Transcript Coordinated School Health Program

Chapter 8
Addressing the Obesity
Epidemic: An Issue for Public
Health Policy
© 2006 Thomson-Wadsworth
Learning Objectives
• Define the terms obesity and
overweight as they apply to adults.
• Define the terms overweight and
at risk for overweight as they
apply to children.
• Describe the epidemiology of
obesity and overweight among
adults and children.
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Learning Objectives
• Explain how to assess and survey
obesity and overweight in the
population.
• List and discuss determinants of obesity
and overweight.
• Discuss various interventions and
intervention strategies for the
prevention and treatment of obesity
and overweight among adults and
children.
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Learning Objectives
• Describe potential public health
strategies to prevent obesity,
including examples of current and
proposed policies and legislation.
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Introduction
• During the past 15 years, obesity
has emerged as a significant public
health problem in both adults and
children.
• Genetics and societal and
environmental factors contribute to
the rising number of obese
individuals.
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Defining Obesity and
Overweight
• In adults, overweight is defined as a
body mass index (BMI) between 25 and
29.9 whereas obesity is defined as a
BMI greater than 30.
• In children, overweight is defined as a
BMI above the CDC growth chart
criterion of 95th percentile whereas at
risk for overweight is defined as a BMI
between the 85th and 95th percentiles.
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Epidemiology of Obesity and
Overweight
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Epidemiology of Obesity and
Overweight
• Two national surveys from which
obesity data is regularly obtained:
– The National Health and Nutrition
Examination Study (NHANES)
– Behavioral Risk Factor Surveillance
System (BRFSS)
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Epidemiology of Obesity and
Overweight
• The Youth Risk Behavior Surveillance
System (YRBSS) provides the
prevalence of youth BMI by state.
– The data are self-reported and limited to
high school students.
– Mississippi and Tennessee reported the
highest rates for overweight
– Utah, Wyoming, and Idaho were the lowest
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Medical and Social Costs of
Obesity
• The Surgeon General’s Report
(2001) estimated the total
economic burden of obesity to be
$117 billion in 2000.
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Medical and Social Costs of
Obesity
• Obesity is costly to society because it is
associated with chronic diseases
including:
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Cardiovascular disease
Type 2 diabetes
Hypertension
Stroke
Dyslipidemia
Osteoarthristis
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Medical and Social Costs of
Obesity
• Obesity is costly to society
because it is associated with
chronic diseases including:
– Selected cancers
– Gallbladder disease
– Sleep-breathing disorders
– Musculoskeletal disorders
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Medical and Social Costs of
Obesity
• Overall quality of life is often worse
with increasing obesity, and obese
people experience prejudice and
discrimination.
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Determinants of Obesity
• Determinants of obesity can be
related to either dietary intake or
physical activity or both.
• They can be genetic,
psychological, behavioral, or
environmental.
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Determinants of Obesity
• Referred to more frequently in the
literature as causes of obesity are:
– an “obesogenic” environment, or one that
promotes obesity.
– a “toxic environment,” or one that limits the
opportunities for physical activity.
• Excess weight accumulation occurs with
an imbalance in energy, caused by
either a surplus of energy intake or lack
of energy expenditure.
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Determinants of Obesity
• Genetic Risk Factors
• Psychosocial Risk Factors
– Depression
– Comfort eating
• Behavioral Risk Factors
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Caloric Intake
Types of Food Consumed
Physical Activity
Use of Television, Video Games, and
Computers
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Determinants of Obesity
• Environmental Risk Factors
– Other Technological Innovations in Food
Production and Transportation
– Other Technological Changes
– Portion Sizes
– Eating Away from Home and Consumption
of “Fast Foods”
– Maternal Employment
– Urban Sprawl and the Built Environment
– Poverty
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Obesity Prevention and
Treatment Interventions
• In public health applications,
interventions that address body weight
are often preventive, rather than
treatment, oriented.
• The goal of an obesity prevention
program is to maintain a stable weight
and not increase body size over time, in
contrast to an obesity treatment
program, in which the primary goal is to
lose weight over time.
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Obesity Prevention and
Treatment Interventions
• Current recommendations for
obesity treatment:
– Lifestyle therapy - weight
management techniques, increases in
physical activity
– Behavioral therapy - goal setting
– Clinical therapies - pharmacotherapy,
weight loss surgery
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Obesity Prevention and
Treatment Interventions
• Adult Interventions
– Most adult-based obesity
interventions have centered on
clinical approaches to obesity
treatment, and thus haven’t been
largely successful.
– Worksite health promotion programs
have shown modest effects on weight
in the short term.
