this is a very vulnerable group of children in terms of the need to make sure that they have sustained access to healthy foods. just as we did, as i mentioned earlier in the wic program, we commissioned the iom to help us with that. well, another aspect of the healthy hunger-free kids act redirects us in our s.n.a.p. or the supplemental nutrition assistance program, our food stamps as it's still called in 22 states, the direction we received was to put an additional focus in our s.n.a.p. education, nutrition education on obesity prevention. we have been working closely with partners, this is where bill dietz and his colleagues have been an invaluable resource to help us review standards, to provide counsel and advice to make sure that we are using the latest science and findings and incorporating those into the nutrition education programs

that we finance. we're also of course the source of the my plate, the icon that is just about a year old, it was released a year ago, the first week in june. that anniversary's coming up. i'm pleased to see it's gone viral across the country. i saw in several of those schools i visited just last week in north carolina. well, we are looking to do even more on that front as a way of again reminding americans, you know, enjoy your food, but eat less, make half your plate fruits and vegetables, look for alternative, drink more water. don't drink so many sugar-sweetened beverages. there are a number of basic messages that can make a difference over time. additionally, this past week, we announced the availability of $4 million in grants to expand the use of ebt or electronic benefit, the ebt cards for

farmers markets across the country. again, part of an effort, an adjunct, to encourage low income folks to have better access to healthier foods. we have similarly a farm to school grant program we are promoting as well. but i also want to make reference to the food, farm and f forestry bill, is so-called farm bill, that is looming, i hope it's going to take place this year. but we are particularly interested, and i am a very strong advocate of the senate version of that bill, for a number of reasons. one, it doesn't make the kind of cuts that the house proposes in the s.n.a.p. or nutrition programs, but i am particularly attracted to an element that is very much part of that senate ag proposal for the farm bill that would give us the authority to require local stores that participate in the s.n.a.p. or

food stamp program to increase their depth of stock. another way of describing those stores would be required to have more fruits and vegetables, more healthier foods and more of them. and the reason i'm very attracted to that, there are now more than 230,000 stores across the country that participate in the s.n.a.p. program. s.n.a.p. is now an $80 billion a year program, so -- it's a major part of the business line for these stores. and i think we -- these are tax collars going into those stores. i think we have the right to say, if you're going to pa participa participate, happily so, we want to make sure you are enabling low income persons who avail themselves of that benefit to have more routine access to an array of healthier foods. so we're watching that very carefully. summer food, we're entering into the period of the year in which an american child is more likely

to face food insecurity or hunger than any other time of year. how so? why so? schools will be out shortly. and we have a summer food service program that we are promoting this time of year. we have about three million, again, american kids who participate in that program. we're also promoting again the most nutritious, for those summer food service programs, to make sure that they are providing access to nutritious foods. the my plate as i mentioned, one year old. we spend about $1 billion a year in the food and nutrition service on nutrition education, $1 billion. our flagship effort in that regard are the dietary guidelines for all americans. we issue those jointly with the department of health and human services and we alternate every five years, which federal agency takes the lead. we took the lead in 2010. now it shifts over to our

colleagues at hhs, but we work very, very closely with them and i do want to mention that dr. howard coe, who is the assistant secretary for health, he oversees that ultimately at the upper level of the hhs with his colleagues at cdc and nih, but we are -- we have a gap in the dietary guidelines in that they currently provide advice to americans for people from age 2 through the life span, and we are both committed, both federal agencies, to in the 2015 versions, to have available shortly thereafter recommendations for infants from birth through age 2, to address a gap that currently exists. so those dietary guidelines, we address obesity in very, very different ways.

i've mentioned some of the advice that are characterized by that -- by the my plate. we also have a super-tracker. we have almost 700,000 americans who are registered with our super-tracker which can give you advice, you can punch in what you're eating, what kind of exercise you're having and it will give you some direct information that we think can be very, very helpful to people. we have also been encouraging partnerships with health groups, with corporate groups and others on the my plate, again, as a way of institutionalizing it, if you will, as part of efforts right across public and private agencies. finally, i want to say that every so many years, the center for nutrition policy and promotion issues something called a healthy eating index. i'm very mindful of this because if you were to fully adhere to

it, exercise but also eat all the healthy foods, you would get a score of 100. well, i don't know if there are any 100 scores across the country, but i can tell you that groups of americans throughout the demographic income groups, nobody gets higher than a 58. and low income people, the folks on the s.n.a.p. 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. we're very committed to do that through a variety of ways and we think healthy hunger free kids and schools are a major way. we think educating people through my plate is another. but also making and promoting initiatives such as better access to healthy foods,

