Moving our Children Toward A Healthy Weight…

finding the will and the way

Kathy Kolasa PhD, RD, LDNProfessor and Section Head

Nutrition Services and Patient Education,Departments of Family Medicine, of Pediatrics

Brody School of Medicine at East Carolina UniversityUHS Nutrition Initiative Consultant

What is best?

There is no one single best diet for every person for prevention/treatment. Nutrigenomics is in the future… tailor based on genetics, lifestyle, environment

Dietary Guidelines for Americans 2000 at: http://www.usda.gov/cnpp/Pubs/DG2000/Index.htm

“USDA Healthy Eating Index” to check overall diet quality http://147.208.9.133

Today’s briefing..

Not about adult diets, but about the kids4

Focused on childhood obesity prevention and treatment A bit of background The local problem…White Paper Highlights of local responses and challenges Foster discussions of “where to go from

here”

Pitt Partners for Health

A grass roots organization identified..

Nutrition & Physical Activity, as a priorityalso…

Access to CareDiabetes

Heart Disease and StrokeOlder Adult Health

Adult size, Pitt Partners for Health,

2000

The weight environment our kids find themselves in:

Weight Status: BMI __ %

Underweight <18.5 2Normal 18.5-24.9 31

Overweight 25.0-29.9 36Obese 30.0-39.9 29Morbidly Obese 40+ 3

Current Costs of obesity in NC

5-20 yrs Life Lost for morbid obesity Obesity-related direct medical expenditures

$2.138 billion (6% NC health care bill) $1.11 billion financed by Medicare and Medicaid

(From RTI and CDC, 2004) NC ranked # 10th highest in spending

NC Prevention Partners estimated $4.9 billion for poor nutrition overweight and obesity; includes productivity loss estimates

Most Kids used to “grow into their

weight”

Overweight children are likely to remain overweight as adults if no intervention if overweight at age 6, 50% chance to be

obese as adult if overweight as teen, 70-80% chance

60% of overweight children at least 1 risk factor for high BP, high cholesterol or type 2 DM

“Remember when we used to have to fatten the kids up first?”

Terminology when talking about KIDS

At risk for overweight: greater than 85th%tile BMI for age

Overweight: greater than 95th%tile BMI for age Obese: do not use term to prevent

stigmatization Health promoting diet: Dietary Guidelines and

Food Guide Pyramid for Americans over 2 yrs Healthy snacks: Winner’s Circle criteria

For Children, BMI Differs by Age

Boys: 2 to 20 years

BMI

BMI

Obesity* Trends Among U.S. AdultsBRFSS, 1985(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

No Data <10% 10%-14% 15-19% 20%

Source: BRFSS, CDC.

Obesity* Trends Among U.S. AdultsBRFSS, 1986(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

No Data <10% 10%-14% 15-19% 20%

Source: BRFSS, CDC.

Obesity* Trends Among U.S. AdultsBRFSS, 1993(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

No Data <10% 10%-14% 15-19% 20%

Obesity* Trends Among U.S. AdultsBRFSS, 1999

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

Source: BRFSS, CDC.

No Data <10% 10%-14% 15-19% 20%

Obesity Trends* Among U.S. AdultsBRFSS, 2001

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10.

High risk children

Have one or both parents overweight Live in families with low income Have a chronic illness or disabilities that

limit mobility Tend to be members of certain racial/ethnic

minority groups such as African American and Hispanic

Live in eastern NC

*All Pitt county children at-risk

At 2 yrs old, ~1 in 10 at risk of overweight; another ~1 in 10 already overweight

Almost 5 out of 10 youth are considered at-risk for overweight

Almost 1 in 3 of these children already are on the path to type 2 diabetes

Grains

Fruits/Vegetables

Meat/Dairy

Fats/Sweets

0 2 4 6 0 0.5 1 1.5 2 2.5 3

The Food Pyramid The Reality

Source: USDA Pyramid; The NPD Group's CREST® and National Eating Trends® Services

Kids aren’t eating a health promoting diet

*We estimate Pitt county kids…

1 in 3 drink 2+ sodas each day 7 in 10 eat no fruit or vegetables daily 2 in 3 do not meet their daily calcium need 1 in 3 get only light daily physical activity Many grade schoolers consume 200-500

excess calories/day (20 min active recess= 30-112 cal; 1- 20 oz Fruitopia = 280 cal))

Rural children eat more fat than urban kids

Nutrition and Dental Health

On average, 23% of Kindergarten children and 8% of fifth-grade children in Pitt County have untreated dental decay.

