Washington State
Nutrition & Physical Activity Plan

Nutrition, Physical Activity and the Health of Washington State

Individuals, families, and society pay a high cost when physical activity and healthy diets are not part of daily life. Poor diet and lack of physical activity cause at least 300,000 deaths in the United States each year.(1) Only tobacco use causes more preventable deaths. Poor diet and physical inactivity are associated with the disabilities and lower quality of life that result from diabetes, cardiovascular disease, cancer, osteoporosis, obesity and stroke.(2) These chronic diseases account for seven of every ten United States deaths and for more than 60 percent of medical care expenditures.(2)

In 2000, the direct medical cost attributable to obesity in the United States was $61 billion.(2) By 2003 the estimated medical cost attributable to obesity had increased to $75 billion.(3) In Washington, the cost of obesity related medical expenses, paid by Medicare and Medicaid, was estimated to be $365 million per year.(3)

The United States spends more money per capita on health care than any other country in the world, but 27 countries have longer average life spans.(4) Medical care expenditures could be profoundly reduced by developing effective ways to promote nutrition and physical activity. Obesity Trends in Washington

Burden of Obesity

In 2006, about 60 percent of adults in Washington were either overweight (36 percent) or obese (24 percent).(5) The prevalence of obesity in Washington has more than doubled since 1990. National data show a similar increase in obesity across the country.(6)

The percentage of young people in the United States who are overweight more than doubled in the last 20 years.(6) In Washington, 11 percent of tenth grade youth were obese and 14 percent were overweight in 2006.(5) Higher rates of overweight and obesity in children threaten to reverse the gains in life expectancy made throughout the twentieth century as people benefited from advances in public health and medicine.(7) Children who are obese are more likely to develop chronic diseases like type 2 diabetes and coronary heart disease earlier in life than lean children from previous generations.(8)

Obesity Rates by County

The social and financial costs of obesity are not distributed evenly among all Washington residents. In 2004 and 2006, the proportion of adults who were obese ranged from 15 percent in San Juan County to 32 percent in Lewis County.Thirteen counties had obesity rates that were higher than the rest of the state: Adams, Clark, Columbia, Cowlitz, Grant, Grays Harbor, Kitsap, Lewis, Mason, Pacific, Pierce, Snohomish, and Yakima counties. Jefferson, King, San Juan, and Whatcom counties had obesity rates below the rest of the state. Asians and Pacific Islanders have the lowest prevalence of obesity followed by whites. American Indians and Alaska Natives, blacks, and adults of Hispanic origin have the highest prevalence of obesity. Higher prevalence of obesity is associated with lower levels of income and education. Adults with annual household incomes of less than $20,000 are 40 percent more likely to be obese than those in households with annual incomes of $50,000 or more. College graduates have lower prevalence of obesity than those with less education.(9)

Concern about body weight is not merely a cosmetic issue. Obesity has significant short- and long-term health effects. People who are obese or overweight are more prone to develop hypertension, elevated blood cholesterol, and diabetes.(8) They are more likely to die at an earlier age than adults who are not obese. Washington adults who are obese are about three times more likely to have diabetes compared to adults who are not obese.(9) Obesity also complicates the management of type 2 diabetes and increases the risk of cardiovascular complications and cardiovascular mortality in people with type 2 diabetes.(7,10) Obesity and overweight also affect mental health and are associated with decreased emotional well-being.(11)

Preventing chronic disease and promoting lifelong health

Chronic diseases like heart disease, cancer, stroke and diabetes are prevalent and costly. They are also, to a great extent, preventable.(12) Women who maintain a desirable body weight, eat a healthy diet, have regular physical activity, do not smoke, and consume a moderate level of alcohol have 83-percent less risk of heart disease than women who do not have these health promoting behaviors.(13) When more people choose active lives and nutritious diets, the burden of chronic disease in Washington will decrease.

The Health of Washington State 2007, published by Washington State Department of Health, contains more information on obesity-related chronic diseases and their prevalence in Washington.

