5 - 2 -1- Almost None Let’s Make Delaware’s Kids the Healthiest in the Nation

1. 5-2-1-Almost NoneLet’s Make Delaware’s Kids the Healthiest in the Nation

2. Obesity Trends* Among U.S. AdultsBRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

3. Obesity Trends* Among U.S. AdultsBRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

4. Obesity Trends* Among U.S. AdultsBRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

5. Obesity Trends* Among U.S. AdultsBRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

6. Obesity Trends* Among U.S. AdultsBRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

7. Obesity Trends* Among U.S. AdultsBRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

8. Obesity Trends* Among U.S. AdultsBRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

9. Obesity Trends* Among U.S. AdultsBRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

10. Obesity Trends* Among U.S. AdultsBRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

11. Obesity Trends* Among U.S. AdultsBRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

12. Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

13. Obesity Trends* Among U.S. AdultsBRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

14. Obesity Trends* Among U.S. AdultsBRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

15. Obesity Trends* Among U.S. AdultsBRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

16. Obesity Trends* Among U.S. AdultsBRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

17. Obesity Trends* Among U.S. AdultsBRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

18. Obesity Trends* Among U.S. AdultsBRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

19. Obesity Trends* Among U.S. AdultsBRFSS, 2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

20. Obesity Trends* Among U.S. AdultsBRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

21. Obesity Trends* Among U.S. AdultsBRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

22. Obesity Trends* Among U.S. AdultsBRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

23. Obesity Trends* Among U.S. AdultsBRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

24. Obesity Trends* Among U.S. AdultsBRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

25. 2007 State Obesity Prevalence and State Rankings

26. 0 What is BMI? A calculation that estimates how much body fat a person has based on his or her weight and height. The BMI formula uses height and weight measurements to calculate a BMI number. Body Mass Index (BMI) = weight(kg)/height (m)2 www.kidshealth.org http://www.cdc.gov/nccdphp/dnpa/bmi/

27. Trends of Obesity* in Children and Adolescents *BMI > 95th Percentile Data Source: CDC NCHS

28. Underweight (BMI < 5th Percentile) 9.5% Obese(BMI > 95th Percentile) 20.5% Overweight(BMI 85th – 94th Percentile) 16.8% Healthy Weight(BMI 5th to <85th Percentile) 53.2% More than one-third of Delaware children and youth are overweight or obese Percentage of Delaware Children and Youth Ages 2-17 by Weight Status Obese (BMI > 95th Percentile) 19.9% Healthy Weight(BMI 5th to <85th Percentile) 60.6% Data Source: Nemours Delaware Survey for Children’s Health, 2006; Note: Data are not adjusted for demographics or co-morbid conditions.

29. 0 What is BMI? A calculation that estimates how much body fat a person has based on his or her weight and height. The BMI formula uses height and weight measurements to calculate a BMI number. Body Mass Index (BMI) = weight(kg)/height (m)2 www.kidshealth.org http://www.cdc.gov/nccdphp/dnpa/bmi/

30. What is obesity and overweight? • Adults • Overweight = BMI at 25.0 – 29.9 • Obesity = BMI at 30.0 or above • Children: BMI is age and gender specific, so BMI-for-age is the measure used • Overweight = heavier than 85% of children • Obesity = heavier than 95% of children • (using growth charts) • BMI is a good screening tool but it has limitations http://www.cdc.gov/nccdphp/dnpa/bmi/

31. Consequences of childhood and adolescent obesity • Discrimination • Persistence into adulthood • Abnormal cholesterol • High Blood Pressure • Type 2 diabetes • Liver and Gallbladder Disease • Depression • Anxiety • Asthma • Sleep problems • Earlier maturation • Reproductive problems • Bone complications

32. Quality of Life • Severely overweight children and adolescents are 5x more likely than healthy weight children to report a low quality of life. • This risk is similar to children diagnosed with cancer Schwimmer et al. Health-related quality of life of severely obese children and adolescents. JAMA. 2003;289:1813-1819. Adapted with permission from NICHQ

33. Economic Burden • “Obesity-related health expenditures are estimated to have accounted for more than 25% of the growth of health care spending between 1987-2001” -Health Affairs (2004) • “In 2003, an estimated $207 million was spent for health-related expenditures due to obesity in Delaware -Finkelstein (2004) Adapted with permission from NICHQ

34. What are the causes of obesity? • More calories eaten • Less physical activity • More inactivity

35. The New Social Norm?

36. Sugar and fat: cheap and abundant

37. Food environment

38. Vending Machines

39. Fast Food

40. Food marketing to children

41. Determinants of weight Energy INTAKE Energy OUTPUT INTAKE OUTPUT OUTPUT INTAKE

42. What do we know? • No single culprit • No magic bullet • MODERATION—such a boring word! • There are some things we can do…

43. Children could reduce their risk of preventable disease if: They consumed5 or more servings of fruits and vegetables each day. They reduced screen time to fewer than 2 hours each day. They engaged in a total of at least 1 hour of physical activity each day. They limited drinks with added sugars, specifically soft drinks, non-100% fruit drinks and sports drinks.

44. 5-2-1-Almost None

45. 5 or more servings of fruits and vegetables per day

46. What’s a serving? • Fruit: 1 medium whole fruit, ½ cup of cut fruit, • ½ cup 100% juice or ¼ cup of dried fruit • Vegetable: 1 cup of leafy vegetables, ½ cup of raw or cooked vegetables or 100% juice • Fresh, frozen or canned? • It is important to eat a variety of colors

47. Fruits and vegetables: • May help your stomach feel full. • May decrease the chance of becoming overweight • Decrease chance of chronic disease: • Cancer • Heart Disease Dietary Guidelines for Americans, 2005; Rolls, 2004.

48. Nationwide, only 21.4% of teens eat 5 fruits and vegetables a day. Source: Youth Risk Behavior Surveillance System, 2007.

49. Poor dietary patterns are beginning at early stages. • Fruit and vegetable intake in infants and toddlers • does not meet national nutrition recommendations. • French fries are one of three most common vegetables fed to infants 9-11 months. • By 15-18 months, French fries become the most common vegetable consumed. Fox MK, Pac S, Devaney B, Jankowski L. Feeding infants and toddlers study: what foods are infants and toddlers eating? J Am Diet Assoc. 2004;104:S22-S30.

50. 2 hours or less of screen time per day