http://www.ubalt.edu/experts/obesity/

Best Practices in Public Health Interventions regarding Adolescent Obesity

Pat Stewart, PhD, RDLEAH Nutrition Discipline Coordinator

Bionutrition Manager CRCURMC

11/15/07

http://www.ubalt.edu/experts/obesity/

Objectives Review public health strategies

and approaches to address child and adolescent obesity

Review outcomes of adolescent school based interventions

Highlight specific state legislation and innovative approaches that address childhood and adolescent obesity

www.kidscount.org

Percent of 10 to 17 year olds who are overweight or obese

www.kidscount.org

Percent of 10 to 17 year olds Overweight by Race/Ethnicity

www.kidscount.org

Percent of 10 to 17 year olds Overweight by Income Level

http://www.ubalt.edu/experts/obesity/

“It is hard to envision an environment more effective than ours (in the USA) for producing obesity”

Battle + Brownell

Med Clin N Amer 2000 84(2)

Best Practices Prevention should be the primary

focus when considering a best practice approach to deal with the problem of childhood obesity

Changes in the environment must be the crux of any public health attempts to address the epidemic

Preventing Childhood obesity Health in Balance IOM 2005

Dr Kaplan, chair of IOM Report on Preventing Childhood Obesity

“changes are needed in our schools and communities, as well as at the national level. Just as it was imperative to make changes across society to protect youth from the hazards of tobacco smoking, it is now critical to alter social norms and attitudes so that healthy eating behaviors and regular PA become a daily part of life for our children and youth.”

Obesity Reviews 2006 7(3):261-269

Public Health Strategies to Combat Childhood Obesity

Breast Feeding Limiting TV/screen time Encouraging physical activity Increasing fruit and vegetable

intake Controlling portion size Limiting soft drink consumption

www.cdc.gov/pcd/issues/2007/jul/06_0082.htm

Successful Health Policy

Existence of sufficient evidence base

Development of effective coalition Commitment of policy makers

http://www.ubalt.edu/experts/obesity/

Target Areas for Childhood Obesity Interventions:

Primary health care Family based interventions School based interventions

Med Clin N Amer 2000 84(2)

School based interventions Are attractive because:

Large contact time Existing organizational structures Reach a large number of children at low

cost Natural lab for exploring impact of

environmental change on eating and activity habits

Life science, health and PE classes offer built in opportunity

Obesity Reviews 2006 7(3), 261-269.

School Based Programs for Adolescents

PATH – (Physical Activity and Teenage Health) - Fardy

Planet Health - Gortmaker Frenn New Moves – Neumark-Sztainer

www.healthyamericans.org

NIH Strategic Plan for Obesity Research

TAAG – Trial of Activity in Adolescent Girls

GEMS – Girls Health Enrichment Multi Site Studies

HEALTHY – - A Middle School-Based Study to Reduce Risk Factors for Type 2 Diabetes in Children

Obesity Reviews 2006 7(3), 261-269.

Summary of Interventions

In general interventions have resulted in modest changes in behaviors and mixed results with indicators of obesity. TV watching seems to be most modifiable behavior, followed by PA and nutrition behaviors.

Obesity Reviews 2006 7(3), 261-269.

Environmental studies

200 – 300% increase in purchases of healthy foods when prices were reduced by 50%

Suggest the potential to influence behaviors related to obesity by changing environmental exposures

Am J PrevMed 2004;27(3S):163-171

Interventions targeted at children and adolescents: Eliminate soda vending machines at

school Implement nutrition guidelines for foods

sold anywhere in school Increase availability of fruit + vegetables

in schools Regulate food advertising + marketing

efforts targeting kids Ban advertising in school

www.healthyamericans.org

Federal Initiatives to Support School Based Approaches Coordinated School Health Program School Health Index Physical Education Curriculum Analysis Tool School Health Policies and Programs Study School Health Profiles Division of Adolescent and School Health

(DASH) Steps to a Healthier US

www.cdc.gov/pcd/issues/2007/jul/06_0082.htm

States Rule!

