Hey_ Were Killing Our Kids Effective Strategies for combating

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					    Hey, We’re Killing Our Kids:
Effective Strategies for Combating
Overweight and Obesity in Today’s
             Penny Lyter, Ph.D.
      University of Wisconsin-Parkside
   Symposium on Adolescent Health Issues
              February 6, 2009
Obesity Trends Among U.S. Adults
    between 1985 and 2007

• Obesity: Having a very high amount of body fat
  in relation to lean body mass, or Body Mass
  Index (BMI) of 30 or higher.
• Body Mass Index (BMI): A measure of weight
  in relation to one’s height, specifically the
  weight in kilograms divided by the square of
  his or her height in meters.
                 Obesity Trends* Among U.S. Adults
                     BRFSS, 1990, 1998, 2007
          (*BMI 30, or about 30 lbs. overweight for 5’4” person)

             1990                                              1998


No Data   <10%      10%–14%   15%–19%      20%–24%   25%–29%   ≥30%
   Obesity Trends Among U.S. Adults
       between 1985 and 2007
• In 1990, among states participating in the Behavioral Risk
  Factor Surveillance System, 10 states had a prevalence of
  obesity less than 10% and no states had prevalence equal
  to or greater than 15%.
• By 1998, no state had prevalence less than 10%, seven
  states had a prevalence of obesity between 20-24%, and no
  state had prevalence equal to or greater than 25%.
• In 2007, only one state (Colorado) had a prevalence of
  obesity less than 20%. Thirty states had a prevalence equal
  to or greater than 25%; three of these states (Alabama,
  Mississippi and Tennessee) had a prevalence of obesity
  equal to or greater than 30%.
                                                 (2, 4, 5)
    Weight of Americans age 20 and Older
•                                                                  Percent                                              Percent
•   Group                                                          Overweight                                           Obese
•   Both sexes                                                     66.0                                                 31.4
•   All races, male                                                70.5                                                 29.5
•   All races, female                                              61.6                                                 33.2
•   White, male                                                    71.0                                                 30.2
•   White, female                                                  57.6                                                 30.7
•   African American, male                                         67.0                                                 30.8
•   African American, female                                       79.6                                                 51.1
•   Latino, male                                                   74.6                                                 29.1
•   Latino, female                                                 73.0                                                 39.4
•   Percent of poverty level
•           Below 100%:                                            63.4                                                 33.7
•           100%–less than 200%:                                   66.2                                                 33.6
•           200% or greater:                                       66.1                                                 30.0

