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  • Overview
  • Obesity prevalence
  • Trends over time
  • Population breakdowns
  • Drivers
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Obesity prevalence

Adults, 2017-2018

Survey type:Measured
Age:18+
Sample size:5429
Area covered:National
References:Reanalysis of NHANES 2017/18 by Rachel Jackson Leach, Jaynaide Powis World Obesity Federation
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2015-2016

Survey type:Measured
Age:20+
Sample size:5406
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Notes:Weighted
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2013-2014

Survey type:Measured
Age:20+
Sample size:5455
Area covered:National
References:Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in Obesity Among Adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284-2291. doi:10.1001/jama.2016.6458.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2011-2012

Survey type:Measured
Age:20+
Sample size:5181
Area covered:National
References:Ruopeng An, “Prevalence and Trends of Adult Obesity in the US, 1999–2012”, ISRN Obesity, vol. 2014, Article ID 185132, 6 pages, 2014. doi:10.1155/2014/185132
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2009-2010

Survey type:Measured
Age:20+
Sample size:5926
Area covered:National
References:NHANES Survey - Published in Flegal KM, Carrolll MD, Kit BK, Ogden CL. Prevalence of Obesity and Trends in the Distribution of Body Mass Index Among US Adults, 1999-2010. JAMA Published online January 17, 2012. doi: 10.1001/jama.2012.39
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2007-2008

Survey type:Measured
Age:20+
Sample size:5555
Area covered:National
References:Flegal KM, Carroll MD, Ogden CL and Curtin LR. (2010). Prevalence and trends in obesity among US adults, 1999-2008. Journal of the American Medical Association, 303 (3): 235 - 241.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2003-2004

Survey type:Measured
Age:20+
Sample size:4431
Area covered:National
References:Ogden CL, Carroll MD, Curtin LR, McDowell MA,Tabak CJ, & Flegal KM. (2006). Prevalence of Overweight and Obesity in the United States, 1999-2004. The Journal of the American Medical Association, Vol 295(13):1549 - 1555.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2003

Survey type:Measured
Age:20+
References:Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555
Notes:1999-2000, 2001-2, 2003-4
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2001-2002

Survey type:Measured
Age:20+
References:Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2000

Survey type:Measured
Age:20+
References:Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555
Notes:1999-2000, 2001-2, 2003-4
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1999-2000

Survey type:Measured
Age:20-74
Sample size:3601
References:Centres for Disease Control and Prevention. http://www.cdc.gov/
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1999

Survey type:Measured
Age:20+
References:Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555
Notes:1999-2000, 2001-2, 2003-4
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1991

Survey type:Measured
Age:20-74
References:Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. International Journal of Obesity (1998);22:39-47
Notes:1971-74 (marked as 1973), 1988-94 marked as 1991
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1988-1994

Survey type:Measured
Age:20-74
References:Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. International Journal of Obesity (1998);22:39-47
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1976

Survey type:Measured
Age:20-74
References:Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. International Journal of Obesity (1998);22:39-47
Notes:1971-74 (marked as 1973), 1988-94 marked as 1991
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1973

Survey type:Measured
Age:20-74
References:Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. International Journal of Obesity (1998);22:39-47
Notes:1971-74 (marked as 1973), 1988-94 marked as 1991
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1971-1974

Survey type:Measured
Age:20-74
References:Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. International Journal of Obesity (1998);22:39-47
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1960-1962

Survey type:Measured
Age:20-74
References:Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. International Journal of Obesity (1998);22:39-47
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 1960

Survey type:Measured
Age:20-74
References:Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. International Journal of Obesity (1998);22:39-47
Notes:1971-74 (marked as 1973), 1988-94 marked as 1991
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Children, 2017-2018

Survey type:Measured
Age:5-17
Sample size:2086
Area covered:National
References:Reanalysis of NHANES 2017/18 by Rachel Jackson Leach, Jaynaide Powis World Obesity Federation
Cutoffs:IOTF

Children, 2015-2016

Survey type:Measured
Age:5-17
Sample size:2398
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Notes:Weighted
Cutoffs:IOTF

Children, 2013-2014

Survey type:Measured
Sample size:1927
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Notes:Sample size based on 5-9yrs, 13-17yrs IOTF International Cut off
Cutoffs:IOTF

Children, 2011-2012

Survey type:Measured
Age:6-11
Sample size:1268
Area covered:National
References:Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA (2014)26;311(8):806-14.
Notes:85th & 95th Centile CDC cut off
Cutoffs:CDC

Children, 2009-2010

Survey type:Measured
Age:5-17
Sample size:2435
Area covered:National
References:NHANES IASO analysis
Notes:IOTF cut off (monthly)
Cutoffs:IOTF

Children, 2003-2004

Survey type:Measured
Age:6-17
Sample size:2613
Area covered:National
References:Lobstein T, Jackson - Leach R. Child overweight and obesity in the USA: prevalence rates according to IOTF definitions. Int J Pediatr Obes. 2007;2(1):62-4.
Notes:IOTF Cut off. Reference: Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000 May 6;320(7244):1240-3.
Cutoffs:IOTF

Children, 2001-2002

Survey type:Measured
Age:6-11
Sample size:4258
References:Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555
Notes:Child Cut-Off: 85/95 Centile (see paper for further details)
Cutoffs:Other

Children, 1999-2000

Survey type:Measured
Age:6-11
Sample size:4018
References:Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555
Notes:Cut-off point: 85/95 Centile (see paper for further details)
Cutoffs:Other

Children, 1988-1994

Survey type:Measured
Age:6-17
Sample size:6108
References:Wang Y, Monteiro C, Popkin B. Trends of obesity and underweight in older children and adolescents in the United States, Brazil, China, and Russia. American Journal of Clinical Nutrition 2002;75:971-7
Notes:IOTF Cut off. Reference: Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000 May 6;320(7244):1240-3
Cutoffs:IOTF

Children, 1971-1974

Survey type:Measured
Age:6-17
Sample size:4471
References:Wang Y, Monteiro C, Popkin B. Trends of obesity and underweight in older children and adolescents in the United States, Brazil, China, and Russia. American Journal of Clinical Nutrition 2002;75:971-7
Notes:IOTF Cut off. Reference: Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: International survey. BMJ. 2000 May 6;320(7244):1240-3
Cutoffs:IOTF

Overweight/obesity by education

Men, 2017-2018

Survey type:Measured
Age:18+
Sample size:5350 (unweighted)
Area covered:National
References:NHANES 2017/18 Reanalysis by Rachel Jackson Leach, Jaynaide Powis, World Obesity Federation, March 2020
Notes:Weighted
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2017-2018

Survey type:Measured
Age:18+
Sample size:5350 (unweighted)
Area covered:National
References:NHANES 2017/18 Reanalysis by Rachel Jackson Leach, Jaynaide Powis, World Obesity Federation, March 2020
Notes:Weighted
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Men, 2015-2016

