Obesity Prevention in Obesity Prevention in Young Children: A Call for Young Children: A Call for Social & Environmental Social & Environmental

ActionAction

Obesity Prevention in Obesity Prevention in Young Children: A Call for Young Children: A Call for Social & Environmental Social & Environmental

ActionActionSharon Tucker, PhD, RN, CNSSharon Tucker, PhD, RN, CNS

Assistant Professor, Mayo Clinic College of MedicineAssistant Professor, Mayo Clinic College of Medicine

Nursing Research & Pediatrics, Mayo ClinicNursing Research & Pediatrics, Mayo Clinic

Robert Wood Johnson Executive Nurse FellowRobert Wood Johnson Executive Nurse Fellow

Growing Health Kids in Dakota CountyGrowing Health Kids in Dakota County

November 16, 2007November 16, 2007

Objectives

• Discuss the multiple and complex factors contributing to childhood obesity and child health and well being.

• Raise awareness regarding the environmental and social change needed to help reverse childhood obesity rates.

• Recommend a number of creative environmental and social strategies that can support parents in their efforts to promote family physical activity, nutritious eating patterns, and parent-child quality time.

It is all about Balance…..

Energy Balance• The same amount of energy IN

and energy OUT over time = weight stays the same

More IN than OUT over time = weight gain

More OUT than IN over time = weight loss

Robert Wood Johnson (RWJ) Publication

• RWJ– Nation's largest philanthropy devoted exclusively to

improving the health and health care of all Americans– Works with a diverse group of organizations and

individuals to identify solutions and achieve comprehensive, meaningful and timely change.

• We Will Reverse the Epidemic of Childhood Obesity…..Risa Lavizzo-Mourey, MD, MBA (2006), President and Chief Executive Officer– Reading from document

1998

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1998, 2006

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

2006

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

CDC Obesity Trends Slides

• http://www.cdc.gov/nccdphp/dnpa/obesity/trend/index.htm

Childhood Obesity Trends

15% of children in the United 15% of children in the United States are overweight.States are overweight.

– Calculating Child Body Mass Index– Gender-specific BMI-for-age percentiles

• < 5th percentile = “underweight”• 5th to <85th percentile = “normal weight”• 85th to <95th percentile = “at-risk for

overweight”• > 95th percentile = “overweight”

Prevalence of Overweight* Among U.S. Children and Adolescents

(Aged 2 –19 Years)

National Health and Nutrition Examination Surveys

Childhood Overweight NHANES I (1971–1974) - NHANES 2003–

2004

• Increases in overweight in all age groups: – Preschool-aged children, aged 2–5 years,

prevalence of overweight nearly tripled from 5.0% to 13.9%.

– School-aged children, aged 6–11 years, prevalence of overweight increased nearly 5-fold from 4.0% to 18.8%.

– School-aged adolescents, aged 12–19 years, prevalence of overweight nearly tripled from 6.1% to 17.4%.

Trust Report (2007)….• Obesity rates continue to rise with adult rates exceeding

25% in 19 states, up from 14 states one year earlier • More than 22% of adult Americans report they do not

engage in any physical activity• More than half report they do not participate in CDC

recommended levels of physical activity• 60% are not sufficiently active to achieve health benefits• Women are less likely to engage in moderate or

vigorous physical activity

High School Students• Nearly 10% do not regularly

participate in vigorous or moderate physical activity – Only 54% had PE class at least once a

week and 33% had daily PE

• More than 35% participated in vigorous activity for more than 60 minutes 5 days during a week

• More than 20 percent of high school students played video or computer games or used a computer for something other than high school for 3 or more hours on an average school day

• More than 35% of high school students watched 3 or more hours on an average school day

Health Consequences

• Overweight and obese individuals are at increased risk for many diseases and health conditions, including the following:– Hypertension (high blood pressure) – Osteoarthritis (a degeneration of cartilage and

its underlying bone within a joint) – Dyslipidemia (for example, high total

cholesterol or high levels of triglycerides) – Type 2 diabetes

– Coronary heart disease – Stroke – Gallbladder disease – Sleep apnea and respiratory

problems – Some cancers (endometrial, breast,

and colon)

Childhood Diabetes

• Type 2 Diabetes has increased from < 5 percent before 1994 to 30 to 50% in subsequent years

• Of the children diagnosed with type 2 diabetes, 85 percent are obese

Obesity Risk Factors• Odds of becoming obese as an adult

are doubled for a child under 10 who has at least one obese parent

• Probability of childhood obesity persisting into adulthood is estimated to increase from approximately 20% at age 4 years to approximately 80% by adolescence

