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Preventing Childhood Obesity:

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Foods available contribute to major food groups of food guide pyramid ... Refrain from using food as a reward/discipline ... tools, guides. Posters. Education ... – PowerPoint PPT presentation

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Title: Preventing Childhood Obesity:


1
Recommendations from the New Hampshire Childhood
Obesity Expert Panel
Preventing Childhood Obesity Promoting
physical activity healthy eating
April 2007
2
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

3
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
4
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

5
National Recommendations
  • Institute of Medicine
  • US Surgeon General
  • American Academy of Pediatrics

6
National Recommendations
7
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

8
Its not easy
9
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.

10
Causes of Overweight Obesity
Kaiser REGIONAL HEALTH EDUCATION
11
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

12
Its not easy
13
Make it easier to do better
  • Make it practical
  • Simple, easy message
  • Tools and resources
  • Evidence based and promising practices

14
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

15
Small Steps
  • Pick the low hanging fruit
  • Build from there!

16
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

17
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

18
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

19
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.

20
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

21
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.)

22
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

23
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

24
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

25
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

26
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.

27
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

28
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.

29
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.

30
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

31
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

32
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

33
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34
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35
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

36
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.

37
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

38
Clinician Tools
39
5-2-1-0 Survey
40
Posters
41
Family tools
42
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

43
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
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