Survey type:Measured
Age:20+
Sample size:5202
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2015-2016

Survey type:Measured
Age:20+
Sample size:5202
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Men, 2013-2014

Survey type:Measured
Age:20+
Sample size:9055
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2013-2014

Survey type:Measured
Age:20+
Sample size:9055
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Men, 2007-2010

Survey type:Measured
Age:25+
Sample size:Large National Survey
Area covered:National
References:CDC/NCHS, National Health and Nutrition Examination Survey.
Notes:Age-adjusted estimates are adjusted using three age groups: 25-44 years, 45-64 years, and 65 years and over. GED is General Educational Development high school equivalency diploma.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2007-2010

Survey type:Measured
Age:25+
Sample size:Large National Survey
Area covered:National
References:CDC/NCHS, National Health and Nutrition Examination Survey.
Notes:Age-adjusted estimates are adjusted using three age groups: 25-44 years, 45-64 years, and 65 years and over. GED is General Educational Development high school equivalency diploma.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Boys, 2015-2016

Survey type:Measured
Age:5-17
Sample size:2315
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Notes:Weighted
Cutoffs:Other

Girls, 2015-2016

Survey type:Measured
Age:5-17
Sample size:2315
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Notes:Weighted
Cutoffs:Other

Boys, 2013-2014

Survey type:Measured
Age:5-9
Sample size:1883
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Notes:IOTF Cut off used 13-17yrs also available
Cutoffs:IOTF

Girls, 2013-2014

Survey type:Measured
Age:5-9
Sample size:1883
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Notes:IOTF Cut off used 13-17yrs also available
Cutoffs:IOTF

Boys, 2013-2014

Survey type:Measured
Age:13-17
Sample size:1883 (5-9rs & 13-17yrs)
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Notes:IOTF Cut off used 5-9yrs also available
Cutoffs:IOTF

Girls, 2013-2014

Survey type:Measured
Age:13-17
Sample size:1883 (5-9rs & 13-17yrs)
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Notes:IOTF Cut off used 5-9yrs also available
Cutoffs:IOTF

Boys, 2007-2010

Survey type:Measured
Age:2-19
Sample size:Large National Survey
Area covered:National
References:CDC/NCHS, National Health and Nutrition Examination Survey.
Notes:Obesity among children 2-19 years of age, by sex of child and education level of head of household. Obesity is body mass index (BMI) at or above the sex- and age-specific 95th percentile BMI cutoff points from the 2000 CDC Growth Charts. GED is General Educational Development high school equivalency diploma.
Cutoffs:CDC

Girls, 2007-2010

Survey type:Measured
Age:2-19
Sample size:Large National Survey
Area covered:National
References:CDC/NCHS, National Health and Nutrition Examination Survey.
Notes:Obesity among children 2-19 years of age, by sex of child and education level of head of household. Obesity is body mass index (BMI) at or above the sex- and age-specific 95th percentile BMI cutoff points from the 2000 CDC Growth Charts. GED is General Educational Development high school equivalency diploma.
Cutoffs:CDC

Overweight/obesity by age

Adults, 2017-2018

Survey type:Measured
Sample size:5432 (unweighted)
Area covered:National
References:NHANES 2017/18 Reanalysis by Rachel Jackson Leach, Jaynaide Powis, World Obesity Federation, March 2020
Notes:Weighted
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2015-2016

Survey type:Measured
Sample size:5406
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2011-2012

Survey type:Measured
Sample size:Large National Survey
Area covered:National
References:Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity among adults: United States, 2011–2012. NCHS data brief, no 131. Hyattsville, MD: National Center for Health Statistics. 2013
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2011-2014

Survey type:Measured
Sample size:Large National Survey
Area covered:National
References:Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS data brief, no 219. Hyattsville, MD: National Center for Health Statistics. 2015
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Children, 2017-2018

Survey type:Measured
Sample size:2086 (unweighted)
Area covered:National
References:NHANES 2017/18 Reanalysis by Rachel Jackson Leach, Jaynaide Powis, World Obesity Federation, March 2020
Notes:Weighted
Cutoffs:IOTF

Children, 2015-2016

Survey type:Measured
Sample size:2088
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Notes:Weighted
Cutoffs:IOTF

Children, 2011-2014

Survey type:Measured
Sample size:Large National Survey
Area covered:National
References:Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS data brief, no 219. Hyattsville, MD: National Center for Health Statistics. 2015
Notes:Obesity in children is defined as a BMI of greater than or equal to the age- and sex-specific 95th percentile of the 2000 CDC growth charts.
Cutoffs:CDC

Children, 2011-2012

Survey type:Measured
Sample size:3355
Area covered:National
References:CDC/NCHS, National Health and Nutrition Examination Survey.
Notes:Obesity is body mass index greater than or equal to the 95th percentile from the sex- and age-specific 2000 CDC Growth Charts.
Cutoffs:cdc

Overweight/obesity by region

Adults, 2014

Survey type:Self-reported
Age:18+
Area covered:National
References:Behavorial Risk Factor Surveillance System, CDC. Found at http://www.cdc.gov/obesity/data/prevalence-maps.html (last accessed 20th April 2016)
Notes:NOT NHANES States N-Z (inclusive)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Adults, 2014

Survey type:Self-reported
Age:18+
Area covered:National
References:Behavorial Risk Factor Surveillance System, CDC. Found at http://www.cdc.gov/obesity/data/prevalence-maps.html (last accessed 20th April 2016)
Notes:NOT NHANES States A - M (inclusive)
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Boys, 1999-2006

Survey type:Measured
Age:2-19
Sample size:15479
Area covered:National
References:Liu J, Jones SJ, Sun H, et al. Diet, physical activity, and sedentary behaviors as risk factors for childhood obesity: An urban and rural comparison. Child Obes 2012;8:440–448
Notes:Children were considered overweight and obese if their body mass index (BMI) was at or above the 85th percentile for age and gender according to growth charts from the National Center for Health Statistics (NCHS).
Cutoffs:Other

Girls, 1999-2006

Survey type:Measured
Age:2-19
Sample size:15479
Area covered:National
References:Liu J, Jones SJ, Sun H, et al. Diet, physical activity, and sedentary behaviors as risk factors for childhood obesity: An urban and rural comparison. Child Obes 2012;8:440–448
Notes:Children were considered overweight and obese if their body mass index (BMI) was at or above the 85th percentile for age and gender according to growth charts from the National Center for Health Statistics (NCHS).
Cutoffs:Other

Overweight/obesity by socio-economic group

Men, 2017-2018

Survey type:Measured
Age:18+
Sample size:4638 (unweighted)
Area covered:National
References:NHANES 2017/18 Reanalysis by Rachel Jackson Leach, Jaynaide Powis, World Obesity Federation, March 2020
Notes:Weighted
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2017-2018

