FIT FOR LIFE Changing The Trajectory Of The Obesity Epidemic

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Get More Energy! Keeping Children Healthy
June 2007LA City Recreation and Parks Division
Kaiser Permanente Southern California
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Helping Communities Thrive
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Healthy Eating, Healthy Parks Training

• Part 1 Obesity Epidemic its Causes
• Part 2 The Science of Nutrition
• Part 3 Ideas to Implement a Nutrition Policy

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About Kaiser Permanente

• One of the nations oldest not-for-profit health
  care delivery systems and a leader in quality.
• 8.5 million members nationwide 6.2 million in
  California.
• Kaiser Permanente has made a deep and
  longstanding commitment to working within our
  communities to encourage healthy eating and
  active living.

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Today we will talk about .

• The Epidemic of Overweight
• Causes
• Individual
• Emotional
• Cultural
• Environmental
• Wellness Policy at the LAUSD

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The Epidemic of Overweight Children

• I think were looking at a first generation of
  children who may live less than their parents as
  a result of the consequences of overweight and
  type 2 diabetes.
• Francine Ratner Kaufman, MD
• Head, Division of Endocrinology Metabolism
• Childrens Hospital Los Angeles

www.discoveryhealthCME.com, N Engl J Med Vol.
352(11) March 2005, pp. 1138-1145
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How serious is the problem of overweight children
in California today?

• Very Serious
• Somewhat Serious
• Not Serious
• No Opinion

1,068 random sample CA residents, telephone
survey 10-11/2003 http//calendow.org/caobesityatt
itudes/index.htm
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How many children are overweight?
Since 1963, the number of overweight children in
the U.S. has tripled!
SOURCE CDC/NCHS, NHES and NHANES
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Some children are more likely to be overweight.
Overweight Kids Teens in 2000

• Teenagers
• Black, Mexican American, American Indian, Alaskan
  Native
• Children of overweight parents

NHANES 1999-2000 JAMA 20022881728-1732
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Do overweight children grow up to be overweight
adults?

• The older the overweight child is, the more
  likely he/she will continue to be overweight as
  an adult.
• 8 out of 10 overweight teens will continue to be
  overweight as adults.

Preventive Medicine 1993 Vol. 22pp.
167-177 Arch Pediatr Adolesc Med Vol. 158 May
2004 pp. 449-452
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How many adults are overweight?
the average weight gain among subjects (20-40
years old) in the population is 1.8 to 2.0
pounds/year. Science. 2997853-855 (2003)
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Obesity Trends Among U.S. AdultsBRFSS, 2004
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
Source Behavioral Risk Factor Surveillance
System, CDC.
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The Growing Epidemic Child Overweight Rates on
the Rise in California Assembly Districts
California Center for Public Health
Advocacyhttp//www.publichealthadvocacy.org/
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What are the costs of overweight and obesity?

• Health care for obese adults costs 37 more than
  for people of normal weight, adding 732 to the
  annual medical bills of every American.
• Treatment of illnesses related to obesity costs
  America 93 billion a year.

Health Affairs May 14, 2003 W3219-226 NIHCM
Obesity in Young Children Impact and
Intervention Aug 2004
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What health problems are related to being
overweight?

• Type 2 diabetes
• Heart disease
• High blood pressure
• Asthma
• Joint problems
• Liver problems
• Depression and low self-esteem

Pediatrics Vol. 112 No. 2 August 2003 pp. 424-430
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How is overweight diagnosed?

• Overweight in childhood is defined as having a
  body mass index (BMI) greater than the 95 for
  age.
• Overweight gt 95 for age
• At Risk of Overweight 85-94 for age
• Underweight lt 5 for age
• BMI uses height and weight to determine the risk
  for diseases
• BMI for age relates to health risks including
  cardiovascular disease, hypertension and type 2
  diabetes
• BMI measurement is recommended by the AAP at all
  well child care visits 2 years and older.

