Moving our Children Toward A Healthy Weight finding the will and the way

1
Moving our Children Toward A Healthy
Weightfinding the will and the way
Kathy Kolasa PhD, RD, LDN Professor and Section
Head Nutrition Services and Patient
Education, Departments of Family Medicine, of
Pediatrics Brody School of Medicine at East
Carolina University UHS Nutrition Initiative
Consultant
2
(No Transcript)
3
What is best?

• There is no one single best diet for every person
  for prevention/treatment. Nutrigenomics is in
  the future tailor based on genetics, lifestyle,
  environment
• Dietary Guidelines for Americans 2000 at
  http//www.usda.gov/cnpp/Pubs/DG2000/Index.htm
• USDA Healthy Eating Index to check overall diet
  quality http//147.208.9.133

4
Todays briefing..

• Not about adult diets, but about the kids4
• Focused on childhood obesity prevention and
  treatment
• A bit of background
• The local problemWhite Paper
• Highlights of local responses and challenges
• Foster discussions of where to go from here

5
Pitt Partners for Health

• A grass roots organization identified..
• Nutrition Physical Activity, as a priority
• also
• Access to Care
• Diabetes
• Heart Disease and Stroke
• Older Adult Health

6
Adult size, Pitt Partners for Health, 2000

• The weight environment our kids find themselves
  in
• Weight Status BMI __
• Underweight lt18.5 2
• Normal 18.5-24.9
  31
• Overweight 25.0-29.9 36
• Obese 30.0-39.9
  29
• Morbidly Obese 40
  3

7
Current Costs of obesity in NC

• 5-20 yrs Life Lost for morbid obesity
• Obesity-related direct medical expenditures
  2.138 billion (6 NC health care bill)
• 1.11 billion financed by Medicare and Medicaid
  (From RTI and CDC, 2004)
• NC ranked 10th highest in spending
• NC Prevention Partners estimated 4.9 billion for
  poor nutrition overweight and obesity includes
  productivity loss estimates

8
Most Kids used to grow into their weight

• Overweight children are likely to remain
  overweight as adults if no intervention
• if overweight at age 6, 50 chance to be obese as
  adult
• if overweight as teen, 70-80 chance
• 60 of overweight children at least 1 risk factor
  for high BP, high cholesterol or type 2 DM

9
Remember when we used to have to fatten the kids
up first?
10
Terminology when talking about KIDS

• At risk for overweight greater than 85thtile
  BMI for age
• Overweight greater than 95thtile BMI for age
• Obese do not use term to prevent stigmatization
• Health promoting diet Dietary Guidelines and
  Food Guide Pyramid for Americans over 2 yrs
• Healthy snacks Winners Circle criteria

11
(No Transcript)
12
For Children, BMI Differs by Age
BMI
Boys 2 to 20 years
BMI
13
Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI ³ 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
14
Obesity Trends Among U.S. AdultsBRFSS, 1986
(BMI ³ 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
15
Obesity Trends Among U.S. AdultsBRFSS, 1993
(BMI ³ 30, or 30 lbs overweight for 54
person)
16
Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI ³ 30, or 30 lbs overweight for 54
person)
Source BRFSS, CDC.
17
Obesity Trends Among U.S. AdultsBRFSS, 2001
Source Mokdad A H, et al. J Am Med Assoc
199928216, 200128610.
18
(No Transcript)
19
High risk children

• Have one or both parents overweight
• Live in families with low income
• Have a chronic illness or disabilities that limit
  mobility
• Tend to be members of certain racial/ethnic
  minority groups such as African American and
  Hispanic
• Live in eastern NC

20
All Pitt county children at-risk

• At 2 yrs old, 1 in 10 at risk of overweight
  another 1 in 10 already overweight
• Almost 5 out of 10 youth are considered at-risk
  for overweight
• Almost 1 in 3 of these children already are on
  the path to type 2 diabetes

21
Kids arent eating a health promoting diet
The Food Pyramid
The Reality
Source USDA Pyramid The NPD Group's CREST and
National Eating Trends Services
22
We estimate Pitt county kids

• 1 in 3 drink 2 sodas each day
• 7 in 10 eat no fruit or vegetables daily
• 2 in 3 do not meet their daily calcium need
• 1 in 3 get only light daily physical activity
• Many grade schoolers consume 200-500 excess
  calories/day (20 min active recess 30-112 cal
  1- 20 oz Fruitopia 280 cal))
• Rural children eat more fat than urban kids

23
Nutrition and Dental Health

• On average, 23 of Kindergarten children and 8
  of fifth-grade children in Pitt County have
  untreated dental decay.
• Studies have confirmed the direct relation
  between intake of dietary sugars and dental
  caries across the life span.
• Studies show that teenage boys and girls are
  drinking nearly three times as much soda as milk.
  