Survey type:Measured
Age:18+
Sample size:4638 (unweighted)
Area covered:National
References:NHANES 2017/18 Reanalysis by Rachel Jackson Leach, Jaynaide Powis, World Obesity Federation, March 2020
Notes:Weighted
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Men, 2015-2016

Survey type:Measured
Age:20+
Sample size:4904
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2015-2016

Survey type:Measured
Age:20+
Sample size:4904
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Men, 2013-2014

Survey type:Measured
Age:20-80
Sample size:9055
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Notes:Total Household earnings per annum
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2013-2014

Survey type:Measured
Age:20-80
Sample size:9055
Area covered:National
References:Data from NHANES 2013/14. Data reanalysed by Danielle Sharfman (University of Wisconsin-Madison), Rachel Jackson Leach on behalf of the World Obesity Federation
Notes:Total Household earnings per annum
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Men, 2005-2008

Survey type:Measured
Age:20+
Sample size:Large National Survey
Area covered:National
References:Ogden CL, Lamb MM, Carroll MD, Flegal KM. Obesity and socioeconomic status in adults: United States 1988–1994 and 2005–2008. NCHS data brief no 50. Hyattsville, MD: National Center for Health Statistics. 2010
Notes:Poverty income ratio (PIR): The ratio of household income to the poverty threshold after accounting for inflation and family size. In 2008, a PIR of 350% was equivalent to approximately $77,000 for a family of four; a PIR of 130% was equivalent to approximately $29,000 for a family of four.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Women, 2005-2008

Survey type:Measured
Age:20+
Sample size:Large National Survey
Area covered:National
References:Ogden CL, Lamb MM, Carroll MD, Flegal KM. Obesity and socioeconomic status in adults: United States 1988–1994 and 2005–2008. NCHS data brief no 50. Hyattsville, MD: National Center for Health Statistics. 2010
Notes:Poverty income ratio (PIR): The ratio of household income to the poverty threshold after accounting for inflation and family size. In 2008, a PIR of 350% was equivalent to approximately $77,000 for a family of four; a PIR of 130% was equivalent to approximately $29,000 for a family of four.
Unless otherwise noted, overweight refers to a BMI between 25kg and 29.9kg/m², obesity refers to a BMI greater than 30kg/m².

Boys, 2017-2018

Survey type:Measured
Age:5-17
Sample size:1852 (unweighted)
Area covered:National
References:NHANES 2017/18 Reanalysis by Rachel Jackson Leach, Jaynaide Powis, World Obesity Federation, March 2020
Notes:Weighted
Cutoffs:IOTF

Girls, 2017-2018

Survey type:Measured
Age:5-17
Sample size:1852 (unweighted)
Area covered:National
References:NHANES 2017/18 Reanalysis by Rachel Jackson Leach, Jaynaide Powis, World Obesity Federation, March 2020
Notes:Weighted
Cutoffs:IOTF

Boys, 2015-2016

Survey type:Measured
Age:5-17
Sample size:2208
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Cutoffs:IOTF

Girls, 2015-2016

Survey type:Measured
Age:5-17
Sample size:2208
Area covered:National
References:NHANES 2015/16. Analysis conducted by the World Obesity Federation, Caroline Litts, Fiona Montague & R Jackson-Leach 2017
Cutoffs:IOTF

Boys, 2005-2008

Survey type:Measured
Age:2-19
Sample size:Large National Survey
Area covered:National
References:Ogden CL, Lamb MM, Carroll MD, Flegal, KM. Obesity and socioeconomic status in children: United States 1988-1994 and 2005-2008. NCHS data brief no 51. Hyattsville, MD: National Center for Health Statistics. 2010
Notes:Obesity defined as Body mass index (BMI) ≥ age- and sex-specific 95th percentile of the 2000 CDC growth charts. Poverty income ratio (PIR): In 2008, a PIR of 350% was equivalent to approximately $77,000 for a family of four; a PIR of 130% was equivalent to approximately $29,000 for a family of four.
Cutoffs:CDC

Girls, 2005-2008

Survey type:Measured
Age:2-19
Sample size:Large National Survey
Area covered:National
References:Ogden CL, Lamb MM, Carroll MD, Flegal, KM. Obesity and socioeconomic status in children: United States 1988-1994 and 2005-2008. NCHS data brief no 51. Hyattsville, MD: National Center for Health Statistics. 2010
Notes:Obesity defined as Body mass index (BMI) ≥ age- and sex-specific 95th percentile of the 2000 CDC growth charts. Poverty income ratio (PIR): In 2008, a PIR of 350% was equivalent to approximately $77,000 for a family of four; a PIR of 130% was equivalent to approximately $29,000 for a family of four.
Cutoffs:CDC

Insufficient physical activity

Adults, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Men, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Women, 2016

References:Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet 2018 http://dx.doi.org/10.1016/S2214-109X(18)30357-7

Children, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Boys, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Girls, 2010

Age:11-17
References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A893?lang=en
Notes:% of school going adolescents not meeting WHO recommendations on Physical Activity for Health, i.e. doing less than 60 minutes of moderate- to vigorous-intensity physical activity daily.
Definitions:% Adolescents insufficiently active (age standardised estimate)

Estimated per-capita fruit intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita fruit intake (g/day)

Estimated per-capita processed meat intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita processed meat intake (g per day)

Estimated per-capita whole grains intake

Adults, 2017

Survey type:Measured
Age:25+
References:Global Burden of Disease, the Institute for Health Metrics and Evaluation http://ghdx.healthdata.org/
Definitions:Estimated per-capita whole grains intake (g/day)

Mental health - depression disorders

Adults, 2015

References:Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
Definitions:% of population with depression disorders

Mental health - anxiety disorders

Adults, 2015

References:Prevalence data from Global Burden of Disease study 2015 (http://ghdx.healthdata.org) published in: Depression and Other Common Mental Disorders: Global Health Estimates. Geneva:World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
Definitions:% of population with anxiety disorders

Oesophageal cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, oesophagus, adults ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, oesophagus, adults ages 20+. ASR (World) per 100,000

Breast cancer

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, breast, females, ages 20+. ASR (World) per 100,000

Colorectal cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, colorectum, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, colorectum, adults, ages 20+. ASR (World) per 100,000

Pancreatic cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, pancreas, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, pancreas, adults, ages 20+. ASR (World) per 100,000

Gallbladder cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, gallbladder, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, gallbladder, adults, ages 20+. ASR (World) per 100,000

Kidney cancer

Men, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, kidney, adults, ages 20+. ASR (World) per 100,000

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, kidney, adults, ages 20+. ASR (World) per 100,000

Cancer of the uterus

Women, 2018

Age:20+
References:Global Cancer Observatory, Cancer incidence rates http://gco.iarc.fr/ (last accessed 30th June 2020)
Definitions:Estimated age-standardized incidence rates (World) in 2018, cervix uteri, females, ages 20+. ASR (World) per 100,000

Raised blood pressure

Adults, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Men, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Women, 2015

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A875?lang=en
Definitions:Age Standardised estimated % Raised blood pressure 2015 (SBP>=140 OR DBP>=90).

