Preventing Childhood Obesity:

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Recommendations from the New Hampshire Childhood
Obesity Expert Panel
Preventing Childhood Obesity Promoting
physical activity healthy eating
April 2007
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NH Childhood Obesity Expert Panel

• Convened September 2007
• Purpose Develop practical recommendations
  for NH communities.
• National reports and recommendations
• Evidence-based and promising practices
• Panel Multiple disciplines represented
• Release date April 2007

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Panel Members
Chuck Cappetta, MD NH Pediatric Society Madeline
Dalton, PhD Hood Center for Children and
Families, Dartmouth Medical School Joe
Drake Plus Time NH Amy Dumont, RN NH Heart
Association and St Joseph Hospital Merrill
Friedman, MA, LCMHC Slatoff and Ward
Psychological David B. Gill NH Recreation and
Park Association Yvonne Goldsberry,
PhD Community Health, Cheshire Medical
Center Travis Harker, MD Capital Regional Family
Health Care Martha Judson, RN Nutrition
Connections, UNH Cooperative Ext. Audrey Knight,
RN State of New Hampshire Department of
Health and Human Services Robert
Lister Portsmouth School System Susan Lynch,
MD Cholesterol Treatment Center, Concord
Hospital Sharon Malenfant , MS, APR The Memorial
Hospital Evelyn Mariani, RD St Joseph
Hospital Melissa McAllister, RD Anthem Blue
Cross Blue Shield
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Panel Members(continued)

• Louise McCormick, PhD Department of Health and
  Human Performance,
• Plymouth State University
• Mary McGowan, MD Cholesterol Treatment Center,
  
• Concord Hospital
• Lila Monahan, MD, FAAP Partners in Pediatrics
• Southern NH Medical Center, Nashua
• Katherine Rannie, MSc, RN Education Consultant,
  Office of School Health
• State of New Hampshire
• Heidi St. Hillaire, RN Elliot Hospital
• Evie Stacy, MS, ARNP Center for Life Management
• Lisa Sutherland Hood Center for Children and
  Families,
• Dartmouth Medical School
• William Tombari, MD Derry Pediatrics, PA
• Ellen Turcotte Whitefield School
• Jennifer Warren, MD Physicians Healthy Weight
  Center
• Rick Wilson, MD Lakes Region Health Care

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National Recommendations

• Institute of Medicine
• US Surgeon General
• American Academy of Pediatrics

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National Recommendations
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Whose responsibility is it?

• Many people believe that dealing with
  overweight and obesity is a personal problemit
  is also a community responsibility
• -- Surgeon General Satcher

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Its not easy
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The problem is not the lack of explanations for
the increase in childhood obesity, but the
abundance of them

• Paxton, C., Donahue, E., Orleans, C.T., Grisso,
  J. A. Introducing the Issue. The Future
  of Children. v16(1) 3-17, 2006.

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Causes of Overweight Obesity
Kaiser REGIONAL HEALTH EDUCATION
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Who should be involved in prevention of childhood
obesity?

• Its a community effort!
• Clinicians
• Hospitals
• Schools
• Day care centers
• After school programs
• Community centers
• Parks and recreation
• Family resource centers
• Worksites

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Its not easy
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Make it easier to do better

• Make it practical
• Simple, easy message
• Tools and resources
• Evidence based and promising practices

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The Result

• Recommendations
• Families
• Clinicians
• Schools
• After school programs
• Community centers, parks and recreation, etc.
• 5-2-1-0 message endorsement
• 5-2-1-0 tools for clinicians and communities
• List of resources to support recommendations

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Small Steps

• Pick the low hanging fruit
• Build from there!

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RecommendationsFamilies

• Positive role models
• Breastfeeding first 4-6 months
• Variety fruits and vegetables, whole grains
• Portion control
• Internal hunger cues
• Not using food as a reward
• Physical activity as part of daily routine
• Outdoor play
• Limit screen time to lt 2 hours per day
• Talk to pediatrician

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Clinical Recommendations

• BMI
• Universal BMI screening and
  documentation on
  growth charts
• Assessment
• Physical activity, basic diet,
  and
  screen time
• Mental health issues
• Educate parents patients
• Growth curve and BMI
• Dietary advice
• Fruit and vegetable consumption more matters!
• Whole grains
• Limit soda and sugar sweetened beverages
• Limit 100 fruit juice
• One hour or more of moderate to vigorous physical
  activity/day
• No more than 2 hours of screen time per day

