CHILDHOOD OBESITY: IMPROVING THE SCHOOL HEALTH INDEX IN URBAN SCHOOL DISTRICTS LeShonda Wallace-Easterling, RN, APN-BC “BURSTING OUT OF OUR SEAMS: CONFRONTING THE CHALLENGE OF OBESITY IN OUR COMMUNITIES” University of Medicine and Dentistry of New Jersey Sponsor, Congressional Black Caucus Health Braintrust Host, Congressman Donald Payne and the UMDNJ-Institute for the Elimination of Health Disparities May 31, 2007

Childhood obesity has more than doubled for ages 2-5 & Childhood obesity has tripled for ages 6-11 Consequently, this increase resulted in the rise of obesity related chronic diseases (Type II diabetes, hypertension, psychosocial, orthopedic, respiratory, hyperlipidemia, steatohepatitis, sleep apnea, gallstones & menstrual irregularities) Prevalence is rampant among African Americans and Hispanics, and those of low-socioeconomic status

Contributing Factors Poor nutritional intake and behaviors –Media, culture, society, and inheritance Minimal physical activity (<30 minutes daily for 50% of children) Working parents –10 hours/day for Caucasians homes –12 hours/day for African Americans Increased television time (average of 4 hours daily) Increased food portions ( %) Out of home eating (school, community programs, fast food) Gym and recess times replaced with efforts to increase academic standards and test outcomes (an attempt to decrease the educational disparity) –1991, 57% of adolescents were active physical education participants –1999, 35% of adolescents were active physical education participants 3% yearly decline for males, 7% yearly decline for females Food used as incentives

Improving the School Health Index: At a Newark Public School Addressed 2 focus areas of Healthy People 2010 –Nutrition and Overweight –Physical Activity and Fitness

School Health Index: A Self Assessment and Planning Guide Developed by the Centers of Disease Control Schools with CDC implemented programs demonstrate less obesity and overweight Organization of a planning team Self Assessment Identification of strength’s and weaknesses in the school’s nutrition and fitness program (part of the school’s improvement plan imposed by the state) Planning to enhance the strengths and improve the weaknesses

SHORT TERM GOALS Decrease the presence of high fat and high cholesterol contents for meals and snacks served Decrease use of high fat and high cholesterol food as rewards Use physical activities such as roller skating as an incentive Strictly enforce prohibiting junk foods bought into the school Make health (nutrition/exercise) a mandatory topic of the elementary curriculum Educate the school's community (students, staff and parents) about good nutrition, exercise and their benefits and consequential effects Parent workshops Staff meetings Visual Aids Readily accessible literature Journals Newsletters Increase recess and gym time (not feasible due to district’s policy) Extracurricular physical activity program Morning Pilates After school cardio workout School sport tournament against staff and students

Habits and Practices in the School Setting December 2005 May 2006 School health, safety policies and environment 41-60%61-80% Health education 61-80%81-100% Physical education and other physical activity programs % Nutritional Services 21-40%41-60% Health services % Counseling, Psychological and Social services 41-60%61-80% Health promotion for staff 21-40%41-60% Family and community Involvement 61-80%81-100%

LONG TERM GOAL –Decrease the BMI of 5 th and 6 th graders with BMI’s >30 (14% of total participants) PCP referrals Individual counseling Nutrition/exercise education –Reassess within years

Limitations –No Child Left Behind: limited flexibility/creativity of academic learning time –Food marketing –Lack of parental support –Funds –Staff participation –Urban low socioeconomic environment –Broad spectrum scorecard –Self assessment bias

What are the major challenges associated with curtailing childhood obesity in our communities, especially among inner city children from racial and ethnic neighborhoods? Low-socioeconomic status Culture Gender Academic competitiveness Myths and Perceptions

What strategies have been successful in reducing childhood obesity and why? Primary Care Providers diagnosis of obese clients –Once diagnosed, PCP are more likely to conduct diagnostics, referrals and implement treatment guideline School based interventions –Start with elementary primary grades –Implementation of programs with expectations of healthy behaviors across of lifespan (“Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.”) –Reinstate home-economics Decreasing sedentary lifestyles and increasing activity Family interventions

Recommendations –Serve culturally familiar healthy foods (i.e. yam sticks) –Offer training to unions and food service workers for staff development and career ladders –Mandatory district approach –Entice policy makers and administrators cooperation to include nutrition and health education into the curriculum with evidence based programs such as “Action for Healthy Kids” –Leave No Parent Behind –Interventions must target entire student population –Keep schools open longer with quality, supervised, after school physical activities that are inclusive, fun for all ages, influenced by culture and modified for all sexes and skill levels –Advocate for community involvement in the co-morbidity campaigns (i.e. American Heart Association, American Diabetic Association) –PCP involvement in public advocacy and policies within the communities they practice –Neighborhood design