Raised cholesterol

Adults, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Men, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Women, 2008

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A885
Definitions:% Raised total cholesterol (>= 5.0 mmol/L) (age-standardized estimate).

Raised fasting blood glucose

Men, 2014-2019

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A869?lang=en
Definitions:Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication).

Women, 2014-2019

References:Global Health Observatory data repository, World Health Organisation, http://apps.who.int/gho/data/node.main.A869?lang=en
Definitions:Age Standardised % raised fasting blood glucose (>= 7.0 mmol/L or on medication).

Diabetes prevalence

Adults, 2017

References:Reproduced with kind permission of IDF, International Diabetes Federation. IDF Diabetes Atlas, 8th edition. Brussels, Belgium: International Diabetes Federation, 2017. http://www.diabetesatlas.org
Definitions:Diabetes age-adjusted comparative prevalence (%).

Health systems

Economic classification: High Income

Health systems summary

Healthcare coverage in the USA is fragmented, with several public and private sources. Public coverage provided by the government include Medicare, a federal program for the disabled and adults over 64, and Medicaid, a means-tested insurance programme that provides free or low-cost care to those who do not have insurance through their employers or cannot afford insurance through the private market. There is also publicly provided military coverage. Publicly financed care is typically funded by a combination of taxation, premiums, federal revenues and co-payments. On the other hand, private sources of health coverage, which include employer-provided health insurance and private insurance, are funded by employers, employees and private spending.

Efforts have been made since the 2010 Affordable Care Act to reduce the number of underinsured and uninsured Americans. There is evidence that the expansion of Medicaid under the Act reduced the percentage of the population uninsured from 16% to 8% and has improved financial risk protection for the low-income population. The USA is an outlier among large, rich countries by not having universal healthcare.

Indicators

Where is the country’s government in the journey towards defining ‘Obesity as a disease’?Some progress
Where is the country’s healthcare provider in the journey towards defining ‘Obesity as a disease’?Some progress
Is there specialist training available dedicated to the training of health professionals to prevent, diagnose, treat and manage obesity?Yes
Have any taxes or subsidies been put in place to protect/assist/inform the population around obesity?Yes
Are there adequate numbers of trained health professionals in specialties relevant to obesity in urban areas?No
Are there adequate numbers of trained health professionals in specialties relevant to obesity in rural areas?No
Are there any obesity-specific recommendations or guidelines published for adults?Yes
Are there any obesity-specific recommendations or guidelines published for children?Yes
In practice, how is obesity treatment largely funded?Out of pocket

Perceived barriers to treatment

  • Lack of training for healthcare professionals
  • Stigma
  • High cost of out of pocket payments
  • Failure to recognise or accept all available treatment options
  • Lack of financial investment and lack of coverage
  • Healthcare professionals disinterested in obesity training and treatment
  • Poor adherence to or fear of treatment
  • Obesity not recognised as a disease

Summary of stakeholder feedback

Stakeholders felt that obesity was not yet recognised as a disease, both at a government and a health provider level. It was recognised that there has been some progress - with the American Medical Association and numerous groups and government agencies recognising obesity as a disease - but not enough. There are still some state governments and insurers who explicitly consider obesity to not be a disease and it was noted that obesity is certainly not yet treated in the same way as other chronic diseases such as diabetes and cancer.

Those living with obesity reportedly present to the system in primary care, but only when they have comorbidities. Despite this, stakeholders noted that obesity is rarely managed in primary care due to a lack of provider knowledge and poor reimbursement of treatment options. Instead, obesity medicine specialists were said to increasingly be the main source of care for people with obesity, a practice that is unsustainable. Stakeholders felt that people tended to leave the system because of lack of specialist referral and poor follow-up.

Once in the system, the type of treatment available to patients is highly dependent on type of health coverage the individual has and the state they live in. This results in great inequality and inequity in the accessibility of treatment. Medicare covers surgery if BMI criteria is met, but what Medicaid covers varies across states. Pharmacotherapy was said to be poorly covered across the board. As a result, many pay out of pocket for treatment across the country.

There are many guidelines and recommendations for treatment of obesity in adults and children. Examples include recommendations/guidelines from the U.S. Preventive Services Task Force, the American Association of Clinical Endocrinologists, and The Obesity Society. One stakeholder highlighted that the issue was not a lack of guidelines, but how existing guidelines could be met. Stakeholders felt that healthcare practitioners were generally not appropriately trained to manage people with obesity, with there being inadequate numbers of trained professionals in both urban and rural areas. There is training available through the America Board of Obesity Medicine, it was said that many have to self-fund. There is another certification by the Academy of Nutrition and Dietetics for dietitians and other integrated health professionals.

Based on interviews/survey returns from 8 stakeholders

Last updated: June 2020

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VA/DoD Clinical Practice Guideline for Screening and Management of Overweight and Obesity

Clinical Practice Guideline that gives recommendations for the management of adult overweight and obesity in the Department of Defense and Veteran Affairs Health Care systems.

Categories:Evidence of Management/treatment guidelines
Year(s):2020 (ongoing)
Target age group:Adults
Organisation:Department of Veteran Affairs, Department of Defense
Find out more:www.healthquality.va.gov
Linked document:Download linked document
References:VA/DoD Clinical Practice Guideline for Screening and Management of Overweight and Obesity, Department of Veteran Affairs, Department of Defense, Version 3.0. 2020.

Move Your Way Campaign

Move Your Way is the promotional campaign for the second edition of the Physical Activity Guidelines for Americans. The goal is to help people live healthier lives through increased physical activity.

Categories:Evidence of Physical Activity Guidelines/Policy
Evidence of Community Interventions/Campaign
Year(s):2019 (ongoing)
Target age group:Adults and children
Organisation:U.S. Department of Health and Human Services
Find out more:health.gov
References:https://health.gov/moveyourway

Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults US Preventive Services Task Force Recommendation Statement

The USPSTF reviewed the evidence on interventions (behavioral and pharmacotherapy) for weight loss or weight loss maintenance that can be provided in or referred from a primary care setting. Surgical weight loss interventions and nonsurgical weight loss devices (eg, gastric balloons) are considered to be outside the scope of the primary care setting.

Categories:Evidence of Management/treatment guidelines
Year(s):2018 (ongoing)
Target age group:Adults
Organisation:US Preventive Services Task Force
Find out more:www.uspreventiveservicestaskforce.org
Linked document:Download linked document
References:Curry, S.J., Krist, A.H., Owens, D.K., Barry, M.J., Caughey, A.B., Davidson, K.W., Doubeni, C.A., Epling, J.W., Grossman, D.C., Kemper, A.R. and Kubik, M., 2018. Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US Preventive Services Task Force recommendation statement. Jama, 320(11), pp.1163-1171.

