Preventing Childhood Obesity: Health in the Balance Ross C. Brownson, Ph.D. St. Louis University Sch

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Preventing Childhood Obesity Health in the
Balance Ross C. Brownson, Ph.D.St. Louis
University School of Public HealthAPHA
ConferenceWashington, DC
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Background

• Congressional request (2002)
• Sponsors CDC, NIH, ODPHP, RWJF
• 19-member multidisciplinary committee
• Task prevention-focused action plan
• 24 months

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Committee on Prevention of Obesity in Children
and Youth

• JEFFREY P. KOPLAN (Chair), Emory University
• DENNIS M. BIER, Baylor College of Medicine
• LEANN L. BIRCH, Pennsylvania State University
• ROSS C. BROWNSON, St. Louis University
• JOHN CAWLEY, Cornell University
• GEORGE R. FLORES, The California Endowment
• SIMONE A. FRENCH, University of Minnesota
• SUSAN L. HANDY, University of California, Davis
• ROBERT C. HORNIK, University of Pennsylvania
• DOUGLAS B. KAMEROW, RTI International

• SHIRIKI K. KUMANYIKA, University of Pennsylvania
• BARBARA J. MOORE, Shape Up America!
• ARIE L. NETTLES, University of Michigan
• RUSSELL R. PATE, University of South Carolina
• JOHN C. PETERS, Procter Gamble Company
• THOMAS N. ROBINSON, Stanford University
• CHARLES ROYER, University of Washington
• SHIRLEY R. WATKINS, SR Watkins Associates
• ROBERT C. WHITAKER, Mathematica Policy Research

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An Epidemic of Childhood Obesity

• Since the 1970s, obesity prevalence has
• Doubled for preschool children aged 2-5 years
• Doubled for adolescents aged 12-19 years
• Tripled for children aged 6-11 years
• More than 9 million children and youth over 6
  years are obese
• Reflect similar trends
• U.S. adults
• Adults and children internationally

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Terminology

• Obesity refers to children and youth who have a
  body mass index (BMI) equal to or greater than
  the 95th percentile of the age- and
  gender-specific BMI charts of the Centers for
  Disease Control and Prevention (CDC)
• In most children, BMI values gt 95th percentile
  are known to indicate elevated body fat and to
  reflect the presence or risk of related diseases
• No BMI-for-age references for children lt 2 years

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Trends in Childhood Obesity Prevalence
Prevalence ()
SOURCE Ogden et al.. J Am Med Assoc. 2002
288(14)1728-1732.
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Implications for Children and SocietyPhysical,
social, emotional health consequences

• Physical Health
• Glucose intolerance and insulin resistance
• Type 2 diabetes
• Hypertension
• Dyslipidemia
• Hepatic steatosis
• Cholelithiasis
• Sleep apnea
• Orthopedic problems

• Emotional Health
• Low self-esteem
• Negative body image
• Depression
• Social Health
• Stigma
• Negative stereotyping
• Discrimination
• Teasing and bullying
• Social marginalization

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Framework for Understanding Obesityin Children
and Youth
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Energy Balance

• Energy intake Energy expenditure
• For children, maintain energy balance at a
  healthy weight while protecting health, growth
  and development, and nutritional status

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Review of the Evidence

• The committee strongly endorsed an action plan
  based on the best available evidence instead of
  waiting for the best possible evidence
• Integrated approach to the available evidence
• Limited obesity prevention literature upon which
  to base recommendations
• Parallel evidence from other public health issues
• Dietary and physical activity literature

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• Key Conclusions

• Serious nationwide health problem requiring a
  population-based prevention approach
• Goal is to create supportive environments that
  promote energy balance healthful eating
  behaviors and regular physical activity
• Societal changes needed at all levels involving
  multiple sectors and stakeholders

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• What is Needed?

