UCLA IOM Moore

Preventing Childhood Obesity:Health in the Balance Barbara J. Moore, Ph.D.President and CEO,Shape Up America! : 

Preventing Childhood Obesity: Health in the Balance Barbara J. Moore, Ph.D. President and CEO, Shape Up America!

“Obesity”: 

'Obesity' Obesity refers to excess adiposity (body fat) Body fat is usually not measured in children nor do accepted body fat standards exist for children Population based approach to prevention

Body Mass Index (BMI): 

Body Mass Index (BMI) BMI is widely accepted proxy for body fat BMI standards (children) issued by CDC in 2000 BMI requires accurate measurement of both height and weight using standardized protocols (minimal clothing, shoes off, etc.) Any error in height measurement is squared: BMI = [Weight] / [Height2]

BMI vs. BMI Percentile: 

BMI vs. BMI Percentile In children (as opposed to adults) BMI per se is not used because they are growing Once BMI is calculated, the age and sex of the child is used to determine the sex- and age-specific BMI Percentile CDC growth charts are required (or website based algorithms)

BMI / BMI Percentile: 

BMI / BMI Percentile Not useful for studies or surveys of children relying on telephone methodology For surveillance, NHANES is singled out in the report because it relies on measured height and weight NHANES budgetary support is always in jeopardy

Slide6: 

An Epidemic of Childhood Obesity 9 million U.S. children and youth older than 6 years: 

An Epidemic of Childhood Obesity 9 million U.S. children and youth older than 6 years

Obese 6-19 Year OldsNHANES 1999-2002: 

Obese 6-19 Year Olds NHANES 1999-2002 Hedley AA et al. JAMA 2004;291:2847-2850.

Schematic Representations of BMI Distribution Models: 

Schematic Representations of BMI Distribution Models U.S. children andamp; youth U.S. adults Source: Flegal KM, Troiano RP. 2000. Int J Obes Relat Metab Disord 24:807-818.

Pediatric Diabetes -- Growing % of New Cases is now Type 2: 

Pediatric Diabetes -- Growing % of New Cases is now Type 2 andlt; 1990 2000

Obesity Related Annual Hospital Costs for Children and Youth (data expressed in millions of dollars) : 

Obesity Related Annual Hospital Costs for Children and Youth (data expressed in millions of dollars)

Perceptions of Obesity: 

Perceptions of Obesity Qualitative and quantitative research indicates that obesity in children is often not perceived by parent/caregiver Some mothers assume the growth charts do not apply to children of color Many health care providers fail to use the growth charts to assess children

Maternal feeding practices and childhood obesity: 

Maternal feeding practices and childhood obesity Qualitative study of WIC mothers of infants 12 to 36 months old found: Moms believe it is better to have a heavy infant because heavy babies are healthier Moms considered heavy weight of infant reflected positively on their success as a parent. [Source: AE Baughcum, et al. Arch Pediatr Adolesc Med. 1998; 152:1010-1014]

WIC Providers see WIC Moms as…: 

WIC Providers see WIC Moms as… Highly stressed and focused on surviving or other more urgent issues (nutrition is not a priority) Using food as a coping mechanism and as a parenting tool – i.e., to manipulate the mood and behavior of their children (and in themselves) Modeling poor eating habits for their children [Source: LA Chamberlin et al. Arch Pediatr Adolesc Med. 2002; 156:662-668]

Risk of Childhood Obesity Increases if One or Both Parents Obese: 

Risk of Childhood Obesity Increases if One or Both Parents Obese

Obesity in Adulthood is Predicted by Weight Status in Early Life[Adapted from Whitaker et al. NEJM: 1997;337:869-873]: 

Obesity in Adulthood is Predicted by Weight Status in Early Life [Adapted from Whitaker et al. NEJM: 1997;337:869-873]

Key Findings: 

