Office of Child Advocacy Community Health Grand Rounds

Healthy Hospital Workgroup (HHW)

January 13, 2014

Adult Obesity

Obesity Trends Among U.S. Adults

1985 – 2010

Childhood Obesity

• Increased rates of obesity • 44% of Boston Public School students are overweight or obese • Overweight is occurring at younger and younger ages (Head Start in

Boston reports 35% of their children are overweight) • 70% of obese adolescents become obese adults

• Racial, ethnic and economic disparities

• Adverse health consequences

There is real concern that because of obesity, children today will have a shorter life expectancy than their parents.

Background: National

• Children’s Hospital Association (CHA), formerly known as National Association of Children’s Hospitals and Related Institutions (NACHRI)

• Convened an obesity workgroup composed of 25 hospitals, including BCH

• In addition to focus on obesity clinical services, identified the Healthy Hospital as one of their work areas

Background: Political • Center for Science in the Public Interest

– National advocacy group focused on nutrition, health, and food safety – Sugar-Sweetened Beverages (SSBs) are one of their six priority areas

• Health Care Without Harm

– Healthy Food in Health Care pledge – Have approached children’s hospitals nationally about the issue of SSBs

Background: Local • Boston Public Health Commission

– Received large CDC grant in 2010 for obesity with a major focus on reducing the consumption of SSBs

– Identified hospitals and healthcare institutions as a major targets for promoting system-wide change

– Also received large CDC grant for tobacco reduction and similarly identified hospitals as a group to model tobacco-free policies

BCH: The Healthy Hospital Workgroup (HHW)

• Reviews and makes recommendations for hospital practices and policies regarding the environmental factors that affect the health of staff, patients, and visitors

• Develops policies to support healthy lifestyles and support the implementation of such policies

• Areas of focus have included: – Food and beverage offerings – Tobacco access and smoking – Access to physical activity – Employee wellness

HHW Composition Co-Chairs

Shari Nethersole, MD, Medical Director for Community Health Sarah de Ferranti, MD, MPH, Director, Preventive Cardiology Clinic

Child Life CHPCC Facilities Management Food Services General Counsel Government Relations Human Resources Inpatient Nursing

Marketing and Communications Nutrition Office of Child Advocacy OWL Patient Support Services Parent Representatives Social Work

HHW Composition

•Steve Coldwell, Marketing and Communications

• Sharon Collier, Clinical Nutrition

• Caroline Costello, Inpatient Nursing

• Chandra Craven, Marketing and Communications

• John DiSessa, Food Services

• SueEllen Donahoe, Facilities Management

• Beth Donegan Driscoll, Child Life Services

• Cara Ebbeling, Endocrinology

• Shawn Goldrick, Patient Support Services

• Skylar Griggs, Clinical Nutrition

• Kelly Haynes, General Counsel’s Office

• Susan Herel, OWL

• Tracy Myers, CHPCC

• Darlene Norris, Parent Representative

• Paul O’Connor, Patient Services

• Lynnie Reid, Parent Representative

• Jamie Robidoux, Environmental/Food Services

• Victor Shopov, Government Relations/OCA

• Dawn Socha, Human Resources

• Laurie Oliver Taylor, Social Work

Individual Members

Summer 2011 Employee Survey: Overview

• 2,298 total responses

• 18.5% male, 81.5% female

• 82.1% full-time, 15.2% part-time, 2.7% other

• 84.5% of respondents agreed that regular SSB consumption can yield negative health effects

• 74.5% of respondents agreed that the high rate of people consuming SSBs is a public health concern

• 73.7% of respondents agreed that BCH should set a positive example for the patients it treats

Summer 2011 Employee Survey: Overview

Summer 2011 Employee Survey: Responses

• No efforts should be made to change how many SSBs people consume – 72.7% disagreed [i.e., we should make an effort] – 13.4% neutral – 13.9% agreed [i.e., we should not make an effort]

• Changing what you drink, while a good idea, should be a personal choice – 22.9% disagreed [i.e., should not be a personal choice] – 11.1% neutral – 66.0% agreed [i.e., should be a personal choice]

