Reducing Childhood Obesity: The Role of Schools

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Reducing Childhood Obesity The Role of Schools

• Patrice Isabella, MS, RD
• Utah Department of Health
• November 2, 2007

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Agenda

• Why collect height and weight data in schools,
  national trends
• Update on strategies for obesity prevention
• Expert Committee, 2007
• Utah Blueprint, 2006
• What can you do?

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Surveillance Systems

• Pediatric Nutrition Surveillance System, CDC
• All WIC participants, 0-5
• Good accuracy
• Youth Risk Behavior Survey
• Adolescents
• Self-report, questionable accuracy
• Behavioral Risk Factor Surveillance System, CDC
• Self-report, adults

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NHANES Prevalence of overweight among children
and adolescents (6-19 years)
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National Public Health Priority

• Healthy People 2010 Goal
• Objective 19.3 Reduce the proportion of
  children and adolescents who are overweight or
  obese to 5 of the population.
• Institute of Medicine
• Prevention of childhood and youth obesity should
  be a national public health priority

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Who Else Cares?

• Consensus Statements/Reviews Recommending School
  Efforts (75)
• Institute of Medicine, 2005
• American Academy of Pediatrics, 2003
• National Institutes of Health, 2003
• National Association of State Boards of
  Education, 2006
• Centers for Disease Control and Prevention, 2005
• National Governors Association, 2006

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Institute of Medicine Endorses BMI Reporting

• Recommends that schools measure each students
  weight, height, and gender- and age-specific BMI
  percentile each year and
• Make the information available to parents and
  also to the students when age-appropriate.
• Concerns student data must be collected and
  reported validly and appropriately, with
  attention to privacy concerns and with
  information on referrals available if follow-up
  health services are needed.

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Why collect measurements in schools?

• Many youth lack health insurance and may not
  receive regular medical care
• Allows preventive measures to be available to all
  families at no cost

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States With BMI Policies/Mandates

• School Health Policy and Programs Study, 2006
• Has your state adopted a policy stating that
  districts or schools will screen for height and
  weight of Body mass problems?
• 11 States responded Yes
• Arkansas, DC, Florida, Illinois, Massachusetts,
  Montana, Nevada, New Jersey, Pennsylvania,
  Tennessee, West Virginia

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BMI or Health Information Collected in States

• Trust for Americas Health, report released
  August 2007
• Examined legislation, rules
• BMI or health information collected in 16 states
• 12 states have passed legislation enabling
  schools to test students BMI levels
• 2 States have enacted legislation requiring
  screening students at risk for Type II diabetes
  (California, Illinois)

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Information Collected in States

• BMI measured/collected (9 states) and report to
  parents (6 states)
• Aggregate data only (1 state)
• Assess fitness, BMI optional (2 states)
• Growth and development screening, BMI encouraged
  (1 state)
• Student measurements as part of a pilot program
  (2 states)
• BMI collected voluntarily from students (1 state)

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Expert Committee, 2007

• Expert Committee Recommendations on the
  Assessment, Prevention, and Treatment of Child
  and Adolescent Overweight and Obesity (June 2007)
• AMA, CDC, MCHB
• Full expert committee papers to be released in
  supplement to Pediatrics late fall of 2007

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Behaviors for Obesity Prevention

• Evidence supports consistent
• Limit sugar sweetened beverages
• Limit television and screen time
• Keep televisions out of childrens bedrooms
• Encourage moderately vigorous physical activity
  of 60 minutes a day or more

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Behaviors for Obesity Prevention

• Evidence supports mixed
• Breastfeed
• Consume recommended fruits and vegetables
• Eat daily breakfast
• Limit fast food
• Use appropriate portion size
• Avoid restrictive eating practices
• Eat meals together as a family

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Behaviors for Obesity Prevention

• Expert Committee suggests
• Avoid excessive fruit juice
• Balance fat, carbohydrate and protein
• Consume a diet rich in calcium

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Recommendations - Assessment

• Assess weight at least annually on all children
  using BMI-for-age
• New classification for cutoffs, consistent with
  adult classification
• Overweight BMI-for-age 85-94 ile
• Obese BMI-for-age 95th ile
• Established 99th percentile cutoffs
• severe obesity affects 4 of children
• Assess medical risk, behaviors and attitude

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Recommendations - Treatment

• Prevention Plus Protocol
• Obesity prevention at Well Care Visits including
  assessment and prevention
• Structured Weight Management
• Prevention Plus visits including treatment
• Comprehensive Multidisciplinary and Tertiary Care
  Protocol.
• Going beyond the Practice including prevention
  and treatment
• Step 4 is referral to pediatric tertiary weight
  management center.

