Docs Adopt© Childhood Obesity PreventionDr. NAME

How did we get here…

Obesity is a recent phenomenon; today normal human behavior results in unhealthy weight gain. Therefore effective intervention

must address the “obesogenic” environment.

THEN vs NOW

1950s NOW

20 year change in average caloric intake

Children 11-18 eat fast food 2X/week*

Fast food meal 187 cal > home meal**

Fast food restaurants more common in low SES predominantly AA neighborhoods***

*Paeratakul J Am Diet Assoc 2003;103:1330**Bowman Pediatrics 2004;113(1):112***Block Am J Preventative Med 2004;27:211

THEN vs NOW

1950s NOW

Screen Time• Most children watch 3 hrs TV/day*• Average child has 5-7 hrs total screen time*• TV in bedroom associated with obesity• Limiting “Media Time” lowered BMI**• 5 h / day = 5X Higher risk obesity

**Robinson JAMA 1999; 282:1561

*www.nlm.nih.gov/medlineplus/ency/patientinstructions/000355.htm

THEN vs NOW

1950s NOW

THEN vs NOW

1950s NOW

Decreased Physical Education and Physical Activity in Schools

• Increased emphasis on academic achievement and testing

• PE & PA enhances learning, academic achievement, and positive behaviors*

*Shepard Pediatric Exercise Science 1997;9:113 Calas Pediatric Exercise Science 1994;6:406Dwyer Pediatric Exercise Science 2001;13:225

THEN vs NOW

1950s NOW

HIGH FRUCTOSE CORN SYRUP

Prevalence of obesity (body mass index >95th percentile) among children and adolescents 2 to 19 years of age in the United States between 1971 to 1974 and 2009 to 2010 shows a recent

plateau from 2003 to 2004 on.

Lakshman R et al. Circulation. 2012;126:1770-1779

Copyright © American Heart Association, Inc. All rights reserved.

Change in the distribution of weight among adults in SC(During the past 40 years, obesity has gone from being rare

to the “normal” condition)

<15% 15-85% 85%-95% >95%0

10

20

30

40

50

60

70

80

19702010

Robert Wood Johnson Foundation County Health Rankings & Roadmapshttp://www.countyhealthrankings.org/app/south-carolina/2014/overview

• 9X risk of hypertension• Early onset puberty in girls*• 25% impaired glucose

tolerance**• 4% type 2 diabetes

mellitus**• 80% adult obesity,

1/4 of whom will have metabolic syndrome***

* Pediatrics 108(2):347,2001; ** NEJM 346(11):802,2002; ***JAMA 287(3):356,2002

Consequences of obesity in children and adolescents

What works …public health efforts to change the environment

What It Takes To Work:Address the obesogenic environment through policy,

systemic and environmental changes

Improve nutritionIncrease physical activityInclude physicians in this effortTarget schools to reach children

Why schools:> 95% young people in schools

Large portion of daily food and exercise occurs at school

Ideal setting to teach about healthy lifestyle

Can enhance academic performance and behavioral improvements(www.cdc.gov/HealthyYouth/keystrategies/why-schools)

“Strengthen schools as the heart of health.”Institute of MedicineAccelerating Progress in Obesity Prevention: Solving the Weight of the Nation May 2012

IOM GOAL 4: Expand the role of health care providers…in obesity prevention

“Health care providers should increase the support … for achieving better population health and obesity prevention. …advocate for improved physical activity and diet opportunities in their patients' communities.”

IOM GOAL 5: Make schools a national focal point for obesity prevention

1. Require quality physical education and opportunities for physical activity

2. Ensure strong nutritional standards for all foods & beverages

3. Ensure food literacy

Public Health Approach for Obesity Prevention:IOM Accelerating Progress in Obesity Prevention 2012

Public Health Approach for Obesity Prevention:IOM Accelerating Progress in Obesity Prevention 2012

The Boeing Center for Children’s WellnessDocs Adopt School Health Initiative©

• Docs-Adopt©– Matches physicians or practices with individual schools– Physicians join school wellness committee– No clinical services

• School Wellness Checklist©– Action guide for implementing evidence-based

strategies to improve overall school health environment

– Basis of an annual contest that leads schools to improve nutrition and increase physical activity

– Qualifying schools receive monetary award to use towards wellness projects of their own choosing