Transcript Strategies for Childhood Obesity

Childhood Obesity:
Strategies to Halt a Growing Epidemic
(and a few words on trans fats)
Lynn Silver, MD, MPH
Assistant Commissioner and
Mary T. Bassett, MPH, MD
Deputy Commissioner
Health Promotion and Disease Prevention
New York City Department of Health and Mental Hygiene
US Conference for Mayors
Washington DC
January 25, 2007
Overview
• The New York City Experience
– Building a healthy environment
• Access to healthy foods
• Opportunity for physical activity
– Regulatory Approaches
• Physical Activity and Nutrition Requirements in
Day Care
• Calorie Labeling
• Restriction of Trans Fat
Obesity Trends* Among U.S. Adults
BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1986
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1987
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1988
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1989
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1991
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1992
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1993
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1994
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1996
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
Obesity Trends* Among U.S. Adults
BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data
<10%
10%–14%
15%–19%
≥20
Obesity Trends* Among U.S. Adults
BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 1999
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
≥20%
Obesity Trends* Among U.S. Adults
BRFSS, 2001
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2002
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2003
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2004
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 2005
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Begins Early
Only Half of NYC’s Elementary School Children
Are at a Healthy Weight
Underweight
4%
Obese
24%
More than
4 in 10 are
overweight
or obese in
Grades K-5
Overweight
19%
Normal
Weight
53%
Percentage of High School Students Who
were Overweight (selected U.S. states)
YRBS, 2005
Why worry about childhood obesity?
• Strong predictor of obesity in adulthood
• Major early risk factor for much of adult
morbidity and mortality – diabetes has doubled
• Health problems associated with obesity:
– Type 2 diabetes (hyperinsulinism, insulin resistance,
IGT)
– Cancer
– CVD (hypercholesterolemia, dyslipidemia, htn)
– Depression, low self-esteem
– Asthma, sleep apnea
– Osteoarthritis
SOURCES: American Academy of Pediatrics, 2003; Dietz & Gortmaker, 2001
Policy Approaches to Address
Obesity
• Obesity is not just a problem of the
individual, but also a problem rooted in
environmental and community factors
• 2001 Surgeon General’s “Call to Action to
Prevent and Decrease Overweight and
Obesity” declared obesity a national
priority
SOURCES: U.S. DHHS, 2001; Galvez, Frieden & Landrigan, 2003
The New York City Experience
• Building a healthy environment
– Access to healthy foods
– Opportunity for physical activity
• Regulatory Approaches
– Day care physical activity and nutrition
– Calorie labeling
– Trans fat (addresses heart disease risk)
Make it easier
to make healthy choices!
• Schools
– More physical activity
– No soda/vending machines
– 1% milk
• Day Care Centers
– More physical activity
– No sugar sweetened drinks, 1% milk only
– Limited TV
• Community Environment
– Shape-Up programs in parks
– Access to fresh fruits and vegetables
– Improving the built environment
Overall Daycare Population in NYC
Day Care
Facility Type
Total
Facilities*
Setting
Law/
Regulation
Approx.
Capacity**
Group Day Care
(GDC) – Permit
2,072
Non-residential
NYC Health Code
(Article 47)
98,696
Group Family Day
Care
(GFDC) – License
2,232
Home of an
unrelated family
18 NYCRR
(part 416)
30,742
Family Day Care
3,775
(FDC) – Registration
Home of an
unrelated family
18 NYCRR
(part 417)
103,942
School Age
(SA) – Registration
1,192
Non-residential
18 NYCRR
(part 414)
121,966
TOTAL,
all facility types
9,271
* 2006 data
** 2002 data
355,346
Group Day Care Population in NYC
• There are 2,072 Group Day
Care programs
• Serve about 100,000
infants, toddler and early
childhood (ages 2 to 5).
Daycare regulations and the NYC
Health Code: A Bit of History
• First day nursery in US opened in NYC in 1854
• Day care was regulated within the Sanitary Code
of the City of New York, beginning approx. 1910
• Compliance with these regulations was not
mandatory until 1943.
• As a side note, the regulations of 1943 required 2
hours of outdoor play and a hot meal at noon and
a "daily allowance of at least a pint of milk a day".
• The Health Code was adopted March 23, 1959.
• New requirements to address obesity effective
January 2007
Day Care:
Physical Activity
Regulations
• Establishes a required minimum number of
physical activity minutes daily:
– For ages 12 mos. and up, at least 60 min./day
– For ages 3 and older, at least 30 min. of that
time must be structured & guided activity
SOURCES: CDC; National Association for Sport and Physical Education
Day Care:
Limits on TV
• Establishes limits on TV & video viewing:
– No TV, video and other visual recordings for
children under two years of age
– For ages 2 and older, limits TV, video and
other visual recordings to no more than 60
minutes per day of educational programs or
programs that engage child movement
SOURCES: American Academy of Pediatrics; Institute of Medicine
Day Care:
Nutrition Standards
Provide guidance on:
– Appropriate kinds of foods & beverages - no
sugar sweetened beverages allowed. 1% milk
only after age 2.
