By William H. Dietz, MD, PhD
September 12, 2026
The United States stands at a precarious juncture in its history of public health. As the nation grapples with a deepening chronic disease crisis, the current administration has championed the "Make America Healthy Again" (MAHA) movement. While the rhetoric suggests a renewed focus on national well-being, the fiscal reality unfolding in the halls of Congress tells a drastically different story. A proposed 70% budget cut to the Division of Nutrition, Physical Activity, and Obesity (DNPAO) at the Centers for Disease Control and Prevention (CDC) threatens to dismantle the very infrastructure required to achieve the goals of the MAHA movement.
The Anatomy of a Crisis: Why Chronic Disease is a National Emergency
The statistics are no longer just data points; they are a clarion call for urgent action. Currently, more than 40% of American adults live with obesity. Projections for 2030 are even more sobering, with estimates suggesting that nearly half of the U.S. population will struggle with obesity and its comorbidities.
The clinical implications are devastating. Obesity is a primary driver of heart disease, Type 2 diabetes, non-alcoholic fatty liver disease, and at least 13 distinct types of cancer. Addressing this epidemic is not merely a matter of individual willpower; it requires a robust, systemic approach rooted in evidence-based preventive efforts. To curb these trends, the U.S. must improve dietary quality, increase physical activity, and ensure equitable access to quality clinical care.
A Legacy of Public Health Infrastructure
From 1997 to 2012, I had the privilege of serving as the inaugural director of the DNPAO. During those formative years, our team worked to establish a foundation of trusted public health tools that practitioners and families rely on to this day.
Our work was defined by a commitment to data-driven interventions. We developed the CDC’s growth charts—a standard tool used by pediatricians worldwide to track child development. We created the Body Mass Index (BMI) calculator, a digital resource accessed over a million times every month by Americans monitoring their health.
Beyond clinical tools, we institutionalized surveillance. The annual state obesity maps produced by the DNPAO serve as the primary dataset for researchers, policymakers, and public health officials to identify emerging trends and allocate resources to the regions where they are needed most. We also pioneered critical initiatives such as fresh food access programs for infants, breastfeeding support frameworks in hospitals, and "produce prescription" pilots that allow physicians to treat chronic conditions by addressing food insecurity. These were not bureaucratic exercises; they were life-saving interventions.
Chronology of a Dismantling: From Foundation to Defunding
The erosion of these critical programs did not happen overnight. It is the result of a calculated shift in federal priorities that prioritizes fiscal austerity over public health resilience.
- 1997–2012: The DNPAO is established and expanded, creating the standard protocols for obesity surveillance and community-based nutrition programming.
- 2024–2025: The MAHA movement gains political momentum, calling for a "reimagining" of federal health agencies.
- June 2025: The administration proposes folding the CDC’s chronic disease programs into a newly conceived entity: the Administration for a Healthy America (AHA). Critics argue this is a consolidation effort that lacks a clear roadmap for protecting existing state and local health surveillance systems.
- FY 2027 Appropriations Cycle: The House Appropriations Committee introduces a spending bill that proposes slashing the DNPAO budget from $54.32 million to a mere $16.5 million. This represents a 70% reduction, effectively gutting the division’s ability to operate.
Supporting Data: The Reach of State and Community Programs
The DNPAO’s impact is perhaps most visible in its "boots on the ground" approach. The division provides essential financial support for state and community-based programs that target the social determinants of health.
Among these initiatives are the State Physical Activity and Nutrition Program (SPAN) and the High Obesity Program (HOP). These programs have successfully reached 17 states, 50 communities and tribal organizations, and 16 land-grant universities. They focus on the fundamental pillars of health: improving access to physical activity, increasing nutritional security, and actively working to reduce health disparities in underserved populations.
When you cut the funding for these programs, you are not simply "trimming the fat" of a federal budget; you are severing the lifeline for community health departments that rely on the CDC for technical assistance, surveillance data, and intervention blueprints. Without these resources, local health departments lose their capacity to prevent disease before it begins, leaving them to manage only the downstream, high-cost clinical consequences of chronic illness.
The Illusion of Pharmacological Solutions
In the face of these cuts, some proponents of the administration’s budget suggest that modern medical breakthroughs, specifically GLP-1 receptor agonists, will solve the obesity crisis. While these medications represent a significant leap forward in the treatment of obesity, they are not a panacea.
The cost and access barriers associated with GLP-1 medications are immense. Furthermore, relying solely on pharmaceutical interventions ignores the necessity of prevention. If the U.S. continues to see an influx of new obesity cases due to poor nutrition and sedentary lifestyles, no amount of medication will be sufficient to curb the prevalence of the disease. Prevention must be the cornerstone of any serious health strategy. This involves scaling the SPAN program to all 50 states, continuing support for the "Active People, Healthy Nation" initiative, and building state-level capacity for chronic disease prevention.
Implications: The High Cost of Inaction
The proposed reorganization—moving these programs into the newly minted Administration for a Healthy America (AHA)—is particularly concerning. While reorganization may look efficient on an organizational chart, the practical reality is a loss of institutional knowledge and the disruption of long-standing partnerships between the CDC and state health departments.
If these surveillance systems, technical assistance networks, and community-level infrastructures are dismantled, the long-term implications are clear:
- Increased Health Care Costs: As preventive measures fail, the burden of managing advanced chronic diseases will fall squarely on the already strained healthcare system, leading to higher Medicare and Medicaid expenditures.
- Widening Health Disparities: Community-based programs often serve the most vulnerable populations. Defunding these initiatives will exacerbate existing health inequalities, as the wealthy will continue to access care while the marginalized lose their primary support structures.
- Data Blindness: Without the DNPAO’s surveillance tools, the nation will effectively go "dark" regarding its own health status. We will lose the ability to track the efficacy of any interventions, effectively flying blind into a deepening health crisis.
Conclusion: A Call for Consistency
The MAHA movement encourages Americans to take personal responsibility for their health. Yet, the current administration’s legislative agenda does the exact opposite by stripping away the tools that empower individuals and their practitioners to manage that health.
You cannot claim to "Make America Healthy Again" while dismantling the very institutions that define what "healthy" means and how we achieve it. The Senate has an opportunity to correct this course by restoring funding to the DNPAO and rejecting the hollow promise of administrative reorganization as a substitute for actual public health investment.
The crisis of chronic disease in America is a choice—a choice of whether to invest in the future of our citizenry or to dismantle the foundations of our health. It is time for Congress to demonstrate that it understands the difference between savings and cost. True health is not found in a pill or a political slogan; it is found in the robust, boring, and essential work of public health infrastructure. We must preserve that work before it is lost for good.