City of Seattle - Sugar Sweetened beverage tax

Tax on sugar sweetened beverages and beverages with added sweeteners.

Categories:Taxation/Subsidies on Food or Beverages or law relating to public health
Year(s):2018 (ongoing)
Target age group:Adults and children
Organisation:Seattle city council
Find out more:www.seattle.gov
Linked document:Download linked document
References:Seattle City Council. Legistlative summary. Available from: https://www.seattle.gov/license-and-tax-administration/business-license-tax/other-seattle-taxes/sweetened-beverage-tax [Last accessed 09.09.20]

Physical Activity Guidelines for Americans

The Physical Activity Guidelines for Americans provides evidence-based guidance to help Americans maintain or improve their health through physical activity. These are the 2nd edition of these guidelines.

Categories:Evidence of Physical Activity Guidelines/Policy
Year(s):2018 (ongoing)
Target age group:Adults and children
Organisation:U.S. Department of Health and Human Services
Find out more:health.gov
Linked document:Download linked document
References:U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Human Services; 2018.

San Francisco - Sugar Sweetened beverage tax

Effective January 1, 2018, there has been a general excise tax on Bottled Sugar-Sweetened Beverage, Syrup, or Powder in the City.

Categories:Taxation/Subsidies on Food or Beverages or law relating to public health
Year(s):2018 (ongoing)
Target age group:Adults and children
Organisation:City and Country of San Francisco
Find out more:sftreasurer.org
Linked document:Download linked document
References:City and County of San Francisco. https://sftreasurer.org/business/taxes-fees/sugary-drinks-tax#:~:text=The%20City%20imposes%20a%20one,beverages%2C%20syrups%2C%20and%20powders. [Last Accessed 09.09.20]

Assessment, Treatment, and Prevention of pediatric obesity: An Endocrine Society Clinical Practice Guideline

Recommendations on diagnosis, prevention, and treatment of obesity in children.

Categories:Evidence of Management/treatment guidelines
Year(s):2017 (ongoing)
Target age group:Children
Organisation:Styne, D.M, Arslanian, S.A, Connor, E.L, Farooqi, I.S, Murad, M.H, Silverstein, J.H, and Yanovski, J.A.
Find out more:academic.oup.com
References:Styne, D.M, Arslanian, S.A, Connor, E.L, Farooqi, I.S, Murad, M.H, Silverstein, J.H, and Yanovski, J.A. 2017. Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical endocrinology and metabolism. 102 (3). pp. 709–757

Boulder, Colorado - Sugar Sweetened beverage tax

Excise tax requiring distributors of sugar-sweetened beverages to pay a tax applied to the drinks they distribute within the City of Boulder. This applies to drinks containing at least 5 grams of added caloric sweeteners (such as sugar and high-fructose corn syrup) per 12 fluid ounces. This includes soda, energy drinks and heavily pre-sweetened tea and the syrups and powders used to produce them.

Categories:Taxation/Subsidies on Food or Beverages or law relating to public health
Year(s):2017 (ongoing)
Target age group:Adults and children
Organisation:City of Boulder Colorado
Find out more:bouldercolorado.gov
Linked document:Download linked document
References:City of Boulder Colorado. Sugar Sweetened Beverage tax. Available from: https://www-static.bouldercolorado.gov/docs/Chapter_16_SSB_Tax_-_final_form-1-201706231802.pdf?_ga=2.207604755.1404175956.1544784563-1014986894.1544784563. [Accessed 14 December 2018].

Philidelphia - Sugar Sweetened beverage tax

Tax applied to any non-alcoholic beverage, syrup, or other concentrate used to prepare a beverage that lists as an ingredient any form of caloric sugar-based sweetener, including, but not limited to sucrose, glucose, or high fructose corn syrup.

Categories:Taxation/Subsidies on Food or Beverages or law relating to public health
Year(s):2017 (ongoing)
Target age group:Adults and children
Organisation:City of Philadelphia
Find out more:www.phila.gov
Linked document:Download linked document
References:City of Philidelphia (2017). CHAPTER 19-4100. SUGAR-SWEETENED BEVERAGE TAX. Available from: https://www.phila.gov/media/20170209150802/CertifiedCopy16017601-1.pdf. [Accessed 14 December 2018].

Policy statement: Stigma Experienced by Children and Adolescents With Obesity

This policy statement discusses the prevalence andnegative effects of weight stigma on pediatric patients and their families. The statement provides 6 clinical practice and 4 advocacy recommendations regarding the role of pediatricians in addressing weight stigma. Recommendations include improving the clinical setting by modeling best practices for nonbiased behaviors and language; using empathetic and empowering counseling techniques, such as motivational interviewing, and addressing weight stigma and bullying in the clinic visit; advocating for inclusion of training and education about weight stigma in medical schools, residency programs, and continuing medical education programs; and empowering families to be advocates to address weight stigma in the home environment and school setting.

Categories:Evidence of Management/treatment guidelines
Year(s):2017 (ongoing)
Target age group:Children
Organisation:Pont, S.J, Puhl, R, Cook, S.R, Slusser, W SECTION ON OBESITY, THE OBESITY SOCIETY
Find out more:pediatrics.aappublications.org
Linked document:Download linked document
References:Pont, S.J, Puhl, R, Cook, S.R, Slusser, W SECTION ON OBESITY, THE OBESITY SOCIETY. 2017. Stigma Experienced by Children and Adolescents With Obesity. American academy of pediatrics. 140(6). DOI: e20173034.

Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement.

An update of the 2010 US Preventive Services Task Force (USPSTF) recommendation on screening for obesity in children 6 years and older.

Categories:Evidence of Management/treatment guidelines
Year(s):2017 (ongoing)
Target age group:Children
Organisation:US Preventive Services Task Force (USPSTF)
Find out more:www.ncbi.nlm.nih.gov
Linked document:Download linked document
References:US Preventive Services Task Force, Grossman DC, Bibbins-Domingo K, Curry SJ, Barry MJ, Davidson KW, Doubeni CA, Epling JW Jr, Kemper AR, Krist AH, Kurth AE, Landefeld CS, Mangione CM, Phipps MG, Silverstein M, Simon MA, Tseng CW. Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 317(23). pp. 2417-2426.

Albanu - Sugar Sweetened beverage tax

City of Albany Ordinance 2016-02 enacts a one cent per ounce general tax, with no expiration date, on the distribution of sugar-sweetened beverages and sweeteners used to sweeten such drinks. The following are exempt: Sweeteners typically used by consumers and distributed to grocery stores; Drinks and sweeteners distributed to small retailers;Milk products, 100% juice, baby formula, alcohol, or drinks taken for medical reasons.

