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WHAT’S UP DOC? School Health and Wellness A Pediatrician’s Perspective

WHAT’S UP DOC? School Health and Wellness A Pediatrician’s Perspective. Claire LeBlanc MD, FRCPC, Dip Sport Medicine University of Alberta. Global Obesity Epidemic 1. More than 400 million adults were obese in 2005 worldwide

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WHAT’S UP DOC? School Health and Wellness A Pediatrician’s Perspective

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  1. WHAT’S UP DOC? School Health and Wellness A Pediatrician’s Perspective Claire LeBlanc MD, FRCPC, Dip Sport Medicine University of Alberta

  2. Global Obesity Epidemic1 • More than 400 million adults were obese in 2005 worldwide • Chronic diseases associated with obesity account for 60% of the 58 million deaths/year2 • Cardiovascular disease, diabetes, some cancers, chronic respiratory diseases 1http://www.who.int/mediacentre/factsheets/fs311/en/index.html; 2 Preventing Chronic Diseases: a Vital Investment: Geneva, World Health Organization 2005

  3. 2003 Obesity Trends: Canadian Adults* No Data <10% 10%-14% 15-19% 20% *P.T. Katzmarzyk, Unpublished Results. Data from: Statistics Canada. Health Indicators, June, 2004

  4. Children not Immune3 • In 2005 at least 20 million children under five years old were overweight globally1 • Up to 80% of obese youth continue this trend into adulthood •  Risk for chronic disease and premature mortality 3 LeBlanc CMA, Gomez J et al. Pediatrics ,2006;117:1834-1842

  5. Prevalence of Overweight & Obesity4 Canadian Children 2004 (2-17yrs) 4 Shields M. Statistics Canada 2005; 82-620-MWE;

  6. Provincial Overweight & Obesity 20044(children aged 2-17) 50% PREVALENCE 0% BC AL SK MN ON QU NB NS PEI NF 4 Shields M. Statistics Canada 2005; 82-620-MWE

  7. What are Some Co-morbidities of Obesity in Youth?3 • Type 2 diabetes • Obstructive sleep apnea • Nonalcoholic Fatty liver (NAFLD) • Polycystic ovary syndrome • Hypertension • Hyperlipidemia • Focal segmental glomerulosclerosis • Orthopedic complications • Depression/anxiety • Poor self-esteem, and lower health-related quality of life 3 LeBlanc CMA, Gomez J et al. Pediatrics ,2006;117:1834-1842

  8. Why are Kids Overweight? • Excessive juice & pop • Low fruit/veggies • Low cereal fiber • Absence of family meal • Fast-foods:  fat and energy • Mega-meals5 5 Newman C. National Geographic 2004;206(2): 46-60

  9. Why are Kids Overweight? • Too muchTVwatching • Strongly linked to obesity4 • Inadequate physical activity (PA) levels6 • Canadian 5-17 year olds average 11,356 steps/day by pedometer • Need 12,000 -16,500 steps/day ~ 90 min mod-vigorous PA/day 6 CANPLAY: Physical Activity Monitor 2005. www.cflri.ca/eng/statistics/surveys/pam2005.php

  10. Why Not Active Enough? •  PA DAILY at home • TV, computer/video games • Unsafe environments •  Recreational facilities • Inactive parents •  PA DAILY at school • 17% Canadian schools(Elementary  High) have daily PE by PE specialists7 7 Cameron C. Opportunities for PA in Canadian Schools: Trends from 2001-2006. www.cflri.ca

  11. Benefits of Healthy Nutrition • Malnourished children have8 • ↓ Physical activity & endurance • ↓ Cognitive function & school performance • Greater frequency of ADHD • Omitting breakfast can interfere with learning even in well-nourished children • School breakfast programs9 • ↑ School attendance • ↑ Math test scores • Optimal growth & development • Obesity prevention 8FanjiangGCurr Opin Clin Nutr Metab Care. 2007 May;10(3):342-7; 9Powell, CA. Am J Clin Nutr 1998;68:873–9.

  12. Benefits of Physical Activity • Aerobic PA ↓ Wt(obese kids)9 • Diet + exercise better than either alone10 • Lifestyle PA better than calisthenics or programmed aerobic exercise11 • Improved co-morbidities • Insulin resistance; fatty liver; dyslipidemias • ↑ Self esteem; ↓ anxiety & depression12 • May improve or not worsen academics13 9Owens S. Med Sci Sports Exerc. 1999;31(1):143-148; 10Epstein LH. J Consult Clin Psychol. 1984;52(3):429-437 11Epstein LH. Behav Ther 1985;16:345-356; 12Kirkcaldy BD. Soc Psychiatry Psychiatr Epidemiol 2002;37:544-550; 13Trudeau F, Shephard RJ. International J of Behavioral Nutrition & Physical Activity 2008;5:10:1-41

  13. Behaviour Must Change…But How? • Historically strategies to ↓ obesity focus on individual behaviour change BUT… • Since 1950, US Federal agencies issued > 37 versions of guides encouraging Americans to ↓ energy intake & ↑ PA….YET… • Obesity rates are still rising…

