Addressing Childhood Obesity:

1

• Addressing Childhood Obesity
• Fit Kids are Smart Kids
• Thompson School Distict Wellness Workshop
• Eduardo Sanchez, MD,MPH,FAAFP
• Vice President and Chief Medical Officer
• BlueCross and BlueShield of Texas
• September 28, 2009

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Start with the conclusion

• Fit Kids are Smart Kids
• Smart kids graduate from high school
• High school graduates (with some additional
  education) live healthier and value education
• High school graduates have fit, smart kids

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The Childhood Obesity Epidemic

• 16.3 of children and adolescents are obese in
  U.S. (one in six)
• Obesity rates have tripled in the last 30 years
• While all children are increasingly obese, the
  poor, African Americans, Latinos, American
  Indians, and Pacific Islanders are
  disproportionately more overweight and obese.

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The Childhood Obesity Epidemic
SOURCE CDC, NHANES
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Prevalence of BMI gt 85 in Boys(Ogden,2008,
JAMA, 299(20), 2401-2405.)
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Prevalence of BMI gt 85 in Girls(Ogden,2008,
JAMA, 299(20), 2401-2405.)
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Colorado Health Survey (2004)

• 14 percent of Colorado children ages 2-14 were
  overweight
• 15 percent of Colorado children ages 2-14 were
  obese
• Obesity is more prevalent among poor children and
  non-White children.

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F as in fat 2009 (2007 National
Survey of Childrens Health)

• 27.2 percent of Colorado children ages 10 - 17
  were overweight and obese
• 27.6 percent of Colorado children ages 6-17
  participate in vigorous physical activity every
  day

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Consequences of Childhood Obesity

• May reduce life expectancy
• More likely to develop hypertension, type-2
  diabetes, and high cholesterol
• Reduced quality of life
• Higher medical expenses
• Higher risk of adult obesity

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Creating Healthy Environments

• Children and parents need healthy environments to
  make healthy choices
• Many children live in places where the unhealthy
  choice is the easy choice

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Child population percentages by race in Colorado

• Race 2003 2004 2005 2006 2007
• Non-Hispanic White 64 63 62 62 61
• Non-Hispanic Black 4 4 4 4 4
• Non-Hispanic Asian 2 2 2 2 3
• Non-H 2 or More Races 3 3 3 3 3
• Hispanic or Latino 26 26 27 28 28
• Source Kids Count Data Center

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Colorado Students Qualifying for Free or Reduced
Price Lunch by School District (percent)

• Poverty level 2000 2003 2007
• Eligible for Free Lunch 20 24 27
• Eligible for Reduced Price Lunch 7 6 7
• Total 27 30 34
• Source Kids Count Data Center

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Colorado High School Graduation Rates by Race
(percent)

• Race 2007
• Black Students 65.4
• Native American Students 58.9
• Asian Students 83.5
• Hispanic Students 57.1
• White Students 82.1
• Source Kids Count Data Center

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Causes of Death, United States 2005
26.6
Diseases of the heart
22.8
All cancers
5.9
Stroke
5.3
Chronic lower respiratory disease
4.8
Unintentional injuries
Diabetes mellitus
3.1
Alzheimers disease
2.9
Influenza and pneumonia
1.8
1.4
Septicemia
0
9
18
27
36
Source cdc.gov
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Underlying Causes of Death, U.S. 2000
Source Mokdad A, Marks JS, Stroup DE, Gerberding
JL. Actual causes of death in the United States.
JAMA 2004 291(10)1238-1245. Correction
published JAMA 2005 293(3) 293-294.
16
The Preventable Causes of Death in the United
StatesComparative Risk Assessment of Dietary,
Lifestyle, and Metabolic Risk Factors
(Danaei,2009)
Deaths attributable to individual risk
(thousands) in both sexes
17
Age adjusted death rates among 25-64 year olds
(per 100,000) by educational attainment (2005)
CDC
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Age adjusted death rates among 25-64 year olds
(per 100,000) by educational attainment (2005)
CDC
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Trends in U.S. Smoking High School Seniors and
Adults (19652004)
DSHS
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Three Disturbing Trends
Obesity and Diabetes CDC NHANES
Expenditures CMS, Health 2004
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The cost of obesity

