Healthy Eating and Obesity Prevention

Healthy Eating Focus Area Process Local data Expert input Best practices Develop statement of the issue Determine what is known through scientific literature; Quantify the issue Develop key messages and recommendations Develop action plan Evaluate program or policy Adapted from “Evidence- Based Decision Making in Public Health, Public Health Management Practice, 1999.

Health Eating Data Within the Social-Ecological Framework Individual Behavior: e.g. Fruit/veg intake; Portion size; Breastfeeding Abundant fast food restaurants Vending machines in schools Lack of local grocery stores

Breastfeeding and Obesity Prevention Breastfeeding is linked to decreased risk of obesity, possibly due to physiologic factors in human milk, feeding and parenting patterns associated with nursing.* Breastfed infants are leaner at 1 year compared to formula-fed counterparts. Early growth pattern may influence later growth.** Prevention of Pediatric Overweight and Obesity, Policy Statement, American Academy of Pediatrics, Vol. 112, No. 2, Aug. 2003, pp Breastfeeding: HHS Blueprint for Action on Breastfeeding, Dept. of HHS, Office of Women’s Health, 2000.

Other Individual Behavior Trends Portion sizes increasing TV watching (especially by children) increasing “Convenience foods” more available in supermarkets Less cooking at home

The “Obesogenic” Environment or ‘Supply Side of Consumption’ in Washtenaw County

The ‘Obesogenic’ Society Hunter/gatherers ate 75% nuts, vegs, fruits; 25% lean game We eat 17% fruits, vegs; 28% fatty meats; 55% carbos, sugars, etc We would need to slow jog for 6-8 miles every day to exercise as hunter/gatherers Cheap, fast, low nutrition, high fat foods Convenient stores ‘Drive-Throughs’ – not much ‘healthy’ food eaten in the car? Perception of increased preparation time for fresh fruits and vegetables Decreased time available – e.g. Americans working more hours, more single parent homes, etc.

The ‘Obesogenic’ Society Linkages between exposure to grocery stores and restaurants and overweight have not been firmly established – but they’re coming… Sensible, but need to be creative about interventions and approaches, evaluate well Anxious to examine Community Prevention Guide recommendations regarding environmental approaches regarding overweight and healthy eating

Relevant Research Lower prevalence of supermarkets and higher prevalence of independently owned grocery stores in low-wealth neighborhoods and greater proportion of households without access to private transportation* Fruit and vegetable intake increases significantly for each additional supermarket in census tract** Forty percent of American food budget spent on fast foods*** Low income communities have significantly fewer supermarkets per capita than similar communities**** * Morland, K. et.al. “Neighborhood characteristics associated with the location of food stores and food service places.” AJPM.2002;22: **Morland, K., et.al.“The Contextual Effect of the Local Food Environment on Residents’ Diets: The Atherosclerosis Risk in Communities Study.” AJPH. 2002;92: ***Dietz, W. “Obesity in Children” UM-SPH Presentation… ****Philadelphia Food Trust *****University of California Cooperative Extension. July 2002

School Environment Trends Local data based on Physical Activity and Healthy Eating Asset Survey, April 2003 Questions based on CDC’s School Health Index for Physical Activity & Healthy Eating 53 of 114 schools in WC returned a survey (46% response rate)

School Environment Trends Junk food accessibility Nationally 26.3% elementary, 62% Middle/JRHS, 94.9% HS (2001) students have access to vending machines at school 26.8% elementary, 39.4% Middle/JRHS, 59.3% HS have school store, canteen or snack bar Washtenaw County 18% of elementary schools, 25% of middle schools, and 69% of high schools allow the sale of junk foods at school 29% of schools have policies regarding availability of low fat foods in school

School Environment Trends Curriculum Locally, only 14% of schools teach all 18 healthy eating curriculum topics recommended by the School Health Index Milk Consumption Nationally, student milk consumption has decreased 40% since 1977 Locally, 91% of schools offer either low-fat or skim milk in their school meals

Teens’ Consumption of Milk and Non-diet Soft Drinks (ages 12-19)

90% girls, 70% boys fail to meet daily calcium recommendation Teens drink 2X as much soda as milk, providing many with 15-20% of their calories Teens average 1 glass milk per day

Common Messages Across Populations (1) Prepare more meals at home – more cooking. Focus on what we are drinking (sweetened beverages). Define what is a healthy beverage. Promote community and school gardens

Common Messages Across Populations (2) Increase fiber intake; more fruits and vegetables; support plant-based diet Cut unnecessary sugar and fat Define “healthy snacking” & replace junk food snacking with healthy snacking Good dine out/fast food options Portion size *

Nutrition, Physical Activity, and Obesity Prevention Program Kim Bandelier, MPH, RD/LD Program Coordinator

Program Staff Kim Bandelier, MPH, RD/LD Lesli Biediger, MPH, RD Chronic Disease Nutrition Consultant Kristy Hansen, M.Ed., CHES Physical Activity Coordinator Brett Spencer Partnership Coordinator 8 Regional Nutritionists

Funding CDC Cooperative Agreement (~$450,000) State Nutrition and Physical Activity Programs to Prevent Obesity and Related Chronic Diseases 5 year award, currently starting year 3 Capacity building level State general revenue (~$800,000)

Caloric Balance Breastfeeding Fruits and Vegetables Reduced TV Nutrition Physical Activity Required Focus Areas

Strategic Plan for the Prevention of Obesity in Texas Originally released in 2003 Currently revising to include All age groups 5-year goals Breastfeeding and reducing TV viewing Specific strategies for communities Final will be released on April 24, 2006 at Texas Public Health Association convention

Demonstration Communities Project In 2004, 2 communities chosen Corpus Christi (urban) & Ft. Stockton (rural) Collected baseline data Conducted visioning workshops and stakeholder interviews Completed strategic/action planning process Currently implementing interventions UT-Austin manages project

Corpus Christi, TX CCAPWell (Coordinated Community Approach to Wellness) coalition 2005 Summer Scorecard Program ~300 children IN MOTION End of Summer Celebration Next interventions will be worksite wellness and breastfeeding promotion

Ft. Stockton, TX Ft. Stockton Lifestyle Coalition Hosted Family Play-Day on June 18, 2005 Conducted worksite wellness pilot in Ft. Stockton ISD Future plans include continuing worksite wellness with FISD, website development, and expanding physical activity programs for teens

Model for Dissemination Skill-Building Workshops Teaching communities skills needed to promote nutrition and physical activity through a community coalition or collaborative Using lessons learned from demonstration communities Regional Nutritionist hosting workshops for interested but not organized or newly organized community coalitions

Skill-Building Workshops 3 Pilot workshops conducted in workshops conducted in 2005 Partnership between NUPAOP and Goal A of the Texas Strategic Health Partnership 14 communities, 110+ attendees 3 new coalitions formed 2 existing coalitions trained

Future of Program Increase CDC funding from Capacity Building to Basic Implementation