Childhood Obesity

1. Childhood Obesity Erin Hoffman, Yanka Skyton, Lindsey Newnes Steve Shea, Lauren DeLucca, Nikki Bonato

2. Health Risk or Health Problem • Childhood obesity rates in the US from 1980 - 2012 • More than doubled in children, age 6 - 11 • 7% to nearly 18% • Quadrupled in adolescents, age 12 - 19 • 5% to nearly 21% • In 2012, more than ⅓ of children & adolescents were overweight or obese.

3. Why is Obesity a Problem? Obesity can lead to: • Coronary Heart Disease • Heart Attack • Heart Failure • Hypertension • Stroke • Type 2 Diabetes • Liver Disease • Kidney Failure • Metabolic Syndrome • Breast Cancer • Colon Cancer • Gallbladder Cancer • Endometrial Cancers • Other Cancers • Sleep Apnea • Obesity Hypoventilation Syndrome • Menstrual Issues • Infertility • Gallstones • Enlarged gallbladder • Poorly functioning gallbladder • Blindness • Self image issues • Discrimination • Osteoarthritis • Other Joint Problems

4. A Vision of a Healthier Generation "Imagine a world where children were fed tasty and nutritious, real food at school from the age of 4 to 18. A world where every child was educated about how amazing food is, where it comes from, how it affects the body and how it can save their lives". - Jamie Oliver (Culinary Hall of Fame Chef and Restaurateur)

5. Health Risk or Health Problem • The USDA reports: • A typical school lunch far exceeds the recommended 500 milligrams of sodium; some districts, in fact, serve lunches with more than 1,000 milligrams. • Less than 1/3 of schools stay below the recommended standard for fat content in their meals. • Last year 21 million students relied on free and reduced cost lunches as their primary meal of the day. • School provided meals account for up to 65 percent of their daily calorie intake.

6. School age Children Society local and total

7. This set of graphs was chosen because of the sheer amount of data that is gatherable in a socialized country and the discernable changes in technology between decades with probable linkage to activity level.

8. Social Determinants • Access and availability for diet and exercise • Resources • Community • rural/urban-this is also an overall trend • locality- access (grocery and parks)

9. Societal Development Mirror image of adult society • Technology/ industrialized mass production • Urbanization - change in lifestyle. • More and cheaper but not necessarily quality. • Vocational and recreational changes

10. Societal Development

11. Public Health Policy • Accessibility and affordability of healthy food in vulnerable areas • Effects of taxation and advertising of food of poor nutritional quality on obesity rates • Limit access to junk food & drinks in public schools

13. Effective Health Legislation NYC 2008 Green Cart Initiative • 1000 permits issued for sale of fruits and veggies (Green Carts) in the areas where the consumption of fruits and veggies was the lowest • Accepting food stamps • availability of healthy foods to the most affected population • demand for healthy food overtime (Leggat, 2012).

14. Public Health Policy “Sugar, rum, and tobacco are commodities which are nowhere necessaries of life, which are become objects of almost universal consumption,and which are therefore extremely proper subjects of taxation." ~ Adam Smith, The Wealth of Nations (1776)

15. S.2342 - Stop Subsidizing Childhood Obesity Act S.2342 - Stop Subsidizing Childhood Obesity Act S.2342 - Stop Subsidizing Childhood Obesity Act Currently Pending Legislation S.2342 - Stop Subsidizing Childhood Obesity Act • eliminates the tax deduction that allows companies to deduct costs associated with advertising food of poor nutritional quality to children • could reduce the rates of childhood obesity by 5 to 7 percent • proceeds would go to gov-t fund for providing fruits and veggies to low income families

16. Local School Wellness Policy • Official policies that guide local educational agencies to establish an environment of health, well-being & ability to learn through nutrition & physical activity. • Helps address the unique needs of children in the school district to address childhood obesity • 2006-2007 all districts were required to establish school wellness policy • Established by Child Nutrition and WIC Reauthorization Act of 2004

17. Healthy, Hunger-Free Kids Act • Established in December 2010 • Goal to provide healthier foods and beverages in schools • Required the USDA establish new nutritional standards for school meals and competitive foods • Increases federal funding to meet USDA nutritional standards • largest increase above inflation in >30 years • $50 million will aid in training of food service workers on how to prepare nutritious meals in schools

18. New Nutritional Standards 1. whole grain rich product 2. 1st ingredient must be a fruit, vegetable, dairy, or protein food 3. “combination foods” have at least ¼ cup fruit or vegetable OR 4. contain 10% of the Daily Value of one of the public health concern nutrients such as potassium, vitamin D, calcium, or dietary fiber.

