Lynn Tarkington, MPH StudentWalden University

PUBH 6165-04Dr. Stephen Arnold

Summer 2009

Childhood overweight and obesity is an epidemic problem in America.◦ Definitions

Overweight: Excess body weight for height. Measured by Body Mass Index (BMI): the ratio of weight to height squared

(kg/m2). Obesity is BMI greater than or equal to 95th percentile of age and

gender on CDC BMI growth chart. 85 to 94th percentile are considered at risk for overweight and obesity

◦ Causes: Complex interacting factors of social, environmental, and policy areas

leading to: Too little physical activity Non-healthy food choices

Centers for Disease Control and Prevention (CDC), 2009a. Health youth-childhood obesity. Retrieved January 8, 2009, from http://www.cdc.gov/healthyouth/obesity/index.htm.Institute of Medicine (IOM), 2007. Committee on Progress in Preventing Childhood Obesity. (2007). Progress in Preventing Childhood Obesity; How Do We Measure Up? Washington, DC: National Academy Press.

Prevalence of Obesity◦ Age 6 – 11 has doubled in the past thirty years

17%◦ Age 12-18 has tripled in the past thirty years

17.6% ◦ 32% of children age 2 -19 are overweight or obese◦ 23 million children

Impacts all categories of race, ethnicity, socioeconomic status (SES), locale◦ Some lower SES, ethnic populations are at higher risk

CDC, 2009a. IOM, 2007.Healthy People 2010. (2009). Healthy People 2010, 2nd Edition, Vol.1. Retrieved January 18, 2009, from www.healthypeople.gov/about.Pekruhn, C. (2009). Preventing Childhood Obesity: A School Health Policy Guide. National Association of State Boards of Education, Center for Safe and Healthy Schools. Retrieved May 11, 2009, from www.nasbe.org.

5-7% of annual healthcare expenditures (Kaplan) 2004:

◦ $14 billion direct costs to treat obese children◦ Medicaid spending:

$6730 per obese child per year $2446 per normal weight child

◦ Total $98 - $129 billion on direct and indirect costs of obesity

Health Affairs (2009)◦ $125.9 million in 2001◦ $237.6 million in 2005◦ Nearly double number of hospitalizations with diagnosis

of obesity.

IOM, 2007.Pekruhn, 2009.Tennessee Department of Education, Office of Coordinated School Health. (2009). Childhood Overweight. Retrieved July 15, 2009 from www.tennessee.gov/education/schoolhealth/overweight/index.html.Trasande, Liu, Fryer, & Weitzman. (2009). Effects of Childhood Obesity on Hospital Care and Costs, 1999-2005. Health Affairs 28(4), w751-760. doi:10.1377/hlthaff.28.4.w751.

Second leading cause of preventable death (after tobacco) in the United States

Immediate Impact - Diseases in Childhood◦ Elevated blood pressure◦ Abnormal lipid profiles◦ Type 2 Diabetes

Increased Health Risk as Adults◦ Diabetes◦ Cardiovascular Disease◦ Stroke◦ Cancer◦ Osteoarthritis

Healthy People, 2009.IOM, 2007.Must & Strauss. (1999). Risks and Consequences of childhood and adolescent obesity. International Journal of Obesity (23), Supplement 2, S2-11. Retrieved January 8, 2009. Trasande, Liu, Fryer, & Weitzman, 2009.

Low self esteem Poor body image Depression

Overweight children feel stigmatized by their weight.

School age girls report they want to lose weight due to media images.

Body image impacts how children assess their abilities and those of other children.

Children perceived their overweight peers as less smart, weak, incapable, and unlikeable

IOM, 2007.Okie, S. (2005). Fed Up! Winning the War Against Childhood Obesity. Washington, DC: Joseph Henry Press. Pekruhn, 2009.

Economic pressure drives down commodity products prices and increases prices of health option like fresh fruits and vegetables.◦ Fast – food driven

Per capita kcal intake up Physical activity down

◦ Economic priorities – road construction (even less need for physical activity)

◦ No sidewalks, bike paths School budget restrictions

◦ Cut PE programs and after school sports Increased time with the TV, computer games, internet

Blumenthal, Hendi, & Marsillo. (2002). A public health approach to decreasing obesity. Journal of the American Medical Association, 288(17), 2178. Retrieved April 17, 2009.Carter, R. (2002). The impact of public schools on childhood obesity. Journal of the American Medical Association 288(17), 2180. Retrieved April 17, 2009.CDC, 2009a.IOM, 2007.Ludwig, D. & Pollack, H. (2009). Obesity and the economy: From crisis to opportunity. The Journal of the American Medical Association, 301(5), 533-535. Retrieved July 15, 2009.Okie, 2005.

4th highest rate of childhood overweight and obesity in America at 20% of ages 10 to 17.

43% of Tennessee children are at risk for overweight or obesity

2007 data for high school students:◦ 17% were obese◦ 18% ate recommended fruits and vegetables◦ 46% drank soda at least once per day

Available in school vending machines◦ 32% of food is consumed away from the home

Usually higher fat foods and beverages & less nutritional value

Tennessee Department of Education, Office of Coordinated School Health. (2009). Childhood Overweight. Retrieved July 15, 2009 from www.tennessee.gov/education/schoolhealth/overweight/index.html.

Department of Health - Initiative to Improve Adolescent and Young Adult Health by 2010:◦ Reduce the proportions of high school students who are

overweight or obese to 5.0% from the 2005 baseline of 14.6%.

