Healthy Eating and Obesity Prevention

1. Healthy Eating and Obesity Prevention

2. Healthy Eating Focus Area Process Develop statement of the issue Adapted from “Evidence-Based Decision Making in Public Health, Public Health Management Practice, 1999. Determine what is known through scientific literature; Quantify the issue • Local data • Expert input • Best practices Evaluate program or policy Develop key messages and recommendations Develop action plan

4. Health Eating Data Within the Social-Ecological Framework Abundant fast food restaurants Individual Behavior: e.g. Fruit/veg intake; Portion size; Breastfeeding Vending machines in schools Lack of local grocery stores Obesogenic Environment

5. Breastfeeding and Obesity Prevention • Breastfeeding is linked to decreased risk of obesity, possibly due to physiologic factors in human milk, feeding and parenting patterns associated with nursing.* • Breastfed infants are leaner at 1 year compared to formula-fed counterparts. Early growth pattern may influence later growth.** • Prevention of Pediatric Overweight and Obesity, Policy Statement, American Academy of Pediatrics, Vol. 112, No. 2, Aug. 2003, pp. 424-430. www.aap.org/policy/s100029.html. • Breastfeeding: HHS Blueprint for Action on Breastfeeding, Dept. of HHS, Office of Women’s Health, 2000.

6. Other Individual Behavior Trends • Portion sizes increasing • TV watching (especially by children) increasing • “Convenience foods” more available in supermarkets • Less cooking at home

7. The “Obesogenic” Environmentor ‘Supply Side of Consumption’ in Washtenaw County

9. The ‘Obesogenic’ Society • Hunter/gatherers ate 75% nuts, vegs, fruits; 25% lean game • We eat 17% fruits, vegs; 28% fatty meats; 55% carbos, sugars, etc • We would need to slow jog for 6-8 miles every day to exercise as hunter/gatherers • Cheap, fast, low nutrition, high fat foods • Convenient stores • ‘Drive-Throughs’ – not much ‘healthy’ food eaten in the car? • Perception of increased preparation time for fresh fruits and vegetables • Decreased time available – e.g. Americans working more hours, more single parent homes, etc.

10. The ‘Obesogenic’ Society • Linkages between exposure to grocery stores and restaurants and overweight have not been firmly established – but they’re coming… • Sensible, but need to be creative about interventions and approaches, evaluate well • Anxious to examine Community Prevention Guide recommendations regarding environmental approaches regarding overweight and healthy eating

11. Relevant Research • Lower prevalence of supermarkets and higher prevalence of independently owned grocery stores in low-wealth neighborhoods and greater proportion of households without access to private transportation* • Fruit and vegetable intake increases significantly for each additional supermarket in census tract** • Forty percent of American food budget spent on fast foods*** • Low income communities have significantly fewer supermarkets per capita than similar communities**** • *Morland, K. et.al. “Neighborhood characteristics associated with the location of food stores and food service places.” AJPM.2002;22:23-29. • **Morland, K., et.al.“The Contextual Effect of the Local Food Environment on Residents’ Diets: The Atherosclerosis Risk in Communities Study.” AJPH. 2002;92:1761-1767. • ***Dietz, W. “Obesity in Children” UM-SPH Presentation… • ****Philadelphia Food Trust • *****University of California Cooperative Extension. July 2002

12. School Environment Trends • Local data based on Physical Activity and Healthy Eating Asset Survey, April 2003 • Questions based on CDC’s School Health Index for Physical Activity & Healthy Eating • 53 of 114 schools in WC returned a survey (46% response rate)

13. School Environment Trends Junk food accessibility Nationally • 26.3% elementary, 62% Middle/JRHS, 94.9% HS (2001) students have access to vending machines at school • 26.8% elementary, 39.4% Middle/JRHS, 59.3% HS have school store, canteen or snack bar Washtenaw County • 18% of elementary schools, 25% of middle schools, and 69% of high schools allow the sale of junk foods at school • 29% of schools have policies regarding availability of low fat foods in school

14. School Environment Trends • Curriculum • Locally, only 14% of schools teach all 18 healthy eating curriculum topics recommended by the School Health Index • Milk Consumption • Nationally, student milk consumption has decreased 40% since 1977 • Locally, 91% of schools offer either low-fat or skim milk in their school meals

15. Teens’ Consumption of Milk and Non-diet Soft Drinks (ages 12-19)

16. Teens’ Consumption of Milk and Non-diet Soft Drinks (ages 12-19) Teens average 1 glass milk per day Teens drink 2X as much soda as milk, providing many with 15-20% of their calories 90% girls, 70% boys fail to meet daily calcium recommendation

17. Common Messages Across Populations (1) • Prepare more meals at home – more cooking. • Focus on what we are drinking (sweetened beverages). Define what is a healthy beverage. • Promote community and school gardens

18. Common Messages Across Populations (2) • Increase fiber intake; more fruits and vegetables; support plant-based diet • Cut unnecessary sugar and fat • Define “healthy snacking” & replace junk food snacking with healthy snacking • Good dine out/fast food options • Portion size *

19. Nutrition, Physical Activity, and Obesity Prevention ProgramKim Bandelier, MPH, RD/LDProgram Coordinator

20. Program Staff • Kim Bandelier, MPH, RD/LD • Lesli Biediger, MPH, RD • Chronic Disease Nutrition Consultant • Kristy Hansen, M.Ed., CHES • Physical Activity Coordinator • Brett Spencer • Partnership Coordinator • 8 Regional Nutritionists

21. Funding • CDC Cooperative Agreement (~$450,000) • State Nutrition and Physical Activity Programs to Prevent Obesity and Related Chronic Diseases • 5 year award, currently starting year 3 • Capacity building level • State general revenue (~$800,000)

22. Required Focus Areas Caloric Balance Physical Activity Nutrition Fruits and Vegetables Breastfeeding Reduced TV

23. Strategic Plan for the Prevention of Obesity in Texas • Originally released in 2003 • Currently revising to include • All age groups • 5-year goals • Breastfeeding and reducing TV viewing • Specific strategies for communities • Final will be released on April 24, 2006 at Texas Public Health Association convention

24. Demonstration Communities Project • In 2004, 2 communities chosen • Corpus Christi (urban) & Ft. Stockton (rural) • Collected baseline data • Conducted visioning workshops and stakeholder interviews • Completed strategic/action planning process • Currently implementing interventions • UT-Austin manages project

25. Corpus Christi, TX • CCAPWell (Coordinated Community Approach to Wellness) coalition • 2005 Summer Scorecard Program • ~300 children • IN MOTION End of Summer Celebration • Next interventions will be worksite wellness and breastfeeding promotion

26. Ft. Stockton, TX • Ft. Stockton Lifestyle Coalition • Hosted Family Play-Day on June 18, 2005 • Conducted worksite wellness pilot in Ft. Stockton ISD • Future plans include continuing worksite wellness with FISD, website development, and expanding physical activity programs for teens

27. Model for Dissemination • Skill-Building Workshops • Teaching communities skills needed to promote nutrition and physical activity through a community coalition or collaborative • Using lessons learned from demonstration communities • Regional Nutritionist hosting workshops for interested but not organized or newly organized community coalitions

28. Skill-Building Workshops • 3 Pilot workshops conducted in 2004 • 5 workshops conducted in 2005 • Partnership between NUPAOP and Goal A of the Texas Strategic Health Partnership • 14 communities, 110+ attendees • 3 new coalitions formed • 2 existing coalitions trained

29. Future of Program Increase CDC funding from Capacity Building to Basic Implementation