Uche Akobundu, PhD, RD Hunger-Free Communities Program Director

1. Trends in Childhood ObesityCurrent Data and A Call to Sustained ActionPresentation to the Essex-Passaic Wellness Coalition Uche Akobundu, PhD, RD Hunger-Free Communities Program Director

2. Introduction Goal • To provide an overview of federal, state and local trends in childhood obesity, determinants of overweight/obesity in children and practical recommendations for action

3. Introduction Overview • Federal, state and local trends in childhood obesity • Social, environmental and policy-based determinants • Effectiveness of available interventions • Future research needs / action steps for community members

4. About the United Way of Passaic CountyHow We Work

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6. Community Impact HEALTH

7. Trends in Childhood ObesityCurrent Data and Opportunities for Action Uche Akobundu, PhD, RD Hunger-Free Communities Program Director

8. Childhood Obesity • Childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years. • The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2010. • Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to 18% over the same period. • Obesity rates are high among preschool children in the United States. Approximately one child in eight aged 2–5 years is obese. • In 2010, more than one third of children and adolescents were overweight or obese. Source: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Adolescent and School Health and National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. http://www.cdc.gov/healthyyouth/obesity/facts.htm

9. Childhood Obesity • Overweight and obesity describe ranges of weights higher than what health professionals note are healthy for a given height. • Overweight and obesity are caused by a variety of factors, including genetics, overeating, and lack of adequate physical activity. • Overweightis defined as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors. Obesityis defined as having excess body fat. Source: Centers for Disease Control and Prevention, 2013. http://www.cdc.gov/healthyyouth/obesity/facts.htm

10. Childhood Obesity Trends Trends In Child - Adolescent Overweight By Age: Center for Disease Control & Prevention

11. Percentage of Overweight 2- to 4-year-old Children (Enrolled in WIC), by Year, New Jersey and U.S., 2000-2005 New Jersey State Health Assessment Data. CDC Pediatric Nutrition Surveillance System (PedNSS), New Jersey. http://www4.state.nj.us/dhss-shad/indicator/view/OveWICChi.UT_US.html

13. Prevalence of obesity among low-income, preschool-aged children Source: Vital Signs: Obesity Among Low-Income, Preschool-Aged Children — United States, 2008–2011. Morbidity and Mortality Weekly Report. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6231a4.htm?s_cid=mm6231a4_w

14. Decreases and increases*† in obesity§ prevalence from 2008 to 2011 among low-income preschool-aged children Source: 2011 Pediatric Nutrition Surveillance System, United States

15. Obesity in New Jersey • Obesity the region has been rising steadily for the past decade. • We can extrapolate that these rates are beginning to flat-line, in line with recent data that suggests a flattening of obesity in adults are across the nation. • Almost one quarter (23.8%) of adults in New Jersey are obese, compared with 19% in 2002. National Center for Chronic Disease Prevention and Health Promotion. State Nutrition, Physical Activity and Obesity profile – New Jersey. http://www.cdc.gov/obesity/stateprograms/fundedstates/new_jersey.html.

16. NJ County-Level Obesity Data Source: New Jersey State Health Assessment Data.

17. Local Data on Children • There is limited local data on childhood obesity and overweight by county, however Rutgers University data is available for selected municipalities

18. Obesity Trends: NJ Adolescents Overall, one in ten students (10.9%) was reported to be obese in 2011. Source: Argawal, M. The Status of Nutrition, Physical Activity and Obesity in New Jersey. Rutgers Center on State Health Policy, 2012. http://www.state.nj.us/health/fhs/shapingnj/library/ObesityReport_v6_Final.pdf

19. Obesity Trends: NJ Adolescents Source: Argawal, M. The Status of Nutrition, Physical Activity and Obesity in New Jersey. Rutgers Center on State Health Policy, 2012. http://www.state.nj.us/health/fhs/shapingnj/library/ObesityReport_v6_Final.pdf

20. NJ is among the states with the lowest rates of obese 10- – 17-year olds Source: F is for Fat 2013. Trust for America's Health and the Robert Wood Johnson Foundation. http://fasinfat.org/files/fasinfat2013.pdf

