1. 5-2-1-Almost None Let’s Make Delaware’s Kids the Healthiest in the Nation

2. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

3. Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

4. Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

5. Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

6. Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

7. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

8. Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

9. Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

10. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

11. Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

12. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

13. Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

14. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

15. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

16. Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

17. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

18. Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

19. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

20. Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

21. Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

22. Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

23. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

24. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2007 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

25. 2007 State Obesity Rates State% % % % (1) Colorado18.7(14) New Mexico24.0(27) Minnesota25.6(40) Michigan27.7 (2) Connecticut21.2(15) Nevada24.1(28) Nebraska26.0(41) North Carolina28.0 (3) Massachusetts21.3(16) Virginia24.3(29) South Dakota26.2(42) Oklahoma28.1 (4) Vermont21.3(17) New Hampshire 24.4(30) North Dakota26.5(43) Texas27.1 (5) Hawaii21.4(18) Idaho24.5(31) Indiana26.8(44) Georgia28.2 (6) Rhode Island21.4(19) Wisconsin24.7(32) Iowa26.9(45) South Carolina28.4 (7) Washington DC21.8(20) Maine24.8(33) Kansas26.9(46) Arkansas28.7 (8) Montana21.8(21) Illinois24.9(34) Pennsylvania27.1(47) West Virginia29.5 (9) Utah21.8(22) New York25.0(35) Delaware27.4(48) Louisiana29.8 (10) California22.6(23) Washington25.3(36) Kentucky27.4(49) Tennessee30.1 (11) New Jersey23.5(24) Arizona25.4(37) Alaska27.5(50) Alabama30.3 (12) Florida23.6(25) Maryland25.4(38) Missouri27.5(51) Mississippi32.0 (13) Wyoming23.7(26) Oregon25.5(39) Ohio27.5 2007 State Obesity Prevalence and State Rankings

26. Body Mass Index (BMI) = weight(kg)/height (m) 2 www.kidshealth.org What is BMI? A calculation that estimates how much body fat a person has based on his or her weight and height. The BMI formula uses height and weight measurements to calculate a BMI number. http://www.cdc.gov/nccdphp/dnpa/bmi/

27. Trends of Obesity* in Children and Adolescents *BMI > 95 th Percentile Data Source: CDC NCHS

28. Healthy Weight (BMI 5 th to <85 th Percentile) 60.6% Obese (BMI > 95 th Percentile) 19.9% Data Source: Nemours Delaware Survey for Children’s Health, 2006; Note: Data are not adjusted for demographics or co-morbid conditions. Healthy Weight (BMI 5th to <85th Percentile) 53.2% Underweight (BMI < 5th Percentile) 9.5% Overweight (BMI 85 th – 94 th Percentile) 16.8% Obese (BMI > 95th Percentile) 20.5% Percentage of Delaware Children and Youth Ages 2-17 by Weight Status More than one-third of Delaware children and youth are overweight or obese

29. Body Mass Index (BMI) = weight(kg)/height (m) 2 www.kidshealth.org What is BMI? A calculation that estimates how much body fat a person has based on his or her weight and height. The BMI formula uses height and weight measurements to calculate a BMI number. http://www.cdc.gov/nccdphp/dnpa/bmi/

30. What is obesity and overweight? Adults –Overweight = BMI at 25.0 – 29.9 –Obesity = BMI at 30.0 or above Children: BMI is age and gender specific, so BMI- for-age is the measure used –Overweight = heavier than 85% of children –Obesity = heavier than 95% of children (using growth charts) BMI is a good screening tool but it has limitations http://www.cdc.gov/nccdphp/dnpa/bmi/

31. Discrimination Persistence into adulthood Abnormal cholesterol High Blood Pressure Type 2 diabetes Liver and Gallbladder Disease Depression Consequences of childhood and adolescent obesity Anxiety Asthma Sleep problems Earlier maturation Reproductive problems Bone complications

32. Quality of Life Schwimmer et al. Health-related quality of life of severely obese children and adolescents. JAMA. 2003;289:1813-1819. Severely overweight children and adolescents are 5x more likely than healthy weight children to report a low quality of life. This risk is similar to children diagnosed with cancer Adapted with permission from NICHQ

33. Economic Burden “Obesity-related health expenditures are estimated to have accounted for more than 25% of the growth of health care spending between 1987-2001” - Health Affairs (2004) “In 2003, an estimated $207 million was spent for health-related expenditures due to obesity in Delaware- Finkelstein (2004) Adapted with permission from NICHQ

34. More calories eaten Less physical activity More inactivity What are the causes of obesity?

35. The New Social Norm?

36. Sugar and fat: cheap and abundant

37. Food environment

38. Vending Machines

39. Fast Food

40. Food marketing to children

41. Determinants of weight Energy INTAKE Energy OUTPUT INTAKE OUTPUT INTAKE OUTPUT

42. What do we know? No single culprit No magic bullet MODERATION—such a boring word! There are some things we can do…

43. Children could reduce their risk of preventable disease if: They consumed 5 or more servings of fruits and vegetables each day. They reduced screen time to fewer than 2 hours each day. They engaged in a total of at least 1 hour of physical activity each day. They limited drinks with added sugars, specifically soft drinks, non-100% fruit drinks and sports drinks.