Categories:Taxation/Subsidies on Food or Beverages or law relating to public health
Year(s):2016 (ongoing)
Target age group:Adults and children
Organisation:City of Albany
Find out more:www.albanyca.org
Linked document:Download linked document
References:City of Albany. https://www.albanyca.org/departments/finance/sugar-sweetened-beverage-tax#:~:text=The%20measure%20approves%20City%20of,sweeten%20such%20drinks%2C%20but%20exempting%3A&text=Milk%20products%2C%20100%25%20juice%2C,drinks%20taken%20for%20medical%20reasons. [Last accessed 09.09.20]

Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity

These AACE/ACE evidence-based clinical practice guidelines address key aspects of obesity care: screening, diagnosis, clinical evaluation, treatment options, therapy selection, and treatment goal.

Categories:Evidence of Management/treatment guidelines
Year(s):2016 (ongoing)
Target age group:Adults
Organisation:American Association of Clinical Endocrinologists
Find out more:www.aace.com
Linked document:Download linked document
References:W. Timothy Garvey, Jeffrey I. Mechanick, Elise M. Brett, Alan J. Garber, Daniel L. Hurley, Ania M. Jastreboff, Karl Nadolsky, Rachel Pessah-Pollack, Raymond Plodkowski, and Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines (2016) AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY COMPREHENSIVE CLINICAL PRACTICE GUIDELINES FOR MEDICAL CARE OF PATIENTS WITH OBESITY. Endocrine Practice: July 2016, Vol. 22, No. Supplement 3, pp. 1-203.

National Physical Activity Plan

The Plan is a comprehensive set of policies, programs, and initiatives designed to increase physical activity in all segments of the U.S. population. The Plan aims to foster a national culture that supports physically active lifestyles. Its ultimate purpose is to improve health, prevent disease and disability, and enhance quality of life.

Categories:Evidence of Physical Activity Guidelines/Policy
Year(s):2016 (ongoing)
Target age group:Adults and children
Organisation:National Physical Activity Plan Alliance
Find out more:www.physicalactivityplan.org
Linked document:Download linked document

Oakland - Sugar Sweetened beverage tax

General Tax of one cent ($0.01) per fluid ounce on the privilege of Distributing Sugar-Sweetened Beverage Products in the City of Oakland

Categories:Taxation/Subsidies on Food or Beverages or law relating to public health
Year(s):2016 (ongoing)
Target age group:Adults and children
Organisation:City of Oakland
Linked document:Download linked document
References:City of Oakland. https://library.municode.com/ca/oakland/codes/code_of_ordinances?nodeId=TIT4REFI_CH4.52SUEEBEDITA_4.52.010SHTI [Last Accessed 09.09.20]

2015-2020 Edition of the Dietary Guidelines for Americans

The Dietary Guidelines is designed for professionals to help all individuals ages 2 years and older and their families consume a healthy, nutritionally adequate diet.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2015-2020
Target age group:Adults and children
Organisation:U.S. Department of Agriculture and the U.S. Department of Health and Human Services
Find out more:health.gov
Linked document:Download linked document
References:U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/

Berkley, California - Sugar Sweetened beverage tax

The purpose of this Ordinance is to diminish the human and economic costs of diseases associated with the consumption of sugary drinks by discouraging their distribution and consumption in Berkeley through a tax. Specifically, the purpose of this ordinance is to levy an Excise Tax of one cent ($0.01) per fluid ounce on the distribution of sugar-sweetened beverage products in the City

Categories:Taxation/Subsidies on Food or Beverages or law relating to public health
Year(s):2015 (ongoing)
Target age group:Adults and children
Organisation:City of Berkley
Find out more:www.healthyberkeley.com
Linked document:Download linked document

Navajo Nation - Junk food tax

The Junk Food Tax applies to the sale of junk food when the transfer of ownership and/or risk of loss occur within the Navajo Nation. “Junk food” means ‘minimal-to-no nutritional value food” as defined by the Junk Food Statute, it includes: sugar-sweetened beverages, pre-packaged and non-pre-packaged snacks stripped of essential nutrients and high in salt, saturated fat and sugar including sweets, chips and crisps. The tax has been effective since April 1, 2015, at a rate of 2%.

Categories:Taxation/Subsidies on Food or Beverages or law relating to public health
Year(s):2015 (ongoing)
Target age group:Adults and children
Organisation:Navajo Nation Council
Linked document:Download linked document

Pharmacological management of obesity: an endocrine Society clinical practice guideline

Clinical practice guidelines for the pharmacological management of obesity.

Categories:Evidence of Management/treatment guidelines
Year(s):2015 (ongoing)
Target age group:Adults and children
Organisation:Apovian C.M, Aronne L.J, Bessesen D.H, McDonnell M.E, Murad M.H, Pagotto U, Ryan D.H, Still C.D; Endocrine Society.
Find out more:www.ncbi.nlm.nih.gov
References:Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Pagotto U, Ryan DH, Still CD; Endocrine Society. Pharmacological management of obesity: an endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015 Feb;100(2):342-62. doi: 10.1210/jc.2014-3415. Epub 2015 Jan 15. Erratum in: J Clin Endocrinol Metab. 2015 May;100(5):2135-6. PMID: 25590212.

The New York City Health Code

Article 81 of the New York City Health Code (addition of section 81.49) states that chain restaurants must put a warning label on menus and menu boards (a salt-shaker symbol) when dishes contain 2,300mg of sodium or more. It came into effect on 1 December 2015 and applies to food service establishments with 15 or more locations nationwide.

Categories:Labelling Regulation/Guidelines
Year(s):2015 (ongoing)
Target age group:Adults and children
Organisation:City of New York
Find out more:www1.nyc.gov
Linked document:Download linked document
References:City of New York. https://www1.nyc.gov/site/doh/about/about-doh/health-code-and-rules.page [Last Accessed 09.09.20]

Choose Health LA

Choose Health LA is a local initiative of the Los Angeles County Department of Public Health to prevent and control chronic disease in Los Angeles County. It aims to improve nutrition, increasing physical activity and reduce obesity in LA County.

Categories:Evidence of Community Interventions/Campaign
Year(s):2014 (ongoing)
Target age group:Adults and children
Organisation:Los Angeles County Department of Public Health
Find out more:www.choosehealthla.com

Menu Labeling Requirements

Menu labeling requirements that apply to restaurants and similar retail food establishments that are part of a chain with 20 or more locations. Covered establishments must disclose the number of calories contained in standard items on menus and menu boards. For self-service foods and foods on display, calories must be listed in close proximity and clearly associated with the standard menu item.

Categories:Labelling Regulation/Guidelines
Year(s):2014 (ongoing)
Target age group:Adults
Organisation:Food and Drug Administration
Find out more:www.fda.gov
Linked document:Download linked document

Plan of Action for the Prevention of Obesity in Children and Adolescents

This is a 5 year plan of action that calls for the implementation of fiscal policies such as taxes on sugar-sweetened beverages, regulation of food marketing and labelling, improvement of school nutrition and physical activity environments and promotion of breast-feeding and healthy eating across the Pan American region.

