Transcript Reducing Diabetes & Obesity among Nashville’s Children

Recommendations for
Nashville’s Road to
Success
Obesity/Diabetes subcommittee report
Alignment Nashville
Health Committee
Jan. 25, 2006
Health Warning: Obesity
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Unhealthy diet and lack of physical activity can be a
contributing factor in many chronic diseases,
including Type 2 Diabetes
Nashville Youth Risk Behavior Survey* (YBRS)
found 13% of Nashville youth are obese, based on
body mass index (BMI)
Healthy People 2010 target for adolescent obesity is
6%
*Based on 2003 Metro Public Health Department survey of 15 public high schools
and 5 private high schools. Margin of error +/- 2.3 percent.
Health Warning: Obesity
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YRBS also found a physical activity rate (vigorous
activity 3 of the last 7 days) among Nashville youth
of 61%
16% of Nashville youth surveyed (21% of AfricanAmerican youth) are at risk of becoming overweight
based on BMI
Health People 2010 target for adolescent physical
activity is 85%
Only 32% of Nashville youth surveyed attend
Physical Education classes daily
Why worry?
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Obesity correlates with blood pressure
Obesity correlates with lipid levels
Obesity correlates with insulin levels
Diabetes rates among school-age children
are on the rise
Diabetes can lead to serious health
complications over time, including heart
disease, kidney disease, blindness, stroke
and amputations
Our Proposal
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Raise awareness of the problem and the
relationship between obesity and
diabetes.
Increase activity levels during school to
the minimum 30-minute standard,
beginning with pilot programs at the
elementary school level.
Reduce obesity rates, a leading indicator
of health risk, among Nashville youth to
Healthy People 2010 goal of 6 percent.
Our Proposal
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In Nashville’s public schools, the focus on
academic performance has resulted in a
decreased focus on PE and its relevance to
academic performance. Our committee
proposes to reverse that trend with the
introduction of a scalable pilot program in
which a standard of at least 30 minutes a day
of physical activity is established for all
children.
Goals
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Raise awareness of the problem and the relationship between obesity and
diabetes.
Reduce the prevalence of obesity among children in the schools targeted
for the program.
Increase activity levels during school to the minimum 30-minute standard.
Incorporate exercise into children’s daily routine as a core part of the
curriculum.
Ensure minimum exercise requirements are met for overweight and obese
children.
Establish a program that is budget neutral after start-up costs.
Ensure that time devoted to exercise does not have an adverse impact on
academic performance (we suspect the opposite).
Have a program that is scalable to all elementary schools and can be
incorporated into the daily routine, including after-school programs.
Include consideration of children with physical or mental handicaps, if
possible.
Proposed Intervention
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Start with elementary schools, and later address middle and high
schools.
Principals in the pilot schools will agree to establish a minimum
standard of 30 minutes each day of physical activity.
There will be buy-in from the central administration on the minimum
standard concept.
Within each school, program will be coordinated by PE teachers and
managed by school principals.
The minimum standard will be met during regular PE for at least 3 days
and by classroom teachers during the other days.
The program will be coordinated by a consulting agency, offering
guidance and measuring impact.
Performance rewards should be a part of the program, making sure that
principals, PE teachers, classroom teachers and children all have their
incentives to participate in the program in alignment.
Proposed Intervention (cont.)
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Actual exercise programs will be developed by the consulting
agency in coordination with the health and wellness coordinator and
the pilot schools. The consulting agency would either develop the
program in-house or use an established concept such as SPARK
(www.sparkpe.org), MarathonKids (www.marathonkids.com), or a
variant of the STEPS program. Programs that meet minimum daily
exercise requirements and are self-sustaining over many years
would be favored.
The consulting agency would be engaged in a start-up fashion and
be contracted over a 2-3 year period. Excluding potential start-up
costs, the program would be budget neutral.
Successful pilots would be expanded to all elementary schools and
simultaneously piloted in middle schools. Successful pilots could
also be expanded to after-school programs.
Measuring Results
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Evaluation would have two components:
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Measure the general impact on all children.
Measure the impact on children who are overweight or
obese at the beginning of the program.
Measures would include:
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BMI measures of all children in the pilot schools and
activity assessments at various points in the program.
Academic performance in the pilot schools would also
be measured. Special precautions would be made to
insure the program does not stigmatize any child.
Funding
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Funding would be sought to cover the costs of the
consulting agency and/or of any trademarked
programs used.