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Clinical Recommendations(cont)

• Language
• Sensitive and non-judgmental.
• Focus on the health of the patient, not their
  weight.
• Continuing education
• Motivational interviewing
• Improve comfort and effectiveness
• Office systems
• Increase awareness of/develop partnerships with
  community resources

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Recommendations for SchoolsNutrition

• You can
• In all areas where food is sold
• Decrease foods high in fat, sodium, and added
  sugars.
• Provide water or skim/non-fat or 1 milk, not
  soda or other sugar sweetened beverages.
• Limit 100 fruit juice.
• Ensure a variety of fruits and vegetables.
• Post nutrition education materials.
• Sell healthy, nutritious foods in fundraisers or
  use non-food items.
• Refrain from using food as a reward/discipline.
• Educate parents about healthy snacks and lunches.

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Schools-Nutrition (cont)

• Work with school officials to
• Modify school cafeteria menus, a-la-carte
  offerings, vending, and other foods
• Foods available contribute to major food groups
  of food guide pyramid
• Eliminate deep fryers and avoid purchasing
  pre-fried foods (baked instead)
• Use whole grain foods
• Offer only healthy, appealing foods in vending
  machines
• Involve students
• Provide adequate time (20 minutes) and space for
  lunch
• Make healthy choices highly visible and price
  competitively

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Schools-Nutrition (cont)

• Pre-service and in-service training to food
  service staff
• Recipe modification
• Healthy foods on a tight budget
• Planning healthy menus based on foods available.
• Promoting healthy eating
• Partner to offer nutrition education (hospitals,
  UNH Cooperative Extension, etc.)

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Recommendations for SchoolsPhysical Activity

• You can
• Activity events (walks, hikes, etc.)
• Promote life-long, non-competitive activities
• Refrain from withholding recess as a punishment
• Promote active recess time
• Recess walking program (map a route!)
• Walk/bike to school program
• Endorse/promote lt 2 hours of screen time a day
• Physical education 50 class time being active

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Schools- Physical Activity (cont)

• Work with school officials to
• Aim to assist every child in accumulating
• 60 minutes of physical activity every day
• Expand physical activity opportunities for
  students clubs, lessons, intramural and
  non-competitive sports and activities.
• Partner with others in your community!
• Daily physical education for all students
• Physical education teachers are certified and
  highly qualified
• Use curriculum-based programs as appropriate
• Allow facilities to be available to community
  during non-school hours

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Recommendations for Schools General

• You can
• Assessment
• Communicate results- use as educational
  opportunity
• Develop and action plan based on results
• Monitor and evaluate progress
• Promote healthy lifestyles among staff
• Health focused field trips
• Local businesses for sponsorship
• Work with school officials to
• Provide training to school nurses
• BMI measurement and classification
• Motivational interviewing

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Schools- General (cont)

• Measure BMI once a year in ALL students
• Ensure privacy
• Communicate results to parents, not students,
  along with other health tests
• Use appropriate language
• Focus on health of student, not weight
• Educate about health risks
• Inform and educate parents/community beforehand
• Ask local health care organizations to assist

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Schools- General (cont)

• Provide community education
• Aggregate BMI results
• Value of physical activity and healthy eating
• Open houses, health fairs, family nights and in
  newsletters
• Increase awareness regarding the efforts of
  schools and their wellness committees.
• Provide media literacy training
• Health education- provide behavioral skills
  training relating to physical activity and
  nutrition.

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RecommendationsAfter School, Community Centers,
Parks and Recreation Depts.Nutrition

• You can
• Educate children and provide
  healthy snacks
• Ask parents to supply healthy snacks
  and lunches-give examples!
• Use water and skim/low-fat milk
  instead of soda or other sugar
  sweetened beverages
• Refrain from using food as a reward/discipline
• Sell healthy foods in fundraisers, or use
  non-food items
• Hold healthy family dinners/events
• Events? Invite vendors who offer healthy foods

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After school, Community Centers, Parks and
Recreation Depts.Nutrition (cont)

• Next steps
• Offer only healthy, appealing foods in vending
  machines.
• Integrate information about healthy eating in
  programs such as art, music, math, etc.
• Consider adopting a fruit and vegetables only
  snack policy.

