The Childhood Obesity Epidemic
Articles Blog

The Childhood Obesity Epidemic

November 9, 2019


>>>GOOD MORNING, EVERYBODY, AND
WELCOME TO THE TENTH PUBLIC HELD GRAND ROUNDS. IT’S UNBELIEVABLE. I WAS JUST TALKING TO A COUPLE
OF PEOPLE A FEW MOMENTS AGO THAT TEN MONTHS AGO WHEN WE STARTED
THIS, WE COULD BARELY GET PEOPLE TO COME IN BECAUSE THIS WAS
GOING TO BE ANOTHER TALK AND SERIES OF WHATEVER. AND RIGHT NOW, WE’RE HAVING
PEOPLE COMING TO US AND WANTING TO GET THEIR TOPICS ON THE
AGENDA BECAUSE THEY UNDERSTAND THERE IS GOING TO BE A LARGE
NUMBER OF PEOPLE AT CDC AND EVEN LARGER AUDIENCE OUTSIDE OF CDC. SO LET ME JUST SAY A FEW OH
OBLIGATORY AND COUPLE OF OTHER WORDS JUST TO REMIND EVERYBODY,
BECAUSE WE GET THIS QUESTION ALL THE TIME, THAT THIS COULD BE
VIEWED BY EVERYBODY WITHIN CDC. IT’S ON OUR INTRANET ON THE
DIRECTOR’S PAGE. BUT ALSO, IT CAN BE VIEWED BY
ANYBODY WHO HAS INTERNET ACCESS ANYWHERE IN THE WORLD. AND WE ARE GETTING, REALLY PROUD
TO SAY, MORE AND MORE VIEWERS OUTSIDE OF CDC. THE LAST TIME, IT WAS RECORD
BREAKING CHLAMYDIA. YOU CAN DRAW THE — WHATEVER
CONCLUSIONS YOU WANT. OVER 14,000 PEOPLE WATCHED US
LIVE OUTSIDE OF CDC. AND WE ESTIMATE THAT IT’S
ANOTHER 1,000 PEOPLE WITHIN CDC, SO THIS WAS RECORD BREAKING. SOME OF YOU WHO MAY HAVE BEEN
HERE REMEMBER THAT, YOU KNOW, OUR AUDIENCE IS GETTING BIGGER
AND BIGGER AND THIS WAS LIKE AFTER A FEW MONTHS, WE HAD
MASSIVE CROWDS. THEN WE WANTED TO MOVE TO THE
JON STEWART SHOW AND SOMEHOW THAT DIDN’T, LIKE, WORK OUT. AND SO NOW WE’RE ATTACKING THE
YOUTUBE. NOW, THIS ONE IS NOT WISHFUL
THINKING. I WOULD LIKE TO INTRODUCE VERY
QUICKLY SHANE JOINER. SHANE, WHERE ARE YOU? WHERE IS HE? HE STEPPED OUTSIDE. OH, THERE HE IS. COME ON IN AND WAVE. I REALLY WANTED PEOPLE TO SEE
WHO HE IS. SHANE IS NOT THE YOUTUBE GUY,
BUT THE PERSON WHO DIRECTS SO MANY ASPECTS OF THESE EVENTS
FROM MEDIA COMMUNICATIONS, POLICY, EVERYTHING ELSE. AND HE IS THE ONE WHO IS GOING
TO MAKE IT POSSIBLE. HE IS WORKING WITH YOUTUBE
PEOPLE TO HAVE US BE ON THEIR — SO THAT WE CAN BE CLICKBLE AND
THAT YOU CAN ACTUALLY WATCH US THROUGH YOUTUBE. AND HE EXPLAINS TO ME THAT THAT
IS BETTER BECAUSE WHEN YOU SEARCH FOR THE GRAND ROUNDS, YOU
CAN BE MUCH EASIER TO FIND US AND ALSO BECAUSE OF THE
CAPACITIES OF THEIR SERVER, IT’S GOING TO BE A BETTER RECEPTION. SO I WANTED TO RECOGNIZE SHANE
FOR THAT KIND OF WORK. ALSO, WE HAVE BEEN POINTING OUT
A RELATIVELY NEW ACTIVITY THAT’S BEEN GOING ON FOR ABOUT A YEAR,
AND THAT’S THE SCIENCE CLIPS, WHICH ARE NOW COORDINATED WITH
THE EVENTS ON THE ROUNDS. AND SO HERE, I DO WANT TO
RECOGNIZE DEB PRELUSCA, FOR HER SELECTION OF THE OBESITY TOPICS
OF THIS WEEK. WE ARE CONTINUING WITH THE
CONTINUING EDUCATION CREDITS. THOSE WHO ARE INTERESTED, PLEASE
GO TO THE WEB PAGE AND MAKE SURE YOU CAN GET CREDIT FOR BEING
PART OF THIS. WE ARE ALSO CONTINUING WITH
SUBMITTING OUR EDITORIALS OR COMMENTARIES. THE FIRST ONE CAME A COUPLE OF
MONTHS AGO ON TOBACCO. WE JUST SUBMITTED ONE YESTERDAY
AND IT WAS ACCEPTED ON RADIOLOGICAL AND NUCLEAR
PREPAREDNESS. AND OUR NEXT ONE IS GOING THE BE
COMING SOON. SO ALL OF THESE ARE TURNING INTO
PUBLICATIONS. THIS IS THE LIST OF TOPICS
COMING UP IN THE NEXT FEW MONTHS, SO PLEASE STAY TUNED. AND SINCE DR. FRIEDEN IS NOT
HERE TODAY WITH US, BUT HE IS WITH US IN SPIRIT AND TRUST ME,
ON E-MAIL, AND WITH COMMENT, VERY INTENSIVELY, WE’RE GOING TO
HAVE A FEW TAPED COMMENTS FROM HIM. >>TODAY WE’RE GOING TO TALK
ABOUT ONE OF THE MOST SEAR WHY YOU EPIDEMICS IN THE U.S.,
OBESITY. OBESITY COSTS ABOUT $150
TRILLION A YEAR TO EAT. IT’S LINKED TO AN UNHEALTHY
ENVIRONMENT THAT INVOLVES OVERCONSUMPTION OF SUGAR, SALT
AND FAT. CHILDREN ARE PARTICULARLY AT
RISK. AS YOU’LL SEE IN THIS SESSION,
CHANGING THE FOOD ENVIRONMENT IS CRITICAL TO EMPOWERING AMERICANS