• Medical costs related to obesity in America in
  2008 may be as high as 147 billion.
• Average annual medical costs
• Health weight - 3400
• Obese - 4900

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Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 20
23
Obesity Trends Among U.S. AdultsBRFSS, 2003
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
24
Obesity Trends Among U.S. AdultsBRFSS, 2008
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
30
25
Low Obesity Prevalence, BRFSS, 2007

• Colorado 18.7
• Connecticut 21.2
• Massachusetts 21.3
• Vermont 31.3
• Hawaii 21.4
• Rhode Island 21.4

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2007 National Diabetes Facts

• Race and ethnic differences in prevalence of
  diagnosed diabetes
• 6.6 of non-Hispanic whites
• 7.5 of Asian Americans
• 10.4 of Hispanics
• 8.2 for Cubans
• 11.9 for Mexican Americans
• 12.6 for Puerto Ricans
• 11.8 of non-Hispanic blacks

CDC government
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Two possible futures

• Scenario one
• Overweight or obese middle and young adults
  competing with elderly baby boomers for limited
  health resources

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Two possible futures

• Scenario two
• Healthy Çoloradoans eating smart, being active
  and reducing the demand for expensive health
  resources

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Obesity Prevalence Among 4thGrade Texans
2000-2002
2004-2005
Obesity is gt 95th Percentile for BMI by Age/Sex
4th Grade Prevalence of Overweight by Health
Service Region, SPAN, 2000-2002 to 2004-2005
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What Caused the Decrease in Overweight Among 4th
Graders in Regions 9 10?

• Paso del Norte Health Foundation
• CATCH initiative
• 8 years
• Resources, support
• Qué Sabrosa Vida
• Walk El Paso
• Legislation
• Senate Bills 19, 42, 530
• Other Policies
• Texas Public School Nutrition Policy

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Average BMI
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Why the difference?

• Higher PE time in EP 14-22 min/week
• Higher PE time in EP 60 min/week
• Higher MVPA 10
• Higher adoption CSHP 25
• Higher district central planning 20
• 5 year, 10 million investment by Paso del Norte
  Health Foundation CATCH funding ended in 2005

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But theres more

• Not only does CATCH improve diet, physical
  activity and obesity, but Texas researchers have
  documented significant improvements on Stanford
  Achievement test scores.
• Among a group of predominantly poor, Latino
  elementary school students, the CATCH classroom
  physical activity intervention produced
  significant increases in achievement in math
  problem-solving.
• Among children identified as not adapting well to
  school, CATCH produces significant improvements
  in Stanford Math and Reading scores.
• Personal communication Dr. Nancy Murray,
  University
• of Texas, School of Public Health.

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Texas Education Agency Releases FITNESSGRAM
Results

• Released by the TEA - March 9, 2009 AUSTIN
• A first-of-its-kind study of more than 2.4
  million Texas students found that students who
  are physically fit are
• More likely to do well on the state's
  standardized tests
• More likely to have good school attendance
• Less likely to have disciplinary referrals

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National and Arkansas Childhood Obesity Trends
NHANES data sources Ogden et al. Prevalence and
Trends in Overweight Among US Children and
Adolescents, 1999-2000. JAMA 2002288(14)1728-173
2. Ogden et al. Prevalence of Overweight and
Obesity in the United States, 1999-2004. JAMA
2006295(13)1549-1555.
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UAMS College of Public Health Evaluation of Act
1220 (2006)

• Parents awareness of obesity-related health
  problems increased (1/3 recognized problem gt2/3)
• 95 of parents read some or all of the Child
  Health Report and 67 found the report helpful
• No feared consequences of BMI measurements
• Measurable change occurring
• Families reducing consumption of chips, soda,
  sweets
• Younger children reducing soda consumption
• Teens reducing vending purchases at school
• Teens increased amount of physical activity
• No increase in physical education time
• Innovations in schools and communities across the
  state - taste tests in cafeterias, curriculum
  changes
• Parental support of improved cafeteria options