Obesity Risk Factors• Hormonal & neurochemical

mechanisms– Responsible for regulating satiety,

hunger, lipogenesis, lipolysis, growth & reproductive development

• Genes• Genes & environment interaction

Factors Influencing Parenting Strategies &

Children’s Health• Food & Nutrition• Dual Working Parents• Environments• Convenience, Business, Structure,

Overbooking• Parent Stress & Mental Health

Factor 1: Food & Nutrition• Easy access to quick fix foods• Limited energy and time for planting

gardens & preparing fresh foods• Limited time for cooking & eating meals• Limited quality meal times as a family

– Eating on the run

• Excess access to high fat and high calorie foods

• Out of control food portions

Factor 2: Dual-working parents

• Women establishing careers• Both parents needing to work to

support expenses• Multiple child extracurricular

activities• Limited neighborhood supports

….Maternal Employment

• Research has shown limited significant impact of maternal employment on the quality of children’s dietary intake, including intake of fast foods.

• In contrast, physical activity levels and risk of obesity does seem to be influenced by maternal employment

…..Child Care Issues • 41% of preschool children are in child

care for 35 or > hours/week• 24% are in care for 15-34 hours/week• 16% are 1-4 hours/week• Approximately 80% of children 5 and

younger with employed mothers are in a child care arrangement for an almost an average of 40 hours/week

…….Child Care Issues • Little research exists on the dietary

quality & types of foods and beverages offered in child care facilities, especially nonlicensed places

• Many preschool-aged children are not meeting the recommended guidelines of two hours of physical activity, and children in child care settings need more physical activity

Factor 3: Environment

• Multiple activities completed in sedentary fashion– Computers– Television & Movies– Videogames

• Transportation in motor vehicles– Few walk to work or school

• Work/jobs require less physical activity– Sedentary activities

• Fewer neighborhoods where children play outside– Safety issues– Hyper-vigilant parents

• School curricula changed with minimal or no physical education

Factor 4: Parent Stress & Mental Health

• Parent stress affects coping and decision making

• Mental health/illness influence parent emotional and physical availability and decision making

• Child mental illness growing rapidly• Overeating and eating disorders

• Alcohol and drug abuse/dependence influence parent availability and judgment– Empty calories, poorer nutrition– Increases child risk of becoming user

and abuser

Factor 5: Convenience, Business, Structure,

Overbooking

• Easy to get around fast with vehicles or public transportation

• Time in day limited for adding activities that require physical effort or exercise

• Sports events are scheduled, no longer as spontaneous

• Fatigue levels lead to easy fixes

• Health clubs expensive• Working out and sweating purely for the

calorie burnout or health benefit (not tied to some other outcome) not motivating and takes substantial commitment and determination to sustain

• Habits…….physical activity can seem ordinary or extraordinary

MOVEMENT BREAK!!!• Stand up and pull arms over head• Bend over & touch toes• Turn around 360 degrees• Jump up and down 10 times• ??? Walk a circle in room• Remaining standing or get up 1-3x

more during the remaining slides

Models for ChangeMulti-Focused

Research on Prevention Interventions

• Overall, obesity interventions that target children have shown marginal success, whereas programs that have targeted parents and families as the agent of change, with modeling and promotion of physical activity (in addition to behavioral counseling and nutrition education) are most effective.

(American Dietetic Association, 2006; Epstein & colleagues, 1990, 2003; Folgelholm et al., 1999; Golan & colleagues, 1998, 2001, 2004, 2006)

Outcomes

• Decreased incidence of obesity among pregnant women and children

• Decreased incidence of disability and diseases related to overweight and obesity

• Reduced health care expenditures due to obesity-related disability and disease

• Increased number of young children maintaining a healthy weight

Partners/Stakeholders…..

• Child Care Settings• Home/Parents• Communities/Neighborhoods• Health Care Providers• Policy Makers

Child Care Settings• Influence licensing standards that

promote good nutrition and physical activity.

• Train and support child care providers on integrating activities that expose children to moderate physical activity and good nutrition within an appropriate early child development approach

Homes/Parents• Promote prenatal maternal health• Provide family-friendly information

and resources across a wide variety of venues– NIH WE CAN Resource

• Ensure that messaging is accessibly, usable and consistent

Communities/Neighborhoods

• Identify and eliminate community barriers to promoting good nutrition and physical activity

• Advocate for, plan, and build, health promoting neighborhoods and communities

• Educate and inform……….