Key Findings Childhood obesity is a serious nationwide health problem requiring a population-based prevention approach. The goal is energy balance – healthful eating behaviors and regular physical activity to achieve a healthy weight while protecting health and normal growth and development. Preventing childhood obesity is a collective responsibility—multiple sectors and stakeholders must be involved in societal changes at all levels. Key Conclusions

Framework for Understanding Obesity in Children and Youth: 

Framework for Understanding Obesity in Children and Youth

National PriorityGovernment at all levels to provide coordinated leadership: 

National Priority Government at all levels to provide coordinated leadership Leadership Money: the budget IS the policy Staff: policies, program requirements and priorities Research: high-risk populations Resources for state and local programs Independent assessment of federal nutrition assistance programs Review of agricultural policies Surveillance (NHANES)

Key Findings: 

Key Findings Leadership Evaluation Resources Efforts at all levels Change in societal norms What is Needed? Culture in which Obesity Prevalence Is Increasing Healthful Eating Behaviors and Physical Activity are the Norm

Key Stakeholders Involved: 

Key Stakeholders Involved Parents Families Schools Communities Leaders and activists at all levels Health Care Providers and Related Professionals and Leaders Industry Food Recreation Entertainment Media (TV, Movies, etc.) Government

Action Plan for Obesity Prevention: 

Action Plan for Obesity Prevention National public health priority Healthy marketplace andamp; media environments Healthy communities Healthy school environment Healthy home environment

Research Priorities: 

Research Priorities Evaluation of interventions – efficacy, effectiveness, cost-effectiveness, sustainability, scaling up Behavioral intervention research – factors involved in changing dietary, physical activity, and sedentary behaviors Community-based population-level research – high-risk populations, health disparities

Preventing Childhood Obesity: Health in the Balance For more information:www.iom.edu/obesityThe executive summary available in PDF formathttp://www.nap.eduFull IOM report can be ordered from National Academies Press.: 

Preventing Childhood Obesity: Health in the Balance For more information: www.iom.edu/obesity The executive summary available in PDF format http://www.nap.edu Full IOM report can be ordered from National Academies Press.

Slide25: 

Healthy Marketplace and MediaFood & Beverage, Restaurant, Entertainment & Recreational Industries: 

Healthy Marketplace and Media Food andamp; Beverage, Restaurant, Entertainment andamp; Recreational Industries Healthful products and meals, innovative packaging and products that promote portion control, physical activity and reduced sedentary behaviors Labeling to provide total calories per container and per serving; expand evidence-based nutrient and health claims; research to improve labeling Develop new advertising and marketing guidelines; FTC authority and resources to monitor compliance Multi-media and public relations campaign To build support for policy changes Directed at children, parents, society at large

Creating a Healthy Media Environment: 

Creating a Healthy Media Environment Develop media campaign in coordination with other federal departments and agencies and with input from independent experts to focus on: building support for policy changes; providing information to parents; and providing information to children and youth. A rigorous evaluation should be a critical component. Reinforcing messages should be provided in diverse media and effectively coordinated with other events and dissemination activities. The media should incorporate obesity issues into its content including the promotion of positive role models.

Healthy CommunitiesPromote Healthful Eating and Regular Physical Activity: 

Healthy Communities Promote Healthful Eating and Regular Physical Activity Mobilize Communities Build diverse coalitions of local governments, public health organizations, schools andamp; community agencies Efforts to eliminate health disparities should prioritize obesity prevention Child- and youth-centered organizations should focus on healthful eating and physical activity programs and should include evaluation component (BMI, etc.) Community evaluation tools should incorporate measures of the availability of/opportunities for healthful eating and physical activity Improve access to supermarkets, farmers’ markets and community gardens, particularly in low-income and underserved areas

Healthy CommunitiesPromote Healthful Eating and Regular Physical Activity: 