Alignment Nashville Special Grant Funding Task
Force should pursue grant funding for pilot
programs. The SPARK program, for example,
qualifies for funding under the Carol M. White
Physical Education Program.
Funding collaborations should be explored via
private/corporate donors, local and state grants,
academic research institutions, etc.
Pilot School Selection
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Focus on those schools already being
monitored for BMI and blood pressure by the
Health Department’s OOPS program.
Focus on schools with greatest health
disparities as identified by the 2005 YRBS
(results pending).
Timeline
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Potential pilot schools and consulting
agencies identified prior to the March 2006
Mayor’s Summit on Children and Youth.
Detailed implementation work begins in
March, following the Mayor’s Summit.
School Board approval by Fall 2006
Program implementation begins Fall 2006 or
as soon as grants/funding are in place.
Mayor’s Challenge
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Draft “A Challenge from the Mayor” that
Mayor Purcell can issue at the Mayor’s
Summit on Children and Youth in March as a
way to draw attention to the issue and what
Nashville is doing to address it.
Committee Research
Best Practices
Metro PE Requirement
After-school programs
Metro Schools PE
requirements
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High school: 1 year (can be taken anytime during
grades 9-12)
Lifetime wellness: 1 year (can be taken anytime
during grades 9-12)
Middle school: PE is an elective. Most principals
choose to offer physical education every other day
or as part of a rotation (usually a 6 or 12 week
rotation).
Elementary: Minimum of 2 days per week. Most
students average 60 minutes or more per week.
Source: School Health division, Metro Public Health/Metro Schools
Best Practices
After-school Program
Demographics
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Boys & Girls Clubs of Middle Tennessee
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Members (930 total) generally participate in 60 minutes of
movement/exercise/sports & games daily (depending on
pick-up times).
77% of K-12 club members are 6-12 years of age
23% are 13-17 years of age
51% are male, 49% are female
86% African-American, 4% Hispanic, 8% Caucasian, 2%
other
83% from single-parent households
82% are economically disadvantaged
77% attend 3 or more times per week
After-school Program
Demographics
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Pearl-Cohn H.S. (35)
Park Avenue E.S. (30)
Wharton M.S. (12)
W. A. Bass M.S. (20)
Rose Park M.S.
West End M.S.
West Meade E.S.
Wright M.S.
Stratford H.S.
Maplewood H.S. (20)
Glen E.S. (15)
Schwab E. S.
Bellshire E.S.
Jere Baxter M.S.
Caldwell E.S. (10)
Bailey M.S.
East Literature
Tom Joy E.S.
Smithson Craighead E.S
Litton M.S.
Hunter Lane H.S.
Hillwood H.S.
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NSA
Cockrill E.S. (20)
McKissack E.S. (50)
Martha Vaught M.S.
W.A. Bass M.S.
Antioch H.S.
Glencliff H.S. (25)
Glenview E.S. (40)
Glengarry E.S. (10)
Mt. View E.S. (25)
Edison E.S.
Croft M.S.
McGavock H.S.
Wright M.S. (65)
Whitsett E.S.
Glencliff E.S. (30)
Paragon Mills E.S. (30)
Meigs M.S.
Fall Hamilton E.S. (60)
Carter Lawrence E.S. (10)
Rose Park M.S. (10)
Cameron M.S. (20)
Walk to the North Pole (Haynes
Middle School)
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Initiative was part of the school’s 2004 Health and Medical Sciences Fall Health
Kickoff.
Students were challenged to "Walk to the North Pole" with the ultimate goal of
encouraging adolescents to have an active lifestyle.
Each student received a pedometer and encouraged to monitor their daily steps.
Recommended number of steps per day was 10,000 (approximately 5 miles).
During the school day classes would take turns walking accompanied by their
teacher.
Collective goal was 4004 miles (the distance between Haynes Middle School and the
North Pole).
A chart at the front of the school mapped progress and provided a visual incentive.
At the end of the challenge, each student was rewarded with a ticket to see The Polar
Express.
Movie tickets were provided by the Meharry-Vanderbilt Alliance, local churches and
individuals who sponsored students by buying a $6.50 movie ticket.
Students sometimes would forget their pedometers, some pedometers were lost, and
a few students were caught shaking the pedometers to artificially increase their meter
readings. Students caught shaking their pedometers had their steps disqualified and
were at risk of being removed from the program.
Website research links
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2003 Youth Risk Behavior Survey www.
www.sparkpe.org
www.MarathonKids.com
www.obesity.org/subs/childhooh