Best Practices in Public Health Interventions regarding Adolescent Obesity

1. Best Practices in Public Health Interventions regarding Adolescent Obesity Pat Stewart, PhD, RD LEAH Nutrition Discipline Coordinator Bionutrition Manager CRC URMC 11/15/07

2. Objectives • 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

3. Percent of 10 to 17 year olds who are overweight or obese www.kidscount.org

4. Percent of 10 to 17 year olds Overweight by Race/Ethnicity www.kidscount.org

5. Percent of 10 to 17 year olds Overweight by Income Level www.kidscount.org

6. “It is hard to envision an environment more effective than ours (in the USA) for producing obesity” Battle + Brownell

7. 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)

8. 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

9. 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

10. Successful Health Policy • Existence of sufficient evidence base • Development of effective coalition • Commitment of policy makers www.cdc.gov/pcd/issues/2007/jul/06_0082.htm

11. Target Areas for Childhood Obesity Interventions: • Primary health care • Family based interventions • School based interventions

12. 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)

13. 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.

14. 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 www.healthyamericans.org

15. 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.

16. 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.

17. 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

18. 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 www.healthyamericans.org

19. States Rule! • Much of the authority for public health policy lies at the state level • States may tie compliance to state funding www.cdc.gov/pcd/issues/2007/jul/06_0082.htm

20. 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

21. 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) www.healthyamericans.org

22. 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 http://www.rwj.org/pdf/Balance122006

23. Obesity Report Cards • A - CA, NY + TN • B – 19 states • C – 19 states • D – 6 states • F - ID UT WY http://www.ubalt.edu/experts/obesity/

24. Childhood Obesity Report Card http://www.ubalt.edu/experts/obesity/

25. 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 http://www.nashp.org/Files/Obesity_final_with_correct_appendix_C.pdf

26. 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 www.rwj.org/pdf/Balance122006

27. “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 www.nga.org

28. Healthy Kids, Healthy America • $110,000 grants for 10 states focusing on preventing childhood obesity through policy + environmental change www.nga.org

29. State Programs Funded by CDC to Prevent Obesity and Other Chronic Diseases www.cdc.gov

30. 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 www.healthiergeneration.org

31. Websites • www.kidscount.org/sld/snapshot.jsp • State differences in rates of overweight or obese youth • http://www.cdc.gov/healthyyouth/shpps/2006/summaries/index.htm • State level summaries for school health programs • http://www.ubalt.edu/experts/obesity/index.html#archived • University of Baltimore state report cards based on efforts to pass state measures • http://www.Healthyamericans.org • How healthy is your state? • www.rwj.org • Balance| State Action to Promote Nutrition, Increase Physical Activity and Prevent Obesity • http://www.healthiergeneration.org

32. Websites con’t • www.nga.org • State by state grantee information • www.ncsl.org/org/program/health/childhoodobesity-2005.htm • Childhood Obesity – 2005 Update and Overview of Policy Options • http://www.nashp.org/Files/Obesity_final_with_correct_appendix_C.pdf • State Approaches to Childhood Obesity/National Academy of State Health Policy • http://www.cdc.gov/nccdphp/dnpa/obesity/state_programs/about_us.htm • CDC state funded grants to address overweight and obesity • http://teamnutrition.usda.gov/success.html • School success stories by state http://www.ubalt.edu/experts/obesity/