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Obesity Advocacy: From Practice to Policy

Obesity Advocacy: From Practice to Policy . Sandra Hassink, MD, FAAP Chairperson, Obesity Leadership Workgroup Director, Nemours Childhood Obesity Initiative A I DuPont Hospital for Children Wilmington, DE . Disclosure. Member AAP Board of Directors U S Prevention Advisory Panel.

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Obesity Advocacy: From Practice to Policy

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  1. Obesity Advocacy: From Practice to Policy Sandra Hassink, MD, FAAP Chairperson, Obesity Leadership Workgroup Director, Nemours Childhood Obesity Initiative A I DuPont Hospital for Children Wilmington, DE

  2. Disclosure • Member AAP Board of Directors • U S Prevention Advisory Panel

  3. Discussion • A quick look at the childhood obesity epidemic • Using the socioecological model to frame the issues • Policy Tool in Practice • Creating and sustaining advocacy Teams

  4. Childhood Obesity in the US http://psa.americanheart.org/images/print/ Childhood_Obesity_lrg.jpg http://www.injuryboard.com/uploadedimages/InjuryBoardcom_Content/Blogs/News_Blog/News/iStock_Childhood_Obesity_Donuts.jpg http://msnbcmedia1.msn.com/j/msnbc/Components/ Photos/050313/050313_RURALOBESITY_hmed.hmedium.jpg

  5. National Perspective www.ncsl.org/.../programs/health/ObesityMap.jpg The National Survey of Children's Health, Overweight and Physical Activity Among Children: A Portrait of States and the Nation 2005; HRSA,Health, United States, U.S. Department of Health and Human Services,Centers for Disease Control and Prevention, National Center for Health Statistics, 2007.

  6. National Perspective http://www.ncsl.org/default.aspx?tabid=13877

  7. The 2007 national Youth Risk Behavior Survey (High School Students) 13% Obese Unhealthy Dietary Behaviors 79% ate fruits and vegetables less than five times per day during the 7 days before the survey. 34% drank a can, bottle, or glass of soda or pop (not including diet soda or diet pop) at least one time per day during the 7 days before the survey. Dietary Patterns

  8. Physical Activity Patterns The 2007 National Youth Risk Behavior Survey (High School Students) 65% did not meet recommended levels of physical activity 46% did not attend physical education classes. 70% did not attend physical education classes daily. 35% watched television 3 or more hours per day on an average school day. 25% played video or computer games or used a computer for something that was not school work for 3 or more hours per day on an average school day.

  9. Health Consequences In childhood, obese children are more at risk for: Type 2 diabetes; High blood pressure; Liver disease; Dyslipidemia including high cholesterol, high triglycerides and low HDL cholesterol; Upper Airway Obstruction Sleep Apnea Syndrome; and Hip and knee problems.

  10. Health Consequences In addition to the devastating physical health consequences, overweight and obese children suffer social and emotional health consequences as well. Obese children: have lower self-esteem; are more likely to be depressed; suffer from bullying and teasing; and have lower academic achievement.

  11. Cost of Obesity An obese child’s healthcare costs are roughly three times more than the average child. Childhood obesity is estimated to cost $14 billion annually in direct and indirect health expenses. Children in Medicaid account for $3 billion of those expenses Annual obesity-related hospital costs for children and adolescents were $238 million in 2005, nearly doubling between 2003 and 2005.

  12. Where

  13. Environmental Determinants of Health Where a child lives and goes to school has a significant impact on his health Today’s food and physical activity environment make it hard to be healthy. For example: Lack of physical activity in schools (i.e. no PE or recess) Car-focused world – active transport (i.e. walking or biking) is not easy Lack of available and affordable fresh fruits and veggies Massive marketing of unhealthy food and beverages Overabundance of energy dense nutrient poor foods

  14. Communities at Risk Communities at risk are neighborhoods and regions where children are more likely to be overexposed to unhealthy factors and underexposed to healthy ones. In these communities, resources are minimal, infrastructure is not conducive to physical activity, income is generally low, and economic opportunities may be scarce. The rates of obesity in communities at risk continue to rise far above those where children have access to healthy foods and places where they can engage in physical activity.

