When meditating about a disease, I never think of finding a remedy for it but rather a means of prev

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When meditating about a disease, I never think
of finding a remedy for it but rather a means
of preventing it. Louis
Pasteur
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Give Children a Running Start Child Health and
Obesity

• 2009 National Smart Start Conference
• May 8, 2009

Jacqueline Quirk, RN, BSN Suzanne Todd, BSE,
MM NC Child Care Health and Safety Resource
Center www.healthychildcarenc.org
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Objectives

• Participants will
• Learn about childhood obesity
• Learn about health risks associated with
  childhood obesity
• Understand how food and physical activity affect
  healthy weight
• Learn how child care facilities can support
  childrens nutrition and physical activity

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Activity
Excess Baggage
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Defining Overweight and Obesity

• Labels for ranges of weight greater than what is
  considered healthy for a given height.
• Ranges of weight that increase the risk of
  certain diseases and other health problems.

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Body Mass Index (BMI)

• BMI is a measure of body fat based
  on height and weight
• Adult BMI 18-24.9 Normal
• BMI 25-29.9 Overweight
• BMI gt 30 Obese
• Children BMI 85th lt95th percentile
  Overweight
• BMI 95th percentile for age Obese
• BMI 99th percentile Extreme
  Obesity
• http//www.cdc.gov/growthcharts/

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Body Mass Index (BMI)

• BMI is used to assess level of body fat in
  children older than two years of age. 
• BMI ranges for children and teens consider
• normal differences in body fat between boys
  and girls
• differences in body fat at various ages

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Childhood obesity has reached epidemic
proportions.

• Nationally, more than one third of children and
  youth are overweight and 17 are obese.
• Approximately 25 million children and youth are
  obese or overweight. The rate of childhood
  obesity more than tripled from 1980 to 2004.
• Trust for Americas Health. F as in Fat How
  Obesity Policies are Failing in America, 2007.
  Washington, D.C. Trust for Americas Health 2007.

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BMI for Age Percentiles Boys, 2-20 years of age
3
10
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BMI for Age Percentiles Girls, 2-20 years of age
3
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Obesity Trends Among U.S. AdultsBRFSS, 1990,
1998, 2007
(BMI ?30, or about 30 lbs. overweight for 54
person)
1998
1990
2007
No Data lt10 1014
1519 2024 2529
30
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Prevalence of Overweight in ChildrenBMI-for-Age
-Percentiles

• Obese
  Overweight 1971-1974 2003-2006
  2003-2006
• 2-5 years 5.0 12.4 24.4
• 6-11 years 4.0 17.0 33.3
• 12-19 years 6.1 17.6
  34.1

8165 children from NHANES. Ogden CL, et al.
JAMA 2008 2401-2405.
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Association Between BMI in Childhood and
Adulthood(Bogalusa Heart Study)

• 2617 subjects 2 17 years of age
• Re-examined at 18 37 years
• 186 children with BMI 95th percentile
• 144 (77) were obese as adults
• 1317 normal weight children
• 92 (7) became obese as adults
• Freedman DS et al. Pediatrics 2001108712-718.

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Complications of Obesity

• Cardiovascular
• Metabolic
• Pulmonary
• Skeletal

• Liver
• Kidney
• Reproductive
• Psychological

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Is Obesity A Disease?

• 65 of obese 5-10 year old children have at
  least one cardiovascular disease risk factor
• 25 of obese 5-10 year olds have
  two or more risk factors
• Dietz WH. J Pediatr 1999134535-536.

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Obesity in ChildrenAges 2-5 years old
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North Carolina

• 5th highest rate in 2007
• of obese children in the nation
• Trust for Americas Health. F as in fat how
  obesity policies are failing in America, 2007.
  Washington, DC Trust for America's Health 2007.
  http//www.healthyamericans.org. Accessed
  February 19, 2008.

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NC Childhood Overweight Data
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Overweight Children by Age, Hispanicity, and Race
White Black Amer Indian Asian Hispanic Total
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11/11/2009
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19
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Contributing Factors for Childhood Overweight and
Obesity

• Behavioral Factors
• Environmental Factors
• Genetic Factors

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Contributing Factors cont.

• Behavioral Factors
• ? Change in quality and quantity of food
• ? Decrease in childrens physical activity
• ? Increase in sedentary behavior

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Children and Television

• The average child or adolescent watches 3 hours
  of television per day.
• 32 of 2-7 year olds and 65 of children 8-18
  have TVs in their bedrooms.
• Committee on Public Education. Pediatrics
  2001107423-426.