Much of the authority for public health policy lies at the state level

States may tie compliance to state funding

http://www.ubalt.edu/experts/obesity/

Topic Areas of State Legislative Initiatives

Improving the quality of food sold in schools

Limiting sale of less nutritious foods

Improving PE + health education Encouraging PA in + out of school BMI reporting

www.healthyamericans.org

Existing Legislation 17 states set nutritional standards for lunch,

breakfast + snacks stricter than USDA 22 states have nutrition standards for

competitive foods 26 states limit when + where competitive

foods maybe sold Only 2 states do not require schools to provide

health ed – (CO + OK) 12 states passed legislation to test BMI

(most including provisions for communicating to parents)

http://www.rwj.org/pdf/Balance122006

Additional State Legislative Activity – 2006

Develop local wellness policies – 8 states

Establish committees, councils, and task forces – 10 states

Increase access to fresh produce – 8 states

Promoting school nutrition – 7 states

http://www.ubalt.edu/experts/obesity/

Obesity Report Cards

A - CA, NY + TN B – 19 states C – 19 states D – 6 states F - ID UT WY

http://www.ubalt.edu/experts/obesity/

Childhood Obesity Report Card

http://www.nashp.org/Files/Obesity_final_with_correct_appendix_C.pdf

States With Innovative Approaches AK + TX – worksite wellness at schools CA – state standards for beverage snacks and side dishes –

school gardens ME – vending machine policy initiative MI – milk vending, requirements for recess + PE/policy for

healthy options outside school lunch MT – healthy vending options/recess before lunch NC – Sybershop/vending machine restrictions/focus groups with

families MA – provides grants for Healthy Choice Program RI – works with school based health centers awards mini grants

to lead policy + environmental change WA – awards for school districts who have made policy

changes

www.rwj.org/pdf/Balance122006

Innovative Approaches –Legislative and Non legislative 2006

CT - financial incentive for schools to offer healthy foods

DE – physical fitness assessment to parents VA – superintendents educated on childhood

obesity NV – constitutional amendment for daily PE MA – Every Body Move! MN – Governor certificate of recognition OH – Best Buckeye Healthy School WV – website showcases success stories

throughout state

www.nga.org

“Healthy America Initiative: wellness where we live, work, and play,” NGA

Encourage + assist state governors in developing + implementing wellness initiatives

Bring together public + private sectors Raise awareness of need for healthier lifestyles Bring together experts for solutions Seek out best practices + innovative programs Hold workshops and provide tools Improve state programs Urge governors to implement state employee

health initiatives

www.nga.org

Healthy Kids, Healthy America

$110,000 grants for 10 states focusing on preventing childhood obesity through policy + environmental change

www.cdc.gov

State Programs Funded by CDC to Prevent Obesity and Other Chronic

Diseases

www.healthiergeneration.org

Alliance for a Healthier Generation

Healthy Schools Program Let’s Just Play Go Healthy

Challenge Beverage Guidelines for US

Schools Guidelines for Snack Foods in

Schools

http://www.ubalt.edu/experts/obesity/

Websites

www.kidscount.org/sld/snapshot.jsp State differences in rates of overweight or obese youth http://www.cdc.gov/healthyyouth/shpps/2006/summaries/index.h

tm State level summaries for school health programs http://www.ubalt.edu/experts/obesity/index.html#archived University of Baltimore state report cards based on efforts to

pass state measures http://www.Healthyamericans.org How healthy is your state? www.rwj.org Balance| State Action to Promote Nutrition, Increase Physical

Activity and Prevent Obesity http://www.healthiergeneration.org

http://www.ubalt.edu/experts/obesity/

Websites con’t www.nga.org State by state grantee information www.ncsl.org/org/program/health/childhoodobesity-2005.htm Childhood Obesity – 2005 Update and Overview of Policy

Options http://www.nashp.org/Files/

Obesity_final_with_correct_appendix_C.pdf State Approaches to Childhood Obesity/National Academy of

State Health Policy http://www.cdc.gov/nccdphp/dnpa/obesity/state_programs/about

_us.htm CDC state funded grants to address overweight and obesity http://teamnutrition.usda.gov/success.html School success stories by state