Childhood Obesity: The Way Forward
Susan DentzerEditor-in-Chief
With thanks to the Robert Wood Johnson Foundation for its generous support
Childhood Obesity: Overview and National Trends
William H. Dietz, MD, PhDDirector Division of Nutrition, Physical Activity, and ObesityCenters for Disease Control and Prevention
54
6 67
5
11 11
15 1516
17
19
17
0
5
10
15
20P
erce
ntag
e
1963-1970
1971-1974
1976-1980
1988-1994
1999-2000
2001-2002
2003-2004
Ages 6-11Ages 12-19
Prevalence of Overweight Among Children and Adolescents Ages 6-19 Years
Source: JAMA, April 5, 2006, Vol. 295, No. 13:1549 and Pediatrics 1998; 101:497
Changes in Obesity Prevalence by Race/ethnicity, Boys 2-19 Years
0
10
20
30
40
50
1999-2000 2001-2002 2003-2004 2005-2006
Perc
en
t
Non-Hispanic White Non-Hispanic Black Mexican American
Ogden CL et al. JAMA 2008;299:2401
Changes in Obesity Prevalence by Race/ethnicity, Girls 2-19 Years
0
10
20
30
40
50
1999-2000 2001-2002 2003-2004 2005-2006
Perc
en
t
Non-Hispanic White Non-Hispanic Black Mexican American
Ogden CL et al. JAMA 2008;299:2401
Impact of Childhood Overweight (BMI > 95th percentile) on Adult Obesity (BMI > 30)
• 25% obese adults were overweight children• 4.9 BMI unit difference in severity• Onset < 8y more severely obese as adults (BMI = 41.7 vs 34.0) • 50% of adults with BMI > 40 were obese as children
Freedman et al, Pediatrics 2001; 108: 712
Costs of Obesity – 1998 vs 2008Costs of Obesity – 1998 vs 2008
1998 2008 Total costs $78.5 B/y $147 B/yMedical costs 6.5% 9.1%
Increased prevalence, not increased per capita costs, was the main driver of the increase in costs
Finkelstein et al. Health Affairs 2009; 28:w822
Average Daily Energy Gap (kcal/day) Between 1988-94 and 1999-2002
Excess Weight Gained(Lb)
Daily Energy Gap (kcal/day)
All Teens 10 110 -165
Overweight Teens 58 678 -1,017
Behavioral implications of 150 kcal:Replacing 1 can of soda (12 oz) with water (140 kcal)Reducing TV watching by an hour (167 kcal/day)1
Walking 1.9 hours instead of sitting (for a 30-kg boy) Increasing PE from 1 to 3 times/week (240 kcal)
Wang YC et al. Pediatrics 2006;118:e1721Wiecha et al. 2006; Arch Pediatr Adolesc Med 160:436
National, State and Local Disparities in Childhood Obesity
Findings from the 2007 National Survey of Children’s Health
Christina Bethell, Lisa Simpson, Scott Stumbo, Adam Carle, Narengeral Gombojav
*2003 versus 2007 rates of obesity are significantly different (P<0.05)
2003 2007Publicly Insured 39.6% 43.2%*Poor (< 100% FPL) 39.8% 44.8%*Hispanic 37.7% 41.0%*
The Nation: 2003 vs. 2007
Within State Disparities
ID=27.5MN=23.1
Significantly lower than U.S.
Lower than U.S., not significant
Higher than U.S., not significant
Significantly higher than U.S.
Low: UT/MN: 23.1%
High: MS: 44.4
Variation Across States
Both Across and Within State Disparities Widened
AK=33.9AZ=30.6
Within State Disparities
School Engagement Missed School Days Repeated a Grade
bStatistically significant differences exist in estimated prevalence across child subgroups for this variable based on a chi square test and p< .01.
Independent Impact on School Outcomes
Higher Odds of Poorer School Outcomes for Overweight or Obese Children
(Adjusted for Health Status, SES, etc.)
