Transcript Healthy Eating Active Living: The CDC’s Approach to
Susan M. Gross, PhD, MPH, RD, LDN Research Associate Population, Family and Reproductive Health Bloomberg School of Public Health
1.
2.
3.
Identify at least two healthy eating and two physical activity policies or practices that can be implemented in the community to address obesity.
Prioritize two guidelines to address obesity, physical activity, and nutrition in your state, region, city, or school district.
Name three groups of stakeholders in your state, region, city, or school district that need to be informed about the obesity prevention guidelines.
MEDIA GOVERNMENT AGENCIES FAITH-BASED ORGANIZATIONS YOUTH-SERVING ORGANIZATIONS SCHOOLS POSTSECONDARY INSTITUTIONS FAMILY HEALTH CARE PROVIDERS EMPLOYERS
Funds 25 states to work with partners across multiple settings ◦ Child care facilities ◦ Workplaces (including hospitals) ◦ Schools, and communities to implement policy, system, and environmental strategies that have been proven to work
Increase consumption of fruits and vegetables Increase physical activity Increase breastfeeding initiation, duration, and exclusivity Decrease consumption of sugar drinks Decrease consumption of high-energy-dense foods, which are high in calories
Promote the Availability of Affordable Healthy Food and Beverages Support Healthy Food and Beverage Choices Encourage Breastfeeding Encourage Physical Activity or Limited Sedentary Activity Among Children and Youth Create Safe Communities That Support Physical Activity Encourage Communities to Organize for Change Centers for Disease Control and Prevention. Recommended Community Strategies and Measurements to Prevent Obesity in the United States MMWR 2009; 58 ( RR-7).
Increase availability of healthier food and beverage choices in public service venues Improve availability of affordable healthier food and beverage choices in public service venues.
Improve geographic availability of supermarkets in underserved areas Provide incentives to food retailers to locate in and/or offer healthier food and beverage choices in underserved areas.
Improve availability of mechanisms for purchasing foods from farms.
Provide incentives for the production, distribution, and procurement of foods from local farms.
A 2002 study of more than 200 neighborhoods found that there are three times as many supermarkets in wealthy neighborhoods as in poor neighborhoods, and four times as many supermarkets in predominantly White neighborhoods as in predominantly African American ones Morland K, Wing S, Diez Roux A, Poole C. (2002). Neighborhood characteristic associated with the location of food stores and food service places. 22[1]:23-9 Am J Prev Med,
Low (0-8.7) Medium (8.7-17.4) High (17.5-26) N/A Haering & Franco (2010) Baltimore City Food Environment.
Residents of neighborhoods with low food availability tend to eat lower quality diets and consequently had a higher body weight.
Franco, Diez Roux, Glass, Caballero & Brancati. (2008). Neighborhood characteristics and availability of healthy foods in Baltimore. American Journal of Preventive Medicine, 35(6), 561 567. The Johns Hopkins Center for a Livable Future
Source: Environ Health Perspect. 2009 March; 117(3): 442–447
Source: Environ Health Perspect. 2009 March; 117(3): 442–447.
Source: Hutchinson, Bodor, Swalm, Rice, Rose, (2012), Health & Place, Volume 18, Issue 4, July 2012, Pages 854-860
School-based environmental interventions to increase availability and promotion of lower-fat foods can increase purchase of these foods among adolescents
Low-fat snack sales as a function of price. French S A J. Nutr. 2005;135:910-912
©2005 by American Society for Nutrition
Fruit sales as a function of price. French S A J. Nutr. 2005;135:910-912
©2005 by American Society for Nutrition
Restrict availability of less healthy foods and beverages in public service venues Institute smaller portion size options in public service venues Limit advertisements of less healthy foods and beverages Discourage consumption of sugar-sweetened beverages
“We’re finding that portion size can influence intake as much as taste. Large packages and containers can lead to overeating foods we do not even find appealing.” ~ Brian Wansink, PhD, John Dyson Endowed Chair in the Applied Economics and Management Department at Cornell University, and author of “Mindless Eating” 1 9
Fig. 1 Differences in mean energy intake (i.e., kcal) across conditions of different portion sizes (PS; 200 vs. 600
David Marchiori , Olivier Corneille , Olivier Klein. Container size influences snack food intake independently of portion size. Appetite Volume 58, Issue 3 2012 814 – 817.
◦ Increase support for breastfeeding Surgeon General's Call to Action to Support Breastfeeding http://www.usbreastfeeding.org/LegislationPolicy/F ederalPoliciesInitiatives/SurgeonGeneralsCalltoActio n/tabid/189/Default.aspx
Source: Arenz, 2004
months months g; 4,5 g; 3,83-5 months; g; 2,3 breastfeedin g; 1,7 0 months 2 months 3-5 months 6-12 months
Source: adapted from: von Kries R, Koletzko B, Sauerwald T et al. (1999). Breast feeding and obesity: cross sectional study. BMJ, 319:147–150.
Strengthen mother-to mother support options.
Create mother-to-mother support groups and for peer counseling programs. Integrate breastfeeding support into community based organizations.
Improve maternity care systems.
Eliminate gaps in continuity of care.
Improve clinician knowledge and skills.
Establish and measure care quality standards.
Develop effective lactation care teams.
Provide safe banked donor milk for fragile infants.
