Transcript ACSH Talk

WHAT’S UP DOC?
School Health and Wellness
A Pediatrician’s
Perspective
Claire LeBlanc
MD, FRCPC, Dip Sport Medicine
University of Alberta
Global Obesity Epidemic1
• More than 400 million
adults were obese in
2005 worldwide
• Chronic diseases
associated with obesity
account for 60% of the
58 million deaths/year2
– Cardiovascular disease,
diabetes, some cancers,
chronic respiratory
diseases
1http://www.who.int/mediacentre/factsheets/fs311/en/index.html;
2 Preventing Chronic Diseases: a Vital Investment: Geneva, World Health Organization 2005
2003 Obesity Trends: Canadian Adults*
No Data
<10%
10%-14%
15-19%
20%
*P.T. Katzmarzyk, Unpublished Results. Data from: Statistics Canada. Health Indicators, June, 2004
Children not Immune3
• In 2005 at least 20
million children under
five years old were
overweight globally1
• Up to 80% of obese
youth continue this trend
into adulthood
–  Risk for chronic disease
and premature mortality
3 LeBlanc CMA, Gomez J et al. Pediatrics ,2006;117:1834-1842
Prevalence of Overweight & Obesity4
Canadian Children 2004 (2-17yrs)
30
25
20
obese
overweight
15
10
5
0
boys
1978
boys
2004
girls
1978
girls
2004
total
1978
total
2004
4 Shields M. Statistics Canada 2005; 82-620-MWE;
Provincial Overweight & Obesity 20044
(children aged 2-17)
40
50%
PREVALENCE
35
30
25
20
15
10
5
0
0%
BC
BC
AB
AL
SK
SK
MN
ON
ON
QC
QU
NB
NB
NS
NS PEI
PEI
NF
NF
4 Shields M. Statistics Canada 2005; 82-620-MWE
What are Some Co-morbidities
of Obesity in Youth?3
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•
•
•
•
•
•
•
•
•
Type 2 diabetes
Obstructive sleep apnea
Nonalcoholic Fatty liver (NAFLD)
Polycystic ovary syndrome
Hypertension
Hyperlipidemia
Focal segmental glomerulosclerosis
Orthopedic complications
Depression/anxiety
Poor self-esteem, and lower
health-related quality of life
3 LeBlanc CMA, Gomez J et al. Pediatrics ,2006;117:1834-1842
Why are Kids Overweight?
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•
•
•
•
Excessive juice & pop
Low fruit/veggies
Low cereal fiber
Absence of family meal
Fast-foods:  fat and
energy
• Mega-meals5
5 Newman C. National Geographic 2004;206(2): 46-60
Why are Kids Overweight?
• Too much TV watching
– Strongly linked to obesity4
• Inadequate physical
activity (PA) levels6
– Canadian 5-17 year olds
average 11,356 steps/day
by pedometer
• Need 12,000 -16,500
steps/day ~ 90 min modvigorous PA/day
6 CANPLAY: Physical Activity Monitor 2005. www.cflri.ca/eng/statistics/surveys/pam2005.php
Why Not Active Enough?
•  PA DAILY at home
–
–
–
–
TV, computer/video games
Unsafe environments
 Recreational facilities
Inactive parents
•  PA DAILY at school
– 17% Canadian schools
(Elementary  High) have
daily PE by PE specialists7
7 Cameron C. Opportunities for PA in Canadian Schools: Trends from 2001-2006. www.cflri.ca
Benefits of Healthy Nutrition
• Malnourished children have8
– ↓ Physical activity & endurance
– ↓ Cognitive function & school performance
– Greater frequency of ADHD
• Omitting breakfast can interfere with
learning even in well-nourished children
• School breakfast programs9
– ↑ School attendance
– ↑ Math test scores
• Optimal growth & development
• Obesity prevention
8Fanjiang
G Curr Opin Clin Nutr Metab Care. 2007 May;10(3):342-7; 9Powell, CA. Am J Clin Nutr 1998;68:873–9
.
Benefits of Physical Activity
• Aerobic PA ↓ Wt (obese kids)9
– Diet + exercise better than
either alone10
– Lifestyle PA better than
calisthenics or programmed
aerobic exercise11
– Improved co-morbidities
• Insulin resistance; fatty liver;
dyslipidemias
• ↑ Self esteem; ↓ anxiety &
depression12
• May improve or not worsen
academics13
9Owens
S. Med Sci Sports Exerc. 1999;31(1):143-148; 10Epstein LH. J Consult Clin Psychol. 1984;52(3):429-437
LH. Behav Ther 1985;16:345-356; 12Kirkcaldy BD. Soc Psychiatry Psychiatr Epidemiol 2002;37:544-550;
13Trudeau F, Shephard RJ. International J of Behavioral Nutrition & Physical Activity 2008;5:10:1-41
11Epstein
Behaviour Must Change…But How?
