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Press Briefing Transcript

CDC Telebriefing on Obesity Among Low-Income Preschool-Aged Children

August 6, 2013 12 noon eastern

OPERATOR: Welcome and thank you for standing by.  At this time participants are in a listen only mode.  During today's session, you may press star one to ask a question.  Today's conference is being recorded.  At this time I’ll turn the call over to Mr. Tom Skinner.  You may begin. 

TOM SKINNER: Thank you and thank you for joining us for our monthly release of Vital Signs, this report is on “Obesity among Low Income Preschool Aged Children, United States, 2008 to 2011.”  We're joined today by Mr. Sam Kass who is the White House executive director of Let's Move! and senior policy adviser on nutrition as well as the director of the CDC, Dr. Tom Frieden.  Dr. Frieden is going to open our call, turn it over to Mr. Kass and then Dr. Frieden will say a few more remarks and we'll get to your questions.  Dr. Frieden? 

TOM FRIEDEN: Good morning or good afternoon, everyone.  Thanks very much for joining us.  As you know each month we issue a Vital Signs on one of the critical health issues facing the country and what can be done about it.  This month we're encouraged to focus on the progress being made reducing early childhood obesity.  Nineteen states and territories are seeing decreasing in rates of obesity among low income preschoolers ages 2 to 4, but we've seen isolated reports in the past that have had encouraging trends but this is the first report to show many states with declining rates of obesity in our youngest children after literally decades of rising rates. This report is from 40 states and I will give you more of the details in a bit as well as answer your questions.  It's a bright spot for our nation's young kids, but the fight is very far from over.  Still about one in five preschoolers in the U.S. is obese, and -- one in eight, I’m sorry, of preschoolers in the U.S. is obese with even higher rates among African-American and Hispanic kids, and there are several trends that are favorable that we believe are associated with this, although what the data is showing is a tipping point really from steady increases or leveling off to crude decreases in many places around the U.S. so it's encouraging news, but we're very, very far from being out of the woods.  I'd like to turn it over to Mr. Sam Kass, executive director of Let's Move! and senior policy adviser for nutrition and then when Mr. Kass is finished with his remarks I’ll give more detail on what today's findings are and any questions people may have.  Mr. Kass? 

SAM KASS: Thank you, Dr. Frieden.  Today's announcement marks a real turning point in our effort to ensure that our youngest generation gets the chance to live healthy and productive lives.  The first lady has really dedicated her time at the White House to work with leaders from across the country from business leaders to public officials, teachers and parents, to really improve the health of our kids, and today we know that our collective efforts as a nation are really working.  We know just how vital it is to get children off to a healthy start in life, and that's exactly why working with the CDC the first lady launched her Let's Move! child care program, which has over 10,000 child care centers from across the country working to improve the nutrition and physical activity of kids across the country, and it's been a spectacular success.  We're seeing the results of so much leadership at every level from across the country, and we could not be more encouraged by the progress we have made, but to echo Dr. Frieden's comments we have a long, long way to go before we can rest and know that the next generation is on a much healthier path than the one current.  So we will take this moment to double down on our efforts and really see this work through, but I want to thank Dr. Frieden for your leadership has been spectacular on this and many other issues and we owe a great deal of gratitude to see these kind of results to you and your team.  So thank you for all of your hard work. 

TOM FRIEDEN: Thank you very much, and we're very encouraged by the progress as well as by the leadership shown through Let's Move! and a series of other initiatives.  I’ll get to those a little bit more in a moment but what I'd like to discuss now is a little bit more of the detail of what we've seen. So if you wanted to get the big picture, there's a graphic that has kind of a children's train in it that shows that just going back from this surveillance system which doesn't go back reliably much before 1990, you see in 1990 about 10 percent of low-income preschoolers were obese.  By 2007, that hit a peak of almost 15 percent, about 14.9 percent.  We've seen even larger decreases in data systems that go back to 1980 and the largest among teens, but what you see since 2007 starting in 2009 is a decrease, and now nationally it's at 14.4 percent, but if you look at the other graphic you can see that 19 states and territories have had significant decreases, significant decreases in the rate of obesity.  And this is really the first report that shows something so widespread.  Eighteen states and one territory reported these decreases.  They're small, but they're statistically significant. 