TO LIVE HEALTHIER LIVES. THE FIRST LADY LET’S MOVE
CAMPAIGN REPRESENTS A FANTASTIC OPPORTUNITY TO MOBILIZE EVERY
SECTOR OF SOCIETY TO HELP FAMILIES MAKE HEALTHIER CHOICES,
IMPROVE NUTRITION IN OUR SCHOOLS, INCREASE PHYSICAL
ACTIVITY AND EXPAND ACCESS TO HEALTHY AND AFFORDABLE FOODS. REVERSING THE OBESITY EPIDEMIC
IS A LEADING HEALTH CHALLENGE OF OUR TIME. KEY ROLES FOR CDC INCLUDE BETTER
UNDERSTANDING THE EPIDEMIC AND HELPING STATE GOVERNMENTS AND
LOCAL COMMUNITIES TO IMPLEMENT AND RIGOROUSLY EVALUATE
PROGRAMS. THANK YOU. >>AND SO WITH THAT, WE’RE GOING
TO BURST THE BUBBLE OF OUR SPEAKERS. BETWEEN TOM AND ME, WE’RE GOING
TO TELL YOU EVERYTHING YOU NEED TO KNOW. THE NEXT THING THAT I DO WANT TO
MENTION IS THAT OBESITY HAS ALWAYS BEEN AN IMPORTANT TOPIC,
OBVIOUSLY. NOT ONLY FOR THE PEOPLE WHO ARE
WORKING ON THIS. BUT A COUPLE OF WEEKS AGO, ON MY
BIRTHDAY, JUNE 2nd, OUR CURRENT SURGEON GENERAL ACTUALLY HAD AN
INTERVIEW IN JMI AND POINTED OUT THAT PHYSICAL ACTIVITY, OBESITY,
NUTRITION IS ONE OF HER TOP PRIORITIES. AND THEN YESTERDAY, AS I WAS
DRIVING HOME, LISTENING TO THE NEWS, I HEARD ABOUT PRESIDENT
BILL CLINTON’S HEALTHIEST SCHOOL INITIATIVE IN GEORGIA. AND ACTUALLY, THEY WERE SAYING
— AND I PICKED IT UP FROM THE WEB THIS MORNING THAT
THERE ARE SEVEN SCHOOLS IN GEORGIA THAT HAVE BEEN
RECOGNIZED IN ATLANTA FOR ALL KINDS OF ACTIVITIES THEY HAVE
BROUGHT TO IMPROVE HEALTH AND OBESITY AND NUTRITION IN SCHOOL. SO THIS IS REALLY MORE THAN
TIMELY AGAIN THAT WE’RE TALKING ABOUT THIS. NOW, AS WE HAVE MOVED OVER TIME,
WE HAVE HAD MORE AND MORE WOMEN PARTICIPATING IN THESE EVENTS
AND AS I ALWAYS SAY, WOMEN RULE. SO HERE IS A SPECTACULAR TRIO OF
WOMEN WHO WILL BE TALKING AND GIVING THEIR PRESENTATIONS TO
YOU TODAY. BUT HOWEVER, YOU ALWAYS HAVE TO
HAVE SOMEBODY COORDINATING THE EVENTS. AND SO, YOU KNOW, OUR
COORDINATOR OF THE DAY AND THE IRONMAN OF THE DAY IS BILL
DIETZ, WHO IS THE KEY PERSON FOR OBESITY, NUTRITION AT CDC. SO ALLOW ME JUST TO SAY WHAT WE
WILL BE DOING IS YOU WILL BE HEARING, YOU KNOW, 01 ON
OBESITY. WE WILL MOVE TO WHAT THE
CHALLENGES AND OPPORTUNITIES ARE. BILL WILL ADDRESS THAT. WE WILL HAVE JUDITH BELL TALK
ABOUT BIG CHANGES, POLICIES AND SYSTEM CHANGES THAT ARE NEEDED
TO MOVE THINGS. THEN, AS DR. FRIEDEN SAYS, WE
WANT TO SEE HOW IT IS ALL DONE AND HOW IT ALL FITS WHEN IT
COMES HAPPENING AT THE STATE LEVEL. SO VICTORIA ROGERS IS GOING TO
CLOSE WITH THAT. SO I AM INVITING OUR FIRST
SPEAKER, CYNTHIA OGDEN, TO COME UP HERE AND I CAN GOING TO GET
YOUR SLIDES GOING. >>GOOD MORNING. MY NAME IS CYNTHIA OGDEN AND I’M
WITH THE NATIONAL CENTRAL FOR HEALTH STATISTICS. MY CHARGE TODAY IS TO LAY THE
GROUND WORK, TO SHOW WHO IS OBESE, DEFINE CHILDHOOD OBESITY
AND DISCUSS THE CONSEQUENCES OF CHILDHOOD OBESITY. WE ALL KNOW THAT THE LEVEL OF
CHILDHOOD OBESITY IS HIGH IN THE UNITED STATES. IN FACT, BASED ON MEASURED DATA
FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY, WE
KNOW THAT 12.5 MILLION CHILDREN AND TEENS ARE OBESE. ALMOST 12.5 — ALMOST 17%. THE RATE IS TWICE AS HIGH AMONG
ADULTS. 34% OF ADULTS ARE OBESE, ALMOST
73 MILLION MEN AND WOMEN. OUR FOCUS TODAY ON CHILDHOOD
OBESITY, BUT CHILDREN EVENTUALLY BECOME ADULTS. AMERICAN ADULTS ARE, ON AVERAGE,
24 POUNDS HEAVIER TODAY THAN THEY WERE IN 1960. DIABETES, A SERIOUS CONSEQUENCE
OF OBESITY, AFFECTS 23.5 MILLION OR 10.7% OF AMERICAN ADULTS. MORE THAN HALF OF THESE
INDIVIDUALS ARE OBESE. OBESITY REFERS TO EXCESS FAT
TISSUE, BUT THIS IS IMPRACTICAL TO MEASURE, CLINICALLY OR IN
EPIDEMIOLOGIC STUDIES. CONSEQUENTLY, EXCESS WEIGHT FOR
HEIGHT, WHICH IS EASY TO OBTAIN, IS USED AS A POROSITY FOR
OBESITY. THE MOST WIDELY USED INDEX IS
BMI, BODY MASS INDEX, DEFINED AS WEIGHT AND KILOGRAMS BY WEIGHT
