Is the MA BMI report a solution, or another case of mixed messages in a real life messy problem?

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Advertising confusion

If you eat 1/3 of it

http://www.cfsan.fda.gov/~dms/foodlab.html#see1

•Food labels

Competing with Exercise

Parents not home

Barriers

to Exercise

Hi-C Blast

Poland Spring’s Water

Which drink is considered junk food according to the national school foods standards?

The Hi-C blast is fortified with vitamins so it’s allowed-even though it is just suger water

We consider water a healthy choice but USDA considers it junk food because it doesn’t contain any vitamins or mineral’s.

Which does USDA consider a junk food in schools?

Breath mints Chocolate bars

The USDA considers breath mints a junk food because they don’t have any vitamins or minerals.

Chocolate candy bars are not considered junk food because they are fortified with vitamins and minerals.

Does the USDA consider French fries junk food?

French fries are not considered junk food. USDA’s nutrition standards for

vending and a la carte do not address fat and sodium.

Pass the ketchup

Thinking!!!!!!!!!

Our PBL Process Road MapExperience with the PBL processOur ‘team mood’

Calculated for adults, using height and weight. For children, height, weight, sex and age are used.

Interpreted as follows:Children have BMI plotted on a CDC scale for

age and a percentile is established for the child.

Classification For Child For Adult

Underweight Less than 5% Under 18.5

Healthy 5%– 84.9% 18.5 – 24.9

Overweight 85% - 94.9% 25.0 -29.9

Obese Higher than 95%

30 or higher

Behavioral Risk Factor Surveillance System (BRFSS) releases the graphs that will be reviewed showing the growth of obesity in America; www.cdc.gov/brfss/

Mokdad AH, et al. The spread of the obesity epidemic in the United States, 1991—1998 JAMA 1999; 282:16:1519–1522.

Mokdad AH, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001; 286:10:1519–22.

Mokdad AH, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003: 289:1: 76–79

CDC. State-Specific Prevalence of Obesity Among Adults — United States, 2005; MMWR 2006; 55(36);985–988

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

No Data <10% 10%–14%

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

No Data <10% 10%–14%

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

No Data <10% 10%–14%

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

No Data <10% 10%–14%

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

No Data <10% 10%–14%

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

No Data <10% 10%–14%

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

No Data <10% 10%–14% 15%–19%

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

No Data <10% 10%–14% 15%–19%

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

No Data <10% 10%–14% 15%–19%

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

No Data <10% 10%–14% 15%–19%

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

No Data <10% 10%–14% 15%–19%

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

No Data <10% 10%–14% 15%–19%

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

No Data <10% 10%–14% 15%–19% ≥20%

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

No Data <10% 10%–14% 15%–19% ≥20%

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

No Data <10% 10%–14% 15%–19% ≥20%

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

No Data <10% 10%–14% 15%–19% ≥20%

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

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

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

Obesity Trends* Among U.S. AdultsBRFSS, 2002

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

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

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

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

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

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

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

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

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

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

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

1998

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1998, 2007

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

2007

1990

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

PBL Process Check In!Step 1Step 2Step 3

Heart DiseaseHigh Blood PressureSleep ApneaPsychological Disorders

Psychological Effects of Obesity

Obese children are prone to low self-esteem, depression, suicide.

Teasing, bullying, ostracized by peers.May cause the development of unhealthy

eating habits, eating disorders which include anorexia and bulimia.

State

Total population

(%) (Millions $)

Medicare population

(%) (Millions $)

Medicaid population

(%) (Millions $)

Above is the estimated percentage of total, Medicare, and Medicaid costs to MA.

Source: http://www.cdc.gov/nccdphp/dnpa/obesity/economic_consequences.htm

MA 4.7 $1822 5.6 $446 7.8 $618

EnvironmentGeneticDietPhysical ActivityCultural/Psychological

Consumption of soft drinks - increased from 27 to 44 gal/y from 1972-92

30,000 products in supermarkets (doubled since 1981)

12,000 new food products/year (doubled since 1986)

In 1970’s, Americans consumed 34% of their food outside their home and in 1990’s, this had increased to 50%

Portion sizes have increased in the US over the past 30 years

Fast food sizes are larger in the US, even when compared to the same restaurant in European countries.