There are another 19 states and the District of Columbia and Puerto Rico that had no significant change and only three states reported small but statistically significant increases.  As I said, about one in eight preschoolers in the U.S. is obese but the rate is much higher among African-American kids, one in five, and Hispanic kids, one in six, and that's between the ages of 2 and 5.  Obesity in early childhood increases the risk of high cholesterol, high blood sugar, asthma, and many other health problems both in childhood and adolescence as well as on into adulthood because children who are obese are five times more likely to be overweight or obese as adults if they're overweight or obese as preschoolers.  Obesity in adults as we know is associated with many of the leading causes of death in the U.S., including heart disease and diabetes and the economic costs of obesity are very high.  The annual medical costs associated with obesity among adults totaled $150 billion in 2008 dollars.  Obesity is a complex problem and we know addressing it isn't going to be quick or simple.  We know it's not going to turn on a dime.  It's going to turn gradually but then we can continue doing things that drive rates down and obviously the best way to deal with many health problems as with obesity is prevention, is avoiding obesity in the first place.  That's why we're so encouraged to see these decreases, even though they're small in this age group. 

There are many different efforts under way to help making healthy eating and active living for parents and children easier in places where they live, they learn, and they play.  There have been state initiatives, federal policy and national initiatives such as Let's Move!  When I kind of step back and look at this, I think there are three broad trends that are encouraging.  The first has been significant changes in the WIC program, the Women, Infants, and Children nutrition program.  This program now aligns much more closely with the dietary guidelines for Americans, and that's made a big difference in not only what participants of WIC get through that program but also the store environment where WIC stores are common.  They're more likely now to carry fruit and vegetables, they're more likely to carry low-fat milk.  They're more likely to promote things that are healthy and I think three of the biggest changes within the WIC program were a shift from juice to whole fruit and vegetables and that's very important because juice should be had only in real moderation.  It's concentrated sugar, whereas whole fruits and vegetables are much healthier.  Second a promotion of lower fat milk which is much lower calories as well, and third is the promotion of breastfeeding.  Previously there were unintentional incentives where the WIC program might have made it less attractive to breastfeed than it would otherwise. We recently announced a steady increase of breastfeeding in the U.S. and certainly the WIC policies in that regard could only have helped. 

The second broad change has been an increase in breastfeeding and while the impact of breastfeeding on childhood weight is somewhat controversial and we have contradictory evidence, it's certainly a great way to start and it's encouraging that we're seeing that increase.  The third is the broad changes led by programs like Let's Move! that have increased awareness of healthy eating.  There's a lot more that state and local officials, business leaders, child care providers, health care providers, communities and families can do, such as making it easier for families to buy healthy, affordable foods and beverages, and we've seen encouraging progress addressing some of the food deserts that have been identified, helping to provide access to safe, free drinking water in parks and child care centers and schools, opening schools and gyms and playgrounds during non-school hours so children can play safely after school and weekends over the summer, helping child care providers adopt the best practices and Mr. Kass mentioned the Let's Move! child care, we have thousands of child care providers getting kids more active, serving healthier foods and that's certainly very important and creating partnerships with civic leaders and child care providers and others to make community changes that promote healthy eating and active living. 

The bottom line is that after decades of rising rates obesity in early childhood is starting to decline in many states.  Unfortunately too many preschoolers are still obese and because of the health implications of obesity, we really need to continue to support parents, caregivers and communities so that we can help our kids live active, healthy lives. And we hope that these small successes signal a potential for really turning the tide in early childhood obesity and galvanizing efforts to address the obesity epidemic not only in early childhood but across the lifespan. So I’ll now turn it over to Tom Skinner, who will coordinate the question and answer period. 

TOM SKINNER: Shirley, I think we're ready for questions.  If you could provide instructions, that would be good. 

OPERATOR: Thank you.  If you would like to ask a question, please press star one, unmute your line and record your name clearly.  To withdraw your question, you may press star 2.  Again, star 1 to ask a question and one moment please for our first question.