44. 5-2-1-Almost None

45. 5 or more servings of fruits and vegetables per day

46. What’s a serving? Fruit: 1 medium whole fruit, ½ cup of cut fruit, ½ cup 100% juice or ¼ cup of dried fruit Vegetable: 1 cup of leafy vegetables, ½ cup of raw or cooked vegetables or 100% juice Fresh, frozen or canned? It is important to eat a variety of colors

47. Fruits and vegetables: May help your stomach feel full. May decrease the chance of becoming overweight Decrease chance of chronic disease: –Cancer –Heart Disease Dietary Guidelines for Americans, 2005; Rolls, 2004.

48. Nationwide, only 21.4% of teens eat 5 fruits and vegetables a day. Source: Youth Risk Behavior Surveillance System, 2007.

49. Fruit and vegetable intake in infants and toddlers does not meet national nutrition recommendations. French fries are one of three most common vegetables fed to infants 9-11 months. By 15-18 months, French fries become the most common vegetable consumed. Poor dietary patterns are beginning at early stages. Fox MK, Pac S, Devaney B, Jankowski L. Feeding infants and toddlers study: what foods are infants and toddlers eating? J Am Diet Assoc. 2004;104:S22-S30.

50. 2 hours or less of screen time per day

51. Overweight by Hours of TV per Day: 0-1 1-2 2-33-4 4-5 5+ Dietz WH, Gortmaker SL. Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics. 1985;75:807-812.

52. Increased snacking and consumption of high caloric foods Increased exposure to food and beverage advertising Displacement of physical activity Screen Time and Obesity Dietz, 1985; Gortmaker, 1996; Robinson, 2001.

53. 28% played video games, computer games, or used a computer for 3 or more hours a day 39% watched television for 3 or more hours a day Sedentary Behaviors of Delaware Youth (2007) Youth Risk Behavior Surveillance Survey (2007).

54. Violent and aggressive behavior Substance use Sexual activity Body image Academic performance TV Can Have Negative Affects On: American Academy of Pediatrics. Children, adolescents, and television. Pediatrics. 2001;107:423-426.

55. 1 or more hours of physical activity per day

56. Any movement that uses energy Wide range of physical activities including: –Household: cleaning, raking leaves –Transportation: walking or biking to work –Occupational: lifting boxes –Leisure time: team sports, exercise classes, walking, biking What is physical activity?

57. Helps control weight and build muscle Helps prevent chronic disease: heart disease, diabetes Reduces feelings of depression and anxiety Helps build and maintain healthy bones Leads to being more physically active as an adult May help kids perform better in school May help kids make better health and lifestyle choices Benefits of physical activity

58. In 2007, –60% did not meet the recommended levels of physical activity (at least 60 minutes per day on 5 or more days a week) –43% attended PE classes, while only 28% attended on a regular basis Delaware Youth Youth Risk Behavior Surveillance Survey (2007).

59. 65% of kids who live within 1 mile of school are driven to school

61. Almost no sugary beverages

62. Drinks with added sugars –Regular soft drinks, fruit drinks, sweetened teas, and sports drinks. Contribute to childhood obesity because they are high in sugar and calories Displace more nutritious drinks that children need to grow, like low-fat milk Contribute to dental cavities Sugary Beverages

63. Beverage Intake Among Adolescents Aged 11-18, 1965-1996 SOURCE: Cavadini C et al. Arch Dis Child 2000;83:18-24 (based on USDA surveys) 0 200 400 600 800 1000 1200 1400 1600 1965197719891996 Per capita grams consumed per day BoysGirls (Soft drinks, diet soft drinks, and fruit drinks) Source: Cavadini C et al. Arch Dis Child 2000;83:18- 24 (based on USDA surveys)

64. National Health and Nutrition Examination Survey, 1988-94. Beverage Intake Among Americans

65. For children 12-24 months, the top 3 sources of total energy were reported to be: –Milk –100% juice –Sugar Sweetened Beverages Poor dietary patterns are beginning at early stages Source: Fox, MK, Reidy K, Novak T, Ziegler P. Sources of energy and nutrients in the diets of infants and toddlers. J Am Diet Assoc. 2006;106:1992-2000.

66. Excessive juice intake in children may be associated with: –Obesity or persistence of obesity in childhood –Dental cavities Why limit juice? Welsh, 2005; Konig, 1995

67. 5-2-1-Almost None