In the past, food insecurity and obesity were viewed as separate public
health problems, yet research now shows that people with unreliable access to
food are also more likely to be obese. A new brief, Making
the Connection: Linking Policies that Prevent Hunger and Childhood Obesity released
by Leadership for Healthy Communities, a national program of the Robert
Wood Johnson Foundation, suggests that policymakers seeking to address hunger in
their communities can find solutions that will also contribute significantly to
reversing the childhood obesity epidemic. Some of the policy strategies outlined
in the brief include:
· Establishing healthy food financing initiatives
to increase access to nutritious foods
· Supporting farm-to-institution, farm-to-school
and school garden programs
· Increasing free and reduced-price school meals
· Partnering with the private sector to increase
the value of federal nutrition assistance benefits for healthful foods through
In the past, food insecurity and obesity were viewed as separate
public health problems, but there is growing concern that the issues are
related. While researchers have yet to definitively answer why people with
unreliable access to food are more likely to be obese, it does appear that lack
of access to healthy affordable food and exposure to high levels of stress may
be contributing factors.10
food-insecure households tend to choose foods high in fat. Although those types
of foods may satisfy hunger more easily, they typically do not provide
Additionally, food-insecure families may tend to overeat when
they do have access to food.13
Policymakers seeking to address hunger in their communities will
find that many of the interventions they consider also can contribute
significantly to reversing the childhood
Making the Connection
The United States is experiencing an obesity crisis: two-thirds
of adults and nearly one-third of children and adolescents are overweight or
is prevalent at all income levels, lower-income households are
disproportionately affected. 18,19
families and some racial and ethnic groups also are at greatest risk for obesity
and food insecurity.20
particularly evident among Hispanic and Black households.21
As neighborhoods across the country continue to confront these
two challenges, policymakers can use the approaches discussed below to help
support the needs of residents at risk for food insecurity and obesity.
by Tikeyah Whittle | Nov 20, 2012
A pediatrician from the Children’s Health Center at St. Mary’s Hospital
in Waterbury thinks so.
“Commercialism is driving change in how we feed our infants,” Dr. M. Alex
Geertsma told a group of advocates Monday at a Capitol forum on childhood
Geertsma said infants go from nursing or breastfeeding, which has proven to
prevent childhood obesity, to eating additive-free, pureed mixed of foods.
“This is where the good news stops,” Geertsma said.
Problems arise at a greater rate when infants begin to give social cues that
they are ready to consume more than liquids and purees. After being on a liquid
diet for the first six months of life, they begin to taste discriminate, or
recognize certain foods as tasty or disgusting. They begin to want something
“novel” whether it is extremely sweet or really salty.
“This suggests to me that we’re meant to continue to get a variety of
different foods as we got a little bit older,” Geertsma said.
This is when the foods that appear on grocery store shelves begin to be
detrimental to children’s health. The change in palate prompts the food
industry to make mixed dinners with huge amounts of added starch and finger
foods like “heavily spiced” Gerber Lil’ Graduates Meat Sticks, Geertsma
These meat sticks contain 300
mg of sodium.
Starting at age nine, children start eating cookies and fruit snacks,
Geertsma said. This provides kids with huge amounts of added sugar and
“clearly primes the pump for them to prefer certain foods.” Think Oreos and
“I try to explain these things to parents and there’s an initial
resistance,” Geertsma said “But as they talk about it in terms of normal
developmental processes they re-think why they respond to their children’s
demands for eating things and they start to see this as a manipulation.”
At the forum, Geertsma discussed the normal growth process in which there is
an increase body fat that occurs after the percentage of body fat reaches its
“Infants will grow most rapidly in particularly weight versus height during
the first six months of life,” Geertsma said. “They then slow somewhat, but
then really slow down in the period from one to approximately seven or eight
years of life.”
So most children look fairly lean during that period of time, he added.
But it has been recently confirmed in Connecticut that an increase in body
fat has been occurring much earlier than seven to eight years of age in children
who eventually become long-term obese. This pattern is worse in African-American
and Latino children, Geertsma said.
“I would not try to impugn the food industry in doing this overtly or even
covertly. They may simply be following what consumers want,” he added.
Obesity is the second-leading cause of preventable death in the United
States, after smoking, according to the Connecticut Public Health Department.
“In just over one generation, U.S. rates of obesity have approximately
tripled among preschoolers and adolescents, and quadruples among children aged
six to 11 years old,” according to the Connecticut Public Health Department.
If a child is overweight before age 8, obesity in adulthood is likely to be
more severe, statistics by the American Academy of Pediatrics revealed.