• Historically strategies to ↓ obesity focus
on individual behaviour change BUT…
– Since 1950, US Federal agencies issued > 37
versions of guides encouraging Americans to ↓
energy intake & ↑ PA….YET…
– Obesity rates are still rising…
INTERNATIONAL
FACTORS
Globalization
of
markets
NATIONAL/
REGIONAL
COMMUNITY
LOCALITY
Transport
Public
Transport
Urbanization
Public
Safety
Health
Health
Care
WORK/
SCHOOL/
HOME
INDIVIDUA
L
Leisure
Activity/
Facilities
Labour
Energy
Expenditure
Infections
Development
Social Security
Media
programs
& advertising
Media &
Culture
Sanitation
System
Manufactured/
Imported Food
Worksite
Food &
Activity
Family &
Home
Education
Food &
Nutrition
Agriculture/
Gardens/
Local markets
POPULATION
School
Food &
Activity
National
perspective
Kumanyika Ann Rev Pub Health 2001;22:293-308
Food
intake :
Nutrient
density
I
T
Y
O%
OBESE
P
R OR
E
UNDERWT
V
A
L
E
Comprehensive School Health Policy
• NEW FOCUS - DEVELOP PUBLIC
POLICY
– Create healthy behavioural norms
– Shape environment where healthy
choices can reach entire populations
• School environments reach large
populations of children who are
– Vulnerable to marketing
– Unable to make fully informed
decisions without guidance
• World Health Organization (Through
Public Health Agency of Canada) is
developing a School Policy Framework
– Implement WHO Global Strategy on
Diet, PA & Health*
– Promote healthy active living for staff
& students
– Policies evidence based…
*http://www.who.int/dietphysicalactivity/en/index.html
Effective School Programs
• 13 Effective PA
programs14
– 12 Randomized Control
Trials (RCT)
– 11 school-based
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• 6 Effective programs to
↓ sedentary activity14
All increased PA
6 ↑ fitness measures
3 ↓ obesity measures
Most were late
elementary – high school
14LeBlanc
CMA. CMAJ 2007;176(8):chapter 22;
16Robinson TN. JAMA 1999;282:1561-7
– 6 RCT; 4 School-based
trials
– 5 ↓ Screen time
– 2 Improved obesity
measures
• Planet Health (2 yr) grade 6-7
students15
• Robinson’s grade 3–4 RCT16
15Gortmaker
SL. Planet Health. Arch Pediatr Adolesc Med 1999;153:409-18;
Effective School Programs
• 16 Effective
• Wellness, Academics & You17
multifaceted programs9 – 1013 4th & 5th graders ↑ PA &
– All RCT
– 7 trials > 1 year duration
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3 increased PA
5 increased fitness
11 improved food intake
7 improved obesity
measures
17Spiegel
veggies & fruit
– ↓ BMI; ↑PA; ↑ fruit & veggies
Fitkids: 18 schools RCT after
school program18
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Grades 3,4,5
Healthy snacks, 80 min/day PA
Improved % body fat & fitness
Summers off  returned to
baseline
SA. Obesity (Silver Spring). 2006 Jan;14(1):88-96; 18Gutin B. Int J Pediatr Obes. 2008;3 Suppl 1:3-9
Research Summary
• Schools are pivotal settings to promote healthy
active living
• Multifaceted programs implemented in multiple
settings targeting behaviour change rather than
isolated knowledge acquisition appear to work best
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Dedicated PE with a variety of aerobic activities
Active recreation before, after and during school
Healthy food and drinks in cafeteria, vending machines
Parental and family involvement important
WHO Suggests
• Set up a School/District Wellness
Committee
• Develop & implement policy
– PA, food, curriculum, school health services
• Monitor & evaluate
– Process, output & outcome indicators
• Involve stakeholders EARLY
STAKEHOLDERS
Schools: Everyone Benefits from
an Active Living Workplace
• Trustees, Superintendents
– Develop policy
– Influential, secure resources, support
staff, bridge with external groups
• Principals
– Leaders; promote & maintain wellness
programs for staff & students
• Teachers (Key implementers)
•
– Require PE training, curriculum aligned
with academic mandates, support from
principal, sufficient time & resources
Students (Key recipients)
– Should have a say in policy/programs
Parents & Extended Family
• School health program can influence
family behaviour at home
– Students change parent behaviour
• Parents can set a good example
• Family can help with active living
homework assignments
• Family can encourage & take part in
safe active transportation
– Walking school bus
• Family can support school health
policy and programs
– PTA
• Family can lobby decision-makers to
support health promotion in schools
Health Professionals: MDs
• Provide families with office-based
healthy lifestyle counseling
– Time? Sufficient?
• MD can set a good example
• Support active school community
– Sit on school/district wellness
committee
• Provide help with advocacy,
research, monitoring, evaluation
• Physicians can provide knowledge
translation
– MDs, health organizations, general
public
• Community wide education: Media
• Letters to or meetings with key decision
makers
Dr. P. Nieman
Marathon runner
Education & Health:
United We Stand
• Canadian Council on Learning 2008*
– 6/10 Canadian adults have insufficient
literacy skills to manage their health
– Those with low health literacy 2.5 x likely
to have fair-poor health
– MDs consulted most (74%) for healthrelated information because of credibility
• Need more training in using simple language
– Media & family/friends consulted next
(67%) but less credible – schools way down
on list
• Opportunity for MDs to learn from
schools on messaging & schools to learn
from MDs on health-related matters
*http://www.ccl-cca.ca/CCL/Reports/LessonsInLearning/LinL20080306HowLowLiteracy
…
Next Steps
• Alberta School districts &
health regions showing
– Best practice examples
• Workshops
– Listen, learn, offer help
– Create feasible action plans
for your region
• Network of MD champions
– NEW MODEL
– Local  Region  Province
Alberta: Will be Canada’s BEST
Province – When We Work Together