Discussion Points

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3. National View. Obesity a growing health issue in US% of children and adolescents defined as overweight more than doubled since 1970'sIncreased body weight causes poor health leading to increased morbidity/mortalityOverweight and obesity linked to type 2 diabetesState-level costs of obesity in

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Discussion Points

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2. 2 Discussion Points Overview of Childhood Overweight Trends Definitions Causes Health Risks Epidemic in Children National, Regional, Local Action Plan

3. 3 National View Obesity a growing health issue in US % of children and adolescents defined as overweight more than doubled since 1970’s Increased body weight causes poor health leading to increased morbidity/mortality Overweight and obesity linked to type 2 diabetes State-level costs of obesity in Virginia, Maryland, and WDC totals $3.5 billion Hospitalizations of children/adolescents for obesity-related diseases have sharply risen since 1979

5. 5 Obesity Trends Among U.S. Adults Between 1985 and 2005 Data shown in maps were collected through CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Each year, state health departments collect data through monthly phone interviews with US adults. Prevalence estimates generated for the maps may vary slightly from those generated for the states by BRFSS (http://aps.nccd.cdc.gov/brfss) as slightly different analytic methods are used. Sources: BRFSS, CDC.; Mokdad A H, et al. JAMA 1999;282:16; Mokdad A H, et al. JAMA 2001;286:10; Mokdad A H, et al. JAMA 2003;289:1; MMWR 2006;55:36.

6. 6 Obesity Trends Among U.S. Adults Between 1985 and 2005 Definitions: Body Mass Index (BMI): measure of weight in relation to height - weight in kilograms divided by the square of his/her height in meters (or use a chart or online tool) Overweight: high amount of body fat in relation to lean body mass, BMI > 25 Obesity: having a very high amount of body fat in relation to lean body mass, or BMI of 30 or higher

7. 7 Obesity Trends* Among U.S. Adults BRFSS, 1990

8. 8 Obesity Trends* Among U.S. Adults BRFSS, 1995

9. 9 Obesity Trends* Among U.S. Adults BRFSS, 2000

10. 10 Obesity Trends* Among U.S. Adults BRFSS, 2005 We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980. We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.

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12. 12 Obesity Rates Increase Over 20 Years 1985: Just a few states participated in CDC’s BRFSS and provided obesity data. 1990: 4 states had obesity prevalence rates of 15-19%; no states had rates at or above 20% 1995: Obesity prevalence was less than 20% in each of 50 states. 2000: 28 states had obesity prevalence rates less than 20% 2005: Only 4 states had obesity prevalence rates less than 20% 17 states had rates equal to or greater than 25% 3 of those states had rates equal to or greater than 30% (Louisiana, Mississippi, West Virginia)

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14. 14 Causes of Obesity in Children… Poor lifestyle choices Lack of physical activity Unhealthy diet Genetics Environmental Technology > sedentary society Safety concerns Economy – both parents working Transportation

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17. 17 Current Research in Children/Adolescents Since 1970’s, overweight in preschoolers and adolescents has more than doubled and more than tripled in children 6-11 Rates of overweight for boys/girls remains similar Some groups affected more than others… Boys – 42.8% Mexican American are either at risk or are overweight compared to 31% non-Hispanic black, 29.2% non-Hispanic white boys Girls – 40.1% non-Hispanic black are at risk compared to 36.6% Mexican American, and 27% of non-Hispanic white girls/young women

18. 18 Health Consequences of Childhood Overweight Asthma boys have increased risk Use more medicine, wheeze, and ER visits Type 2 Diabetes Impaired glucose tolerance in all ethnic groups Leads to blindness, heart, kidney disease Cardiovascular risk Blood lipids Blood Pressure Sleep Apnea – obstructive Stopped breathing during sleep, loud snoring Daytime sleepiness Behavior problems Psychosocial Low self esteem Loneliness, sadness, nervousness More like to smoke/alcohol Stress** Biological switch by which stress can promote obesity

19. 19 Obesity and Overweight People with excess body fat-especially around the waist-are more likely to develop heart disease and stroke EVEN IF THEY HAVE NO OTHER RISK FACTORS! Raises BP, blood cholesterol and triglyceride levels and lowers HDL “good” cholesterol Body mass index (BMI) of 25-29.9 = overweight; BMI 30+ considered obese Losing even 10 pounds can lower your heart disease risk

20. 20 2007 Child/Adolescent Obesity Survey (Inova Health System, PRI, 2007) Telephone survey (85 questions) of households with children aged 2-8 in No. Va 400 interviews each in Prince William County, Arlington, Alexandria, Fairfax, & Loudoun Respondents screened, parent and 1 child in each home Survey addressed: Perceptions of overweight in children/teens Overweight prevalence Nutrition Physical activity Combating obesity in children and teens

21. 21 Overweight Prevalence Over 100,000 No. VA. kids aged 2-18 are either overweight or at risk of becoming overweight 16.5% overweight (est. 66,100) 9.9% are at-risk (est. 39,700) At greater risk: Elementary school-aged kids Those living at lower incomes African American children/adolescents Children/adolescents in Alexandria city

22. 22 Perceptions of Parents Only 24.6% of parents perceive their child as being ‘overweight’ Only 21.3% are currently trying to lose weight Only 20.2% have had a doctor advise a parent that the child is overweight *Survey did not reveal a strong correlation between parents’ and children’s overweight status

23. 23 Typical Child/Adolescent in No. Va. Eats breakfast every day Eats a home-cooked dinner six nights a week Dines out once per week Eats 3 meals/week from school breakfast/lunch program 72.4% have 2+ servings milk/dairy a day 6.5% have 2+ servings non-diet soda/day 30% have 2+ servings/day of other sugar drinks 29.2% have 1 or more fast food snacks or meals/day

24. 24 Screen time Estimated 232,300 children (58%) spend 4 or more hours/day in front of TV or computer Higher in PWC (62%) On a typical school day, child watches 2+ hours TV Higher in PWC 57.2% 86,500 No. Va. kids (estimated) have TV’s in bedrooms including 11,200 kids aged 2-5

25. 25 Conclusions – The Bad News! 1 out of 4 No. Va. children/adolescents is overweight or at risk of becoming overweight Low income, African American children are at greatest risk Poor nutrition Access to fresh fruits/vegetables Physical inactivity Screen time PWC faces particular challenges Parents typically fail to recognize when child overweight/MD’s are not advising parents that child is overweight Most children spend 4+ hours/day in front of a screen!!

