Childhood Obesity What Nurses Can Do in the

Childhood Obesity: What Nurses Can Do in the Fight Against a Growing Health Concern Presented By: Linda Henry, RN, MS Linda Royer, RN, MPH, MSN George Mason University

Objectives for the Viewer • • Define Obesity Identify Effective Measurement Standards Understand the Historical Significance Identify Societal & Environmental Factors Identify Burden of Cost Identify Intervention Resources Learn Political Strategies for Advocacy

Obesity Defined • Presence of excess adipose (fat) tissue • Significant increase in weight-for-height percentile for age (above 75%ile) Obesity occurs when there is an imbalance of energy source intake and energy expenditure

Standards of Measurement • Hydrodensitometry (displacement measurement in water) • Subscapular skinfold • Body Mass Index (BMI) • Height-Weight Chart

Historical Analysis

Predictive Analysis

The Burden of Obesity (Adapted from American Obesity Association source, 2002)

The Burden of Cost Taxes • More than ½ of obesity-related medical costs are paid by taxpayers – in 2003 a total of $75 billion – That comes to $39 billion/year, or about $175/ person. • Covers treatment for type II diabetes, cardiovascular diseases, several types of cancer, and gallbladder disease. • Patients of public sector health plans: Medicaid, Medicare

Measurement Screener

The Following Slides Describe What Nurses Can Do to Affect Policymaking on Several Levels _______

STRATEGIES FOR Success

Strategies for Success 1. “The Surgeon General’s Call To Action To Prevent and Decrease Overweight and Obesity, 2001”. a. CARE- communication, action, research and evaluation b. 5 settings of action to include: families and communities, schools, health care, media and communications and worksites.

Strategies for Success 2. Support the Honorable Mr. Patrick J. Tiberi’s concurrent resolution -- H. Con. Res. 76. [Now in the Committee on Energy and Commerce] Recognizes associated health risks of obesity (rising incidence of DMII, sleep apnea leading to learning problems, hi cholesterol, HTN, orthopedic problems, liver disease, and asthma) Increased hospital treatment costs Largely behaviorally based Encourages parents to promote healthy weight & increased physical activity to their children

More on H. Con. Res. 76 Introduced 3/27/03 To express “the sense of Congress” Requires approval by both House and Senate, but is not sent to President for signature – therefore does not have the force of law No appropriations

Subcommittee Members Democrats Republicans Bilirakis FL Barton TX Upton MI Greenwood PA Deal GA Burr NC Whitfield KY Norwood GA Cubin WY Wilson NM Shadegg AZ Pickering MS Buyer IN Pitts PA Fletcher KY Ferguson NJ Rogers MI Tauzin LA Brown OH Waxman CA Hall TX Towns NY Pallone Jr NJ Eshoo CA Stupak MI Engel NY Green TX Strickland OH Capps CA Gordon TN De. Gette CO John LA Dingell MI

Strategies for Success o In June 2003, U. S. Senate Majority Leader Bill Frist (R-TN), Senator Jeff Bingaman (D-NM), and Senator Christopher Dodd (D-CT) introduced a bill to reduce obesity, particularly among children and adolescents; it passed in December 2003. It is called “Improved Nutrition and Physical Activity Act” or the IMPACT Act. o It provides $60 million for a demonstration program to fund communities in developing proven interventions

Strategies for Success 3. The third strategy would be to support Department of Health and Human Services (DHHS) Secretary, Tommy Thompson with: a. Public docket meetings b. Food and Drug Administration 4. Fourth strategy – support state and local efforts such as the Marin County -The Safe Routes to School Program

Strategies for Success 5. Encourage your community visionaries to apply for HHS announced $13. 7 million to go towards 12 grants supporting community programs designed to prevent diabetes, asthma and obesity. These grants are part of the new program at HHS entitled, Steps to a Healthier US.

Strategies for Success 6. Support: • proposed revisions in the nation’s dietary guidelines including a healthier proportioned daily food model than of the current pyramid • school lunch programs • the Women’s, Infants and Children’s Food program (The Nation’s Health, 2003). -Michael Jacobson, the Executive Director for the Center for Science in the Public Interest

Controversy Over Dietary Guidelines Policymaking Mary Story of APHA, Food & Nutrition – “Cornerstone of Federal Nutrition Policy” is an advocate; her committee scrutinizes public policymaking CSPI (Center for Science in the Public Interest) opposes the inclusions of committee members on DHHS taskforces addressing obesity who serve dual loyalties (American Egg Bd. , Sugar Assoc. , National Dairy Council). Peter Fitzgerald, R-Ill – is critical of USDA’s role.

Strategies for Success 7. Remove barriers to physical activity. – A recent study reported that children of Hispanic, Mexican- American and African. American ethnicity had decreased opportunities to participate in after school physical activity programs. (Duke, Huhman, & Heitzler in JAMA 290(10): 1308 -1313. )

Strategies for Success #7 continued – National Coalition for Promoting Physical Activity. • Four focus areas for physical activity to include: – – After-school programs Community designs School programs. » Three sections: » Rationale, » Recommended policy options » Policies in action

Strategies for Success 8. Support Nutrition Educators To get reimbursed for their services as they help to incorporate health promotion strategies into nutrition education interventions

Strategies for Success 9. Support and expand the media’s efforts to make the general public aware of the epidemic proportion of childhood obesity.

Strategies for Success • CDC conducted a qualitative study to help researchers understand young people’s beliefs and issues related to healthy and unhealthy eating; healthy and unhealthy weight, underweight, overweight and obesity; physical activity/sport behaviors; barriers to engaging in healthy eating and physical activities and potential campaign messages. The findings offer implications in communication strategies when targeting young people and healthy weight communication (CDC, 2003).

Dissemination of Knowledge General Public Officials Federal State Local Special Interest Groups & Media Public and Private Schools Nursing Organizations Specialty Groups Internet viewers (nurses) Tool Kit Letter - Poster Brochure - Kid’s Risk Chart Power. Point presentation Health Care Workers Pediatric Clinics Public Health Dept School Based Clinics

Summary The nine strategies, as well as proposal and tools for dissemination of information, offer impetus to your effort of establishing community-based programs to combat the rising childhood obesity epidemic. The sad fact is that once children become obese the likelihood of returning to and maintaining a normal weight is small (Surgeon General, 2001). So, we must act now and work together to create a winning environment for the young people of our community.