PER METERS SQUARED. BMI DOES NOT DISTINGUISH BETWEEN
BODY FAT AND MUSCLE. USING BMI IN CHILDREN IS MORE
COMPLICATED THAN USING BMI IN ADULTS. UNLIKE IN ADULTS, THERE ARE NO
SET RISK BASE CUTOFFS IN BMI USED TO DEFINE OBESITY. AND THE BMI IN CHILDREN VARIES
WITH AGE AND SEX MORE THAN IT DOES IN ADULTHOOD. SUBSEQUENTLY, A STATISTICAL BMI
IS USED. CHILDREN’S BMIs ARE COMPARED TO
A REFERENCE POPULATION OF THE SAME AGE AND SEX. IN THE UNITED STATES, THE
REFERENCED POPULATION USED IS THE BMI FOR AGE, 2000 CDC GROWTH
CHART WHICH REPRESENTS THE U.S. POPULATION FOUR DECADES AGO. CHILDREN AT OR ABOVE SEX
SPECIFIC 95th PERCENTILE ARE CONSIDERED OBESE. THOSE IN THE 85th TO 96th
PERCENTILE ARE CONSIDERED OVERWEIGHT. TODAY I AM USING THE 97th
PERCENTILE AS A CUTOFF FOR SEVERE OBESITY. CHILDREN BETWEEN THE 5th AND THE
85th PERCENTILE ARE CONSIDERED HEALTHY WEIGHT. TO BRING THIS DISCUSSION BACK TO
ACTUAL CHILDREN, HERE, YOU CAN SEE A CHILD CONSIDERED A HEALTHY
WEIGHT USING THE BMI FOR AGE DEFINITION. THIS CHILD IS CONSIDERED
OVERWEIGHT. AND THIS CHILD IS CONSIDERED
OBESE. BMI IS NOT A PERFECT MEASURE OF
BODY FAT. YOU SEE HERE THE PERCENT OF
GIRLS WITH EXCESS BODY FAT WITHIN BMI CATEGORY. OBESITY IS CLEARLY ASSOCIATED
WITH BODY FAT. THE MAJORITY OF GIRLS IN THE
OBESE CATEGORY HAVE HIGH BODY FAT. IN THE OVERWEIGHT CATEGORY,
HOWEVER, MORE THAN HALF OF U.S. GIRLS DO NOT HAVE HIGH BODY FAT. MOREOVER, THERE ARE SIGNIFICANT
DIFFERENCES IN BODY FAT BETWEEN RACE ETHNIC GROUPS OF THE SAME
BMI LEVEL. AFRICAN-AMERICAN GIRLS ARE
SIGNIFICANTLY LESS LIKELY THAN NONHIS PANIC WHITES TO HAVE
EXCESS BODY FAT IN THE THREE BMI CATEGORY. THIS DIFFERENCE IS PARTICULARLY
STRIKING IN THE OVERWEIGHT CATEGORY. A SIMILAR PICTURE IS SEEN AMONG
BOYS. TURNING TO OBESITY TRENDS, WE
CAN SEE A RAPID INCREASE IN THE PREVALENCE IN THE 1980s AND
1990s. THE PREVALENCE OF OBESITY AMONG
CHILDREN AND TEENS TRIPLED FROM APPROXIMATELY 5% TO MORE THAN
15% IN 20 YEARS. DURING THE LAST TEN YEARS,
HOWEVER, THE RAPID INCREASE IN PREVALENCE SEEN IN PREVIOUS
DECADES HAS SLOWED. IN FACT, THERE WERE NO
SIGNIFICANT TRENDS IN OBESITY PREVALENCE AMONG CHILDREN AND
TEENS. UNFORTUNATELY, AMONG BOYS 16 TO
19 MONTHS OF AGE, THERE WAS A SIGNIFICANT INCREASING TREND IN
SEVERE OBESITY. THE PREVALENCE OF SEVERE OBESITY
ROSE FROM 9.3 TO 15.1% OVER THE LAST DECADE. THE HEAVIEST BOYS ARE GETTING
HEAVIER AND THIS WAS DRIVEN BY AN INCREASE AMONG NONHIS PANIC
WHITE BOYS. SIGNIFICANT DISPARITIES EXIST. HIS PANIC BOYS AND
AFRICAN-AMERICAN GIRLS ARE DISPROPORTIONATELY AFFECTED. COB TEAR TO POPULAR OPINION, THE
RELATIONSHIP BETWEEN SOCIOECONOMIC STATUS IS NOT
CONSISTENT AMONG RACE AND ETHNIC GROUP. AMONG WHITES, THERE IS AN
INVERSION ASSOCIATION. FOR EXAMPLE, A SIGNIFICANT
INVERSE RELATIONSHIP EXISTS AMONG NONHIS PANIC WHITE BOYS,
BUT NOT AMONG AFRICAN-AMERICANS OR MEXICAN AMERICAN BOYS. THE BOTTOM LINE IS THAT OBESITY
IS A CONCERN FOR OUR ENTIRE POPULATION, NOT JUST BEFORE. THE LEVELS ARE NOT DIFFERENT
AMONG THE MIDDLE CLASSES COMPARED TO THE POOR. THE COSTS OF OBESITY HAVE
INCREASED DRAMATICALLY IN THE LAST TEN YEARS. ONE ESTIMATE PUT THE COST AT
$147 BILLION ANNUALLY OVER 9% OF ALL MEP MEDICAL COSTS IN 2008,
UP FROM $78.5 BILLION IN 1998. APPROXIMATELY HALF OF THESE
COSTS ARE PAID BY MEDICAID AND MEDICARE. THESE DATA SUGGESTS THAT OBESITY
IN CHILDHOOD PERSISTENT TO ADULTHOOD MAY CONTRIBUTE
DISPROPORTIONATELY TO THE COST OF OBESITY. IN THE SHORT RUN, CHILDHOOD
OBESITY CAN LEAD TO PSYCHO SOCIAL PROBLEMS AND METABOLIC
SYNDROME, HIGH BLOOD PRESSURE, HIGH CHOLESTEROL AND ABNORMAL
GLUCOSE TOLERENCE IN DIABETES. 30% HAVE TWO OR MORE RISK
FACTORS. ALTHOUGH THE PREVALENCE OF TYPE
II DIABETES IN TEENS IS VERY LOW, A RECENT REPORT ESTIMATES