– Appropriate portion sizes for children
(while remaining consistent with federal CACFP
policy for meal & snack reimbursement)
SOURCES: Child and Adult Care Food Program; U.S. Dietary Guidelines
for Americans, 2005
Implementation/Support
• Nutrition training efforts
– to day care inspectors
– to nutrition staff in
community through the
bureau of daycare
• Educational materials
disseminated to children
and parents through
daycare staff
• SPARK training in early
childhood settings
SPARK!
• Since 2003, DOHMH has partnered with
the Sports, Play and Active Recreation for
Kids! (SPARK) program
• Goal – train and equip all daycare centers
(17% trained so far), schools, K-2
teachers, and after-schools in highest risk
communities
• Since November 2003, SPARK training
and equipment provided to over 2500 staff
from more than 600 sites.
Healthy Bodega Initiative
Brooklyn survey: Access to healthy foods
– Conducted among 2 of the poorest neighborhoods
in NYC
•
•
•
•
•
•
84% of food stores are bodegas
6% of food stores are supermarkets
28% provide limited fresh fruit, if any at all
33% sell reduced fat milk, but at higher prices
6% of bodegas sell any type of leafy vegetables
Health food access is extremely poor
– Similar findings in other high risk areas
Healthy Bodega Initiative
• Healthy Bodegas Initiative
– 1% milk campaign
• Partnership with bodegas to stock 1% milk, offer
discounts and distribute health information
– Fruits & vegetables campaigns (Pilot project)
• Bodega owners are provided with a free shipment of prepackaged ready-to-eat apples and carrot snacks, if
interested they can re-order from distributor
• Bodegas received a toolkit containing bi-lingual
promotional items
• HD will conduct outreach and education to local schools,
day cares and WIC centers
NYC Health Code Calorie Labeling
• Requires certain FSEs to post calorie content on
menu boards and menus next to each menu item
• Applies to FSE who provide standardized menu
items and for which calorie information is publicly
available on or after March 1, 2007
• Does not apply to FSEs that have not made calorie
information publicly available
• FSEs have six months to comply - July 1,2007
Partial Phase-Out
of Trans Fat in
Restaurants
Amendment to the NYC Health
Code Approved December 2006
Phase I: July 2007 – Frying
Oils and Spreads
Phase II: July 2008 - All other
uses
Trans Fat Increases Heart Disease Risk
5% or more of cardiac events due to trans fat
More Dangerous than Saturated Fat
No one will miss it
Good (HDL)
Cholesterol
Trans fat
Saturated fat
Bad (LDL)
Cholesterol
Major Food Sources of Artificial
Trans Fat for U.S. Adults
Household
Shortening
5%
Salad
Dressing
4%
Breakfast
Cereal
1%
Potato Chips,
Corn Chips,
Popcorn
6%
Fried
Potatoes
10%
Margarine
22%
Data Source: http://www.fda.gov/fdac/features/2003/503_fats.html
Candy
1%
Cakes,
Cookies,
Crackers,
Pies,
Bread,
etc.
51%
Trans Fat Use Did Not Decline
Despite Voluntary Campaign
Where Use Could Be Determined
% Restaurants Using Trans Fat
in Oils and Spread
100%
Health
Bulletin to
200,000
people
75%
Info & tools to
food suppliers
and to >20,000
NYC restaurants
9,000 FSEs
received
additional info
50%
25%
7,800 restaurant
operators trained
50%
50%
0%
2005
2006
Effective Public Health Requires
Government Action
• Precedents:
– Removing Lead – like trans fat it was unnecessary,
repleaceable, and is not missed
– Adding Folate
– Seatbelt requirements
– Limit exposure to second-hand smoke
• Individual action alone is not enough:
–
–
–
–
Can’t tell if food contains transfat
Poor judgement of calorie content
For many, exercise opportunities are limited
Access to healthy foods is not a personal choice
We are getting a lot of questions
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California
Florida
Connecticut
Massachusetts
New Jersey
Pennsylvania
Washington State
•
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Ohio
Oregon
Michigan
Washington DC
Illinois
West Virginia
Virginia
Strategies for Consideration
• Create the Environment
– Increase access to healthy foods for everyone
• Target poor, high risk areas/neighborhoods
• Improve public procurement
• Regulate & improve food service in schools, day care
centers, after-school, camps
• Encourage more drinking of water and no use of sugar
sweetened beverages
– Increase access to physical activity
• Structured physical activity and facilities in schools,
communities, workplace
• Built environment modifications provides opportunity for safe
and convenient exercise
– Calorie labeling
– Soda Tax
Thank you!