1. Preventing Childhood Obesity: Community Interventions That Work Presented by Anne Kendall, PhD, RD, LD/N Food Science and Human Nutrition, UF

2. Objectives Describe the prevalence of childhood obesity and its health implications Identify appropriate goals and outcomes for community interventions to prevent youth obesity Describe the elements of successful nutrition education community interventions Identify resources to assist with developing community programs

3. Why Are We Concerned? Prevalence of obesity in children and adolescents has increased from 5% in 1980 to 11-13% in 1999

4. Why Are We Concerned? Obesity in childhood may persist into adulthood and increase risk of developing hypertension, diabetes, cardiovascular disease, stroke and some cancers Obesity-related diseases account for more than half of the annual deaths in Florida each year

5. Why Are We Concerned? Obese children have increased rates of: Depression Low self-esteem Social isolation If obesity persists, decreases in: College acceptance Socioeconomic status Marriage

6. Why Target Youth? Risk factors for chronic disease tend to begin in youth: those at the upper end of the range for total cholesterol, blood pressure or weight maintain their relative rank in adulthood Some food and physical activity related behaviors track from childhood into later years Obesity in adulthood is very difficult to treat

7. Why Target Youth? Percent of Children Aged 5-10 with CVD Risk Factors Normal Weight Overweight 1 RF27%61% 2 RF 7%27% Source: Freedman DS et al. Pediatrics 1999;103:1175-1182.

8. Developing Programs to Address Child and Adolescent Obesity Define goals and desired outcomes Conduct community needs assessment Identify target audience Plan program and select learning activities Implement program Evaluate process and outcomes

9. Identifying Goals, Defining Success Almost none of the community interventions targeted at all children that have published results have successfully changed body weight or BMI

10. Identifying Goals, Defining Success MCHB Expert Committee on Pediatric Obesity recommends that healthy eating and activity be the goal of programs addressing child and adolescent obesity, not achievement of IBW (Obesity Evaluation and Treatment: Expert Committee Recommendations. Pediatrics 1998; Volume 102) http://www.pediatrics.org/cgi/reprint/102/e29.pdf) http://www.pediatrics.org/cgi/reprint/102/e29.pdf Community interventions have successfully changed diet and increased physical activity

11. Community Needs Assessment Epidemiological Behavioral Consumption patterns, physical activity Environmental Educational Predisposing, reinforcing and enabling factors for behavior change Administrative and policy Organizational and administrative capacity, resources Green & Kreuter. Health Promotion Planning: An Educational Approach. CA:Mountain View Publishing. 1999

12. Community Needs Assessment Administrative and policy Organizational and administrative capacity, resources http://www.cdc.gov/nccdphp/dash/ School Health Index: A Self-Assessment and Planning Guide Assessment tools for nutrition services; physical education; health education; health services; family and community involvement; health promotion for staff; counseling, psychological and social services; healthy school environment

13. Selecting Your Target Audience Primary prevention Efforts designed to prevent the development of obesity Target all children Secondary prevention Efforts that target overweight children

14. Planning Your Program Identify behavioral objectives Select program activities

15. Elements of Successful Nutrition Education Interventions Contento I, Balch GI, Bronner YL, Lytle LA, Maloney SK, White, SL, Olson CM, Swadener S. The effectiveness of nutrition education and implications for nutrition education policy, programs and research: a review of research. J Nutr 1995;27:277-422. Comprehensive review of 217 nutrition intervention studies

16. Nutrition Education Any set of learning experiences designed to facilitate the adoption of eating and other nutrition-related behaviors conducive to health and well-being

17. Types of Studies Reviewed Preschool children: 23 studies Effect of education Role of parents School-aged children: 43 studies Interventions targeting knowledge, attitudes and behaviors Behaviorally focused studies Adults: 80 studies Mass media campaigns Large-scale community interventions EFNEP interventions Worksite interventions Point of purchase interventions

18. Types of Studies Reviewed Pregnant women: 18 studies Individual counseling Group education Breastfeeding education: 16 studies Prenatal counseling and classes In-hospital counseling Follow-up support, often with peer counselors Older adults: 16 studies Classes Print media Screening In-service training of professionals and paraprofessionals: 21 studies

19. Elements of Successful Nutrition Education Interventions Behaviorally focused rather than simply disseminating knowledge Based on theory and prior research Attention paid to motivators and reinforcers of behavior change of the target group Personalized self-assessment of dietary status or food-related behaviors

20. Elements of Successful Nutrition Education Interventions Active participation by the audience – tasting and preparing food, diet analysis, goal setting, participation in group projects to impact the environment Foster social support by families Use an empowerment approach that enhances personal control

21. Elements of Successful Nutrition Education Interventions Intervening in the food environment of schools, worksites and communities to maintain long- term change Active participation of community leaders Use of mass media to increase awareness and enhance motivation, especially with children

22. Elements of Behaviorally Focused Interventions Target motivations, incentives and behavioral skills needed for change Self-assessment of current perceptions, skills, behaviors Active, hands-on learning about effective behaviors for healthful eating Goal-setting: making contracts for behavior change in small achievable steps to enhance self-control Self-monitoring of behaviors Observing credible peer and adult role models Promoting self-initiated rewards and incentives

23. Successful Nutrition Education Interventions for Preschoolers Involvement of parents/families Modeling eating healthful meals and snacks by peers and adult role models Offering foods in a positive social environment and appropriate use of rewards Food-based activities Programs will be used if integrated into the early childhood curriculum, staff are adequately trained and the program is easy to understand and is affordable

24. Successful Interventions for School-aged Children Use behaviorally-focused curricula that address the cognitive, affective and behavioral domains of learning Devote adequate time and intensity to nutrition education: ~50 hours of education may be necessary to produce changes in behavior Involve families if working with younger children Include intervention in the school environment and in the larger community

25. Breastfeeding Promotion Two recently published studies found that breastfeeding decreases risk of developing overweight and obesity The greater the duration of breastfeeding the greater the risk reduction

26. Things to Avoid Excessive focus on weight Guilt Weight loss diets for growing children Focusing on individual nutrients rather than healthful diets

27. Resources Center for Weight and Health, UC Berkeley Child and Adolescent Obesity Task Force, Iowa Department of Health Healthy Youth Funding Database, CDC