THAT TYPE II DIABETES REPRESENTS ABOUT 15% OF NEW CASES AMONG
CHILDREN AND ADOLESCENTS WHEN IT WAS VIRTUALLY UNHEARD OF THREE
DECADES AGO. BLACKS, HIS PANICS AND AMERICAN
INDIANS ARE OVERREPRESENTED IN THIS GROUP. CHILDHOOD OBESITY HAS LONG-TERM
CONSEQUENCES. OBESITY IN CHILDHOOD TRACKS TO
ADULTHOOD. OBESE CHILDREN OFTEN BECOME
OBESE ADULTS AND OBESE ADULTS ARE AT INCREASED RISKS FOR MANY
HEALTH CONDITIONS, SUCH AS DIABETES, CARDIOVASCULAR DISEASE
AND CANCER. THIS RELATIONSHIP IS STRONGER IN
OLDER CHILDREN. ALTHOUGH THERE IS VARIATION IN
STUDY RESULTS, IN ONE STUDY, 87% OF OBESE ADOLESCENTS BECAME
OBESE ADULTS AND 39% OF THESE OBESE ADOLESCENTS BECAME
SEVERELY OBESE ADULTS. RISK FACTORS IN CHILDHOOD CAN
BECOME DISEASES IN ADULTHOOD. IN SOME, THERE IS A CHILDHOOD
OBESITY CRISIS IN THE UNITED STATES. ALTHOUGH BMI IS AN IMPERFECT
MEASURE OF BODY FAT, THE PREVALENCE HAS TRIPLED SINCE
1980. BUT THE RAPID INCREASE HAS
SLOWED. THE ONLY SIGNIFICANT INCREASE IN
PREVALENCE SEEN DURING THE LAST DECADE WAS THE PREVALENCE OF
SEVERE OBESITY IN BOYS 6 TO 19 YEARS OF AGE. HIS PANIC BOYS AND
AFRICAN-AMERICAN GIRLS ARE AMONG THOSE WITH THE HIGHEST RATES. CHILDHOOD OBESITY HAS SEVERUS
CONSEQUENCES, INCLUDING SIGNIFICANT FINANCIAL BURDEN,
INCREASES IN CARDIOVASCULAR RISK FACTORS AND THE PRECURSORS TO
DIABETES. AND OVER THE LONG-TERM,
CHILDHOOD OBESITY OFTEN TRACKS TO ADULTHOOD. THANK YOU. OUR NEXT PRESENTER IS OUR
COLLEAGUE, DR. BILL DIETZ. >>THANK YOU, CYNTHIA. GOOD MORNING. MY NAME IS BILL DIETZ. DISEASE PREVENTION AND HEALTH
PROMOTION. TODAY I’M GOING TO DISCUSS THE
APPROPRIATE BEHAVIORS AND TARGETS AND STRATEGIES TO
ADDRESS THEM AND SEVERAL EXAMPLES FROM THE FIELD THAT
DEMONSTRATES THE EFFICACY OF INTERVENTION AND PROGRESS BEING
MADE. THE SHIFTS IN BMI IN ADOLESCENCE
AS CYNTHIA DESCRIBED CAN BE ACCOUNTED FOR BY 110 TO 105
CALORIES A DAY BETWEEN 1988 AND 2002. THIS MODEST IMBALANCE LIKELY
RESULTS FROM MULTIPLE SMALL CHANGES IN ENERGY INTAKE AND
ENERGY EXPENDITURE. THIS PHOTOGRAPH SHOWS WHAT AN
AVERAGE AMERICAN OF FAMILY OF FOUR CONSUMED IN 1952. NOTICE THE ALMOST COMPLETE
ABSENCE OF PROCESSED FOODS. CONTRAST 1952 WITH TODAY’S
FAMILY SHOWN HERE WITH THE FOOD THAT THEY CONSUMED WITHIN THE
COURSE OF A WEEK. NOTE THE NUMBER OF HIGH CALORIE
FOODS AND LESS FRUITS AND VEGETABLES. THESE CHANGES REFLECT MULTIPLE
CHANGES IN THE FOOD SUPPLY, THE DECREASED COST OF FOODS HIGH IN
FAT AND SUGAR AS WELL AS A VARIETY OF FOODS. THESE FACTORS COMBINE TO
INCREASE THE INTAKE OF LESS HEALTHFUL FOODS AND REDUCE THE
INTAKE OF HEALTHIER OPTIONS. ALTHOUGH THE CHANGES IN PHYSICAL
ACTIVITY ARE HARDER TO DOCUMENT, THIS GRAPH SHOWS PHYSICAL
ACTIVITY IS PART OF DAILY LIFE FOR CHILDREN HAS CHANGED
SUBSTANTIALLY OVER THE LAST 40 YEARS. WALKING AND BIKING TO SCHOOL HAS
DECREASED WHILE CAR TRANSPORT HAS INCREASED. THESE SHIFTS REFLECT CHANGES IN
COMMUNITY DESIGN AS WELL AS CONCERN ABOUT CHILD SAFETY. TELEVISION TIME IS ALSO
ASSOCIATED WITH OBESITY. FOOD IS HEAVILY MARKETED TO
CHILDREN ON TELEVISION AND THE MORE TELEVISION THAT CHILDREN
WATCH, THE MORE LIKELY THEY ARE TO EAT WHILE WATCHING TELEVISION
AND THE FOODS THEY CONSUME ARE THOSE ADVERTISED ON TELEVISION. TELEVISION IN CHILDREN’S ROOMS
INCREASES TELEVISION TIME AND ALSO INCREASES THE RISK OF
CHILDHOOD OBESITY. TO REDUCE CHILDHOOD OBESITY, WE
BELIEVE THAT THE IDENTIFICATION OF CAUSES LESS IMPORTANT THAN
THE IDENTIFICATION OF EFFECTIVE INTERVENTION. THERE ARE MANY EXAMPLES IN
MEDICINE OF EFFECTIVE THERAPIES FOR DISEASE WHERE THE CAUSE HAS
NOT BEEN IDENTIFIED. FOR MAXIMAL POPULATION IMPACT,
WE SHOULD FOCUS ON POPULATION STRATEGIES THAT ALTER THE FOOD
AND PHYSICAL ENVIRONMENTS IN PLACES WHERE PEOPLE LIVE, LEARN,
WORK, PLAY AND PRAY. INTERVENTIONS AIMED AT SINGLE
