Healthy Eating and Obesity Prevention in Washtenaw County

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New information on.
Healthy Eating and Obesity Prevention in
Washtenaw County
Community Health Committee Meeting January 13,
2004
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Healthy Eating Focus Area Process
Develop statement of the issue
Adapted from Evidence-Based Decision Making in
Public Health, Public Health Management Practice,
1999.
Determine what is known through scientific
literature Quantify the issue

• Local data
• Expert input
• Best practices

Evaluate program or policy
Develop key messages and recommendations
Develop action plan
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From the Ann Arbor News, November 13, 2003
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Our Approach to Healthy Eating
Lifespan
Obesity Prevention
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Health Eating Data Within the Social-Ecological
Framework
Abundant fast food restaurants
Individual Behavior e.g. Fruit/veg
intake Portion size Breastfeeding
Vending machines in schools
Lack of local grocery stores
Obesogenic Environment
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Adult Obesity - 2000
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Overweight in Local Children

• Good news
• Overall decrease
• 6 to 11 year age group
• Bad news
• Teen overweight increases

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Individual Behavior Data
I Am What I Ate.And Im Frightened! --new book
by Bill Cosby
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5-a-day in Washtenaw Adults
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Whos Avoiding Their Fruits and Veggies??

• Black women (37.8)
• People with less than a high school education
  (38.2)
• Residents of Ypsilanti (37.9)

• Men overall (35.1)
• Men aged 18-29 years (38.9)
• White men (35.3)
• Black men (38.7)

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5-a-day in Washtenaw Kids

• Overall, 16.5 of children eat 5 or more servings
  per day (according to parents)
• 17.6 have very low intake
• Intake of fruits and vegetables decreases with
  age, particularly in children 9 years and older
• High correlation between parent intake and child
  intake

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Breastfeeding and Obesity Prevention

• Breastfeeding is linked to decreased risk of
  obesity, possibly due to physiologic factors in
  human milk, feeding and parenting patterns
  associated with nursing.
• Breastfed infants are leaner at 1 year compared
  to formula-fed counterparts. Early growth pattern
  may influence later growth.

• Prevention of Pediatric Overweight and Obesity,
  Policy Statement, American Academy of Pediatrics,
  Vol. 112, No. 2, Aug. 2003, pp. 424-430.
  www.aap.org/policy/s100029.html.
• Breastfeeding HHS Blueprint for Action on
  Breastfeeding, Dept. of HHS, Office of Womens
  Health, 2000.

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State and Local WIC Breastfeeding Rates, 2003
WIC Breastfeeding Rate ReportPoint in Time,
8/11/03
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Head Start data slides
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Other Individual Behavior Trends

• Portion sizes increasing
• TV watching (especially by children) increasing
• Convenience foods more available in
  supermarkets
• Less cooking at home

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The Obesogenic Environmentor Supply Side of
Consumption in Washtenaw County

• Adreanne Waller, MPH

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The Obesogenic Society

• Hunter/gatherers ate 75 nuts, vegs, fruits 25
  lean game
• We eat 17 fruits, vegs 28 fatty meats 55
  carbos, sugars, etc
• We would need to slow jog for 6-8 miles every day
  to exercise as hunter/gatherers
• Cheap, fast, low nutrition, high fat foods
• Convenient stores
• Drive-Throughs not much healthy food eaten
  in the car?
• Perception of increased preparation time for
  fresh fruits and vegetables
• Decreased time available e.g. Americans working
  more hours, more single parent homes, etc.

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The Obesogenic Society

• Linkages between exposure to grocery stores and
  restaurants and overweight have not been firmly
  established but theyre coming
• Sensible, but need to be creative about
  interventions and approaches, evaluate well
• Anxious to examine Community Prevention Guide
  recommendations regarding environmental
  approaches regarding overweight and healthy
  eating

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Relevant Research

• Lower prevalence of supermarkets and higher
  prevalence of independently owned grocery stores
  in low-wealth Black neighborhoods and greater
  proportion of households without access to
  private transportation
• Fruit and vegetable intake increases
  significantly for each additional supermarket in
  census tract
• Forty percent of American food budget spent on
  fast foods
• Low income communities have signficantly fewer
  supermarkets per capita than similar
  communities
• Food insecurity related to overweight among
  Latino women in Sacramento, Ca.

