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Reducing Childhood Obesity: The Role of Schools


Institute of Medicine Endorses BMI Reporting ... BMI or health information collected in 16 states. 12 states have passed legislation enabling schools to test ... – PowerPoint PPT presentation

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Title: Reducing Childhood Obesity: The Role of Schools

Reducing Childhood Obesity The Role of Schools
  • Patrice Isabella, MS, RD
  • Utah Department of Health
  • November 2, 2007

  • Why collect height and weight data in schools,
    national trends
  • Update on strategies for obesity prevention
  • Expert Committee, 2007
  • Utah Blueprint, 2006
  • What can you do?

Surveillance Systems
  • Pediatric Nutrition Surveillance System, CDC
  • All WIC participants, 0-5
  • Good accuracy
  • Youth Risk Behavior Survey
  • Adolescents
  • Self-report, questionable accuracy
  • Behavioral Risk Factor Surveillance System, CDC
  • Self-report, adults

NHANES Prevalence of overweight among children
and adolescents (6-19 years)
National Public Health Priority
  • Healthy People 2010 Goal
  • Objective 19.3 Reduce the proportion of
    children and adolescents who are overweight or
    obese to 5 of the population.
  • Institute of Medicine
  • Prevention of childhood and youth obesity should
    be a national public health priority

Who Else Cares?
  • Consensus Statements/Reviews Recommending School
    Efforts (75)
  • Institute of Medicine, 2005
  • American Academy of Pediatrics, 2003
  • National Institutes of Health, 2003
  • National Association of State Boards of
    Education, 2006
  • Centers for Disease Control and Prevention, 2005
  • National Governors Association, 2006

Institute of Medicine Endorses BMI Reporting
  • Recommends that schools measure each students
    weight, height, and gender- and age-specific BMI
    percentile each year and
  • Make the information available to parents and
    also to the students when age-appropriate.
  • Concerns student data must be collected and
    reported validly and appropriately, with
    attention to privacy concerns and with
    information on referrals available if follow-up
    health services are needed.

Why collect measurements in schools?
  • Many youth lack health insurance and may not
    receive regular medical care
  • Allows preventive measures to be available to all
    families at no cost

States With BMI Policies/Mandates
  • School Health Policy and Programs Study, 2006
  • Has your state adopted a policy stating that
    districts or schools will screen for height and
    weight of Body mass problems?
  • 11 States responded Yes
  • Arkansas, DC, Florida, Illinois, Massachusetts,
    Montana, Nevada, New Jersey, Pennsylvania,
    Tennessee, West Virginia

BMI or Health Information Collected in States
  • Trust for Americas Health, report released
    August 2007
  • Examined legislation, rules
  • BMI or health information collected in 16 states
  • 12 states have passed legislation enabling
    schools to test students BMI levels
  • 2 States have enacted legislation requiring
    screening students at risk for Type II diabetes
    (California, Illinois)

Information Collected in States
  • BMI measured/collected (9 states) and report to
    parents (6 states)
  • Aggregate data only (1 state)
  • Assess fitness, BMI optional (2 states)
  • Growth and development screening, BMI encouraged
    (1 state)
  • Student measurements as part of a pilot program
    (2 states)
  • BMI collected voluntarily from students (1 state)

Expert Committee, 2007
  • Expert Committee Recommendations on the
    Assessment, Prevention, and Treatment of Child
    and Adolescent Overweight and Obesity (June 2007)
  • Full expert committee papers to be released in
    supplement to Pediatrics late fall of 2007

Behaviors for Obesity Prevention
  • Evidence supports consistent
  • Limit sugar sweetened beverages
  • Limit television and screen time
  • Keep televisions out of childrens bedrooms
  • Encourage moderately vigorous physical activity
    of 60 minutes a day or more

Behaviors for Obesity Prevention
  • Evidence supports mixed
  • Breastfeed
  • Consume recommended fruits and vegetables
  • Eat daily breakfast
  • Limit fast food
  • Use appropriate portion size
  • Avoid restrictive eating practices
  • Eat meals together as a family

Behaviors for Obesity Prevention
  • Expert Committee suggests
  • Avoid excessive fruit juice
  • Balance fat, carbohydrate and protein
  • Consume a diet rich in calcium

Recommendations - Assessment
  • Assess weight at least annually on all children
    using BMI-for-age
  • New classification for cutoffs, consistent with
    adult classification
  • Overweight BMI-for-age 85-94 ile
  • Obese BMI-for-age 95th ile
  • Established 99th percentile cutoffs
  • severe obesity affects 4 of children
  • Assess medical risk, behaviors and attitude

Recommendations - Treatment
  • Prevention Plus Protocol
  • Obesity prevention at Well Care Visits including
    assessment and prevention
  • Structured Weight Management
  • Prevention Plus visits including treatment
  • Comprehensive Multidisciplinary and Tertiary Care
  • Going beyond the Practice including prevention
    and treatment
  • Step 4 is referral to pediatric tertiary weight
    management center.

