Addressing Factors that Influence Weight in MCH Populations NACCHO and CityMatCH Emerging Issues in MCH March 29, 2007 Helene Kent, RD, MPH HM Kent Consulting.
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Addressing Factors that Influence Weight in MCH Populations
NACCHO and CityMatCH
Emerging Issues in MCH March 29, 2007 Helene Kent, RD, MPH HM Kent Consulting
The Numbers – Adults
Over 60 million people, 30 percent of adults 20 years of age and over, were classified as obese in 1999-2002 compared with 23 percent in 1994. More adult women are obese (33 percent) than men (28 percent), with the problem greatest among: non-Hispanic black women (49 percent) Mexican-American women (38 percent) non-Hispanic white women (31 percent). (CDC, NCHS 2007)
The Numbers – Women
One out of four women of reproductive age is considered obese. Utah documented a 25 percent increase in prepregnancy overweight and obesity and a nearly 29 percent increase in maternal obesity between 1991 and 2001.
Overweight All* 54.3
Percent of Overweight & Obesity for Women ages 20 to 39 by Racial/Ethnic Group, 1999-2000
Non-Hispanic White 49.0
Non-Hispanic Black 70.8
Mexican American 61.6
Obese 28.4
24.4
46.2
30.6
*Includes racial/ethnic groups not shown separately. AMCHP/CityMatCH Partnership, Promoting Healthy Weight Among Women of Reproductive Age.
The Numbers – Children & Youth
Among children and teens ages 6-19, 16 percent (over 9 million) are overweight or triple what the proportion was in 1980.
Another 15 percent of youth are considered at risk of becoming overweight
.
(CDC, NCHS 2007)
The Numbers Children & Youth
Non-Hispanic black (21 percent) and Mexican-American adolescents (23 percent) ages 12-19 were more likely to be overweight than non-Hispanic white adolescents (14 percent).
Mexican-American children ages 6-11 were more likely to be overweight (22 percent) than non-Hispanic black children (20 percent) and non-Hispanic white children (14 percent).
Implications
Obese adults are at increased risk of type II diabetes, hypertension, stroke, certain cancers, and other conditions.
Women who are obese have higher rates of amenorrhoea and infertility, and when pregnant have an increased risk of pregnancy and delivery complications, and poor pregnancy outcomes. Overweight adolescents often become obese adults.
The Factors
Biology
Genetics
Social and Physical Environment
Behavior
The Issues
Eating Habits and Behaviors (portion sizes, costs, sugar-sweetened drinks, food choices, etc.) Physical Activity and Behaviors (built environment, labor market changes, etc.) Food Availability and Marketing availability and accessible, etc.) (low cost, ready
Intervention Opportunities
Childhood and youth when health behaviors are developing Late adolescence/young adulthood The perinatal period Depression Smoking cessation
Action
Healthy weight is part of a larger comprehensive approach to preventive health.
To make a difference, a multitude of actions need to take place at the all levels including the individual.
Action Strategies
Adapted From AMCHP/CityMatCH Women’s Health Partnership
National Scientific Advisory Group on Healthy Weight for Women
Action -
Food Distribution & Availability
Survey what are the community barriers to food distribution and availability and increase access, e.g. stores.
Promote policies that support subsided (i.e. WIC and Food Stamps) access to farmers' and community markets. Work with the child care providers and the education system, to promote healthy eating and lifestyles to children and youth. Use education and social marketing to increase consumer demand for healthy food.
Action Collaboration
Join, support and strengthen existing coalitions. Strengthen collaboration between programs with similar goals. Develop mutual healthy weight goals across agency programs. Know who “competitors” are and understand their focus/need. Seek common ground.
Make nutrition and physical activity education part of all public health work and every contract, for example ensure that foods and beverages are health promoting.
Action Built/Physical
Work within communities to create free and readily available opportunities for physical activity e.g. trails in parks, amenities on existing trails, walking programs etc. Participate in community development activities that lead to more health promoting environments. Increase access to physical activity programs in the workplace and community.
Action Environmental
Increase customer demand for healthy foods through education/skills building such as cooking class in community centers or stores. Increase availability of healthy food options e.g. address vending machine issues, increase farmers and community markets.
Provide grants to community groups who have innovative and feasible ideas to promote physical activity and healthy eating .
Action Social/Cultural/Interpersonal
Engage in education regarding healthy eating and physical activity in setting used by women and families, e.g. workplace, churches etc. Participate in community activities related to school food choices. Involve community women and youth in the development of targeted strategies.
Model behaviors by promoting healthy eating and physical activity within your own work place.
Action Communication
Engage in coordinated well-designed social marketing campaigns to promote healthy weight among women of childbearing age.
Create simple message, that are health-based, not values-based, on a variety of subjects (portion sizes, activity, healthy weight etc., how to make healthy choices). Provide messages at schools, workplaces, restaurants and other places. Build upon work already done by USDA and CDC.
Action – Advocacy/Polic y
Increase health literacy among consumers and stakeholder regarding nutrition and exercise.
Educate funders and legislators about the needs and experiences of consumers related to weight.
Support legislation and policy activities at all levels of government that encourages effective strategies to reduce obesity. Create change through education offered to decision and policy makers.
Action – Workforce
Change workplace culture and policies, such as how health insurance is purchased. Include rewards for positive behaviors.
Conduct walking meetings, promote exercise breaks, provide healthy snacks or no food at meetings. Model these positive behaviors in your own office.
Build awareness among employers about the need to address healthy weight through a combination of environmental strategies and the promotion of healthy nutrition and physical activity.
Action – Financing
Use financial incentives to support programs.
Identify and incorporate ways to improve program effectiveness (e.g. informatics or electronic health records) to improve continuity/comprehensiveness of care
Action – Measure & Monitor & Evaluate
Measure, monitor, and evaluate the impact of efforts. Set performance measures. Translate research to practical interventions and programs.
Develop, use, and disseminate Promising Practices that promote healthy weight among women and children.
Develop pilot programs to test messages and strategies for health promotion targeting families.
Action - Women
A primary prevention approach to maintaining weight Maintenance of weight loss Referral to resources for weight-loss Evidenced-based activities focused on good nutrition, physical activity, and positive behavior change
Action - Women
Weight is primarily about health, not appearance Is culturally-appropriate and meets the needs of community women Helps a woman develop behaviors that she can maintain over a lifetime
Action - Children & Youth
Promote increases in physical activity Promote breastfeeding Increase fruit and vegetable consumption Reduce television-viewing time Reduce consumption of sweetened beverages Support School-Based Activities
Action - Individual
Aim for a Healthy Weight
Be Active
Eat Well
And More …
Resources
AMCHP/CityMatCH Partnership, Reproductive Age.
Promoting Healthy Weight Among Women of 1/2006. AMCHP.org
CDC,
Promising Practices in Chronic Disease Prevention and Control .
2003.
http://www.cdc.gov/nccdphp/publications/PromisingPractices
NIH,
Modifiable Environmental and Behavioral Determinants of Overweight among Children and Adolescents: Report of a Workshop.
esity_children.pdf
2004 http://www.publico.clix.pt/docs/pesoemedida/NIH_2004_conference_report_ob
CDC, Division of Adolescent and School Health, http://www.cdc.gov/HealthyYouth CDC, Division of Nutrition and Physical Activity, http://www.cdc.gov/nccdphp/dnpa
In the long run we only hit what we aim at. Henry David Thoreau