Diet, Physical Activity and Cancer

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Diet, Physical Activity and Cancer

• Preliminary Report of the Diet and Physical
  Activity Committee

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Diet and Physical Activity Committee

• 3 meetings, future meetings to be scheduled
• Choice of problems
• Limited scope to a small number of big picture
  problems for which the
• Scientific evidence is adequately compelling
  according to health organizations (e.g., ACS) and
  government agencies (e.g., NCI)
• Prevalence is high in the U.S., including in
  Maryland
• Dissenting view
• Choice of contributors to problems and solutions
• Solicited from committee members in writing
• Original thoughts or based on existing resources
• Discussion of problems in meeting, comments on
  possible solutions by email

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Risk Factors for Cancer in Places like Maryland

• At this point in time
• Compelling evidence and Committee consensus
• Inactivity
• Obesity
• Diet
• High in energy
• Low in fruits and vegetables
• Evidence not yet compelling and/or lack of
• Committee consensus
• For specific components of the diet
• For certain cancers

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Prevalence of overweight/obesity, physical
activity, and suboptimal diet in Maryland

• Information source - Centers for Disease Control
• Maryland Behavioral Risk Factors Survey (BRFSS)
• Youth Risk Behavior Surveillance System (YRBSS)
• Maryland does not participate (42 states do)

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Behavioral Risk Factors Survey, Adults in
Maryland 2000http//apps.nccd.cdc.gov/brfss/page.
asp?yr2000stateMDcatRFRF

• Body mass index
• 36.5 were overweight (25-29.9 kg/m2)
• 20.2 were obese (30 kg/m2)
• 72.6 consumed lt 5 servings of fruits and
  vegetables per day
• Physical inactivity
• 24.2 did not participate in any physical
  activities during the past month
• 77.7 did not participate in in regular and
  sustained exercise

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Youth Risk Behavior Survey, High School
Students 2001 http//www.cdc.gov/nccdphp/dash/yrbs
/2001/summary_results/usa.htmref

• Dietary behaviors
• 14 At risk for becoming overweight
• 10 Overweight
• 79 Ate lt 5 servings of fruits and vegetables per
  day during the past 7 days
• Physical activity
• 48 Were not enrolled in physical education class
  
• 68 Did not attend physical education class daily
  
• 31 Did not participate in vigorous physical
  activity and did not participate in moderate
  physical activity

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Problems in Youth and Adults

• Overweight/obesity
• Inactivity
• Suboptimal diet
• Too little consumption of fruits and vegetables
• Too much energy consumption

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Sources of influence on diet and physical
activity
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Contributors to ProblemsYouth and Adults

• Behaviors
• Lack of information
• Other perceived and actual barriers

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Example Contributors to Problems

• Families May not have knowledge or resources to
  prepare healthy meals
• Communities Lack of sidewalks, paths
• Schools Vending machines, limited PE,
  inconsistent nutrition education, optimal school
  meals?/a la carte items
• Workplace Lack of activity breaks, lack of
  employee wellness programs
• Food purveyors Pricing of healthful foods vs.
  fast foods
• Health Institutions Inadequate provider
  reimbursement for preventive services, unhealthy
  foods in hospitals, clinics, etc.
• Government Walkability of communities not part
  of planning process
• Interventionists May not know barriers to
  healthy eating and activity, may not know
  knowledge, attitudes, beliefs of citizens and
  providers about prevention of cancer through
  healthy diet and activity

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Multifaceted solutions to the problems of diet,
physical activityand cancer
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Does not have knowledge / No action toward change
Individual/Family/ Community Nonhealth
institutions Health institutions Government
Intervention
Has knowledge / No action toward change
Targeted interventions for problems are needed at
the individual and societal level
Barriers
Lack of motivation
Perceived
Actual
Intervention
Intervention
Intervention
Adopted healthful diet and physical activity
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Solutions Families

• Foster good eating patterns and physical activity
  from birth on
• By talking with their children
• By example
• Bring concerns to local school health program
  advisory council and be an advocate of
• Education on diet and physical activity
• Daily PE
• Increasing healthy choices in school meals

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Solutions Communities

• Grassroots advocacy for
• Access to healthy food in schools and
  neighborhoods
• Sidewalks and trails for biking and hiking
• Playgrounds, parks monitor upkeep
• Safety, lighting
• Nutrient labeling for fast foods, restaurants
• Promote farmers markets, community gardens,
  Community Supported Agriculture
• Promote healthy eating and physical activity
  through community groups
• Example Black and minority churches implementing
  ACSs Body and Soul program