Not Being Engaged in School
1.32 greater odds
Missing 2 or more weeks of school in year
1.59 greater odds
Repeated a grade in school
1.42 greater odds
31.0
While being publicly insured and not having access to a park or recreation center independently predicts overweight/obesity in children, most overweight or obese children are still privately insured and have neighborhood amenities
A National Issue
How Much Should We Invest In Preventing Childhood Obesity?
Leonardo Trasande, MD, MPPMount Sinai School of Medicine
BackgroundPolicy makers generally agree that childhood obesity is a national problem and costly to our economy.
However, it is not always clear whether enough is being spent to combat it.
While continued research is needed to develop successful initiatives to prevent and treat obesity and overweight, estimating the economic benefits of successful intervention can permit policy makers to determine the level of investment in developing interventions that would be worth considering.
MethodsThis paper presented nine scenarios that assume three different degrees of reduction in obesity/overweight rates among children in three age groups.
A mathematical model was then used to project lifetime health and economic gains.
These data were then used to calculate the level of investment that would be cost-effective using widely accepted criteria in health care if it produced reductions in the number of obese or overweight children.
ResultsDuring childhood, U.S. children who were 12 years old in 2005 are estimated to incur $6.24 billion in attributable medical expenditures over their lifetime, and lose 2,102,522 Quality Adjusted Life Years will be lost as a result of being overweight or obese in adulthood.
A one point reduction of obesity in this age group would save $260.4 million in medical expenditures and 102,749 Quality Adjusted Life Years.
At a value of $50,000/Quality Adjusted Life Year, spending $2 billion a year would be cost-effective if it reduced obesity among twelve-year-olds by one percentage point.
ResultsRegardless of the degree of reduction in obesity/overweight and the age group in which the impact of prevention was studied, large investments no smaller than $103 million and potentially in the tens of billions of dollars, each year, would be warranted if it could produce small reductions in the number of children with this significant comorbidity.
DiscussionIn conveying the scope of the effort that should be undertaken, this analysis took a conservative approach, analyzing only direct medical expenditures in childhood and adulthood and Quality Adjusted Life Years lost as a result of obesity/overweight in childhood.
This analysis suggests that even some costly interventions of uncertain efficacy and additional research to develop interventions may even be worth pursuit on a broad scale, if they actually produce success in reducing the number of overweight/obese children.
As debate about health reform continues, this manuscript provides additional data to underscore the need to focus on child health and especially on prevention as a mechanism to improve health cost-effectively.
A Statewide Strategy To Battle Child Obesity in DelawareMarch 2010
Debbie I. Chang ([email protected])Allison Gertel-RosenbergVonna L. DraytonShana SchmidtGwendoline B. Angalet
www.nemours.org
This research was funded, in part, by the Robert Wood Johnson Foundation
360o of Child Health Promotion: Impacting a Child Throughout the Day
Progress Results at the Population Level Results from the 2008 DSCH, compared to the 2006 DSCH, suggest that the
prevalence of overweight and obesity has leveled off for children ages 2 -17 years in Delaware
– Overweight remained unchanged at 17%
Evidence indicates the prevalence of obesity and overweight has leveled off in all Delaware counties and within subpopulations
Disparities still remain among racial groups
Household awareness between 2006-2008 of the 5-2-1-Almost None campaign increased fourfold (5% to 19%)
When parents were aware of the 5-2-1-Almost None message, significantly more children engaged in:
– 1 hour of physical activity per day (26% versus 10% if parent not aware of campaign)
– Moderate to vigorous physical activity for more than 20 minutes (33% versus 21% if parent not aware of campaign)
Progress Results - Child Care and School Child care regulations adopted statewide in 2007 reflect NHPS’ 5-2-1-Almost None healthy lifestyle behaviors
