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The Weight of the Nation is Out of Control and We Can Change ThatSandra Hoyt Stenmark M.D. May 2013


WE BUILD A BRIGHTER FUTUREtogetherDisclosures

School-Based Health Center: Conference: Strengthening the Core

Speaker: Sandra Hoyt Stenmark M.D. Physician Lead for Pediatric Cardiovascular Health at Kaiser Permanente in Colorado

Date: May 2013

Disclosures: NONE


WE BUILD A BRIGHTER FUTUREtogether

WHO definition of Health

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.



Objectives

1. Identify health and economic consequences

of obesity

2. Analyze factors contributing to obesity and

poor cardiovascular health

3. Construct interventions which will decrease

obesity and improve cardiovascular health



Many Factors Drive and Shape Health

Family History and Genetics

30%

Environmentaland Social

Factors20%

Personal Behaviors 40%

Medical Care 10%

Drivers of Health

5

Source: McGinnis et al, Health Affairs, 2002



6

The Social Ecological Framework

Neighborhood /Community

Society

Individual / Family

Home / School /Worksite

Physical and Mental Health “Body, Mind and Spirit”


WE BUILD A BRIGHTER FUTUREtogetherChildhood Overweight and

ObesityOn average, between 2010 and 2011, 28 percent of all Colorado children ages 2

to 14 were overweight or obese, up from 26 percent in 2008-2010.

DenverPueblo

MontroseDelta

LarimerMontezuma

La PlataEl Paso

ArapahoeAdams

ColoradoLogan

MorganJeffersonFremont*

WeldSummitGarfield

EagleMesaElbertTellerRoutt

DouglasBroomfield

Boulder

0% 5% 10%15%20%25%30%35%40%45%

41%37%

36%36%

31%31%31%31%

29%29%

28%26%26%26%

24%20%20%20%20%

19%17%

16%14%14%

13%13%

Source: CDPHE: Health Statistics Section. 2010-2011 Child Health Surveys.



Obesity Prevalence Colorado Children 2-14 years 2008-10

White Hispanic Black0

5

10

15

20

25

30

35

40

obeseoverweight

Colorado Department of Health and Environment- Child Health Survey



Prevalence of Food Insecurity and Obesity in Colorado Children

<100% FPL 100-199% FPL

200-299% FPL

300%+FPL0

10

20

30

40

50

60

70

80

Food InsecureObesity

Health Statistics CDPHE, Child Health Survey 2010



More than one in six Colorado kids lived in poverty in 2011.

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0%

5%

10%

15%

20%

25%

17%

23%

10%

18%

United StatesColorado

3%

Children Living in Poverty

since 2010

Source: U.S. Census Bureau. 2000 and 2001 Supplemental Surveys, 2002-2011 American Community Surveys.



Effects of childhood obesity

• Increased rates of premature death in adults -NEJM 2010;362:485-93

•Adverse levels of lipids, insulin and blood pressure -Pediatrics 1999;103:1175-82

•Fatty streaks and lesions in coronary arteries in young adults

- NEJM 1998;338:1650-6

•Fatty liver and liver fibrosis in children -J Ped 2003;143:500-5



Emotional and social impacts of childhood obesity

•Weight bias begins in preschool

•Higher BMI -more frequent and intense victimization

•Source of bias: peers, teachers, parents

• Impacts: poor self esteem, depression, less likely to be chosen as friend, increased suicidal ideation

-Puhl, Psychological Bulletin 2007, Vol 133, No 4, 557-80


WE BUILD A BRIGHTER FUTUREtogetherObesity is Expensive

Annual Medical costs of obesity•United States $147 billion•Colorado $874 millionwww.cdc.gov/obesity/causes/economics.html

United States medical costs + loss of productivity costs•Overweight- $72 billion•Obese- $198 billion

Source: 2010 Society of Actuaries: Obesity and its Relation to Mortality

and Morbidity Costs

http://www.cdc.gov/obesity/causes/economics.html


WE BUILD A BRIGHTER FUTUREtogetherCase I

5 yo Ethiopian male with BMI 99.1% in for CPE

How do you bring up weight?

How do you engage patient and parent?

What evidenced based family behaviors are important to address?



Messaging and motivating behavior change

• Lack of awareness re weight status

• When parents made aware they are more motivated to action

livewellcolorado.org/


WE BUILD A BRIGHTER FUTUREtogetherMessaging which engaged

Hispanic families

“Too much weight for his health”

“Demasiado peso para su salud”



KPCO RD Intervention

# 3 phone visits and 1 in person visit 9/2012-1/2013

Topics addressed:• daily active play • fruit & vegetable intake • sugared beverages • portions • healthy snacks


