A Coordinated Approach To Child Health

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A Coordinated Approach To Child Health

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Why are we here?Our purpose is to provide
school personnel with the knowledge and skills to
successfully implement and maintain Coordinated
School Health Programming.

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Objectives for Today

• Clarify and identify the objectives of each CATCH
  component
• Assemble a CATCH committee and begin the process
  of developing a plan to implement CATCH
• Target things in your area of specialty that you
  can do to begin implementing CATCH immediately
• Coordinate, highlight share with others things
  you are already doing that meet the CATCH
  philosophy
• Have fun!

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A Different Perspective
How old would you be if you didnt know how old
you was?
Satchel Paige
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Basic AssumptionBehavior change is influenced
or determined by the environment because
environments value and reward certain behaviors.
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Overweight Children and AdolescentsNHANES
Equal or greater than 95 age/sex CDC Growth
Charts
Source Medline, 2006 Ogden et al.
JAMA1951549-55, Hedley et al. JAMA2912847-2850
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Kids Diets
What are they eating or not eating?
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Vegetables

• ¾ of children (all ages) report eating at least
  one vegetable every day
• Most popular vegetable is French Fries!
• Next is tomato products (spaghetti sauce)
• Lower is green beans, corn, peas
• Lowest is nutrient packed dark green or deep
  yellow vegetables

• http//www.barc.usda.gov/bhnrc/foodsurvey/Kidspr.h
  tml

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Percentage of 2-9 year olds who ate the
recommended number of fruits vegetables
Source http//www.barc.usda.gov/bhnrc/cnrg
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Families are Eating Out!

• Percent calories consumed at home dropped from
  74.1 to 60.5 between 1977 and 1996.
• Away-from-home meals are higher in total fat,
  saturated fat, and sodium. They are also lower
  in fiber, iron and calcium as compared to at-home
  meals. St. Onge, et al. Am J Clin Nutr 2003
  78 1068-73
• 68 to 75 of U.S. children exceed the current
  dietary recommendations for intake of total or
  saturated fats.
• CSFII http//www.barc.usda.gov/bhnrc/foodsurvey/
  home.htm

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Where do we eat out?

• 1. Fast food (includes pizza) -(accounts for more
  than half of away-from-home meals)
• Lin, et al. Food Rev 1998212-10
• 2. Restaurant (with table service)
• 3. From grocery or convenience store
• 4. From someone elses home

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Eating Behaviors

• What is the most influential factor that
  determines how much children and adults eat???
• A. Hunger
• B. Mood
• C. Portion Size
• D. Time of Day
• C. PORTION SIZE

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Adults Children eat more if given a larger
portion size

• Children 3-5 years old consumed 25 more of an
  entrée and 15 more calories at lunch when
  presented with portions that were double an
  age-appropriate standard size
• Fisher, et al. Am J Clin Nutr 2003, v.77
• Adults ate more food when given larger portions
  and rated hunger and satiety the same
• Rolls, et al. J Am Diet Assoc. 2004, v.104

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Super Size It!

• Portion sizes are getting bigger and bigger!

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Portion Sizes

• Original McDonalds burger, fries and 12 ounce
  soft drink 590 Calories
• Super size Extra Value Meal - Quarter Pounder
  with cheese, super size fries and a super size
  soft drink 1,550 Calories
• Go Active! Happy Meal - one of McDonalds four
  Premium Salads, a fountain drink of choice or
  bottled water, a Stepometer to track ones daily
  steps, and an informative booklet. (California
  Cobb Salad medium soft drink 580 kcal

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National Geographic, August 2004 The Heavy Cost
of Fat, p. 59
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Soft Drinks and Sweetened Beverages

• Between 1977 1994, consumption of carbonated
  soft drinks increased 41 Bowman, J Am Diet
  Assoc. 20021021234-9
• Children who drank more than 12 ounces of
  sweetened drinks Gained significantly more
  weight, drank less milk, and took in 244 more
  calories/day Mrdjenovic Levitsky. J Pediatr
  2003142604-10

• In a review of over 3,000 children and
  teenagers diets, no other single food provided
  more calories to a childs diet than sodas and
  fruit drinks. In all, these sweet drinks provide
  about 13 of total calories more than cakes,
  cookies, and other sugary foods Abstract from
  Experimental Biology Scientific Conference,
  April 2005 Beverages as a source of energy and
  nutrients in diets of children and adolescents.
  