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Stage 1 Prevention Plus

• BMI 85th ile
• 5-2-1-0 Model
• At least 5 servings of fruits and vegetables
  daily
• No more than 2 hours of screen time
• No TV in bedroom, no TV
• At least one hour physical activity daily
• No sugar-sweetened beverages
• Limit eating out
• Involve the whole family
• Acknowledge cultural differences

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Implemention

• National Initiative for Childrens Healthcare
  Quality, joint effort with RWJ
• Childhood Obesity Action Network
• COAN has released Implementation Guide for the
  new Expert Committee Obesity Recommendations
• Implementation Guide will support practitioners
  with the tools and resources to put the new
  recommendations into practice
• To join the network
• www.nichq.org/obesityactionnetwork

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(No Transcript)
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Utah Blueprint

• GOAL Utahs schools will assume an active role
  in addressing childhood overweight.
• Objectives
• Increase the number of schools that have policies
  and an environment that encourages regular
  physical activity
• Gold Medal Schools, PE requirements
• Increase access to and selection of healthy foods
  in schools
• Educate and advocate for nutritional standards
  for competitive foods and beverages
• Nutritional foods for all extracurricular
  activities, including athletics

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Objectives for schools, cont.

• Increase the number of elementary school teachers
  who teach the Utah nutrition core curriculum
• Increase the number of elementary school teachers
  who teach nutrition and behavioral skills as
  opposed to didactic information
• Decrease the number of activities and fundraisers
  focusing on food at events
• Encourage PTAs, student groups and clubs to
  choose activities and fundraisers that do not
  focus on food
• Encourage parents and teachers to limit foods
  used in the classroom for rewards and parties

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Standards for Competitive Foods

• 22 States have nutritional standards for
  competitive foods
• 26 States have limited access to competitive
  foods
• Utah not included on either list
• F as in Fat How Obesity Policies are Failing in
  America
• Trust for Americas Health, 2007
• School Health Policies and Programs Study
• CDC, 2006

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What can you do?

• Participate in Gold Medal Schools
• Join Action for Healthy Kids
• Advocate for changes to competitive foods
  policies (including vending)
• Support adoption of new core physical education
  curriculum in elementary schools
• Work with administration to develop effective
  School Wellness Policies
• Be a good role model

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• School Wellness Policy mandate
• School year 2006-2007
• As required by law, a local wellness policy, at a
  minimum, shall include
• Goals for nutrition education, physical activity
  and other school-based activities that are
  designed to promote student wellness in a manner
  that the local educational agency determines is
  appropriate
• http//www.fns.usda.gov/tn/Healthy/wellness_policy
  requirements.html

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Healthy School Pioneers

• Healthy School Pioneers
• Davis
• North Summit
• Provo
• Salt Lake
• South Sanpete
• On the Trail
• Box Elder
• Grand
• Nebo
• Ogden
• Uintah
• Wayne
• Wasatch

• Moving Ahead
• Alpine
• Granite
• Juab
• Murray
• North Sanpete
• Park City
• Tooele
• Washington
• Weber
• Getting Started
• Duchesne
• Emery
• Garfield
• Iron
• Jordan
• Kane
• Logan

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Tools and Resources

• Utah Action for Healthy Kids
• Model Local School Wellness Policies on Physical
  Activity and Nutrition
• National Alliance for Nutrition and Activity
  (NANA), March 2005
• Overweight Children and Adolescents
• Position Statement, National Association of
  School Nurses
• Tipping The Scales Toward a Healthier Population
  The Utah Blueprint to Promote Healthy Weight for
  Children, Youth and Adults
• CDCs School Health Index Self-Assessment and
  Planning Guide

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Thank You!

• Slides will be available
• health.utah.gov/obesity/news