News Release from Trust for America’s Health

Washington, D.C. July 7, 2011 - Hawaii was named the fifth least obese state in the country, according to the eighth annual F as in Fat: How Obesity Threatens America's Future 2011, a report from the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF). Hawaii's adult obesity rate is 23.1 percent.

Adult obesity rates increased in 16 states in the past year and did not decline in any state. Twelve states now have obesity rates over 30 percent. Four years ago, only one state was above 30 percent. Obesity rates exceed 25 percent in more than two-thirds of states (38 states)

This year, for the first time, report examined how the obesity epidemic has grown over the past two decades:

• Over the past 15 years, seven states have doubled their rate of obesity. Another 10 states nearly doubled their obesity rate, with increased of at least 90 percent, and 22 more states saw obesity rates increase by at least 80 percent
• Fifteen years ago, Hawaii had an obesity rate of 10.6 percent and was ranked least obese state in the nation. The obesity rate in Hawaii doubled over the last 15 years.
• Since 1995, obesity rates have grown the fastest in Oklahoma, Alabama, and Tennessee, and have grown the slowest in Washington, D.C., Colorado, and Connecticut.
• Ten years ago, no state had an obesity rate above 24 percent, and now 43 states have higher obesity rates than the state that was the highest in 2000.

"Today, the state with the lowest adult obesity rate would have had the highest rate in 1995," said Jeff Levi, Ph.D., executive director of TFAH. "There was a clear tipping point in our national weight gain over the last twenty years, and we can't afford to ignore the impact obesity has on our health and corresponding health care spending."

In addition, for many states, their combined rates for overweight and obesity, and rates of chronic health problems, such as diabetes and high blood pressure, have increased dramatically over the past two decades. For Hawaii, long-term trends in rates include:

• Fifteen years ago, Hawaii had a combined obesity and overweight rate of 42.2 percent. Ten years ago, it was 49.4 percent. Now, the combined rate is 57.5 percent.
• Diabetes rates have doubled in ten states in the past 15 years. In 1995, Hawaii had a diabetes rate of 4.4 percent. Now the diabetes rate is 8.3 percent.
• Fifteen years ago, Hawaii had a hypertension rate of 21.5 percent. Now, the rate is 27.8 percent.

Racial and ethnic minority adults, and those with less education or who make less money, continue to have the highest overall obesity rates:

• Adult obesity rates in Hawaii were 35.3 percent for Blacks. Nationally, obesity rates for Blacks topped 40 percent in 15 states, 35 percent in 35 states, and 30 percent in 42 states and D.C.
• Rates of adult obesity for Latinos were 27 percent in Hawaii. National Latino obesity rates were above 35 percent in four states (Mississippi, North Dakota, South Carolina, and Texas) and at 30 percent and above in 23 states.
• Meanwhile, rates of adult obesity for Whites topped 30 percent in just four states (Kentucky, Mississippi, Tennessee, and West Virginia) and no state had a rate higher than 32.1 percent. The rates of adult obesity for Whites were 19.3 percent in Hawaii.
• Nearly 33 percent of adults who did not graduate high school are obese compared with 21.5 percent of adults who graduated from college or a technical college.
• More than 33 percent of adults who earn less than $15,000 per year were obese compared with 24.6 percent of adults who earn $50,000 or more per year.

The most recent state-by-state data on obesity rates for youth 10 to 17 are from 2007 and also were included in last year's report. According to the data, 11.2 percent of children and adolescents in Hawaii are considered obese.

"The information in this report should spur us all – individuals and policymakers alike – to redouble our efforts to reverse this debilitating and costly epidemic," said Risa Lavizzo-Mourey, M.D., M.B.A, RWJF president and CEO. "Changing policies is an important way to provide children and families with vital resources and opportunities to make healthier choices easier in their day-to-day lives."

To enhance the prevention of obesity and related diseases, TFAH and RWJF provide a list of recommended actions in the report. Some key policy recommendations include:

The report also examines a range of policy efforts that the federal and state governments are taking to prevent and control obesity.

Some state efforts include:

• Twenty states now have school meal standards that are stricter than the U.S. Department of Agriculture (USDA) requirements.
• Twenty-nine states including Hawaii limit when and where competitive foods (foods and beverages sold outside of the formal meal programs, through à la carte lines, vending machines and school stores) may be sold beyond federal requirements.
• Every state has some physical education requirements for students. However, these requirements are often limited or not enforced, and many programs are inadequate.
• Twenty-one states not including Hawaii now have legislation that requires body mass index (BMI) screening or weight-related assessments other than BMI for children and adolescents. Seven years ago, only four states required BMI screening or other weight-related assessments.
• Twenty-six states not including Hawaii have now established farm-to-school programs. Five years ago, only New York had a law establishing a farm-to-school program.
• Sixteen states including Hawaii now have Complete Streets laws. "Complete streets" are roads designed to allow all users – bicyclists, pedestrians, drivers, and public transit users – to access them safely. Seven years ago only five states had these laws.

Some federal efforts include:

• The Patient Protection and Affordable Care Act (ACA) authorizes new resources and strategic planning initiatives aimed at reducing obesity and increasing opportunities for physical activity and improved nutrition, including the Prevention Fund, the National Prevention Strategy, Community Transformation Grants, greater coverage for preventive services, a Childhood Obesity Demonstration Project, and strategic new approaches through the Center for Medicare and Medicaid Innovation.
• The Healthy, Hunger-Free Kids Act, the Agriculture Appropriations Act, and the Healthy Food Financing Initiative also include a number of important nutrition and obesity-related provisions

This year's report also includes a series of recommendations from TFAH and RWJF on how policymakers and the food and beverage industry can help reverse the obesity epidemic.

The recommendations for policymakers include:

1. Protect the Prevention and Public Health Fund: TFAH and RWJF recommend that the fund not be cut, that a significant portion be used for obesity prevention, and that it not be used to offset or justify cuts to other Center for Disease Control and Prevention (CDC) programs.
2. Implementing the Healthy, Hunger-Free Kids Act: TFAH and RWJF recommend that the USDA issue a final rule as swiftly as possible regarding school meal regulations and issue strong standards for competitive food and beverages.
3. Implementing the National Physical Activity Plan: TFAH and RWJF recommend full implementation of the policies, programs, and initiatives outlined in the National Physical Activity Plan. This includes a grassroots advocacy effort; a public education program; a national resource center; a policy development and research center; and dissemination of best practices.
4. Restoring Cuts to Vital Programs: TFAH and RWJF recommend that the $833 million in cuts made in the fiscal year 2011 continuing resolution be restored and that programs to improve nutrition in child care settings and nutrition assistance programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children be fully funded and carried out. If fully funded these programs could have a major impact on reducing obesity.

"Creating healthy environments is key to reversing the obesity epidemic, particularly for children," remarked Dr. Lavizzo-Mourey. "When children have safe places to walk, bike and play in their communities, they're more likely to be active and less likely to be obese. It's the same with healthy food: when communities have access to healthy affordable foods, families eat better."

Additionally, for the food and beverage industry, TFAH and RWJF recommend that industry should adopt strong, consistent standards for food marketing similar to those proposed in April 2011 by the Interagency Working Group, composed of representatives from four federal agencies – the Federal Trade Commission, CDC, Food and Drug Administration and the USDA – and work to implement the other recommendations set forth in the 2005 Institute of Medicine report on food marketing to children and youth.

The full report with state rankings in all categories is available on TFAH's website at www.healthyamericans.org and RWJF's website at www.rwjf.org. The report was supported by a grant from RWJF.

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