• Leadership
• Evaluation
• Resources
• Efforts at all levels
• Change in societal norms

Healthful Eating Behaviors and Physical
Activity are the Norm
Obesity Prevalence Increasing
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Changing Social Norms Public Health Precedents

• Tobacco control
• Underage drinking
• Highway safety
• Use of seatbelts and child car seats
• Vaccines
• Fluoridation

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• Key Stakeholders to Involve

• Children, youth, parents, families
• Child- and youth centered organizations
  community-based organizations
• Community development and planning
• Employers and work sites
• Food and beverage industries, food producers,
  advertisers, marketers, and retailers
• Foundations and nonprofit organizations
• Government agencies and programs
• Health-care providers and delivery systems
  professional societies
• Health-care insurers, health plans, and
  accrediting organizations
• Mass media, entertainment, recreation, and
  leisure Industries
• Public health professionals
• Recreation and sports enterprises
• Researchers
• Schools, child care programs

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Action Plan for Obesity Prevention

• National Public Health Priority
• Healthy Marketplace and Media Environments
• Healthy Communities
• Healthy School Environment
• Healthy Home Environment

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National PriorityGovernment at all levels to
provide coordinated leadership

• Federal coordination
• Program and research efforts to prevent childhood
  obesity in high-risk populations
• Resources for state and local grant programs,
  support for public health agencies
• Independent assessment of federal nutrition
  assistance programs and agricultural policies
• Research and surveillance efforts

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Healthy Marketplace and Media

• Healthful products, expand meals, create physical
  activity opportunities
• Labeling
• New advertising and marketing guidelines
• Multi-media and public relations campaign

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Healthy Communities

• Mobilize communities
• Build diverse coalitions
• Develop and evaluate community programs
• Address barriers for high-risk populations
• Enhance built environment
• Revise city planning practices
• Improve opportunities for physical activity
• Prioritize capital improvement projects
• Improve access to healthful food

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Examples of Community Programs

• Kids Off the Couch Modesto, CA
• Provides information and tools to parents and
  caregivers
• Feet First Seattle, WA
• Neighborhood assessments of potential for
  physical activity- walking, bike paths
• Edible Schoolyard Berkeley, CA
• 6-8 graders participate in school garden
  seed-to-table approach (ecoliteracy)
• Safe Routes to Schools
• Education, engineering, and encouragement
  approaches to walk- and bike-to-school programs

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Healthy Schools

• Develop nutritional standards for all school
  foods
• Increase physical activity to at least 30
  minutes/day
• Enhance curriculum
• Reduce in-school advertising
• Utilize school health services
• Provide individual student BMI assessments to
  parents
• Bolster after-school programs
• Use schools as community centers

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Healthy Homes

• Exclusive breastfeeding first 4-6 months
• Provide healthful foods - consider nutrient
  quality and energy density
• Encourage healthful decisions re portion size,
  how often and what to eat
• Encourage and support regular physical activity
• Limit recreational screen time to lt 2 hours/day
• Parents should be role models
• Discuss childs weight with health care provider

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School Food

• Develop nutritional standards for all school
  foods
• Currently
• Minimal federal regulations beyond school meal
  programs many states and localities have adopted
  stricter standards
• Proposed
• All foods sold and served in schools meet
  nutritional standards includes contents of
  vending machines, school stores, fundraisers
• State education agencies and local school boards
  should adopt and implement these standards or
  develop stricter standards for their local
  schools

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Physical Activity

• Current recommendations 60 minutes of moderate
  to vigorous physical activity each day
• At least 30 minutes at school
• Currently
• Reduced PE classes, reduced participation in PE
  particularly in high school students
• Proposed
• Expand intramural and extramural options
• Innovative, varied, and engaging activities
• Promote walking and biking to school

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Walking and Biking to School

• 1969 48 of all students walked or biked, among
  those within a mile 90 walked or biked
• 1999 19 walked and 6 biked at least once a
  week
• Current barriers
• Schools sited at distances from neighborhoods
• Parental concerns about safety, time, weather
• Lack of sidewalks, safe street crossings
• Recommendations
• Promote walking/biking to school programs
• Evaluate interventions

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School Environment

• Promote consistent school environment with
  healthy choices
• Other areas to address
• Increase and enhance wellness curriculum
• Reduce advertising in schools
• Engage school health services
• Annually assess student BMI and provide
  information to parents
• Enhance after-school programs
• Use schools as community centers
• Evaluate school programs and policies

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Summary

• Epidemic of childhood obesity is upon us
• Many sectors need to be mobilized to make
  positive changes
• Comprehensive approaches are key
• Several aspects of the built environment are
  likely to be key
• School community
• Should rely in existing evidence-based strategies
  and new, innovative approaches should be
  evaluated
• It will take years to decades to reverse this
  trend

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Preventing Childhood Obesity Health in the
Balance To orderwww.nap.eduExecutive summary
available for free downloadFor more information
www.iom.edu/obesity