The more fast food restaurants there are in a neighborhood, the more likely the population will be obese.

Restaurants have been deliberately built within walking distance of schools.

*Soft drinks = carbonated beverages, fruit-flavored and part juice drinks, and sports drinksSource: USDA, Continuing Survey of Food Intake by Individuals, 1994-96

15 teaspoons of sugar per day

11% of their calories

from soft drinks*

Slide Courtesy of Massachusetts Department of Education, Nutrition Programs and Services

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tsp. added sugarsrecommended

Guthrie and Morton JADA 2000;100:43-48.Slide Courtesy of Massachusetts Department of Education, Nutrition Programs and Services

34%

16%19%

11%

9%

4%4% 3%

Soft DrinksSweets/candySweetened grainsFruit drinksMilk productsCerealsOther beveragesOther

Sources of Added Sugars in the U.S. Diet

Guthrie and Morton, JADA 2000;100:43-48.

Slide Courtesy of Massachusetts Department of Education, Nutrition Programs and Services

• Physical activity reduces the risk of heart disease, diabetes, high blood pressure, and colon cancer

• National Health interview Survey show 1997-98, 4 in 10 adults reported no participation in physical activity

Physical Fitness

Physical FitnessApproximately 1/3 age 65 or older lead

sedentary lives

Older women are less active than older men

54 % men and 66% women age 75 and older engage in no physical activity

The increase of no physical activity increases the risk of chronic disease

Could children's physical activity fall short due to their role models?

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C 2002 Health Management Resources Corporation, Boston, MA

Slide Courtesy of Massachusetts Department of Education, Nutrition Programs and Services

PBL Process Check In!Step 4Problem Statement:

Childhood obesity is most affected by adult actions surrounding food and nutrition. In order to change children’s perceptions of food, we need to change the adult’s perception of food.

BMI Report Card will be evaluated and provided to children in grades 1, 4, 7 and 10

Reports are sent home to parents with educational material based on results

Parents can ‘opt out’ of having BMI calculated in school

Concerns with Weight Report CardWill it solve the issue of Obesity?Is it a Band aid that the Patrick

Administration has put on the obesity epidemic?

Will schools change their lunch meals to more healthier meals?

Will physical education be reinstated?Will children psychological well being be

effected?Will children’s self-image be distorted?

PBL Process Check In!Revisit Step 4Step 5Step 6

OLD: Childhood obesity is most affected by adult actions surrounding food and nutrition. In order to change children’s perceptions of food, we need to change the adult’s perception of food.

NEW: Childhood obesity is strongly influenced by parental and adult actions (attitudes and beliefs) surrounding nutrition and exercise. The BMI weight report card does not effectively address these actions.

What did we want to find out?We wanted confirmation that our problem

statement was appropriate for MA residents.We wanted to capture more information about

the actions of parents and adults surrounding food and exercise choices.

We wanted to gather information that had not been previously gathered in this population.

Adult perceptions of obesity and how it correlated to their BMI.

We devised an online survey with both background information for the respondent and 9 additional questions

The survey included multiple choice, yes/no responses, open-ended answers, and an “other” category for some questions

From April 9th to April 15th (about a week), we collected responses by sending a link to the online survey to people within our networks that are Massachusetts residents and at least 18 years of age

See handout!

For the 49.2% respondents who indicated they ‘somewhat’ or ‘did not’ consider the nutritional value, their comments were as follows:

70% stated lack of time 30% stated they enjoyed the taste of food

Lack of Exercise (88.5%)Focus on calories out

Parental actions/role modeling (59.0%)Not concerned with calories, focus is on learned

behavior parental actions surrounding food choices

Overeating/overconsumption by child (37.7%)Focus on calories in

More respondents believe that parental actions are responsible for childhood obesity than the actual overconsumption of food by the child

Missing in Prevention of Obesity

Observations re: Actions of AdultsWhile the majority of respondents stated that

they would start a diet/exercise program on their own, when it came to their children, they would be more likely to consult with their child’s physician

-The top 3 actions listed as missing all pertain to actions that would be taken by the schools; however, the respondents list the individual/family as the person responsible for taking action

-Is there miscommunication? Misunderstanding?