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Milk Consumption

• Between 1977 1994, milk consumption declined
• 24 among boys (6-11 years old)
• 32 among girls
• Milk was found to be the primary source in a
  childs diet for Calcium, Phosphorous, Magnesium,
  and Potassium. Those who drank more milk than
  soda weighed less and had less body fat.

• http//www.barc.usda.gov/bhnrc/foodsurvey/Kidspr.h
  tml, Borrud et al., Nutr Week, 1997274-5
• Abstract from Experimental Biology Scientific
  Conference, April 2005 Beverages as a source of
  energy and nutrients in diets of children and
  adolescents.

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Television/Multimedia

• A recent study found that children under 11 years
  of age spend about 3 hours a day watching TV,
  videos, and playing computer games. Christakis,
  Pediatrics 2004145652
• Hours of TV is associated with increased obesity.
  Andersen, et al. JAMA. 1998279938-42
• TV confuses children. The more TV kids watch, the
  less able they are to identify what types of
  foods are healthy. June 2005 University of
  Illinois
• What other messages do children get from TV?

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Physical Inactivity

• 48 of girls 26 of boys do not exercise
  vigorously on a regular basis. MMWR CDC
  Guidelines,1997461-36
• School-aged youth should participate in 60
  minutes or more of moderate to vigorous physical
  activity every day. Review in June 2005 issue of
  Pediatrics

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Obesity in American Adults2001-2002

• 66.3 are overweight (BMI 25)
• 32.2 are obese (BMI 30)
• 4.8 are extremely obese (BMI 40) (_at_100 lb.
  overweight)

Ogden et al. JAMA 20061951549-55
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Physical Inactivity

• Physical activity declines progressively from
  ages 12 to 21. Cancer Prevention Early
  Detection Facts and Figures 2005.
• Childrens walking and biking trips to school
  have declined by 50
• Daily PE enrollment dropped from 42 of students
  in 1991 to 25 in 1995. Surgeon General Report,
  1999

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What is the result of a lifestyle with
consistently too many calories and not enough
physical activity?
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Obesity

• Body Mass Index (BMI) - a measure of weight in
  relation to height.
• Adult Obesity - having a very high amount of body
  fat in relation to lean body mass, or Body Mass
  Index (BMI) of 30 or higher.
• Adult Overweight - increased body weight in
  relation to height, when compared to some
  standard (BMI over 25).
• For adults, A BMI of 19-25 is associated with the
  lowest health risk

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Calculate your BMI

• To calculate your body mass index (BMI)
• Multiply your weight (in pounds) by 705 and
  divide by your height (in inches) squared
• (Weight x 705/height2)

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For Children, BMI Differs by Age
BMI
BMI
Example 95th Percentile Tracking Age
BMI 2 yrs 19.3 4 yrs 17.8 9 yrs
21.0 13 yrs 25.1 http//www.cdc.gov/nccd
php/dnpa/bmi/bmi-for-age.htm
Boys 2 to 20 years
BMI
BMI
Source CDC Growth Chart Slides
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Obesity Trends Among U.S. AdultsBRFSS, 1991
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1992
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1993
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1994
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1996
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs overweight for 5 4
person)
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Obesity Trends Among U.S. AdultsBRFSS, 2001
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI 30, or 30 lbs overweight for 5 4
person)
(BMI ?30, or 30 lbs overweight for 54 person)
No Data lt10 1014
1519 2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2003
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2004
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
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11th Grade Prevalence of Overweight by Public
Health Region in Texas, 2000-2002
Overweight is gt 95th Percentile for BMI by
Age/Sex
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8th Grade Prevalence of Overweight by Public
Health Region in Texas, 2000-2002
Overweight is gt 95th Percentile for BMI by
Age/Sex
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4th Grade Prevalence of Overweight by Public
Health Region in Texas, 2000-2002
Overweight is gt 95th Percentile for BMI by
Age/Sex
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Childhood Obesity

• Health problems Overweight children miss 3-4
  times as much school. Kids born today may have
  lower life expectancies than their parents. March
  2005 New England Journal of Medicine
• Associated with social problems Severely
  overweight kids scored lower on a quality of life
  survey than kids with cancer! Out of 100, the
  overweight kids average score was a 67. Journal
  of American Medical Association
• Cost burden
• Surgeon Generals report 2001 US expenditures
  on obesity - 117 billion
• Child Adolescent Hospitalizations for diseases
  associated with obesity increased sharply between
  1979 and 1999
• From 1987 to 2002 health care spending on obesity
  rose from 2 to 11.6. - Journal of Health
  Policy and Research.

