The Childhood Obesity Epidemic Role of the Home and Family

1
The Childhood Obesity EpidemicRole of the Home
and Family
Kathleen Colleran, MD Associate Professor of
Medicine University of NMHSC Project ECHO
2
Objectives

• Understand how changes in food consumption
  contribute to childhood obesity
• Understand how changes in environment contribute
  to obesity.
• Understand how TV/advertising contribute to
  childhood obesity
• Understand the role of the home/family in
  preventing/treating obesity

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Today, about 16 percent of all children and teens
in the United States are overweight.
From the statistical sourcebook A Nation at
Risk Obesity in the United States. To order,
call 1-800-AHA-USA1 or email inquiries_at_heart.org
4
Obesity-associated annual hospital costs for
children more than tripled between 1979 and 1999.
(Wang G, Dietz WH. Economic burden of obesity
in youths aged 5 to 17 years 1979-1999.
Pediatrics 2002109(5)E81-E86)
From the statistical sourcebook A Nation at
Risk Obesity in the United States. To order,
call 1-800-AHA-USA1 or email inquiries_at_heart.org
5
The possible causes

• Food
• Exercise
• TV/advertisement

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According to a national study, 92 percent of
elementary schools do not provide daily physical
education classes for all students throughout the
entire school year. (School Health Policies and
Programs Study. Journal of School Health
2001717)
From the statistical sourcebook A Nation at
Risk Obesity in the United States. To order,
call 1-800-AHA-USA1 or email inquiries_at_heart.org
7
Six out of 10 children ages 9-13 dont
participate in any kind of organized
sports/physical activity program outside of
school. Children whose parents have lower incomes
and education levels are even less likely to
participate. Nearly 23 percent dont engage in
any free-time physical activity. (Physical
activity levels among children aged 9-13 years
United States, 2002. MMWR 2003523375-8)
From the statistical sourcebook A Nation at
Risk Obesity in the United States. To order,
call 1-800-AHA-USA1 or email inquiries_at_heart.org
8
At least 30 minutes of moderate physical activity
on most days of the week is the recommended
minimum. Nearly 23 percent of children and 40
percent of adults get no free-time physical
activity at all. (Physical activity levels
among children aged 9-13 years United States,
2002. MMWR 20035233785-8) and (National
Center for Health Statistics. National Health
Interview Survey, 1999-2001)
From the statistical sourcebook A Nation at
Risk Obesity in the United States. To order,
call 1-800-AHA-USA1 or email inquiries_at_heart.org
9
The (possible) causes

• Increased car travel and less person-powered
  transport
• Increased concerns over child safety - stranger
  danger and traffic
• Fewer walkable destinations - shops, letter boxes

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The (possible) causes

• Personal injury litigation and reduced
  opportunities for physical activity
• More families with two working parents
• Go inside and lock the door until we get home
• Parents working longer hours -
• too tired and too busy to play

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The (possible) causes

• Increasing opportunities for sedentary recreation
• television and video
• internet use and chat rooms
• computer games

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The (possible) causes

• Increasing demands for better academic
  performance
• coaching
• homework
• reading
• computer work (not games)

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The (possible) causes

• Poor fundamental movement skills - as children
  participate less, they fail to develop these
  fundamental skills so want to participate less
• The sedentary cycle

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Summary of Problems

• the demands for achievement and safety we place
  on our children
• the demands for (sedentary) entertainment our
  children place on us

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In 1980, about 50 percent of high school seniors
reported eating green vegetables nearly every
day or more. By 2003, that figure had dropped
to about 30 percent. (YES Occasional Papers.
Paper 3. Ann Arbor, Mich. Institute for Social
Research, May 2003)
From the statistical sourcebook A Nation at
Risk Obesity in the United States. To order,
call 1-800-AHA-USA1 or email inquiries_at_heart.org
16
Between 1977-78 and 2000-01, milk consumption
decreased by 39 percent in children ages 6-11,
while consumption of fruit juice rose 54 percent,
fruit drink consumption rose 69 percent and
consumption of carbonated soda rose 137 percent.
(Cleveland L. U.S. Department of Agriculture
National Food Consumption Survey, 1977-78 What
We Eat in America, NHANES 2001-02)
From the statistical sourcebook A Nation at
Risk Obesity in the United States. To order,
call 1-800-AHA-USA1 or email inquiries_at_heart.org
17
In 1970, about 25 percent of total food spending
occurred in restaurants. In 1995, 40 percent of
food dollars were spent away from home.
(Paeratakul S, Ferdinand D, Champagne C, Ryan D,
Bray G. Fast-food consumption among US adults and
children. J Am Diet Assoc 20031031332-8)
From the statistical sourcebook A Nation at
Risk Obesity in the United States. To order,
call 1-800-AHA-USA1 or email inquiries_at_heart.org
18
Children eat nearly twice as many calories (770)
at restaurants as they do during a meal at home
(420). (Zoumas-Morse C, Rock CL, Sobo EJ,
Neuhouser ML. Childrens patterns of
macronutrient intake and associations with
restaurant and home eating. J Am Diet Assoc
2001101-923-5)
From the statistical sourcebook A Nation at
Risk Obesity in the United States. To order,
call 1-800-AHA-USA1 or email inquiries_at_heart.org
19
changes in childrens food choices
consuming poor food choices by age Food
2-3y 4-7y 8-11y 12-15y snack foods
23 32 35 34 soft drinks
28 35 39 47   Fruit
77 69 59 54 Source NNS Australia 1995 ABS 1999
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Interrelationship of food and TV viewing and
obesity

