Maine Center for Public Health

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WHY??
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Causes of Overweight Obesity
Kaiser REGIONAL HEALTH EDUCATION
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Genetics Permits Obesity Environment Causes It!
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The Bottom Line
EXCEEDS
gtgt
ENERGY IN
ENERGY OUT!!
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Too Much Energy In

• Portion size, portion size, portion size
• Readily available, cheap, high calorie foods
• Fast paced lives ? fast (high calorie) food
• Soda, sugared drinks

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BAGEL
Portion Distortion!!
20 Years Ago
Today
140 calories 3-inch diameter
How many calories are in this bagel?
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BAGEL
Portion Distortion!!
20 Years Ago
Today
140 calories 3-inch diameter
350 calories 6-inch diameter
Calorie Difference 210 calories
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FRENCH FRIES
Portion Distortion!!
20 Years Ago
Today
210 Calories 2.4 ounces
How many calories are in todays portion of fries?
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Portion Distortion!!
FRENCH FRIES
20 Years Ago
Today
610 Calories 6.9 ounces
210 Calories 2.4 ounces
Calorie Difference 400 Calories
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Portion Distortion!!
SODA
20 Years Ago
Today
85 Calories 6.5 ounces
How many calories are in todays portion?
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Portion Distortion!!
SODA
20 Years Ago
Today
Calorie Difference 165 Calories
250 Calories 20 ounces
85 Calories 6.5 ounces
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POPCORN
Portion Distortion!!
Today
20 Years Ago
How many calories are in todays large popcorn?
270 calories 5 cups
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POPCORNRN
Portion Distortion!!
Today
20 Years Ago
630 calories11 cups
270 calories 5 cups
Calorie Difference 360 calories
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Portions Pyramids
Serving size for steak? 8oz steak 4 servings!
Serving size for pasta?? 2C spaghetti 4
servings!
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US Consumers More is Better

• Americans buy and eat for value i.e.
• More is better!
• Translated by marketers into
• Super size
• Biggie fries
• Real meal deals
• Bigger portion sizes at home, restaurants, and
  schools!
• Super-combo meals can easily top 2000 calories
  Can total a full days calorie needs for many
  teens and adults!

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What About the Soft Drinks?

• More than half of all US children(74 of boys,
  65 of girls) drink soft drinks DAILY
• Over 80 of soft drinks (soda juices) consumed
  are sugar-sweetened, not diet
• Children who drink at least 1 soft drink daily
  consume about 200 cal/day more than those who
  dont (totals 10 pounds a year!)
• For children aged 7-11, odds of becoming
  overweight increased 1.6X for each additional can
  of sugar-sweetened drink consumed per day

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Trends in Beverage Consumption Among US
Adolescents, USDA
Consumption (ml/d)
Cavadini et al. Arch Dis Child 2000
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Not Enough Energy Out

• Decreased physical activity
• Decreased daily activities
• Reductions in spontaneous play, fewer unorganized
  sports
• Increased screen time
• Increased sedentary lifestyle, changes in built
  environment
• Suburban spread, lack of sidewalks, walking
  paths, safe walking routes
• Who walks to school??

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In the days before television
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Facts About Kids TV Viewing

• Nationally, children 2 to 18 yo spend average gt4
  hours per day watching TV, videotapes or using
  computer
• Most of this time (almost 3 hours) is spent
  watching TV
• About 17 of children watch more than 5 hours of
  TV per day
• Prevalence of overweight significantly higher in
  children who watch more TV

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Trends in TV Time
Source Robinson and Godbey, 1999 authors
calculation using FISCT 1999
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How TV Contributes to Overweight

• Uses up time for physical activity
• More calories consumed while TV is on (dinner and
  snacking)
• TV in bedroom has been associated with more
  viewing
• Food, drink advertisements on TV affect food
  choices made by children

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In the Past 100 Years, Weve Moved From
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Relatively Small Changes Can Have BIG
Consequences
Excess Energy In
Fixed Energy Out

e.g. 2 cookies per day 200 excess calories/d
1400 excess calories per week 0.5 lbs/wk 25
lbs / year!
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Relatively Small Changes Can Have BIG
Consequences
Fixed Energy In
Less Energy Out

e.g. missing 30 mins/d of vigorous play 200
less calories/d burned
1400 excess calories per week 0.5 lbs/wk 25
lbs / year!
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How to Start?
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Solutions

• Policy
• Environmental policy need to restructure our
  communities!
• Transportation policies
• School policies
• Leadership
• Individual action restructure our workday,
  school days, family life
• Educate, motivate, act!

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State-level Activities

• Awareness and education (BOH ad campaigns)
• 31 Healthy Maine Partnerships
• Communities Promoting Health at PROP!
• Healthy Maine Walks
• HealthyMainewalks.com
• Dept of Education pending rules to remove soda
  machines, junk food from schools
• Commission to Study Public Health 27
  recommendations

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Comm to Study Public Hlth School-related Recs

• Prohibit advertising of unhealthy foods in
  schools
• Limit schools to serving only healthy foods and
  beverages, and limit portion sizes
• Implement pilot program to install dairy vending
  machines in schools
• Prohibit use of food or beverages as rewards in
  schools
• Provide no fewer than 20 minutes for teachers
  students to eat lunch
• Direct schools to post nutritional information
  for food items sold
• Require elementary and middle school students to
  participate in 150 minutes of physical activity
  per week outside of recess, and high school
  students to participate in 220 minutes per week
• Direct schools to provide nutrition education in
  accordance with Learning Results guidelines
• Direct schools to confidentially assess record
  students body mass index (BMI)
• http//mainegov-images.informe.org/legis/opla/obes
  rpt.pdf

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A Comparison With Tobacco Strategies
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What WE Can Do!

