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					Food, Nutrition and Health in
      the 21st Century


        Lindsey Turner, Ph.D.
    University of Illinois at Chicago
         EARTH Equation Seminar
             Dec. 1st, 2004
Nutrition, Physical Activity, and
Disease
   Unhealthy eating and physical inactivity
    contribute to 4 of the top 10 causes of
    death in America (obesity, cancer,
    cardiovascular disease, and diabetes)

   Responsible for 400,000* deaths per
    year in America
*???
Effects of Poor Nutrition and Physical
Inactivity


Inadequate    Obesity     Heart Disease
 Nutrition
                          Cancer
Inadequate                Diabetes
 Physical
 Activity                 Learning/Attention
                          Problems

                          Digestive Problems
                          Other chronic health
                          issues
    The Importance of Good Nutrition
Preventing Disease
 Two meals per week containing fish may
   be as effective as statins in preventing
   heart-disease-related deaths

   Diets high in fiber and low in fat reduce the
    risk of developing cancer

   Good nutrition and regular physical activity
    lower the chances of getting diabetes (10
    million Americans are at risk)
The Importance of Good Nutrition

Treatment
 Diets high in fruit and vegetables and
  lowfat dairy can reduce high blood
  pressure

   Physical activity and dietary changes
    can minimize the reliance on insulin for
    people with diabetes
                  Obesity Trends* Among U.S. Adults
                       BRFSS, 1991, 1996, 2003
                          (*BMI 30, or about 30 lbs overweight for 5’4” person)

                    1991                                                           1996




                                                 2003




    No Data        <10%         10%-14%           15%-19%          20%-24%             25%

Source: Behavioral Risk Factor Surveillance System, CDC.
Trends in Child and Adolescent Overweight

   20                                                                                   20

   15                                                                                   15
                                     Males 12-19
   10                                                                                   10
              Males 6-11                                   Females 12-19
     5                                                                                  5
                        Females 6-11
     0                                                                                  0
              1963-74            1976-80                 1988-94         1999-2000

Source: National Health Examination Surveys II (ages 6-11) and III (ages 12-17),
NationalHealth and Nutrition Examination Surveys I, II, III and 1999-2000, NCHS, CDC.
           CHICAGO:
     The Sinai Health System
Improving Community Health Survey
   (Steven Whitman, Cynthia Williams, Ami Shah)
  Obesity among Children Ages 2-12 years, n = 542
  60
  50
                                          East
  40                                      West Town
  30                                      South Lawndale
                                          North Lawndale
  20                                      Roseland
                                          Norwood Park
  10
   0
Costs to Society
   Annual medical spending due to
    overweight and obesity: $92.6 billion in
    2002 dollars

   9.1 % of U.S. health expenditures
The Sinai Health Survey
Factors Contributing to
Childhood Obesity

     Energy Balance

Intake                   Output
Eating <-----------> Physical Activity
Physical Activity
 More than 50% of American adults do not
  get enough physical activity to provide
  health benefits.
 More than a third of students in grades 9–12
  do not regularly engage in vigorous physical
  activity.
 Daily participation in high school physical
  education classes dropped from 42% in
  1991 to 32% in 2001.

Source: Centers for Disease Control
Television Viewing: Another
Risk Factor




Source: Steven Gortmaker, Ph.D., Harvard University
The Sinai Health Survey
Trends Contributing to
Overweight/Changes in Nutrition
 Decreased physical activity/increased
  TV time
 Pre-packaged foods (high in fat, sugar,
  calories)
 Increasing portion size
 Increased soft drink consumption
Fast Food: Part of the Problem
  The Sinai Health Survey
•   Clip from Super Size Me

•   Nutrition Quiz
So, what do we mean when we
encourage people to eat a
“healthy diet”?
Underlying the Food Pyramid?
USDA Advisory Panel
Recommendations
   Consume a variety of foods within and among the
    basic food groups while staying within energy needs
   Control calorie intake to manage body weight
   Be physically active each day
   Increase daily intake of fruits and vegetables, whole
    grains, and nonfat or lowfat milk and milk products
   Choose carbohydrates wisely for good health
   Choose and prepare foods with little salt
   If you drink alcoholic beverages, do so in moderation
   Keep food safe to eat
Percentage of Adults Who Reported
Eating Fewer Than Five Servings of Fruits
and Vegetables a Day 2002