TOM FRIEDEN: While Shirley is collecting the first question, let me comment a bit on the methodology.  So this study was done using a very large number of measurements primarily from the WIC program, and the reason for that is that we have those measurements available.  Children are weighed twice a year, so that gives us a unique opportunity to track changes over time.  It's also a population that tends to have higher rates of obesity so seeing a decrease in that rate in that population is encouraging, even though we know that the decrease is small and there have been some changes in the WIC population.  It's grown slightly and that may have included some new people who would be less likely to be obese but when we correct it for everything that we can correct it for, the trends do seem to be both real and widespread.  So over to questions. 

OPERATOR: Thank you.  Our first question comes from Mike Stobbe with Associated Press.  You may ask your question. 

MIKE STOBBE: Hi, thank you for taking my question, two actually.  One, I just want to make sure it was 11.6 million children who were in this study population.  Is that right?  That just seems like a lot.  There's only 4 million kids born each year, and my second question was for Mr. Kass, he described the Let’s Move campaign as being successful.  I think Dr. Frieden started to address this but could you say more on what -- how you measured success and specifically which success had bearing on preschooler obesity rates?  Thank you. 

TOM FRIEDEN: Let me ask Dr. Ashley May to address the same question first, and I don't know if Mr. Kass is on with us if not I’ll address some of the Let’s Move issues.

ASHLEY MAY: To answer your question Mr. Stobbe, there were 11.6 million children included in our final sample and these were data that were collected between 2008 and 2011.  The children were between the ages of 2 to 4 years old. 

TOM FRIEDEN:  And Let’s Move Child Care is one component of Let’s Move, encouraging people to be active and that has really had a big pickup from our child care providers around the country.  What it's done is to encourage at least an hour or two of physical activity throughout the day, including outside play, when possible, zero screen time for children under 2 years of age, for 2 and older limiting screen time to no more than 30 minutes per week during child care and try to encourage reduction in, with parents and caregivers, serving fresh fruit and vegetables every meal, encouraging family style meals, eliminating fried foods, providing access to water during meals and throughout the day, not serving sugary drinks and for kids 2 and older serving low-fat, 1% or non-fat milk and no more than a single 4 to 6 ounce of serving of 100% juice a day and encouraging breastfeeding.  So those are some of the components and I think what's been encouraging is the excitement that it’s generated in a number of kids and a number of child care providers who are participating. 

MIKE STOBBE: But if I may, has anyone been able to survey or measure whether preschool providers or families have been complying with those recommendations? 

TOM FRIEDEN:  I don't know, Dr. May or if someone else in the program can comment on that specifically.  If not we’d be happy to get back to you. 

HEIDI BLANCK: Hi, this is Captain Heidi Blanck.  One of the things I’ll add to that, similar to the school aged youth where we use measures like the School Health Index to ensure that schools are making changes we have a tool called the NAP SAC which allows child care providers to make plans and changes.  So we are seeing progress among the 14 best practices that are happening in the child care arena.  I think research is under way right now to see if those changes in the environment are leading to changes in behavior but we don't have many published studies outside of the research area yet. 

TOM SKINNER: Mike that was Dr. Heidi Blanck, her last name is spelled b-l-a-n-c-k. 

OPERATOR: Thank you.  Our next question comes from Lena Sun with The Washington Post you may ask your question. 

LENA SUN: Hi, Tom.  My question has to do with the data.  If you look on the map, there are some of the states that have the highest obesity rates, their data is not included, Texas, Oklahoma, Louisiana, South Carolina.  Can you talk about how that might affect the overall picture and also why was there no data from them? 

TOM FRIEDEN:  I’ll turn it over to Dr. May for the second part of that question, but the fact is that the decreases are so widespread and consistent across the country that we're confident that they do represent a real impact but in terms of the details, let me turn it over to the programmer. 

ASHLEY MAY:  To answer your question there are ten states that are not included in the report that we're releasing today.  We excluded those states because they did not -- either they did not have consistent data between 2008 to 2011 to include in this analysis, or they changed their methodology during that time which may have influenced results, so there are ten states that are excluded, and to answer your second question regarding whether or not this would influence our results, even if those ten states all had increases, significant increases in obesity, we would have 13 states total with increasing obesity, whereas we have 19 with decreases, and in comparison to where we were a few years ago, in another analysis, another similar analysis, we found in that analysis that there were, I’m sorry, excuse me, 24 states increasing, so even if we take these ten states into account, 24 between 2003 to 2008 and potentially 13 in this analysis, we are still seeing progress. 