Stage 1 Prevention Plus
  • BMI 85th ile
  • 5-2-1-0 Model
  • At least 5 servings of fruits and vegetables
  • No more than 2 hours of screen time
  • No TV in bedroom, no TV
  • At least one hour physical activity daily
  • No sugar-sweetened beverages
  • Limit eating out
  • Involve the whole family
  • Acknowledge cultural differences

  • National Initiative for Childrens Healthcare
    Quality, joint effort with RWJ
  • Childhood Obesity Action Network
  • COAN has released Implementation Guide for the
    new Expert Committee Obesity Recommendations
  • Implementation Guide will support practitioners
    with the tools and resources to put the new
    recommendations into practice
  • To join the network

(No Transcript)
Utah Blueprint
  • GOAL Utahs schools will assume an active role
    in addressing childhood overweight.
  • Objectives
  • Increase the number of schools that have policies
    and an environment that encourages regular
    physical activity
  • Gold Medal Schools, PE requirements
  • Increase access to and selection of healthy foods
    in schools
  • Educate and advocate for nutritional standards
    for competitive foods and beverages
  • Nutritional foods for all extracurricular
    activities, including athletics

Objectives for schools, cont.
  • Increase the number of elementary school teachers
    who teach the Utah nutrition core curriculum
  • Increase the number of elementary school teachers
    who teach nutrition and behavioral skills as
    opposed to didactic information
  • Decrease the number of activities and fundraisers
    focusing on food at events
  • Encourage PTAs, student groups and clubs to
    choose activities and fundraisers that do not
    focus on food
  • Encourage parents and teachers to limit foods
    used in the classroom for rewards and parties

Standards for Competitive Foods
  • 22 States have nutritional standards for
    competitive foods
  • 26 States have limited access to competitive
  • Utah not included on either list
  • F as in Fat How Obesity Policies are Failing in
  • Trust for Americas Health, 2007
  • School Health Policies and Programs Study
  • CDC, 2006

What can you do?
  • Participate in Gold Medal Schools
  • Join Action for Healthy Kids
  • Advocate for changes to competitive foods
    policies (including vending)
  • Support adoption of new core physical education
    curriculum in elementary schools
  • Work with administration to develop effective
    School Wellness Policies
  • Be a good role model

  • School Wellness Policy mandate
  • School year 2006-2007
  • As required by law, a local wellness policy, at a
    minimum, shall include
  • Goals for nutrition education, physical activity
    and other school-based activities that are
    designed to promote student wellness in a manner
    that the local educational agency determines is
  • http//

Healthy School Pioneers
  • Healthy School Pioneers
  • Davis
  • North Summit
  • Provo
  • Salt Lake
  • South Sanpete
  • On the Trail
  • Box Elder
  • Grand
  • Nebo
  • Ogden
  • Uintah
  • Wayne
  • Wasatch
  • Moving Ahead
  • Alpine
  • Granite
  • Juab
  • Murray
  • North Sanpete
  • Park City
  • Tooele
  • Washington
  • Weber
  • Getting Started
  • Duchesne
  • Emery
  • Garfield
  • Iron
  • Jordan
  • Kane
  • Logan

Tools and Resources
  • Utah Action for Healthy Kids
  • Model Local School Wellness Policies on Physical
    Activity and Nutrition
  • National Alliance for Nutrition and Activity
    (NANA), March 2005
  • Overweight Children and Adolescents
  • Position Statement, National Association of
    School Nurses
  • Tipping The Scales Toward a Healthier Population
    The Utah Blueprint to Promote Healthy Weight for
    Children, Youth and Adults
  • CDCs School Health Index Self-Assessment and
    Planning Guide

Thank You!
  • Slides will be available