1. Childhood Obesity in the Cherokee Nation CDR David Gahn, MD, FACOG Cherokee Nation Surveillance Programs Health Services HEALTHY NATION

2. Cherokee Nation Public Health Working towards PHAB accreditation Self-determination 2

4. Largest Impact Smallest Impact Factors that Affect Health Eat healthy, be physically active; Patient education Rx for high blood pressure, high cholesterol, diabetes Poverty, education, housing, inequality Immunizations, brief intervention, cessation treatment, colonoscopy Fluoridation, 0g trans fat, iodization, smoke-free laws, tobacco tax Socioeconomic Factors Changing the Context to make individuals’ default decisions healthy Long-lasting Protective Interventions Clinical Interventions Counseling & Education

5. 5 Data Collection Goals Quantify the problem for Cherokee Nation –Native American ≠ Cherokee Find the disparities within Cherokee Nation

6. 6 Cherokee Nation Health

7. Legend Cherokee Nation Clinic IHS Hospital Main Complex Three Rivers Health Center Sam Hider Jay Community Clinic Wilma P. Mankiller Health Center Redbird Smith Health Center Hastings Indian Medical Center A-Mo Salina Health Center Claremore Indian Hospital Bartlesville Health Clinic Vinita Health Clinic Nowata Health Center CHEROKEE NATION Tribal Jurisdictional Service Area (TJSA)

8. Childhood Obesity in the US 8

9. How do we measure obesity? Obesity = excess body adiposity BMI – screening tool that indicates excess weight for height Children BMI percentile ≥ 85 th percentile = overweight ≥ 95 th percentile = obese ≥ 99 th percentile = extremely obese 9

10. Prevalence of obesity among US children and adolescents by age, 1971-2008 Source: CDC/NCHS: NHANES I,II,III, and 1999-2008

11. Prevalence of overweight and obesity, 6-19 years, 1999-2008 Source: Ogden, JAMA, 2010 Overweight Obese Severe obesity

12. 12 Methods 16,530 children age 2-19 Cherokee Nation beneficiaries Data from RPMS Compared to national data from CDC

13. 13 Results

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17. Teenage Pregnancy and Obesity 17

18. Intervention: What does the evidence say? CDC Guidelines Institute of Medicine – Prevention –Government –Industry –Communities –Schools –Homes 18

19. Bottom Line: All levels of the environment 19

20. 20 Fighting the Winnable Battle Childhood Obesity Task Force –Group of local experts –Informed policy recommendations –Communication –Technical support –Evaluation and monitoring Joining Public Health and Clinical Services

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22. Chief’s School Health Leadership Grant Program 42 Schools $10K Each Fitnessgram 22

23. School Health Index Informs schools of areas for improvement Policies –Lunch –Recess –Soda machines 23

24. Built Environment Parks Sidewalks Safe routes to school 24

25. Clinical Persistent message Childhood Obesity Toolkit –AAP –Adaptable, culturally appropriate 25

26. Surveillance How do we measure progress –Clinical data –School data (government mandated?) –NHANES –BRFSS –WIC 26

27. THANKS! 27