81 % of child centers participating in NHPS’ learning collaborative made significant changes in healthy eating and physical activity practices
Schools were 4 times as likely to report implementation of the federally-mandated wellness policy if district policy included specific Nemours-recommended content and language
School changes include healthy vending, evidence-based physical fitness programs, fitness equipment, and activity breaks
Principles and staff identified the following facilitated implementation:–Technical assistance; Networking with other districts/schools; Support from other school administrators
Schools participating in fitness pilot of 150 minutes of physical activity per week:–Increased fitness level as measured by FITNESSGRAM® tests–Students 1.5 times more likely to achieve Healthy Fit Zone, an indicator of fitness
Progress Results in Primary Care Primary Care providers receiving technical assistance from NHPS are more likely
to provide children with appropriate screening, care, and treatment for overweight and obesity
Delaware Primary Care Quality Improvement Initiative
19 multidisciplinary primary care teams achieved high results:– 98.2% of providers classified BMI or weight-for-length in 2009 (83% in 2007)– 88.6% of providers provided counseling on healthy lifestyles in 2009 (72.7% in 2007)– 88.1% of providers developed a care plan and family-management goals with obese/overweight
patients who were ready to change in 2009 (74.2% in 2007)
Nemours’ providers:– Nemours’ provider classification of BMI during well child visits doubled, 49% (2007)
to 94% (2008) – Nemours’ providers offer lifestyle counseling to 95% of all patients (almost double the national
reported rate of 54.5%)– Health promotion was built into Nemours’ Electronic Medical Record (EMR)
Lessons Learned Sustaining policy and practice changes
– Policy and practice change, together, in multiple sectors is critical– Policy can drive practice and practice can drive policy – Community capacity is critical to sustainability and to promoting, supporting and
implementing change Create strong partnerships
– Develop strong relationships with influential organizations– Clearly define roles among partners, understand partners’ reasons for involvement– Provide partners with data, tools and training to make recommended changes
Focus on maintaining strategy– Clearly defined program goals are critical to success– Focus on a limited set of priority areas and sectors to avoid dilution of effort and
impact Design an evaluation that works
– Acknowledge the strengths and limitations of the evaluation– Outcome measures (BMI) should remain a focal point– Align evaluation efforts with strategy– Achieving outcomes takes time - establish intermediate milestones to help track
progress– Focus on demonstrating broad association and linkages where possible
Childhood Obesity: The New Tobaccoor…Childhood Obesity as a Social Movement: Lessons from Tobacco
Jonathan D. Klein, MD, MPHAmerican Academy of Pediatrics
William C. Dietz, MD, PhDCenters for Disease Control and Prevention
• Shared, personalized perception of a threat
• Common framing of the problem
• Grass roots commitment
• Social network focused on collective action
• Local nodes with dense social ties, linked to
others with weak bridging ties (rapid diffusion)
• Organizational structure realignment
Social Movements
• Surveillance/data- led to recognition of the problem
• Early voices - scientists and advocates
• Industry deception and secondhand smoke harm to others became common frame - leading to changing social norms
• Uniting against common enemy - cigarette companies - lead to political will and policy changes
• Organized movement - realignment of framing
Tobacco’s success
• Surveillance/data- recognition as a pressing problem
• Early alarmed voices - scientists, advocates, funders
• No common frame - physical activity, eating, both• Personal responsibility/choice• Toxic food environment• Industry role mixed
• No parallel to non-smokers rights movement
• Advocates are not coordinated (breastfeeding, social justice, local food, disease prevention, environment)
Where Are We For Obesity?
• Practice based interventions–Medical home–Access to levels of care–Family centered care
• Community and policy based interventions–Nutrition programs–Physical activity promotion–Physical environment–Sugar sweetened beverages–Food labeling and marketing
What Can Clinicians Do?
Social Strategies
ScientificKnowledge
Political Will
Do we have the political will?