Studies have confirmed the direct relation between intake of dietary sugars and dental caries across the life span.

Studies show that teenage boys and girls are drinking nearly three times as much soda as milk.

This creates a cavity equation:

soda , milk = sugar, calcium = CAVITIES!

Need the details?

Can access through ECU Pediatrics web sitewww.ecu.edu/pediatrics

Can access through the UHS Children’s Hospital Web site page

www.uheast.com

*Obesity as Health Problem

Neither kids nor parents see obesity as health issue.

Parents think of it as a social issue…worry about child’s self esteem & peer acceptance.

Parents don’t see their role in this epidemic Clueless on appropriate portion sizes

Am Dietet Assn Survey 2003

*Academic performance

Eat healthy….. not just on test days Improved cognitive performance,math

scores Improved physical performance, fitness,

endurance Psychological benefits and feelings of well

being Increased productive energy Attendance, attentiveness

No agency has primary responsibility

What’s happening… the Healthy Schools Task

Force is working

Voluntary grass roots collaboration of agencies &

organizations; Developed a plan of action for

improving nutrition & increasing physical activity

“Living” the plan

Develop resources through expertise of members

Collectively seek funding to address needs

identified in plan of action

Vision from Healthy Schools Task Force

Eat Smart Move More

“Pitt county students and staff will develop healthy lifestyle habits that will influence their

well being for a lifetime through education, experiential participation, healthy choices and

a healthy environment”

Moving Our ChildrenToward a Healthy Weight

Finding the Will and the Way

North Carolina Department of Health and Human Services

We Struggle with the “Quick Fix” mentality promoted by some…

RWJ Poll 90% teachers & parents support converting

vending machines to healthy food & drinks 86% ban vending from elementary schools 80% require PE at every grade level

Am Academy Pediatrics focused on Soft drinks and School meals

Need reasoned/moderate approach for Pitt Cnty

If you haven’t looked at Pitt County Child Nutrition

lately, look again

Higher quality meals over last 5 years; leader in a buying cooperative

Age appropriate portions served Winner’s Circle healthy choice signage;

highlighted menus sent home 32 of 33 schools have breakfast program “Taste Explorers” in 20 schools reaching

15,000 kids introducing “new” fruits and vegetables

4 Achievement Levels (needs improve, basic, proficient, superior)

Grade Levels (K-5, 6-8, 9-12) Time & Place

Vending: beverages & snacks After school programs School events: instructional & non School meals; Ala-carte

Preliminary review: meet superior in all but vending in middle and high school; Plan to by 2005-2006

Is it enough? “Where we can live comfortably”

All Foods Available..new policy

in 2004

Vending in PCS

No “pouring rights” contracts. Carbonated beverages

Not available in elementary school In middle school after school day

Few machines in elementary schools; all meet Winner’s Circle criteria

Machines in high school operated by Child Nutrition program. 50% items are Winner Circle

~ 21,000 children in PC schools

~12,000 lunches served each day

~9,000 FREE lunch

~1,500 Reduced price lunch

More than 50% of children in 18 of 31 schools qualify for free and reduced meals. As % goes down, funding affected

After-school program snacks are “healthy”

Challenges for Child Nutrition

Need Principal, Teacher and Parental support and encouragement Need support every day, not just TESTING days Children with money buy extra portions or calories Children make poor choices, need education and

role models Stay the course, revenues down with vending

healthy options. Expect rebound.