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Obesity Prevention and
Treatment Interventions
• Child and Adolescent Interventions
– Largely implemented in the school
environment
– Tended to be most effective when
they included a component of
decreasing television viewing
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Public Health Policy Options for
Addressing the Global Obesity Epidemic
• Although obesity is a significant
public health issue, efforts to
control obesity at the public policy
level in the United States are
lacking.
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Public Health Policy Options for
Addressing the Global Obesity Epidemic
• Obesity Surveillance and
Monitoring Efforts
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Public Health Policy Options for
Addressing the Global Obesity Epidemic
• Awareness Building, Education,
and Research
– Department of Health and Human
Services (DHHS)
• Centers for Disease Control and
Prevention (CDC)
• National Institutes of Health (NIH)
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Public Health Policy Options for
Addressing the Global Obesity Epidemic
• Awareness Building, Education,
and Research (continued)
– United States Department of
Agriculture (USDA)
– Federal Trade Commission (FTC)
– Recent Legislative Efforts
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Public Health Policy Options for
Addressing the Global Obesity Epidemic
• Regulating Environments
– The Food Environment
– The School Environment
– The Built Environment
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Public Health Policy Options for
Addressing the Global Obesity Epidemic
• Private Enforcement and Litigation
– Personal Responsibility in Food
Consumption Act (H.R. 339)
– Commonsense Consumption Act (S
1428)
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Public Health Policy Options for
Addressing the Global Obesity Epidemic
• Pricing Policies
– The U.S. Congress supports food
industries, particularly agribusiness,
through subsidies, price fixing, and
price supports.
– In response, price policies, such as
subsidies and taxing, have been
suggested as a way to reverse the
obesity epidemic.
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Public Health Policy Options for
Addressing the Global Obesity Epidemic
• Societal-Level Solutions
– In general, low socioeconomic status (SES)
groups are more likely to be obese than
their high-SES counterparts in industrialized
countries.
– Upper SES groups are more likely to be
obese in developing countries.
– In developing nations, childhood obesity is
most prevalent in wealthier sections of the
population.
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Public Health Policy Options for
Addressing the Global Obesity Epidemic
• Societal-Level Solutions (continued)
– A primary goal of public health initiatives
addressing the global obesity epidemic is to
increase the consciousness in the nonhealth sectors of the potential adverse
effects of their various actions on the ability
of people to maintain energy balance.
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Culture and education
Commerce and trade
Development
Planning
Transport
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Coordinated School Health
Programs
• Coordinated School Health
Program - CDC model that views
the school in a multidimensional
fashion, in which all components at
the school level work together to
maintain consistent, healthful
messages.
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Coordinated School Health
Programs
• Coordinated Approach To Child
Health (CATCH) program
– Probably the best example of a
coordinated school health program
that addresses both nutrition and
physical activity
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Coordinated School Health
Programs
• Goals and Objectives
– Overall goal = create healthy children
and healthy school environments
– Specific aims:
• Encourage students to consume a diet
that is low in fat and saturated fat and
higher in fruits and vegetables
• Encourage students to participate in
increased amounts of moderate to
vigorous physical activity (MVPA)
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Coordinated School Health
Programs
• Goals and Objectives
– Specific aims (continued):
• Increase MVPA in schools to 50% of the
physical education class
• Provide food in school cafeterias that is
lower in fat and saturated fat
• Encourage parental participation in the
school health program
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Coordinated School Health
Programs
• Priority Population
– Target population groups:
– Elementary school children and their
parents
– Elementary school teachers
– School administration and staff
– Main trial included a cohort of 5,106
third-grade students from 96 schools
in 4 sites
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Coordinated School Health
Programs
• Rationale for the Intervention
– Children’s diets were high in fat and
saturated fat
– Health behaviors track from childhood
into adulthood
– Therefore, changes in children’s
diets/physical activity habits would
benefit them in the future as well as
in the present
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Coordinated School Health
Programs
• Methodology
– Randomized clinical trial (main CATCH
study)
– Each of 96 schools at 4 sites was
assigned to 1 of 3 conditions:
• Control (usual health program) (n = 40)
• School-based program (n = 28)
• School-based program plus family
component (n= 28)
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Coordinated School Health
Programs
• Methodology (continued)
– Main trial followed by dissemination
phase
– Opinion leaders and change agents
were contacted
• Opinion leaders - people who influence
other people’s attitudes about a program
• Change agents - people who can
influence decisions to implement a
program
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Coordinated School Health
Programs
• Methodology (continued)
– They influenced others to adopt the
program or suggest legislative efforts
– Partnerships formed between groups with
the common goal of promoting schoolbased physical activity and nutrition
programs
– CATCH dissemination was measured using
quantitative and qualitative methods
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Coordinated School Health
Programs
• Results
– Significant changes in self-reported diet and
physical activity levels of the children
– Changes maintained for 3 years without
additional intervention
– As of October 2004:
• > 1,600 schools had adopted part of the CATCH
curriculum
• > 700 schools had been trained in coordinated
school health
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Coordinated School Health
Programs
• Lessons Learned
– It is possible to implement a schoolbased health promotion program to
change child/adolescent diet and
physical activity patterns
– Changes in diet and physical activity
do not necessarily result in changes
in related physiologic risk factors
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Coordinated School Health
Programs
• Lessons Learned (continued)
– Example of translational research
• Translational research - research in
which studies that are rigorously
evaluated under controlled conditions
and show promising results are
“translated” into community-based
interventions that are implemented in
real-life situations
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Where Do We Go From Here?