    SOURCE: National Center for Health Statistics. 2006. Health, United States, 2006, with Chartbook on Trends in the Health of Americans.
    Hyattsville, Md.: National Center for Health Statistics.
Childhood and Adolescent Obesity
• 18.8% of 6-11 year-olds*
• 17.4% of 12-19 year-olds*
• Since the 1970’s obesity rates have:
  – more than doubled for 2-5 year-olds and 12-19 year-
  – more than tripled for 6-11 year old children.
• Children who are minorities, from low-income
  households, and from rural areas are more likely
  to be obese.
  *BMI for gender and age percentile ≥ 95th
        Impact of Childhood Obesity
• Increases risk of:
    – Type II diabetes
    – Cardiovascular diseases
    – Asthma
    – Sleep disorders
    – Psychiatric disorders
    – Orthopedic problems
    – Early puberty
    – Learning disorders
    – Depression
    – Decreased quality of life (lower physical functioning and lower self-
    – Being bullied
     Factors Contributing to Childhood
•   Genetics
•   Dietary excesses
•   Lack of physical activity
•   Parental obesity
•   Birth weight and infant fatness
•   Duration of breastfeeding
•   Parental feeding styles
•   Previous overweight
•   Socioeconomic status
•   Ethnicity
•   Time spent on media use
•   Short sleep duration
    “Obesogenic” environment
– Wide availability of inexpensive, high-energy
  density foods
– Increasing opportunities to consume food
  throughout the day
– Reduced energy demands of daily activities
– Increasingly sedentary leisure time
– Limited opportunities for recreational physical
Trends in Availability of Food and Convenience
           Over the Last 25-30 Years
• Increased number of locations where ready-to-eat
  foods are available
• Increased proportion of food dollars spent away from
• Preference for restaurants with limited menus, quick
  service, and the option for take-out
• Increased distribution of food through vending
• Increased proportion of traditional grocery offerings
  geared to ease of preparation
• Increases in portion and packaging size
               Intervention Factors (WHO, 2002)
Evidence               Decreases Risk                Increases Risk
Convincing             -Regular physical activity    -High intake of energy-dense
                       -High dietary fiber intake    foods
                                                     -Sedentary lifestyle
Probable               -Home and school              -Heavy marketing of energy-
                       environment that supports     dense foods and fast food
                       healthy food choice for       outlets
                       children                      -Adverse social and economic
                       -Promoting linear growth      conditions in developed
                                                     countries (particulary for
                                                     -Sugar-sweetened soft drinks
                                                     and juice
Possible               -Low glycemic index foods     -Large portion sizes
                       -Breast feeding               -High proportion of food
                                                     prepared outside of homes
                                                     -Rigid restraint and/or
                                                     periodic disinhibition eating
Insufficient           -Increased eating frequency   -Alcohol
Make it “easy to do the healthier thing”
      Population Level Approach
•   Physical issues – e.g., what is available and promoted, such as food choices in the
    home or school; exposure to and quality of TV advertising; opportunities or
    barriers to physical activity
    Consistency in messages from the private and public sectors could be a
    significant factor in population-level prevention efforts.
           * The development and promotion of low-fat food products paralleled
           health promotion messages. “The food industry spends in the
           neighborhood of $50 per person per year to publicize food products. In
           contrast, the USDA spends about $1.50 per person per year for all types
           of nutritional education” (4, p. 155).
•   Economic issues – e.g., price of soda versus water, price of fatty meats vs. lean
    meats, price of fruits & vegetables, subsidies to sugar and corn producers
•   Policy issues - e.g., rules about food service standards, regulations on marketing
    targeting young children
•   Sociocultural issues – e.g., attitudes, perceptions, beliefs, and values such as
    fast food, everyday food, and personal responsibility.              (11)
     Effective Strategies for Schools(CDC)
1.  Address physical activity and nutrition through a Coordinated School
    Health Program approach.
2. Designate a school health coordinator and maintain an active school
    health council.
3. Assess the school’s health policies and programs and develop a plan for
4. Strengthen the school’s nutrition and physical activity policies.
5. Implement a high-quality health promotion program for school staff.
6. Implement a high-quality course of study in health education.
7. Implement a high-quality course of study in physical education.
8. Increase opportunities for student to engage in physical activity.
9. Implement a quality school meals program.
10. Ensure that students have appealing, healthy choices in foods and
    beverages offered outside of the school meals program.
    School Based Intervention Partners
•   Parents/Guardians
•   Youth
•   Teachers
•   School Food Service Staff
•   School Administrators and School Board Members
                         Parents Can:
•   Be a positive role model –eat healthy and move!
