1 Section 2: Obesity in Children Be Our Voice is a program of the National Initiative for Children’s Healthcare Quality (NICHQ), in cooperation with: Sponsored by the Robert Wood Johnson Foundation.

2 Objectives 1.Describe the magnitude and trends associated with the nation’s obesity epidemic. 2.Identify those children at greatest risk for obesity. 3.Rank states with the highest risk for obesity. 4.Describe why children need advocates for obesity prevention. 5.Articulate at lest two policy strategies to support obesity prevention.

3 The National Survey of Children's Health, Overweight and Physical Activity Among Children: A Portrait of States and the Nation 2005; HRSA,Health, United States, U.S. Department of Health and Human Services,Centers for Disease Control and Prevention, National Center for Health Statistics, National Perspective

4 State Rankings RankStates % Overweight & Obese 10-to 17- year-olds (95% CIs) 1Mississippi44.4% (+/- 4.3) 2Arkansas37.5% (+/- 4.2) 3Georgia37.3% (+/- 5.6) 4Kentucky37.1% (+/- 4.1) 5Tennessee36.5% (+/- 4.3) 6Alabama36.1% (+/- 4.6) 7Louisiana35.9% (+/- 4.6) 8West Virginia35.5% (+/- 3.9) 9D.C.35.4% (+/- 4.8) 10Illinois34.9% (+/- 4.1)

5 A Closer Look  Opportunity to customize slide here with Local State or County Data

6 The 2007 national Youth Risk Behavior Survey (High School Students)  13% Obese  Unhealthy Dietary Behaviors  79% ate fruits and vegetables less than five times per day during the 7 days before the survey.  34% drank a can, bottle, or glass of soda or pop (not including diet soda or diet pop) at least one time per day during the 7 days before the survey. Dietary Patterns

7 Physical Activity Patterns The 2007 National Youth Risk Behavior Survey (High School Students)  65% did not meet recommended levels of physical activity  46% did not attend physical education classes.  70% did not attend physical education classes daily.  35% watched television 3 or more hours per day on an average school day.  25% played video or computer games or used a computer for something that was not school work for 3 or more hours per day on an average school day.

8 Health Consequences In childhood, obese children are more at risk for:  Type 2 diabetes;  High blood pressure;  Liver disease;  Dyslipidemia including high cholesterol, high triglycerides and low HDL cholesterol;  Upper Airway Obstruction Sleep Apnea Syndrome; and  Hip and knee problems.

9 Health Consequences  In addition to the devastating physical health consequences, overweight and obese children suffer social and emotional health consequences as well.  Obese children:  have lower self-esteem;  are more likely to be depressed;  suffer from bullying and teasing; and  have lower academic achievement.

10 Cost of Obesity  An obese child’s healthcare costs are roughly three times more than the average child.  Childhood obesity is estimated to cost $14 billion annually in direct and indirect health expenses.  Children in Medicaid account for $3 billion of those expenses  Annual obesity-related hospital costs for children and adolescents were $238 million in 2005, nearly doubling between 2003 and 2005.

11 Health Disparities  Mexican-American and African-American children ages 6-11 are more likely to be overweight or obese than white children:  43% of Mexican-American children  37% of African-American children  32% of white children  Data on Native American children is limited, but one study of the Aberdeen Area youths age 5-17 found:  48% of Native American boys were obese or overweight  46% of Native American girls were obese or overweight

12 A Closer Look  Opportunity to customize with data regarding marginalized populations in your target community or state

13 Environment Where Children Live  Where a child lives and goes to school has a significant impact on his health  Today’s food and physical activity environment make it hard to be healthy. For example:  Lack of physical activity in schools (i.e. no PE or recess)  Car-focused world – active transport (i.e. walking or biking) is not easy  Lack of available and affordable fresh fruits and veggies  Massive marketing of unhealthy food and beverages  Overabundance of energy dense nutrient poor foods

14 Communities at Risk  Communities at risk are neighborhoods and regions where children are more likely to be overexposed to unhealthy factors and underexposed to healthy ones. In these communities, resources are minimal, infrastructure is not conducive to physical activity, income is generally low, and economic opportunities may be scarce.  The rates of obesity in communities at risk continue to rise far above those where children have access to healthy foods and places where they can engage in physical activity.