TOM SKINNER:  That was Dr. Ashley May.  Next question?  Shirley? 

OPERATOR: Thank you.  Our next question comes from Betsy McKay with The Wall Street Journal. You may ask your question. 

BETSY MCKAY: Hi, thanks.  I had a couple of questions and one I think has been already answered but I wondered since this is in a specific population, even though it's the most vulnerable population what are these findings then saying about what's going on in the broader population of children, you know in childhood obesity both childhood obesity overall and obesity of very young children, all very young children? And then the second question was there were some limiting factors in the two different populations in 2008 and 2011.  The size of the cohort was slightly larger and there were more African-American children if I get that right and I just wonder what, how that might have influenced some of these results if you could talk a little bit more about that.  Thanks. 

TOM FRIEDEN:  Sure.  I think first off, we have some other studies on broader populations, for example, school aged populations where we've seen decreases in a handful of jurisdictions.  This is the first -- this is the largest data system that exists nationally, so there's nothing else like this in terms of a relatively representative data system, but what we are seeing in various places is our decreases in broader population groups interestingly we seem to see the largest decreases in the younger kids, as you might expect.  So for example an MMWR, we published a while back, showed from New York City that there was a very substantial decrease in 5 and 6 years old in schools and this was with very large sample sizes in public schools and a decrease but less so in older aged groups, and from around the country, generally we have seen signs of decreases in broader population groups.  In terms of the representativeness of the sample, I kind of mentioned in the introductory remarks there has been an increase in number of kids who are covered by this program by a certain percentage but we don't think that increase accounts for the decrease we're seeing, even when we control for factors like race, ethnicity, we see the same decrease in the obesity rates.  So I think, I do believe these are real.  I would say there is a caveat, as I mentioned at the outset that the population has increased and may have changed somewhat, and that the decreases though real are really quite small, but given that rates have been increasing or at best flat for decades, we do think it's good news.  Maybe Dr. May or someone else would like to comment further on the sample size issue. 

ASHLEY MAY: And just to go back to what you previously mentioned we did control for age, race and sex in these analyses and then a secondary set of analyses, we also controlled for income for 34 states that had income data available to us and we did not find that that changed our results.  So we don't think that the changes that we're seeing in population are really affecting the declines that we're seeing.  We really think this is a true decline potentially. 

OPERATOR: Thank you our next question comes from Yasmeen Abuteableb with Reuters.  You may ask your question. 

YASMEEN ABUTEABLEB: Hi, thank you.  I was just wondering how you defined low income? 

TOM FRIEDEN:  Dr. May? 

ASHLEY MAY: To answer your question, for this sample all of the children or most of the children who are included in the Pediatric Nutrition Surveillance System are WIC participants, and so by that, they would be classified or considered low-income given the eligibility requirements for that program.  There also are children who participate in two other federal nutrition programs that are also based on low income classification and that's the Early Periodic Screening, Diagnosis, and Treatment Program as well as the Maternal and Child Health Bureau, Title V Program, so each of those programs has an income eligibility requirement. 

YASMEEN ABUTEABLEB:  Thank you. 

OPERATOR: Thank you.  Our next question comes from Sabrina Tavernise with New York Times, you may ask your question. 

SABRINA TAVERNISE: Hi, guys, I have two questions.  One is in those ten states that aren't reporting or we don't have information from, did we have information from them the last time you did this, and what were their directions?  And then also, there is some skepticism about, you know, the sort of government interventions in schools and -- sorry, a loud truck -- in schools and by municipalities and by states.  I mean is -- what do you say to the skeptics that say that a lot of these obesity interventions simply don't work? 