AAP pledges to:• Body Mass Index (BMI %ile) • Prescription for healthy, active living
…and information about
how to achieve healthy weight,and on the impact of eating and physical activity on health
Overcoming obesity in this generation
Impact of Childhood Obesity On Employers
M-J. Sepúlveda, MD FACPIBM Fellow & Vice President, Integrated Health ServicesIBM Corporation
The Framework Of Parent-Child Interactions Potentially Affecting Employers
• Parents promote obesity in children
• Obese children beget 1 of 4 obese adults
• Both incur high costs in health care
• Caregiving for physical and psychosocial needs consume adult time and energy from work
Parent Health Child Health
Health care costs
Absenteeism,Presenteeism
Future Workforce
Parent Behavior Child Behavior
Adult Health
Employer
Parent Performance
Health care costs
The Direct Financial Impact on Employers
• Average claims costs for obese adults as well as obese children are nearly twice that of the non-obese
• Average claims cost of children with type II diabetes exceeds the average claims cost of adult type II diabetics
Source: IBM, 2008 claims based on obesity diagnosis and costs
$1,640
$10,789
$2,907$4,520
$8,844$8,889
Non
-obe
se
Obe
se
TII D
iabe
tes
TII D
iabe
tes
Obe
se
Non
-obe
se
Children (18 and under)
Adults
Children’s Health Rebate
1- baseline inventory2- set goals3- track and report
What we’ve learned so far …. Families engage, 11.7K earn rebate in 2008 – many add own goals…
“Kids write what fruits and veggies they want” “No parents’ TV or computer between 6 & 9 PM”“Start with smaller portions and have kids ask for seconds” “Both parents in the pool during children’s swim lessons” “Adults watch portion sizes on desserts”
Families change behavior, some change is harder than others
Source: IBM, 2008 Children’s Health Rebate Earners
Families value program, IBM
Children eat healthy breakfast 5+days
Children eat healthy dinner 5+days
Family eats/prepares healthy meals together 5+ days
Children get physical activity 5+days
Family is physically active together 3+days
Children have < 1hr entertainment screen time
Adults have < 1hr entertainment screen time
Children eat only healthy snacks on typical day
Children eat 5+ fruits/veggies
Percent of Participants (N=11,743)
Beginning of Program
End of program (12 weeks)
Motivating Employers to Act Employer population data: prevalence rate, direct costs, +/- productivity costs
Benchmark data: community, competitor, best practices
- Health care providers to diagnose and code - De-identified data sets: geographic trends from new government registries
and costs from health plans Evidenced based solutions from providers, insurers, non profits, government agencies
Employer Opportunities to Act Workforce policies: flexible work arrangements, access to health promotion programs
Health benefits coverage for overweight/obesity care and support services
Payment and demands for pediatric medical home services
Innovative collaborations with employer groups, health care provider organizations, public health agencies and communities
Specialized Care of Overweight Children in Community Health Centers
Shikha Anand, MD, MPH
Components of High Quality Pediatric Obesity Treatment1. Assessment of Medical Risk – labs, family history review,
medical exam
2. Nutrition Assessment – junk food, sweetened beverages, fast food, fruits and vegetables
3. Activity Assessment – screen time and physical activity
4. Health Behavior Change - goals for lifestyle change set by patient
5. Monthly follow-up (recommended by the American Academy of Pediatrics)
Current Options for Obesity Treatment
1. Specialty Care in Hospital Clinics• Pros: Includes nutrition, physical activity, medical assessment and health
behavior change in a single visit• Cons: Expensive, monthly visits outside of primary care office –
inconvenient, difficult to coordinate with primary care clinic
2. Monthly Visits in Primary Care• Pros: Convenient for families, cheaper than hospital-based care• Cons: Provider not trained in obesity or health behavior change, obesity
visits are difficult to schedule – take longer than usual primary care visits, other providers such as dieticians not included in visits - need to schedule additional visits to see other providers