• As a community
• As a school system
• As parents, families, individuals

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As a Community

• Advocate for pedestrian and bicycle friendly
  zoning, paths, and facilities
• Make healthy foods AND appropriate portion sizes
  available and affordable in schools, recreational
  settings, and parks
• Improve access to parks, walkways, and other
  recreational areas and programs for all ages
• Counteract unhealthy media messages
• Support local wellness programs and initiatives

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As a School System

• Promote healthy food choices AND appropriate
  portion sizes in all foods offered in schools
• Advocate for adequate funding so schools do not
  rely on sales from soda, candy, other
  non-nutritious snacks
• Support proposed DOE rules to remove soda
  machines, junk food from schools
• PUBLIC HEARING FEB 8th!
• Avoid marketing of soda, candy at school events,
  scoreboards, etc

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Overweight Prevention in Schools

• Support salad bars and other low cost,
  prepackaged (fast!) healthy meal options
• Promote more physical education and physical
  activity for ALL ages
• Support more fun opportunities for physical
  activity both team sports AND non-competitive
  activities
• Integrate health promotion into curriculum
• Link activities at school and home

REGIONAL HEALTH EDUCATION
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Resources for Schools Communities

• CDC School Health Index www.cdc.gov/nccdphp/dash/S
  HI/index.htm
• The Children and Weight What Schools and
  Communities Can Do About It Resource Kit
  www.cnr.berkeley.edu/cwh
• Guide to Community Preventive Services
  www.thecommunityguide.org
• CDC Physical Activity and Nutrition (PAN) Program
  www.cdc.gov/nccdphp/bb_nutrition/index.htm

REGIONAL HEALTH EDUCATION
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As Parents, Families, Individuals

• Take steps to live healthier lives
• Be physically active every day
• Make healthy food choices
• Be leaders and role models in our families,
  schools, and communities
• Support efforts around us that promote healthier
  living

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5-2-1-0Power Up!
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5 Fruits Vegetables Every Day!
5 or more fruits or vegetables per day
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Limit Screen Time to 2 Hours or Less
5 or more fruits or vegetables per day
2 hours or less of total screen time
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1 Hour or More of Physical Activity Daily
5 or more fruits or vegetables per day
1 hour or more of physical activity daily
2 hours or less of total screen time
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Avoid Sugared Drinks
1 hour or more of physical activity daily
5 or more fruits or vegetables per day
2 hours or less of total screen time
Zero sugared drinks or whole milk
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5-2-1-0 Power UP!
1 hour or more of physical activity daily
5 or more fruits or vegetables per day
2 hours or less of total screen time
Zero sugared drinks or whole milk
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The New American Plate!
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Parents Responsibilities

• Have pleasant family meals prepare and eat more
  meals at home
• Buy and offer healthy foods for home
• Help children learn about appropriate portion
  sizes
• When eating out, avoid all-you-can-eat buffets,
  supersized meals, and other overeating deals

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Parents Responsibilities

• Be a role model for good eating and activity
  behaviors
• Avoid using food as a reward
• Set limits on TV and video games
• Be flexible and understanding
• Encourage healthy behaviors and show affection

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Positive Family Attitudes

• Having extra weight is no ones fault
• Losing weight most likely to happen when taken on
  as a family commitment
• Theres no such thing as good food or bad food
• Any activity is helpful, it doesnt have to be
  exercise
• There is no right weight or body shape

Kaiser REGIONAL HEALTH EDUCATION
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Childs Responsibilities

• To eat as much or as little as they need among
  the food available
• To eat 3 meals a day with healthy snacks
• To make activity fun
• To try to be active every day
• To be responsible for TV and video game limits
• To do things that they are proud of
• To choose goals and areas to improve on

Kaiser REGIONAL HEALTH EDUCATION
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Brought to you by

• Keep ME Healthy
• A partnership of the Maine Center for Public
  Health and the Maine Chapter of the American
  Academy of Pediatrics
• Goals
• Improve the prevention of youth overweight by
• Raise awareness among families and children about
  the importance of healthy eating and physical
  activity
• Improve evaluation and treatment of children with
  overweight

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Maine Youth Overweight Collaborative

• Joint effort of Maine Center for Public Health,
  Maine Chapter of the American Academy of
  Pediatrics, and National Initiative for Child
  Health Quality (NICHQ)
• Funded by Maine Health Access Foundation
• Working with 12 primary care practice across
  state over 18 months to improve prevention and
  care of youth overweight

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Maine Youth Overweight Collaborative

• Practices commit to making changes to improve
  care e.g.
• Measure BMI for age/gender on all children
• Use 5-2-1-0 survey for all children 5-18yo on
  annual preventive care visit
• Use clinical guidelines to routinely evaluate
  overweight children for medical, psychological
  problems
• Develop skills to better support patients,
  families in making behavior changes for a healthy
  lifestyle

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5-2-1-0 Survey
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Weight Interventions
REGIONAL HEALTH EDUCATION
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With Thanks to

• Dr. Dora Mills, Maine Bureau of Health
• Maine Center for Public Health
• Maine Chapter American Academy of Pediatrics
• Dr. Scott Gee, Kaiser Permanente Regional Health
  Education
• T. Kristian von Almen, Ph.D., Committed to Kids
  Program