1. Daniel Clark MD/PhD/MPH/RN/BS/GED/Promotoro/ CHW and Kuei Lee

2. Childhood Obesity Increasing in prevalence (1976-1980 vs 2003-2006) – 6-11 yrs old: from 6.5% to 17.0% – 12-19 yrs old: from 5.0% to 17.6% 1 of 10 key health indicators for Healthy People 2010 15% of American children are overweight Inactivity and poor diet cause 300,000 deaths/year in U.S. Obesity-related diseases cost over $100 billion/year in U.S. Kuei Source: http://www.cdc.gov/obesity/childhood/prevalence.htmlhttp://www.cdc.gov/obesity/childhood/prevalence.html http://www.sph.uth.tmc.edu/catch/cns.htm Dan

3. School-Based Interventions 3 Basic Approaches: (1)Nutrition -Guidelines -Price Interventions -Product regulation (2)Physical Activity (3)Environmental -Community and Family Interventions Source: http://www.cdc.gov/obesity/childhood/prevalence.html

4. School-Based Interventions Meta-analysis “Do School Based Food and Nutrition Policies Improve Diet and Reduce Obesity?” Published and unpublished literature U.S. and Europe 18 studies met inclusion criteria Source: Jaime, Patricia C. & Lock, Karen. “Do School Based Food and Nutrition Policies Improve Diet and Reduce Obesity?” Preventive Medicine, Vol. 48, 1; 2009; p. 45-53.

5. School-Based Nutrition Interventions: Meta-Analysis Nutritional guidelines Decreased total and saturated fat Increased fruit & vegetable availability Improved students’ dietary intake Source: Jaime, Patricia C. & Lock, Karen. “Do School Based Food and Nutrition Policies Improve Diet and Reduce Obesity?” Preventive Medicine, Vol. 48, 1; 2009; p. 45-53.

6. School-Based Nutrition Interventions: Meta-Analysis Price Interventions Increased fruit & vegetable sales No negative effect on profits Source: Jaime, Patricia C. & Lock, Karen. “Do School Based Food and Nutrition Policies Improve Diet and Reduce Obesity?” Preventive Medicine, Vol. 48, 1; 2009; p. 45-53.

7. School-Based Nutrition Interventions: Meta-Analysis Product regulation Decreased sale of foods with minimal nutritional value Unintended negative consequences Source: Jaime, Patricia C. & Lock, Karen. “Do School Based Food and Nutrition Policies Improve Diet and Reduce Obesity?” Preventive Medicine, Vol. 48, 1; 2009; p. 45-53.

8. Physical Inactivity Independent risk factor for CHD 30% CV deaths 30% DM deaths 60% of cancer deaths Source: Stone et. al., Am J Prev Med 1998;15(4).

9. CATCH PROGRAM First initiated as a research study involving the University of California at San Diego, University of Minnesota, Tulane University and the University of Texas Health Science Center – Houston Purpose: to develop an elementary school-based program to reduce the risk factors related to cardiovascular disease. Four Components: 1.Eat Smart school nutrition program 2.K-5 and 6-8 Classroom curriculum 3.Physical Education Program 4.Family Programs

10. CATCH: Eat Smart

12. CATCH: Classroom Curriculum

13. CATCH Activities and Games

14. CATCH: Family Activities

16. CATCH: Follow Up from 1991-1997 Nader et al. Arch Pediatr Adolesc Med. 1999;153:695-704

17. CATCH: Follow Up from 1991-1997 Nader et al. Arch Pediatr Adolesc Med. 1999;153:695-704

18. CATCH: Follow Up from 1991-1997 Nader et al. Arch Pediatr Adolesc Med. 1999;153:695-704

19. CATCH: Follow Up from 1991-1997 Nader et al. Arch Pediatr Adolesc Med. 1999;153:695-704

20. CATCH: Follow Up from 1991-1997 Nader et al. Arch Pediatr Adolesc Med. 1999;153:695-704

21. CATCH: Follow Up Conclusions Intervention group demonstrated significantly healthier behaviors as compared to the control group. Behavioral differences between both groups persisted for 3 years after intervention. The difference between experimental and control groups, though still statistically different over time, are narrowing over time. More research needs to be done to develop the best modalities for maintaining intervention effects beyond elementary school level. Programs to alter environments for elementary, middle, junior, and high schools are warranted.

22. Acknowledgements Laredo Roger Perales Roger Perales Kelsey Vaughn Kelsey Vaughn Sylvia Arellano Sylvia Arellano All the Speakers All the Speakers La Bestia Blanca La Bestia Blanca Harlingen Pat Bortoni Pat Bortoni Noe Garza Noe Garza Beatriz Tapia Beatriz Tapia

23. Questions?