19. Challenges Implementing Change • GAO found challenges when implementing the new school lunches • plate wasting • decrease in student lunch participation • managing food costs • planning menus • difficulty with portion size & calorie requirements • Caused by substantial changes being rolled out in a short time • Challenges will improve as student and food staff adjust

20. Colorado State Legislation • CO SB 68: In 2012 Colorado prohibited artificial trans fats being made available to students in public school. • CO SB 81: Farm-to-School Healthy Kids Act. Aimed to encourage and provide incentives for school and child care facilities to use state-grown, raised, or processed agricultural products benefiting child health and the local agricultural economy.

21. Who is Benefitting & How • A meta analysis estimated the value of childhood obesity prevention efforts and found: • most obese children obese adults • ⅔ normal weight children overweight or obese adults • estimated incremental lifetime medical costs of an obese 10yo who remained obese into adulthood $16,310 - $19,350 • $14 billion health care costs for only obese 10yo (Finkelstein et al., 2014) • Prevention efforts have potential to improve healthy eating behaviors for more than obese youth, and can last into adulthood.

22. Nursing and Childhood Obesity “As the largest group of healthcare professionals, nurses are well positioned to be influential in preventing, identifying, and treating obesity and promoting advocacy efforts for multi-level policy changes necessary to create less obesigenic environments.” Budd and Hyman, 2008, p. 111

23. Professional Organization Position Statements American Nurses Association “Childhood obesity... is one of the most serious public health threats of this century. Professional nurses are instrumental in collaborating with families, communities, and other health professionals to eliminate this hazard and restore a healthy future to America’s children.” The National Association of School Nurses “The registered professional school nurse has the knowledge and expertise to promote the prevention of overweight and obesity and address the needs of overweight and obese youth in schools.”

24. Nursing Implications A paradox exists that “overnourished” children are often “malnourished” because dense, high calorie foods though inexpensive and easily accessible are lacking vital nutrients. Calories: 65 Calories: 300 Total fat: 0 g Total fat: 9g Vitamins: A, C Vitamins: none

25. Additional Nursing Implications Comorbidities now associated with childhood obesity that previously were only associated with adults include: • Orthopedic: slipped femoral epiphysis • Gastrointestinal: gallbladder disease • Respiratory: sleep apnea • Metabolic: Type II Diabetes • Cardiovascular: acute myocardial infarction • Psychological: low quality of life; equal to that of children with cancer

26. Additional Nursing Implications Some studies have indicated that childhood obesity prompts the development of biomarkers for serious illnesses later in life such as: • Stunted growth • Joint problems • Early onset of puberty in females • increased risk of depression and alcoholism • Anxiety problems

27. Advocacy Strategies • Consider the resources available to most families within the community. • for example, proximity to fresh produce and pricing of sports programs or after-school activities • Family involvement and understanding increases success rates of programs • Encourage the entire family to make lifestyle changes • 35% of Hispanic parents didn’t realize child was obese

28. Policy Development • Policies should include: • Goals for nutritional education. • Guidelines for food and beverages that are available at schools. • Guideline for activities to promote proper nutrition and wellness. • Plans for implementation. • Re-assessment • Participation by parents, members of the educational system & the community (dieticians, pediatricians, food companies, vendors & others).

29. Professional Nurses Can Make an Impact • Advocate for federal, state & local governments to increase nutritional education and policy development in the educational system. • Actively participate in professional organizations that support the creation of policies aimed at reducing childhood obesity. • Support efforts to preserve and enhance parks as areas for physical activity, to develop walking and bicycle paths, and to promote families use of physical activity opportunities. • Engage families with parental obesity in prevention activities • Encourage parenting styles that support increased physical activity and reduce sedentary behaviors • Encourage parental modeling of healthy dietary choices.

30. Nurses Can Make an Impact - In Schools • Identify areas for nutritional improvement within schools. • Act as an advisor to the school board and health committees. • Education about the impact of proper nutrition on obesity, overall health, learning and brain function. • Advocate for the availability of healthy food and beverage choices during school lunch, in vending machines & elsewhere in the school. • Lead or actively participate in the development of new policies related to proper nutrition. • Lead policy implementation • Once implemented, manage the policy & related programs. • Educate the children, families, school staff and community. • Provide support, follow up and referrals if indicated.

