1. Healthy Changes, Healthier Families Megan Hammer, MPH, RD WIC Nutrition Program Consultant June 12 th, 2008

2. Food for Thought What is the prevalence of obesity nation wide? How are we doing in Arizona? What do we know about food, environment, and obesity? How can WIC help?

3. NHANES 2003-2004

4. What about children? JAMA, April 5, 2006, Vol 295, No. 13, 1549-1555 Homer, C. The National Initiative for Children’s Health Care Quality.

5. Who is at greatest risk? JAMA, April 5, 2006, Vol 295, No. 13, 1549-1555 Homer, C. The National Initiative for Children’s Health Care Quality.

6. Obesity and Income “The risk of obesity appears to be of particular concern among children who are members of racial and ethnic minorities or who come from lower income families.” (Rosenbaum & Wilensky, 2005) Nationally, the poorest children are nearly 80% more likely to be overweight or obese as children in families at the highest income levels (39.9% vs 22.7% respectively). Publicly insured children are nearly 50% more likely to be overweight or obese (39.6% vs 26.7% respectively). (COAN draft monograph: Addressing Child Obesity Within and Across State Disparities) Homer, C. The National Initiative for Children’s Health Care Quality.

7. Diabetes Non-Type 1 Diabetes in children is now 32% of cases (10 fold increase from 1982-1994).(1) The lifetime risk of developing diabetes for a Hispanic female born in the United States in the year 2000 until their death is 1 in 2.(2) This may be the first generation of children who may live less long than their parents as a result of the consequences of overweight and type 2 diabetes.(3) 1. Pediatrics May 2005 Vol. 115 No. 5: pp. e553-e560 2. JAMA 2003 October 8;290(14):1884-1890 3. New Engl J Med Vol. 352(11) March 2005, pp. 1138-1145 Homer, C. The National Initiative for Children’s Health Care Quality.

8. Obesity in Arizona Adults A 21% increase in only 10 years! Arizona adults with BMI >25 (BRFSS 2006)

9. Childhood Obesity in Arizona At risk for overweightOverweight CDC Pediatric Nutrition Surveillance System

10. Why does Arizona care? Physical Health Glucose intolerance and insulin resistance Type 2 diabetes Hypertension Dyslipidemia Hepatic steatosis Cholelithiasis Sleep apnea Menstrual abnormalities Impaired balance Orthopedic problems Emotional Health Low self-esteem Negative body image Depression Social Health Stigma Negative stereotyping Discrimination Teasing and bullying Social marginalization IOM Fact Sheet September 2004

11. What causes obesity? Homer, C. The National Initiative for Children’s Health Care Quality

12. What causes obesity? Low income families face additional challenges –Economic stress –Reduced access to affordable health foods and opportunities for physical activity –Overexposure to targeted advertising and marketing of energy-dense foods –Family dynamics Homer, C. The National Initiative for Children’s Health Care Quality

13. The role of environment “Genetics loads the gun, but the environment pulls the trigger.” (Judith Stern, UC Davis) Homer, C. The National Initiative for Children’s Health Care Quality By improving the environment, especially in low- income and minority communities, it may be possible to decrease the community’s and the nation’s disease burden. (Kumaniyka & Grier, 2006)

14. How does WIC fit in? We have the opportunity to change the environment of all Arizona WIC participants with the new WIC food package! –Fruits and vegetables –Whole grains –Low-fat and fat free milk –Less juice –Breast feeding promotion

15. WIC Foods: Based on Recommendations According to the Institute of Medicine: “Overall, the emphasis on fruits and vegetables, whole grains, and fat reduced milk and milk products are major steps in improving consistency of the WIC food packages with the Dietary Guidelines for Americans.” Institute of Medicine. WIC Food Packages: Time for a Change.

16. Fruits and Vegetables Percentage of Arizonans who do not eat the recommended amounts of fruits and vegetables BRFSS 2006

17. Fruits and Vegetables Important for: –Essential nutrients (vitamins, minerals, fiber) –Disease prevention (cardiovascular disease, cancer) –Weight management We have been promoting fruits and vegetables in WIC for 34 years, and now we can actually provide them! Centers for Disease Control and Prevention.

18. Fruits and Vegetables: WIC Clients More diverse, balanced food packages Greater variety and choice Consistency with Dietary Guidelines for Americans More culturally appropriate Supports improved nutrient intakes Addresses nutrition-related concerns Better nutrition! Sallack, L. California WIC Food Package Summit, 2008.

19. Fruits and Vegetables: WIC Clients The power of environmental change: Improving access to fresh fruits & vegetables will increase consumption and is an evidence-based strategy to reduce obesity. DiSogra, L. California WIC Food Package Summit, 2008.

20. Fruits and Vegetables: WIC Clients WIC can finally “practice what we preach” –Importance of fruits and vegetables –Variety, colors –How to use fruits and vegetables in meals and snacks –Setting good examples –Establishing behaviors that will last a lifetime

21. Fruits and Vegetables: Communities In addition to health benefits for WIC clients… WIC has the potential to revolutionize access to healthy foods in rural areas and inner cities and to transform communities. DiSogra, L. California WIC Food Package Summit, 2008.

22. WIC Food Package Impact The new WIC food package, especially the addition of fruits and vegetables, has the potential to improve the health status of Arizona’s most at-risk and disadvantaged populations. Entire communities will benefit from the increased availability of healthy foods in local grocery stores.

23. New WIC Food Packages: Now is the time to make change matter.