WE BUILD A BRIGHTER FUTUREtogether5-2-1-0

Modifiable Behaviors



Colorado Children’s Daily Behaviors 2010-2011

5 Fruit & Veg 60 min PA One or more SSB05

101520253035404550

5-11 yrs12-14 yrs

http://www.chd.dphe.state.co.us/Resources/cms/hs/yrbs/ChildHealthCategories.html



Five servings of vegetables and fruits/day



Two Hours or Less of Screen Time/ Day

GENERATION M2: Media in the Lives of 8- to 18-Year-OldsKaiser Family Foundation Report 2010


WE BUILD A BRIGHTER FUTUREtogetherOne Hour or More of Daily

Physical Activity

Improves:

mood, cognition, fitness,

bone strength, sleep quality

Lowers risk of:

diabetes, heart disease, obesity, anxiety, depression, stress, colon & breast cancers

www.health.gov/paguidelines


WE BUILD A BRIGHTER FUTUREtogetherTime Outdoors Increases

Physical Activity

Burdette Arch Pediatr Adol Med 2004;159:46-50.

Cleland V, et al. Int J Obesity 2008;32:1685-93.


WE BUILD A BRIGHTER FUTUREtogetherZero Sugared Beverages

Sugared beverages account for nearly half of all added sugar consumption in the average American diet. Dietary Guidelines of America 2010



Other Obesity Interventions

• Portion size• Breakfast• Diet quality• Food Insecurity• Sleep• Family meals• Eating out/ Take out



KPCO RD intervention results


WE BUILD A BRIGHTER FUTUREtogetherCase II

11 yo Hispanic male with BMI 99%, persistent asthma presents at CPE

Neighborhood without safe places to play or walk and no easy access to fruits and vegetables.

How do you engage family?

What resources would you consider?


WE BUILD A BRIGHTER FUTUREtogetherBarriers to Walking-Photovoices


WE BUILD A BRIGHTER FUTUREtogetherCase II

Mom discussed barriers during first 2 phone visits

On 3rd phone visit ready to

goal set:• physical activity • sugared beverages


WE BUILD A BRIGHTER FUTUREtogetherCommunity Resources

Fire up Your Feethttp://fireupyourfeet.org/

Outdoor Resourceshttp://www.getoutdoorscolorado.org/

Boys and Girls Clubshttp://www.bgca.org

Let’s Moveletsmove.gov

http://fireupyourfeet.org/

http://fireupyourfeet.org/

http://www.getoutdoorscolorado.org/

http://www.getoutdoorscolorado.org/

http://www.bgca.org/

http://www.bgca.org/



Safe Routes to School Reduces Injury

The annual rate of school aged pedestrian injury during school-travel hours decreased 44% in census tracts with SRTS interventions.

http://www.saferoutespartnership.org/ Pediatrics 2013;131:290–296

http://www.saferoutespartnership.org/



Strengthen Schools as the Heart of Health

.

http://thrivingschools.kaiserpermanente.org/www.letsmove.gov

Accelerating Progress in Obesity Prevention- IOM May 2012

http://thrivingschools.kaiserpermanente.org/

http://thrivingschools.kaiserpermanente.org/



Community Weight Loss Resources

• Kaiser Permanente Resources www.kphealthyme.com

• MEND Http://us.mendcentral.org/

• Por Tu Familia

http://www.diabetes.org/in-my-community/local-

offices/denver-colorado/por-tu-familia-colorado.html

• Weigh and Win for Adults www.weighandwin.com/

http://www.kphealthyme.com/

http://us.mendcentral.org/





http://www.weighandwin.com/


WE BUILD A BRIGHTER FUTUREtogetherCase III

15 yo female presents with BMI of 99% and the following growth chart

How do you engage

patient and family?

Next steps?


WE BUILD A BRIGHTER FUTUREtogetherCase IV

What questions would you ask if you saw this child between ages of 10-16 years?

What interventions took place when he was 16 yo?



A Colorado Solution for Hunger

Hunger Free Hotline



Case V

10 yo male with BMI 99%

Mom concerned because he is being teased about his weight

Engage? Next Steps? Resources?


WE BUILD A BRIGHTER FUTUREtogetherBullying Prevention

http://www.stopbullying.gov

• Encourage kids to speak to a trusted adult

• Encourage friendships and hobbies

• Website with tips and strategies for staying safe and stopping bullying

• Promote an environment in which all individuals are treated with respect

http://www.stopbullying.gov/





KPCO School Initiatives

State Legislation:• Hunger assistance • Breakfast after the bell• Beverage Standards• Physical Activity Standards• Complete Streets

Grants:• Live Well Communities• Fire Up Your Feet• Thriving Schools• National Safe Routes to School• Playworks• KP Educational Theater Program



We Can Fix It

• School based health centers have an important role in identifying, preventing and treating obesity

• School policies, programs and environments can promote health

• Engaging students, parents, school officials and community members will increase success


WE BUILD A BRIGHTER FUTUREtogetherThank you

[email protected]

kp.org/communitybenefit the weight of the nation is out of control and we can change that sandra...

Documents

definition of health

brighter future

cardiovascular health

drivers of health

health affairs

colorado department

child health surveys

poor cardiovascular