Moving our Children Toward A Healthy Weight finding

Moving our Children Toward A Healthy Weight… finding the will and the way Kathy Kolasa Ph. D, RD, LDN Professor and Section Head Nutrition Services and Patient Education, Departments of Family Medicine, of Pediatrics Brody School of Medicine at East Carolina University UHS Nutrition Initiative Consultant

What is best? n n n 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/DG 2000/Inde x. htm “USDA Healthy Eating Index” to check overall diet quality http: //147. 208. 9. 133

Today’s briefing. . n n Not about adult diets, but about the kids 4 Focused on childhood obesity prevention and treatment n n 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 priority also… Access to Care Diabetes Heart Disease and Stroke Older Adult Health

Adult size, Pitt Partners for Health, 2000 The weight environment our kids find themselves in: Weight Status: BMI __ % Underweight Normal <18. 5 -24. 9 2 31 Overweight Obese Morbidly Obese 25. 0 -29. 9 30. 0 -39. 9 40+ 36 29 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) q q § $1. 11 billion financed by Medicare and Medicaid (From RTI and CDC, 2004) NC ranked # 10 th 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” n n Overweight children are likely to remain overweight as adults if no intervention 1. if overweight at age 6, 50% chance to be obese as adult 2. 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 85 th%tile BMI for age Overweight: greater than 95 th%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 BMI Boys: 2 to 20 years BMI

Obesity* Trends Among U. S. Adults BRFSS, 1985 (*BMI ³ 30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% Source: BRFSS, CDC. 10%-14% 15 -19% ³ 20%

Obesity* Trends Among U. S. Adults BRFSS, 1986 (*BMI ³ 30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% Source: BRFSS, CDC. 10%-14% 15 -19% ³ 20%

Obesity* Trends Among U. S. Adults BRFSS, 1993 (*BMI ³ 30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%-14% 15 -19% ³ 20%

Obesity* Trends Among U. S. Adults BRFSS, 1999 (*BMI ³ 30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% Source: BRFSS, CDC. 10%-14% 15 -19% ³ 20%

Obesity Trends* Among U. S. Adults BRFSS, 2001 Source: Mokdad A H, et al. J Am Med Assoc 1999; 282: 16, 2001; 286: 10.

High risk children n n 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 n n n 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

Kids aren’t eating a health promoting diet The Food Pyramid The Reality Fats/Sweets Meat/Dairy Fruits/Vegetables Grains Source: USDA Pyramid; The NPD Group's CREST® and National Eating Trends® Services

*We estimate Pitt county kids… n n n 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)) n Rural children eat more fat than urban kids

Nutrition and Dental Health n n 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 site www. ecu. edu/pediatrics § Can access through the UHS Children’s Hospital Web site page www. uheast. com

*Obesity as Health Problem n n 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 n Improved cognitive performance, math scores n Improved physical performance, fitness, endurance n Psychological benefits and feelings of well being n Increased productive energy n 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 Children Toward 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… n n n RWJ Poll q 90% teachers & parents support converting vending machines to healthy food & drinks q 86% ban vending from elementary schools q 80% require PE at every grade level Am Academy Pediatrics focused on q 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 n n 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

All Foods Available. . new policy in 2004 § 4 Achievement Levels (needs improve, basic, proficient, § § superior) Grade Levels (K-5, 6 -8, 9 -12) Time & Place q Vending: beverages & snacks q After school programs q School events: instructional & non q 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”

Vending in PCS n n No “pouring rights” contracts. Carbonated beverages q Not available in elementary school q 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 n Need Principal, Teacher and Parental support and encouragement q Need support every day, not just TESTING days q Children with money buy extra portions or calories q 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 q Recommended 150 min/wk: elementary q 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 n Project YEAH! Physical activity incentive program, 4 th yr n Growing Up FIT! nutrition and physical activity in elementary, 4 th yr n PHASE (Physically active sensible eaters) staff wellness in 1 elementary, 1 st yr n Walking trail construction 2 in planning And more… 4 serving 5 schools;

What’s happening Our local Health Care and Education Missions are coming together in several grants: n Pitt Health Education Fnd grant…brochures n Healthy Weight Initiative Grant q 51 Take 10 kits; 49 physical activity equipment sets; $ for 2 walking trails n 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. . n 1 of 20 funded grants in NC, Health and Wellness Trust Fund n n Targets K-5 public school students Goal: formal policy changes by year 3 q Be active 30 min every school day q After school programs have 60 min PA q Nutrition improvements in cafeteria and classroom

What’s happening. . PCMH n n n Developing UHS Nutrition Initiative Winner’s Circle Dining Pediatric Healthy Weight Case Mgmt Leadership Team convened…proposal to Duke Endowment n n n Connecting students to services and programs Foundation’s Community Benefits program: priority to nutrition ed & physical activity projects Vi. Quest employee program supporting changes in home & school environments

Health Sciences Division East Carolina University n ECU-UHS Pediatric Healthy Weight Research & Treatment Center q Research Summit August 2003. Building collaborations Building multi-disciplinary membership q Providing training on prevention and treatment q Offering comprehensive treatment clinics for o Youth with obesity related disease; or at-risk o Medical Nutrition Therapy Services (referrals)

Medical Nutrition Therapy Resources for Overweight Youth in Pitt County ECU Family Practice Center Specify child has a weight concern, or is enrolled in KIDPOWER study Ask for Emilie Davis, MPH, RD, LDN Cost: 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 Mc. Kee BSPH, Latosha Hope Redd, BS; Ginger Hester, MS, RD, LDN Cost: $38 for initial assessment (60 mins); $17 for follow-up (30 mins) Pitt County Health Department Ask for Joanne Moylan, MPH, RD, LDN Cost: Free for Medicaid children; sliding scale for others Vi. Quest Ask 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… n High quality fresh fruits & vegetables available in schools, after-school programs, community events, supermarkets, corner stores, & nearby farmers markets n Children have healthy foods every day, not just on test days n School cafeterias exceed the Recommended Standards for All Foods Available in Schools n 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

Society The State of North Carolina Community county, municipality Organizational organizations, social institutions Interpersonal family, friends, social networks Individual knowledge, attitudes, behaviors

Where do we go from here? n n n Congratulate and encourage the collaborative work Spread the word to the community (culture shift) q Obesity is a health issue q Nutrition & physical activity supports academic performance Get staff, parents and kids “on board”

Challenges n Alternate funding for lost food revenues n Support for policy and environmental changes n Motivating staff and families n Others…………. .

In Summary n n 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!