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Crespo CJ et al. Arch Pediatr Adolesc Med 2001
155360-365.
Obesity rate
Time Spent Watching Television(hrs/day)
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Advertising Directed at Children

• 10 food commercials/hr of TV time
• 10-12 billion/yr spent on food and
  beverage ads
• 80 of food ads are for sugary
  cereals, candy, soft drinks, and fast food
• 2 of food ads are for fruits and vegetables
• Toys used to promote food sales
• Borzekowski D, Robinson T. J Am Diet Assoc
  2001101.

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Contributing Factors cont.

• Environmental Factors
• ? At Home
• ? At Child Care
• ? In the Community

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Contributing Factors cont.

• Genetic Factors
• ? May increase susceptibility
• ? Exists with behavior and environmental factors

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Consequences ofChildhood Overweight and Obesity

• Health Risks
• Psychosocial Risks
• Economic Costs

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Consequences cont.

• Health risks
• Heart disease
• high cholesterol and/or
• high blood pressure
• Type 2 diabetes
• Asthma
• Sleep apnea

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Consequences cont.
Psychosocial risks

• Social discrimination
• Low self-esteem
• Depression
• Lower academic functioning
• Lower social functioning

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Consequences cont.

• Economic Cost
• Increase in medical expenses
• Reduction in economic opportunity / productivity
• Time lost from work or school
• Increase in child care costs
• Annual cost to NC taxpayers gt 2.1 billion. US
  annual cost is 92 billion.

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Activity
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Available from www.mypyramid.gov/kids/index.html
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The Portion Plate for Children
veggies
The Portion Plate for Adults
http//www.theportionplate.com/index.html
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Healthy Weight Strategies

• Balance calories
• Support breastfeeding in child care.

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Healthy Weight Strategies cont.

• Balance calories
• Provide plenty of vegetables, fruits, and
  whole-grain products.
• Include low-fat or non-fat milk and dairy
  products. (Whole milk for children under 2)
• Serve lean meats, poultry, fish, lentils, and
  beans for protein.
• Encourage children to drink lots of water.

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Healthy Weight Strategies cont.

• Limit empty-calories food
• Limit sugar-sweetened beverages. Serve 100
  juice, 1 serving a day.
• Limit consumption of sugar and saturated fat.
• READ THE LABEL.

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Activity
Available at www.agr.state.nc.us/cyber/kidswrld/nu
trition/Labels.htm Nutrition Facts Label
http//www.cfsan.fda.gov/acrobat/nutfacts.pdf
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Strategies for Physical Activity

• Schedule 60 minutes each day
• Plan for moderate to vigorous active play
• Encourage outdoor activities
• Movement
• Loose parts
• Stationary equipment
• Landscaping

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Strategies for Physical Activity cont.

• Indoor activities
• Movement
• Props
• Room arrangement

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Benefits of Physical Activity

• Benefits
• Helps maintain healthy weight
• Develops motor skills
• Strengthens bones
• Decreases blood pressure
• Hidden benefits
• Reduces stress and anxiety
• Increases self-esteem

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Nutrition and Physical Activity Programs in North
Carolina

• Eat Smart, Move More
• NAP SACC
• Color Me Healthy
• Be Active Kids
• I Am Moving, I Am Learning

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Eat Smart, Move More

• NC initiative that promotes increased
  opportunities for physical activity and healthy
  eating through policy and environmental change.
• www.eatsmartmovemorenc.com
• Find information on preschool programs.
• Find out what people are doing in their
  communities.
• Find resources for adults.

Moving Our Children to a Healthy Weight
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5 3 2 1 - Almost None
Involve entire family in lifestyle change
5 or more servings daily of fruits and
vegetables 3 structured meals a day
eat a healthy breakfast, less fast food,
and more meals prepared at home 2 hours
or less of screen time No more than 2 times
dining out per week 1 hour of moderate to
vigorous physical activity daily
Almost None Limit sugar sweetened drinks
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NAP SACC
N nutrition A and P physical activityS selfA
assessment for C child C care
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5 Step Program

• Self-Assessment
• 2. Action Planning/Goal Setting
• 3. Workshop Delivery
• 4. Targeted Technical Assistance
• 5. Evaluate, revise and repeat

CCHC or RD trained in NAP SACC provide
education, TA and support for child care
programs.
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Smart Start and NAP SACC

• NCs childhood overweight and
  obesity epidemic
• Smart Starts support of nutrition
  and physical activities
• Smart Starts commitment to
  CCHC projects
• NAP SACCs research and evaluation data
• NAP SACCs strong support and commitment

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Color Me Healthy

• Used in family child care homes,
  
• Head Start, and child care centers with children
  ages 4 and 5.
• Materials include fun, interactive learning
  opportunities on physical activity and healthy
  eating.
• Materials available to child care providers,
  after participation in training.
• www.colormehealthy.com