Need different equipment (e.g. milk machines)

What’s happening.. Physical activity

Among 12-21 year olds

50% no vigorous physical activity

14% no physical activity

24% NC high school students, moderate physical activity

48% NC middle school students, moderate physical activity

Healthy Active Children Policy

(passed by State Board of Education Jan. 2003, unfunded mandate)

Local School Health Advisory Council. Pitt has long standing one

Physical Education & Activity

Recommended 150 min/wk: elementary

Recommended 225 min/wk: middle

Assessing physical activity and healthy school environment

Recess cannot be taken away as punishment

Policy fully implemented by 2006-07 school year. Plan due 2004

What’s happening..Pitt isn’t just starting

Project YEAH! Physical activity incentive program, 4th yr

Growing Up FIT! nutrition and physical activity in elementary, 4th yr

PHASE (Physically active sensible eaters) staff wellness in 1 elementary, 1st yr

Walking trail construction 4 serving 5 schools; 2 in planning

And more…

What’s happening

Our local Health Care and Education Missions are coming together in several grants: Pitt Health Education Fnd grant…brochures Healthy Weight Initiative Grant

51 Take 10 kits; 49 physical activity equipment sets; $ for 2 walking trails

2003-2004 positive “pilot” of what is to come for K-5 in 2004-2005

Pitt County HWTF Project 2004-2006

EAT SMART, MOVE MORE… In support of FIT Together..

1 of 20 funded grants in NC, Health and Wellness Trust Fund

Targets K-5 public school students

Goal: formal policy changes by year 3 Be active 30 min every school day After school programs have 60 min PA Nutrition improvements in cafeteria and classroom

What’s happening.. PCMH

Developing UHS Nutrition Initiative Winner’s Circle Dining Pediatric Healthy Weight Case Mgmt Leadership

Team convened…proposal to Duke Endowment Connecting students to services and programs

Foundation’s Community Benefits program: priority to nutrition ed & physical activity projects

ViQuest employee program supporting changes in home & school environments

Health Sciences Division

East Carolina University

ECU-UHS Pediatric Healthy Weight Research & Treatment Center Research Summit August 2003. Building

collaborations Building multi-disciplinary membership

Providing training on prevention and treatment Offering comprehensive treatment clinics for

o Youth with obesity related disease; or at-risko Medical Nutrition Therapy Services (referrals)

Medical Nutrition Therapy Resourcesfor Overweight Youth in Pitt County

ECU Family Practice CenterSpecify child has a weight concern, or is enrolled in KIDPOWER study

Ask for Emilie Davis, MPH, RD, LDNCost: Free. Supported by grant from Pitt Memorial Hospital Foundation.

ECU Family Practice Center and Pediatric Outpatient Center, Brody School of Medicine

Ask for Catherine Sullivan MPH, RD, LDN; Nancy Harris MS, RD, LDN; Amanda McKee BSPH, Latosha Hope Redd, BS; Ginger Hester, MS, RD,

LDNCost: $38 for initial assessment (60 mins);$17 for follow-up (30 mins)

Pitt County Health DepartmentAsk for Joanne Moylan, MPH, RD, LDN

Cost: Free for Medicaid children; sliding scale for others

ViQuestAsk for Karen Bellacera, MA, RD

Cost for non-members: $50 for initial assessment (60 mins); $30 for follow-up)

Members eligible for one free initial and follow-up session

Imagine Pitt County Eating “Smarter”

where…

High quality fresh fruits & vegetables available in schools, after-school programs, community events, supermarkets, corner stores, & nearby farmers markets

Children have healthy foods every day, not just on test days

School cafeterias exceed the Recommended Standards for All Foods Available in Schools

These are NORM not the exception

“Moving More”…

Adequate intergenerational facilities are available where all Pitt county residents can MOVE MORE

We exceed the Healthy Active Children Policy expectations

These are NORM not exception

knowledge, attitudes, behaviors

family, friends, social networks

organizations, social institutions

Society

Community

Organizational

Interpersonal

Individual

The State of North Carolina

county, municipality

Where do we go from here?

Congratulate and encourage the collaborative work

Spread the word to the community (culture shift) Obesity is a health issue Nutrition & physical activity supports

academic performance Get staff, parents and kids “on board”

Challenges

Alternate funding for lost food revenues

Support for policy and environmental changes

Motivating staff and families

Others…………..

In Summary

Obesity is a health issue for children & families

Collaborative efforts underway to help Pitt County “Eat Smart and Move More”. Everyone has a role.

Health and Education missions are merging in schools

Finding the will & way is critical

If we are not successful… researchers are now saying…

The generation of youth now in school may be the first to have a shorter life expectancy than their parents.

· Be Active North Carolina

· JAMA 2003; 289:187-193

Local Leaders are talking about raising One Healthy Generation

That means….

The active promotion of health and well-being in our children

Let’s All Join in!