Nutrition, Physical Activity, and Obesity
Poor diet and physical inactivity contribute to many serious and costly health conditions, including obesity, heart disease, diabetes, some cancers, unhealthy cholesterol levels, and high blood pressure.1–3
The Prevention Status Reports highlight—for all 50 states and the District of Columbia—the status of policies and practices recommended by the Institute of Medicine, Community Preventive Services Task Force, US Surgeon General, CDC, and other expert bodies. The recommendations are based on expert judgment or evidence from scientific studies that the policies and practices can improve diet, improve breastfeeding, increase physical activity, or reduce obesity.6–14 These policies and practices include
During 2009–2010, approximately 17% of children and adolescents and 36% of adults were obese.- Implementing nutrition standards to limit the availability of less nutritious foods and beverages in schools
- Implementing nutrition standards for foods and beverages in state government facilities
- Implementing nutrition and physical activity standards in state regulations of licensed child care facilities
- Establishing physical education time requirements in high schools
- Promoting evidence-based practices that support breastfeeding in hospitals and birth centers
Policies & Practices
Secondary schools not selling less nutritious foods and beverages
Maintaining a healthy diet helps children and adolescents achieve optimal growth and reduces their risks for many health problems, including obesity.1,6 Schools can provide environments that support students’ efforts to follow a healthy diet. In addition to providing school meals, many schools offer foods and beverages in other venues, such as school stores, canteens, snack bars, vending machines, and classrooms. The Institute of Medicine recommends nutrition standards for such foods and beverages,7 and CDC recommends that schools limit the availability of less nutritious foods and beverages and ensure that “only nutritious and appealing foods and beverages are provided in all food venues in schools . . . .”6
CDC’s School Health Profiles assesses whether secondary schools sell certain less nutritious foods and beverages by whether the schools allow sales of these items from vending machines or at the school store, canteen, or snack bar.15 For a school to be identified as not selling less nutritious foods and beverages, the school principal had to respond “no” to each item when asked whether students can purchase each of the following five items: 1) chocolate candy; 2) other kinds of candy; 3) salty snacks that are high in fat, such as regular potato chips; 4) cookies, crackers, cakes, pastries, or other baked goods that are high in fat; and 5) soda pop or fruit drinks that are not 100% juice. Data were provided for 45 states and the District of Columbia and represented only those states that participated in the survey and had an overall response rate of at least 70%.15
Percentages of secondary schools where less nutritious foods and beverages were not offered for sale, United States (2012)
(State count includes the District of Columbia.)
± How the ratings were determined
± More information on this indicator
State nutrition standards policy for foods and beverages sold or provided by state government agencies
States can create environments that support healthy dietary behaviors by setting nutrition standards for foods and beverages sold or provided by government agencies. The Institute of Medicine recommends that government agencies implement “strong nutrition standards for all foods and beverages sold or provided through the government” and ensure “that healthy options are available in all places frequented by the public.”8
For purposes of this report, strong policies are those that meet the following criteria: 1) apply to at least 90% of government agencies in the state executive branch, 2) cover all food purchased, contracted, distributed, or sold by government agencies in the state executive branch, 3) provide quantifiable standards for foods or nutrients (e.g., set a maximum for the amount of sodium a food item can include), and 4) set minimal standards that limit sodium content, fat content, and the availability of high-calorie, low-nutrient foods and beverages.
Status of state policies on nutrition standards for foods and beverages sold or provided by government agencies, United States (2012)
(State count includes the District of Columbia.)
± How the ratings were determined
± More information on this indicator
Inclusion of nutrition and physical activity standards in state regulations of licensed childcare facilities
State regulations for licensed childcare facilities can help create environments that support healthy dietary behaviors, breastfeeding, and physical activity for young children.
The Institute of Medicine has recommended including specific requirements related to physical activity, sedentary activity, and child feeding in childcare regulations.9 The American Academy of Pediatrics, American Public Health Association, and National Resource Center for Health and Safety in Child Care and Early Education have identified 47 components that childcare regulatory agencies and childcare providers should include in standards for infant feeding, nutrition, physical activity, and screen time in licensed childcare settings.10
Inclusion of nutrition and physical activity standards in state regulations of licensed childcare facilities, United States (2012)
± How the ratings were determined
± More information on this indicator
State physical education time requirement for high school students
For children and adolescents, regular physical activity helps improve cardiorespiratory and muscular fitness, bone health, and cardiovascular and metabolic health biomarkers, and results in a healthier body composition.2 Schools can help youth meet physical activity recommendations through comprehensive school physical activity programs, which should include quality physical education.6
The Community Preventive Services Task Force recommends the implementation of quality physical education programs that increase the length of, or activity levels in, school-based physical education classes.11 This recommendation is based on strong evidence of such programs’ effectiveness in improving physical activity levels and physical fitness among school-aged children and adolescents.11CDC and the National Association for Sport and Physical Education recommend that high school students receive at least 225 minutes of physical education per week.6,12 States and the District of Columbia can help increase physical activity among high school students by setting minimum requirements for time spent in physical education.
Status of state physical education time requirements for high school students, United States (2012)
(State count includes the District of Columbia.)
± How the ratings were determined
± More information on this indicator
Average birth facility score for breastfeeding support
Breastfeeding is associated with health benefits for the child and the mother. Children who are breastfed are at lower risk for a number of health problems, including childhood infections, sudden infant death syndrome (SIDS), and obesity. Women who breastfeed have a lower risk of breast and ovarian cancer.19 Hospitals and birth centers can create environments that support the decision to breastfeed.
The US Surgeon General recommends that maternity care practices throughout the United States fully support breastfeeding.13 A review of evidence by the Cochrane Collaboration found that institutional changes in maternity care practices effectively increased breastfeeding initiation and duration rates.14
The state birth facility score for breastfeeding represents the average score across participating birth facilities in a state. Each participating birth facility, based on its response to a self-administered survey, was scored on multiple evidence-based practices that support breastfeeding across seven categories: 1) labor and delivery, 2) breastfeeding assistance, 3) mother-newborn contact, 4) newborn feeding practices, 5) breastfeeding support after discharge, 6) nurse/birth attendant breastfeeding training and education, and 7) structural and organizational factors related to breastfeeding.20 The total score can range from 0 to 100, with a higher score representing more support. The national average score across all states was 70.
Status of state average birth facility scores for breastfeeding support, United States (2011)
(State count includes the District of Columbia.)
± How the ratings were determined
± More information on this indicator
Prevention Status Reports: Nutrition, Physical Activity, and Obesity, 2013
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