healthier families may start at the dinner table

Healthier Families May Start at the Dinner Table

Miriam Gaines, MACT, RD, LDNutrition and Physical Activity DirectorAlabama Department of Public Health

February 2009

The Problem

Overview of Alabama’s Adults• Trust for America’s

Health (2005- 2007) ranked Alabama as:– 2nd highest for adult

hypertension (33.5%)– 33rdrd highest for adult highest for adult

obesity (30.1%)obesity (30.1%)– 4th highest for

diabetes (10%)– 6th highest for physical

inactivity (29.6%)

Obesity Trends* Among U.S. AdultsBRFSS, 1986

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14%

1996

1991

2003

Obesity Trends* Among U.S. AdultsBRFSS, 1991, 1996, 2003

(*BMI 30, or about 30 lbs overweight for 5’4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. AdultsBRFSS, 2004

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. AdultsBRFSS, 2005

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsBRFSS, 2006

Obesity Trends* Among U.S. AdultsBRFSS, 2007

Obesity in Alabama 2004

Obesity in Alabama 2006

Obesity Trends in Alabama

Obesity is ComplexDietary Habits Are Important

• In Alabama, 78.9 % of adults do NOT eat 5 servings of fruits and vegetables a day.

Obesity is Complex A Sedentary Society Burns Fewer Calories

• Contributories– Automobiles– Television– Computers– Convenience

Engineering– Built Environment– Human Nature

Physical Activity is Important

• In Alabama, 59.6% of adults do NOT get 30 minutes or more of moderate activity on 5 or more days of the week.

Obesity is Associated with Over 30 Health Problems

• Diabetes• Cancer

– Endometrial– Breast– Colon

• Heart Disease– Hypertension– High cholesterol– Heart attacks

• Sleep disorders• Respiratory problems• Abdominal pain

(gallbladder, constipation)

• Menstrual abnormalities

• Anxiety• ETC

Adults Diabetes in US2005

http://apps.nccd.cdc.gov/DDT_STRS2/NationalDiabetesPrevalenceEstimates.aspx

Adult Diabetes in Alabama 2005

http://apps.nccd.cdc.gov/DDT_STRS2/CountyPrevalenceData.aspx

Cancer Trends in AlabamaCancer Type Rate per 1000,000 population

In Alabama

All cancers 214.2

Lip, oral, pharynx, esophagus

7.5

Prostate 23.4

Female reproduction organs

18.0

Trachea, lung 67.1

Cancer Death Rates Alabama vs. United States, 2004

http://apps.nccd.cdc.gov/StateCancerFacts/Table.aspx?Group=5f&TableType=MORT&SelectedState=Alabama

Health Indicators and TrendsHeart Health

Major Heart Disease Totals State

351.7

Hypertension 8.9

Atherosclerosis 4.5

Ischemic Heart Disease 125.9

Alabama’s Children Follow Our Adults

• 11th in nation for childhood obesity

(10- 17 yr)• 16.7% obese children

(Trust for America’s Health)

• Recent after school studies in Alabama indicate the rate may be higher.

Alabama’s Children Are OUR Children

• ADPH Dental Program 2006-2007

• Heights & weights collected for 3rd grade students

• 17.9% overweight• 24.6% were obese

42.5% of 3rd graders

Alabama’s Children are Following the Adults in Obesity Rates

0

10

20

30

40

50

60

overweight obese

obese 23.9 26.3 35.8 20.9 28.8 31.1

overweight 17.6 17.4 17.9 18.3 18.6 15

White Male

Black Male

Hispanic Male

White Female

Black Female

Hispanic Female

Overweight/Obesity, 3rd Graders, Alabama,, 2006-7

Overweight and Obese in Alabama High Schools

1999-2007 YRBS

0

5

10

15

20

25

30

35

overweight obese

obese 11.1 12.3 13.5 14.8 13.6

overweight 17.3 15.2 14.5 17.8 16.6

1999 2001 2003 2005 2007

Sedentary Students in Alabama

• 81% of youth do NOT get moderate physical activity 30 minutes or more on 5 days or more of the week

• 59% of youth were not enrolled in physical education classes

Sedentary Students in Alabama

• 41.7% of youth watched three or more hours of television a day

• Over 2 hours a day is related to obesity

• Children view an average of one food ad every 5 minutes of TV viewing time. Average child views 2-3 hours of food ads each week.

Nutrition and Physical Activity 2005, YRBS

14.78.5

58.2

21.7

38.445.1

20.116.2

64.1

26.5

37.233

0

10

20

30

40

50

60

70

5 a Day 3 a Day VigorousPA

ModeratePA

TV Daily PE

AL 05 US 05

What DO Our Children Eat?

What Influences Our Children?

Recognize These?