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How is BMI exactly calculated?
BMI (English) weight (lb) / height (in) /
height (in) x 703 BMI (metric) weight (kg) /
height (cm) / height (cm) x 10,000 BMI
Conversion Tables http//www.cdc.gov/ Web
Calculator http//www.cdc.gov/ Palm Calculator
and Growth Chart http//www.pdacortex.com/ BMI
Calculator Wheel http//www.trowbridge-associates
.com/ 5
Pediatrics Vol. 112 No. 2 August 2003 pp. 424-430
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Causes of Overweight and Obesity
Prevention is our strongest tool to combat this
problem
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What are the causes of overweight and obesity?
METABOLISM
GENES
SOCIO-ECONOMIC STATUS
CULTURE
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What behaviors are related to children becoming
overweight?

• Not enough physical activity.
• Too much TV video games.
• Not enough milk, dairy, fruits and vegetables.
• Too many sweetened drinks (e.g., soda, juice
  drinks, sports drinks) and too much fast food.
• Skipping meals and breakfast.

Position Paper - Prevention of Childhood
Overweight What Should Be Done? Center for Weight
and Health - U.C. Berkeley 10/02
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Why is physical activity important?

• 3 out of 4 children in California fail to meet
  the minimum fitness standards in 5th, 7th and 9th
  grade.
• Being in good shape
• reduces the risk of being overweight and heart
  disease
• is related to better school performance

California Department of Education
12/10/02 http//www.cde.ca.gov/news/releases2002/r
el37.asp
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Why is TV harmful?

• Children average 2-3 hours of TV viewing every
  day.
• 30-50 of children have a TV in their bedroom.
• TV viewing is associated with...
• increased risk for being overweight
• school problems
• aggressive behavior drug use

Pediatrics Vol. 107 No. 2 February 2001 pp.
423-426
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Are dairy products important?

• Milk consumption in the U.S. has declined over
  the last 40 years.
• Milk and calcium consumption has declined
  significantly for adolescent girls.
• Drinking milk may reduce the risk of
• becoming overweight
• developing osteoporosis

J Am Diet Assoc. 20031031626-1631.
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Are eating fruits and vegetables important?

• In California, of 7th, 9th and 11th graders
  surveyed less than half reported eating fruits or
  vegetables at least once per day in the past
  week.
• Eating 5 servings of fruits and vegetables every
  day can help reduce the risk of overweight.

Food Review. 20022528-31.
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Why are sweetened drinks harmful?

• Teenagers drink an average of 20 ounces of soda
  every day.
• Drinking more than 12 ounces a day of sweetened
  drinks is associated with
• an increased risk of being overweight
• drinking less milk
• an increased risk of cavities

J PEDIATRICS Vol. 142 June 2003, pp.
604-610 BMJ. 20043281237
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What about eating out and fast food?

• Eating out has increased from 16 to 27.
• Some fast food portion sizes have tripled from
  1960 to 2000.
• Fast food and eating out may be associated with
  an increased risk for overweight.

Int J Obes Relat Metab Disord. 200428282-289.
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What are the risks of skipping breakfast?

• Eating breakfast by teens has declined by 20
  over the last 20 years.
• 44 of teens said they skipped meals to lose
  weight.
• Skipping breakfast is associated with
• eating more later in the day and
• the risk of becoming overweight.

J Am Diet Assoc. Vol. 101, 2001, pp. 798-802
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The Emotional, Cultural, and Environmental Side
of Obesity
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Emotions May Lead Children/Adolescents to Eat
More than Usual

• Feelings of sadness
• Anxiety
• Stress
• Depression and Low Self-Esteem
• Problems in the home
• How can parents help their children/adolescents?

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What should I say to my child?

• Families can ask children to think about what
  they eat and why?
• Explain to children that people come in different
  shapes and sizes and that you love them whatever
  their size.
• Avoid saying skinny, fat, obese or teasing
  your child about his/her weight.
• It is best to address eating and activity as a
  family issue, not as the childs problem.