21. How Did We Get Here?

22. Selected Determinants of Childhood Obesity • Food Behaviors • Over-consumption of sugar and salty foods/not getting recommended amounts of fruits & vegetables • Lack of exercise • Food Environment • Disparities in availability of and access to healthy food retail • Highly prevalent junk food marketing • Physical Activity Behavior • Almost all children do not meet the guidelines for being physically active for 60 minutes each day • Changes in Society • American household structure, including delayed marriage, increased divorce, and women's movement into paid labor force • Access to nutrition education • Diet-related health literacy is challenged by information-rich environment • Physical Activity Environment • Traffic, crime level, pleasantness of neighborhoods and parks condition of sidewalks are most commonly reported barriers. Source: F is for Fat 2013. Trust for America's Health and the Robert Wood Johnson Foundation. http://fasinfat.org/files/fasinfat2013.pdf

23. Selected Determinants of Childhood Obesity • Economic Constraints • Health insurance, transportation access, ability to purchase/access to health supportive activities • Limited Time • Long working hours, increased car time • Schools • Marketing of foods, availability of low nutrition foods and beverages, curriculum changes (health education and physical education) • Community Design • Driver-centered, limited public transportation, retail/employment centers separate from housing • Marketing and Advertising • Junk food marketing to children, popularity of fad dieting/extreme weight loss programs Source: F is for Fat 2013. Trust for America's Health and the Robert Wood Johnson Foundation. http://fasinfat.org/files/fasinfat2013.pdf

24. There is Hope!

25. What is Going Well • Dietary intake of children • Number of children (HS students) meeting physical activity guidelines • Menu labeling environment • Parental knowledge, awareness and demand for healthy foods and environments

26. What is Going Well • Number of children eating a healthy diet is improving Center for Nutrition Policy and Promotion. Diet Quality of Children Age 2-17 Years as Measured by the Healthy Eating Index-2010.

28. But there is cause for concern…

30. Childhood Obesity

31. Effective Treatment of Obesity Evidence suggests that the key components of a successful treatment program include: • Modify diet (i.e., traffic light diet) • Limit sedentary behavior to no more than 2 hours per day Gradually increase physical activity to 60 minutes of moderate intensity activity per day • Weight maintenance (not weight loss) • Use behavioral techniques to increase and maintain motivation for lifestyle change (pros and cons of change, identify and overcome barriers, goal-setting, develop coping strategies)

32. Future Intervention/Research Needs • High-quality evidence on successful, generalizable treatment programs is limited. • Research as present is mixed due to variety of studies, protocols, populations studies and outcomes • More research is needed to determine the effect of pediatric obesity treatment on behavioral, physiological, and psychosocial outcomes. • The effect of improvements in cardiovascular and metabolic health on the long-term co-morbidities associated with childhood obesity has not been studied. • The cost effectiveness of obesity treatments should be determined since they may appear to be expensive. • Research that quantifies the Return on Investment presented by such interventions can facilitate policy change.

33. Action Steps: Community Groups • To continue the downward trend in obesity, continued communitywide action is needed. Community members can help prevent obesity in young children by: • Creating partnerships with civic leaders and child-care providers to make changes that promote healthy eating and active living; • Making it easier for families with children to buy healthy, affordable foods and beverages in their neighborhood; and • Providing opportunities for children to play safely through access to community parks and other recreation areas. • Creating ‘buzz’ around the topic of childhood obesity – make it a local issue • Leverage local resources to engage the community in action steps towards creating a healthy food environment

34. Interventions Targeted at Childcare and School Settings Physical activity in and around schools! • School meals matter! • 12.5 Million eat Breakfast • 31 Million eat Lunch

35. Local Organizations Making a Difference Camden, Newark, Trenton, & Vineland Essex, Morris, Passaic, Sussex, & Union Counties

36. Interventions Targeted at Business Community Hudson Institute. Better-For-You-Foods. Its Just Good Business. Obesity Solutions Initiatives, 2011.

37. Local Organizations Making a Difference Camden, Newark, Trenton, & Vineland Department of Health, Rockland County, NY Department of Health and Mental Hygiene, New York City, NY

38. Take Home Messages • Childhood obesity in the US and New Jersey is high but the rate of increase is slowing. • Changes to our social, environmental, family life, food shopping and dietary patterns all contributed to rising rates. • However, there is hope and there are many efforts at the state, regional and local levels that provide great models for addressing childhood obesity in the community. • There are many practical actions local groups can take to also make a difference to the health of children in the community.

39. Public Health Matters! Improvements our built and social environment & policies can impact our health! VS

40. Thank You! Uche Akobundu, PhD, RD Hunger-Free Communities Program Director United Way of Passaic County Paterson, NJ (973) 279-8900 ucheoma@unitedwaypassaic.org