BackgroundBackground

• In June 2007, an international conference was held in Toronto, ON, to examine issues related physical activity and obesity in children

• The conference was attended by nearly 1000 delegates from 35 countries

• review the most current scientific evidence concerning the problems of obesity and physical activity in children and youth

• Explore what can be done

• Summarize Promising Practices for community-based interventions

Overview of this PresentationOverview of this Presentation

Defining Obesity in ChildrenDefining Obesity in Children

• A weight to height ratio (kg/m2) known as the Body Mass Index (BMI) is most commonly used

• Contrary to adults, BMI changes with sex and age in children

• Sex- and age-specific values based on standard growth charts should be used

• Insufficient evidence for use of waist circumference in children

Childhood Obesity in CanadaChildhood Obesity in Canada

In Canada,

• 25% of children and youth (2-17 y) are overweight /obese

• 41% of Aboriginal children living off-reserve are overweight/obese

• 55% of Aboriginal children living on reserve are overweight/obese

Data Sources: CCHS 2004; First Nations Regional Longitudinal Health Survey 2002/2003

HOW DID WE GET HERE?HOW DID WE GET HERE?

What are the causes of the Obesity Epidemic What are the causes of the Obesity Epidemic in Children?in Children?

• genetics

• maternal health

• in utero growth

• low birthweight

• parent obesity

• parenting styles

• personality traitsand many more …

Many contributors to Childhood ObesityMany contributors to Childhood Obesity

Food & NutritionFood & Nutrition

• Shifts in Food Practices

food availability, portion size, consumption of

soft drinks, frequency of family meals

• The Cost of Calories

• Mass Marketing

Average Number of Steps Per DayAverage Number of Steps Per Day

Source: CFLRI

2007 Report Card Indicators

PHYSICAL ACTIVITY / INACTIVITY 

Physical Activity LevelsGrade: F(2006 Grade D)

Screen TimeGrade: D-(2006 Grade D-) 

Sport ParticipationGrade: C(2006 Grade C-)

Number of students who participate in 60 minutes of moderate to vigorous Physical Activity

on 5 or more days per week

Lower levels of PA among:

• girls

• new Canadians

• low SES

Courtesy of Dr. M. Tremblay

Changes in Time (min/week) Spent in Activities by Changes in Time (min/week) Spent in Activities by Children Ages 3-5 years in USA:Children Ages 3-5 years in USA:

Change from 1981-1997Change from 1981-1997

Strum R. Public Health Practice and Policy. 2:1:1-9, 2005Data from University of Michigan:Hofferth SL & Sandberg JF. 2001

Friedman. Room For Thought. 2005

“Recreation has gone from

spontaneous to organized and

regimented activity: parents

exercise at the gym while the

young play soccer and hockey

in leagues with schedules

rather than in the backyard or

the street in front. More time is

often spent preparing for and

getting there rather than on

the activity itself.”

We must think about physical activityWe must think about physical activity

over the WHOLE DAY rather than just over the WHOLE DAY rather than just

sports, exercise, or recreation. sports, exercise, or recreation.

Time spent in various types of activityTime spent in various types of activity

Sedentary Sedentary 459.9 min/day

56%

LightLight341.6 min/day

41%

Moderate Moderate 18.1 min/day18.1 min/day

2.2%2.2%

Vigorous Vigorous 5.6 min/day

0.7%

TAAG study, USA

HOW SHOULD WE APPROCH THE HOW SHOULD WE APPROCH THE PROBLEM?PROBLEM?

What does the evidence suggest?What does the evidence suggest?

There is No Single Cause There is No Single Cause

• It is impossible to identify a single cause of the current obesity epidemic

• It is likely explained by a broad range of changes that have occurred together throughout the past 20-30 years

Therefore, SOLUTIONS must also be multi-faceted!

To address the

problem we will have

to examine both our

biology and our

environment.

Small amounts of physical activity

Large amounts of

physical activity

optimum growth

Prevention is easier than TreatmentPrevention is easier than Treatment

Bo

dy

Wei

gh

t

Time

excessive growth

Energy Gap

Developed by: Dr. William Haskell, 2007

Three Common Behavioral Settings Three Common Behavioral Settings for Youthfor Youth

HOMEHOME SCHOOLSCHOOLCOMMUNITYCOMMUNITY

The Physical EnvironmentThe Physical Environment

Everything we - see - hear - touch - smell - taste

Rules, norms,expectations

Socialhierarchies

Factors thatinfluence howwe respond tothe physicalenvironment

The Social EnvironmentThe Social Environment

Behavioral Settings

Influences on Health BehaviorInfluences on Health Behavior

IndividualBiological

PsychologicalBehavioral Skills

InterpersonalFamily, Friends, Social Networks

Policy Context

Physical & Social EnvironmentHome, School, Community

One-dimensional interventions may be One-dimensional interventions may be ineffective…ineffective…

Narrow Focus

WHY?

… Combined efforts can become multi-level

Young People have to:

• Want to

• Think they can

• Overcome barriers

• Be reinforced

IndividualIndividual

Families (Interpersonal)Families (Interpersonal)

Family interventions have not been greatly successful despite good evidence that support from parents, siblings, and peers is related to youth physical activity

Other approaches need further study:

• Reducing sedentary behaviours

• Transporting and paying for

activity programs

• Walking/cycling to school

Physical & Social EnvironmentPhysical & Social Environment

“If you build it, they will come”…?