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What are positive family attitudes?

• Having extra weight is no ones fault.
• Any activity is helpful, it doesnt have to be
  exercise.
• There is no ideal weight or body shape.
• Body size is just one part of who a person is.

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Portion Size and Marketing are Also Causes of
Childhood Obesity

• Portion Size
• We eat more when we're given more.
• Package size influences us to eat more.
• We don't compensate for eating too much at one
  sitting by eating less at the next.
• Having access to big portions can override our
  natural sense of fullness.
• Advertising/Marketing
• Advertising geared to children consists of ads
  for sugary cereals, candy and fast-food
  restaurants

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Culture and Childhood Overweight

• Families
• May not perceive their children as overweight or
  obese.
• May perceive being overweight as a sign of
  prosperity.
• May not think that obesity is a true medical
  condition with future implications.
• May attribute increased weight as being
  big-boned or as running in the family.

Section 3
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Culture and Childhood Overweight

• Families
• May believe that nature not nurture determines
  weight.
• May have trouble controlling childs eating
  habits or use food to shape childs behavior.
• May themselves be dealing with weight issue.
• May say one thing to child but model a different
  behavior.

Section 3
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How can the environment contribute to obesity?
Environmental factors such as lack of access to
supermarkets and the high cost of nutritious food
can contribute to the risk of obesity.
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Environmental Influence on ObesityGeographic
Disparities

• Making healthy choices is difficult when
  supermarkets and other sources for fresh food are
  not readily available.
• A 2002 study conducted in Los Angeles County
  showed that
• Middle and upper income neighborhoods have 2.3
  times as many supermarkets per capita as
  low-income communities
• Predominately white communities have 3.2 times
  the supermarkets of predominately black
  communities and 1.7 times those of predominately
  Latino communities.

Healthy Food, Healthy Communities Improving
Access and Opportunities Through Food Retailing
Policy Link, Fall 2005.
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Environmental Influence on Obesity Cost
Disparities

• At small stores such as grocery/gas combinations
  and corner stores in the inner city and rural
  areas, food can cost between and 10 and 49 more
  than at supermarkets elsewhere!
• Example
• A middle income neighborhood might pay 3/lb for
  grapes.
• Lower income neighborhoods would pay between
  3.30-4.47 for the same product!

Healthy Food, Healthy Communities Improving
Access and Opportunities Through Food Retailing
Policy Link, Fall 2005.
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LAUSD Wellness Nutrition Goals

• Increase access to healthy breakfast lunch
• Encourage meals vs. a la carte
• Explore second chance breakfast
• Implement a computerized cafeteria management
  system
• Reduce competitive food sales

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LAUSD Physical Education Goals

• Provide adequate space, adequate equipment
• Class size comparable to other classes
• PE Instructional guides that supports a written
  curriculum for teachers
• Offer extracurricular physical activity programs
  before/after school
• SCHOOL REQUIREMENTS
• 200 minutes of PE each 10 school days
• Fitnessgram administered to grades 5,7,9 Feb
  May
• Comply with nutritional guideline laws

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What is the LAUSD doing to Implement the Wellness
Policy?

• The Healthy School Food Coalition was initiated
  by the Center for Food and Justice (Occidental
  College)
• Coalition goals include
• Establish a cafeteria committee to provide
  input in LAUSD nutrition activities.
• Develop changes to the nutritional content of
  school meals by lowering sodium, fat, sugar
  levels and by eliminating trans fats from
  entrees.
• Increase participation in the school breakfast
  and lunch programs.
• Ensure school sites comply with food and beverage
  sales policies to reduce the availability of
  high-calorie snacks and beverages on school
  campuses

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Stop An Epidemic

• Together we can make healthy eating and active
  living a reality for everyone in a community.