• This creates a cavity equation
• soda , milk sugar,
  calcium CAVITIES!

24
Need the details?

• Can access through ECU Pediatrics web site
• www.ecu.edu/pediatrics
• Can access through the UHS Childrens Hospital
  Web site page
• www.uheast.com

25
Obesity as Health Problem

• Neither kids nor parents see obesity as health
  issue.
• Parents think of it as a social issueworry about
  childs self esteem peer acceptance.
• Parents dont see their role in this epidemic
• Clueless on appropriate portion sizes

Am Dietet Assn Survey 2003
26
(No Transcript)
27
Academic performance

• Eat healthy.. not just on test days
• Improved cognitive performance,math scores
• Improved physical performance, fitness, endurance
• Psychological benefits and feelings of well being
• Increased productive energy
• Attendance, attentiveness

28

No agency has primary responsibility
29
Whats happening the Healthy Schools Task Force
is working

• Voluntary grass roots collaboration of agencies
  
• organizations Developed a plan of action
  for
• improving nutrition increasing physical
  activity
• Living the plan
• Develop resources through expertise of members
• Collectively seek funding to address needs
• identified in plan of action

30
Vision from Healthy Schools Task Force
Eat Smart Move More Pitt county students and
staff will develop healthy lifestyle habits that
will influence their well being for a lifetime
through education, experiential participation,
healthy choices and a healthy environment
31
(No Transcript)
32
We Struggle with the Quick Fix mentality
promoted by some

• RWJ Poll
• 90 teachers parents support converting vending
  machines to healthy food drinks
• 86 ban vending from elementary schools
• 80 require PE at every grade level
• Am Academy Pediatrics focused on
• Soft drinks and School meals
• Need reasoned/moderate approach for Pitt Cnty

33
If you havent looked at Pitt County Child
Nutrition lately, look again

• Higher quality meals over last 5 years leader in
  a buying cooperative
• Age appropriate portions served
• Winners Circle healthy choice signage
  highlighted menus sent home
• 32 of 33 schools have breakfast program
• Taste Explorers in 20 schools reaching 15,000
  kids introducing new fruits and vegetables

34
All Foods Available..new policy in 2004

• 4 Achievement Levels (needs improve, basic,
  proficient, superior)
• Grade Levels (K-5, 6-8, 9-12)
• Time Place
• Vending beverages snacks
• After school programs
• School events instructional non
• School meals Ala-carte
• Preliminary review meet superior in all but
  vending in middle and high school Plan to by
  2005-2006
• Is it enough? Where we can live comfortably

35
Vending in PCS

• No pouring rights contracts.
• Carbonated beverages
• Not available in elementary school
• In middle school after school day
• Few machines in elementary schools all meet
  Winners Circle criteria
• Machines in high school operated by Child
  Nutrition program. 50 items are Winner Circle

36
21,000 children in PC schools

• 12,000 lunches served each day
• 9,000 FREE lunch
• 1,500 Reduced price lunch
• More than 50 of children in 18 of 31 schools
  qualify for free and reduced meals. As goes
  down, funding affected
• After-school program snacks are healthy

37
Challenges for Child Nutrition

• Need Principal, Teacher and Parental support and
  encouragement
• Need support every day, not just TESTING days
• Children with money buy extra portions or
  calories
• Children make poor choices, need education and
  role models
• Stay the course, revenues down with vending
  healthy options. Expect rebound.
• Need different equipment (e.g. milk machines)

38
Whats happening.. Physical activity

• Among 12-21 year olds
• 50 no vigorous physical activity
• 14 no physical activity
• 24 NC high school students, moderate physical
  activity
• 48 NC middle school students, moderate
  physical activity

39
Healthy Active Children Policy

• (passed by State Board of Education Jan. 2003,
  unfunded mandate)
• Local School Health Advisory Council. Pitt has
  long standing one
• Physical Education Activity
• Recommended 150 min/wk elementary
• Recommended 225 min/wk middle
• Assessing physical activity and healthy school
  environment
• Recess cannot be taken away as punishment
• Policy fully implemented by 2006-07 school
  year. Plan due 2004

