Healthy Eating and Obesity Prevention

Healthy Eating Focus Area Process

• Local data

• Expert input

• Best practices

Develop statement of

the issue

Determine what is known through scientific literature;Quantify the issue

Develop key messages and

recommendations

Develop action plan

Evaluate program or

policy

Adapted from “Evidence-Based Decision Making in Public Health, Public Health Management Practice, 1999.

Health Eating Data Within the Social-Ecological Framework

Individual Behavior: e.g.

Fruit/veg intake;Portion size;

Breastfeeding

Abundant fast food restaurants

Vendingmachinesin schools

Lack of local grocery stores

Breastfeeding and Obesity Prevention

Breastfeeding is linked to decreased risk of obesity, possibly due to physiologic factors in human milk, feeding and parenting patterns associated with nursing.*

Breastfed infants are leaner at 1 year compared to formula-fed counterparts. Early growth pattern may influence later growth.**

•Prevention of Pediatric Overweight and Obesity, Policy Statement, American Academy of Pediatrics, Vol. 112, No. 2, Aug. 2003, pp. 424-430. www.aap.org/policy/s100029.html.

•Breastfeeding: HHS Blueprint for Action on Breastfeeding, Dept. of HHS, Office of Women’s Health, 2000.

Other Individual Behavior Trends

Portion sizes increasing TV watching (especially

by children) increasing “Convenience foods”

more available in supermarkets

Less cooking at home

The “Obesogenic” Environmentor ‘Supply Side of Consumption’ in Washtenaw County

The ‘Obesogenic’ Society Hunter/gatherers ate 75% nuts, vegs, fruits; 25% lean game We eat 17% fruits, vegs; 28% fatty meats; 55% carbos, sugars, etc We would need to slow jog for 6-8 miles every day to exercise as

hunter/gatherers Cheap, fast, low nutrition, high fat foods Convenient stores ‘Drive-Throughs’ – not much ‘healthy’ food eaten in the car? Perception of increased preparation time for fresh fruits and vegetables Decreased time available – e.g. Americans working more hours, more

single parent homes, etc.

The ‘Obesogenic’ Society Linkages between exposure to grocery stores and

restaurants and overweight have not been firmly established – but they’re coming…

Sensible, but need to be creative about interventions and approaches, evaluate well

Anxious to examine Community Prevention Guide recommendations regarding environmental approaches regarding overweight and healthy eating

Relevant Research Lower prevalence of supermarkets and higher prevalence of

independently owned grocery stores in low-wealth neighborhoods and greater proportion of households without access to private transportation*

Fruit and vegetable intake increases significantly for each additional supermarket in census tract**

Forty percent of American food budget spent on fast foods*** Low income communities have significantly fewer supermarkets

per capita than similar communities****

*Morland, K. et.al. “Neighborhood characteristics associated with the location of food stores and food service places.” AJPM.2002;22:23-29.

**Morland, K., et.al.“The Contextual Effect of the Local Food Environment on Residents’ Diets: The Atherosclerosis Risk in Communities Study.” AJPH. 2002;92:1761-1767.

***Dietz, W. “Obesity in Children” UM-SPH Presentation…

****Philadelphia Food Trust

*****University of California Cooperative Extension. July 2002

School Environment Trends

Local data based on Physical Activity and Healthy Eating Asset Survey, April 2003Questions based on CDC’s School Health Index for

Physical Activity & Healthy Eating53 of 114 schools in WC returned a survey (46%

response rate)

School Environment TrendsJunk food accessibility

Nationally 26.3% elementary, 62% Middle/JRHS, 94.9% HS (2001) students

have access to vending machines at school 26.8% elementary, 39.4% Middle/JRHS, 59.3% HS have school

store, canteen or snack bar

Washtenaw County 18% of elementary schools, 25% of middle schools, and 69% of

high schools allow the sale of junk foods at school 29% of schools have policies regarding availability of low fat foods

in school

School Environment Trends

CurriculumLocally, only 14% of schools teach all 18 healthy

eating curriculum topics recommended by the School Health Index

Milk ConsumptionNationally, student milk consumption has decreased

40% since 1977Locally, 91% of schools offer either low-fat or skim

milk in their school meals

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Boys1977-78

Boys1994-96

Girls1977-78

Girls1994-96

ou

nce

s p

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MilkSoft Drinks

Teens’ Consumption of Milk and Non-diet Soft Drinks (ages 12-19)

Teens’ Consumption of Milk and Non-diet Soft Drinks (ages 12-19)

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Boys1977-78

Boys1994-96

Girls1977-78

Girls1994-96

ou

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s p

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ay

MilkSoft Drinks

90% girls, 70% boysfail to meet daily

calcium recommendation

Teens drink 2X as muchsoda as milk, providing

many with 15-20%of their calories

Teens average 1 glass milk per day

Common Messages Across Populations (1)Prepare more meals at home – more

cooking. Focus on what we are drinking

(sweetened beverages). Define what is a healthy beverage.

Promote community and school gardens

Common Messages Across Populations (2)

Increase fiber intake; more fruits and vegetables; support plant-based diet

Cut unnecessary sugar and fatDefine “healthy snacking” & replace junk

food snacking with healthy snackingGood dine out/fast food optionsPortion size *

Nutrition, Physical Activity, and Obesity Prevention Program

Kim Bandelier, MPH, RD/LDProgram Coordinator

Program Staff

Kim Bandelier, MPH, RD/LD Lesli Biediger, MPH, RD

Chronic Disease Nutrition Consultant Kristy Hansen, M.Ed., CHES

Physical Activity Coordinator Brett Spencer

Partnership Coordinator 8 Regional Nutritionists

Funding

CDC Cooperative Agreement (~$450,000)State Nutrition and Physical Activity

Programs to Prevent Obesity and Related Chronic Diseases

5 year award, currently starting year 3Capacity building level

State general revenue (~$800,000)

Caloric Balance

Breastfeeding Fruits and Vegetables

Reduced TV

Nutrition Physical Activity

Required Focus Areas

Strategic Plan for the Prevention of Obesity in Texas

Originally released in 2003 Currently revising to include

All age groups 5-year goals Breastfeeding and reducing TV viewing Specific strategies for communities

Final will be released on April 24, 2006 at Texas Public Health Association convention

Demonstration Communities Project

In 2004, 2 communities chosenCorpus Christi (urban) & Ft. Stockton (rural)

Collected baseline dataConducted visioning workshops and

stakeholder interviewsCompleted strategic/action planning

processCurrently implementing interventionsUT-Austin manages project

Corpus Christi, TX

CCAPWell (Coordinated Community Approach to Wellness) coalition2005 Summer Scorecard Program

~300 children IN MOTION End of Summer CelebrationNext interventions will be worksite wellness

and breastfeeding promotion

Ft. Stockton, TX

Ft. Stockton Lifestyle CoalitionHosted Family Play-Day on June 18, 2005Conducted worksite wellness pilot in Ft.

Stockton ISDFuture plans include continuing worksite

wellness with FISD, website development, and expanding physical activity programs for teens

Model for Dissemination

Skill-Building WorkshopsTeaching communities skills needed to

promote nutrition and physical activity through a community coalition or collaborative

Using lessons learned from demonstration communities

Regional Nutritionist hosting workshops for interested but not organized or newly organized community coalitions

Skill-Building Workshops

3 Pilot workshops conducted in 20045 workshops conducted in 2005

Partnership between NUPAOP and Goal A of the Texas Strategic Health Partnership

14 communities, 110+ attendees3 new coalitions formed2 existing coalitions trained

Future of Program

Increase CDC funding from Capacity Building to Basic Implementation