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Solutions Schools

• Primary and secondary school education on
  nutrition and physical activity
• Evaluate existing Maryland law effectiveness
• Mandate consistent objectives for nutrition and
  physical activity education in grades K through
  12
• Compile list of existing curricula
• Enhance teacher access to these curricula
• Seek foundation support for curricula
  implementation
• Include nutrition and physical activity questions
  on Maryland Assessment exams

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Solutions Schools

• Very specific examples
• Brief education sessions (grade-appropriate)
• What is cancer?
• What are its causes?
• How does healthy eating and physical activity
  reduce risk?
• Field trips to produce section of supermarkets
• School gardens
• Healthy snacks, improved physical activity in
  after-school programs

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Solutions Schools

• Vending machines
• Notify parents
• Offer healthy options (e.g., real juices, water,
  fruit)
• Enforce policies/laws on access
• Offer principals other options for fund raising
• School meals and snacks
• Reflect education to students about nutrition
• School health council
• Evaluate school meals to see if they can be made
  even healthier

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Solutions Schools

• Physical education
• Promote greater choice of activities/tailor
  activities to childs fitness level
• Teach/promote noncompetitive and lifelong
  activities
• Increase school-related physical activity outside
  of physical education
• Stretch/dance breaks during the school day

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Solutions Workplace

• Adopt health promotion programs and policies
• Release time for exercise
• On-site facilities
• Workplace competitions (e.g., stair climbing,
  running/walking teams)
• Subsidize gym fees
• Educate workplace events planners to hold healthy
  meetings (ACSs Meeting Well Too!)

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Solutions Health Institutions

• Healthcare providers
• Use any visit to assess in detail nutrition and
  physical activity status of patient (ADA
  assessment forms?)
• Make specific recommendations to patients and
  point them to resources for guidance
• More training of providers about diet and
  physical activity
• How to intervene
• Encourage providers to practice what they preach

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Solutions Media

• Enhanced local public service campaigns about the
  importance of diet and physical activity in the
  prevention of cancer
• News article series about nutrition, activity and
  links to disease
• Promote community/statewide/national
  nutrition/physical fitness days

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Solutions Government

• Schools
• ? Ban vending machines
• Mandate daily physical education
• ? Lengthened school day or year to allow for PE
• Work with food purveyors to open and keep grocery
  stores in the urban setting
• Enhance and link existing food programs
• Preparation of healthful meals for child and self
  from the foods covered by WIC
• Partner WIC/Food stamps/5 A Day programs with
  local farmers markets

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Solutions Government

• Dedicate resources/build
• Sidewalks, trails, playgrounds, parks
• Lighting/safety features
• Allow access to school tracks, courts
• Partner city planners with parks/recreation depts
• Educate planning agencies on health benefits of
  walking to influence their development
• Legislate reimbursement for prevention services
• Statewide tax breaks/incentives for workplaces to
  incorporate employee wellness programs

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Solutions Interventionists

• Identify and implement existing programs for
  intervention to improve healthy eating and
  physical activity targeted to
• Youth
• Young adults (period of weight gain)
• Adults
• Healthcare providers
• Where gaps exist, design and implement programs
  based on knowledge, attitudes, beliefs surveys

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Solutions Interventionists

• Convey simple and race/culture-specific messages
• What should a healthful plate of food look like?
• What is a healthful portion size?
• What to choose when eating out?
• What counts as fruits and vegetables?
• Fresh, frozen, canned, dried
• How to store
• What counts as physical activity?
• Even brisk walking counts
• The Food Pyramid
• Underserved (e.g, fewer calculations)
• Specific racial/ethnic groups
• How does healthy eating and physical activity
  reduce cancer risk?

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Solutions Academia, Government, and Advocacy
Groups

• Continue research on nutrition and physical
  activity in relation to cancer
• Determine when evidence is strong enough to merit
  intervention
• Continue behavioral and economic research on
  individual and societal interventions
• Promote etiologic research on nutrition and
  physical activity and cancer
• Promote research on targeted and effective
  nutrition and physical activity interventions

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Evaluation

• Evaluation of the nutrition and physical activity
  committee recommendations is warranted
• Were they implemented effectively?
• Improvements in nutrition and physical activity
  in Maryland
• Adults
• Adolescents
• Children
• Long-term benefit on cancer incidence and
  mortality

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Next Steps of the Diet and Physical Activity
Committee

• Examine prior Maryland Comprehensive Cancer
  Control Plan sections on diet and physical
  activity
• Look for repetition of problems and solutions
• Were solutions implemented?
• Develop areas of research needs
• Etiology
• Behavior
• Education
• Interventions