26. 26 The Good News!! Parents recognize child/teen overweight/obesity as more of a problem than alcohol/drug abuse, tobacco, or accidents Majority of parents would pay more taxes to support anti-obesity programs/policies Majority of parents interested in local nutrition classes or seminars Parents recognize they need to play a major role in fighting childhood obesity, then healthcare providers and schools

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28. 28 National Guidelines to Combat this Epidemic 5 servings of fruits/vegetables/day No more than 2 hours of screen time (non-homework related) per day At least 1 hour of physical activity every day Almost no drinks containing sugar

29. 29 National/Local Goals Increase daily physical activity among children, adolescents, and families Reduce amount of recreational screen time for children Decrease consumption of energy-dense, high sugar/high fat foods Increase consumption of nutritious foods Create social, monetary and policy-driven incentives that reinforce long-term environmental and behavioral changes

30. 30 Local School Wellness Policies Status and goals of local school wellness policies in Virginia: a response to the child nutrition and WIC Reauthorization Act of 2004. By fall 2006 each school division participating in National School Lunch Program was mandated to establish a local wellness policy Study objective: assess schools' plans for the policy, including goals for food, nutrition education, and physical activity and evaluation. Surveys were administered to 132 School Health Advisory Board coordinators in Virginia in early 2006; 92 (69.7%) responded. Findings highlight gaps toward meeting minimum requirements for the policy; give guidance on how nutrition educators and researchers can provide expertise to optimize the policy and document progress and impacts on children's health related to the policy. Serrano E, Kowaleska A, Hosig K, Fuller C, Fellin L, Wigand V. Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061-0430, USA. [email protected]

31. 31 Current Strategies Emphasis on nutrition education for parents and children Icon ‘fruits & veggies MORE matters’ – www.fruitsandveggiesmorematters Calculating a healthy diet – AHA’s The Fat Translator (www.americanheart.org/facethefats) Exercise prescription

32. Governor's Nutrition and Physical Activity Award Program Promotes health and wellness in Virginia's public schools by encouraging good nutrition and increased physical activity. Schools earn either a bronze, silver, or gold award for best practices that promote healthy lifestyles while combating childhood obesity, hypertension, and other preventable diseases. Interactive scorecard allows schools to measure their progress and receive recognition for their success in meeting the goals of the Governor's Healthy Virginians initiative. http://www.virginia.gov/doe/login.html

33. Nutrition & Physical Activity Resource Guide Posted on websites: Health Smart Virginia: http://healthsmartva.pwnet.org/ VA Dept of Education: http://www.pen.k12.va.us/VDOE/Instruction/PE VA Comprehensive Health Education Training & Resource Center at Longwood University http://www.longwood.edu/vchetrc/

34. Activities for Before and After School Bike Smart Virginia Girls on the Run International: www.girlsontherun.org KidsWalk-to-School: http://www.cdc.gov/nccdphp/dnpa/kidswalk/ MyPyramid Blast Off Game: http://www.mypyramid.gov/kids/index.html Virginia's Safe Routes to School Program: www.bikewalkvirginia.org/programs/saferoutes.htm Sports, Play, and Active Recreation for Kids (SPARK) http://www.sparkpe.org

35. Active Learning Resources http://www.actionbasedlearning.com Jean Blaydes Madigan’s presentations cite brain research findings that support and demonstrate the importance of movement in the learning process; includes Action Based Learning Lab. http://www.ddrgame.com Website offers resources to make exercise fun for young people, with a variety of dance, dance revolution pads and other games.

36. Active Learning Resources, con’t. Energizers: http://www.ncpe4me.com/energizers.html Classroom based physical activities, developed by the NC Dept. of Education, integrate physical activity with academic concepts. Learning in Motion http://www.longwood.edu/staff/colvinay/ Resources for teachers to use during classroom time; incorporate movement into the Virginia Math, English, and Science Standards of Learning in grades K-5. Take 10! http://www.take10.net/ Helps teachers incorporate 10 minute breaks for physical activity into the school day. Lessons link key academic curriculum subjects with fun & educational activities.

37. Playground Safety National Program for Playground Safety www.playgroundsafety.org NPPS has developed a comprehensive clearinghouse of outdoor play areas and safety information and resources. Virginia Department of Health's Playground Safety Resources www.vahealth.org/civp/topics/playground.asp VDH’s Division of Injury & Violence Prevention provides information on S.A.F.E. playgrounds and playground safety training.

38. Resources for Families Healthy Habits for Healthy Kids: A Nutrition and Activity Guide for Parents http://www.wellpoint.com/healthy_parenting/index.html/ Guide discusses what parents can do at home to help children develop healthy habits, including role of family, realistic goals, nutrition and physical activity. Recommendations targeted toward healthy weight for children ages 4-12. We Can! (Ways to Enhance Children's Activity & Nutrition) http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/index.htm Helps parents and caregivers interested in practical tools to help children 8-13 years old stay at a healthy weight by addressing: improved food choices, increased physical activity and reduced screen time.

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