fully adhere to it, exercise but also eat all of the healthy foods, you would get a score of 100. well, i don't known there are any 100 scores across the country, but i can tell you groups of americans throughout the demographic income groups, no one gets higher than a 58 and low income people, the folks on the snap program or food stamp program, get a 52, so they are marginally lower, but just so. we have a challenge as a country. it isn't both in the overall food environment, but also in just habits and culture that we really need to address and overcome, and we're very committed to do that through a variety of ways. we think healthy free hungry kids in schools are a major way. educating people through my plate is another, but also making and promoting an issue such as better access to healthy

foods, and also encouraging access on a regular basis to reduce food insecurity. so, thanks, all for being here today. we look forward to the press conference. >> well, thank you for that introduction and it really is a great pleasure to be here with you today to talk about cdc's efforts and obesity. before i do that, i want to acknowledge the extraordinary work you've done, kevin, at usda in terms of leading efforts to change the programs that provide for so many in this country. i can't think of another time in our history, in our recent history, when the changes have been as profound. when i want to begin with three facts, regarding the prevalence, costs and caloric deficits we need to achieve with regard to

childhood obesity and with regard to the target strategies we use to implement those targets in a variety of settings and close where i think we need to go, in the very near future. the first observation is the prevalence in adults and children is relatively flat, with one exception, african-american boys, in whom the prevalence of obesity is still increasing. and that's been true for most groups for about ten years, suggesting that we are maybe at a corner. but we have to remind ourselves that 34% of adults, 17% of children and adolescents are still obese and will generate additional costs of obesity. those costs in a paper we published three years ago approximated $150 billion a year, or 10% of the national health care budget and two recent papers suggest that, if anything, is an underestimate of those costs. and finally, a recent paper in

the american journal of preventtive medicine, says the caloric deficit necessary to return mean bmi of children in 1970 before the epidemic started is relatively achievable. that deficit on a daily basis for the next eight years is about 30 calories in two to five year olds, 150 calories in six to ten years old, and that's the deficit over time necessary in order to restore mean bmi in-to-that level it won't change very much the deficits necessary to reduce the obese individuals to a healthy weight. that deficit is more in the neighborhood of 700 to 800 calories a day over that same time period, and it's not achieved by the system and environmental changes that the cdc is focused on. our efforts are to prevent obesity. we are the nation's prevention

agency. but those same strategies necessary for prevention are also essential to sustained weight loss after it occurs and the issue about excess body weight is not that people wasn't lose weight, but that they can't sustain those weight losses over time. many of the same strategies we're going to be using for prevention are also strategies relative to weight maintenance after loss. the target behaviors that we're focused on are physical activity, breast feeding, reduced screen time, reduced energy foods. those are targets. some examples are to increase walking to increase physical activity. to put in place baby friendly hospitals in which breast feeding, rather than the provision of formula is the default. or healthy food financing initiatives which put in

supermarkets healthy food choices that kein was describing in underserved areas. restoring water to schools. who would have thought 20 years ago that having water available in schools would be a significant issue, but in boston there, are only about 30 schools that have potable water by virtue of the lead that exists in those pipes. or other strategies within communities, to ban sugar drinks in all of the public settings controlled by the city. with respect to energy density, procurement policies that change the food availability in settings, and we've just initiated, and it's now moving out through the general services administration, procurement policy which sets standards for the food served in federal agencies and one of the most notable groups that is getting on board with that is the department of defense which serves millions of people around the country and their dependents, and abroad.

screen time is the biggest challenge, and the place where we're looking to limit screen time is really in settings where there are -- there's a regulatory approach to controlling television time. the places where we're trying to implement those strategies are a variety of settings in which people spend time. no single strategy and cessing is likely to be successful. we need to implement multicomponent, multisector levels. i'll give you a sense what they might be. because the caloric deficit between 2 and 5 years old, early education is a key. convening a variety of groups invested in the early care and education that has subsequently been adopted by the child care challenge, first ladies initiative and focuses on

elimination of sugar drinks, provision of no fat or lo fat milk, control of television time. 60 minutes a day of active play and the provision of water in place of sugar drinks. schools. kevin already mentioned that will help to transform those meals that were available. we are equally focused on education. schools are one of the few places remaining where children can be physically active and safe at the same time. and a good example of work sites that were invested in is creating healthy hospitals. healthy hospitals should be the healthiest work site on the planet. part of their mission, and yet we see fast food emporiums in children's hospitals across the country. but in increasing engagement to provide healthier options like the procurement policy that's going across the federal government in those hospitals.

