerosis in Youth PDAY Research Group Natural History of Aortic and Coronary Atherosclerotic Lesions in Youth; Findings from the PDAY Study Arteriosclerosis and Thrombosis 1993, vol 13, pp 1291-1298 37 Munoz K, et al Food Intakes of US Children and Adolescents Compared with Recommendations Pediatrics 1997, vol 100, pp 323-329 38 Nielsen S, Seiga-Riz AM, and Popkin B Trends in Energy Intake in US between 1977 and 1996: Similar Shifts Seen Across Age Groups Obesity Research 2002, vol 10, pp 370-378 39 Centers for Disease Control and Prevention CDC, US Department of Health and Human Services Fact Sheet: Youth Risk Behavior Trends,
1991-99 Atlanta: CDC Accessed at http://wwwcdcgov/nccdphp/dash/yrbs/trendhtm on February 5, 2002 40 Kann L, et al Youth Risk Behavior Surveillance - United States, 1999 Morbidity and Mortality Weekly Report 2000, vol 49, no SS-5, pp 1-96 41 Agricultural Research Service, US Department of Agriculture Food and Nutrient Intakes by Children 1994-96, 1998 1999 Table Set 17 Accessed at http://wwwbarcusdagov/bhnrc/foodsurvey/homehtm on August 17, 2001 42 Wang G, Dietz W Economic Burden of Obesity in Youths Aged 6-17 Years: 1979-1999 Pediatrics 2002, vol 109, pp e81
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