Transcript Document

Helping Kids to Health
The role of Iowa
public schools
Collaborators
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Iowa Dietetic Association
Iowa Dental Hygienists Association
Iowa School Food Service Association
Iowa Fit Kids Coalition
ISU Extension
Discussion Objectives
To understand and describe
 Three examples of health problems that
can be prevented
 How the school environment impacts
health and nutrition
 Policy changes that can impact health of
students
Children: A Valuable Resource
Invest in a Child’s Health
To help his/her…
 Ability to learn
 Physical ability
 Appearance
 Social opportunities
 Success in school and future employment
Health is key to a long and productive life!
Preventable & Interrelated
Health Problems
 Obesity
 Dental Caries
 Osteoporosis
 Psychosocial
Concerns
Trends in Overweight
18.0%
16.0%
14.0%
NHANES
Boys
12.0%
10.0%
8.0%
NHANES
Girls
6.0%
4.0%
2.0%
0.0%
1963-65 1971-74 1976-80 1988-91
1999
Overweight and Obesity
 Obesity has been related to changes in our
lifestyle, including diet and physical activity
 Efforts to lose weight have proven
unsuccessful for many adults.
 Obese children are 43.5 times more likely to
have at least 3 cardiovascular risk factors.
Nicklas, 2001
 As many as 45% of children newly diagnosed
with diabetes have type 2 diabetes.
The Problem of Childhood
Overweight
 Complex …but simple
 Cannot ignore that one cause is caloric
intake that exceeds caloric expenditure.
 Experts recommend that we concentrate
on preventing overweight.
No Simple Answer to the Obesity
Epidemic Food Glycemic
Industry
Index
TV
Candy
Sugar
Genes
Soft Drinks
Pouring
Contracts
Obesity
Epidemic
Decreased PE
in Schools
Energy
Density
Decreasing
Physical
Activity
Junk Food
School
Feeding
Restaurants
Working
Mothers Poverty
Nicklas, TA, 2003
Fast Food
Computers
Poor
Parenting
Genetic vs. Environmental
Obesity gene
 Children have higher risk of obesity when
either one or both parents are obese.
 Obesity associated with genetic syndromes
What has changed? …
 “Gene pool” has not changed
 Environment: has changed
Dental Health
 Tooth decay is the most common chronic
disease among children--5 times more
common than asthma.
 An estimated 51 million school hours per
year are lost due to dental related illness
 Children with chronic dental pain are
unable to attend to school work. (Oral Health
in America: A Report of the Surgeon General, 2000)
 Poor oral health tied to decreased school
performance, poor social relationships and
less success later in life
Dental Health
 20% of low income children in Iowa have
untreated decay in permanent teeth.
 68% of low income children have a history of
decay compared to 52% of higher income
children.
 56% of children participating in the IDPH
dental sealant programs have a history of
decay.
What Dentists are Seeing
“Pre-fluoride” conditions of mouths
Bone Health
 Bones are formed during childhood and
adolescence.
 Milk and dairy products are the best
sources of calcium needed to form bones.
 Lack of calcium in adolescence could lead
to bone health in later years.
 Weight bearing exercise is an important
factor in bone formation and retention.
Bone Health
 Osteoporosis is “a pediatric disease with a
geriatric outcome”
 Physically active girls who consume soft
drinks have more bone fractures
Wyshak, G, Arch Pediatr. Adolesc. Med, 2000; 154:610-613.
 Over 10 million men & women are estimated
to have osteoporosis in 2002; another 33.6
million have low bone mass and are at risk
for osteoporosis.
National Osteoporosis Foundation
http://www.nof.org/osteoporosis/state.htm
Psychosocial Concerns of
Poor Health
 Lowered self esteem
 Body image disturbances
 Depression
 Poor academic performance
 Increased behavior problems
Why be Concerned?
 70 to 80% of overweight teens become
overweight as adults.
 Poor diet/inactivity in adults causes
300,000+ deaths annually.
 Osteoporosis decreases mobility and
increases pain and has been reported
in women.
What has Changed?
Physical Activity
 22% children did not participate in
moderate or vigorous physical activity
 20% were not enrolled in physical
education class
 86% did not attend physical education
class daily
(Youth Risk Behavior Survey, CDC, 2000)
Physical Activity
 Physically fit children perform better
academically – California schools
 NASPE recommends 150 minutes/week
of physical education
 Qualified teachers can ensure safety
and teach appropriate activities that
are enjoyable, develop motor skills and
maintain health related fitness.
What has Changed?
Children’s Eating Habits
 Only 2% of kids meet all Food Guide
Pyramid Recommendations
 16% do not meet any recommendations
 12% report skipping breakfast
 Only 11% eat a breakfast that contains
three food groups and provides >25% of
RDA for energy
Compared to
Recommendations
 84% of kids eat too much fat;
 91% eat too much saturated fat
 Only 15% get enough fruits
 Only 20% get enough vegetables
 Only 30% get enough milk
 Only 19% of girls aged 9 to 19 years of
age meet calcium recommendations
Soft Drinks Cancel Out Milk
Gallons Consumed Per Year
60
50
40
milk
soft drinks
30
20
10
0
1970
1980
1990
1997
Soft Drinks: The Facts
Who drinks soft drinks?
