Healthy Eating and Active Lifestyles

After this presentation, participants will be able to:

• Articulate trends in obesity and overweight• Describe how obesity affects Job Corps • Discuss how the built environment affects

health status• Describe the Healthy Eating and Active

LifeStyles (HEALS) program• List various center staff members’

responsibilities in creating a healthy environment and center culture

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So, what’s the big deal?

Medical significance of obesity. Associated with increased risk for many conditions:

• High blood pressure• Diabetes• Elevated cholesterol• Heart Disease• Stroke• Gall bladder disease• Sleep apnea• Certain cancers: uterine, prostate, colorectal

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Employment Significance of Obesity: Bias and Discrimination

• Hiring prejudice• Inequity in wages, promotions and

termination• Education setting• Medical setting

6Source: Puhl R, Brownell, KD. Bias, discrimination, and obesity. Obesity Research. 2001 Dec; 9(12):788-805

Costs of Obesity

7Source: The George Washington University School of Public Health. (2010). First-ever report on the individual cost of obesity. Retrieved online from: http://www.gwumc.edu/newsevents/firsteverreportontheindividualcostofobesityunveiled

ACCESS TO CARE  

ENVIRONMENT

GENETICS

HEALTHBEHAVIORS

ACCESS TO CARE

88%

OTHER 8%

HEALTH BEHAVIORS 4%

10%

20%

20%

50%

Influence National Health Expenditures $1.2 Trillion

Sources: Centers for Disease Control and Prevention, University of California at San Francisco, Institute for the Future. Reprinted from Advances: The Robert Wood Johnson Foundation Quarterly Newsletter, 2000, Issue 1, supplement, page 1

Factors That Influence Health Status

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Environment and Weight Status

• Neighborhoods have disparity in access to healthy foods in the U.S.

• Unhealthy foods are more available, more convenient, more heavily advertised and less expensive (especially in low income neighborhoods)

• Proximity to fast-food restaurants positively associated with likelihood of gaining more than 20kg weight during pregnancy

• For residents of urban neighborhoods, higher concentrations of small grocery stores was positively related to obesity and BMI

Environment and Weight Status

• More affluent neighborhoods – more supermarkets, easier access to whole grains, low-fat foods, more diverse fresh fruits and vegetable choices

• Increase in portion sizes at restaurants and pre-packaged foods

Neighborhoods and Chronic Disease

• Economic disadvantage • Social environment

– Connectedness and social order – Immigration, concentration of crime, segregation,

residential stability• Built environment

– Connectivity, air pollution, density

Source: Freedman et al. Neighborhoods and Chronic Disease in Later Life; AJPH, 2011; Vol 101(1). 12

Neighborhoods and Chronic Disease

• Looked at 6 common chronic conditions (self-report)– Hypertension, heart problems, stroke, diabetes,

cancer and arthritis• When all neighborhood factors included,

disadvantaged neighborhoods associated with:– Increased risk heart problems and cancer in women – Increased risk cancer for when all neighborhood

factors included– Proposed result of possible stress response

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Costs of Treating Heart Disease

• Estimated costs to treat – will triple by 2030• Includes treatment of hypertension, coronary heart disease,

heart failure and stroke

• $273 billion to $818 billion in 2030• U.S. medical expenditure already highest in world;

15% of GDP• 36.9% of Americans have some form of heart

disease today• Estimated 40.5% by 2030 based on current rates of

riseSource: Circulation: JAMA; Costs to Treat Heart Disease will triple by 2030; January 25, 2011. 14

Primary Disease Prevention Costs Savings

• Modest reductions (5%) in prevalence of diabetes and hypertension would save $9 billion annually

• If include reductions in co-morbidities- could save $24.7 billion annually

• Focus on well-designed interventions to improve lifestyle related risk factors

Ormond et al (2011) Potential National and State Medical Care Savings From Primary Disease Prevention; AJPH Vol 101(1).

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Food “Choices”

• Taste– Acquired – Can expand

• Cost • Convenience

Source: Drewnowski et al (2009) can low-income Americans afford a health diet? www.cphn.org/reports/brief1.pdf

Physical Activity and Weight Status

• 25% of all trips in U.S. are less than 1 mile and yet 75% of these trips are taken by car

• Increased time in car per day increases risk of obesity

• Safety and community design influence method of transportation; the more “walkable” a community, the lower the risk of obesity

Environment and Weight Status

• Surgeon General report in 2010 – 8 to 18 year olds spend over 7 hours per day playing video games, on the computer, or watching TV

• Social norms influence weight – if your friends gain weight, you are more likely to gain weight

Behavioral Ecological Model

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Step 1: JC Data Collection

• Collaboration• Leadership• Motivation• Variety

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Step 2: Public Schools

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Step 3: Job Corps Centers

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Lunch at Delaware Valley JCC

Step 4: A Meeting of the Minds

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The Program

• Holistic and individualized• Step-by-step guide• Website for food service staff• Evidence-based curriculum• A guide for recreation staff• Policy (food service, recreation, programmatic)• Webinars• Tips to create a healthy environment

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It takes a “village” to promote student health.

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The Triumvirate• Three powerful

individuals, each a triumvir

• The core: health and wellness, recreation, and food service

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Who Else?