Source: CDC, Behavioral Risk Factor Surveillance System.
Vegetable Consumption:
Children 2-19 Years Old (1999-2000)
                                 Other
                                 potatoes
                       Orange/ 10%
                       dark green
                       8%
                                            Fried
                                            potatoes
                                            46%
                      Other
                      vegetables
                      22%


                             Legumes
                             6%    Tomatoes
                                   9%




Source: National Health and Nutrition Examination Survey
Grain Servings Consumed Daily:
Children 2-19 years old (1999-2000)


                   Whole
                   grain
                   12%

                                   All other
                                    grains
                                     88%



Source: National Health and Nutrition Examination Survey
Healthy Diets: A Few Highlights

 Low in saturated fats (red meat, full-fat
  dairy, fried foods)
 Low in added sugar
 High in fruits and vegetables
 Favoring whole grains over refined,
  processed carbs
Part 2:

What Influences the Food Preferences
and Eating Habits of Children and
Adolescents?
Levels of Influence

      Community/school characteristics

          Family characteristics


          Child characteristics
          Family characteristics
              Child Weight
Child Influences

 Age
 Gender
 Genetics


   Child attitudes and behaviors: shaped
    by family and environment
Family Influences

 Food availability at home
 Parent food knowledge
 Parent food preferences
 Parent weight status
 Parent attitudes
 Child feeding practices
 Peer habits
Environmental Influences

 Quality of school lunches
 Availability of other foods at school (“a
  la carte items, competitive foods,
  vending machines)
 Modeling by peers, teachers
 Social norms supportive of good
  eating/activity choices
 Physical activity- recess/PE classes
Recommendations for Change
Surgeon General’s Call to Action to Prevent
and Decrease Overweight and Obesity 2000

What can schools do?
Make sure the school breakfast and
lunch programs meet nutrition standards
Provide food options low in fat, calories,
added sugar
Daily physical education
Previous Intervention Trials

   Many programs are school-based

   Some show minimal change, but many
    have been successful

   Changes in dietary habits fairly
    common; changes in obesity less
    common
Source: Campbell et al., 2001, Obesity Reviews, 2(3), 149-157.
What Works? One Example

 Planet Health
 6th-8th graders
 Interdisciplinary Curriculum
 4 targets: reduce TV time; increase
  physical activity; decrease high-fat
  foods; increase fruit/vegetables
 Language arts, math, science, social
  studies, and physical education
Gortmaker, Peterson, et al., 1999. Reducing obesity via a school-based…
Archives of Pediatrics & Adolescent Medicine, 153, 409-418.
Planet Health Outcomes

 Reduced TV time for girls and boys
 Increased fruit/veg consumption among
  girls
 Decreased obesity among girls
 Lower incidence of eating disorders
  among girls
Components of Successful
Interventions
 Multimodal (e.g., pamphlets, seminars,
  curriculum)
 Multi-target (e.g., eating, physical
  activity, sedentary behavior, “healthy
  lifestyles”)
 High-intensity strategies: “single-shot”
  approaches rarely have an impact and
  are not sustainable
 Culturally-relevant
“Farm to School” Programs
The Future of Collaboration?
 Programs link suppliers (local farmers,
  food distributors) with school food-
  service providers
 Many programs involve a lot of
  parent/teacher/administrator
  involvement
 Growing government recognition and
  financial support
Frequent Components of Farm to
School Programs
 Sourcing fresh, healthy food from local
  farmers (typically small farmers, using
  sustainable agriculture methods)
 Linking learning and eating through
  curriculum (food tastings, classroom
  workshops)
 School and community gardens
 Meeting the farmer/farm tours
Examples

   Wisconsin Homegrown Lunch- Madison

   Farmers’ Market Salad Bar- Santa
    Monica/Malibu

   Locally: Oak Park Program with Seven
    Generations Ahead
Summary
 We are facing many public health
  challenges associated with eating
  habits
 There are some promising solutions
  being tested
 Change will require efforts at multiple
  levels (individual, school, media, govt
  policy)
 Schools and teachers are in an ideal
  position to create positive change

				
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