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NH Childhood Obesity Project

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Title: NH Childhood Obesity Project


1
NH Childhood Obesity Project
  • Shawn V. LaFrance, MS, MPH
  • Foundation for Healthy Communities
  • Changing the Scene Conference March 23, 2007

2
Foundation for Healthy Communities
  • Mission improve health and health care in New
    Hampshire
  • Quality of care
  • Access to care
  • Community health
  • Partnerships include hospitals, clinicians,
    health plans, home care agencies, public policy
    officials, etc.

3
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4
The Problem Related Conditions
  • Type 2 Diabetes
  • Atherosclerosis
  • High Cholesterol
  • Sleep Apnea
  • Fatty Liver disease
  • High Blood Pressure
  • Depression
  • Gallbladder disorders
  • Skeletal disorders
  • Eating disorders

5
NH Childhood Obesity Survey
  • Objective Document the prevalence of childhood
    obesity among children ages 6-12 yrs old
  • Approach Convenience sample from 25 primary care
    sites statewide
  • 1,453 medical records

6
NH Childhood Obesity Survey
  • Methodology
  • 50/50 split x gender
  • 65 records/practice
  • 6-9 yrs 35 and 10-12 yrs 30
  • well child visits in 2005
  • 2 yrs in the practice

7
Defining Obesity
  • BMI kg/m2 wt in lbs/ ht² in inches x 703
    (calculate and plot on chart)
  • Terminology is not standardized
  • AAP and CDC recommends
  • 85-95 at risk for overweight
  • 95 overweight
  • Many (including the American Obesity Assoc.) use
    BMI 85 - 95 overweight and BMI95 obese

8
Prevalence
9
Prevalence
10
Insurance Status
11
Documented Diagnosis
12
Documented Diagnosis
13
Practice Location
14
Physical Activity
15
Diet
16
Other Assessments
17
An epidemic
  • 2003-2004 NHANES 17.1 of US children (6-19 yo)
    are obese with BMI 95.
  • Obesity increased from 13.8 to 16 in girls and
    from 14 to 18.2 in boys since the 1999-2002
    survey.
  • 37 of children (ages 6-11yo) and 34 of teens
    (ages 12-19) are overweight (BMI of 85-95).

18
Do obese kids obese adults?
  • Chance of obese child becoming obese adult
    increases from 20 at age 4 to 80 by
    adolescence.
  • Obese adults who were obese as children have
    higher BMIs than obese adults who were normal
    weight as children.
  • Whitaker et al NEJM. 1997337869-873
  • Schwarzndberg S, MinnMed. 200562-66

19
Costs of Obesity
  • Annual hospital costs related to childhood
    obesity rose from 35 million in 1979-1981 to
    127 million from 1997-1999
  • The number of days spent in the hospital doubled
    during that same time period.
  • CDC National Hospital Discharge Survey (NHDS)

20
Root Causes of Obesity
  • American Heart Association (July 2006) issued
    Scientific Statement on Diet and Lifestyle. This
    document identified large portions and
    inexpensive fast foods as major causative factors
    in our current obesity epidemic.
  • Circulation July 2006

21
FRENCH FRIES
20 Years Ago
Today
210 Calories 2.4 ounces
610 Calories 6.9 ounces
How many calories are in these fries?
Calorie Difference 400 Calories
How to burn 400 calories   Walk 2 hr 20 Minutes
Based on 130 pound person
22
Television
  • Incidence of obesity is highest in children
    watching TV4 hours/day
  • Incidence of obesity is lowest in children
    watching TV
  • Kids watch 1,023 hrs/yr (Neilsen 2000)
  • Rate of obesity 8X greater if a child watchs TV
    5hrs/d
  • 25 American kids watch 4hrs/d
  • TV in bedroom increases odds of overweight by
    additional 31 for every hour watched
  • 57 of children 8-16 have TV in BR
  • Dennison et al. Pediatrics 20021091028-1035,
    Ridout et al. Henry J Kaiser Family
    Foundation. 2003 Pediatrics 2003
    112(2)424-430, Crespo et alArch Ped Adol Med,
    155360-365

23
Diet-restaurants
  • Increased eating out from 16 to 29 from
    1977-1995
  • By mid 1990s Americans eating 23 meals/month out
    with 8 of 23 from fast food restaurants
  • USDA survey in 1995 showed school age kids get
    40 of calories out of home.
  • USDA data from NCFS 1977-78 and CSFII 1994-95

24
Environment Matters
  • American Heart Association notes that the
    environment has a powerful influence on whether
    people consume excess calories and follow a
    healthy diet.
  • Walking has decreased by 40 in adults and by 60
    in children since 1977
  • Decreased playing outside due to increased
    traffic and crime.
  • Innovations lead to decreased activity
  • Remotes, garage door openers, escalators
  • Convenience foods
  • US Dept Transportation Bureau of Transportation
    Statistics, JNHTS 2001 Highlights report,
    BTS03-03

25
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26
Recommendations from the New Hampshire Childhood
Obesity Expert Panel
Preventing Childhood Obesity Promoting
physical activity healthy eating
April 2007
Beth Gustafson Wheeler, MS Changing the Scene
Conference March 23, 2007
27
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

28
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
29
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

30
National Recommendations
  • Institute of Medicine
  • US Surgeon General
  • American Academy of Pediatrics

31
National Recommendations
32
Whose responsibility is it?
33
Its not easy
34
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.

35
Causes of Overweight Obesity
Kaiser REGIONAL HEALTH EDUCATION
36
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

37
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

38
Its not easy
39
Make it easier to do better
  • Make it practical
  • Simple, easy message
  • Tools and resources
  • Evidence based and promising practices

40
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

41
Small Steps
  • Pick the low hanging fruit
  • Build from there!

42
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
  • Talk to pediatrician

43
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

44
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

45
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.

46
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

47
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.)

48
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
  • Physical education 50 class time being active

49
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

50
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

51
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

52
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.

53
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

54
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 healthy snack policy.

55
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
  • Substitute non-educational screen time with
    activity programs.
  • Promote programs to schools, pediatricians,
    community organizations.

56
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

57
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

58
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

59
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60
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61
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

62
5-2-1-0Supporting Literature
  • 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.

63
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

64
Clinician Tools
65
5-2-1-0 Survey
66
Posters
Draft designed by Square Spot Design
67
Family tools
68
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

69
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

70
Community Prevention and Treatment
InitiativeChildhood Obesity Project
  • Aims to bring communities together to collaborate
    on developing coordinated strategies for the
    prevention and treatment of childhood obesity.
  • Clinical practice interventions
  • Community strategies

71
The CPTI Model
72
Community Prevention and Treatment
InitiativeChildhood Obesity Project
  • 3 pilot communities
  • Nashua
  • North Conway
  • Derry/Londonderry
  • Guiding documents
  • NH Childhood Obesity Prevention recommendations
  • Evidence-based and promising practices
  • Local assessments

73
Summary
  • Focus on health, not weight.
  • It takes a community effort.
  • Partner with others in your community.
  • Small changes can help get you started but build
    from there.

74
Questions?
  • For more information contact
  • Beth at Bwheeler_at_healthyNH.com
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