one of the new initiatives around communities was one started by the stimulus bill, which provided cdc with funds to fund a number of community around the country to invest in nutrition, physical activity, strategies and in addition toto bako prevention and control. that has been replaced now by the community transformation act community care act. but to begin to implement strategies which begin accessibility of healthy foods and improved physical activity as part of those strategies. those trends are beginning turn the corner and suggested data from a number of states from around the country that the prevalence of obesity, certainly the rate of increase, has stopped and there is some suggestion that we're beginning see modest decreases in the

prevalence of obesity, particularly in children, out where as i said that deficit offers much more promise than i think the strategies in adults. so the question becomes where do we go next? the -- the sustainability of the cdc programs that i've mentioned is particularly those in communities and within states is dependent on continued funding of the affordable care act, and particularly in the affordable care act, prevention of public health fund, which was supposed to grow to 1$1.5 billion by 201. and as those of you who have followed the student loan issue carefully know, there was an effort to deplete funds to pay for maintaining funds that were reduced in interest rate. that now has been pushed back. but at fordable care act, and particularly the prevention and public health fund in the affordable care act is highly

vulnerable, and, therefore, our efforts in communities are highly vulnerable. kevin mentioned at our way to the conference last week, the iom released a report, called increasing obesity prevention. we want to increase physical fitness and pointed to the change environment. we want to look at community transformation grant to foster that. a second goal to create food and beverage environments that ensure healthy food and bev range options are the routine, easy choice this means reduced access to sugared drinks, improved restaurant options and pro fewerment policies that improve the quality of foods available in a variety of settings. a third goal, to transform messages about physical activity and nutrition, included a

positive marketing efforts as well as ongoing efforts to reduce the marketing of unhealthy foods, particularly to children. and also emphasized healthy food retail that is already as i mentioned, incorporated in our community programs. fourth, expand the role of health care providers in obesity prevention and control, and i meant to mention earlier, that unlike many other public health challenges, there is both a prevention side to obesity prevention and control and a clinical side. because the individuals who have -- that are already obese has such a substantial caloric deficit, they really need aggressive clinical intervention. an important opportunity here as emphasized in the iom report, for clinical and community partnerships to both complement -- to be muttaly

complimentary. and to make schools a focal point for nutrition standards in school meals that kein mentioned and restoration of physical activity and joint use agreement for schools to be open to communities after hours so the community can use resources for physical activity is a mandate of the apop, the accelerating progress and prevention report of the iom. second initiative, which also offers exceptional promise, is the hbo special on entitled "weight of the nation." we licensed hbo to use the handle weight of the nation, and as many of you know there, are four one-hour documentaries that have been released and available on the hbo website if you have not been able to view them and 12 short films which amplify some of the themes developed in the four documentaries, including small films on stigma,

a very powerful film, which emphasizes the discrimination that obese individuals suffer, but also films that point to community solutions. there is a film on nashville, one of our ccpw community where the mayor of nashville has taken an active movement to build trails as well as food-based initiatives. another important film on latino health access. a group in santa ana, california, documents the efforts to control obesity and major is its major sequealae, diabetes. and one of the most poignant moments, a young boy who is overweight, goes to a parking lot afterhours, because that is the only place they have access to where he can be physically

active. he says in the most striking voice, can't they build a park somewhere, somewhere for us? isn't there somewhere we can go? and that's one of the problems, traesing the disparities. there is a film on disparities, fruit and vegetable intake and others that i think will be useful, in expanding what films can do. these films were produced in association with nih and cdc. we were -- the two federal agencies were responsible for assuring the accuracy of the content of those films. the films were supported by the michael and susan dell foundation and kaiser permanente and the iom is the group which facilitated the interaction of the four partners with hbo. but part of what was invested by the michael and susan dell foundation and casey permanente

