REDUCING CHILDHOOD OBESITY: Public Policy And Broad-Based Strategies

1. REDUCING CHILDHOOD OBESITY:Public Policy AndBroad-Based Strategies Philip M. Bonaparte, MD Chief Medical Officer Horizon NJ Health March 31, 2007

2. Definitions • Obesity • High amount of body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or higher • Overweight • Body Mass Index between 25 and 29 • Children Overweight • BMI is > 95th percentile according to the age and gender * Source: CDC, 2005

3. BMI • Measure of a person’s weight in relation to height • Adults and children • Weight in kilograms divided by the square of his or her height in meters. * Source: CDC, 2005

4. National Center For Health Statistics • Children • 16% of children and teens (over 9 million) aged 6-19 years are considered overweight • Adults • 65% overweight or obese • 30% of U. S. adults 20 years of age or older (60 million) are obese

5. NJ Behavioral Risk Factor Surveillance System Percent Overweight Obese Overall 36.7 17.7 Gender Males 47.8 18.2 Females 26.5 17.2 Race/ethnicity White, non-Hispanic 35.7 17.0 Black, non-Hispanic 42.5 25.0 Hispanic 38.3 19.5 *Source: NJ Dept. of Health and Human Services

6. Kids ROCK Program • Kids Reaching Out to Create Healthy Kids • HNJH Pilot Program • 5-13 yrs old • 3 Physician groups: Husband and wife PCP, North Hudson Community Action and CamCare • Children >85th percentile • Collaboration between Physician and HNJH Diabetes DM Program

7. Kids ROCK Program • Goals- No increase in weight. Make life style changes • AAP Policy Statement • CDC guidelines: BMI • Outcomes Measures- Life Style Survey. BMI changes

8. Kids ROCK Program Member education materials • How to Read a Food Label • Portion Control visual scale of What is a Portion (uses palm of hand, thumb, fist) • TV Zombies and Soda Monsters • Member incentives include: jump ropes, frisbees, H2O bottle, pedometer

9. Kids ROCK Program Physician Support : • Reinforcement of physician education • Encourage members to keep visits • Link members to community resources including mental health, family counseling, nutritional education

10. Kids ROCK Program • Over 108 children registered • Majority of children did not keep follow up appointments (about 90%) • Incorporated, “Dancing To Your health”

11. Energy Imbalance • Weight gain • Calories consumed > Calories used • Weight loss • Calories consumed < Calories used • No weight change • Calories consumed = Calories used

12. Causes • Poor diet • Lack of or insufficient physical activity • Family history • Poor choices

13. Unhealthy Nutrition • Bigger portion sizes • More fast foods • Advertisements • Encourages fast foods • Soft drinks • Sweets • Sugar loaded foods like breakfast cereals

14. Unhealthy Nutrition • Large meal=less cost

15. Fast Foods • McDonalds Calories Fat • 4 pieces chicken nuggets 210c 13g • 12 fl. Oz. Coca Cola 110c 0g • Cheeseburger 330c 14g • Small French Fries 210c 10g • Cookies 2 oz bag 230c 8g • Hot fudge sundae 360c 12g

16. Fast Foods Calories Fat • Cinnabon • Classic Cinnabon Cinnamon Roll 816 32 • Pizza Hut • 1 slice cheese pan pizza 285 14 • 1 slice cheese thin’n crispy 210 9 • KFC • Drumstick 140 8 • Mash potatoes 120 6 • Macaroni & cheese 180 8 • Baked beans 190 3

17. Age at first visit to McDonald’s, Burger King or Wendy’s

18. Lack Of Physical Activity • Fewer PA classes at school • Lack of safe areas • Television • Computer • Video games

19. Childhood Obesity Causes & Effects Type II Diabetes Heart Disease Social Issues Childhood Obesity Psychological Issues Pediatric Hypertension Low Self-Esteem Stress On Joints

20. What Changes Are Needed? • Teach parents and children to read labels • Warn against the dangers of Trans Fat • Safer neighborhoods • Increase PE at school • PSA campaign on Healthy Lifestyle • Open dialogue with Fast Food Chain

21. Read The Label Starthere  Checkcalories  Quick guide to %Daily Value 5% or less is low 20% or more is high  Limit these  Get enough of these  Footnote

22. When It’s Time To Eat… • Offer a variety of foods • Regular schedule • Set a good example • Turn OFF the TV

23. Give Them Less… • Doughnut • French fries • Regular chips • Soda • Fried chicken nuggets

24. Who We Need? • Parents • Schools • Government • Healthcare

25. Increase Physical Activity • Make it fun! • 30 minutes at once or 10 minutes at a time • Start at a moderate level and gradually increase • Make it a family or friends activity!

26. Healthy People 2010 • Reduce the prevalence of children and adolescents (6-19 y/o) who are overweight to 5%

27. Obesity - A Global Epidemic • Worldwide, more than a billion people, 10% of whom are children, are obese or overweight • It is the sixth most important risk factor in the overall burden of disease • No coordinated obesity prevention efforts

28. Obesity - US • The US has the highest rate of overweight and obese people • Set to overtake smoking as the main preventable cause of illness and early death • Obesity shortens life and increases the risk of developing heart disease and stroke, diabetes, arthritis and certain types of cancer Source: The Lancet Medical Journal

29. Risk: Lack of Parental Concern • Many healthcare providers assume that parents are eager to make changes to help their children lose weight • Not all parents open to making lifestyle changes even if they could help their overweight children shed pounds • Of 151 parents studied, 44 % of parents were not planning on making lifestyle changes any time soon Source: Pediatrics, July 2005

30. Risk: Lack of Parental Concern • Parents more open to change if they viewed themselves as overweight • Study included mostly African American and Hispanic families seen at a Philadelphia pediatric practice • The children were between the ages of 2 and 12, and all were either overweight or at risk of becoming so