“Shaping” The Future of Georgia’s Children Using Data and Systems Modeling to Inform Legislative Discussions on Childhood Obesity “Shaping” The Future of Georgia’s Children Debra L. Kibbe, Senior Research Associate Georgia Health Policy Center Andrew Young School Policy Studies, Georgia State University dkibbe@gsu.edu 404-413-0287 Southern Obesity Summit October 22-24, 2018

Objectives Objective #1 – Identify how a legislative health policy certificate program can inform and engage legislators in taking action to address childhood obesity Objective #2 - Examine how childhood obesity-related data can be used to inform policy discussions Objective #3 - Understand that specific policies and evidence-based programs can affect childhood obesity in the short- and long-term

Legislative Health Policy Certificate Program Objective #1 Legislative Health Policy Certificate Program Since 2008, GHPC has offered a legislative education initiative, applying systems thinking to state health policymaking. Beginner & Advanced certificate programs Topics include: Evaluating Health Policy from a Systems Thinking Perspective, Health Financing, Health Coverage, Access to Care, Prevention, Special Health Topics (e.g., childhood obesity, behavioral health, etc.) 120+ legislators and staff have attended the LHPCP; 40 have completed the Advanced Health Policy program Powell KE, Kibbe DL, Ferencik R, Soderquist C, Phillips MA, Vall EA, Minyard KJ. Systems Thinking and Simulation Modeling to Inform Childhood Obesity Policy and Practice. Public Health Rep. 2017 Nov/Dec;132(2_suppl):33S-38S. 

LHPCP & Childhood Obesity Objective #1 LHPCP & Childhood Obesity Problem – 2007: nearly 1 in 3 GA adolescents are overweight or obese. 2008: State legislators & their staff and experts in obesity, health economics, health policy, and systems dynamics convened to construct a systems model Focus: impact of policy interventions on youth obesity (Body Mass Index for age percentile). 2014: New data available - Obesity systems model updated with GA BMI data and new interventions 2017: New data, investments & progress presented to LHPCP participants Childhood obesity model created with legislators, their staff and subject matter experts Model features interventions or “levers” that are funded through legislative decisions (healthcare, school, transportation, education) Updates provided to legislators since 2008 to advise COB-related investments and progress against a goal

69% of GA Students will be in the Healthy Fitness Zone for BMI Georgia Shape’s Goal Objective #1 By 2023, 69% of GA Students will be in the Healthy Fitness Zone for BMI How do we achieve this goal? Over the next ten years Georgia Shape will work towards increasing the number of students in the Healthy Fitness Zone for Body Mass index by 10%. Other objectives set forth by the Governor and Georgia Shape include reaching disparate populations, increasing the aerobic capacity measure of Georgia’s youth, increasing the breast feeding rate across Georgia, and increasing the number of early care centers that excel in nutrition and physical activity measures. Baseline 2013: 59%

Data Used to Inform Policy Change Objective #2 Data Used to Inform Policy Change 2009: House Bill 229 passed; requires annual fitness assessment in Georgia students in grades 1 through 12 1.1 million students assessed annually since 2012 2013-Present: Statewide childhood obesity initiative, GA Shape, provides training on integration of 30-minutes of physical activity as a key “energy balance” strategy Power Up for 30 impacts 68% - approx. 400,000 - elementary students State obesity prevalence declines 1.25% since 2013 2018: Legislators introduce House Bill 273 requiring daily recess in elementary and recommending unstructured breaks be available in middle schools Amended by Senate, sent back to House for review Again big fonts, do not alter title

Obesity Model Tabletop Activity Objective #3 Obesity Model Tabletop Activity Evidence-based Strategies (those that change BMI): School Physical Education, Classroom-based Physical Activity, Afterschool Physical Activity and Nutrition, Preschool Physical Activity and Nutrition Competitive Foods in School Nutrition Program, Medical Nutrition Therapy Breastfeeding Safe Routes to Schools To date more than 120 legislators and staff have attended the LHPCP and almost 40 of the participating legislators and staff have continued on to attend an Advanced Health Policy Institute session Powell KE, Kibbe DL, Ferencik R, Soderquist C, Phillips MA, Vall EA, Minyard KJ. Systems Thinking and Simulation Modeling to Inform Childhood Obesity Policy and Practice. Public Health Rep. 2017 Nov/Dec;132(2_suppl):33S-38S. 

Activity Choose a preferred policy Objective #3 Activity Choose a preferred policy Graph what you think will happen to Childhood Obesity Prevalence over 20 years Starting = 18% Ending = ? ? %

EXAMPLE: Georgia Childhood Obesity Systems Model Single Intervention: 50% of GA Elementary Classrooms Integrate PA Objective #3 Courtesy of Georgia Health Policy Center Obesity Prevalence in Georgia 18% Baseline Single Intervention: 50% of elementary school students experience classroom based physical activity In 2034, obesity prevalence estimates are 14.6% As a reminder, we are not "predicting the future" with the model; the model features interventions that are funded by legislative decision and we use the best available evidence about daily caloric change resulting from the intervention to model the impact of different  interventions individually or in combination.

QUESTIONS? Debra Kibbe dkibbe@gsu.edu 404-413-0287