Healthy Eating and Active Lifestyles

1. Healthy Eating and Active Lifestyles

2. After this presentation, participants will be able to: • Articulate trends in obesity and overweight • Describe how obesity affects Job Corps • Discuss how the built environment affects health status • Describe the Healthy Eating and Active LifeStyles (HEALS) program • List various center staff members’ responsibilities in creating a healthy environment and center culture

5. So, what’s the big deal? Medical significance of obesity. Associated with increased risk for many conditions: • High blood pressure • Diabetes • Elevated cholesterol • Heart Disease • Stroke • Gall bladder disease • Sleep apnea • Certain cancers: uterine, prostate, colorectal

6. Employment Significance of Obesity: Bias and Discrimination • Hiring prejudice • Inequity in wages, promotions and termination • Education setting • Medical setting Source: Puhl R, Brownell, KD. Bias, discrimination, and obesity. Obesity Research. 2001 Dec; 9(12):788-805

7. Costs of Obesity Source: The George Washington University School of Public Health. (2010). First-ever report on the individual cost of obesity. Retrieved online from: http://www.gwumc.edu/newsevents/firsteverreportontheindividualcostofobesityunveiled

8. Factors That Influence Health Status Influence National Health Expenditures $1.2 Trillion 10% 20% 20% 50% Sources: Centers for Disease Control and Prevention, University of California at San Francisco, Institute for the Future. Reprinted from Advances: The Robert Wood Johnson Foundation Quarterly Newsletter, 2000, Issue 1, supplement, page 1

10. Environment and Weight Status • Neighborhoods have disparity in access to healthy foods in the U.S. • Unhealthy foods are more available, more convenient, more heavily advertised and less expensive (especially in low income neighborhoods) • Proximity to fast-food restaurants positively associated with likelihood of gaining more than 20kg weight during pregnancy • For residents of urban neighborhoods, higher concentrations of small grocery stores was positively related to obesity and BMI

11. Environment and Weight Status • More affluent neighborhoods – more supermarkets, easier access to whole grains, low-fat foods, more diverse fresh fruits and vegetable choices • Increase in portion sizes at restaurants and pre-packaged foods

12. Neighborhoods and Chronic Disease • Economic disadvantage • Social environment • Connectedness and social order • Immigration, concentration of crime, segregation, residential stability • Built environment • Connectivity, air pollution, density Source: Freedman et al. Neighborhoods and Chronic Disease in Later Life; AJPH, 2011; Vol 101(1).

13. Neighborhoods and Chronic Disease • Looked at 6 common chronic conditions (self-report) • Hypertension, heart problems, stroke, diabetes, cancer and arthritis • When all neighborhood factors included, disadvantaged neighborhoods associated with: • Increased risk heart problems and cancer in women • Increased risk cancer for when all neighborhood factors included • Proposed result of possible stress response

14. Costs of Treating Heart Disease • Estimated costs to treat – will triple by 2030 • Includes treatment of hypertension, coronary heart disease, heart failure and stroke • $273 billion to $818 billion in 2030 • U.S. medical expenditure already highest in world; 15% of GDP • 36.9% of Americans have some form of heart disease today • Estimated 40.5% by 2030 based on current rates of rise Source: Circulation: JAMA; Costs to Treat Heart Disease will triple by 2030; January 25, 2011.

15. Primary Disease Prevention Costs Savings • Modest reductions (5%) in prevalence of diabetes and hypertension would save $9 billion annually • If include reductions in co-morbidities- could save $24.7 billion annually • Focus on well-designed interventions to improve lifestyle related risk factors Ormond et al (2011) Potential National and State Medical Care Savings From Primary Disease Prevention; AJPH Vol 101(1).

