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Keeping Kids at a Healthy Weight Innovative Public Health Approaches Partnership for After School Ed

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Title: Keeping Kids at a Healthy Weight Innovative Public Health Approaches Partnership for After School Ed


1
Keeping Kids at a Healthy WeightInnovative
Public Health ApproachesPartnership for After
School Education November 7, 2008
  • Lynn Silver, MD, MPH
  • Assistant Commissioner
  • Chronic Disease Prevention Control
  • NYC Department of Health and Mental Hygiene

2
Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
3
Obesity Trends Among U.S. AdultsBRFSS, 1986
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
4
Obesity Trends Among U.S. AdultsBRFSS, 1987
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
5
Obesity Trends Among U.S. AdultsBRFSS, 1988
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
6
Obesity Trends Among U.S. AdultsBRFSS, 1989
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
7
Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
8
Obesity Trends Among U.S. AdultsBRFSS, 1991
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519
9
Obesity Trends Among U.S. AdultsBRFSS, 1992
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519
10
Obesity Trends Among U.S. AdultsBRFSS, 1993
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519
11
Obesity Trends Among U.S. AdultsBRFSS, 1994
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519
12
Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519
13
Obesity Trends Among U.S. AdultsBRFSS, 1996
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519
14
Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 20
15
Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 20
16
Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 20
17
Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 20
18
Obesity Trends Among U.S. AdultsBRFSS, 2001
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
19
Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
20
Obesity Trends Among U.S. AdultsBRFSS, 2003
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
21
Obesity Trends Among U.S. AdultsBRFSS, 2004
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
22
Obesity Trends Among U.S. AdultsBRFSS, 2005
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
30
23
Obesity Trends Among U.S. AdultsBRFSS, 2006
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
30
24
Obesity Trends Among U.S. AdultsBRFSS, 2007
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014
1519 2024 2529
30
25
Policy Approaches to Address Obesity
  • Obesity is not just a problem of the individual,
    but also a problem rooted in environmental and
    community factors
  • 2001 Surgeon Generals Call to Action to Prevent
    and Decrease Overweight and Obesity declared
    obesity a national priority

SOURCES U.S. DHHS, 2001 Galvez, Frieden
Landrigan, 2003
26
Obesity is Epidemic in New York City
27
Obesity Begins EarlyOnly Half of NYCs
Elementary School Children Are at a Healthy Weight
More than 4 in 10 are overweight or obese in
Grades K-5
28
Among NYC Children in Head Start, 42 are
Overweight or Obese
SOURCE DOHMH Vital Signs 2006 5(2)1-2.
29
Childhood Obesity Pattern for Life
  • Overweight children and adolescents are more
    likely to become obese as adults.
  • Approximately 80 of children who were overweight
    at aged 1015 years were obese adults at age 25
    years.
  • 25 of obese adults were overweight as children.
  • If overweight begins before 8 years of age,
    obesity in adulthood is likely to be more severe.

http//www.cdc.gov/nccdphp/dnpa/obesity/childhood/

30
What are the Health Implications of Childhood
Obesity?
31
Health Implications (1)
  • Most widespread consequences of childhood obesity
    are psychosocial
  • Target of discrimination
  • Negative self-image (persistent to adulthood)
  • Decreased self-esteem (persistent to adulthood)
  • Lower health-related quality of life
  • Efforts to reduce stigma and discrimination need
    to be integrated in prevention or control
    interventions

32
Health Implications (2)
  • Multiple medical consequences of childhood
    obesity
  • Early maturation
  • Hyperlipidemia
  • Asthma
  • Glucose intolerance
  • Hypertension (less common)
  • Sleep apnea
  • Increased risk of adult fatness
  • Increases in truncal distribution of fat
  • Increased risk of eating disorders
  • Increased risk of cardiovascular disease
    diabetes
  • Increased mortality risk

33
Bogalusa Heart Study, 1973-1994
  • Community-based study of cardiovascular disease
    (CVD) risk factors in early life
  • Overweight children were
  • 2.4 times more likely to have elevated total
    cholesterol
  • 4.5 times more likely to have elevated SBP
  • 12.6 times more likely to have high levels of
    fasting insulin
  • 60 of overweight children had at least one CVD
    risk factor compared to 10 percent of
    non-overweight children