Categories:Transnational Obesity Strategies/Policy or Action Plan
Year(s):2014-2019
Target age group:Adults and children
Organisation:Pan America Health Organisation (PAHO)
Find out more:www.paho.org
Linked document:Download linked document

Eat Smart Move More

Eat Smart, Move More' North Carolina is a statewide movement that promotes increased opportunities for healthy eating and physical activity wherever people live, learn, earn, play and pray. The work includes North Carolina’s Plan to Address Overweight and Obesity, which is a guide of evidence-informed or evidence-based strategies for anyone working in the area of overweight and obesity prevention.

Categories:Evidence of National Obesity Strategy/Policy or Action
Evidence of Community Interventions/Campaign
Year(s):2013 (ongoing)
Target age group:Adults and children
Organisation:North Carolina Division of Public Health
Find out more:www.eatsmartmovemorenc.com

Guideline for the Management of Overweight and Obesity in Adults

Clinical practice guidelines for assessment of cardiovascular risk, lifestyle modifications to reduce cardiovascular risk, management of blood cholesterol in adults, and management of overweight and obesity in adults.

Categories:Evidence of Management/treatment guidelines
Year(s):2013 (ongoing)
Target age group:Adults
Organisation:American College of Cardiology (ACC), American Heart Association (AHA), The Obesity Society (TOS)
Find out more:www.ncbi.nlm.nih.gov
Linked document:Download linked document
References:Jensen, M.D, et al. 2014. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. HHS Author Manuscripts. 129(25 Suppl 2): S102–S138.

Institute for Clinical Systems Improvement: Prevention and Management of Obesity for Adults, 2013

Guidelines on the prevention and management of obesity in adults.

Categories:Evidence of Management/treatment guidelines
Year(s):2013 (ongoing)
Target age group:Adults
Organisation:Fitch A, Everling L, Fox C, Goldberg J, Heim C, Johnson K, Kaufman T, Kennedy E, Kestenbaun C, Lano_x000D__x000D_ M, Leslie D, Newell T, O’Connor P, Slusarek B, Spaniol A, Stovitz S, Webb B.
Find out more:www.healthpartners.com
Linked document:Download linked document
References:Fitch A, Everling L, Fox C, Goldberg J, Heim C, Johnson K, Kaufman T, Kennedy E, Kestenbaun C, Lano M, Leslie D, Newell T, O’Connor P, Slusarek B, Spaniol A, Stovitz S, Webb B. Institute for Clinical Systems Improvement. Prevention and Management of Obesity for Adults. Updated May 2013. Available from: https://www.healthpartners.com/ucm/groups/public/@hp/@public/documents/documents/cntrb_037112.pdf. [Accessed 7th January 2019].

Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies

Guidance for public health professionals and others on how to select strategies to support breastfeeding mothers and increase breastfeeding rates.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2013 (ongoing)
Target age group:Adults and children
Organisation:Centers for Disease Control and Prevention.
Find out more:www.usbreastfeeding.org
Linked document:Download linked document
References:Centers for Disease Control and Prevention. 2013. Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies. Atlanta: U.S. Department of Health and Human Services; 2013. Available from: https://www.cdc.gov/breastfeeding/pdf/BF-Guide-508.PDF. [Accessed 7th January 2019].

Fit NOLA

Since 2012, the Fit NOLA partnership has been committed to ensuring that all New Orleanians have access to community resources that promote nutritional foods and physical activity. The ultimate goal of the initiative is to increase physical activity and healthier eating.

Categories:Evidence of Community Interventions/Campaign
Year(s):2012 (ongoing)
Target age group:Adults and children
Organisation:City of New Orleans Health Department and local organisations
Find out more:www.nola.gov
Linked document:Download linked document

Food Fit Philly

Food Fit Philly is part of Get Healthy Philly, the Division of Chronic Disease and Injury Prevention for the Philadelphia Department of Public Health. Get Healthy Philly's goal is to make healthy choices easier by 1) Ensuring that all Philadelphians have access to healthy and affordable food. 2) Reducing the consumption and marketing of sugary drinks and junk foods among children and adults. 3) Creating safe spaces for physical activity in communities, including walking and cycling.

Categories:Evidence of Community Interventions/Campaign
Year(s):2012 (ongoing)
Target age group:Adults and children
Organisation:Philadelphia Department of Public Health
Find out more:www.foodfitphilly.org

Strong4Life

Strong4Life is a wellness movement designed to ignite societal change and reverse the epidemic of childhood obesity and its associated diseases in Georgia. Strong4Life reaches families through public awareness, policy change efforts, school programs, healthcare provider programs, and community partnerships.

Categories:Evidence of Community Interventions/Campaign
Year(s):2012 (ongoing)
Target age group:Children
Organisation:Children's Healthcare of Atlanta
Find out more:www.strong4life.com

Food Hero

Food Hero's mission is to help low-income Oregonians improve their health through the increased consumption of fruits and vegetables. Food Hero helps families budget for, plan, and createcountless healthy, super tasty meals.

Categories:Evidence of Community Interventions/Campaign
Year(s):2011 (ongoing)
Target age group:Adults and children
Organisation:Oregon State University
Find out more:www.foodhero.org

Food Literacy Center

The Food Literacy Center is a non-profit organisation based in the Sacramento area. It aims to teach low-income elementary children cooking and nutrition to improve their health, environment and economy.

Categories:Evidence of Community Interventions/Campaign
Year(s):2011 (ongoing)
Target age group:Children
Organisation:Food Literacy Center
Find out more:www.foodliteracycenter.org

Hawaii 5210 "Let's Go!"

Hawaii 5210 "Let's Go!" is an initiative to promote healthy eating and active living and prevent childhood obesity in Hawaii through a coordinated, collaborative, locally relevant health education campaign.

Categories:Evidence of Community Interventions/Campaign
Year(s):2011 (ongoing)
Target age group:Children
Organisation:Hawaii Initiative for Childhood Obesity Research and Education
Find out more:www.hawaii5210.com

National Prevention Strategy

The National Prevention Strategy’s vision is Working together to improve the health and quality of life for individuals, families, and communities by moving the nation from a focus on sickness and disease to one based on prevention and wellness.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2011 (ongoing)
Target age group:Adults and children
Organisation:U.S. Department of Health and Human Services
Linked document:Download linked document
References:National Prevention Council, National Prevention Strategy, Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General, 2011.

School Health Guidelines to Promote Healthy Eating and Physical Activity

CDC integrated research and best practices related to promoting healthy eating and physical activity in schools, culminating in the School Health Guidelines. There are 9 School Health Guidelines that serve as the foundation for developing, implementing, and evaluating school-based healthy eating and physical activity policies and practices for students.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Evidence of Physical Activity Guidelines/Policy
Year(s):2011 (ongoing)
Target age group:Children
Organisation:Centers for Disease Control and Prevention
Find out more:www.cdc.gov
Linked document:Download linked document
References:Centers for Disease Control and Prevention. School Health Guidelines to Promote Healthy Eating and Physical Activity. MMWR 2011;60

Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Increase Physical Activity in the Community

This document provides guidance for program managers, policy makers, and others on how to select strategies to increase physical activity in the community.