Fay W. Boozman College of Public Health Year Two
Evaluation Arkansas Act 1220 of 2003 to Combat
Childhood Obesity. http//www.uams.edu/coph/repor
ts/Act1220Eval.pdf. Accessed 27 March, 2006
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MEND
Mind Exercise Nutrition Do it!
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Mission
To enable a significant, measurable and sustained
reduction in overweight and obesity

• We partner across sectors to achieve this
  mission
• Foundations / Third sector
• Academia
• Companies
• Government

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A cost-effective solution

• Not only a high-quality out-of-school program
• Low staff/child ratio (typically 110)
• High participation rates (gt70)
• Highly qualified staff (4-day training)
• Also an evidence-based child obesity intervention
  proven to reduce BMI and waist circumference
• Cost-effective first-line community prevention
  and treatment
• 350 - 750 per family / program
• Meets Wallace Foundation Jan 09 Report
  criteria
• depends on volume to achieve economies of scale

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1st UK RCT results a foundation for healthy
living
n104-82, 57 girls, 52 Caucasian, mean age
10.1, mean BMI z-score 2.8, 63.5 manual /
unemployed
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How will TSD prevent and reverse childhood
obesity in its schools?

• Good food (healthy, green, just, and affordable)
  most of the time
• Science-based dietary guidelines for all foods in
  schools
• Fresh fruits and vegetables
• Universal school breakfast/lunch
• Farm to School
• School gardens
• Classroom teaching about good eating
• 30 minutes per day physical activity in schools
  HHS guidelines released 2009
• Universal coordinated school health programs
• No child left behind 100 high school
  graduation

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TSD Employee Wellness

• Potential Benefits of School Employee Wellness
  Programs
• Decreased employee absenteeism
• Lower health care and insurance costs
• Increased employee retention
• Improved employee morale
• Fewer work-related injuries
• Fewer worker compensation and disability claims
• Attractiveness to prospective employees
• Positive community image
• Increased productivity
• Increased motivation to teach about health
• Increased motivation to practice healthy
  behaviors
• Healthy role models for students

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How will Loveland reduce childhood obesity ?

• Develop and standardize health/nutrition
  guidelines for FNS/SNAP/WIC
• Summer food programs for eligible children
• Community access to good food healthy, green,
  just, and affordable
• Water over soda
• No child left inside
• Community access to recreation facilities
  playgrounds, parks, trails
• Walkable communities sidewalks, lighting, and
  traffic calmimg

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The Role of Local Government

• Local government is uniquely positioned to create
  healthy environments for children
• Already experienced in promoting childrens
  health
• Already have jurisdiction of many aspects of
  daily life

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Health Equity

• Health equity is the fair distribution of health
  determinants, outcomes, and resources within and
  between segments of the population, regardless of
  social standing1
• Many individuals do not have the resources or
  opportunities to eat more fruits and vegetables
  and be more physically active.
• Local governments can change peoples
  environments to provide equal access to factors
  that determine health

1CDC Health Equity Working Group
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12 Most Promising Action Steps

• Attract supermarkets and grocery stores to
  underserved neighborhoods
• Require menu labeling in chain restaurants
• Mandate and implement strong nutrition standards
  for foods and beverages in government-run or
  regulated after-school programs

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12 Most Promising Action Steps

• Adopt building codes to require access to, and
  maintenance of water fountains
• Implement a tax strategy to discourage
  consumption of foods and beverages that have
  minimal nutritional value
• Develop media campaigns to promote healthy eating
  and active living

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12 Most Promising Action Steps

• Plan, build, and maintain a network of sidewalks
  and street crossings that creates a safe and
  comfortable walking environment and that connects
  to destinations
• Adopt community policing strategies that improve
  safety and security of streets and parks
• Develop and implement a Safe Routes to School
  program

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12 Most Promising Action Steps

• Build and maintain parks and playgrounds that are
  safe and attractive for playing, and close to
  residential areas
• Establish joint use of facilities agreements
  allowing playing fields, playgrounds, and
  recreation centers to be used when schools are
  closed
• Institute policies mandating minimum play space,
  physical equipment, and duration of play in
  preschool, after-school, and child-care programs