34
Whats changed in so short a time?
  • Our genes?
  • Nope!
  • Our morals?
  • Hope Not!
  • Our physical activity amounts?
  • Just a little
  • Our calorie intake?
  • YES! 200 300 more calories a day

35
(No Transcript)
36
NYC Approaches to Battling
Obesity
  • Policy
  • Daycare Regulations
  • Calorie Labeling
  • Design Construction Guidelines (PENDING)
  • Public Procurement Guidelines
  • Environmental
  • Built Environment
  • (Stairwells, Water Access, Construction)
  • Parks
  • Healthy Bodegas
  • Fruit Vegetable Access
  • Community Programs
  • SPARK Shape Up, School PE
  • Food Fitness Partnership
  • Daycare Eat Well Play Hard (FSNE)
  • Fitnessgram for school children
  • HealthTrak in daycares

37
Policy Approach
38
NYC Health Code Daycare Regulations
  • On Nutrition, Physical Activity and
    TV Viewing.

39
Day CareNutrition Standards
  • Provide guidance on
  • Appropriate kinds of foods beverages
  • Promote water
  • Limit juice to 6 oz/day
  • No sugar sweetened beverages
  • 1 milk only after age 2
  • Appropriate portion sizes for children
  • Remaining consistent with federal CACFP policy
    for meal snack reimbursement

SOURCES Child and Adult Care Food Program U.S.
Dietary Guidelines for Americans, 2005
40
Day CarePhysical Activity Standards
  • Required minimum physical activity minutes daily
  • For ages 12 mos. and up, at least 60 min./day
  • For ages 3 and older, at least 30 min. of that
    time must be structured guided activity
  • Young children should not be sedentary for more
    than 60 min. consecutively, except when sleeping
  • In inclement weather, safe, active indoor play
    shall be substituted for outdoor play

SOURCES CDC National Association for Sport and
Physical Education
41
Day CareTV Viewing Standards
  • TV Viewing limited
  • Maximum of 1 hr./day
  • Educational programs only

SOURCES CDC National Association for Sport and
Physical Education
42
Daycare Implementation/Support
  • SPARK training in early childhood settings
    citywide
  • Nutrition training efforts
  • Eat Well Play Hard (FSNE) training kids, parents
    staff
  • To day care inspectors
  • To nutrition staff in community through Bureau of
    Daycare
  • Educational materials disseminated to children
    and parents through daycare staff

43
SPARK!Physical Activity for Children
  • Since 2003, DOHMH has partnered with the Sports,
    Play and Active Recreation for Kids! (SPARK!)
    program
  • Goal train and equip all daycare centers
    schools, K-2 teachers, and as many after-schools
    as possible in the highest risk communities, and
    then citywide
  • To date SPARK training and equipment has reached
  • Daycare 8,226 daycare staff trained _at_ 1219 sites
  • School Based Pre-K 1584 staff trained _at_ 464
    sites
  • After School Programs 747 participants trained _at_
    175 sties

44
Food Procurement Task Force
  • All city agencies procuring food are represented
    on the task force.
  • Focus is on nutrition standards within city
    agencies (including school system) specifically
    regarding concessions, vending machines, and
    food contracts.
  • Nutrition Guidelines released by Mayor September
    2008.

45
Over 225 Million Meals and Snacks Served by City
Agencies per year
Number of snacks served (in millions) DHS
.27 DYCD .19

DOE 9.9 DOC .39
46
Highlights from Procurement Guidelines
  • Beverages
  • 25 calories per 8 oz for beverages other then
    100 juice or milk
  • NO SUGAR SWEETENED SODA!
  • Juice must be 100 fruit juice (limited to 8
    oz)
  • Milk must be 1 or non-fat
  • Food
  • Minimum of 2 servings of fruits vegetables for
    lunch and dinner
  • Elimination of deep fryers no deep frying
    allowed!