PBL Process Check In!Step 7

On April 8th, 2009, the Public Health Council unanimously approved the screening of Massachusetts students to determine if they are overweight, as part of a major public health campaign

We analyzed the comments made to a article about this decision

“BMI Screening Will Begin this Fall in Mass. Schools”

As of April 17th, 2009, there were 176 comments

Comments were mostly negative or neutral, with very few completely positive comments

Against the BMI: 20% Against MA government: 19% Too costly to implement program: 17%Increased low self esteem in children: 9% Increased eating disorders in children: 7%

Increased Phys Ed/recess: 14% Improved school lunches: 10% Nutrition programs in schools: 8% Use body fat % instead of the BMI: 3% Offer counseling to the children: 1%

Parents: 22% Physicians: 11% Teachers/Schools: 5% Children: 2% Food companies: 1% Government: less than 1%

Most people said that child obesity should be the parent/family’s responsibility However, the top 3 suggestions to solve this problem all

involved the schoolsPeople distrust the MA government; think they

are invading our privacy Can we successfully decrease the rise of childhood

obesity without government support?There is a lack of understanding about the weight

report card It is not costly, parents can opt their children out, this

program has been implemented in other states with successful results

PBL Process Check In!Step 8 Step 9

•The department of public health has made obesity prevention one of the top priorities

• Mass in motion is the plan

•The goal of the commissioner’s obesity task force is:

1.Goals collect data through the BMI report card and inform parents

2. Implementing successful school nutrition/physical activity wellness policies

1. They realize there is an obesity epidemic not only across the nation but right her e in Massachusetts

2. They realize that the obesity epidemic is not equally distributed among races

3. They believe that the state and the government need to provide funding to promote model programs

4. they believe that not just one agency can do it alone.

• They know that schools fall short on nutrition and exercise and claims financial barriers are the cause of decreased fresh fruits and vegetables.

• They have decrease recess and gym programs

• They mention that other policies have been put in place to support nutrition and exercise but there is no standard system monitoring the quality of the policy’s being implemented.

BMI

Push for the laws A. The act to improve quality physical

education B. Act to promote proper school nutrition

Increase nurses duties to participate in schools efforts and

implementing and promote students health

Making it safe for children to walk to school

1. Caloric menu labeling for large chain restaurants. 2. An Executive Order by Governor Patrick requiring State Agencies

responsible for large-scale food purchasing (e.g., DPH and DMH hospitals) to follow healthy nutritional guidelines in their food service operations. State purchases of food by these agencies runs into the tens of millions of dollars per year;

3. The expansion of a state-sponsored Workplace Wellness program throughout the state to help employers create work sites that encourage healthy behaviors and reduce absenteeism and health insurance costs.;

4. The launch of a state-sponsored Mass In Motion web site that promotes healthy eating and physical activity at home, work, and in the community. The objective of the website is to provide simple, practical, cost-effective ways for Massachusetts’ residents to:

Improve eating habits Increase physical activity Ask experts questions about improving their eating and physical activity routineo Get involved in helping to build healthy communities

Source:  Massachusetts Department Of Public Health

WarningsPeople have been urged and warned about

bad nutrition and lack of exercise but no one addresses the social forces that can derail even the most motivated individuals

Through our survey and other research materials parents claim they can do it them selves but it is clear by this epidemic we need help!

The BMI Weight Report Card is not an effective way to address childhood obesity, or as our problem statement focused on, the adult’s choices surrounding nutrition and exercise

We would not have recommended that the BMI weight report card be passed

We do recognize the need for involvement of the government because of the public health costs associated, but the most successful programs we found in research were individual and community based

It is the team’s belief that family and community based programs will have greater potential than programs operating in schools because of the multilevel approach, but few studies have been done in this area

Physical Activity Intervention Studies - shows that school based programs focusing on nutrition and exercise have not carried into the home and community

We recommend to the government that they evaluate, contact, research existing programs:

•CATCH- Coordinated Approach To Child Health

•SPARKS- Sports, Play, and Active Recreation for Kids

•Bodybybrandy4kids

•Go Kids Boston

To solve this epidemic we must use creative resources and collaboration of multiple groups to solve this at the family and community level….with government support.

And this sounds a lot like the PBL process….

PBL Process Check In!Step 10