TARGETS ARE UNLIKELY TO HAVE A SIGNIFICANT IMPACT. LIKE TOBACCO, MULTI SECTORAL
COMPREHENSIVE NEED TO BE THE GOAL AND RELY ON PRACTICE BASED
EVIDENCE. I WOULD LIKE NOW TO TURN TO NEW
OPPORTUNITIES FOR OBESITY PREVENTION AND CONTROL. THIS INCLUDES LET’S MOVE. LET’S MOVE ALSO INCLUDED
ESTABLISHMENT OF AN INTERGOVERNMENTAL CHILDHOOD
OBESITY TASK FORCE, WHICH ADDED CHILD CARE AND PREGNANCY TO THE
PILLARS OF LET’S MOVE. AN HHS HEALTHY WEIGHT TASK FORCE
IS DEVELOPING BROAD SECTORS AND YOU WILL HEAR FROM JUDITH BELL
ABOUT THE CONVERGENCE PARTNERSHIP. TWO OTHER PROGRAMS WITH FUNDS
FROM THE AMERICAN RECOVERY AND REINVESTMENT ACT PROVIDE KEY
LEARNING LABORATORIES FOR NUTRITION AND PHYSICAL ACTIVITY
STRATEGIES. THESE PROGRAMS INCLUDE
COMMUNITIES PUTTING PREVENTION TO WORK, WHICH PROVIDES 373
MILLION DOLLARS FOR 44 COMMUNITIES. 30 OF THESE COMMUNITIES ARE
FOCUSED ON NUTRITION AND PHYSICAL ACTIVITY. IN ADDITION TO THE 25 STATES WE
WITH ALREADY FUND TO ADDRESS NUTRITION AND PHYSICAL ACTIVITY,
A STATE AND TERRITORIAL INITIATIVE PROVIDES $120 MILLION
FOR ALL STATES, AND ADDITIONAL FUNDS FOR EIGHT STATES TO FOCUS
ON NUTRITION AND PHYSICAL ACTIVITY. THESE PROGRAMS PROVIDE
OPPORTUNITIES TO EXAMINE THE IMPACT OF INTENSIVE
INTERVENTIONS AT THE STATE AND COMMUNITY LEVEL. OUR STATE AND COMMUNITY PROGRAMS
ARE EXPECTED TO ADDRESS MANY OF THROUGH POLICY AND ENVIRONMENTAL
CHANGES. I WILL FOCUS ON INTERVENTIONS
THAT PROMOTE BREAST-FEEDING, REDUCE ENERGY INTAKE AND
INCREASE ENERGY EXPENDITURE. BREAST-FEEDING HAS SUBSTANTIAL
BENEFITS FOR CHILDREN AND REDUCES THE RISK OF EARLY
CHILDHOOD OBESITY. HOWEVER, OUR MOST RECENT DATA
INDICATES THAT ALMOST 30% OF MOTHERS CHOOSE NOT TO
BREAST-FEED AND ONLY ABOUT 40% OF INFANTS ARE STILL BRETT FED
AT SIX MONTHS OF AGE. A STUDY OF MOTHER’S EXPERIENCES
DURING THEIR MATERNITY CARE HOSPITAL STAY FOUND THAT THE
NUMBER OF BABY FRIENDLY STEPS THE MOTHER PRESENTED IN THE
HOSPITAL EFFECTIVELY PREDICTED HER BREAST-FEEDING DURATION. THESE INCLUDED EARLY
INITIATATION OF BREAST-FEEDING, GROOMING IN AND SEVERAL OTHER
STRATEGIES. NONETHELESS, FEW MATERNITY
HOSPITALS CURRENTLY SUPPORT THESE PRACTICES. SODA AND JUICE ARE THE BIGGEST
CONTRIBUTORS TO EXCESS ENERGY INTAKE IN YOUTH AND SUBSTITUTION
OF WATER TOER SUGAR SWEETENED BEVERAGES CAN REDUCE CALORIC
INTAKE A TAKE BY 255 CALORIES. HOWEVER, THE REDUCTION IN SUGAR
SWEETENED BEVERAGES IS ONLY A FRACTION OF THE TOTAL CALORIES
DERIVED FROM SUGAR SWEETENED BEVERAGES. STRATEGIES TO FURTHER DECREASE
THE INTAKE OF SUGAR SWEETENED BEVERAGES INCLUDE REGULATIONS
THAT ELIMINATE SUGAR SWEETENED BEVERAGES, THE INCREASED
AVAILABILITY OF FRESH WATER IN PARKS AND RECREATION FACILITIES
AND LOWER PRICES FOR HEALTHIER OPTIONS IN VENDING MACHINES. HALF OF ALL THE MONEY SPENT ON
FOOD OUTSIDE THE HOME IS SPENT ON FAST FOOD. SEVERAL YEARS AGO, DISNEY
CHANGED THE DEFAULT CHOICE FOR CHILDREN’S MEALS IN ITS THEME
PARKS TO FRUIT AND MILK WITH NO APPARENT CHANGE IN REVENUE. SEVERAL WEEKS AGO, 16 COMPANIES
THAT ARE MEMBERS OF THE HEALTHY WEIGHT COMMITMENT AND PROVIDE
25% OF THE U.S. FOOD SUPPLY ANNOUNCED THAT THEY WOULD CHANGE
THEIR PRODUCT TO REDUCE CALORIES BY APPROXIMATELY 12.5 CALORIES
PER CAPITA BY 2015. FINALLY, PURCHASING STRATEGIES
BY INSTITUTIONS SUCH AS CHILD CARE CAN REDUCE THE AVAILABILITY
OF HIGH CALORIE FOODS. THE RELATIONSHIP OF TELEVISION
TIME TO CHILDHOOD OBESITY APPEARS MEDIATED BY THE $800
MILLION THAT COMPANIES SPEND ANNUALLY TO PROMOTE HIGH CALORIE
FOODS TO CHILDREN. STRATEGY TOES REDUCE THE IMPACT
OF ADVERTISING INCLUDE LIMITING EXPOSURE BY REDUCING TELEVISION
TIME. THIS STRATEGY INCLUDES
REGULATIONS THAT LIMIT TV TIME IN CHILD CARE SETTINGS AND
KEEPING TELEVISIONS OUT OF CHILDREN’S BEDROOMS. COMPANIES THAT ACCOUNT FOR OVER
TWO-THIRDS OF CHILDREN’S FOOD AND DRINK ADS ON TELEVISION HAVE