  14. WORK/ INTERNATIONAL NATIONAL/ COMMUNITY LOCALITY SCHOOL/ FACTORS REGIONAL HOME Leisure Activity/ Facilities Transport Public Transport Globalization of markets Urbanization Public Safety Labour Infections Health Care Health Development Worksite Food & Activity Social Security Sanitation Media & Culture Media programs & advertising System Family & Home Manufactured/ Imported Food Education School Food & Activity Food & Nutrition Agriculture/ Gardens/ Local markets National perspective INDIVIDUAL POPULATION Energy Expenditure I T Y % OBESE OR UNDERWT O P R E V Food intake : Nutrient density A L E Kumanyika Ann Rev Pub Health 2001;22:293-308

  15. Comprehensive School Health Policy • NEW FOCUS - DEVELOP PUBLIC POLICY • Create healthy behavioural norms • Shape environment where healthy choices can reach entire populations • School environments reach large populations of children who are • Vulnerable to marketing • Unable to make fully informed decisions without guidance • World Health Organization(Through Public Health Agency of Canada) is developing a School Policy Framework • Implement WHO Global Strategy on Diet, PA & Health* • Promote healthy active living for staff & students • Policies evidence based… *http://www.who.int/dietphysicalactivity/en/index.html

  16. 13 Effective PA programs14 12 Randomized Control Trials (RCT) 11 school-based All increased PA 6 ↑ fitness measures 3 ↓ obesity measures Most were late elementary – high school 6Effective programs to ↓ sedentary activity14 6 RCT; 4 School-based trials 5 ↓ Screen time 2 Improved obesity measures Planet Health (2 yr) grade 6-7 students15 Robinson’s grade 3–4 RCT16 Effective School Programs 14LeBlanc CMA. CMAJ 2007;176(8):chapter 22;15Gortmaker SL. Planet Health. Arch Pediatr Adolesc Med 1999;153:409-18; 16Robinson TN. JAMA 1999;282:1561-7

  17. Wellness, Academics & You17 1013 4th & 5th graders ↑ PA & veggies & fruit ↓ BMI; ↑PA; ↑ fruit & veggies Fitkids: 18 schools RCTafter school program18 Grades 3,4,5 Healthy snacks, 80 min/day PA Improved % body fat & fitness Summers off  returned to baseline 16 Effective multifaceted programs9 All RCT 7 trials > 1 year duration 3 increased PA 5 increased fitness 11 improved food intake 7 improved obesity measures Effective School Programs 17Spiegel SA. Obesity (Silver Spring). 2006 Jan;14(1):88-96; 18Gutin B. Int J Pediatr Obes. 2008;3 Suppl 1:3-9

  18. Research Summary • Schools are pivotal settings to promote healthy active living • Multifaceted programs implemented in multiple settings targeting behaviour change rather than isolated knowledge acquisition appear to work best • Dedicated PE with a variety of aerobic activities • Active recreation before, after and during school • Healthy food and drinks in cafeteria, vending machines • Parental and family involvement important

  19. WHO Suggests • Set up a School/District Wellness Committee • Develop & implement policy • PA, food, curriculum, school health services • Monitor & evaluate • Process, output & outcome indicators • Involve stakeholders EARLY

  20. STAKEHOLDERS

  21. Schools: Everyone Benefits from an Active Living Workplace • Trustees, Superintendents • Develop policy • Influential, secure resources, support staff, bridge with external groups • Principals • Leaders; promote & maintain wellness programs for staff & students • Teachers (Keyimplementers) • Require PE training, curriculum aligned with academic mandates, support from principal, sufficient time & resources • Students (Key recipients) • Should have a say in policy/programs

  22. Parents & Extended Family • School health program can influence family behaviour at home • Students change parent behaviour • Parents can set a good example • Family can help with active living homework assignments • Family can encourage & take part in safe active transportation • Walking school bus • Family can support school health policy and programs • PTA • Family can lobby decision-makers to support health promotion in schools

  23. Health Professionals: MDs • Provide families with office-based healthy lifestyle counseling • Time? Sufficient? • MD can set a good example • Support active school community • Sit on school/district wellness committee • Provide help with advocacy, research, monitoring, evaluation • Physicians can provide knowledge translation • MDs, health organizations, general public • Community wide education: Media • Letters to or meetings with key decision makers Dr. P. Nieman Marathon runner

  24. Education & Health: United We Stand • Canadian Council on Learning 2008* • 6/10 Canadian adults have insufficient literacy skills to manage their health • Those with low health literacy 2.5 x likely to have fair-poor health • MDs consulted most (74%) for health-related information because of credibility • Need more training in using simple language • Media & family/friends consulted next (67%) but less credible– schools way down on list • Opportunity for MDs to learn from schools on messaging & schools to learn from MDs on health-related matters *http://www.ccl-cca.ca/CCL/Reports/LessonsInLearning/LinL20080306HowLowLiteracy…

  25. Next Steps • Alberta School districts & health regions showing • Best practice examples • Workshops • Listen, learn, offer help • Create feasible action plans for your region • Network of MD champions • NEW MODEL • Local  Region  Province

  26. Alberta: Will be Canada’s BEST Province – When We Work Together

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