YASMEEN ABUTEABLEB:  So I’ll take the second question and ask Dr. May to take the first.  Obesity in kids has gotten worse over the past generation, far faster than anyone could have anticipated, and this has happened when there has been no change in our genetics, so it's clearly a result of changes in the environment, and it will be changed back by more changes in the environment.  And we think that sensible changes like increasing physical activity, decreasing the consumption of high-calorie, low-nutrition items, and basically getting calories into better balance can only help.  We're very encouraged by these findings not only because they're so widespread but because they are so consistent with what we're seeing from jurisdictions around the country that are beginning to see a turning of the tide.  Now I think the concept to get clear here is that we went from a low rate to a high rate to a little less high rate.  It's not that we're out of the woods but it is that we're going in the right direction really for the first time in a generation and that's encouraging, and though we cannot prove what are the changes in the environment and in policy that have led to that, it's hard to believe that things like much better policies in WIC, much better policies with encouraging child care, that I went through earlier, aren't having a big role here, and I think that's particularly likely because we see it in the younger kids who are more likely to be affected by those policies.  Dr. May, in terms of the ten states? 

ASHLEY MAY: We can provide those states to you after the call.  Mr. Skinner will share those states with you. 

TOM SKINNER:  Sabrina, we'll e-mail that information to you. 

OPERATOR: Thank you our next question comes from Ginna Roe with Cox Media Group.  You may ask your question. 

GINA ROE: Hi, my question is for Dr. Frieden.  Last week Pennsylvania Senator Bob Casey sent you a letter to investigate reports on the sixth case of Legionnaire's disease at the Pittsburgh VA.  I’m just wondering do you plan on reopening the investigation and why or why not? 

TOM SKINNER:  This is Tom Skinner.  You can follow up with our press office and we can provide follow-up information for you regarding that situation.  We're talking about this particular report today, so please, follow up with our press office.  Next question, please? 

OPERATOR: Thank you, our next question comes from Brad Balukjian with Los Angeles Times you may ask your question. 

BRAD BALUKJIAN: Hi, thanks for taking my question.  Quick question about the ten states again, you mentioned if those ten states were included that you would still have more states that show a decrease than shades that show an increase.  If you were to include those ten states' data, what about the overall trend, not breaking it down by states but just an overall sort of absolute numbers look at whether or not it's increasing or decreasing? 

TOM FRIEDEN: Let me just clarify before Dr. May answers, what we were saying earlier was that even if every one of those states had an increase, there's no reason to think that they would, we would still see more going in the right direction than the wrong direction.  Dr. May, other data about those ten? 

ASHLEY MAY: I guess the only other thing that I would add is that we didn't look at that overall trend for these data, so we can't, you know, answer that question specifically at this time. 

TOM FRIEDEN: Okay.  I would say this, from past data that we've looked at that was published previously and it is summarized in that overall graph, that does seem consistent nationally, not state by state, but nationally in terms of a decrease. 

BRAD BALUKJIAN: Okay, thank you. 

TOM SKINNER:  And we can send you that data and follow-up. 

BRAD BALUKJIAN: Thank you. 

OPERATOR: Thank you, at this time I’m showing no further questions. 

TOM FRIEDEN:  Okay, well, I want to thank everyone for joining us.  I'll just say a couple of closing remarks that what we're seeing is a data system that's unusual.  It's millions and millions of kids, and generally when you have that many kids in a data system, you can pick up small changes and you're not likely to have very large biases, so this is really the largest surveillance system we have to track childhood obesity, and really for the first time in a generation, we're seeing it go in the right direction in 2 to 4 years old and we're seeing that happen across the country, 19 states, only a couple of states, three states had very small increases.  So it's encouraging but we have a lot further to go.  We are seeing significant progress among young low-income kids, we’re moving in the right direction and that's to a large extent a reflection of how things like the Let’s Move program, like better policies in WIC, like increases in breastfeeding, like a better recognition of need that kids need to be active and that the energy needs to be in balance like reducing things like juices and increasing whole fruit, whole fruits and vegetables and physical activity, decreasing screen time.  So we hope this is the start of a continuing trend, getting us back into balance, and I want to thank everyone for your interest. 

TOM SKINNER:  Thank you, Dr. Frieden, thank you, Shirley, and thank you all for joining us.  Any follow-up questions about the report can be directed to the CDC press office at 404-639-3286.  Thanks, once again, for joining us. 

OPERATOR: Thank you, and this does conclude today's conference.  We thank you for your participation.  At this time you may disconnect your lines.  

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