AGREED TO LIMIT FOODS ADVERTISED TO CHILDREN IN AN AGREEMENT
KNOWN AS THE CHILDREN’S FOOD AND BEVERAGE ADVERTISING INITIATIVE. HOWEVER, ONE STUDY HAS SHOWN
ONLY MODEST SHIFTS IN THE PRODUCTS ADVERTISED. A WORKING GROUP CONSISTING OF
FOUR FEDERAL AGENCIES HAS RECENTLY PROPOSED MORE RIGOROUS
STANDARDS FOR FOODS ADVERTISING IN CHILDREN, BUT THESE HAVE NOT
YET BEEN FORMALLY RELEASED FOR COMMENT YET IN THE FEDERAL
REGISTER. PHYSICAL ACTIVITY PLAYS AN
IMPORTANT ROLE IN THE PREVENTION OF OBESITY AND CAN REDUCE THE
HYPER LIPIDEMIA AND ELEVATED PRESSURE ASSOCIATED WITH
EPIDEMIOLOGY EVEN IF WEIGHT IS BEING MAINTAINED. PROVIDING CHILDREN WITH SAFE
ROUTES FOR WALKING OR BIKING TO SCHOOL OFFERS AN OPPORTUNITY TO
REDUCE CAR TRAFFIC AROUND SCHOOLS AND INCREASE ACTIVITY. LIKEWISE, RECREATION OF PHYSICAL
EDUCATION POLICEMANS IN SCHOOLS PROVIDES A SAFE ENVIRONMENT IN
WHICH CHILDREN CAN BE PHYSICALLY ACTIVE. RECENT ANALYSIS BY CDC’S
DIVISION OF ADOLESCENCE IN SCHOOL BASED PHYSICAL ACTIVITY
HAS A POSITIVE IMPACT ON ACADEMIC PERFORMANCE. AN EXAMPLE OF A SCHOOL BASED
PLAN IN PHILADELPHIA INDICATES REDUCED TELEVISION TIME,
INCREASED PHYSICAL ACTIVITY AND INCREASED FRUITS AND VEGETABLE
INTAKE. THE INTERVENTION WAS BASED ON
CDC’S SCHOOL HEALTH GUIDELINES FOR NUTRITION AND INCLUDED
CHANGES IN THE SCHOOL FOOD SUPPLY TO MEET THE DIE TEAR
GUIDELINES FOR AMERICANS. THE TWO-YEAR INTERVENTION
RESULTED IN A 50% REDUCTION IN THE INCIDENCE OF OVERWEIGHT AND
A 10% REDUCTION IN THE PREVALENCE OF OVERWEIGHT. BOTH INACTIVITY AND TELEVISION
VIEWING DECLINED. IN SUMMARY, POLICY AND
ENVIRONMENTAL INTERVENTION SHOW EARLY EVIDENCE OF EFFICACY. NONETHELESS, WE NEED MORE
STUDIES OF IMPACT AND EFFECTIVENESS AND WE NEED TO
IDENTIFY AND VAULT PROMISING APPROACHES FROM THE MANY
EXPERIMENTS GOING ON AROUND THE COUNTRY. ALTHOUGH DECREASED CONSUMPTION
OF SODA AND JUICES IN SCHOOLS AND THE REDUCTION OF CALORIES IN
THE FOOD SUPPLY ANNOUNCED BY THE HEALTHY WEIGHT COMMITMENT ARE
STEPS IN THE RIGHT DIRECTION, THEY ONLY ACCOUNT FOR A FRACTION
OF THE CALORIE GAP ASSOCIATED WITH OBESITY. ADDITIONAL EFFORTS ARE NEEDED TO
REDUCE THIS GAP EVEN FURTHER. FINALLY, THE COMBINATION AND
DOSE OF STRATEGIES TO CONTROL CHILDHOOD OBESITY IS STILL
UNCERTAIN. HOWEVER, THE HIGH VISIBILITY
ACCORDED TO CHILDHOOD OBESITY BY THE LET’S MOVE INITIATIVE AND
THE STATES AND COMMUNITIES FUNDED BY COMMUNITIES PUTTING
PREVENTION TO WORK PROVIDE US WITH AN UNPARALLELED
OPPORTUNITIES TO REVERSE THE OBESITY EPIDEMIC. THANK YOU. IT’S NOW MY PLEASURE TO
INTRODUCE JUDITH BELL WITH THE POLICY LANGUAGE. >>GOOD MORNING. I’M JUTH YITH BELL AND I’M THE
PRESIDENT OF POLICY LINK AND THE PROGRAM DIRECTOR FOR THE HEALTHY
EATING, ACTIVE LIVING NATIONAL CONVERGENCE PARTNERSHIP. I WILL START WITH A BRIEF
INTRODUCTION OF POLICY LINK AND THE CONVERGENCE PARTNERSHIP AND
DISCUSS THE PARTNERSHIP’S EFFORTS FOCUS ON ACCESS TO
HEALTHY FOOD, BUILDING THE FIELD LOCALLY AND REGIONALLY AND THE
BLD BUILT ENVIRONMENT. POLICY LINK IS A NATIONAL
RESEARCH AND ACTION INSTITUTE ADVANCING ECONOMIC AND SOCIAL
EQUITIES BY LIFTING UP WHAT WORKS. WE PARTNER WITH EQUITY ADVOCATES
AT THE LOCAL, STATE AND NATIONAL LEVELS TO HIGHLIGHT BEST
PRACTICES AND CREATE POLICIES THAT BUILD A JUST AND FAIR
SOCIETY. BROAD, NATIONAL PARTNERSHIPS ARE
INSTRUMENTAL TO ACHIEVING EQUITY. THE CONVERGENCE PARTNERSHIP IS A
COLLABORATIVE OF SIX NATIONAL FOUNDATIONS AND HEALTH CARE
ORGANIZATIONS WITH THE CDC ACTING AS A TECHNICAL ADVISER. THE PARTNERSHIP SEEKS TO SUPPORT
AND FOSTER MULTI FIELD EQUITY FOCUSED POLICY AND ENVIRONMENTAL
CHAINGS CHANGE EFFORTS TO ACHIEVE HEALTHY PEOPLE IN
HEALTHY PLACES. POLICY LINK IS THE PROGRAM
DIRECTOR FOR THE PARTNERSHIP PROVIDING GUIDANCE AND POLICY
