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Best Practices in Public Health Interventions regarding Adolescent Obesity. Pat Stewart, PhD, RD LEAH Nutrition Discipline Coordinator Bionutrition Manager CRC URMC 11/15/07. Objectives. Review public health strategies and approaches to address child and adolescent obesity

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best practices in public health interventions regarding adolescent obesity

Best Practices in Public Health Interventions regarding Adolescent Obesity

Pat Stewart, PhD, RD

LEAH Nutrition Discipline Coordinator

Bionutrition Manager CRC



  • Review public health strategies and approaches to address child and adolescent obesity
  • Review outcomes of adolescent school based interventions
  • Highlight specific state legislation and innovative approaches that address childhood and adolescent obesity
“It is hard to envision an environment more effective than ours (in the USA) for producing obesity”

Battle + Brownell

best practices
Best Practices
  • Prevention should be the primary focus when considering a best practice approach to deal with the problem of childhood obesity
  • Changes in the environment must be the crux of any public health attempts to address the epidemic

Med Clin N Amer 2000 84(2)

dr kaplan chair of iom report on preventing childhood obesity
Dr Kaplan, chair of IOM Report on Preventing Childhood Obesity
  • “changes are needed in our schools and communities, as well as at the national level. Just as it was imperative to make changes across society to protect youth from the hazards of tobacco smoking, it is now critical to alter social norms and attitudes so that healthy eating behaviors and regular PA become a daily part of life for our children and youth.”

Preventing Childhood obesity Health in Balance IOM 2005

public health strategies to combat childhood obesity
Public Health Strategies to Combat Childhood Obesity
  • Breast Feeding
  • Limiting TV/screen time
  • Encouraging physical activity
  • Increasing fruit and vegetable intake
  • Controlling portion size
  • Limiting soft drink consumption

Obesity Reviews 2006 7(3):261-269

successful health policy
Successful Health Policy
  • Existence of sufficient evidence base
  • Development of effective coalition
  • Commitment of policy makers

target areas for childhood obesity interventions
Target Areas for Childhood Obesity Interventions:
  • Primary health care
  • Family based interventions
  • School based interventions
school based interventions
School based interventions
  • Are attractive because:
  • Large contact time
  • Existing organizational structures
  • Reach a large number of children at low cost
  • Natural lab for exploring impact of environmental change on eating and activity habits
  • Life science, health and PE classes offer built in opportunity

Med Clin N Amer 2000 84(2)

school based programs for adolescents
School Based Programs for Adolescents
  • PATH – (Physical Activity and Teenage Health) - Fardy
  • Planet Health - Gortmaker
  • Frenn
  • New Moves – Neumark-Sztainer

Obesity Reviews 2006 7(3), 261-269.

nih strategic plan for obesity research
NIH Strategic Plan for Obesity Research
  • TAAG – Trial of Activity in Adolescent Girls
  • GEMS – Girls Health Enrichment Multi Site Studies
  • HEALTHY – - A Middle School-Based Study to Reduce Risk Factors for Type 2 Diabetes in Children

summary of interventions
Summary of Interventions
  • In general interventions have resulted in modest changes in behaviors and mixed results with indicators of obesity. TV watching seems to be most modifiable behavior, followed by PA and nutrition behaviors.

Obesity Reviews 2006 7(3), 261-269.

environmental studies
Environmental studies
  • 200 – 300% increase in purchases of healthy foods when prices were reduced by 50%
  • Suggest the potential to influence behaviors related to obesity by changing environmental exposures

Obesity Reviews 2006 7(3), 261-269.

interventions targeted at children and adolescents
Interventions targeted at children and adolescents:
  • Eliminate soda vending machines at school
  • Implement nutrition guidelines for foods sold anywhere in school
  • Increase availability of fruit + vegetables in schools
  • Regulate food advertising + marketing efforts targeting kids
  • Ban advertising in school