3. Specialized Primary Care• Combines expertise offered in specialty clinics with convenience and cost
savings of primary care
Specialized Primary Care Treatment of Obesity1. The Model• Monthly multi-disciplinary clinic visits for overweight children• Medical provider, dietician, case manager in a single visit• Assess medical risk factors, nutrition, and activity• Promote health behavior change• Visits occur within the community health center where a child receives
primary care
2. The Setting• Eight community health centers in Massachusetts• Urban and rural clinics, provide pediatric primary care • Target poor and minority children
3. Early results• 174 children with more than one clinic visit in first 14 months• 50.0% decreased BMI, 100.0% set goals for lifestyle change (increased
activity, decreased sweetened beverages, etc), 79.8% reported making such a change at a later visit
Implications for Future Practice
1. Improved effectiveness over current standard of obesity treatment in pediatric primary care
2. Increased efficiency by combining multiple providers in a single visit
3. Decreased cost compared to hospital-based clinics
4. Replication in eight diverse community health centers indicates that model is scalable
5. Specialized, multi-disciplinary primary care could be expanded to other common chronic conditions including ADHD and asthma
Acknowledgements
1. Bill Adams, MD and Barry Zuckerman MD
2. Healthy weight Clinic Teams: Holyoke, Greater Lawrence, Codman Square, Whittier Street, Greater New Bedford, Outer Cape, Lowell, and Bowdoin Street Community Health Centers
3. Healthy Weight Initiative Staff: Penny Marston and Deirdre Connor, MPA
4. Howard Bauchner, MD
5. Vijay Nayak, MD
6. Funding for this work provided by CAVU Foundation and Paul and Phyllis Fireman Foundation
Specialized Care of Overweight Children in Community Health Centers March 1, 2010 Page 01
Specialized Care of Overweight Children in Community Health Centers
Shikha Anand, MD, MPH
Evidence-Based Components of High Quality Pediatric Obesity Treatment
Specialized Care of Overweight Children in Community Health Centers March 1, 2010 Page 02
1. Assessment of Medical Risk – labs, family history review, medical exam
2. Comprehensive Nutrition Assessment – junk food, sweetened beverages, fast food, fruits and vegetables
3. Activity Assessment – screen time and physical activity
4. Health Behavior Change - goals set by patient for diet and activity changes, facilitated by provider with training in motivational interviewing
5. Monthly follow-up (recommended by the American Academy of Pediatrics)
Current Options for Medical Obesity Treatment
1. Specialty Care in Hospital Clinics• Pros: Includes nutrition, physical activity, medical assessment and health
behavior change in a single visit• Cons: Expensive, monthly visits outside of primary care office –
inconvenient, difficult to coordinate with primary care clinic
2. Monthly Visits in Primary Care• Pros: Convenient for families, cheaper than hospital-based care• Cons: Provider not trained in obesity or health behavior change, obesity
visits are difficult to schedule – take longer than usual primary care visits, other providers such as dieticians not included in visits - need to schedule additional visits to see other providers
3. Specialized Primary Care• Combines expertise offered in specialty clinics with convenience and cost
savings of primary care
Specialized Care of Overweight Children in Community Health Centers March 1, 2010 Page 03
Specialized Primary Care Treatment of Obesity1. An Innovative Model• Monthly multi-disciplinary clinic visits for overweight children• Medical provider, dietician, case manager in a single visit• Assess medical risk factors, nutrition, and activity• Promote health behavior change
2. Delivery Within Underserved Communities• Visits occur within the community health center where a child receives
primary care• Urban and rural clinics, provide pediatric primary care • Target poor and minority children
3. Promising Early Results• 174 children with more than one clinic visit in first 14 months• 50.0% decreased BMI, 100.0% set goals for lifestyle change (increased
