A Weighty Proposition

1. A Weighty Proposition What is Known Regarding Childhood Obesity Learning Session #1

2. A Review of Literature • Summations of Evidence for Findings in the Following Settings: • Surveillance • Clinical • Schools • Community • Education

3. Method • Searched for manuscripts and documents which systematically reviewed the evidence presented in a variety of peer-reviewed research journals • Present the overall findings based on settings for the delivery of the service • Highlight areas on the CHIP to CHIRP model

4. Levels of Prevention • Tertiary Prevention – interventions to slow down or reverse the increase in BMI • Secondary Prevention – prevention efforts including the identification and intervention of asymptomatic children who are at risk for overweight • Primary Prevention – prevention efforts occurring before individuals are overweight

5. Surveillance • Although BMI is a measure of relative weight rather than adiposity (fat), it is recommended widely for use among children and adolescents to determine overweight and is the currently preferred measure • BMI may have limited validity for racial / ethnic minorities (Whitlock et al)

6. Surveillance Need • It is suggested that there are three critical periods for the development of overweight in children • Intrauterine or early infancy • 5 to 7 years of age • Adolescence • Approximately one half of over weight school-age children and three quarters of overweight teenagers grow up to be obese adults (ADA Report)

8. Clinical • Limited research is available on effective, generalizable interventions for overweight children and adolescents that can conducted in primary care settings or through primary care referrals (Whitlock et al) • Recommendations include application of behavioral choice theory (Epstein et al)

10. Position of the American Dietetic Association • Reviewed only programs that included an outcome measure of weight status or adiposity (body weight, BMI, skinfold thickness, percent body fat)

11. Definitions • Dietary Counseling / Nutrition • Physical Activity Counseling / Education • Sedentary Activity Counseling / Education • Behavioral Counseling • Family Counseling • Parent Training • Parent / Family Involvement • Physical Activity Environment • School Food Environment

12. What Works • Two specific kinds of overweight interventions: a) multi-component, family based programs for children age 5-12 years and b) school-based programs for adolescents • Multi-component programs include behavioral health counseling, promotion of physical activity, parent training/modeling, dietary counseling /nutrition education

14. Schools • Active Education: Physical Education, Physical Activity and Academic Performance RWJ Active Living Research – Research Brief 2009

15. Schools Studies consistently show that more time in physical education and other school-based physical activity does not adversely affect academic performance. In some cases, more time in physical education leads to improved grades and standardized test scores.  Physically active and fit children tend to have better academic achievement.  Evidence links higher levels of physical fitness with better school attendance and fewer disciplinary problems.  There are several possible mechanisms by which physical education and regular physical activity could improve academic achievement, including enhanced concentration skills and classroom behavior.

16. Pre-School / After School • Preventing Obesity Among Preschool Children: How Can Child-Care Settings Promote Healthy eating and Physical Activity? Source: RWJ Healthy Eating Research and Active Living Research- Research Synthesis October 2011

17. Pre- School Research in child-care settings has identified opportunities to improve the nutritional quality of foods provided to children, mealtime behaviors of caregivers, and the provision of nutrition education. Regulations regarding nutrition and physical activity practices in child-care settings are limited and vary widely among and within U.S. states. Many preschool children enrolled in child care are not meeting recommendations for physical activity. Child-care practices and policies relating to 1) the amount of time allocated for physical activity; 2) required training and supportive staff behaviors; and 3) appropriate physical settings for play have the potential to influence physical activity levels.

18. Pre School (Cont) There is some evidence of a relationship between use of informal child-care arrangements (e.g., relative care) and increased risk for obesity. Research examining the relationship between children’s weight status and use of formal child-care arrangements (e.g., licensed family child-care homes, child-care centers, Head Start programs) has produced mixed results. Opportunities for parent education and involvement may be limited in many childcare settings, and only a few studies have examined parent perceptions relevant to nutrition and physical activity environments. Existing evidence indicates the following may be successful strategies for promoting healthy eating and physical activity in child-care settings: integrating opportunities for physical activity into the classroom curriculum; modifying foodservice practices; providing classroom-based nutrition education; and engaging parents through educational newsletters or activities. At this time, it is not clear which combinations of specific strategies are effective for reducing obesity among preschool children.

20. Community • CDC Strategies July 24, 2009 MMWR

21. Community Strategies • Strategies to Promote Availability of Affordable Healthy Food and Beverages • Strategies to Support Healthy Food and Beverage Choices • Strategy to Encourage Breastfeeding • Strategies to Encourage Physical Activity or Limit Sedentary Activity • Strategies to Create Safe Communities that Support Physical Activity

23. Education / Knowledge • We have yet to find a comprehensive evaluation of multiple education intervention in comparison with each other. We are continuing to search.