REDUCING CHILDHOOD OBESITY: Public Policy And BroadBased Strategies

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REDUCING CHILDHOOD OBESITYPublic Policy
AndBroad-Based Strategies

• Philip M. Bonaparte, MD
• Chief Medical Officer
• Horizon NJ Health
• March 31, 2007

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Definitions

• Obesity
• High amount of body fat in relation to lean body
  mass, or Body Mass Index (BMI) of 30 or higher
• Overweight
• Body Mass Index between 25 and 29
• Children Overweight
• BMI is gt 95th percentile according to the age and
  gender
• Source CDC, 2005

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BMI

• Measure of a persons weight in relation to
  height
• Adults and children
• Weight in kilograms divided by the square of his
  or her height in meters.
• Source CDC, 2005

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National Center For Health Statistics

• Children
• 16 of children and teens (over 9 million) aged
  6-19 years are considered overweight
• Adults
• 65 overweight or obese
• 30 of U. S. adults 20 years of age or older (60
  million) are obese

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NJ Behavioral Risk Factor Surveillance System

• Percent
• Overweight Obese
• Overall 36.7 17.7
• Gender
• Males 47.8 18.2
• Females 26.5 17.2
• Race/ethnicity
• White, non-Hispanic 35.7 17.0
• Black, non-Hispanic 42.5 25.0
• Hispanic 38.3 19.5
• Source NJ Dept. of Health and Human Services

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Kids ROCK Program

• Kids Reaching Out to Create Healthy Kids
• HNJH Pilot Program
• 5-13 yrs old
• 3 Physician groups Husband and wife PCP, North
  Hudson Community Action and CamCare
• Children gt85th percentile
• Collaboration between Physician and HNJH Diabetes
  DM Program

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Kids ROCK Program

• Goals- No increase in weight. Make life style
  changes
• AAP Policy Statement
• CDC guidelines BMI
• Outcomes Measures- Life Style Survey. BMI changes

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Kids ROCK Program

• Member education materials
• How to Read a Food Label
• Portion Control visual scale of What is a Portion
  (uses palm of hand, thumb, fist)
• TV Zombies and Soda Monsters
• Member incentives include jump ropes, frisbees,
  H2O bottle, pedometer

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Kids ROCK Program

• Physician Support
• Reinforcement of physician education
• Encourage members to keep visits
• Link members to community resources including
  mental health, family counseling, nutritional
  education

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Kids ROCK Program

• Over 108 children registered
• Majority of children did not keep follow up
  appointments (about 90)
• Incorporated, Dancing To Your health

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Energy Imbalance

• Weight gain
• Calories consumed gt Calories used
• Weight loss
• Calories consumed lt Calories used
• No weight change
• Calories consumed Calories used

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Causes

• Poor diet
• Lack of or insufficient physical activity
• Family history
• Poor choices

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Unhealthy Nutrition

• Bigger portion sizes
• More fast foods
• Advertisements
• Encourages fast foods
• Soft drinks
• Sweets
• Sugar loaded foods like breakfast cereals

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Unhealthy Nutrition

• Large mealless cost

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Fast Foods

• McDonalds
• Calories
  Fat
• 4 pieces chicken nuggets 210c 13g
• 12 fl. Oz. Coca Cola 110c 0g
• Cheeseburger 330c 14g
• Small French Fries 210c 10g
• Cookies 2 oz bag 230c 8g
• Hot fudge sundae 360c 12g

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Fast Foods

• Calories Fat
• Cinnabon
• Classic Cinnabon Cinnamon Roll 816 32
• Pizza Hut
• 1 slice cheese pan pizza 285 14
• 1 slice cheese thinn crispy 210 9
• KFC
• Drumstick 140 8
• Mash potatoes 120 6
• Macaroni cheese 180 8
• Baked beans 190 3

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Age at first visit to McDonalds, Burger King or
Wendys
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Lack Of Physical Activity

• Fewer PA classes at school
• Lack of safe areas
• Television
• Computer
• Video games

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Childhood Obesity
Causes Effects
Type II Diabetes
Heart Disease
Social Issues
Childhood Obesity
Psychological Issues
Pediatric Hypertension
Low Self-Esteem
Stress On Joints
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Diseases And Health Conditions

• Hypertension
• Type 2 Diabetes
• Coronary heart disease
• Stroke
• Respiratory problems
• Some cancers
• Source CDC

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What Changes Are Needed?