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

targets are and the strategies that we use to implement those targets in a variety of settings and close with where i think we need to go in the very near future. first observation is that the prevalence in adults and children is relatively flat with one exception, african-american boys, in whom the prevalence of obesity is still increasing. 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 edadolescents are still obese and still as they grow generate additional costs of obesity. those costs in a paper we published three years ago approximated about $150 billion a year or 10% of the national health care budget and two recent papers suggests that that, if anything, is an underestimate of those costs. and finally, a recent paper in the "american journal of preventive medicine" suggested the caloric deficit necessary to

return mean bmi of children to where it was 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 2 to 5-year-olds. 150 calories in 6 to 11-year-olds and 180 calories in adolescents. that's the deficit over time to restore mean bmi to that level. that's not going to 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 that's not going to be achieved by the kind of policy systems and environmental changes that the cdc is focused on. our efforts are to prevent obesity. we are the nation's prevention agency. and those same strategies necessary for prevention are

also essential to sustain weight loss after it occurs, and the issue about excess body weight is not that people can't lose weight, but that they can't sustain the weight losses over time. so, many of the same strategies that we're going to be using for prevention are also strategies relevant to weight maintenance after loss. now, the target behaviors that we're focused on are physical activity, breast feeding, fruit and vegetable intake, reduced screen time. reduced energy density foods and reduced sugar drink intake. those are targets. examples of the potential strategies we're using, for example, are to increase walking. as a way of increasing 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 or other healthy food choices in smaller stores as kevin was describing, in

underserved areas. restoring water to schools. i mean, who would have thought 20 years ago that having water available in schools would be a significant issue? in boston, there are only about 30 schools that have potable water. and mayor menino banning sugar drinks in all public settings controlled by the city. with respect to energy density procurement promises that change the food availability in setting and we've just initiated and it's moving through the general services administration a procurement policy which sets standards for the food served in federal agencies and one of the most notable groups that is getting onboard 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 and no single strategy and no single setting is likely to be successful. so our perspective is we need to implement multicomponent, multisectorial efforts. i'll give you a sense what those might be. because the caloric deficit is so small among 2 to 5 year olds, early care and education is an important target. and with kevin's assistant several years ago, we initiated an effort to focus on early care and education by convening a variety of groups that were invested in the delivery of early care and education. that has subsequently been adopted by the "let's

we're equally focused on the importance of physical education, because schools are one of the few places remaining where children can be physically active and safe at the same time. a good example of work sites that we're invested in, creating healthy hospitals. hospitals should be the healthiest work site on the planet. it's part of their mission, and yet we see fast-food emporiums in children's hospitals across the country, but an increasing engagement to provide healthier options like the procurement policy 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 communities around the country to invest in nutrition physical activity strategies in addition to tobacco prevention and control. that has been replaced now by the community transformation grants as part of the affordable care act, but the principles are the same. to begin to implement strategies which increase accessibility of healthy foods and improve physical activity as part of those strategies. those trends, i think, have, are beginning to turn the corner, and there is suggested data from a number of states and communities around the country that the prevalence of obesity, certainly the rate of increase has stopped, and there's some suggestion that we're beginning to see modest decreases in the prevalence of obesity, particularly in children, 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 sustainability of the cdc programs i mentioned is particularly those in communities and within states, it's dependent on continued funding of the affordable care act and particularly in the affordable care act the prevention in public health fund, which is what was supposed to grow to $1.5 billion by 2015. and as those of you who have followed the student loan issue carefully know, that there was an effort to deplete those funds to pay for maintaining the student loan funds that are reduced interest rates. that now has been pushed back, but that, the affordable care act and particularly the prevention in public health fund in the affordable care act is highly vulnerable and therefore our efforts in communities are

highly vulnerable. kevin mentioned at our weight of the nation conference last week that the iom released a report entitled progress and obesity prevention, five goals and a number of recommendations under each of those goals. these included making physical activity and integral and routine part of life and pointed in the changes of the -- in the environment, putting conventions prevention to work and the community transformation grants are fostering. a second goal, create food and beverage environments that ensure healthy food and beverage options are the routine, easy choice. this means reduced access to sugar drinks, improved restaurant options and procurement policies that improve the quality of foods available in a variety of settings. a third goal, transform messages about physical activity and nutrition, this included positive marketing efforts as well as ongoing efforts to

reduce the marketing of unhealthy foods. particularly to children. it also emphasized that healthy food retail that is already, as i mentioned, incorporated in our community programs. a fourth was to expand the role of health care providers, insurers and employers in obesity prevention and control. and i meant to mention earlier that unlike many other public health challenges, there's both a prevention side to obesity prevention and control and a clinical side, because the individuals that have, who are already obese, have such a substantial caloric deficit they really are going to need in aggressive clinical intervention. but there's an important opportunity here, as emphasized in the iom report, for clinical and community partnerships, to both compliment, to be mutually complimentary in terms of obesity prevention and control. and the fifth recommendation was to make schools a national foe cause point for obesity prevention.