31. You can make an impact! In your own practice: • Stay informed on current local, state and federal policy • Form your own opinion on policy that relates to childhood obesity • Be a community leader, advocating for wellness programs and activities • Serve as a resource to your community for health and wellness information • Support public health agencies and community coalitions in their collaborative efforts to promote and evaluate obesity prevention interventions

32. References American Psychological Association (2010). Retrieved from How parents can confront childhood obesity by fostering environmental change in their communities, Washington, D.C. Beck, Christina (July 2010). The Colorado Health Foundation Report: Food Access in Colorado. Retrieved on June 22, 2014 from http://www.coloradohealth.org/studies.aspx Berkowitz, B., Borchard, M., (January 31, 2009) "Advocating for the Prevention of Childhood Obesity: A Call to Action for Nursing" OJIN: The Online Journal of Issues in Nursing Vol. 14, No. 1. Manuscript 2. DOI: 10.3912/OJIN.Vol14 No1 Man02 Budd, G. M., & Hayman, L. L. Addressing the Childhood Obesity Crisis: A Call to Action. The American Journal of Maternal/Child Nursing, 33, 111-118. Retrieved June 20, 2014, from http://www.nursingcenter.com/lnc/cearticle?tid=778567 Chinn Susan, Rona Roberto J, 2001, Prevalence and trends in overweight and obesity in three cross sectional studies of British children, British Medical Journal Edelman, C.L., Kudzma, E.C., & Mandle, C.L. (2010). Health promotion throughout the lifespan. (7th ed.). St. Louis: Mosby Elsevier.Medical J Journal, January 6th; 322(7277): 24-26 Finkelstein, E. A., Graham, W. C. K., & Malhortra, R. (2014). Lifetime direct medical costs of childhood obesity [Electronic version]. Pediatrics 133(5), 1-9. Hopkins, K. F., DeCristofaro, C., & Elliott, L. (2011). How can primary care providers manage pediatric obesity in the real world?. Journal Of The American Academy Of Nurse Practitioners, 23(6), 278-288. doi:10.1111/j.1745-7599.2011.00614.x

33. References Jones, T. (2010, June 1). Fighting Childhood Obesity: Taking a stand to control an epidemic one child at a time. American Nurses Association. Retrieved June 20, 2014, from Childhood-Obesity.pdf http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/ Leggat, M., Kerker, B., Nonas, C., and Marcus, E. (2012, June). Pushing Produce: The New York City Green Cart Initiative. Journal of Urban Health. Retrieved June 22, 2014 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3531353/ Maurer, FA., & Smith, CM. (2013). Community/Public health nursing practice: Health for families and populations. 5th ed. St. Louis, MO: Elsevier. National Association of School Nurses. (2013, March). School Wellness Policies. Retrieved June 20, 2014, from https://www.nasn.org/ToolsResources/SchoolWellnessPolicies National Center for Health Statistics. Health, United States, 2011: With Special Features on Socioeconomic Status and Health. Hyattsville, MD; U.S. Department of Health and Human Services; 2012. National Conference of State Legislatures (2013, January). Trans fat and menu labeling legislation. Retrieved June 20, 2014 from http://www.ncsl.org/research/health/trans-fat-and-menu-labeling-legislation.aspx Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association 2014;311(8):806-814. Robert Wood Johnson Foundation (2011, July). How can the Healthy, Hunger-Free Kids Act make school foods healthier? Health Policy Snapshot Series. Retrieved June 13, 2014 from http://www.rwjf.org/en/research-publications/find-rwjf-research/2011/07/how-can-the-healthy--hunger -free-kids-act-make-school-foods-heal.html

34. References S. Rep No. 10-081 (2010). Sen. Blumenthal, Richard (2014, May 15) . S.2342 - Stop Subsidizing Childhood Obesity Act. 113th Congress (2013-2014). Retrieved on June 22, 2014 from https://beta.congress.gov/bill/113th-congress/senate-bill/2342/text?q=%7B%22search%22%3A%5B%22obesity%22%5D%7D Shanks, B., Lechttenberg, J., & Delger, S. (2013, June 1). Overweight and Obesity in Youth in Schools: The role of the school nurse. Overweight Children and Adolescents. Retrieved June 20, 2014, from http://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/ NASNPositionStatementsArticleView/tabid/462/ArticleId/39/Overweight-Children-and-Adolescents-Adopted-2002 U.S. Department of Agriculture Food and Nutrition Service (2014, March). School meals: Local school wellness policy. Retrieved June 20, 2014 from http://www.fns.usda.gov/school-meals/local-school-wellness-policy U.S. Department of Agriculture Food and Nutrition Service – Child Nutrition Division (2014). Interim final rule: Nutrition standards for all foods sold in school. Retrieved June 20, 2014 from http://www.fns.usda.gov/sites/default/files/SmartSnacks2014.pdf U.S. Government Accountability Office (2014, January). School lunch: Implementing nutrition changes was challenging and clarification of oversight requirements is needed. Retrieved June 20, 2014 from http://www.gao.gov/assets/670/660427.pdf