was an investment to extend films as community action strategies. 40,000 copies of the dvds with a screening kit available by communities or institutions that link back to a community action kit which in turn links to a variety of sources on the hbo website, and links back to cdc and kaiser permanente and other institutions. and we hope these films can foster a discussion at the local level and begin to organize communities and institutions about what they can do to reverse the epidemic. we may be at a turning point on whether we can sustain the energy that's accompanied the epidemic of obesity remains to be seen. the resources are there, and i hope increasingly the political will is there. so i think i'll close and we'll

look forward to the discussion. >> thank you. >> thanks. [ applause ] >> so i have a couple of questions, and we want to open this up so it's very much of a dialog. you both talked about the increasing collaborations between your agencies. i wondered if you could expand on that a little more and talk about what the impact has been on this synergy. >> i can begin by saying that i spent most of my career in state governments as the health and human services director in three states. i've been with the federal government just under three years now. the career people, the senior people i work with on a daily basis, all reflect to me, they have seen more cross the federal government interaction in this

administration that over the life of their careers and i can tell you that in the food and nutrition area, whether it's getting right down to our -- i referenced the review that cdc made and recommendations to us, more recently bill dietz' sector actually detailed or allowed someone to come up and work at our center for nutrition policy and promotion, both to help us better understand how cdc moves its initiatives, but to share with the cdc how these policies and programs are developed on our side. howard coe was the health director in massachusetts when i was in maine. we've carried that relationship back and along with bill, we're all red sox fans as well. but that has nothing to do with health agenda. >> oh, yes, it does. our mental health. >> but we are -- we have really

a strong relationship with hhs in particular, but also with the department of education, as we move forward on our healthy hunger free kids act. a lot of cross agency collaboration with us. and i often say day to day whenever i'm out on the road, everything we do in the food and nutrition arena, we do through others, we do through state agencies or county agencies, food banks in some cases, public university extension services that provide much of the nutrition education, so it is at the core of our efforts often as i describe them. our relationships, and it is important, we promote that to be good -- to be good partners with other parts of the government, but also with the private sector, that's how we move things forward. so i think it is very -- it has been an environment of a lot of

cooperation. and for us, even internally, in the u.s. department of education, we work very closely, particularly with the economic research service as an example, we participated with them earlier this week and a wonderful study they did on the issue of affordability of healthy foods. we're often fighting this -- this old chestnut that says, gee, i can't afford to eat healthy, healthy foods are always more expensive. it depends on how you define it. it's a very important study they've done and we are ready to challenge that, to say one can eat in a healthy manner, it takes planning, takes prudence, takes access, but it can be done. >> i came to cdc in 1997, and up until this administration, the principal collaborations, which worked well, were around the

dietary guidelines and the national fruit and vegetable alliance, a very successful public/private partnership, but the degree of collaboration has really been extraordinary in the last three years, and kevin mentioned reactions from cdc. in our department it occurred not only with the agencies to dekalb ra be collaborated. a good example is the work that is going on which i didn't mention, a million hearts which is focused on aspirin, blood pressure control, cholesterol screening, and smoking cessation is a joint program with cms. the degree of collaboration around tobacco control between

the cdc and are fda is a fantastic effort. and collaboration over food safety, and, you know, it's hard to know why that progress didn't exist sooner, because these issues have moved forward so substantially in the last couple of years. >> do we have questions out in the audience that -- while crisis chris is getting it, i will ask one more for bill and then i have one for kevin. as you look at this space, how do we achieve broader social change? what is it going to take? >> as i -- as i think i indicated, the changes in the food and physical activity environments really need to be transformative in order to reverse this epidemic. analogous to a social movement.

and there is certainly a lot of movement, but i'm not yet sure u.s. a movement, and one of the problems the constituencies around these issues are different. so that the same group that promote s increased rates of breast feeding may be very different than those who want to market healthy food to children. the second factor, most social movements have not been top down the way the obesity epidemic has evolved with the government at several levels and a variety of medical groups and businesses driving it. it's really had a grass-roots component. and that's what's missing and what i hope the hbo documentaries will help foster. >> i think we have a question over here. >> hi, katie kiefer from heritage radio network.