  15. Making the Link: Practice and Community Case Study A 12 year-old girl At her 12 year well check mother reports her daughter’s increasing comments about her weight and being “fat”. BMI = 23, 90th percentile for a 12 year-old girl Identified as overweight

  16. Community/Social/Demographic Ethnicity Parenting Styles Socioeconomic Status School Lunch Program Child Feeding Practices Peer/ Sibling Interactions Child Characteristics Crime Rates General Safety Foods Available In House Family TV Viewing School Schedule Child’s Weight Status age gender School Physical Education Programs Sedentary Behavior Parent Monitoring of TV Nutritional Knowledge Dietary Intake Work Hours Physical Activity Decision Making Parent Activity Patterns Parent Dietary Intake family genetics Schedule School Environment Corner Store Parent Encouragement of Activity Parent Food Preferences Parent Weight Status Family Leisure Time Activities At Home Accessibility of Convenience Foods & Restaurants Availability of Recreational Activities

  17. Skips breakfast (no time) Eats pretzel and juice for lunch (not hungry for a regular lunch) After school – soda and snack food (poor choices) Dinner – Family eats out 3x/week (too busy to cook) Bedtime – Cereal (eating while watching TV) 12 Year-Old GirlDietary Patterns – Behavioral Perspective

  18. Community/Social/Demographic Ethnicity Parenting Styles Socioeconomic Status School Lunch Program Child Feeding Practices Peer/ Sibling Interactions ChildCharacteristics Crime Rates General Safety Foods Available In House Family TV Viewing School Schedule Child’s Weight Status age gender School Physical Education Programs Sedentary Behavior Parent Monitoring of TV Nutritional Knowledge Dietary Intake Work Hours Physical Activity Decision Making Parent Activity Patterns Parent Dietary Intake family genetics Schedule School Environment Corner Store Parent Encouragement of Activity Parent Food Preferences Parent Weight Status Family Leisure Time Activities At Home Accessibility of Convenience Foods & Restaurants Availability of Recreational Activities

  19. 12 Year-Old GirlDietary Patterns – Environmental Perspective Skips breakfast (school start time/availability of school breakfast) Eats pretzel and juice for lunch (school lunch) After school – soda and snack food (corner store) Dinner – Family eats out 3x/week (fast food availability) Bedtime – Cereal (TV in bedroom)

  20. Community/Social/Demographic Ethnicity Parenting Styles Socioeconomic Status School Lunch Program Child Feeding Practices Peer/ Sibling Interactions Child Characteristics Crime Rates General Safety Foods Available In House Family TV Viewing School Schedule Child’s Weight Status age gender School Physical Education Programs Sedentary Behavior Parent Monitoring of TV Nutritional Knowledge Dietary Intake Work Hours Physical Activity Decision Making Parent Activity Patterns Parent Dietary Intake family genetics Schedule School Environment Corner Store Parent Encouragement of Activity Parent Food Preferences Parent Weight Status Family Leisure Time Activities At Home Accessibility of Convenience Foods & Restaurants Availability of Recreational Activities

  21. 12 Year-Old Girl Physical Activity Patterns - Behavioral Perspective No outdoor time (doesn’t want to go outside) Computer, IM etc 3 hours/day (nothing else to do) Homework 2 hours/day (prefers not to do homework at study period) Weekends “TV all the time” (doesn’t know what to do if not watching TV) Extracurricular activity - Cheerleading 2x/week

  22. Community/Social/Demographic Ethnicity Parenting Styles Socioeconomic Status School Lunch Program Child Feeding Practices Peer/ Sibling Interactions ChildCharacteristics Crime Rates General Safety Foods Available In House Family TV Viewing School Schedule Child’s Weight Status age gender School Physical Education Programs Sedentary Behavior Parent Monitoring of TV Nutritional Knowledge Dietary Intake Work Hours Physical Activity Decision Making Parent Activity Patterns Parent Dietary Intake family genetics Schedule School Environment Corner Store Parent Encouragement of Activity Parent Food Preferences Parent Weight Status Family Leisure Time Activities At Home Accessibility of Convenience Foods & Restaurants Availability of Recreational Activities

  23. 12 Year-Old Girl Physical Activity Patterns - Environmental Perspective No gym this session (school schedule) No recess (school schedule) No outdoor time (neighborhood safety) Computer, IM etc 3 hours/day (family entertainment environment) Homework 2 hours/day (family scheduling) Weekends “TV all the time” (family activity) Extracurricular activity Cheerleading 2x/week

  24. Community/Social/Demographic Ethnicity Parenting Styles Socioeconomic Status School Lunch Program Child Feeding Practices Peer/ Sibling Interactions Child Characteristics Crime Rates General Safety Foods Available In House Family TV Viewing School Schedule Child’s Weight Status age gender School Physical Education Programs Sedentary Behavior Parent Monitoring of TV Nutritional Knowledge Dietary Intake Work Hours Physical Activity Decision Making Parent Activity Patterns Parent Dietary Intake family genetics Schedule School Environment Corner Store Parent Encouragement of Activity Parent Food Preferences Parent Weight Status Family Leisure Time Activities At Home Accessibility of Convenience Foods & Restaurants Availability of Recreational Activities

