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REDUCING CHILDHOOD OBESITY: Public Policy And Broad-Based Strategies. Philip M. Bonaparte, MD Chief Medical Officer Horizon NJ Health March 31, 2007. Definitions. Obesity High amount of body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or higher Overweight

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reducing childhood obesity public policy and broad based strategies

REDUCING CHILDHOOD OBESITY:Public Policy AndBroad-Based Strategies

Philip M. Bonaparte, MD

Chief Medical Officer

Horizon NJ Health

March 31, 2007

  • Obesity
    • High amount of body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or higher
  • Overweight
    • Body Mass Index between 25 and 29
  • Children Overweight
    • BMI is > 95th percentile according to the age and gender

* Source: CDC, 2005

  • Measure of a person’s weight in relation to height
  • Adults and children
    • Weight in kilograms divided by the square of his or her height in meters.

* Source: CDC, 2005

national center for health statistics
National Center For Health Statistics
  • Children
    • 16% of children and teens (over 9 million) aged 6-19 years are considered overweight
  • Adults
    • 65% overweight or obese
    • 30% of U. S. adults 20 years of age or older (60 million) are obese
nj behavioral risk factor surveillance system
NJ Behavioral Risk Factor Surveillance System


Overweight Obese

Overall 36.7 17.7


Males 47.8 18.2

Females 26.5 17.2


White, non-Hispanic 35.7 17.0

Black, non-Hispanic 42.5 25.0

Hispanic 38.3 19.5

*Source: NJ Dept. of Health and Human Services

kids rock program
Kids ROCK Program
  • Kids Reaching Out to Create Healthy Kids
  • HNJH Pilot Program
    • 5-13 yrs old
    • 3 Physician groups: Husband and wife PCP, North Hudson Community Action and CamCare
    • Children >85th percentile
  • Collaboration between Physician and HNJH Diabetes DM Program
kids rock program1
Kids ROCK Program
  • Goals- No increase in weight. Make life style changes
  • AAP Policy Statement
  • CDC guidelines: BMI
  • Outcomes Measures- Life Style Survey. BMI changes
kids rock program2
Kids ROCK Program

Member education materials

  • How to Read a Food Label
  • Portion Control visual scale of What is a Portion (uses palm of hand, thumb, fist)
  • TV Zombies and Soda Monsters
  • Member incentives include: jump ropes, frisbees, H2O bottle, pedometer
kids rock program3
Kids ROCK Program

Physician Support :

  • Reinforcement of physician education
  • Encourage members to keep visits
  • Link members to community resources including mental health, family counseling, nutritional education
kids rock program4
Kids ROCK Program
  • Over 108 children registered
  • Majority of children did not keep follow up appointments (about 90%)
  • Incorporated, “Dancing To Your health”
energy imbalance
Energy Imbalance
  • Weight gain
    • Calories consumed > Calories used
  • Weight loss
    • Calories consumed < Calories used
  • No weight change
    • Calories consumed = Calories used
  • Poor diet
  • Lack of or insufficient physical activity
  • Family history
  • Poor choices
unhealthy nutrition
Unhealthy Nutrition
  • Bigger portion sizes
  • More fast foods
  • Advertisements
    • Encourages fast foods
    • Soft drinks
    • Sweets
    • Sugar loaded foods like breakfast cereals
unhealthy nutrition1
Unhealthy Nutrition
  • Large meal=less cost
fast foods
Fast Foods
  • McDonalds

Calories Fat

    • 4 pieces chicken nuggets 210c 13g
    • 12 fl. Oz. Coca Cola 110c 0g
    • Cheeseburger 330c 14g
    • Small French Fries 210c 10g
    • Cookies 2 oz bag 230c 8g
    • Hot fudge sundae 360c 12g
fast foods1
Fast Foods

Calories Fat

  • Cinnabon
    • Classic Cinnabon Cinnamon Roll 816 32
  • Pizza Hut
    • 1 slice cheese pan pizza 285 14
    • 1 slice cheese thin’n crispy 210 9
  • KFC
    • Drumstick 140 8
    • Mash potatoes 120 6
    • Macaroni & cheese 180 8
    • Baked beans 190 3
lack of physical activity
Lack Of Physical Activity
  • Fewer PA classes at school
  • Lack of safe areas
  • Television
  • Computer
  • Video games

Childhood Obesity

Causes & Effects

Type II Diabetes







Psychological Issues



Low Self-Esteem

Stress On


what changes are needed
What Changes Are Needed?
  • Teach parents and children to read labels
  • Warn against the dangers of Trans Fat
  • Safer neighborhoods
  • Increase PE at school
  • PSA campaign on Healthy Lifestyle
  • Open dialogue with Fast Food Chain
read the label
Read The Label


 Checkcalories

 Quick guide to %Daily Value

5% or less is low

20% or more is high

 Limit these

 Get enough of these

 Footnote

when it s time to eat
When It’s Time To Eat…
  • Offer a variety of foods
  • Regular schedule
  • Set a good example
  • Turn OFF the TV
give them less
Give Them Less…
  • Doughnut
  • French fries
  • Regular chips
  • Soda
  • Fried chicken nuggets
who we need
Who We Need?
  • Parents
  • Schools
  • Government
  • Healthcare
increase physical activity
Increase Physical Activity
  • Make it fun!
  • 30 minutes at once or 10 minutes at a time
  • Start at a moderate level and gradually increase
  • Make it a family or friends activity!
healthy people 2010
Healthy People 2010
  • Reduce the prevalence of children and adolescents (6-19 y/o) who are overweight to 5%
obesity a global epidemic
Obesity - A Global Epidemic
  • Worldwide, more than a billion people, 10% of whom are children, are obese or overweight
  • It is the sixth most important risk factor in the overall burden of disease
  • No coordinated obesity prevention efforts
obesity us
Obesity - US
  • The US has the highest rate of overweight and obese people
  • Set to overtake smoking as the main preventable cause of illness and early death
  • Obesity shortens life and increases the risk of developing heart disease and stroke, diabetes, arthritis and certain types of cancer

Source: The Lancet Medical Journal

risk lack of parental concern
Risk: Lack of Parental Concern
  • Many healthcare providers assume that parents are eager to make changes to help their children lose weight
  • Not all parents open to making lifestyle changes even if they could help their overweight children shed pounds
    • Of 151 parents studied, 44 % of parents were not planning on making lifestyle changes any time soon

Source: Pediatrics, July 2005

risk lack of parental concern1
Risk: Lack of Parental Concern
  • Parents more open to change if they viewed themselves as overweight
  • Study included mostly African American and Hispanic families seen at a Philadelphia pediatric practice
  • The children were between the ages of 2 and 12, and all were either overweight or at risk of becoming so