A recent Connecticut report
found that about one third of Connecticut children in kindergarten and third
grade are overweight or obese and about one out of every seven are obese.
The Connecticut Coalition Against Childhood Obesity, a coalition of more than
30 health advocacy organizations across the state, hosted the forum Monday to
discuss ways to overcome the obesity epidemic, which they say is contributing to
the achievement gap.
According to the American Medical Association obesity kills more Americans
than AIDs, cancer, and injuries combined. At this rate, the current generation
of children will not live as long as their parents.
Halting the Epidemic by Making Health Easier
At A Glance 2011
The Obesity Epidemic
More than one-third of U.S. adults (over 72
million people) and 17% of U.S. children are obese. During 1980–2008, obesity
rates doubled for adults and tripled for children. During the past several
decades, obesity rates for all population groups—regardless of age, sex, race,
ethnicity, socioeconomic status, education level, or geographic region—have
Obesity and Health Disparities
Recent reports show that substantial
differences exist in obesity prevalence by race/ethnicity, and these differences
vary by sex and age. For example, according to 2005–2008 data from the
National Health and Nutrition Examination Survey, 51% of non-Hispanic black
women aged 20 years or older were obese, compared with 43% of Mexican Americans
and 33% of whites. Among females aged 2–19 years, 24% of non-Hispanic blacks,
19% of Mexican Americans, and 14% of whites were obese. Efforts are being made
to reduce these disparities by focusing interventions on subgroups with high
prevalence of obesity.
Health Consequences of Obesity
Obesity increases the risk of many health
conditions, including the following:
Coronary heart disease, stroke, and high
Type 2 diabetes.
Cancers, such as endometrial, breast, and
High total cholesterol or high levels of
Liver and gallbladder disease.
Sleep apnea and respiratory problems.
Degeneration of cartilage and underlying
bone within a joint (osteoarthritis).
Reproductive health complications such as
Mental health conditions.
Obesity Is Costly
In 2008, overall medical care costs related to
obesity for U.S. adults were estimated to be as high as $147 billion. People who
were obese had medical costs that were $1,429 higher than the cost for people of
normal body weight. Obesity also has been linked with reduced worker
productivity and chronic absence from work.
Policy and Environmental Approaches Needed
The causes of obesity in the United States are
complex and numerous, and they occur at social, economic, environmental, and
individual levels. American society has become characterized by environments
that promote physical inactivity and increased consumption of less healthy food.
Public health approaches that can reach large numbers of people in multiple
settings—such as in child care facilities, workplaces, schools, communities,
and health care facilities—are needed to help people make healthier choices.
Policy and environmental approaches that make
healthy choices available, affordable, and easy can be used to extend the reach
of strategies designed to raise awareness and support people who would like to
make healthy lifestyle changes.
CDC's Division of Nutrition, Physical
Activity, and Obesity (DNPAO) is working to improve nutrition and
physical activity and reduce obesity through state programs, technical
assistance and training, surveillance and applied research, program
implementation and evaluation, translation and dissemination, and partnership
Supporting State Programs
CDC's State-Based Nutrition and
Physical Activity Program to Prevent Obesity and Other Chronic Diseases
(NPAO) currently funds 25 states to work with partners across multiple
settings—such as child care facilities, workplaces (including hospitals),
schools, and communities—to implement policy, system, and environmental
strategies that have been proven to work. These strategies address the five
target areas identified by CDC for preventing and reducing obesity, which are to
Increase consumption of fruits and
Increase physical activity.
Increase breastfeeding initiation,
duration, and exclusivity.
Decrease consumption of sugar drinks.
Decrease consumption of high-energy-dense
foods, which are high in calories.
The NPAO Program emphasizes the need to reduce
health disparities among different population groups, such as racial and ethnic
minorities, and requires that states implement a comprehensive state plan. CDC
provides technical assistance to help states develop comprehensive plans,
implement interventions, and build the leadership needed to improve nutrition
and physical activity environments and reduce obesity rates. State program
highlights are available at http://www.cdc.gov/obesity/stateprograms/statestories.html.
CDC's Communities Putting Prevention to
Work (CPPW) State and Territory Initiative is a 2-year cooperative
agreement (2010–2012) that is focused on helping states promote health and
prevent chronic disease through sustained policy, system, and environmental
strategies. DNPAO provides program and evaluation assistance to 50 states and 8
U.S. territories to help them implement changes to the social and physical
environments that make it easier for people to make healthy choices. DNPAO also
provides technical assistance to the CPPW Communities Initiative, which gives
direct funding support to selected communities.