ABOUT THE STRATEGIES TO ADVANCE THE PARTNERSHIP’S MISSION. CHANGING POLICY IS OFTEN THE
MOST EFFECTIVE WAY TO IMPLEMENT AND SUSTAIN THE KINDS OF
ENVIRONMENTAL CHANGES THAT DR. DIETZ JUST DESCRIBED. POLICY CHANGES CAN HAVE BROAD
IMPACTS AND POLICIES NOT TRADITIONALLY THOUGHT OF AS
HEALTH POLICIES, TRANSPORTATION, LAND USE, EDUCATION,
AGRICULTURAL CAN AFFECT HEALTH AND OBESITY RATES. THE CONVERGENCE PARTNERSHIP HAS
FOCUSED ITS FUNDING AND ADVOCACY ON ACCESS TO HEALTHY FOODS,
BUILDING THE FIELD LOCALLY AND REGIONALLY AND THE BUILT
ENVIRONMENT. SO LET’S DIVE INTO THE ISSUE OF
ACCESS TO HEALTHY FOOD. THE LAST FARM BILL INTRODUCED
THE ISSUE OF FOOD DESERTS TO NATIONAL POLICYMAKERS. THE USDA CONDUCTED RESEARCH AND
CONCLUDED THAT THERE ARE MORE THAN 23.5 MILLION AMERICANS THAT
LIVE IN FOOD DESERTS, AREAS WITHOUT ACCESS TO HEALTHY FOODS. LOW INCOME COMMUNITIES OF COLOR
ARE PARTICULARLY AFFECTED. THE USDA DATA AND OTHER STUDIES
CLEARLY SHOW THIS IS A NATIONAL PROBLEM WITH SERIOUS
IMPLICATIONS FOR NATIONAL HEALTH AND OBESITY. THIS IS A PROBLEM NOT JUST IN
URBAN AREAS, BUT IN RURAL AREAS, AS WELL. THE DARKER PARTS OF THIS MAP
SHOW WHERE WITH RESIDENTS MUST DRIVE 10 MILES OR MORE TO REACH
A SUPER MARKET OR FOOD CENTER. IN RURAL MISSISSIPPI, ADULTS
LIVING IN COUNTIES WITHOUT SUPER MARKETS WERE 23% LESS LIKELY TO
MEET GUIDELINES FOR DAILY 23R50U9 AND VEGETABLE
CONSUMPTION COMPARED TO ADULTS LIVING IN COUNTIES WITH SUPER
MARKETS. >>LACK OF ACCESS TO HEALTHY
FOODS IN URBAN AREAS ARE ILLUSTRATED HERE IN NEW YORK
CITY. THE DARKER THE COLOR, THE
GREATER THE NEED. THE AREAS WITH THE HIGHEST NEED
ARE VERY SIMILAR TO THOSE WITH THE HIGHEST CONCENTRATIONS OF
RESIDENTS WHO ARE OVERWEIGHT AND OBESE AND THOSE WITH RESIDENTS
WHO REPORT NOT EATING FRUITS OR VEGETABLES IN THE LAST DAY. SEVERAL STUDIES, INCLUDING THIS
ONE IN CALIFORNIA, FIND THAT PEOPLE IN LOWER INCOME
COMMUNITIES OF COLOR ARE MORE LIKELY TO LIVE IN FOOD
ENVIRONMENTS. THIS STUDY FOUND THAT OBESITY
AND DIABETES PREVALENCE IS HIGHEST FOR THOSE LIVING IN THE
WORST FOOD ENVIRONMENT, A 20% HIGHER PREVALENCE OF OBESITY. EVEN AMONG LOW INCOME
COMMUNITIES, THOSE COMMUNITIES WITH THE WORST FOOD ENVIRONMENTS
HAVE HIGHER RATES OF OBESITY AND DIABETES. IMPROVED ACCESS TO HEALTHY FOOD
IS TIED TO CHANGES IN EATING HABITS AND CHANGED IN EATING
HABITS ARE TIED TO DECREASES IN OVERWEIGHT AND OBESITY. THE FRESH FOOD FINANCING
INITIATIVE IN PENNSYLVANIA IS AN INNOVATIVE PUBLIC/PRIVATE
PARTNERSHIP THAT HAS DRAMATICALLY IMPROVED ACCESS TO
HEALTHY FOOD I WOULDN’T SAY USING ONE TIME LOANS AND GRANTS. SINCE 2004, THE FRESH FOOD
FINANCING INITIATIVE HAS SUPPORTED 83 PROJECTS ACROSS THE
STATE FROM FULL SCALE SUPERMARKETS TO SMALL GROCERIES
TO FARMER’S MARKETS AND CO-OPS. THE STATE’S ORIGINAL $30 MILLION
INVESTMENT HAS BEEN LEVERAGED WITH PRIVATE CAPITAL TO BECOME
MORE THAN $190 MILLION IN TOTAL PROJECT COST. AS A RESULT, MORE THAN 400,000
PEOPLE NOW HAVE ACCESS TO HEALTHY FOOD WHO DID NOT HAVE IT
BEFORE. 5,000 JOBS HAVE EITHER BEEN
CREATED OR RETAINED AND MORE THAN 1.7 MILLION SQUARE FEET OF
RETAIL SPACE HAS BEEN CREATED OR SAVED. THIS IS A TRIPLE BOTTOM LINE
IMPACT. HEALTH IMPACT, ECONOMIC IMPACT,
AND NEIGHBORHOOD REVITALIZATION. REPLICATION OF THE PENNSYLVANIA
POLICY IS UNDERWAY IN MANY STATES. THE CONVERGENCE PARTNERSHIP IS
SUPPORTING EFFORTS TO BRING IT TO SCALE AT THE NATIONAL LEVEL. AND THERE ARE OTHER INNOVATIONS
UNDER WAY IN COMMUNITIES TO IMPROVE ACCESS TO HEALTHY FOOD,
PARTICULARLY FOR LOW INCOME COMMUNITIES OF COLOR. THE PRESIDENT’S PROPOSED 2011
BUDGET INCLUDES SUPPORT FOR HEALTHY FOOD FINANCING
INITIATIVE BASED ON THE PENNSYLVANIA MODEL. THE PRESIDENT PROPOSES SPENDING
$345 MILLION FOR LOANS, GRANTS AND TAX CREDITS TO SUPPORT A