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Type 2 Diabetes

• Type 2 Diabetes was formerly known as adult
  onset diabetes, but there has been an increasing
  incidence of type 2 diabetes in youth. Rosenbloom
  et al., 1999
• Approximately 85 of children diagnosed with type
  2 diabetes are overweight or obese American
  Diabetes Association
• As the US population becomes increasingly
  overweight, researchers expect type 2 diabetes to
  appear more frequently in younger children
  American Diabetes Association
• Higher prevalence in Hispanics (1.9x) African
  Americans (1.7x) NIDDK, 2000

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Possible Diabetes Indicators

• Acanthosis nigricans, a darkening of the skin, an
  indicator for Type 2 diabetes. It is
  characterized by brown, velvety hyperkeratotic
  patches in the body folds. (may indicate high
  levels of insulin in the blood)
• Family history
• Sugar in the urine
• Overweight

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Changes In .

• Portion Distortion
• High Fat Content/Energy Dense Foods
• High Sugar Content
• Fast Food Marketing and Advertising to Children
  (93 Focused on Fast Foods and Foods with High
  Sugar Content)
• Mothers Move to Workforce (Children Move Inside)
  less time for nutritious meals at home.
• Decline in Physical Activity

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Basic AssumptionBehavior change is influenced
or determined by the environment because
environments value and reward certain behaviors.
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Assumption 2

• The answer to the obesity problem is to affect an
  environmental change that teaches/educates,
  reinforces and rewards physical activity and
  healthy eating habits (The premise of CSHP).

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What is Coordinated School Health?

• Coordinated School Health Programming is a
  process which brings a school community together
  to teach children to be healthy for a lifetime
• Effective coordinated school programs reinforce
  positive healthy behaviors throughout the day and
  makes clear that good health and learning go hand
  in hand

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Coordinated School Health
Health Education
Family Community Involvement
Physical Education
School-site Health Promotion for Staff
School Health Services
School Nutrition Services
Healthy School Environment
School Counseling Social Services
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What is CATCH?

• The CATCH Program is a resource for bringing
  schools, families, and communities together to
  work toward creating a healthy school
  environment.
• It is a Coordinated Program designed to promote
  physical activity, healthy food choices, and
  prevent tobacco use in elementary school aged
  children.

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Coordinated School Health
Health Education
Family Community Involvement
Physical Education
School-site Health Promotion for Staff
School Health Services
School Nutrition Services
Healthy School Environment
School Counseling Social Services
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CATCH Research Trial1991-94

• Research study was called the Child and
  Adolescent Trial for Cardiovascular Health
• First research trial to integrate school, child
  family
• Ethnically diverse population, over 5,000
  students involved in nearly 100 schools
• Four geographic areas of the U.S.
• California
• Louisiana
• Minnesota
• Texas

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Does CATCH Work?

• Reduced total fat and saturated fat content of
  school lunches.
• Increased moderate-to-vigorous physical activity
  (MVPA) during P.E. classes.
• Improved students self-reported eating and
  physical activity behaviors.
• Effects persisted over three years without
  continued intervention.
• Luepker RV, et al (1996). JAMA, 275(10), 768-76.
• Nader PR, et al (1999). Arch Pediatr Adolesc Med,
  153(7), 695-704.

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It Takes Everyone Working Together
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Ultimately Its a Matter of Value

• Its easy getting everyone to agree that they
  want to live and work in a healthy setting.
  Wanting to be healthy is a common shared value,
  one that can bring people together. Therein lies
  one of the keys to establishing a successful
  CSHP.

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The Second Key is to Makethe Process Positive
and Enjoyable.

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ITS A CHEGG THING! So, what comes first?
Coordinated school health programming or a
coordinated school health program/curricula? Answe
r They both do!

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• So . . .
• What is Coordinated School Health?
• What is CATCH?