• Social Development• Instructors• CD/Administration• Finance• SGA/students• Community

Connections• Others

28Poll question

What Makes a Successful Program?

• Collaboration• Leadership• Motivation• Variety

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The Healthy Eating and Active LifeStyles Committee!Poll question

Sneak Preview

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Overeating as an Addiction

Game Break!

True or False?

The same parts of the brain are responsible for both food and cocaine addiction.

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True

Functional neuroimaging studies revealed that good smelling, looking, tasting, and

reinforcing food has characteristics similar to that of drugs of abuse.

Source: Liu, Y. et al. (2010). Food addiction and obesity: evidence from bench to bedside. Journal of Psychoactive Drugs. 42(2); 133-145.

TEAP Specialist’s Role

• Work with students who are struggling with both addictions/cravings

• Be cognizant of replacing one addiction with another

• Another good reason to work closely with recreation

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The Mind and the Body

True of False?

More people suffer from bulimia than from binge eating disorder.

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False

Approximately 2% of the population, and 10-15% of overweight people suffer from

binge eating disorder. One out of every 200-300 people summer from bulimia.

True of False?

People who are depressed are more likely to be overweight.

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True

Sometimes obesity leads to depression; sometimes depression

leads to obesity

Disordered Eating

75% of women eat, think, and behave abnormally around food some of the time.

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Source: University of North Carolina at Chapel Hill, news release, April 22, 2008

CMHC’s Role

• Collaborate with recreation staff• Incorporate exercise into groups• Foods and Moods curriculum • Screen for disordered eating

– Partnership with outside treatment facility • Brief cognitive behavioral therapy• Food addictions group

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Recreation

True of False?

Eating healthy is more important than exercise for weight loss.

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False—But really this is a trick question

Food matters more for calories but physical activity is the #1 predictor of

sustained weight loss.

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National Weight Control Registry (NWCR)

• There is variety in how NWCR members keep the weight off. Most report continuing to maintain a low calorie, low fat diet and doing high levels of activity. – 78% eat breakfast every day. – 75% weigh themselves at least once a week. – 62% watch less than 10 hours of TV per week. – 90% exercise, on average, about 1 hour per day.

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Recreation’s Role

• Make physical activity fun• Offer activity that appeal to male and female

students• Sell the stress-reduction benefits of exercise

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Food Service

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Game Break!

True or False?

Labeling a healthy food with a heart or other icon is the most effective way to get students to choose healthy foods.

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False

Labeling with an icon is a mixed bag; although there is some evidence that

providing calorie information on menus reduces the number of calories people eat.

Source: Albright, C.L. et al. (1990). Restaurant menu labeling: impact of nutrition information on entrée sales and patron attitudes. Health Education Quarterly. 17(2), 157167.Harnack, L.J. & French, S.A. (2008). Effect of point-of-purchase calorie labeling on restaurant and cafeteria food choices. International Journal of Behavioral Nutrition and Physical Activity. 26(5); 51.

Game Break!

True or False?

Slightly reducing the cost of healthy foods in comparison to unhealthy foods will encourage healthier eating.

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$0.10

True

As little as a 10% reduction in cost of healthy foods will encourage an increase in consumption of

healthy foods. Larger reductions encourage people to buy more snacks and consume more calories.

Source: French, S.A. (2003). Pricing effects on food choices. Journal of Nutrition. 133(3), 841S-843S.

Food Service’s Role

• Stay within budget• Serve foods that students want to eat• Control portion sizes• Promote healthy foods• Cut back on soda, fried foods, processed

foods, etc.

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Education and Programs

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Game Break!

True or False?

Watching and discussing a health-related documentary, like Food, Inc., is more effective in eliciting behavior change than imparting basic nutrition knowledge during a health class.

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True

Students in a Food and Society course ate more vegetables and decreased high-fat dairy compared to students in a standard

nutrition course.

Source: Heckler, E.B., Gardner, C.D., & Robinson, T.N. (2010). Effects of a college course about food and society on students’ eating behaviors. American Journal of Preventative Medicine. 38(5), 543-547.

Game Break!

True or False?

Tangible prizes (e.g., t-shirts, gift cards) are the most effective way of motivating adolescents to change a health behavior.

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False

Fun activities, support, competence, and autonomy are effective ways of

motivating students.

Source: Ryan R.M. & Deci, E.L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist. 55(1), 68-78. doi:10.1039/0003-066x.55.1.68

Up for Grabs

• Use health education curriculum to teach students

• Run programs• Plant a center garden• Teach students how to grocery shop and cook

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Nurses’ and Physicians’ Roles

• Intake• Follow the Obesity

Chronic Care Management Plan

• Track students’ BMI and waist circumference

• Lead the wellness team• Lend expertise

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What’s Coming?

• “Best Health Mentor” competition • A marketing kit for your center • Two new websites • Guidance on how to select a HEALS

committee/submission of committees • Staff trainings• Ongoing program support• Guidance to kick off the program• Quarterly campaigns

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Best Health Mentor Competition

• Each member of the Job Corps community may nominate one staff member and one student as the center’s Best Health Mentor.

• Nominees should be individuals who both model healthy behaviors and help others adopt these behaviors. One staff member and one student will be selected from each region as a Best Health Mentor.

• Email to julie.luht@humanitas.com 72

Any questions about your piece of the puzzle?

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