activity, decreased sweetened beverages, etc), 79.8% reported making such a change at a later visit
• Exciting given the challenges of treating obesity in underserved youth
Specialized Care of Overweight Children in Community Health Centers March 1, 2010 Page 04
Elements of our Community-Oriented Initiative Beyond the Model1. Exciting Clinic-to-Clinic Collaboration• Model pilot tested at a single clinic in 2006 and then spread to eight
community health centers in Massachusetts in 2008 and 2009• Clinics have conference calls every month and face-to-face meetings twice
every year• Interactions serve as basis for quality improvement, problem-solving, and
best-practice sharing throughout initiative• Centralized technical assistance team provides support for these
interactions as well as expert advice for clinics
2. Innovative Use of Health Information Technology• Standardized clinical encounter form drives care quality at each
community health center• Web-based data collection system yields graphical analysis of health
outcomes• Quarterly review of data with clinics to drive improvement over time
Specialized Care of Overweight Children in Community Health Centers March 1, 2010 Page 05
Implications for Future Practice
1. Improved effectiveness over current standard of obesity treatment in pediatric primary care
2. Increased efficiency by combining multiple providers in a single visit
3. Decreased cost compared to hospital-based clinics
3. Tie in to current patient-centered medical home movement occurring in community health centers nationwide
4. Replication in eight diverse community health centers indicates that model is scalable
5. Specialized, multi-disciplinary primary care could be expanded to other common chronic conditions including ADHD and asthma
Specialized Care of Overweight Children in Community Health Centers March 1, 2010 Page 06
Acknowledgements
1. Bill Adams, MD and Barry Zuckerman MD
2. Healthy Weight Clinic Teams: Holyoke, Greater Lawrence, Codman Square, Whittier Street, Greater New Bedford, Outer Cape, Lowell, and Bowdoin Street Community Health Centers
3. CAVU Staff: Penny Marston and Deirdre Connor, MPA
4. Howard Bauchner, MD
5. Vijay Nayak, MD
6. Funding for this work provided by CAVU Foundation and Paul and Phyllis Fireman Foundation
Specialized Care of Overweight Children in Community Health Centers March 1, 2010 Page 06
The Role of the Built Environment and Neighborhood Conditions in Childhood Obesity
Gopal K. Singh, Ph.D.U.S. Department of Health & Human Services Health Resources & Services Administration
Maternal and Child Health Bureau
Obesity Prevalence (%) by Neighborhood Built Environment Index, 2007
2019
17
15
33
26
20
15
10
15
20
25
30
35
Fewest neighborhood amenities
2nd fewest neighborhood
amenities
2nd most neighborhood
amenities
Most neighborhood amenities
All Children Aged 10-17
Female Children Aged 10-11
Source: Singh GK, Siahpush M, Kogan MD. Health Affairs. Vol. 29, No. 3. March 2010.
Prevalence (%) of Physical Inactivity and TV Viewing Time byBuilt Environment Index, Children Aged 10-17 Years, 2007
17
1212
11
28
2524
22
5
10
15
20
25
30
Fewest neighborhood amenities
2nd fewest neighborhood
amenities
2nd most neighborhood
amenities
Most neighborhood amenities
No Physical Activity Watch TV > 2 hours/day
Source: Singh GK, Siahpush M, Kogan MD. Health Affairs. Vol. 29, No. 3. March 2010.
Excess Obesity Risk (Percent Higher Odds) Among Children Aged 10-17 From Unfavorable Neighborhood Built Environments, 2007
3432
26
20
15
10
15
20
25
30
35
Built Environment Index (low vs high
amenities)
No access to sidewalks or walking
paths
No access to parks or playgrounds
No access to recreation or
community centers
No access to library or bookmobile
Source: Singh GK, Siahpush M, Kogan MD. Health Affairs. Vol. 29, No. 3. March 2010.
Excess Obesity Risk (Percent Higher Prevalence) Among Children in Unfavorable Neighborhood Social Conditions, 2007
34
43
33
24
6
93
80
55
64
37
0
20
40
60
80
100
Social conditions (least vs most
favorable)
Unsafe neighborhood
Garbage/litter in streets or sidewalks
Poorly kept or rundown housing
Vandalism (broken windows or graffiti)
All Children Aged 10-17
Female Children Aged 10-11
Source: Singh GK, Siahpush M, Kogan MD. Health Affairs. Vol. 29, No. 3. March 2010.