47
People Are Eating Out More
48
Eating Out Is Associated with Obesity
  • 1/3 of our calorie intake comes from food
    prepared outside the home
  • Eating out is associated with higher calorie
    intake and obesity
  • Children eat almost twice as many calories in
    restaurant meals compared to meals at home (770
    vs. 420 calories)

Guthrie JF et al., 2002 Zoumas-Morse C, Rock
CL, Sobo EJ, Meuhouser ML. , 2001
49
Increasing Calories in Fast Food
1977-1978 1994-1996
419
497
171
284
191
131
972
721
Increase of 251 calories (35)
50
Calorie Labeling in NYC
  • Consumers underestimate calories in restaurant
    food and over consume
  • Availability of calorie information leads to
    healthier choices

51
Lots of Calories Little
Information
  • Except at Subway, only 4 of patrons reported
    seeing calorie information as currently provided

Does nutrition information on a tray liner work?
According to our study, not as much as fast food
chains would like you to believe.
Bassett MT, Dumanovsky T, Huang C, Silver LD,
Young C, Nonas C, Matte T, Chideya S, Frieden
TR.  Purchasing Behavior and Calorie Information
at Fast-Food Chains in New York City, 2007. 
American Journal of Public Health,
2008981457-1459.
52
NYC Calorie Labeling Regulation
  • On January 22, 2008 the
    New York City Board of Health voted to require
    restaurants to post calories on menu boards and
    menus the regulation went into effect on
    March 31, 2008.

53
NYC Now Has Calorie Information Posted!
Starbucks, 2008
54
Chipotle, 2008
55
Most Covered FSEs Have Posted
Calories
McDonalds July 21, 2008
56
Preliminary Signs of Menu Reformulations
57
Success Already
  • Some restaurants have had their own sticker
    shock and started offering lighter options. Cosi
    had a nutritionist look for ways to save on every
    item. Switching to low fat mayo brought the Cosi
    Club from nearly 800 calories to 447 Having to
    post this information in New York really focused
    us on paying attention as well says Chris
    Carroll, the chains chief marketing officer
  • - Wall Street Journal July 29, 2008

58
Calorie Labeling from Coast to Coast
59
Environmental Approach
60
20
WE HAVE REPLACED HUMAN AND ANIMAL ENERGY WITH
PETROCHEMICAL ENERGY IN ALMOST EVERY ACTIVITY
61
20
WE HAVE REPLACED HUMAN AND ANIMAL ENERGY WITH
PETROCHEMICAL ENERGY IN ALMOST EVERY ACTIVITY
62
DOHMHs STAIR PROMPT CAMPAIGN 2008
What you can do Get the kids ( staff) in your
program to always take the stairs!! To request a
stair prompt for your location please call 311.
  •   

63
Community Approach
64
Healthy Bodega Initiative
  • Move to 1 Milk Partnership with bodegas to
    stock 1 milk, also work with community to
    increase demand, over 1000 bodegas recruited
    (Sept 07-March 08)
  • Fruits vegetables campaign
  • Rollout started late April, 2008
  • Working with over 450 bodegas to address issues
    of quantity, quality, display, and distribution
  • Small pilot of Farm2Bodega

65
Green Carts
  • Over the next 2 years 1000 green carts will be
    on the streets in under accessed neighborhoods
  • Only fresh, non processed produce can be sold on
    the carts 

66
Health Bucks
  • 2 Coupons for purchase of fresh fruits
    vegetables at participating farmers markets.
  • Each customer gets additional 2 Health Buck for
    every 5 spent using EBT at the farmers market

67
Building Partnerships
  • Neighborhood level Food and Fitness
    coalitions/workgroups have begun this year in the
    South Bronx, East and Central Harlem, and North
    and Central Brooklyn.
  • New York City Coalition on Food and Fitness was
    launched in June to address obesity in children
    and families. Over 100 organizations are a part
    of the coalition.

68
What Can After School Providers
Do To Address Obesity?
  • Provide strong, creative physical activity
    programming that gets all participating kids
    moving most of the time
  • Turn OFF the television!
  • Refer children with obesity to community
    providers who are prepared to address the issue
  • Get rid of vending machines with soda and junk
    food!!
  • USE THE STAIRS!

69
And more
  • Serve only healthy meals and beverages (that
    still leaves room for dessert sometimes ?)
  • Teach kids, parents staff how to prepare and
    eat vegetables and fruits
  • Have a fruit bowl out with fresh fruit for
    snacking
  • Grow a vegetable garden

70
No Silver Bullet
  • Tackling obesity and chronic disease requires
    changing our physical, food and social
    environment
  • It requires political will and multifaceted
    approaches
  • The health sector alone cannot accomplish this
  • Changing the societal default rather than
    solely educating people to choose wisely is
    essential
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