•   Provide healthy snacks for school parties and special events.
•   Help school staff plan activities where students can sample healthy foods.
•   Involve children in selecting and preparing food.
•   Offer children a variety of healthy foods, keep healthy snacks on hand, and
    make mealtime an enjoyable experience.
•   Limit sugary beverages (soda, juice, punch, etc.)
•   Learn more about healthy eating and exercise. Share this information with
    children and talk with them about nutrition projects and homework
•   Reduce media use and the number of meals children eat in front of the TV.
•   Promote more physical activities – take a walk, Wii, participate in a fun
    run/walk as a family, etc.
•   Prepare and eat meals at home.
                          Teachers Can:
•   Be a positive role model – healthy eating and moving!
•   Develop a comprehensive scope and sequence for nutrition education and physical
    education as part of a sequential, comprehensive school health program.
•   Choose curricula that meet the criteria set out in the CDC guidelines.
•   Work with food service managers, coaches, physical education teachers, and other
    staff to coordinate nutrition education efforts and give students consistent
    messages about healthy eating.
•   Request healthy snacks for class parties.
•   Avoid using food to reward students.
•   Take part in nutrition training sessions and share experiences with other teachers.
•   Find and use resources for nutrition education and physical education.
•   Involve families and community organizations in nutrition education and physical
    education activities. Help educate the parent/family.
•   Provide more opportunities for physical movement, before, during and after
    school (Wii, Dance revolution, Geocaching, integrate movement in the curriculum,
    provide movement breaks).
    School Food Service Staff Can:
• Provide meals that are tasty and appealing to students and that
  meet USDA nutrition standards and the Dietary Guidelines for
• Support classroom lessons by offering foods that illustrate key
  messages, decorating the cafeteria with educational posters, and
  posting the nutritional content of foods served.
• Coordinate activities with classroom and physical education
  teachers and other staff.
• Involve students and families in planning school menus.
• Offer meals that reflect the cultural diversity and preferences of
• Take part in training sessions on nutrition education and on
  marketing school meals.
• Invite parents to lunch and give them information about the
  nutritional value of the meal.
     School Administrators and School
          Board Members Can:
•   Organize a school health or nutrition advisory committee that includes all key
    groups. (classroom and physical education teachers, parents, food service
    managers, and other staff together.
•   Make sure students have enough time to eat in a safe and comfortable dining area.
•   Stock vending machines with 100% fruit juice and other healthy snacks; make sure
    that healthy foods are served at school meetings and events.
•   Prohibit the sale of high-fat, high-sugar snacks.
•   Allocate adequate time for nutrition education and physical education as part of a
    sequential, comprehensive school health program.
•   Hire teachers and food service managers with appropriate training and support
    ongoing in-service training.
•   Evaluate school nutrition programs.
•   Revise physical education to include age and culturally appropriate activities such
    as dancing, and strength and endurance training.
•   Provide more opportunities for physical movement, before, during and after
    school (intramurals, etc).
•   Allow only “healthy” fundraisers. (healthy foods sales, movement based activities,
    school related promotional items, raffles, etc.)
•   Provide a health promotion program for staff.
               Bottom line -
• Focus on healthier lifestyle for all (healthy
  eating and physical activity) – not dieting.
• Make healthier options easy.
• Make healthier options the norm.
• Start with small steps and keep making
• Meaningful change requires action on your
1.    American Academy of Pediatrics-Committee on Nutrition. Prevention of pediatric overweight
      and obesity. Pediatrics 2003; 1: 152-154.
2.    BRFSS, Behavioral Risk Factor Surveillance System http: //www.cdc.gov/brfss/
3.    Caballero, B. Obesity prevention in children: Opportunities and challenges. International Journal
      of Obesity 2004; 28: 590-595.
4.    CDC. U.S. Obesity Trends 1985-2007 http://www.cdc.gov/nccdphp/dnpa/obesity/trend/
5.    CDC. State-Specific Prevalence of Obesity Among Adults — United States, 2005; MMWR 2006;
6.    CDC. Healthy Youth http://www.cdc.gov/HealthyYouth/nutrition/guidelines/help.htm
7.    Jeffery RW, Utter, J. The changing environment and population obesity in the United States.
      Obesity Research 2003; 11: 125-225.
8.    Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight
      and obesity in the United States, 1999-2004. JAMA 2006; 295: 1549-1555.
9.    Swallen K, Reigher E, Haas S, Meier A. Overweight, obesity, and health-related quality of life
      among adolescents: The National Longitudinal Study of Adolescent Health. Pediatrics 2005;
      115(2): 340-347.
10.   Tudor-Locke C, Kronenfeld J, Kim S, Benin M, Kuby J. A geographical comparison of prevalence
      of overweight school-aged children: The National Survey of Children’s Health 2003. Pediatrics
      2007; 120(4):1043-e1050.
11.   University of Delaware Cooperative Extension. Brown, M, Nelson, P. Childhood obesity
      prevention literature review – 2006.

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