so, both the nutrition standards in school meals that kevin mentioned as well as the restoration of physical activity and joint use agreements for schools to be open to communities after hours so that the community can use those resources for physical activity was a mandate of the report of the iom. the second initiative also offers exceptional promise is the hbo special, we licensed hbo to use the handle of weight of the nation. and as many of you know, there are -- there are four one-hour documentaries released and available on the hbo website, if you've not been able to view them. as well as 12 short films which amplify some of the themes that are 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's a film on nashville which is one of our cppw communities in which the mayor has taken a leadership role to increase physical activity infrastructure, building sidewalks, extending bike trails, as well as food-based initiatives. another important film is on latino health access. a group in santa ana, california and -- which documents the efforts to control obesity and its major sequela, diabetes. and there's a very poignant, one of most poignant moments in any of the films, is when there's a small boy -- a young boy who is overweight, who goes to a parking lot after hours, because that's the only access they have to a place where he can be physically active, and he says in just this most striking voice, "can't they build a park

somewhere? somewhere for us? isn't there some place where we can go?" and that is the problem. addressing the disparities. there's another film, in fact, on disparity, another on fruit and vegetable intake, and others that i think will be useful, and in expanding what these 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 in kaiser permanente, and the iom was 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 kaiser permanente was an investment to extend these films as community action strategies.

so, there are 40,000 copies of the dvds, with a screening kit, that are available for use by communities or institutions, that link back to a community action kit, which, in turn, links to a variety of resources on the hbo website and the links back are to cdc and kaiser pe permane permanente invested in obesity control. our hope, these films can be used to foster a discussion at the local level and begin to organize communities and institutions about what they can do to reverse this epidemic. so, as i said at the beginning, i think we may be at a turning point. whether we can sustain the movement and energy that has accompanied the epidemic of obesity thus far remains to be seen. but 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. >> so, i have just a couple of questions, and then we want to open this up, so it's very much of a dialogue. you both talked about the increasing collaborations between your agencies. and i wondered if you could both expand on that a little bit more and talk about what the impact has been on this cinergy. >> i can begin by saying that i spent most of my career in state governments as the health and human service director in three states. i've been with the federal government just under three years now, but 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 than 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 at cdc actually detailed, or allowed somebody 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 also, to share with the cdc, how these policies and programs are developed on our side. howard coe was the health commissioner up in massachusetts when i was up in maine. we've carried that relationship over. and i think 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 -- i mean, we have really a strong relationship

with hhs in particular, but also with department of education, as we move forward on our healthy hunger-free kids act. a lot of cross agency collaboration with us. i often say, day-to-day, when ever 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 in our relationships. 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 just participated with them earlier this week, and in a wonderful study that 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. well, it depends on how you define it. and i think that's a very powerful study they've done and we're anxious to push it out to really challenge that, to say, one can eat in a healthy manner. it takes planning, it 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, which was a very successful public/private partnership. but the degree of collaboration has really been extraordinary in the last three years, and kevin mentioned the interaction with cdc. from our perspective, that interaction has occurred not only with usda but within hhs, across agencies that had not previously collaborated. a couple of examples is the joint, the interagency working group on food marketing to children, which was a collaboration of usda, ftc, fda and cdc. another 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 scessatio, that is a joint program with cms. the degree of collaboration around tobacco control between the cdc and fda is another

really exceptional effort. and i suspect you heard earlier about the collaboration around food safety, which crosses cdc, fda and usda. and, you know, it's hard to know why that progress didn't exist, because these issues have moved forward to substantially in the last couple of years. >> do we have questions out in the audience that -- while chris is getting it, i'll ask just one more to bill and then i have another one for kevin. as you look at this space, how do we achieve broader social change? what do you think it's 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 that it's a movement, and one of the problems is the constituencies around these issues are different. so that the same group that promotes increased rates of breast feeding and is passionate about it, may be quite different than the group that wants to restrict the marketing on healthy food to children. a second factor is 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 that are 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. >> yeah. hi, katie kiefer, again, from heritage radio network. sorry. mr. concannon, this is really a question for you. i think we