Healthy Communities Promote Healthful Eating and Regular Physical Activity Enhance the Built Environment Revise city planning practices to increase availability of/opportunities for physical activity and healthful foods in new developments Prioritize capital improvement projects to increase opportunities for physical activity and healthful foods in existing areas Prioritize street and sidewalk safety along routes used for walking and bicycling to school DHHS and DOT should fund community-based research to examine the impact of changes to the built environment on physical activity and dietary behaviors

Healthy SchoolsProvide A Consistent Health-Promoting Environment: 

Healthy Schools Provide A Consistent Health-Promoting Environment USDA and State and Local Educational Authorities Develop and implement nutritional standards for all competitive foods and beverages sold or served in schools Ensure all school meals meet Dietary Guidelines Pilot programs to expand school meal funding in schools with a large percentage of children at high risk of obesity Examine fiscal incentives and budgetary constraints on school food service (cafeteria) facilities and how this might be contributing to the problem of childhood obesity (profit requirements, plate waste, etc.)

Healthy SchoolsProvide A Consistent Health-Promoting Environment: 

Healthy Schools Provide A Consistent Health-Promoting Environment State and Local Educational Authorities Require at least 30 minutes of moderate to vigorous physical activity during the school day Expand opportunities for physical activity at school PE classes, intramural andamp; interscholastic sports programs and other physical activity clubs, programs and lessons After-school use of school facilities Use of schools as community centers Walking and biking to school programs

Healthy SchoolsProvide A Consistent Health-Promoting Environment: 

Healthy Schools Provide A Consistent Health-Promoting Environment State and Local Educational Authorities Enhance behavioral focus of health curriculum Insure topics are covered: nutrition, physical activity, reducing sedentary behaviors, and energy balance Develop, implement and evaluate pilot programs to explore innovative approaches to both staffing and teaching about health, nutrition, physical activity, and reducing sedentary behaviors Improve education about parenting (role models, skill building, basics of child development)

Healthy SchoolsProvide A Consistent Health-Promoting Environment: 

Healthy Schools Provide A Consistent Health-Promoting Environment State and Local Educational Authorities Develop, implement and enforce school policies to make schools advertising-free to the greatest extent possible Involve school health services Annual assessments of each student’s weight, height and BMI percentile and report to parents Perform periodic assessments of school policies and practices related to nutrition, physical activity and obesity prevention

Health Care Community: 

Health Care Community Professionals who care for children Pediatricians, family physicians, nurses, breastfeeding counselors, dietitians, etc. Professional organizations AAP, AAFP, ANA, etc. Training programs and certifying entities Medical schools, residencies, CME, MoC, boards Health plans, insurers, and accreditors Kaiser, CIGNA, NCQA, etc.

Health Care Professionals: 

Health Care Professionals Routinely track BMI Offer relevant evidence-based counseling and guidance to parents and children, as appropriate Serve as role models Provide leadership in their communities (shape policy, educate, influence budget and allocation of resources, etc.)

Professional Organizations: 

Professional Organizations Disseminate evidence-based clinical guidance Establish programs on obesity prevention Coordinate with each other to present a consistent message

Health Plans, Insurers, and Accreditors: 

Health Plans, Insurers, and Accreditors Provide incentives to their enrollees for maintaining healthy body weight Cover costs of routine screening and counseling about body weight—diet and physical activity—as clinical preventive services Include these activities as benchmarks in quality assessment measures

Healthy HomesPromote Healthful Eating and Regular Physical Activity: 

Healthy Homes Promote Healthful Eating and Regular Physical Activity Exclusive breastfeeding first 4-6 months Provide healthful foods - consider nutrient quality and energy density Encourage healthful decisions re: portion size, how often and what foods are available to eat Encourage and support regular physical activity Limit recreational screen time to andlt; 2 hours/day Parents should be role models Monitor and discuss child’s weight with health care provider

Low-Income Families and Communities: 

Low-Income Families and Communities Federal support is needed especially for high-risk groups and to evaluate federal food and nutrition assistance programs that serve those groups Committee recommended that communities provide opportunities for healthful eating and physical activity in existing and new community programs, particularly for high-risk populations