15 Making the Link: Practice and Community Case Study  A 12 year-old girl  At her 12 year well check mother reports her daughter’s increasing comments about her weight and being “fat”.  BMI = 23, 90 th percentile for a 12 year-old girl  Identified as overweight

16 Community/Social/Demographic Parenting Styles Child Characteristics Child’s Weight Status gender age Dietary Intake Decision Making family genetics Sedentary Behavior Physical Activity Schedule Child Feeding Practices Peer/ Sibling Interactions Foods Available In House Nutritional Knowledge Parent Dietary Intake Parent Food Preferences Parent Weight Status Parent Encouragement of Activity Parent Activity Patterns Parent Monitoring of TV Family TV Viewing School Schedule School Lunch Program Ethnicity Work Hours School Environment Availability of Recreational Activities Accessibility of Convenience Foods & Restaurants Family Leisure Time Corner Store School Physical Education Programs Crime Rates General Safety Socioeconomic Status Activities At Home

17 Behavioral Perspective 12 Year-Old Girl Dietary Patterns – Behavioral Perspective  Skips breakfast (no time)  Eats pretzel and juice for lunch (not hungry for a regular lunch)  After school – soda and snack food (poor choices)  Dinner – Family eats out 3x/week (too busy to cook)  Bedtime – Cereal (eating while watching TV)

18 Community/Social/Demographic Parenting Styles Child Characteristics Child’s Weight Status gender age Dietary Intake Decision Making family genetics Sedentary Behavior Physical Activity Schedule Child Feeding Practices Peer/ Sibling Interactions Foods Available In House Nutritional Knowledge Parent Dietary Intake Parent Food Preferences Parent Weight Status Parent Encouragement of Activity Parent Activity Patterns Parent Monitoring of TV Family TV Viewing School Schedule School Lunch Program Ethnicity Work Hours School Environment Availability of Recreational Activities Accessibility of Convenience Foods & Restaurants Family Leisure Time Corner Store School Physical Education Programs Crime Rates General Safety Socioeconomic Status Activities At Home

19 Environmental Perspective 12 Year-Old Girl Dietary Patterns – Environmental Perspective  Skips breakfast (school start time/availability of school breakfast)  Eats pretzel and juice for lunch (school lunch)  After school – soda and snack food (corner store)  Dinner – Family eats out 3x/week (fast food availability)  Bedtime – Cereal (TV in bedroom)

20 Community/Social/Demographic Parenting Styles Child Characteristics Child’s Weight Status gender age Dietary Intake Decision Making family genetics Sedentary Behavior Physical Activity Schedule Child Feeding Practices Peer/ Sibling Interactions Foods Available In House Nutritional Knowledge Parent Dietary Intake Parent Food Preferences Parent Weight Status Parent Encouragement of Activity Parent Activity Patterns Parent Monitoring of TV Family TV Viewing School Schedule School Lunch Program Ethnicity Work Hours School Environment Availability of Recreational Activities Accessibility of Convenience Foods & Restaurants Family Leisure Time Corner Store School Physical Education Programs Crime Rates General Safety Socioeconomic Status Activities At Home

21 Behavioral Perspective 12 Year-Old Girl Physical Activity Patterns - Behavioral Perspective  No outdoor time (doesn’t want to go outside)  Computer, IM etc 3 hours/day (nothing else to do)  Homework 2 hours/day (prefers not to do homework at study period)  Weekends “TV all the time” (doesn’t know what to do if not watching TV)  Extracurricular activity - Cheerleading 2x/week

22 Community/Social/Demographic Parenting Styles Child Characteristics Child’s Weight Status gender age Dietary Intake Decision Making family genetics Sedentary Behavior Physical Activity Schedule Child Feeding Practices Peer/ Sibling Interactions Foods Available In House Nutritional Knowledge Parent Dietary Intake Parent Food Preferences Parent Weight Status Parent Encouragement of Activity Parent Activity Patterns Parent Monitoring of TV Family TV Viewing School Schedule School Lunch Program Ethnicity Work Hours School Environment Availability of Recreational Activities Accessibility of Convenience Foods & Restaurants Family Leisure Time Corner Store School Physical Education Programs Crime Rates General Safety Socioeconomic Status Activities At Home