Categories:Evidence of Physical Activity Guidelines/Policy
Year(s):2011 (ongoing)
Target age group:Adults and children
Organisation:Centers for Disease Control and Prevention
Find out more:www.cdc.gov
Linked document:Download linked document
References:Centers for Disease Control and Prevention. Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Increase Physical Activity in the Community. Atlanta: U.S. Department of Health and Human Services; 2011.

Healthy Hunger - Free Kids Act of 2010

The Healthy, Hunger-Free Kids Act is a federal statute signed into law by President Barack Obama on December 13, 2010. The legislation authorized funding and set policy for USDA's core child nutrition programs: the National School Lunch Program, the School Breakfast Program, the Special Supplemental Nutrition Program for Special Supplemental Nutrition Program for Women, Infants, and Children , the Summer Food Service Program, and the Child and Adult Care Food Program.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2010 (ongoing)
Target age group:Children
Organisation:U.S Government
Find out more:www.fns.usda.gov

Healthy People 2020

Healthy People 2020 aims to identify nationwide improvement priorities, increase public awareness and understanding of the determinants of health and disease, provide measurable objectives and goals, engage multiple sectors and identify critical research, evaluation and data collection needs.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):2010 (ongoing)
Target age group:Adults and children
Organisation:U.S Department of Health and Human Sciences
Find out more:www.healthypeople.gov
Linked document:Download linked document
References:U.S Department of Health and Human Sciences

Salad bars to schools

Healthy school lunch initiative aiming to provide every school in the US with a salad bar to help ensure that every child has access to fruit, vegetables,fibre, wholegrains and healthy protein.

Categories:Evidence of Community Interventions/Campaign
Year(s):2010 (ongoing)
Target age group:Children
Organisation:Chef Ann Foundation, National Fruit and Vegetable Alliance, United Fresh Start Foundation, and Whole Foods Market
Find out more:www.saladbars2schools.org
References:Salad bars to schools. (2019). Available from: http://www.saladbars2schools.org/. [Accessed 2 May 2019].

Solving the Problem of Childhood Obesity in a Generation

White House Task Force on Childhood Obesity’s action plan for solving the problem of childhood obesity in a generation. commendations focus on the four priority areas set forth in the Memorandum: (1) empowering parents and caregivers; (2) providing healthy food in schools; (3) improving access to healthy, affordable foods; and (4) increasing physical activity

Categories (partial):Evidence of National Obesity Strategy/Policy or Action
Year(s):2010 (ongoing)
Target age group:Children
Organisation:White House Task Force
Linked document:Download linked document

Recommended Community Strategies and Measurements to Prevent Obesity in the United States

The document recommends 24 strategies for obesity prevention. There is a suggested measurement for each strategy that communities can use to assess performance and track progress over time. The 24 strategiesare divided into six categories: 1) strategies to promote the availability of affordable healthy food and beverages), 2) strategies to support healthy food and beverage choices, 3) a strategy to encourage breastfeeding, 4) strategies to encourage physical activity or limit sedentary activity among children and youth, 5) strategies to create safe communities that support physical activity, and 6) a strategy to encourage communities to organise for change.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Evidence of Marketing Guidelines/Policy
Evidence of Physical Activity Guidelines/Policy
Taxation/Subsidies on Food or Beverages or law relating to public health
Evidence of Community Interventions/Campaign
Year(s):2009 (ongoing)
Target age group:Adults and children
Organisation:Centers for Disease Control and Prevention (CDC)
Find out more:www.cdc.gov
Linked document:Download linked document
References:Keener, D., Goodman, K., Lowry, A., Zaro, S., & Kettel Khan, L. (2009). Recommended community strategies and measurements to prevent obesity in the United States: Implementation and measurement guide. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

Physical Activity Guidelines for Americans

The Physical Activity Guidelines for Americans (PAG) are an essential resource for health professional and policymakers. They provide guidance on how children and adults can improve their health through physical activity.

Categories:Evidence of Physical Activity Guidelines/Policy
Year(s):2008-2018
Target age group:Adults and children
Organisation:U.S. Department of Health and Human Services
Linked document:Download linked document

The Consortium to Lower Obesity in Chicago Children (CLOCC)

CLOCC is a nationally recognized childhood obesity prevention program. CLOCC aims to address childhood obesity by promoting healthy and active lifestyles for children throughout the Chicago metropolitan area.

Categories:Evidence of Community Interventions/Campaign
Year(s):2002 (ongoing)
Target age group:Children
Organisation:Consortium to Lower Obesity in Chicago Children
Find out more:www.clocc.net

5 A Day for Better Health Program

The National Cancer Institute's '5 A Day for Better Health Program' is a national program that approaches Americans with a simple, positive message: Eat 5 or more servings of vegetables and fruit daily for better health. The Program, a partnership between the vegetable and fruit industry and the NCI, has four major components: mass media, point of purchase, community coalitions, and research.

Categories:Evidence of Nutritional or Health Strategy/ Guidelines/Policy/Action plan
Year(s):1991 (ongoing)
Target age group:Adults and children
Organisation:The National Cancer Institute (NCI)
Linked document:Download linked document

California Project LEAN

California Project LEAN (Leaders Encouraging Activity and Nutrition) is a program run by the Public Health Institute. California Project LEAN works to advance nutrition and physical activity policy in schools, early childcare and other community settings in order to prevent obesity and its associated chronic diseases.

Categories:Evidence of Community Interventions/Campaign
Year(s):1987 (ongoing)
Target age group:Adults and children
Organisation:Public Health Institute
Find out more:www.californiaprojectlean.org

The Expanded Food and Nutrition Education Program (EFNEP)

The Expanded Food and Nutrition Education Program (EFNEP) is a federally-funded programme that offers nutrition education to limited-resource families and children in all 50 states and U.S. territories.

Categories:Evidence of Community Interventions/Campaign
Year(s):1969 (ongoing)
Target age group:Adults and children
Organisation:United States Department of Agriculture, National Institute of Food and Agriculture (USDA NIFA)
Find out more:nifa.usda.gov

4-H Healthy Living Programs

4-H Healthy Living programs aim to help 4-H youth learn how to lead lives that balance physical, mental, and emotional health. 4-H healthy living programs are available through local 4-H clubs and through grant-funded programs. Focus areas for 4-H healthy living programs include nutrition, childhood obesity, drug awareness, bullying prevention, health and fitness, safety, stress management, and food science.

Categories:Evidence of Community Interventions/Campaign
Target age group:Children
Organisation:4-H
Find out more:www.4-h.org

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