Department of Education – Office of Coordinated School Health

Action for Healthy Kids◦ Improved nutrition and increased physical activity

Recharge! ProgramHealthy School Recognition Program (2004-2005)

Get Fit TN. (2009). Get Fit TN. Retrieved January 10, 2009, from www.getfittn.com/index.aspx.Tennessee Department of Education, 2009.Tennessee Healthy Weight Network. (2004). Eat smart-move more-tune in. Retrieved February 7, 2009, from www.tnhealthyweight.org.

Mission: “To cultivate the ability, intellect, and character of each student.” (2009).

Wellness Policy and Guideline – 2006:◦ “Good health fosters student attendance and

education” School Health Councils Nutritional Quality of Foods and Beverages Sold and

Served on Campus Nutrition and Physical Activity Promotion Physical Activity, Physical Education, and Health

Education Opportunities

Pekruhn, 2009.Williamson County Schools. (2006-2009). Williamson County School District – Wellness Policy and Guideline. Retrieved July 15, 2009, from www.williamsoncounty-tn.gov.

Farm to School programs incorporate healthy, nutritious, local produce into school lunches and snacks.

Combine with nutritional education, farm visits, school gardens, and classroom education.

Various methods of Federal or State sponsorship/support:◦ USDA◦ DOD

US Department of Agriculture, Food and Nutrition Services. (2005). Eat Smart-Farm Fresh. Retrieved from www.usda.gov .

Three basic steps:◦ Determine what and how much you need.◦ Coordinate with local farmers.◦ Have the food delivered to schools.

Assess possible distribution models:◦ Direct local purchase◦ Farmer cooperative◦ Farmers’ market◦ Local purchase through traditional wholesaler

Popular foods include:◦ Salad greens◦ Sweet potatoes◦ Tomatoes◦ Melons◦ Apples◦ Strawberries

US Department of Agriculture, 2005.

Agriculture is important to our state and county:◦ Almost 80,000 farms in Tennessee.◦ In 2004, Tennessee ranked 4th in the US in tomato

and snap bean harvests, 24th for peaches, and 28th for apples.

◦ Multiple farms in Williamson County with bountiful fruit and vegetable crops, and a superb Farmers’ Market in Franklin.

Tennessee Department of Agriculture, 2009.

Research:◦ What, Where, and Who?◦ Find collaborators:

Department of Agriculture Other State or County Departments Partners for funding

◦ Research potential regulatory hurdles. Plan for incorporating educational

component for students. Start Small!

Epidemic of childhood overweight and obesity is a major public health concern in our country today leading to:◦ Chronic illness◦ Poor quality of life◦ Decreased productivity◦ High health care costs

Williamson County, Tennessee should show leadership in assisting the children trusted to our educational system.

Blumenthal, S., Hendi, J., & Marsillo, L. (2002). A public health approach to decreasing obesity. Journal of the American Medical Association, 288(17), 2178. Retrieved April 17, 2009.

Carter, R. (2002). The impact of public schools on childhood obesity. Journal of the American Medical Association 288(17), 2180. Retrieved April 17, 2009.

Centers for Disease Control. (2009a). Health youth-childhood obesity. Retrieved January 8, 2009, from http://www.cdc.gov/healthyouth/obesity/index.htm.

Centers for Disease Control and Prevention. (2009b) . Obesity trends among US Adults. Retrieved July 15, 2009, from http://www.cdc.gov/brfss.

Get Fit TN. (2009). Get Fit TN. Retrieved January 10, 2009, from http://www.getfittn.com/index.aspx.

Healthy People 2010. (2009). Healthy People 2010, 2nd Edition, Vol.1. Retrieved January 18, 2009, from www.healthypeople.gov/about.

Institute of Medicine, Committee on Progress in Preventing Childhood Obesity. (2007). Progress in Preventing Childhood Obesity: How Do We Measure Up? Washington, DC: National Academy Press.

Ludwig, D. & Pollack, H. (2009). Obesity and the economy: From crisis to opportunity. The Journal of the American Medical Association, 301(5), 533-535. Retrieved July 15, 2009.

Must, A., Strauss, R.S. (1999). Risks and consequences of childhood and adolescent obesity. International Journal of Obesity (23), Supplement 2, S2-11. Retrieved January 8, 2009.

Okie, S. (2005). Fed up! Winning the war against childhood obesity. Washington, DC: Joseph Henry Press.

Pekruhn, C. (2009). Preventing childhood obesity: A school health policy guide. National Association of State Boards of Education, Center for Safe and Healthy Schools. Retrieved May 11, 2009 from www.nasbe.org.

Tennessee Department of Agriculture. (2009). Statistics. Retrieved July 15, 2009 from http://tennessee.gov/agriculture/html.

Tennessee Department of Education, Office of Coordinated School Health. (2009). Childhood Overweight. Retrieved July 15, 2009 from http://tennessee.gov/education/schoolhealth/overweight/index.shtml

Tennessee Healthy Weight Network. (2004). Eat smart-move more-tune in. Retrieved February 7, 2009, from http://www.tnhealthyweight.org.

Trasande, L., Liu, Y., Fryer, G., Weitzman, M. (2009). Effects of childhood obesity on hospital care and costs, 1999-2005. Health Affairs 28(4), w751-w760. doi: 10.1377/hlthaff.28.4.w751.

United States Department of Agriculture, Food and Nutrition Services. 2005. Eat Smart – Farm Fresh. Retrieved from http://www.usda.gov.

Williamson County Tennessee. (2006). Williamson County School District – Wellness Policy and Guideline. Retrieved July 15, 2009, from http://www.williamsoncounty-tn.gov.

Vieweg, V., Johnson, C., Lanier, J., Fernandez, A., Pandurangi, A. (2007). Correlation between high risk obesity groups and low socioeconomic status in school children. Southern Medical Journal 100(1):8-13.