Conducting Surveillance and Research
CDC tracks obesity trends among children and
adults, as well as policy, environmental, and behavioral factors related to
obesity and overweight. For example, in 2010, CDC's new Vital Signs program used
2009 data from the Behavioral Risk Factor Surveillance System to describe the
prevalence of obesity at the state level. The data showed that no state had met
the national goal of reducing the adult obesity rate to less than 15% and that,
in 9 states, at least 30% of adults were obese.
CDC also publishes state-level reports on
policy, environmental, and behavioral indicators associated with nutrition
(e.g., fruit and vegetable consumption, breastfeeding) and physical activity.
States can use these state indicator reports, which include action guides and
train-the-trainer materials, to identify priority actions for state coalitions,
monitor their progress over time, and celebrate successes.
CDC also identifies, evaluates, translates, and
disseminates effective or promising interventions for obesity prevention and
control. For example, CDC provides funding and technical support for the Nutrition
and Obesity Policy Research and Evaluation Network (NOPREN), whose
members include Prevention Research Centers (PRCs) across the country. Network
members work to identify effective policies, the factors needed to support them,
and the barriers that can prevent their adoption. They also assess whether
policy changes can improve people's access to healthy foods and beverages
(including water), determine if food labels give people the information they
need to make healthy choices, and improve eating behaviors and health outcomes.
The Harvard University PRC coordinates the network, and five additional PRCs are
funded as collaborating centers.
Working with Partners
CDC is making progress in stopping
the obesity epidemic through innovative partnerships such as the following:
The Healthy Eating Active Living
Convergence Partnership fosters policy and environmental change by
working with partners in fields not traditionally involved in public health.
The group is currently focused on changing transportation and food systems
to develop active living environments and improve access to healthy foods.
Partners include the California Endowment, Kaiser Permanente, Nemours,
Robert Wood Johnson Foundation, and W.K. Kellogg Foundation.
CDC provides technical assistance, PolicyLink (a national research and
action institute) provides program direction, and the national, nonprofit
Prevention Institute provides policy research, analysis, and strategic
- The National Collaborative on
Childhood Obesity Research (NCCOR) brings together research funders
in a public-private collaboration to accelerate progress on reversing the
epidemic of overweight and obesity among U.S. youth. NCCOR's focus is on
identifying and evaluating effective interventions (particularly policy and
environmental interventions) at individual, community, and population
levels. The NCCOR Web site provides a database of diet and physical activity
measures used in childhood obesity research and a catalog of relevant
surveillance systems. (http://www.nccor.org)
NCCOR members build on each other's strengths through complementary and
joint projects. Partners include the Robert Wood Johnson Foundation,
National Institutes of Health, CDC, and U.S. Department of Agriculture.
Evidence and Research
CDC translates practice-based
evidence and research findings for use by practitioners, communities, and the
public to foster environments that support healthy eating and active living.
Recent efforts and products include the following:
The Center of Excellence for
Training and Research Translation (Center TRT) works with CDC's
NPAO Program to bridge the gap between research and public health practice,
with a focus on nutrition, physical activity, and the prevention and control
of obesity. The Center TRT Web site presents information on intervention
strategies that focus on the factors that contribute to obesity and on
interventions that have been used and evaluated in other communities. It
also provides Web-based training modules on obesity and other chronic
diseases and tools that can help practitioners implement effective
interventions in their
CDC also cosponsors an obesity prevention course on policy and environmental
change strategies each year with the Center TRT at the University of North
Carolina. Forty public health practitioners attended in 2010 to learn how to
promote integrated strategies at state and community levels to address
LEAN Works! Leading Employees to
Activity and Nutrition is a Web-based resource that offers interactive tools
and evidence-based resources that can be used to design effective workplace
programs to prevent and control obesity. (http://www.cdc.gov/leanworks)
The Healthy Weight Web site includes a body
mass index (BMI) calculator and gives people information and tools to help
them achieve and maintain a healthy weight for a lifetime. (http://www.cdc.gov/healthyweight)
The Body Mass Index: Considerations for
Practitioners fact sheet summarizes the science behind BMI. It
emphasizes that BMI is not a diagnostic tool, but a population surveillance
tool and a screening tool designed to identify people who may be at risk for
health problems because of their weight. (http://www.cdc.gov/obesity/downloads/BMIforPactitioners.pdf
The Weight Management Research to Practice
Series summarizes the science in this area and highlights the implications
of research findings for public health and medical care professionals. (http://www.cdc.gov/weightr2p)
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For more information
please contact the
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
4770 Buford Highway NE, Mail Stop K-26, Atlanta, GA 30341-3717
Telephone: 800-CDC-INFO (232-4636) • TTY: 888-232-6348
E-mail: email@example.com • Web: http://www.cdc.gov/nccdphp/dnpao/