40
Whats happening..Pitt isnt just starting

• Project YEAH! Physical activity incentive
  program, 4th yr
• Growing Up FIT! nutrition and physical activity
  in elementary, 4th yr
• PHASE (Physically active sensible eaters) staff
  wellness in 1 elementary, 1st yr
• Walking trail construction 4 serving 5 schools
  2 in planning
• And more

41
Whats happening

• Our local Health Care and Education Missions are
  coming together in several grants
• Pitt Health Education Fnd grantbrochures
• Healthy Weight Initiative Grant
• 51 Take 10 kits 49 physical activity equipment
  sets for 2 walking trails
• 2003-2004 positive pilot of what is to come
  for
• K-5 in 2004-2005

42
(No Transcript)
43
Pitt County HWTF Project 2004-2006

• EAT SMART, MOVE MORE In support of FIT
  Together..
• 1 of 20 funded grants in NC, Health and Wellness
  Trust Fund
• Targets K-5 public school students
• Goal formal policy changes by year 3
• Be active 30 min every school day
• After school programs have 60 min PA
• Nutrition improvements in cafeteria and classroom

44
(No Transcript)
45
Whats happening.. PCMH

• Developing UHS Nutrition Initiative
• Winners Circle Dining
• Pediatric Healthy Weight Case Mgmt Leadership
  Team convenedproposal to Duke Endowment
• Connecting students to services and programs
• Foundations Community Benefits program priority
  to nutrition ed physical activity projects
• ViQuest employee program supporting changes in
  home school environments

46
Health Sciences DivisionEast Carolina University

• ECU-UHS Pediatric Healthy Weight Research
  Treatment Center
• Research Summit August 2003. Building
  collaborations Building multi-disciplinary
  membership
• Providing training on prevention and treatment
• Offering comprehensive treatment clinics for
• Youth with obesity related disease or at-risk
• Medical Nutrition Therapy Services (referrals)

47
Medical Nutrition Therapy Resourcesfor
Overweight Youth in Pitt County

• ECU Family Practice Center
• Specify child has a weight concern, or is
  enrolled in KIDPOWER study
• Ask for Emilie Davis, MPH, RD, LDN
• Cost Free. Supported by grant from Pitt
  Memorial Hospital Foundation.
• ECU Family Practice Center and
• Pediatric Outpatient Center, Brody School of
  Medicine
• Ask for Catherine Sullivan MPH, RD, LDN Nancy
  Harris MS, RD, LDN Amanda McKee BSPH, Latosha
  Hope Redd, BS Ginger Hester, MS, RD, LDN
• Cost 38 for initial assessment (60 mins)17
  for follow-up (30 mins)
• Pitt County Health Department
• Ask for Joanne Moylan, MPH, RD, LDN
• Cost Free for Medicaid children sliding scale
  for others
• ViQuest
• Ask for Karen Bellacera, MA, RD
• Cost for non-members 50 for initial assessment
  (60 mins) 30 for follow-up)
• Members eligible for one free initial and
  follow-up session

48
Imagine Pitt County Eating Smarter where

• High quality fresh fruits vegetables available
  in schools, after-school programs, community
  events, supermarkets, corner stores, nearby
  farmers markets
• Children have healthy foods every day, not just
  on test days
• School cafeterias exceed the Recommended
  Standards for All Foods Available in Schools
• These are NORM not the exception

49
Moving More

• Adequate intergenerational facilities are
  available where all Pitt county residents can
  MOVE MORE
• We exceed the Healthy Active Children Policy
  expectations
• These are NORM not exception

50
Society

The State of North Carolina
Community
county, municipality
Organizational
organizations, social institutions
Interpersonal
family, friends, social networks
Individual
knowledge, attitudes, behaviors
51
Where do we go from here?

• Congratulate and encourage the collaborative work
• Spread the word to the community (culture shift)
• Obesity is a health issue
• Nutrition physical activity supports academic
  performance
• Get staff, parents and kids on board

52
Challenges

• Alternate funding for lost food revenues
• Support for policy and environmental changes
• Motivating staff and families
• Others..

53
In Summary

• Obesity is a health issue for children families
• Collaborative efforts underway to help Pitt
  County Eat Smart and Move More. Everyone has a
  role.
• Health and Education missions are merging in
  schools
• Finding the will way is critical

54
If we are not successful researchers are now
saying

• The generation of youth now in school may be the
  first to have a shorter life expectancy than
  their parents.
• Be Active North Carolina
• JAMA 2003 289187-193

55
Local Leaders are talking about raising One
Healthy Generation

• That means.
• The active promotion of health and
• well-being in our children
• Lets All Join in!