sorry. mr. con c conc c concannon, this is a primarily a question for you. i have interviewed a bunch of people, including the lunch lady, and one of the issues that comes up over and over again about improving school nutrition, the actual kitchen facilities themselves have been essentially dismantled so that all of the food that comes in is already preprepared, they just put it on a sheet pan, put it in a fryer, throw it in the oven and very little actual cooking going on and that the people who work in the lunchroom, the lunch ladies, don't have culinary skills. so my question to you is two fold. one, does -- is there funding for programs to retrain school cafeteria personnel and retrofit those kitchens, and secondly, in

an earlier session, scott faber was talking about entitlements in the upcoming farm bill, and one of the statistics you quieted, $142 billion is being earmarked as subsidies and entitlements for successful farming operations and insurance companies, which don't need the money, but are getting. and i'm wondering if any of the money being proposed for those entities could be allocated back toward school lunch and programs that would help improve nutrition in schools by retrofitting kwiretrofit ing kitchens, training personnel, and getting more fruits and vegetables from local farmers. sorry for the long question. >> the second question is a little easier for me to answer, respond to. not sure where he got those numbers.

raising the issue of how we spend agricultural dollars broadly. let me say, the annual budget of the u.s. department of agriculture is in the area of around 1$150 billion. $105 billion of that comes to the nutrition area that i have responsibility for, so it's one of those public perception issues. if you ask the american people where is the agriculture department's budget, where most of the goes? most of the goes to the nutrition space, and i'm very proud of that, and i think as americans we can be proud of that, it has enjoyed over the years sort of bipartisan support. i hope that holds in this more challenged environment. so i guess as i say, i'm not sure where some of those numbers came from. your question about schools. first of all, many schools historically over the years didn't have kitchens, period,

especially in older school buildings. kids brought their lunches from home. so they were never adequately equipped in the point of view in many cases of having a full-blown kitchen. we in the stimulus bill two years ago put out about $100 million in a matter of weeks to help schools equip and modern eyes their school food service areas. within a short period of time, we had requested for 6$650 million. we had $100 million. we had an additional $25 million in the last budget. there is no question about the fact that schools are really challenged in terms of their infrastructure environment around cooling particularly as we get into more vegetables and fruits and salads. you need to have cooling equipment as well. now, what many -- yet, at the same time, i've been in schools,

recall a school in denver i was at that has pretty old equipment, and doing all foods from scratch. actually whole grain breads, et cetera. so it can be done. it's more of a challenge. and the healthy, hunger free kids act, congress appropriated $50 million to provide training and technical assistance to school nutrition folks across the country. we're very committed to that, already engaged in that, we've been running something down in fredericksburg, virginia, the past two years, called product safety university where we're enabling and educating school nutrition leaders on local purchasing. so that they deal with safety issues, traceability, but also ways in which school foods are presented to engage children. some of the work of brian wansik

at caramel on how you structure foods to nudge kids, make the right choice, the healthy choice. i've been able to see, out to visit many schools. about 3,000 of them, that have already met at least one level of the criteria from the healthy -- the first lady's let's move challenge. healthy u.s. school challenge. those schools are doing it. many of them not without the latest equipment. it can be done it will be challenging, but i don't think we should -- i wouldn't be satisfied, nor do i think it would be reasonable to think that the majority of public and private schools can't meet the challenges of healthier foods that kids would consume, even with the challenges they have in their infrastructure. >> other questions out there? while chris is doing the -- i'm going to ask -- go ahead. you got there fast. >> not so far this time. thanks, chris. thanks to both of you for being

here this is sarah borne from food and water watch. mr. dietz, you mentioned the pro possessed voluntary guidance and that seems to be back burnered if i understand correctly. and i wonder, with the competitive foods regulations that are going to be coming out in the next couple of weeks, if the voluntary guidance is the place where we can really push on creating some kind of industry standard on foods marketed to children. if the competitive foods standard might be a de facto standard if industry needs to meet their requirements to sell their foods in schools if we'll have more widespread impact in location where is food is marketed to children. >> i'll let kevin answer the competitive foods piece, and they are really two separate issues. the interagency working group is focused on marketing starnted, and i think