1. 1 Creating a Health Movement Lydia Tinajero-Deck,M.D. Co-director of the HEAL(healthy eating, active living program) Program Childrens Hospital and Research Center, Oakland

2. 2 What we have learned at the HEAL program? Working to make the environment better for your patients

3. 3 Barriers perceived by our teens and staff Poor family support and poor peer support Environment Poor access to healthy foods Motivation Self-esteem Socio-economics/Health disparities Abundance of sedentary entertainment Medical problems Food/sweets are good

4. 4 The barriers Media, food industry, social constructs, neighborhood designs Food is good and eating is complicated Parenting styles School environment Reimbursement

5. 5 Why is this epidemic occurring? We live in a toxic environment. Cheap, ample food supply –decreased fat but increased calories –supersizing –increased eating opportunities Less energy is expended –labor saving devices –less physical jobs –sedentary entertainment

6. 6 Poor family &peer support Teens home alone Everyone is big in our family Teasing Shield

7. 7 Environment Neighborhood design Unsafe neighborhoods Accessible community resources ie parks, YMCAs

8. 8 Poor access to healthy foods Cafeteria Home refrigerator Corner stores Fresh produce Affordable healthy foods

9. 9 Motivation Time Get up and go

10. 10 Self-esteem Embarrassed to exercise in public

11. 11 Health disparities Socioeconomics Ethnicity Urban areas Suburban areas

12. 12 Ethnic groups Genetics, risk factors Traditional food Parenting styles

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16. 16 Abundance of sedentary entertainment TV Video games Cell phone computers

17. 17 Medical problems Asthma Joints Allergic rhinitis Sickle cell disease Psych meds

18. 18 Food is good Sweets Chips Soda Fast food nation

19. 19 Breaking the Epidemic--- Recognize the role of genetics Delete portion distortion Replace simple with complex carbohydrates Create an American culture on the move. Initiate a healthy body weight rights movement

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22. 22 What we can do? In the office Encourage breastfeeding BMI, Follow-up, Referrals as needed Nutrition 101 in the office Encourage physical activity Be informed about a few resources

23. 23 Schools Wellness policy PTA health speaker Sponsor a salad bar or school garden Get involved in a walkathon Meet with the principal Meet with the school district board

24. 24 Community Community design Parks and Recreation YMCA Boys and Girls Club Public Health Department Hospital Council

25. 25 Advocacy groups AAP ENACT Local government officials CMA

26. 26 Other groups that are working on this epidemic WIC California Nutrition Network University of California Extension, Alameda County (5 a day power play) Local grocery store or farmers market events Breastfeeding Coalitions

27. 27 Physical Activity Walk the Talk One resource or many in your waiting room or on your walls. Screen for physical activity and sedentary habits