 50% of all Americans
 65% of adolescent girls
 74% of adolescent boys
Borrud, et al., Community Nutrition Inst, 1997
Plaque
pH
7.0
Acidity in the mouth after drinking a
sweetened beverage
single glucose
rinse
6.0
5.0
critical pH
4.0
0
20
40
60
80
minutes
100
120
Acidity after repeated exposures to
a sweetened beverage
Plaque
pH
First
sip
Second
sip
Third
sip
Fourth
sip
7.0
6.0
critical pH
5.0
4.0
0
20
40
60
80
minutes
100
120
Double Trouble: pH and Sugar Content
Acidity (pH)
Sugar (tsp)
Water
7.00
0.0
Diet Coke
3.39
0.0
Mountain Dew
3.22
11.0
Diet Pepsi
3.05
0.0
Gatorade
2.95
3.3
Coke
2.53
9.3
Pepsi
2.49
9.8
Challenges for Change
 Public Health cannot compete with
industry’s advertising budget
 Mandated changes are controversial
 Lifestyle changes are difficult for
individuals
Aim for small improvements over time
Hope for Change
 Simple policies can promote health
 Activity promotion fits in well with fun
school events
 Alternative fund raisers
 Children adapt to new ideas and
experiences
 School provides a venue for
experiencing new tastes and activities
Why Change the School Health
Environment?
Education is a process
of planning and
preparing for a
successful future
Why Schools?
 Schools play a role in demonstrating to
the parents and community the
elements that lead to a successful and
healthy lifestyle
 Children spend time in school
Roles for Schools
 Continue to provide nutritionally
balanced meals to children
 Coordinate nutrition education with
opportunities to eat healthy foods.
 Support nutrition education messages in the
overall school environment.
 Provide tools for lifelong physical activity and
healthy eating.
Nutrition
for
Schools in the 21st Century
 Budget constraints for schools and school
meal programs
 Shortened meal times
 Weak regulations for physical activity and
health in schools
 School meals must compete with offerings
both on and off campus
 Foods sold in competition with the school
lunch program for revenue are often of
minimal nutritional value
Carbonated Soft Drink Sales
• Source of revenue for schools
• Competes with goals & revenue of
school lunch
• Conflicts with nutrition education
message
• USDA regulations only limit placement
& timing of vending machines
Carbonated Soft Drinks
in the School
 Potential to disrupt the classroom
 Sugar intake gives children a surge of
energy followed by a drop of energy.
 More than 51 million school hours are
lost each year to dental-related illness.
American Dental Association
Policy: 2000
House of Delegates :
 oppose contracts that offer
increased access of soft drinks
to children and influence their
consumption patterns.
 calls for continued monitoring
of scientific facts and data on
the oral health effects of soft
drinks.
(2000)
Taking a Position on Healthy
School Environments
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American Dietetic Association
American Academy of Pediatrics
Society for Nutrition Education
Centers for Disease Control and
Prevention
 Center for Food and Justice
 American School Food Service
Association
• Create school meal advisory teams of students,
parents and teachers to assist in selected menu
items.
• Survey students on preferred foods.
• Educate students about serving sizes
• Employ economies of scale to increase revenue
• Ensure that food sale revenues for competitive
foods are credited to the school food service
 Develop positive, healthy
options for vending, school stores,
cafeteria environment
 Ask soft drink companies to market
healthier alternatives.
 Provide water, 100% juices, milk and
soy drinks
 Require closed campuses during lunch
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periods.
Competitively price healthy foods
Sell items that increase physical
activity: pedometers, water bottles.
Establish relationships with local food
producers
Participate in school gardening projects
• Ensure that adequate time and space is
available for all children to eat
comfortably
• Schedule recess before lunch
• Encourage teachers and staff to eat with
children
 Limit use of food and candy as a
reward.
 Encourage fund raising efforts
associated with healthy lifestyles
 Provide daily recess
 Plan physical education that is inclusive
of all students, including those with
disabilities
 Fruit & Vegetable Pilot Project
 25 schools in Iowa
 Free fruits & vegetables provided
throughout the day
 Children learned new foods; enjoyed them
 Decreased use of vending machines
 Positive influence on school environment
Resources
School Health Index
• http://www.cdc.gov/nccdphp/dash
• http://www.cdc.gov/nddphp/dnpa
Changing the Scene
• www.fns.usda.gov/tn
Fit Healthy & Ready to Learn
• http://www.nasbe.org/HealthySchools/
healthy_eating.html
More Resources
Team Nutrition
• www.fns.usda.gov/tn
Healthy Schools Summit
• www.actionforhealthykids.org
Alternative ways to raise money
– http://www.scn.org/edu/cccs/
– www.commercialfree.org
Conclusions
 Schools can positively impact the health
of students
 A number of options are available to
implement school health programs.
 A number of tools are available to
evaluate environments within schools
Acknowledgements
Thanks to the following persons who have
provided expertise and visual support for this
presentation
Dr. Michael Kanellis, DDS, MS
Dr. Jonathan Shenkin, DDS, MPH
Linda Snetselaar, RD, PhD
Eva Tsalikian, MD
University of Iowa School of Dentistry, College of Public
Health and College of Medicine
Evaluation
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