Policy Solutions to the Grocery Gap
Allison Karpyn Director of Research and EvaluationThe Food Trust
Replicating Pennsylvania’s Fresh Food Financing Initiative
Identification of Areas of Need
Lessons Learned
• Adapt to Local Circumstances
• Maintain Focus
• Engage Diverse Sectors
• Include Industry
• Nurture Local Efforts
• Conduct More Research
Sodexo’s Commitment to Student Well-Being
Roxanne E Moore MS, RDNational Director of WellnessSodexo Education
65
Sodexo encourages student well-being
Sodexo was one of the first companies to join the MyPyramid Corporate Challenge to promote the USDA's dietary guidelines
Sodexo is the first foodservice company to formally adopt the snack and beverage guidelines from the Alliance for a Healthier Generation, a joint initiative of the American Heart Association and the William J. Clinton Foundation
As a participant in the National School Lunch Program and the School Breakfast Program, Sodexo culinary professionals create menus for school districts that meet or exceed all USDA nutritional guidelines for school meals
Sodexo educates students on good nutrition
Not only does Sodexo feed kids, but we also help to educate them
● Nutrition labeling● A to Z Salad Bar● Produce of the Month● Kids Cooking● School Gardens● Los Kitos● Age-appropriate nutrition education
Sodexo supports teachers with materials to aid with nutrition education lessons
Sodexo managers, chefs and dietitians work with parents, nurses, administrators, PTAs and district wellness committees to create nutrition programs that nourish and educate students
Sodexo partners with First Lady’s Let’s Move initiative
First Lady Michelle Obama is seeking the support of business leaders to end the epidemic of childhood obesity with the Let’s Move initiative
Sodexo is helping this fight by making nutritious school lunches affordable and accessible to all students and by focusing on nutrition education in the schools we serve
Sodexo’s support of HealthierUS School Challenge certification efforts is a great example of how we fight obesity on the local level
Sodexo helps schools get certified in the HealthierUS School Challenge
To earn HealthierUS School Challenge certification, school districts must meet a wide variety of guidelines that include menu planning, nutrition education and physical activity
Sodexo meets with clients to collaborate on the certification process, including the development of new programs, promotions and activities that help district’s meet the USDA requirements
Along with menu planning, Sodexo uses its many resources to assist clients with education and physical activity requirements
Sodexo fights to end childhood hunger
Research shows that poverty is a major contributor to childhood obesity
Sodexo School Services uses innovative programs to end hunger in the communities we serve
Breakfast in the Classroom programs bring delicious and nutritious meals directly to the students to ensure that they get the fuel they need to succeed in school
The Backpack Program provides nutritious weekend meals to students that might otherwise go without
Helping Hands Across America encouraged Sodexo employees to fight hunger locally and included a company-wide canned food drive
Agriculture Policy & Childhood ObesityA Food Systems and Public Health Commentary
David WallingaDirector, Food and Health Program Institute for Agriculture and Trade Policy
Agriculture policy since 1974: “Cheap food”
Success as a cheap calorie policy
• Production-driven• Export-driven
Commodity subsidies not written into Farm Bill until 2002
Of 300 calorie excess, relative to 1985 Of 300 calorie excess, relative to 1985 (Putnam et al. 2002(Putnam et al. 2002))
Added sweeteners account for 23 percentAdded sweeteners account for 23 percent Added fats account for 24%Added fats account for 24% Grains, mostly refined, account for 46 percent
Linked to Linked to obesity obesity
promotionpromotion
400
Economic Research Service. Loss adjusted food availability [database on the Internet]. Washington Economic Research Service. Loss adjusted food availability [database on the Internet]. Washington (DC): U.S. Department of Agriculture; updated 2009 Feb [cited 10 Jan 2010]. Available from: (DC): U.S. Department of Agriculture; updated 2009 Feb [cited 10 Jan 2010]. Available from: http://www.ers .usda.gov/Data/FoodConsumption/ FoodGuideIndex.htm .usda.gov/Data/FoodConsumption/ FoodGuideIndex.htm
38.9%
20.4%
11.5%
-0.6%-3.2% -4.5%
-7.0%
-14.0%
-23.6%-30.0%
-20.0%
-10.0%
0.0%
10.0%
20.0%
30.0%
40.0%Fresh fruits & veggies
Total fruits & veggies
Red meatsDairy
Cereal & baked goods
Sugars & sweets
Fats & oils
Soda pop
Poultry
Change in food prices, 1985 –2000, real $
Foods high in fats, sugars and calories are some of the least expensive, most inflation-resistant in the American food environment.
Wallinga D. Today's food system: how healthy is it? J Hunger Environ Nutr 2009;4(3):251-81.
Near-term policy changeNear-term policy change
• A food systems analysis commensurate with the A food systems analysis commensurate with the complexity of the health problems.complexity of the health problems.
• Farmers as partners against childhood obesity.Farmers as partners against childhood obesity.
• Agriculture research to achieve synergies between Agriculture research to achieve synergies between growing healthier foods, with fewer fossil fuels, and growing healthier foods, with fewer fossil fuels, and with American farmers.with American farmers.
A Healthy Food, Healthy Farm Bill
American spending on food, health relative to disposable income
Figure 1 , Wallinga D. Today's food system: how healthy is it? J Hunger Environ Nutr 2009;4(3):251-81.
