Transcript Healthier Families May Start at the Dinner Table

Healthier Families May Start
at the Dinner Table
Miriam Gaines, MACT, RD, LD
Nutrition and Physical Activity Director
Alabama 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%)
– 3rd highest for adult
obesity (30.1%)
– 4th highest for
diabetes (10%)
– 6th highest for physical
inactivity (29.6%)
Obesity Trends* Among U.S. Adults
BRFSS, 1986
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
Obesity Trends* Among U.S. Adults
BRFSS, 1991, 1996, 2003
(*BMI 30, or about 30 lbs overweight for 5’4” person)
1996
1991
2003
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Obesity Trends* Among U.S. Adults
BRFSS, 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. Adults
BRFSS, 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. Adults
BRFSS, 2006
Obesity Trends* Among U.S. Adults
BRFSS, 2007
Obesity in Alabama
2004
Obesity in Alabama
2006
Obesity Trends in Alabama
Obesity is Complex
Dietary 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 US
2005
http://apps.nccd.cdc.gov/DDT_STRS2/NationalDiabetes
PrevalenceEstimates.aspx
Adult Diabetes in Alabama
2005
http://apps.nccd.cdc.gov/DDT_STRS2/CountyPrevalenceData.aspx
Cancer Trends in Alabama
Cancer Type
In Alabama
Rate per 1000,000
population
All cancers
214.2
Lip, oral, pharynx, 7.5
esophagus
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&SelectedSt
ate=Alabama
Health Indicators and Trends
Heart 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
overweight
obese
60
50
40
30
20
10
0
obese
overweight
White
Male
Black
Male
23.9
17.6
26.3
17.4
Hispanic White
Male
Female
35.8
17.9
Black Hispanic
Female Female
20.9
18.3
Overweight/Obesity, 3rd Graders, Alabama,, 2006-7
28.8
18.6
31.1
15
Overweight and Obese in Alabama
High Schools
1999-2007 YRBS
overweight
obese
35
30
25
20
15
10
5
0
obese
overweight
1999
2001
2003
2005
2007
11.1
17.3
12.3
15.2
13.5
14.5
14.8
17.8
13.6
16.6
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
AL 05
70
US 05
64.1
58.2
60
50
45.1
38.437.2
40
30
20
33
26.5
21.7
20.1
14.7
16.2
8.5
10
0
5 a Day
3 a Day
Vigorous
PA
Moderate
PA
TV
Daily PE
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
US Ad Spending in Millions
2003
McDonald’s
Burger King
Pepsi/diet Pepsi
Coke/diet Coke
Mountain Dew
M&M candies
Snickers candy bar
Frito-Lay chips/snacks
Pringles
Kool-Aid
Lunchables
$ 619 M
$ 294 M
$ 207 M
$ 167 M
$ 60 M
$ 73 M
$ 70 M
$ 57 M
$ 35 M
$ 25 M
$ 23 M
Advertising Age, June 2004
Budget Comparison
U.S. government’s entire budget
for nutrition education
Is one-fifth the advertising
budget for…
Altoids mints
Nestle, 2002
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
“Cover Concepts places
your brand directly into
the hands of kids and
teens in a clutter-free
environment.”
Juicy Fruit Gum
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.
So What?
Does food advertising and marketing
influence children’s food preferences,
eating behavior, and weight status?
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
Obesity
Evidence
Increased Risk
Convincing
• Sedentary lifestyle
• High intake of energy-dense micronutrient poor foods
Probable
• Heavy marketing of energy-dense foods and
fast-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 Models
Nutrition
• 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.
“No nation is
any healthier than
its children”
Harry S. Truman, 1946
Guard Our Children’s Future
Eat Better and Move More