• Use a solution-based approach - focus on solution rather than problem

• Connect science with advocacy efforts- i.e. frame issue as a story, backed up

with data

• Tailor communications to emphasize short-term benefits for policy-makers

PolicyPolicy

Policies have broad reach - housing, transportation, environment, economic

Marrying Research and PracticeMarrying Research and Practice

Researchers and Practitioners need each other!!Researchers and Practitioners need each other!!

BEST PRACTICESBEST PRACTICES

EVALUATION

EVALUATION

Research

Promising Practices

Public Health

Promising Practices

PROMISING PRACTICESPROMISING PRACTICES

Who or What Should We Target?Who or What Should We Target?

Who and What Should We Target?Who and What Should We Target?

• Girls (& boys?)

• Mothers & Infants

• Pre-school children

• Active Play

• Active Transport

• Organized Activities

• Physical Education

• Sedentary Behaviours

WHO?WHO? WHAT?WHAT?

The Home EnvironmentThe Home Environment

• Changing home environments to increase PA is challenging

Children should be encouraged to:

• go outdoors

• use active transport

• reduce screen time

The School EnvironmentThe School Environment

Offers Several Opportunities for PA:

• School grounds

• After-school sports and activities

• Physical education programs, facilities

• Travel to and from

• Crime (stranger danger, gangs, bullying)

• Too much traffic (school, neighbourhood)

• Cars drive too fast through neighborhood

• Inadequate sidewalks/bikeways on the route to school

• School is too far away

• Not enough time

• Child would be walking/biking alone to school

• Easier to drop off child on the way to work

• Child does not want to/like to walk or bicycle to school

Challenges to Active Commuting Challenges to Active Commuting

The Community EnvironmentThe Community Environment

• Youth PA is influenced by urban design, especially proximity to destinations

More PA if youth live close to recreational facilities and school

• Venues and physical features of a location matter in determining:

What activity occurs Intensity of activity

• Novelties (e.g. markings, equipment, signs) can increase PA

Social Factors are Potential MultipliersSocial Factors are Potential Multipliers

Creating activity-friendly environments may not be enough,…

But, more activity-friendly environments should

make individual programs more effective!

Social factors determine when and whether people will be exposed to specific physical environments

• e.g. Public spaces (parks, schoolyards) are used more when organized activities are available

Support Healthier ChoicesSupport Healthier Choices

Create home and community environments thatCreate home and community environments that make healthful choices easy. make healthful choices easy.

AndAnd motivate and educate people to make those motivate and educate people to make those choices. choices.

Create ‘Optimal Defaults’Create ‘Optimal Defaults’

Consider:Consider:

• Abundance – lots of opportunities

• Convenience – cost, proximity, etc.

• Choice – appealing to target group

Make Healthy Choices The Easy ChoiceMake Healthy Choices The Easy Choice

VS.VS.

VS.VS.

Many Potential AlliesMany Potential Allies

HealthHealth• Emphasising benefits• Addressing costs

EconomicEconomic• Appraisal of health impacts

Transport / PlanningTransport / Planning• Alignment with targets e.g. road safety, congestion

IndustryIndustry• Alignment with product design, architecture, etc.

Climate ChangeClimate Change

Community Capacity BuildingCommunity Capacity Building

• Leadership

• Organizational structures

• Partnerships

• Skilled workforce

• Resources

Creates ownership

Creates ownership

Improves sustainability

Improves sustainability

Helps decreaseHelps decrease

inequalities inequalities

Community capacity to promote PA

Need many targets for intervention

• e.g. increasing physical activity and decreasing sedentary time are both recommended

Need multiple, complimentary approaches

• The complex interactions between social and built environments provide strong support for multi-level action

Need to aim for sustainability

• Involve many partners

Keys to SuccessKeys to Success

What Impact Can You Expect?What Impact Can You Expect?

Certainty of Certainty of EffectivenessEffectiveness Population ImpactPopulation Impact

High

Moderate

Low

Low Moderate High

*** **** *****

** *** ****

* ** ***

* = least promising; ***** = most promising

Swinburn et al. Obesity Reviews 2005

EvaluateEvaluate Process Process

EvaluateEvaluate Outcome Outcome

• Why was it successful/unsuccessful?

• Appropriate outcome measures?

• What are other implications of intervention?

• Were there unintended consequences?

• How can future interventions be improved?

Evaluate!Evaluate!

SUMMARYSUMMARY

• Look for opportunities to be active throughout the ENTIRE day

• Make HEALTHY choices the EASY choices identifying the barriers to physical activity in your community

• Consider ways to target multiple “levels of influence”

• Improving physical structures alone may not change physical activity

• Social structures need to be in tune with physical changes

• Don’t be discouraged by obstacles

• Small changes are good

• ‘Lighthouse’ interventions can be valuable

• Develop future programs based on best available evidence

Physical Activity is Physical Activity is about having fun…about having fun…

……this should not be lost!!this should not be lost!!

ADDITIONAL ADDITIONAL RESOURCESRESOURCES

more info available at: www.phe.queensu.ca/epi/obesity/index.htmwww.phe.queensu.ca/epi/obesity/index.htm

Thanks to:Thanks to:

Canadian Fitness and Lifestyle Research Institute