• The awareness of obesity and
overweight as a significant public health
issue is in its beginning stages.
• In general, environmental changes will
need a strong lead from policy and/or
social change.
• The roles of the community nutritionist
in this endeavor are varied and crucial.
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Cigarette Consumption and
Public Health Initiatives
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Diet Confusion: Weighing the
Evidence
• How Do Diets Work?
– Diets work because people limit their
food consumption.
– Table 8-10 compares caloric content
and macronutrient distribution of
several types of diets...
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Diet Confusion: Weighing the
Evidence
• What Are Some Common Diets?
– Common diets appearing in recent
years include the following...
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Diet Confusion: Weighing the
Evidence
• Dr. Atkins New Diet Revolution
– Consumption of high-fat meats,
cheeses, and fats is encouraged
– Consumption of carbohydrates is
severely limited
– Underlying premise = elimination of
these foods will produce “benign
dietary ketoacidosis”
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Diet Confusion: Weighing the
Evidence
• The Zone Diet
– Rigid eating plan that separates foods
into “macronutrient blocks”
• The South Beach Diet
– More healthful version of the Atkins
diet
– Incorporates lower-fat protein
sources such as chicken, fish, whole
grains, vegetables and fruits
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Diet Confusion: Weighing the
Evidence
• Weight Watchers
– Dieters may use a list of core foods or a
point system to select and eat foods to
reduce caloric intake
• Dr. Ornish Eat More, Weigh Less
– A very-low-fat diet with little meat, oils,
nuts, butter, dairy (except non-fat), sweets,
or alcohol
– Original Ornish plan included exercise and
stress reduction
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Diet Confusion: Weighing the
Evidence
• Eat Right for Your Blood Type
– Based on the claim that your blood
type determines the types of foods
that you should eat and how your
body absorbs nutrients
– [Pause for uproarious laughter]
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Diet Confusion: Weighing the
Evidence
• Dr. Phil’s Ultimate Weight Solution
– Book focuses on “Keys to Weight Loss
Freedom”
– No defined meal plans or recipes
– Promotes seafood, poultry, meat,
low-fat dairy, whole grains, fruits,
vegetables, some oils, supplements,
weight-loss bars and shakes
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Diet Confusion: Weighing the
Evidence
• The New Glucose Revolution
– Encourages consumption of lowglycemic foods, such as beans, pasta,
most fruits, vegetables, low-fat dairy,
and meats
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Diet Confusion: Weighing the
Evidence
• How Can You Evaluate a Diet to
Determine Whether It Is Healthful?
– Does the weight-loss program
systematically eliminate one group of foods
from a person’s eating pattern?
– Does the weight-loss program encourage
specific supplements or foods that can be
purchased only from selected distributors?
– Does the weight-loss program tout magic or
miracle foods or products that burn fat?
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Diet Confusion: Weighing the
Evidence
• How Can You Evaluate a Diet? (cont.)
– Does the weight-loss program promote
bizarre quantities of only one food or one
type of food?
– Does the weight-loss program have rigid
menus?
– Does the weight-loss program promote
specific food combinations?
– Does the weight-loss program promise a
weight loss of more than 2 pounds per
week for an extended period of time?
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Diet Confusion: Weighing the
Evidence
• How Can You Evaluate a Diet? (cont.)
– Does the weight-loss program provide a
warning to people with diabetes, high blood
pressure, or other health conditions?
– Does the weight-loss program encourage or
promote increased physical activity?
– Does the weight-loss program encourage an
intake that is very low in calories (below
800 kcal/d) without supervision of medical
experts?
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Diet Confusion: Weighing the
Evidence
• What Can You Do?
– Be familiar with the current fad diets.
– Recommend appropriate weight-loss
strategies and programs.
– Refer the public to websites that list
resources for determining whether a
diet is a fad.
– Report fraudulent or deceptive
weight-loss claims.
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