• Education is the best way to encourage lower consumption – 8.1% disagreed [i.e., education is not the best way] – 8.2% neutral – 83.7% agreed [i.e., education is the best way]

Summer 2011 Employee Survey: Responses

• Environmental changes should be made to reduce consumption – 9.3% disagreed [i.e., no changes should be made] – 9.6% neutral – 81.2% agreed [i.e., changes should be made]

• Taxes and pricing should be used to encourage lower consumption – 39.6% disagreed [i.e., taxes/pricing should not be used] – 16.4% neutral – 44.0% agreed [i.e., taxes/pricing should be used]

• BCH cafeteria/kiosks should not sell SSBS – 52.2% disagreed [i.e., should sell] – 19.7% neutral – 28.1% agreed [i.e., should not sell]

Summer 2011 Employee Survey: Open Responses “I think they should be banned. Yes we live in America which the common peon mistakenly believes gives them the "right" to make personal choices. Well to quote Justice Scalia, the right to free speech doesn't mean you can yell fire in a crowded theatre.” “As a leader in Obesity research and the impact sugary beverages have on children's health it is hypocritical to be [selling] these beverages on site!” “We are [a] hospital. We are in the business of wellness, health, and healthcare and should promote it. How can we promote our business if we sell products that contradict the reason for which we exist: to help people recover and get and stay healthy?” “In general, I don't believe SSBs should be restricted by law or policy & believe in personal choice. But at a HOSPITAL, where we are supposed to present an environment of health, presence of SSBs is somewhat inappropriate. I would support banning the sale of SSBs at CHB; would not support banning SSBs brought from home.”

“I feel that these beverages should be available, but support education campaigns and healthier available choices to allow people healthier options.” “Many [patients] and families seek the comfort of the familiar when hospitalized. Not having something as "simple" as a regular Coke available in the kitchen, for example, has more negative consequences than you might expect.” “Parents, family and staff are under considerable stress while in the hospital [environment], just as a child will regress while hospitalized, I feel it is important to remember that people have different coping mechanisms as well … I think to remove these products all together and enforce the hospital's beliefs on parents and families is not being culturally sensitive.” “I think education and information about caloric intake from sugary drinks is helpful, but I think that it is not up to the hospital to decide what their patients/staff/visitors are drinking … I think it would be entirely appropriate to provide education about sugary beverages - and then leave it to the adult to make the decision for themselves or their children.”

VS

Summer 2011 Employee Survey: Lessons Learned

Consuming SSBs is bad for me BUT

It is a personal choice (although we should make efforts to change other people’s habits)

Frequent consumption of SSBs is a public health concern

BUT Education and environmental changes are the best course of action, not

prohibition

Boston Children’s Hospital should set a positive example for its patients BUT

It should not stop selling SSBs

BCH Policy Changes • Sugar-Sweetened Beverages

– SSBs removed from (old) catering and inpatient floor menus – Reduced price of water – Educational signage in café

• Tobacco

– EMR screening – Quitworks partnership – Employee patch giveaway – New signage at main entrance

• Food

– Mindful Program – Revised inpatient menus

• Retail/Vending

– Established criteria – Incorporated stoplight program

The Guilt-Free Grill • Mozzarella Caprese Panini $4.99

• Asian Citrus Salmon Burger $5.99

• Bistro Turkey Burger $4.99

• Grilled Chicken Breast Sandwich $4.99

• Spicy Black Bean Burger $4.99

• Grilled Turkey Hot Dog $1.99

Results +20% Sales

-15% Transactions

65% Wellness

Recognition • In September 2013, Boston Children’s Hospital was awarded “Gold Apple”

status by North Carolina Prevention Partners

• BCH is one of eleven children’s hospitals across the country that has received the Gold Apple Award for excellence in creating a healthy food environment

Community Participation

• July 2012: Fenway Family Health Fair

• Center for Young Women’s Health, Injury Prevention, Food Services, and Nutrition were all represented

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The Future

• Cafeteria Renovations

• New Employee Survey – Is it needed? – If so, on what should we focus?

• Improved Access to Water

– How do we encourage more water consumption/replacement of SSBs?

• Promotion of Physical Activity – Ideas?

• Other areas of focus?

Questions / Comments