Am J PrevMed 2004;27(3S):163-171

federal initiatives to support school based approaches
Federal Initiatives to Support School Based Approaches
  • Coordinated School Health Program
  • School Health Index
  • Physical Education Curriculum Analysis Tool
  • School Health Policies and Programs Study
  • School Health Profiles
  • Division of Adolescent and School Health (DASH)
  • Steps to a Healthier US

states rule
States Rule!
  • Much of the authority for public health policy lies at the state level
  • States may tie compliance to state funding

topic areas of state legislative initiatives
Topic Areas of State Legislative Initiatives
  • Improving the quality of food sold in schools
  • Limiting sale of less nutritious foods
  • Improving PE + health education
  • Encouraging PA in + out of school
  • BMI reporting
existing legislation
Existing Legislation
  • 17 states set nutritional standards for lunch, breakfast + snacks stricter than USDA
  • 22 states have nutrition standards for competitive foods
  • 26 states limit when + where competitive foods maybe sold
  • Only 2 states do not require schools to provide health ed – (CO + OK)
  • 12 states passed legislation to test BMI

(most including provisions for communicating to parents)

additional state legislative activity 2006
Additional State Legislative Activity – 2006
  • Develop local wellness policies – 8 states
  • Establish committees, councils, and task forces – 10 states
  • Increase access to fresh produce – 8 states
  • Promoting school nutrition – 7 states

obesity report cards
Obesity Report Cards
  • A - CA, NY + TN
  • B – 19 states
  • C – 19 states
  • D – 6 states
  • F - ID UT WY

childhood obesity report card
Childhood Obesity Report Card

states with innovative approaches
States With Innovative Approaches
  • AK + TX – worksite wellness at schools
  • CA – state standards for beverage snacks and side dishes – school gardens
  • ME – vending machine policy initiative
  • MI – milk vending, requirements for recess + PE/policy for healthy options outside school lunch
  • MT – healthy vending options/recess before lunch
  • NC – Sybershop/vending machine restrictions/focus groups with families
  • MA – provides grants for Healthy Choice Program
  • RI – works with school based health centers awards mini grants to lead policy + environmental change
  • WA – awards for school districts who have made policy changes

innovative approaches legislative and non legislative 2006
Innovative Approaches –Legislative and Non legislative 2006
  • CT - financial incentive for schools to offer healthy foods
  • DE – physical fitness assessment to parents
  • VA – superintendents educated on childhood obesity
  • NV – constitutional amendment for daily PE
  • MA – Every Body Move!
  • MN – Governor certificate of recognition
  • OH – Best Buckeye Healthy School
  • WV – website showcases success stories throughout state

healthy america initiative wellness where we live work and play nga
“Healthy America Initiative: wellness where we live, work, and play,” NGA
  • Encourage + assist state governors in developing + implementing wellness initiatives
  • Bring together public + private sectors
  • Raise awareness of need for healthier lifestyles
  • Bring together experts for solutions
  • Seek out best practices + innovative programs
  • Hold workshops and provide tools
  • Improve state programs
  • Urge governors to implement state employee health initiatives

healthy kids healthy america
Healthy Kids, Healthy America
  • $110,000 grants for 10 states focusing on preventing childhood obesity through policy + environmental change

alliance for a healthier generation
Alliance for a Healthier Generation
  • Healthy Schools Program
  • Let’s Just Play Go Healthy Challenge
  • Beverage Guidelines for US Schools
  • Guidelines for Snack Foods in Schools

  • State differences in rates of overweight or obese youth
  • State level summaries for school health programs
  • University of Baltimore state report cards based on efforts to pass state measures
  • How healthy is your state?
  • Balance| State Action to Promote Nutrition, Increase Physical Activity and Prevent Obesity
websites con t
Websites con’t
  • State by state grantee information
  • Childhood Obesity – 2005 Update and Overview of Policy Options
  • State Approaches to Childhood Obesity/National Academy of State Health Policy
  • CDC state funded grants to address overweight and obesity
  • School success stories by state