Childhood Obesity and Act 1220: Opportunity for Arkansas Suzanne G. McCarthy Founding Associate

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% Source: Mokdad A H, et al. JAMA 1999;282:16;2003;289:1

Facts

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Over 60% of adult Arkansans are either overweight (BMI 25-29.9) or obese (BMI > 30) One in four Arkansas high school students are either overweight or at risk for being overweight Overweight children are more likely to develop childhood diabetes, hypertension and lung problems Overweight school age children are 50% more likely to become obese adults Overweight adolescents are 70-80% more likely to become obese adults Obese young adults will die 5-20 years sooner than normal weight persons Obese adults have significantly higher rates of diabetes, heart disease, cancer, stroke, hypertension and arthritis In 2002, the United States spent an estimated 92.6 billion dollars on illnesses related to obesity

Arkansas Preventive Nutrition and Physical Activity Summit March 8, 2002

• State-wide summit of all interested parties on obesity and physical activity • Supported by NIH educational funds • Task force groups in multiple areas including policy, child and adolescent health, school health • Participants from Department of Pediatrics, ADH, ACH, ACHI and others

Select Summit Recommendations

• Establish office on nutrition and physical activity • Food stamp / WIC policy changes • Enhance school nutrition and physical activity environment • Restrict foods of minimal nutritional value in schools • Improve availability of fruits and vegetables in local grocers • Require caloric content on restaurant menus • BMI vital sign added to clinical charts • Media program to influence beverage consumption

American Academy of Pediatrics Recommendations

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Identify and track patients at risk by virtue of family history, birth weight, socioeconomic, ethnic, cultural or environmental factors Calculate and plot BMI once a year in all children and adolescents Use change in BMI to identify rate of excessive weight gain relative to linear growth Encourage, support and protect breastfeeding Encourage parents and caregivers to promote healthy eating patterns Routinely promote physical activity, including unstructured play Recommend limitation of television and video time to a maximum of two hours per day

84th General Assembly Act 1220 of 2003

Representatives Bradford, Biggs, Cleveland, Milligan Senators Bisbee, Argue AN ACT TO CREATE A CHILD HEALTH ADVISORY COMMITTEE; TO COORDINATE STATEWIDE EFFORTS TO COMBAT CHILDHOOD OBESITY AND RELATED ILLNESSES; TO IMPROVE THE HEALTH OF THE NEXT GENERATION OF ARKANSANS; AND FOR OTHER PURPOSES.

Act 1220 Content

• Child Health Advisory Committee • Eliminates vending machines from elementary schools • Requires public disclosure of pouring contracts • Requires development of nutrition and physical activity guidelines • Training for food preparation staff • Community advisory groups for each school • BMI assessment reported to parents

Act 1220 Goals

• Increase awareness of childhood obesity and environmental factors contributing to the problem • Enhanced parental knowledge • Informed community choices • Improved nutrition and physical activity agenda in schools • Long-term impact on childhood obesity

Evidence for BMI Report to Parents

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Experimental field trial of BMI School Report Card

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Chomitz et al, Archives of Pediatric and Adolescent Medicine; 2003 157:765-772 Cambridge, MA public school system Three groups of children

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(PI) personalized weight and fitness health report card

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(GI) general-information intervention (CG) control group

Cambridge Study Results

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Among overweight students, intervention parents were more likely to know their child's weight status (PI, 44%; GI, 41%; CG, 23%) (P =.02) No group effect on concern or preventive behaviors was detected. Most parents of overweight children who read materials requested annual weight and health information on their child (PI, 91%; GI, 67%).

Cambridge Study Results (cont.)

Parents of overweight children, intent to take action: Action PI GI CG P-value Medical help 25% Diet modification Physical activities 19% 42% 7% <5% 27% 9% <5% 13% p=.004

p=.02

p<.001

Arkansas Act 1220 BMI Activities

• BMI Task Force formed • Decision to NOT report on school report cards • Pilot tests underway in select schools – Measurement strategies (accuracy, reliability) – Personnel resource requirements – Data security and management – Parent health report under development • Statewide deployment early in 2004 • Parental reports by May 2004 • Clinician engagement strategy under development

Act 1220 Status Report

• Child Health Committee addressing issues: nutrition, physical activity, education, vending machines in HS • Vending machines eliminated (K-5) • 35 schools volunteering to pilot test BMI initiative – 5 Phase I pilot schools – 30 Phase II schools • Affected schools, students, and parents – 312 school districts, – 1500 schools, – 450,000 public school students

Act 1220 Opportunities

• Accurate information to parents • Community mobilization • Population based assessments – Age, race, poverty, rural/urban, physical activity • Longitudinal assessments – BMI required every year on every child • Childhood obesity “Framingham” study