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RecommendationsAfter school, Community Centers,
Parks and Recreation Depts.Physical Activity

• You can
• Summer programs ensure kids receive 60 minutes
  of physical activity/day.
• Incorporate physical activity into programs
  Lifelong, non-competitive activities that are all
  inclusive.
• Avoid taking physical activity away as a
  punishment.
• Endorse and promote lt 2 hours of screen time/day.
• Substitute non-educational screen time with
  activity programs.
• Promote programs to schools, pediatricians,
  community organizations.

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RecommendationsAfter school, Community Centers,
Parks and Recreation Depts.Physical Activity
(cont)

• Next steps
• Make activities available to all children at
  reasonable costs
• Increase access
• Work with local schools

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RecommendationsAfter school, Community Centers,
Parks and Recreation Depts.General

• Educate parents
• Support local initiatives in publications
• Integrate a wellness plan into goals
• Evaluate efforts
• Partner with community organizations
• Provide education and training to staff

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The Result

• Practical recommendations
• Families
• Clinicians
• Schools
• After school programs
• Community centers, parks and recreation, etc.
• 5-2-1-0 message endorsement
• 5-2-1-0 tools for clinicians and communities
• List of resources to support recommendations

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5-2-1-0

• Massachusetts BCBS promotes 5-2-1
• Maine Center for Public Health
• KeepMEhealthy 5-2-1-0 Power Up!
• Pediatric and family practices
• Schools

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5-2-1-0Supporting Literature

• Dietary Guidelines for Americans 2005. United
  States Department of Agriculture and United
  States Department of Health and Human Services.
• Physical Activity for Children A Statement of
  Guidelines for Children Ages 5-12, 2nd Edition.
  Council for Physical Education for Children
  (COPEC) of the National Association for Sport and
  Physical Education, 2004.
• Patrick, K. et al. Diet, physical activity, and
  sedentary behaviors as risk factors for
  overweight in adolescence. Arch Pediatr Adolesc
  Med V 158, p. 385-390, 2004.
• Gable, S. et. al. Television and frequency of
  family meals are predictive of overweight onset
  and persistence in a national sample of
  school-aged children. Journal of the American
  Dietetic Association. V 107,1, p. 53-61, 2007.
• Dennison et. al. Television viewing and
  television in bedroom associated with overweight
  risk among low-income preschool children.
  Pediatrics V 109, p. 1028-1035, 2002.
• Crespo, et al. Television watching, energy
  intake, and obesity in US children. Results from
  the third national health and nutrition
  examination survey, 1988-1994. Arch Pediatr
  Adolesc Med V 155, p. 360-363. 2001.
• Giammattei, J. et. al. Television watching and
  soft drink consumption Associations with
  obesity in 11 to 13 year old schoolchildren. Arch
  Pediatr Adolesc Med V157, p. 882-886. 2003.
• Faith, MS et al. Fruit juice intake predicts
  increased adiposity gain in children from low
  income families Weight status-by-environment
  interaction. Pediatrics V118(5) p. 2066-2075,
  2006.
• Wang, YC, et. al. Estimating the energy gap
  among US children A counterfactual approach.
  Pediatrics V118(6) p. e1721-e1733, 2006.
• Malik VS et. al. Intake of sugar-sweetened
  beverages and weight gain A systematic review.
  Am J Clin Nutr V 8427488, 2006.

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The Result

• Practical recommendations
• Families
• Clinicians
• Schools
• After school programs
• Community centers, parks and recreation, etc.
• 5-2-1-0 message endorsement
• 5-2-1-0 tools for clinicians and communities
• List of resources to support recommendations

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Clinician Tools
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5-2-1-0 Survey
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Posters
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Family tools
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The Result

• Practical recommendations
• Families
• Clinicians
• Schools
• After school programs
• Community centers, parks and recreation, etc.
• 5-2-1-0 message endorsement
• 5-2-1-0 tools for clinicians and communities
• List of resources to support recommendations

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Resources

• Evidence based and promising programs
• Local and national resources promoted
• Presentation slides
• recommendations
• childhood obesity
• 5-2-1-0 message 5-2-1-0 materials
• Clinician tools, guides
• Posters
• Education handouts