Healthy Changes, Healthier Families

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Healthy Changes, Healthier Families

• Megan Hammer, MPH, RD
• WIC Nutrition Program Consultant
• June 12th, 2008

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Food for Thought

• What is the prevalence of obesity nation wide?
• How are we doing in Arizona?
• What do we know about food, environment, and
  obesity?
• How can WIC help?

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NHANES 2003-2004
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What about children?
Homer, C. The National Initiative for Childrens
Health Care Quality.
JAMA, April 5, 2006, Vol 295, No. 13, 1549-1555
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Who is at greatest risk?
Homer, C. The National Initiative for Childrens
Health Care Quality.
JAMA, April 5, 2006, Vol 295, No. 13, 1549-1555
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Obesity and Income

• The risk of obesity appears to be of particular
  concern among children who are members of racial
  and ethnic minorities or who come from lower
  income families.
• (Rosenbaum Wilensky, 2005)
• Nationally, the poorest children are nearly 80
  more likely to be overweight or obese as children
  in families at the highest income levels (39.9
  vs 22.7 respectively).
• Publicly insured children are nearly 50 more
  likely to be overweight or obese (39.6 vs 26.7
  respectively).

(COAN draft monograph Addressing Child Obesity
Within and Across State Disparities)
Homer, C. The National Initiative for Childrens
Health Care Quality.
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Diabetes

• Non-Type 1 Diabetes in children is now 32 of
  cases (10 fold increase from 1982-1994).(1)
• The lifetime risk of developing diabetes for a
  Hispanic female born in the United States in the
  year 2000 until their death is 1 in 2.(2)
• This may be the first generation of children who
  may live less long than their parents as a result
  of the consequences of overweight and type 2
  diabetes.(3)

1. Pediatrics May 2005 Vol. 115 No. 5 pp.
e553-e5602. JAMA 2003 October 8290(14)1884-1890
3. New Engl J Med Vol. 352(11) March 2005, pp.
1138-1145
Homer, C. The National Initiative for Childrens
Health Care Quality.
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Obesity in Arizona Adults
Arizona adults with BMI gt25 (BRFSS 2006)
A 21 increase in only 10 years!
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Childhood Obesity in Arizona
At risk for overweight
Overweight
CDC Pediatric Nutrition Surveillance System
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Why does Arizona care?

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

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

IOM Fact Sheet September 2004
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What causes obesity?
Homer, C. The National Initiative for Childrens
Health Care Quality
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What causes obesity?

• Low income families face additional challenges
• Economic stress
• Reduced access to affordable health foods and
  opportunities for physical activity
• Overexposure to targeted advertising and
  marketing of energy-dense foods
• Family dynamics

Homer, C. The National Initiative for Childrens
Health Care Quality
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The role of environment

• Genetics loads the gun, but the environment
  pulls the trigger.
• (Judith Stern, UC Davis)

By improving the environment, especially in
low-income and minority communities, it may be
possible to decrease the communitys and the
nations disease burden. (Kumaniyka Grier,
2006)
Homer, C. The National Initiative for Childrens
Health Care Quality
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How does WIC fit in?

• We have the opportunity to change the environment
  of all Arizona WIC participants with the new WIC
  food package!
• Fruits and vegetables
• Whole grains
• Low-fat and fat free milk
• Less juice
• Breast feeding promotion

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WIC FoodsBased on Recommendations

• According to the Institute of Medicine
• Overall, the emphasis on fruits and vegetables,
  whole grains, and fat reduced milk and milk
  products are major steps in improving consistency
  of the WIC food packages with the Dietary
  Guidelines for Americans.
• Institute of Medicine. WIC Food Packages Time
  for a Change.

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Fruits and Vegetables
Percentage of Arizonans who do not eat the
recommended amounts of fruits and vegetables
BRFSS 2006
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Fruits and Vegetables

• Important for
• Essential nutrients (vitamins, minerals, fiber)
• Disease prevention (cardiovascular disease,
  cancer)
• Weight management
• We have been promoting fruits and vegetables in
  WIC for 34 years, and now we can actually provide
  them!

Centers for Disease Control and Prevention.
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Fruits and Vegetables WIC Clients

• More diverse, balanced food packages
• Greater variety and choice
• Consistency with Dietary Guidelines for Americans
• More culturally appropriate
• Supports improved nutrient intakes
• Addresses nutrition-related concerns
• Better nutrition!

Sallack, L. California WIC Food Package Summit,
2008.
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Fruits and Vegetables WIC Clients

• The power of environmental change
• Improving access to fresh fruits vegetables
  will increase consumption and is an
  evidence-based strategy to reduce obesity.

DiSogra, L. California WIC Food Package Summit,
2008.
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Fruits and Vegetables WIC Clients

• WIC can finally practice what we preach
• Importance of fruits and vegetables
• Variety, colors
• How to use fruits and vegetables in meals and
  snacks
• Setting good examples
• Establishing behaviors that will last a lifetime

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Fruits and Vegetables Communities

• In addition to health benefits for WIC clients
• WIC has the potential to revolutionize access to
  healthy foods in rural areas and inner cities and
  to transform communities.

DiSogra, L. California WIC Food Package Summit,
2008.
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WIC Food Package Impact

• The new WIC food package, especially the addition
  of fruits and vegetables, has the potential to
  improve the health status of Arizonas most
  at-risk and disadvantaged populations.
• Entire communities will benefit from the
  increased availability of healthy foods in local
  grocery stores.

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New WIC Food PackagesNow is the time to make
change matter.