Health Care Providers

• Enhance rapidity of integration of research-based approaches into practice– Preventive Services Task Force

• Health care professionals deliver culturally-sensitive tools, resources, and information that enhances patients’ understanding of the health benefits of good nutrition and physical activity

• Routinely review weight as a “vital sign” from birth and forward– Expect to discuss child weight/BMI

from birth at all well child care visits– Discuss nutritional intake & physical

fitness minutes

Policy Makers• Revamp delivery system to focus on

prevention and chronic care• Address the toxic environment & the

environments in which we live and work towards redesign for movement

• Reinvest in the public health infrastructure to manage chronic illnesses

• Engage the public in dialogue about the future

Our Focus in Rochester

• Exploring and studying approaches– that partner different stakeholders – build on Dr. James Levine and colleagues

research on NEAT

• Study One– Targeting working parents (nurses) who are

obese and have a child under 10 years– Aiming to increase NEAT within the work flow

of registered nurses

The activities of living:•Posture•Walking•Dancing•Shopping•Chatting•Mowing the lawn•Tapping your toes

Dr. Jim Levine’s Comments (July, 2007, Mayo Clinic Proceedings)

• Emphasis is moving away from intermittent sweat-drenched bouts of arduous exercise to more frequent walking, whether in the park, at work, or at home

• All exercise is good, more is better• Regardless of the study population,

walking improves health

A quote…..In the short span of 150 years, we

have forsaken our legs as a means of locomotion, work, and leisure. We are designed to walk all day long, and Nemoto’s [research] article suggests that we should.

Study Two• Robert Wood Johnson Executive Nurse

Fellows Program Project Funds• Collaboration between Mayo, Public Health,

Public Schools, & Winona State University• Partnering senior nursing students with 4-5th

grade elementary students and parents, and engaging teachers, to contractually establish and implement a walking and standing plan (assessed weekly) for one semester

• Using WE CAN Program as a guide and resource

One Public Health Approach: We Can Campaign

• WE CAN!: Ways to Enhance Children’s Activity & Nutrition – A new public education outreach

program designed to help children 8–13 years old stay at a healthy weight through improving, food choices, increasing physical activity, and reducing screen time.

• We Can! is unique because it focuses on parents and families in home and community settings.

• We Can! is harnessing power through:– Programs in local communities

throughout the country– Partnerships with other national

organizations that care about children and their health

We Can….Learn It

– View 60 second video clip– Healthy weight– Energy balance– Child risks

We Can…Live It

– Get started– Everyday tips– Good food– Get moving– Wean the screen– Resources

We Can…Get Involved

– Help your family– Help your patients– Run the We Can Program– Become a We Can Partner

Experience JournalChildren’s Hospital Boston

• One mother’s comments……– “I think that, to support our children who

struggle with weight or any kind of disease or illness, we should back them one hundred percent- especially where weight is concerned. Our whole family got on board......and we all made the changes necessary. Gavin wasn't left alone; he wasn't left to feel like well, this is his food, and that is our food. It was: this is everybody's food; this is what we all eat”.

“We all made a change for the better because we all were not eating properly…..One person in a rowboat takes a long time to cross a lake. But with four or five people in that rowboat, it's so much easier”.

http://www.experiencejournal.com/overweight/family_interview.shtml

Summary• Childhood obesity is a growing concern and

needs action!!!• ENERGY BALANCE IS THE MESSAGE!!• Parents set the stage for their children and

are the primary role models in the critical foundational first 5 years of life.

• Parents care about their children’s health • Many parents misunderstand facts about

weight, healthy foods and physical activity– Increasing awareness of the reality and facts

about the problem are the first step

• But, most parents are willing to think and talk about their children’s weight

• Child care settings are also very important for a majority of young children

• Partnerships with parents and others are CRITICAL to establish approaches that work if we want to see sustained change – “Energy expenditure” needs to accommodate

“energy” in with realistic & creative strategies for activity

Web Sites

• http://www.obesity.org/subs/childhood/prevention.shtml

• http://www.nemours.org/internet?url=no/news/releases/2006/060322_parents_obesity.html

• http://www.healthinschools.org/ejournal/2005/oct1.htm

• http://www.actionforhealthykids.org/pdf/Parents%20FR_823FINAL.pdf

• http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan_mats/parent_hb_en.pdf

• http://www.experiencejournal.com/overweight/family_interview.shtml

• http://www.icfi.com/markets/social-programs/doc_files/childhood-obesity.pdf

• http://hp2010.nhlbihin.net/portion/portion.cgi?action=question&number=1

• http://hp2010.nhlbihin.net/portion/portion2.cgi?action=question&number=1

• http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/index.htm

THANK YOU!!!

Tucker.sharon@mayo.edu

QUESTIONS???