Marketing Strategies

• Many venues

– Schools, grocery stores, malls, theaters, sporting events, child care

• Many media vehicles

– Broadcast and print media, Internet, videogames, cell phones

• School-based marketing practices

– Product sales, direct and indirect advertising, marketing research

McDonald’s $ 619 MBurger King $ 294 MPepsi/diet Pepsi $ 207 M Coke/diet Coke $ 167 MMountain Dew $ 60 MM&M candies $ 73 MSnickers candy bar $ 70 MFrito-Lay chips/snacks $ 57 MPringles $ 35 MKool-Aid $ 25 MLunchables $ 23 M

US Ad Spending in Millions 2003

Advertising Age, June 2004

U.S. government’s entire budgetfor nutrition education

Is one-fifth the advertising budget for…

Altoids mints

Nestle, 2002

Budget Comparison

Amount Spent on Advertising to Children

Approximately $2 billion a year is for advertisements targeting children

This is a 20-fold increase from 1990.

J. McNeal, 2003

Growth in New Food Products Targeted to Children and Youth

1994 to 2004

New products targeted to total market

New products targeted to children & youth

Source: Williams J. 2005b. Product Proliferation Analysis for New Food and Beverage Products Targeted to Children, 1994–2004. University of Texas at Austin Working Paper.

Why Are Youth and Children Targeted?

1) They are a primary market - they spend their own money

2) They are an influence market - they influence their parents’ spending

3) They are a future market - they will spend money in the future.

Heavy marketing to children is driven by desire to build brand awareness, brand preference and brand loyalty (BRANDING)

Advertising on School Buses

Logos on Scoreboards, Banners, Bulletin Boards

Textbook covers

Gatorade

Juicy Fruit Gum

“Cover Concepts places your brand directly into the hands of kids and teens in a clutter-free environment.”

BRAND LOGOS TOUCH EVEN YOUNGER CHILDREN

Basic Counting Books

Internet Marketing to Children

Contests and Sweepstakes

Television Advertising to Children Still the Main

Medium

• Over 75% of food advertising budgets and 95% of fast food chain budgets are for TV

• An average child views about 3 hours of TV/ day; sees between 20,000 - 40,000 commercials per year

• Food is the most frequently advertised product category on children’s TV, accounting for over 50% of all ads.

Does food advertising and marketing influence children’s food preferences, eating behavior, and weight status?

So What?

YES

Effects of Food Promotion on Children’s Food Preferences and

Behavior

Strength of Evidence

Preferences Strong

Purchase-related behavior Strong

Consumption Modest

G. Hastings et al., 2003 Review The Extent and Nature of Food Promotion to Children

Strength of Evidence on Factors That Might Promote Weight Gain and

ObesityEvidence Increased RiskConvincing • Sedentary lifestyle

• High intake of energy-dense micronutrient poor foods

Probable • Heavy marketing of energy-dense foods andfast-food outlets

• High intake of sugar-sweetened drinks

Possible • Large portion sizes• High proportion of food prepared outside the home• “Rigid restraint/periodic disinhibition” eating patterns

Insufficient • Alcohol

Examined the strength of evidence linking diet and lifestyle factors to obesity.

Four levels of evidence:

– convincing

– probable

– possible

– insufficient

WHO/FAO Report, 2003

The Solution

What Can Be Done to Improve the Health of Our Children?

• National nutrition legislation

• State policies

• Local policies

• Family policies

Limiting Marketing of Low Nutrition Foods to Children

• Join nation groups against marketing low nutrition foods to children (Center for Science in the Public Interest)

• Encourage and thank sponsors for healthy eating – Fast food– TV Stations– ETC

What do you see in your child’s school and after school, church, gym, doctors office, etc… ?

Encourage Others to be Good Role Models

• Who is around your child - teachers, coaches, care givers, etc.?

• Who influences your child – state or local authorities, health providers, church leaders, etc.?

Family Policies What Can WE Do As Families?

• Be Good Role Models– Nutrition– Physical Activity

• Be Careful Food Gatekeepers

• Watch Out for Outside Influences

Be Good Role ModelsNutrition

• They learn from watching you.

• Eat fruits and vegetables and your kids will too.

Be Good Role Models

• Cook Together

• Eat Together

• Talk Together

Be Good Role Models Physical Activity

Food “Gate Keepers” Make Mealtime a Family Time

http://www.makemealtimefamilytime.com/

Why Family Meal Time?

Tips To Remember for Family Meals

• Sometimes new foods take time

• Patience versus pressure

• Let them learn by serving themselves at the table

Food Gate Keeper Includes Healthy Snacks

• Have fruits and vegetables cut and ready to eat

• Use the 10- 10- 5 guideline for snacks in the house – keep only healthy snacks

Let Your Kids Be Produce Pickers … Literally

In the garden In the stores

Finding Resources to Help Parents

More Resources

• Family Day - A Day to Eat Dinner with Your Children ™ is a national movement to inform parents that the parental engagement fostered during frequent family dinners is an effective tool to help keep America’s kids substance free. Family Day reminds parents that Dinner Makes A Difference! http://casafamilyday.org/familyday/

Tested Messages to Use for Older Children

• Eat Smart to Play Hard

• Drink milk at meals.

• Fuel up with milk at meals and soar. through your day like a rocket ship.

• Snack like a super hero. Eat fruit and veggies at meals and snacks.

Harry S. Truman, 1946

“No nation isany healthier than

its children”

Guard Our Children’s FutureEat Better and Move More