◦ Created in 1991 Gold standard for evidence-based breastfeeding care in hospitals Numerous studies show that adherence to Ten Steps predicts breastfeeding duration and exclusivity long after hospital discharge DiGirolamo et al. (2008) Women who did not experience any of the Ten Steps (vs. >6 steps) were eight times more likely to fail at breastfeeding by six weeks
Establish paid maternity leave.
Ensure lactation support is available for employees.
Allow working mothers direct access to their babies.
Ensure child care providers support breastfeeding.
Require physical education in schools Increase the amount of physical activity in PE programs in schools Increase opportunities for extracurricular physical activity Reduce screen time in public service venues
◦ ◦ Safety School Neighborhood Insecure neighborhoods, decreased connections Conflict, violence, isolation, homelessness Children needing fostering Child abuse and neglect Recreational opportunities Food availability
Shorter lunch periods Block scheduling Increased a la carte offerings Higher fat foods moved from NSLP to a la carte More vending machines Exclusive beverage contracts More school stores and snacks Federal reimbursement rates/inflation Increase in indirect costs
Distance from School and Percent of Students who Walk to School
MMWR (2005). 54(38), 949-952
Percentage of High School Students Who Met Recommended Levels of Physical Activity,* by Sex** and Race/Ethnicity,*** 2007 * Were physically active doing any kind of physical activity that increased their heart rate and made them breathe hard some of the time for a total of at least 60 minutes/day on 5 or more days during the 7 days before the survey.
** M > F *** W > B, H
total; Male; 43,7 total; Total; 34,7 total; Female; 25,6 total; White; 37 total; Hispanic; 31,1 30,2
Source: National Youth Risk Behavior Survey. (2007).
Percentage of High School Students Who Did Not Participate in 60 or More Minutes of Physical Activity on Any Day,* by Sex** and Race/Ethnicity,*** 2007 * Did not participate in 60 or more minutes of any kind of physical activity that increased their heart rate and made them breathe hard some of the time on at least 1 day during the 7 days before the survey.
** F > M *** B > H > W
total; Female; total; Total; 24,9 31,8 total; Male; 18 22,4 total; Black; 32 27,1
Source: National Youth Risk Behavior Survey. (2007).
Percent 60 50 40 30 20 10 0
Percentage of High School Students Who Attended Physical Education Classes Daily, 1991–2007
42% 34% 25% 27% 32.2% 28.4% 33.0% 30.3%
* 5 days in an average week when they were in school.
** M > F
1991 1995 2000 2007
Source: National Youth Risk Behavior Survey. (2007).
Percentage of High School Students Who Attended Physical Education Classes Daily,* by Sex** and Race/Ethnicity, 2007
total; Female; 27,3 28,9 total; Hispanic; 36 31,9
Source: National Youth Risk Behavior Survey. (2007).
Decrease in Physical Activity in Teenage Girls: African Americans Decrease Most Source: Kimm. (2002). NEJM.
School Based Interventions on Childhood Obesity Protective of Overweight and Obesity Prevalence Source: Gonzalez-Suarez et al.(2009). Am J Prev Med, 37(5):418–427.
Improve access to outdoor recreational facilities Enhance infrastructure supporting bicycling Enhance infrastructure supporting walking Support locating schools within easy walking distance of residential areas.
Improve access to public transportation Zone for mixed use development Enhance personal safety in areas where persons are or could be physically active Enhance traffic safety in areas where persons are or could be physically active.
Communities with higher percentages of African-American residents tend to have fewer available parks and green spaces, places to play sports, and public pools and beaches Powell LM, Slater S, Chaloupka FJ. (2004). The relationship between physical activity settings and race, ethnicity, and socioeconomic status. 1[2]:135–44 Evidence-Based Preventive Medicine,
Source: http://beh.columbia.edu/neighborhood-walkability/
Source: J Med Internet Res 2009;11(3):e28
GOOD Outdoor Environment: high percentage of parks/recreation, and high perceived safety POOR Outdoor Environment: low percentage of parks/recreation, and low perceived safety Saelens, Sallis, Frank, et al. American Journal of Preventive Medicine, April 2012
Communities should participate in community coalitions or partnerships to address obesity
The mission of the Maryland Healthy Eating and Active Lifestyle Coalition is to coordinate efforts and resources to increase the number of Maryland residents who eat healthfully and engage in physically active behaviors. This is best accomplished through facilitation of the implementation activities of the Maryland Nutrition and Physical Activity Plan .
http://healthyactivemaryland.org/npaexecsummary.pdf
1.
2.
3.
Identify at least two healthy eating and two physical activity policies or practices that can be implemented in the community to address obesity.
Prioritize two strategies to address obesity, physical activity, and nutrition in your state, region, city, or school district.
Name three groups of stakeholders in your state, region, city, or school district that need to be informed
Population impact Existing efforts/partners/financial and personnel resources Potential efforts/partners/financial and personnel resources Passion/interest among coalition members Winnable battles/political environment
It is important to be able to measure the impact of the strategy implemented ◦ Example: ◦ ◦ Strategy: Communities Should Increase the Amount of Physical Activity in PE Programs in Schools Measurement: The largest school district located within the local jurisdiction has a policy that requires K--12 students to be physically active for at least 50% of time spent in PE classes in public schools.
Resources: ◦ Centers for Disease Control and Prevention. Recommended Community Strategies and Measurements to Prevent Obesity in the United States MMWR 2009; 58 ( RR 7). ◦ http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5807a1.
htm