Are “Competitive Foods” Sold at Schools Making Our Children Fat?Nicole Larson PhD, MPH, RD Mary Story PhD, RD
Competitive Foods in U.S. Schools:A Review of the Evidence
• Purpose: Conduct a comprehensive review of the research to :– Examine the availability and nutritional
content of competitive foods in schools– Examine the impact of competitive foods
on students’ dietary intake and students’ weight status
• Methods: Literature search of peer-reviewed studies from 1999-2009
• Discuss policy implications
Competitive Foods and Dietary Intake• 17 peer-reviewed studies
– All 9 observational studies– 4 of 8 policy evaluations/interventions
• Students have better diets when unhealthy foods are not available at school
• Students may purchase & consume more healthful foods (e.g., fruits & vegetables) when they are available at school
Competitive Foods and Weight Status• 6 peer-reviewed studies
– All 3 observational studies– All 3 multi-component intervention studies
• Greater availability of unhealthy foods at school related to higher body fatness
• Limiting the availability of unhealthy foods at school was a component of successful interventions shown to reduce overweight
Schools and Competitive Foods: What do we know?Nutritionally poor foods are widely available in schoolsFindings from SNDA-III (2004-2005)
• Nationally, 1 or more sources of competitive foods were available in 73% of elementary schools, 97% of middle schools and 100% of high schools.
• Overall, 40% of students consumed 1 or more competitive foods on a typical school day and consumption increased with grade level.
• Healthy foods and beverages are increasingly available, but the most common items sold outside school meals are candy, sugary drinks, salty snacks and desserts.
Bottom line: While schools have made improvements, more is needed.
What is the impact of competitive foods on child nutrition?Findings from SNDA-III
• Students who ate competitive foods/beverages at schools on average consumed 277 Kcal/day; two-thirds of these Kcal (177) were from low-nutrient, energy dense sources.
• The availability of snacks and drinks sold in schools are associated with higher student intakes of total calories, soft drinks, total fat and saturated fat intakes and lower intakes of fruits and vegetables and milk.
• The availability of junk foods in vending machines in or near the school cafeteria in middle schools was associated with higher than average body fatness.
• School food policies and practices that limited the availability of competitive beverages were associated with reduced consumption of calories from sweetened beverages schools. Students did not “make up” by drinking more outside of school.
Institute of Medicine’s Institute of Medicine’s Nutrition Standards for Foods in Schools Nutrition Standards for Foods in Schools (2007)(2007)
Major conclusions:1. Opportunities for competitive foods
should be limited. The federal school nutrition programs should be the main source of nutrition at schools.
2. If competitive foods are available, they should consist of nutritious fruits, vegetables, whole grains, and nonfat or low-fat milk/dairy products, plain water, 100% juice (4-8 oz).
Competitive Foods: Our current situation
• Federally subsidized school meals are required by Congress and USDA to meet nutrition standards and comply with the Dietary Guidelines for Americans.
• Standards for competitive foods are 30 yr old and don’t address calories, fats, salt, and sugars.
• The USDA does not have authority to regulate foods or beverages sold outside the cafeteria or outside mealtimes.
Not Allowed
Current competitive food standards don’t make sense
Allowed
Fruitades (with little juice)
French fries Ice cream
barsCandy bars
CookiesChips
Snack cakesDoughnuts
Seltzer waterCaramel corn
Popsicles (without fruit juice)
Jelly beansChewing gum
LollipopsCotton candyBreath mints
Policy Recommendations: What is Needed?
Update the national nutrition standards for competitive foods and beverages to bring them in line with the Dietary Guidelines and apply them to the whole campus for the entire school day. The new standards should:– Restrict the sale of sugar-sweetened beverages
throughout the day in all schools.
– Limit the availability of low-nutrient, energy-dense foods sold a la carte and in vending machines and fundraisers.
– Promote children’s consumption of fruits, vegetables, whole grains and non-fat or low-fat dairy products.
Childhood Obesity: The Way Forward
With thanks to the Robert Wood Johnson Foundation for its generous support