Forward to a colleague April 2003   Volume 9, No. 1
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NUTRITION INITIATIVES AT THE CDC
Guest editor:
William Dietz, MD, PhD
Director, Nutrition Division of CDC

Obesity is the most pressing chronic disease issue in this century, and poor nutrition and physical inactivity are leading contributors to the problem. As the nation's prevention agency, the Centers for Disease Control and Prevention (CDC) is focusing many of its resources on the obesity epidemic.

Organizationally, the CDC is divided into centers that focus on the major disease issues in the United States. Within the National Center for Chronic Disease Prevention and Health Promotion is the Division of Nutrition and Physical Activity (DNPA). Through the DNPA, the CDC is developing and implementing strategies in the areas of surveillance, applied research, and programs for managing the obesity epidemic.

Surveillance strategies
Several surveillance strategies are currently in place. The Behavioral Risk Factor Surveillance System is a state-based telephone survey, which questions about 200,000 people annually on characteristics such as height and weight. Because the focus of public health efforts in this country is at the state level, state-based data are important. The National Health and Nutrition Examination Survey (NHANES) is the latest of a series of surveys that began in the 1960s. Advantages of NHANES are that it is continuous, has linkages to morbidity and mortality, and offers some dietary data. The Youth Risk Behavior Surveillance System is a school-based survey that focuses on behaviors in high school age youth. The Pediatric Nutrition Surveillance System and the Pregnancy Nutrition Surveillance System enable the CDC to assess vulnerable populations. Major foci in these groups are iron deficiency anemia and nutrition intervention. The most recent survey is the School Health Policies and Programs Study (SHPPS), which measures how effectively states and communities employ clinical changes. SHPPS records such statistics as the numbers of schools with physical education classes and with vending machines.

Current population-based data have limitations, however. Many surveys don't link birth weight to subsequent outcomes, which can be a critical variable in diseases such as hypertension and cardiovascular disease. Moreover, there are few data on 6 to 14-year-olds and few longitudinal studies, which are necessary to link diet and physical activity with subsequent disease outcomes. These data also lack environmental measures, which evaluate factors such as how access to supermarkets affects fruit and vegetable consumption and how access to parks and recreation areas affects physical activity levels.

Applied research
DNPA research tends to be applied. Current efforts are striving to identify at-risk populations. One vulnerable group is the pediatric population. Substantial data from David Freedman offer the most reliable and valid estimates of the impact of childhood on adult obesity. NHANES identified a second vulnerable population: Some 15% of all individuals with a body mass index ¡Â 40 are African-American women.

Other research efforts focus on identifying factors including dietary intake, decreased physical activity, and increased inactivity related to the onset of obesity. Over the last 20 years, our society has seen many changes in food consumption, including an increased intake of fast foods and soft drinks, fewer family meals, and substantially larger portion sizes. It is important that the Department of Health and Human Services works with the food industry to identify healthy dietary alternatives and to create a demand for them.

Three obesity prevention strategies are now in place. One is the promotion of breast-feeding. Three large studies have shown that breast-fed children have a 15% to 30% lower incidence of obesity in early childhood. Limiting television viewing in children and adolescents also has benefits. Several studies with children and adolescents show a linear relationship between watching television and the prevalence of obesity or excess weight gain. Another beneficial strategy is to increase physical activity. Although school-based physical education programs are a recommended strategy to increase physical activity, the numbers of these programs have declined. While 42% of schools had physical education programs in 1991, only 29% had such programs by 1999.

Programs
The CDC is now funding 12 state programs with about $400,000 yearly. This is just a beginning. More public health programs are needed to address tobacco cessation, nutrition, and physical activity and to link medical intervention with community support. Programs must focus on policy and environmental changes and how to incorporate them into communities schools, medical settings, and work sites.




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M.V.I. - 12¨, Unit Dose. 10-mL Unit Vial for a single dose. Box of 10 Unit Vials.
 0186-1199-41 66591-199-41
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 0186-1199-38 66591-199-38
M.V.I. - 12¨, Multi-dose in two 50-mL Vials labeled #1 and #2. Both vials to be used to provide 10 single doses.
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 0186-1199-71 66591-199-71
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 0186-1839-31 66591-839-31
AQUASOL A¨  Parenteral, 50,000 USP Units;
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 0186-4239-21 66591-239-21
AQUASOL E¨  Drops, 15 IU/0.3 mL (30 mL).
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0186-5800-12 66591-800-12
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