Transcript BURSTING OUT OF OUR SEAMS: CONFRONTING THE …

CHILDHOOD OBESITY: IMPROVING THE SCHOOL
HEALTH INDEX IN URBAN SCHOOL DISTRICTS
LeShonda Wallace-Easterling, RN, APN-BC
“BURSTING OUT OF OUR SEAMS: CONFRONTING THE CHALLENGE OF
OBESITY IN OUR COMMUNITIES”
University of Medicine and Dentistry of New Jersey
Sponsor, Congressional Black Caucus Health Braintrust
Host, Congressman Donald Payne and the
UMDNJ-Institute for the Elimination of Health Disparities
May 31, 2007
• Childhood obesity has more than doubled for
ages 2-5 & 12-19
• Childhood obesity has tripled for ages 6-11
• Consequently, this increase resulted in the rise
of obesity related chronic diseases (Type II
diabetes, hypertension, psychosocial,
orthopedic, respiratory, hyperlipidemia,
steatohepatitis, sleep apnea, gallstones &
menstrual irregularities)
• Prevalence is rampant among African Americans
and Hispanics, and those of low-socioeconomic
status
Contributing Factors
•
Poor nutritional intake and behaviors
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Minimal physical activity (<30 minutes daily for 50% of children)
Working parents
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Increased television time (average of 4 hours daily)
Increased food portions (195-700%)
Out of home eating (school, community programs, fast food)
Gym and recess times replaced with efforts to increase academic
standards and test outcomes (an attempt to decrease the educational
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Media, culture, society, and inheritance
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10 hours/day for Caucasians homes
12 hours/day for African Americans
disparity)
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1991, 57% of adolescents were active physical education participants
1999, 35% of adolescents were active physical education participants
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3% yearly decline for males, 7% yearly decline for females
Food used as incentives
Improving the School Health Index:
At a Newark Public School
• Addressed 2 focus areas of
Healthy People 2010
– Nutrition and Overweight
– Physical Activity and Fitness
School Health Index:
A Self Assessment and Planning Guide
Developed by the Centers of Disease Control
Schools with CDC implemented programs demonstrate
less obesity and overweight
• Organization of a planning team
• Self Assessment
• Identification of strength’s and weaknesses in
the school’s nutrition and fitness program (part of
the school’s improvement plan imposed by the
state)
• Planning to enhance the strengths and improve
the weaknesses
SHORT TERM GOALS
Decrease the presence of high fat and high cholesterol contents for meals and
snacks served
Decrease use of high fat and high cholesterol food as rewards
Use physical activities such as roller skating as an incentive
Strictly enforce prohibiting junk foods bought into the school
Make health (nutrition/exercise) a mandatory topic of the elementary curriculum
Educate the school's community (students, staff and parents) about good
nutrition, exercise and their benefits and consequential effects
Parent workshops
Staff meetings
Visual Aids
Readily accessible literature
Journals
Newsletters
Increase recess and gym time (not feasible due to district’s policy)
Extracurricular physical activity program
Morning Pilates
After school cardio workout
School sport tournament against staff and students
Habits and
Practices in the
School Setting
December
2005
School health, safety
policies and environment
41-60%
May
2006
61-80%
Health education
61-80%
81-100%
Physical education and other
physical activity programs
81-100%
81-100%
Nutritional Services
21-40%
41-60%
Health services
81-100%
81-100%
Counseling, Psychological and
Social services
41-60%
61-80%
Health promotion for staff
21-40%
41-60%
Family and community
Involvement
61-80%
81-100%
LONG TERM GOAL
– Decrease the BMI of 5th and 6th graders
with BMI’s >30 (14% of total
participants)
• PCP referrals
• Individual counseling
• Nutrition/exercise education
– Reassess within 1.5-2 years
Limitations
– No Child Left Behind: limited
flexibility/creativity of academic learning
time
– Food marketing
– Lack of parental support
– Funds
– Staff participation
– Urban low socioeconomic environment
– Broad spectrum scorecard
– Self assessment bias
What are the major challenges associated with
curtailing childhood obesity in our communities,
especially among inner city children from racial and
ethnic neighborhoods?
• Low-socioeconomic status
• Culture
• Gender
• Academic competitiveness
• Myths and Perceptions
What strategies have been
successful in reducing
childhood obesity and why?
• Primary Care Providers diagnosis of obese clients
– Once diagnosed, PCP are more likely to conduct diagnostics,
referrals and implement treatment guideline
• School based interventions
– Start with elementary primary grades
– Implementation of programs with expectations of
healthy behaviors across of lifespan (“Give a man a fish
and you feed him for a day. Teach a man to fish and you
feed him for a lifetime.”)
– Reinstate home-economics
• Decreasing sedentary lifestyles and increasing activity
• Family interventions
Recommendations
– Serve culturally familiar healthy foods (i.e. yam sticks)
– Offer training to unions and food service workers for staff
development and career ladders
– Mandatory district approach
– Entice policy makers and administrators cooperation to include
nutrition and health education into the curriculum with
evidence based programs such as “Action for Healthy Kids”
– Leave No Parent Behind
– Interventions must target entire student population
– Keep schools open longer with quality, supervised, after school
physical activities that are inclusive, fun for all ages,
influenced by culture and modified for all sexes and skill levels
– Advocate for community involvement in the co-morbidity
campaigns (i.e. American Heart Association, American Diabetic
Association)
– PCP involvement in public advocacy and policies within the
communities they practice
– Neighborhood design