  25. Obesity in the Context of This 12 Year-Old’s Environment Interaction of environment and behavior is critical Making healthy decisions only works when there are safe and affordable healthy options readily available in the environment The next slide highlights all the factors that influence this 12 year-old’s food and physical activity environments

  26. Community/Social/Demographic Ethnicity Parenting Styles Socioeconomic Status School Lunch Program Child Feeding Practices Peer/ Sibling Interactions Child Characteristics Crime Rates General Safety Foods Available In House Family TV Viewing School Schedule Child’s Weight Status age gender School Physical Education Programs Sedentary Behavior Parent Monitoring of TV Nutritional Knowledge Dietary Intake Work Hours Physical Activity Decision Making Parent Activity Patterns Parent Dietary Intake family genetics Schedule School Environment Corner Store Parent Encouragement of Activity Parent Food Preferences Parent Weight Status Family Leisure Time Activities At Home Accessibility of Convenience Foods & Restaurants Availability of Recreational Activities

  27. Who

  28. PEDIATRICIANS Take Action You can help your patients and improve your clinical care by becoming an advocate and being part of a movement to create healthy environments that foster healthy active living for all children. Children need you to be their advocates because environmental change does not occur without advocacy and children don’t have a voice in their childcare/school operations, community, and public policy. You can provide the voice and the expertise to make positive changes in the environment.

  29. Where?

  30. Creating an Environmentfor Healthy Active Living • In our homes • In our own offices/workplaces • In schools • In childcare • In the community

  31. How? http://www.ampestsolutionsinc.com/sitebuildercontent/sitebuilderpictures/Hispanic-Family.jpg

  32. Policy Opportunities: HOW To Take Action A variety of policy strategies exist to support healthier communities Centers for Disease Control & Prevention, Institute of Medicine, Robert Wood Johnson Foundation and AAP have identified some specific strategies that fall into the following categories: Improving access to healthy foods and beverages Limit access to unhealthy foods and beverages Improve opportunities for safe and affordable physical activity Increase active transportation through community design Improve school and childcare environments Support breastfeeding

  33. Policy Opportunities Tool To further distill the various policy strategies, the AAP created a tool that looks at the different opportunities in terms of: existing clinical anticipatory guidance and messaging (5, 2, 1, 0,breastfeeding and BMI), and the various sectors where changes can occur (practice, community, school, state, and federal) The tool also highlights which strategies are recommended by AAP, CDC, IOM, RWJF, and/or the National Governors Association www.aap.org/obesity/policymatrix

  34. http://www.aap.org/obesity/matrix_1.html

  35. Approach to Advocacy • Traditional advocacy in a group setting: one person is the driver and does most of the work, others start out enthusiastic but fade away, initial leader gets overwhelmed and overworked, initiative eventually falls apart. • Team approach: group develops goals and assigns/volunteers for tasks together, tracking and regular communication takes place, group reconvenes periodically to assess progress and adjust course.

  36. Creating, Strengthening and Supporting Advocacy Teams A real team – appropriately focused and rigorously disciplined - is the most flexible and the most powerful unit of performance, learning, and change in today's complex world. Katzenbach and Smith

  37. Definition of a Real Team A real team is a small number of people with complementary skills that are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable. Katzenbach and Smith

  38. Performance Results Problem solving Mutual Skills Accountability Technical/ function Small number of people Interpersonal Individual Specific goals Common approach Meaningful purpose Collective Work Products Personal Growth Commitment Team Basics

  39. Leaders Enhance Team Performance • Clarify purpose and goals • Build commitment and self-confidence • Strengthen the team's collective skills and approach • Remove externally imposed obstacles • Create opportunities for others • Do real work

  40. Leader driven Single- leader working group Position skill Individual accountability Efficiency Leader's goals and approach Working Group vs. Team Performance Driven Real Team Mutual accountability Complimentary skills Performance results Collective Work products Personal growth Team’s goals and approach Collective Work Products Time required

  41. The Team Performance Curve

  42. Groups become teams through disciplined action when they : Share a common purpose Agree on performance goals Define a common working approach Develop high level of complementary skills Hold themselves accountable for results Becoming a Real Team

  43. Activity-Based Goals Develop a plan for communicating about childhood obesity in the community Short-Term Goals Outcome-Based Performance Goals Reduce percent obese children in our community The Goal Difference Teams thrive on performance challenges; they flounder without them. Recruit 10 new team members this year

  44. Advocate • Advocate • Individual • Able to articulate unique experience • Able to engage others to advocate for the cause • Can respond quickly to emerging issues

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