• In addition to its impact on physical activity,
  TV viewing is associated with energy intake
  through increased consumption of drinks and
  snacks
• Children of low SES families watch more TV and
  consume more energy than do children of high SES
  families, and low SES parents more often have the
  TV on during meals
• TV viewing during meals may not only increase
  childrens exposure to advertising of foods, it
  may also limit opportunities for modelling of
  healthy eating

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How often is the television on during the evening
meal?

• Low SES parents were significantly more likely to
  usually have the TV on during meal times
• Twice as many low SES families as high SES
  families (40 vs. 20) reported that it was
  parents who wanted the TV on during meal times
• Only 25 of mothers believed TV advertising
  influenced their childs eating, and there were
  no SES differences

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television advertisements

• average child in USA sees over 20,000
  advertisements a year
• viewing time food ads/hr Cals /hr Fat /hr
  Sugar/hr

children's 12 2,590 74g 418g adult
5 1,398 62g 14g mixed 6 1,731 77g 17g
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Effect of TV ads by ageing
up to age 4 ads seen as entertainment age 6 to 7
believe ads provide information age
78 cant distinguish between information and
intent to persuade age 1012 can understand
motives aims of advertising, but most still
cant adequately explain sales techniques
sources Young B (1998), Emulation, Fears and
Understanding A review of recent research on
children and television advertising, ITC, London.
Kunkel D Children and Advertising A Fair
Game? 1994. Ward S., Wackman D. Wartella E.,
(1977), How Children Learn to Buy, Beverly Hills
CA Sage, cited in Young B (1998)
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pester power
73 of children demand advertised products 80
persist with demands when parents say no
Source CWS Ltd 2000 Blackmail the first in a
series of inquiries into consumer concerns about
the ethics of modern food production and
advertising, CWS Ltd Manchester Sustain 2000
Reaching the parts. Community mapping working
together to tackle social exclusion and food
poverty. Sustain London
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pester power
The Home/Family Component
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Why focus on family environment?

• It is where (many of) our childrens eating and
  activity habits are learnt and reinforced
• The family environment mediates the influence
  of the broader environment
• We have some (limited) research that supports its
  importance
• Common sense suggests it will be important
  parents want to do the best for their children

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Some findings on the family environment

• 35 parents have schedules making it difficult
  for families to eat the evening meal together
• 30 mothers find it difficult to find time to
  prepare the evening meal
• 15 dont consider the evening meal to be a
  pleasant family time
• 30 of families have the TV on during the evening
  meal on most nights

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Family influences on childrens eating

• A range of factors have been shown in small scale
  studies in the USA to influence childrens
  eating
• Parent-child feeding relationship
• Food availability and accessibility
• Media exposure
• Opportunities for modeling
• Few population studies conducted

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Family influences on childrens activity

• Evidence from limited number of studies in the
  USA
• Physical environment, e.g. play space, fencing,
  recreational equipment
• Family rules (activity and sedentary)
• Parental modelling
• Parental support and encouragement

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Summary of Probelms

• Almost every aspect of the way we live has the
  potential to contribute to reduced activity among
  our children
• No single factor is the main cause so we need to
  consider and address all of the potential
  culprits

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Possible solutions needed

• the home
• set aside time for healthy meals
• limit television viewing

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changes needed
Possible solutions needed

• schools
• fund mandatory physical education
• establish stricter standards for school lunch
  programs
• eliminate unhealthy foods such as soft drinks and
  lollies
• provide concessions on healthy snacks

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changes needed
Possible solutions needed

• marketing and media
• consider a tax on fast food and soft drinks
• subsidise nutritious foods fruits and
  vegetables
• require nutrition labels on fast-food packaging
• prohibit food advertisement and marketing
  directed at children
• increase funding for public-health campaigns

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Recommendations - 1

• We need a better understanding of the role of the
  family environment - research is essential
• We need to find ways of better supporting
  parents, especially first-time parents
• For example
• Via child and maternal health services
• Via the school and education system
• Via child care and child support systems

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Recommendations - 2

• Whatever we do it must be evaluated to ensure the
  investment benefits our children
• We need to work to co-ordinate our efforts
  nationally
• No one-off programs we need to look at making
  systemic changes that are sustained

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Conclusions

• The family environment and parenting behaviours
  are likely to be critically important
• We currently have a poor understanding of the
  influence of the family environment on the
  development and maintenance of childrens
• Eating behaviours
• Physical activity habits
• Risk of childhood and adult overweight/obesity

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New ECHO initiatives to expand access and
eliminate disparities in diabetes health care

• Motivational Interviewing training for ECHO
  participants
• Virtual Community of CDEs/building CDEs
• Building and supporting Diabetes Community Health
  Specialists