Healthy Eating

Healthy eating lowers the risk of chronic diseases including cardiovascular disease, hypertension, some types of cancer, diabetes, and osteoporosis.(8) Consuming at least five daily servings of vegetables and fruits may prevent cancer, especially cancer in the mouth, pharynx, larynx, esophagus, lung, stomach, colon, rectum, bladder, and cervix.(14) Coronary heart disease, stroke, cataract formation, diverticulosis, and hypertension may also be prevented by increasing vegetable and fruit intake.(15) Increasing consumption of vegetables and fruits might also be an effective strategy in the treatment of obesity.(16) Eating low-energy dense foods, such as fruits and vegetables, might protect against obesity. Foods with low-energy density have fewer calories per weight than foods with high-energy density. Foods naturally high in fat and foods with added fat, like fried foods, have high-energy density.(17,18) Other dietary factors, like adequate intake of whole grains and calcium and low intake of saturated and trans-fats are important in preventing chronic disease.(19)

In 2005, one in four adults in Washington (25 percent) ate fruits and vegetables five or more times a day.(5) Because people often eat more than one serving of fruits and vegetables at a given time, it is estimated that about half of Washington adults are likely to eat five or more servings of fruits and vegetables daily.

For most babies, breast milk provides the best early nutrition. Breastfeeding is associated with a decreased risk for many early-life diseases and conditions, including ear and respiratory tract infections, eczema, gastroenteritis, type 2 diabetes, sudden infant death syndrome, and obesity.(20) Breastfeeding also is associated with health benefits to women, including decreased risk for type 2 diabetes, ovarian, and breast cancer. Efforts to increase breastfeeding should be broad-based and include health-care providers and the community.

The Dietary Guidelines, developed by the United States Department of Health and Human Services and the United States Department of Agriculture, provide science-based advice to promote health and to reduce risk for major chronic diseases through diet and physical activity.

See Appendix F: Healthy Eating Guidelines.

Physical Activity

Being physically active and limiting sedentary behaviors, such as watching TV, protect against overweight, obesity, heart disease, high blood pressure, type 2 diabetes, some cancers, and falls and fractures.(8,14) Physical activity is essential to healthy aging and is an effective component of prevention and treatment of mental health disorders.(21,22,23) Children and adults of all ages gain immediate benefits by being active as well as long term protection against disease and disability.

For health benefits, the recommended minimum amount of physical activity is at least 30 minutes of moderate activity on five or more days a week, or at least 20 minutes of vigorous physical activity three or more days per week.(19) When work-related activity was considered along with leisure time activity, 64 percent of Washington adults reported activity at the recommended level in 2005.(5) When just leisure time activities were counted, only 54 percent of adults met recommended activity levels. In 2006, only 47 percent of Washington students in grade eight, 42 percent in grade ten, and 39 percent in grade 12 met the Dietary Guidelines for Americans-2005 recommendation of at least 60 minutes of physical activity on most days of the week.(24,25)

Healthy Aging

In Washington in 2006, 11 percent of the population was aged 65 and older. By 2030, the proportion of older adults will increase to 20 percent.(5) As the state’s population ages the burden and costs of chronic conditions could increase substantially since 75 percent of Washington’s health-care costs are due to chronic diseases.(5,26) However, much of the physical decline associated with aging is preventable,(27) and steps can be taken to reduce the health care costs and loss of quality of life in an aging population. National Blueprint: Increasing Physical Activity Among Adults Age 50 and Older calls for instituting urban design policies based on the needs and preferences of older adults.(28) People of all ages would likely benefit from pedestrian and bicycle-friendly communities, mixed-use development, slower traffic patterns, better street lighting, and improved access to quiet green spaces.(2)

See Appendix H: For Information on Physical Activity and Aging

Body Mass Index (BMI), Obesity, and Overweight

Body Mass Index (BMI)

A number calculated from a person's weight and height. BMI provides a easy way to estimate body fatness for most people and is used to screen for weight categories that may lead to health problems. BMI is a mathematical formula in which a person's body weight in kilograms is divided by the square of his or her height in meters. A BMI of 25 to 29.9 is considered overweight. A BMI of 30 or more is considered obese.


An excessively high amount of body fat in relation to lean body mass. Body fat can be more accurately estimated by skinfold measure, by waist-to-hip circumference ratios, or by techniques such as ultrasound, computed tomography, or magnetic resonance imaging (MRI)..


Increased body weight in relation to height, when compared to a standard of acceptable or desirable weights. Overweight may or may not be due to body fat. Professional athletes may be very lean and muscular with very little body fat. However, they may weigh more than others who are the same height because muscle weighs more than fat. While they may qualify as "overweight," they are not necessarily "over fat."