• Morland, K. et.al. Neighborhood characteristics
  associated with the location of food stores and
  food service places. AJPM.20022223-29.
• Morland, K., et.al.The Contextual Effect of
  the Local Food Environment on Residents Diets
  The Atherosclerosis Risk in Communities Study.
  AJPH. 2002921761-1767.
• Dietz, W. Obesity in Children UM-SPH
  Presentation
• Philadelphia Food Trust
• University of California Cooperative
  Extension. July 2002

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Data Limitations

• Grocery Stores and Restaurants identified
  through Ameritech and Michigan Bell Yellow Pages
• Geocoding approximately 75-85 accurate
• Micro analyses ( e.g. census tract level) would
  require further work.
• X number of groceries per x square miles
• Party Stores defined conservatively
• party in name or known convenient store
• Fast Food defined conservatively
• drive-through drive-in in name or known
  drive through chain
• take-away primary reputation for delivery or
  take out food, e.g. pizza, coney island

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Grocery Stores and Restaurants Per 100,000
PopulationWashtenaw County 1950-2003
Source Waller-Washtenaw County Public Health
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Grocery Stores By TypeWashtenaw County
1950-1990
2003 data omitted due to Yellow Pages
categories shifting Party Stores out of
Grocery Stores to their own category.
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Restaurants By TypeWashtenaw County 1950-2003
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Restaurants By TypeWashtenaw County 1950-2003
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School Environment Trends

• Local data based on Physical Activity and Healthy
  Eating Asset Survey, April 2003
• Questions based on CDCs School Health Index for
  Physical Activity Healthy Eating
• 53 of 114 schools in WC returned a survey (46
  response rate)

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School Environment Trends

• Junk food accessibility
• Nationally
• 26.3 elementary, 62 Middle/JRHS, 94.9 HS
  (2001) students have access to vending machines
  at school
• 26.8 elementary, 39.4 Middle/JRHS, 59.3 HS
  have school store, canteen or snack bar
• Washtenaw County
• 18 of elementary schools, 25 of middle schools,
  and 69 of high schools allow the sale of junk
  foods at school
• 29 of schools have policies regarding
  availability of low fat foods in school

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School Environment Trends

• Curriculum
• Locally, only 14 of schools teach all 18 healthy
  eating curriculum topics recommended by the
  School Health Index
• Milk Consumption
• Nationally, student milk consumption has
  decreased 40 since 1977
• Locally, 91 of schools offer either low-fat or
  skim milk in their school meals

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Teens Consumption of Milk and Non-diet Soft
Drinks (ages 12-19)
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Teens Consumption of Milk and Non-diet Soft
Drinks (ages 12-19)
Teens average 1 glass milk per day
Teens drink 2X as much soda as milk, providing
many with 15-20 of their calories
90 girls, 70 boys fail to meet daily calcium
recommendation
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Question of panelistsDo these data match what
you experience with the populations you work
with/study?Panel confirmation of populations of
concern
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Panelists Confirmed Populations of Concern

• Children
• Families
• Adult men
• African American adults
• Community
• People with transportation difficulties (low
  income seniors, disabled, teens)

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Common Messages Across Populations (1)

• Prepare more meals at home more cooking.
• Focus on what we are drinking (sweetened
  beverages). Define what is a healthy beverage.
• Promote community and school gardens

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Common Messages Across Populations (2)

• Increase fiber intake more fruits and
  vegetables support plant-based diet
• Cut unnecessary sugar and fat
• Define healthy snacking replace junk food
  snacking with healthy snacking
• Good dine out/fast food options
• Portion size

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Next Steps

• Report summarizing expert panel session input
  from those who couldnt come
• Present data and results of session at January
  2004 Community Health Committee meeting
• Create report Promoting Healthy Eating in the
  Washtenaw County Community (incorporate CPG data)
  -- by spring 2004
• Host community event to release report and
  provide training on promoting physical activity
  and healthy eating in various settings -- late
  spring 2004
• CHC chooses an environmental/policy strategy to
  champion in our community

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Now We Need YOUR Help!

• Spring workshop to promote healthy eating and
  physical activity for obesity prevention, with a
  special focus on active living and walkable
  communities
• Sessions with hands-on, practical information
  about implementing best practices in these
  settings community, faith-based, schools,
  worksites
• Choose a setting for further discussion of the
  event