• Teach parents and children to read labels
• Warn against the dangers of Trans Fat
• Safer neighborhoods
• Increase PE at school
• PSA campaign on Healthy Lifestyle
• Open dialogue with Fast Food Chain

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Read The Label
? Start here
? Check calories
? Quick guide to Daily Value 5 or less is
low 20 or more is high ? Limit these ? Get
enough of these
? Footnote
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When Its Time To Eat

• Offer a variety of foods
• Regular schedule
• Set a good example
• Turn OFF the TV

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Give Them Less

• Doughnut
• French fries
• Regular chips
• Soda
• Fried chicken nuggets

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Who We Need?

• Parents
• Schools
• Government
• Healthcare

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Increase Physical Activity

• Make it fun!
• 30 minutes at once or 10 minutes at a time
• Start at a moderate level and gradually increase
• Make it a family or friends activity!

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Healthy People 2010

• Reduce the prevalence of children and adolescents
  (6-19 y/o) who are overweight to 5

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Healthy People 2010

• Reduce the prevalence of obesity among adults to
  less than 15
• Reduce the prevalence of children and adolescents
  who are overweight to 5, 6-19 years old

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NJ BRFSS

• 
  Participation in physical activity
• Inactive
  Irregular Regular Regular/Vigorous
• Overall 29 27 30
  14
• Gender
• Men 27 27 33
  14
• Women 31 27
  28 15
• Age Group
• 18-64 27
  27 32 14
• 65
  35 26 22
  18
• Race/Ethnicity
• White, non-Hispanic 25
  27 31 16
• Black, non-Hispanic 29
  32 30 9
• Hispanic 40
  25 25 10
• Inactive no physical activity
• Irregular lt3times/week or lt20min/session
  
• Regular 3times/week, 20min/session,
• lt50of capacity
• Regular/Vigorous 3times/week, 20min/session,
  50of capacity

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Balance

• Physical Activity
• Improves health
• Control Body Weight
• 30 minutes
• Prevent weight gain
• 60 minutes
• Children and teenagers
• 60 minutes every day

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Serving Sizes

• Grain
• 6 oz.
• 1 slice bread, ½ cooked cereal, ½ cup cooked rice
  
• Fruit
• 1 ½ cup
• 1 cup of raw, cooked or juiced fruit
• Vegetables
• 2 ½ cups
• 1 cup of raw, cooked or juiced vegetables
• 2 cups of leafy salad greens

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Serving Sizes

• Milk
• 3 cups, 2 cups for children 2 to 8 years
• 1 cup milk or yogurt,1 ½ oz of cheese, ½ cup ice
  cream
• Meat
• 5 oz.
• 1 ounce of lean meat, poultry or fish, 1 egg, ¼
  cup cooked dry beans
• Based on a 1,800 calorie diet

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Obesity - A Global Epidemic

• Worldwide, more than a billion people, 10 of
  whom are children, are obese or overweight
• It is the sixth most important risk factor in the
  overall burden of disease
• No coordinated obesity prevention efforts

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Obesity - US

• The US has the highest rate of overweight and
  obese people
• Set to overtake smoking as the main preventable
  cause of illness and early death
• Obesity shortens life and increases the risk of
  developing heart disease and stroke, diabetes,
  arthritis and certain types of cancer

Source The Lancet Medical Journal
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Risk Lack of Parental Concern

• Many healthcare providers assume that parents are
  eager to make changes to help their children lose
  weight
• Not all parents open to making lifestyle changes
  even if they could help their overweight children
  shed pounds
• Of 151 parents studied, 44 of parents were not
  planning on making lifestyle changes any time soon

Source Pediatrics, July 2005
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Risk Lack of Parental Concern

• Parents more open to change if they viewed
  themselves as overweight
• Study included mostly African American and
  Hispanic families seen at a Philadelphia
  pediatric practice
• The children were between the ages of 2 and 12,
  and all were either overweight or at risk of
  becoming so