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Be Active Kids

• Innovative, interactive physical activity,
  nutrition, and food safety curriculum
• For children ages 4 and 5
• Develops positive physical activity and nutrition
  habits
• Materials available to child care providers,
  after participating in training
• www.beactivekids.org

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I Am Moving, I Am Learning

• Increase quantity of time spent in moderate to
  vigorous physical active during daily routines
• Improve the quality of structured movement
  experiences intentionally facilitated by teachers
  and adults
• Improve healthy nutrition choices for children
  every day

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Time Magazine August 19, 2002
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Questions?
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One minute evaluation

• What did I learn about child care and childhood
  overweight and obesity?

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Think, Pair and Share

• What tip
• for improving nutrition and physical activity
  will you take home to your programs?

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Nutrition and Physical Activity Internet
Resources

• National Resources
• Nutrition.Gov
• www.nutrition.gov
• National Network for Child Care (NNCC)
• Nutrition Diet
• http//cyfernet.ces.ncsu.edu/cyfdb/browse_2.php?se
  archNNCC
• United States Dept. of Agriculture (USDA)
• www.usda.gov
• President's Council on Physical Fitness and
  Sports
• www.fitness.gov
• Food and Nutrition Information Center
• www.nal.usda.gov/fnic
• USDA Center for Food Safety and Applied
  Nutrition.

• MyPyramid
• mypyramid.gov
• KidsHealth. Nutrition and fitness information.
• http//kidshealth.org/parent/nutrition_fit/index.h
  tml
• American Dietetic Association
• www.eatright.org
• Healthy Meals Resource Center (HMRC)
• www.nal.usda.gov/childcare
• USDA Child and Adult Care Food Program (CACFP)
• www.fns.usda.gov/cnd/care/cacfp/cacfphome.htm
• Centers for Disease Control and Prevention, Div.
  of
• Nutrition, Physical Activity and Obesity
• http//cdc.gov/nccdphp/dnpa/
• National Child Care Information and Technical

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Nutrition and Physical Activity Internet
Resources

• North Carolina Resources
• Fit Together North Carolina
• http//www.fittogethernc.org/
• NC Nutrition Services Branch
• www.nutritionnc.com
• Eat Smart, Move More NC is a statewide initiative
  that
• promotes increased opportunities for physical
  activity and
• healthy eating. They provide simple solutions on
  how you
• can eat smart and move more and a free monthly
  newsletter
• with tips and ideas at www.eatsmartmovemorenc.com.
  
• Nutrition and Physical Activity Self-Assessment
  for
• Child Care (NAP SACC) Program is an intervention
  in child
• care centers with the goal of improving nutrition
  and physical
• activity practices and policies that impact
  children between
• the ages of 2 and 5. www.napsacc.org

• Resources for Children
• Oregon Museum of Science and Industrys
  Nutrition
• and Fitness Exhibits
• www.omsi.edu/everybodyeats/
• Fruit and Veggie Color Champions
• www.foodchamps.org/
• Additional Physical Activity Resources
• Extension Service, Iowa State University of
  Science
• and Technology
• Growing Up Fit Preschool Fitness Activities
• www.extension.iastate.edu/Publications/PM1359B.pdf
  
• We Can!
• Ways to Enhance Children's Activity Nutrition"
  is a

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Nutrition and Physical Activity Internet
Resources

• Additional Nutrition Resources
• The Food Allergy and Anaphylaxis Network
• www.foodallergy.org
• University of Idaho
• Feeding Young Children in Group Settings
• www.ag.uidaho.edu/feeding/index.htm
• La Leche League International Breastfeeding
  information
• www.lalecheleague.org
• Centers for Disease Control and Prevention
• Breastfeeding information
• www.cdc.gov/breastfeeding/index.htm
• USDA Healthy Meals Resource System
• Menu Planning Guide for Child Care Homes - Menu
  Magic
• for Children

• MCH Knowledge Path
• Overweight and Obesity in Children and
  Adolescents
• Knowledge Path
• www.mchlibrary.info/KnowledgePaths/kp_overweight.h
  tml
• Nutrition in Children and Adolescents Knowledge
  Path
• www.mchlibrary.info/KnowledgePaths/kp_childnutr.ht
  ml

NC Child Care Health and Safety Resource
Center 1-800-367-2229 Jackie Quirk, Project
Coordinator 919-807-3003 Jackie_Quirk_at_unc.edu Suz
anne Todd, Child Care Training and Data
Specialist 919-807-3004 Suzann
e_Todd_at_unc.edu