16. Food “Choices” • Taste • Acquired • Can expand • Cost • Convenience Source: Drewnowski et al (2009) can low-income Americans afford a health diet? www.cphn.org/reports/brief1.pdf

17. Physical Activity and Weight Status • 25% of all trips in U.S. are less than 1 mile and yet 75% of these trips are taken by car • Increased time in car per day increases risk of obesity • Safety and community design influence method of transportation; the more “walkable” a community, the lower the risk of obesity

18. Environment and Weight Status • Surgeon General report in 2010 – 8 to 18 year olds spend over 7 hours per day playing video games, on the computer, or watching TV • Social norms influence weight – if your friends gain weight, you are more likely to gain weight

19. Behavioral Ecological Model

21. Step 1: JC Data Collection • Collaboration • Leadership • Motivation • Variety

22. Step 2: Public Schools

23. Step 3: Job Corps Centers Lunch at Delaware Valley JCC

24. Step 4: A Meeting of the Minds

25. The Program • Holistic and individualized • Step-by-step guide • Website for food service staff • Evidence-based curriculum • A guide for recreation staff • Policy (food service, recreation, programmatic) • Webinars • Tips to create a healthy environment

26. It takes a “village” to promote student health.

27. The Triumvirate • Three powerful individuals, each a triumvir • The core: health and wellness, recreation, and food service

28. Who Else? • Social Development • Instructors • CD/Administration • Finance • SGA/students • Community Connections • Others Poll question

29. What Makes a Successful Program? • Collaboration • Leadership • Motivation • Variety The Healthy Eating and Active LifeStyles Committee! Poll question

30. Sneak Preview

31. Overeating as an Addiction

32. Game Break! True or False? The same parts of the brain are responsible for both food and cocaine addiction.

33. True Functional neuroimaging studies revealed that good smelling, looking, tasting, and reinforcing food has characteristics similar to that of drugs of abuse. Source: Liu, Y. et al. (2010). Food addiction and obesity: evidence from bench to bedside. Journal of Psychoactive Drugs. 42(2); 133-145.

34. TEAP Specialist’s Role • Work with students who are struggling with both addictions/cravings • Be cognizant of replacing one addiction with another • Another good reason to work closely with recreation

35. The Mind and the Body

36. True of False? More people suffer from bulimia than from binge eating disorder.

37. False Approximately 2% of the population, and 10-15% of overweight people suffer from binge eating disorder. One out of every 200-300 people summer from bulimia.

38. True of False? People who are depressed are more likely to be overweight.

39. True Sometimes obesity leads to depression; sometimes depression leads to obesity

40. Disordered Eating 75% of women eat, think, and behave abnormally around food some of the time. Source: University of North Carolina at Chapel Hill, news release, April 22, 2008

41. CMHC’s Role • Collaborate with recreation staff • Incorporate exercise into groups • Foods and Moods curriculum • Screen for disordered eating • Partnership with outside treatment facility • Brief cognitive behavioral therapy • Food addictions group

42. Recreation

43. True of False? Eating healthy is more important than exercise for weight loss.

44. False—But really this is a trick question Food matters more for calories but physical activity is the #1 predictor of sustained weight loss.

46. National Weight Control Registry (NWCR) • There is variety in how NWCR members keep the weight off. Most report continuing to maintain a low calorie, low fat diet and doing high levels of activity. • 78% eat breakfast every day. • 75% weigh themselves at least once a week. • 62% watch less than 10 hours of TV per week. • 90% exercise, on average, about 1 hour per day.

47. Recreation’s Role • Make physical activity fun • Offer activity that appeal to male and female students • Sell the stress-reduction benefits of exercise

48. Food Service

49. Game Break! True or False? Labeling a healthy food with a heart or other icon is the most effective way to get students to choose healthy foods.

50. False Labeling with an icon is a mixed bag; although there is some evidence that providing calorie information on menus reduces the number of calories people eat. Source: Albright, C.L. et al. (1990). Restaurant menu labeling: impact of nutrition information on entrée sales and patron attitudes. Health Education Quarterly. 17(2), 157167. Harnack, L.J. & French, S.A. (2008). Effect of point-of-purchase calorie labeling on restaurant and cafeteria food choices. International Journal of Behavioral Nutrition and Physical Activity. 26(5); 51.