23 Environmental Perspective 12 Year-Old Girl Physical Activity Patterns - Environmental Perspective  No gym this session (school schedule)  No recess (school schedule)  No outdoor time (neighborhood safety)  Computer, IM etc 3 hours/day (family entertainment environment)  Homework 2 hours/day (family scheduling)  Weekends “TV all the time” (family activity)  Extracurricular activity Cheerleading 2x/week

24 Community/Social/Demographic Parenting Styles Child Characteristics Child’s Weight Status gender age Dietary Intake Decision Making family genetics Sedentary Behavior Physical Activity Schedule Child Feeding Practices Peer/ Sibling Interactions Foods Available In House Nutritional Knowledge Parent Dietary Intake Parent Food Preferences Parent Weight Status Parent Encouragement of Activity Parent Activity Patterns Parent Monitoring of TV Family TV Viewing School Schedule School Lunch Program Ethnicity Work Hours School Environment Availability of Recreational Activities Accessibility of Convenience Foods & Restaurants Family Leisure Time Corner Store School Physical Education Programs Crime Rates General Safety Socioeconomic Status Activities At Home

25 Obesity in the Context of This 12 Year-Old’s Environment  Interaction of environment and behavior is critical  Making healthy decisions only works when there are safe and affordable healthy options readily available in the environment  The next slide highlights all the factors that influence this 12 year-old’s food and physical activity environments

26 Community/Social/Demographic Parenting Styles Child Characteristics Child’s Weight Status gender age Dietary Intake Decision Making family genetics Sedentary Behavior Physical Activity Schedule Child Feeding Practices Peer/ Sibling Interactions Foods Available In House Nutritional Knowledge Parent Dietary Intake Parent Food Preferences Parent Weight Status Parent Encouragement of Activity Parent Activity Patterns Parent Monitoring of TV Family TV Viewing School Schedule School Lunch Program Ethnicity Work Hours School Environment Availability of Recreational Activities Accessibility of Convenience Foods & Restaurants Family Leisure Time Corner Store School Physical Education Programs Crime Rates General Safety Socioeconomic Status Activities At Home

27 Exercise: Obesity and Your Environment  Take a minute to complete the Healthy Lifestyles and Your Environment Exercise

28 Take Action  You can help your patients/clients and improve your clinical care by becoming an advocate and being part of a movement to create healthy environments that foster healthy active living for all children.  Children need you to be their advocates because environmental change does not occur without advocacy and children don’t have a voice in their childcare/school operations, community, and public policy. voice  You can provide the voice and the expertise to make positive changes in the environment.

29 Policy Opportunities: Where You Can Take Action  A variety of policy strategies exist to support healthier communities  Centers for Disease Control & Prevention, Institute of Medicine, Robert Wood Johnson Foundation and AAP have identified some specific strategies that fall into the following categories:  Improving access to healthy foods and beverages  Limit access to unhealthy foods and beverages  Improve opportunities for safe and affordable physical activity  Increase active transportation through community design  Improve school and childcare environments  Support breastfeeding

30 Policy Opportunities Tool  To further distill the various policy strategies, the AAP created a tool that looks at the different opportunities in terms of:  existing clinical anticipatory guidance and messaging (5, 2, 1, 0,breastfeeding and BMI), and  the various sectors where changes can occur (practice, community, school, state, and federal)  The tool also highlights which strategies are recommended by AAP, CDC, IOM, RWJF, and/or the National Governors Association   An additional tool is the RWJF Key Local Strategies to Address Childhood Obesity

31 Policy Tool Exercise  Opportunity to pick a high-risk behavior and figure out a strategy to address this behavior in schools

32 Conclusion  Now you have an understanding of:  Magnitude and trends of obesity;  The children at highest risk;  Why children need advocates for obesity prevention; and  What policy opportunities exist.  In the next section of this training, you will learn the “how” of advocacy.