RANGE OF PROJECTS DESIGNED TO INCREASE ACCESS TO HEALTHY FOOD. THE CONVERGENCE PARTNERSHIP IS
SUPPORTING EFFORTS TO MAKE THIS PROPOSAL A REALITY. A BROAD COALITION HAS COME
TOGETHER IN SUPPORT OF THE HEALTHY FOOD FINANCING
INITIATIVE, INCLUDING THE GROCERY INDUSTRY, UNIONS,
HEALTH, CIVIL RIGHTS AND CHILDREN’S ORGANIZATIONS. THE FIRST LADY HAS BEEN A BIG
CHAMPION AND THE HEALTHY FOOD FINANCING INITIATIVE IS INCLUDED
AS A PILLAR OF HER LET’S MOVE INITIATIVE. NOW LET’S SHIFT TO LOOK AT SOME
OF THE PARTNERSHIP’S EFFORTS TO BUILD THE FIELDS LOCALLY AND
REGIONALLY. TO BUILD THE FIELD, INCREASE
EQUITY FOCUSED ACTIVITY ON LAND USE, BUILT ENVIRONMENT AND
ACCESS TO HEALTHY FOOD, THE CONVERGENCE PARTNERSHIP LAUNCHED
AN INNOVATION FUND, AN EFFORT THAT PROVIDES 50% MATCHING
DOLLARS TO FOUNDATIONS TO SUPPORT MULTI STEEL
COLLABORATIVES WORKING ON THESE ISSUES. SO FAR, WITH MORE THAN $4
MILLION COMMITTED, A VARIETY OF 15 PROJECTS IN DIFFERENT PLACES
WITH DIFFERENT TYPES OF GRANT MAKING AND PARTNERSHIPS HAVE
BEEN LAUNCHED. IN ORDER TO INCREASE THE NUMBER
OF FOUNDATIONS ENGAGED IN THESE TYPES OF EFFORTS, THE
CONVERGENCE PARTNERSHIP HAS BEEN SUPPORTING EFFORTS THAT ARE
SIMILAR TO THE NATIONAL CONVERGENCE EFFORT IN MANY
REGIONS ACROSS THE COUNTRY. DR. ROGERS, THE NEXT SPEAKER, IS
A LEADER IN THE MAIN CONVERGENCE EFFORTS. THESE REGIONAL CONVERGENCE
EFFORTS ARE FOCUSED ON POLICY IMPROVE HEALTHY EATING AND
ACTIVE LIVING AND REDUCE OBESITY. THE WORK OF THE CONVERGENCE
PARTNERSHIP HAS ALSO INCLUDED EDUCATING THE FIELD AROUND BUILT
ENVIRONMENT STRATEGIES FOR WALKABLE AND BIKEBLE
NEIGHBORHOODS. PLACES FOR PHYSICAL ACTIVITY,
AND TO ENSURE THAT THEIR ANALYSIS AND ADJUSTMENTS MADE
FOR HEALTH IMPACTS. THE CONVERGENCE PARTNERSHIP
COMMISSIONED A SERIES OF PAPERS, COLLECTED IN THE VOLUME — THE
TRANSPORTATION PRESCRIPTION THAT FOCUSES ON TRANSPORTATION AND
EQUITY AND THE IMPACTS OF TRANSPORTATION ON THE BUILT
ENVIRONMENT AND ON HEALTH. IN ADDITION TO ITS EDUCATION
EFFORTS, THE PARTNERSHIP HAS BEEN SUPPORTING ADVOCACY ON
TRANSPORTATION. EVERY FIVE TO SIX YEARS, THE
FEDERAL TRANSPORTATION LEGISLATION IS REAUTHORIZED. THIS IS A MASSIVE INVESTMENT OF
FEDERAL FUNDS THAT FLOWS THROUGH THE STATES, REGIONS AND
LOCALITIES TO FUND HIGHWAYS, PUBLIC TRANSIT, PEDESTRIAN AND
BICYCLE FACILITIES, SAFE ROUTES TO SCHOOLS AND COMPLETE STREETS. THE LAST REAUTHORIZATION WAS FOR
$244 BILLION WITH 80% OF THE FUNDS GOING FOR HIGHWAYS. THESE FUNDS HAVE CLEAR IMPACTS
ON THE BUILT ENVIRONMENT AND ON EQUITY AND ON HEALTH. IN FACT, RESEARCH SHOWS THAT THE
MORE VEHICLE MILES DRIVEN, THE GREATER THE RISK OF OBESITY. AND THOSE WHO USE PUBLIC TRANSIT
ARE LESS LIKELY TO BE OBESE. THE CONVERGENCE PARTNERSHIP IS
SUPPORTING EFFORTS TO CHANGE IN THE NEXT REAUTHORIZATION TO
IMPROVE ITS HEALTH IMPACT. ALREADY, THE PUBLIC EDUCATION
AND ADVOCACY EFFORTS HAVE INCREASED AWARENESS OF THE
CONNECTION BETWEEN HEALTH AND TRANSPORTATION AND HAVE ALSO
ALTERED POLICY PROPOSALS. IN ADDITION TO SUPPORTING
EDUCATION AND ADVOCACY EFFORTS, THE PARTNERSHIP HAS BEEN ADDING
ITS VOICE FOR CHANGE, INCLUDING FOR HEALTH REFORM, SUSTAINABLE
COMMUNITIES AND OBESITY REDUCTION. CLEARLY, MOMENTUM IS BUILDING. THERE ARE MANY MULTI SECTOR
EQUITY FOCUSED EFFORTS ADVANCING AT THE LOCAL, STATE AND NATIONAL
LEVELS. AS WE MOVE FORWARD, IT IS
IMPORTANT TO CONTINUE TO FIND AND SUPPORT LOCAL INNOVATIONS
FOCUSED ON EQUITY IMPACTS AND THE EFFORTS TO BRING THEM TO A
NATIONAL SCALE. OUR NEXT SPEAKER WILL TALK ABOUT
A LOCAL EFFORT THAT IS TAKING OFF NATIONALLY. THANK YOU VERY MUCH. >>HELLO, MY NAME IS TROY
ROGERS. HE’D A PEDIATRICIAN FROM THE
BARBARA BUSH CHILDREN’S HOSPITAL AT MAINE MEDICAL CENTER IN
PORTLAND, MAINE. I WELCOME THE OPPORTUNITY TO
TALK TO YOU. I’VE BEEN WORKING IN THE FIELD
OF CHILDHOOD OBESITY FOR ABOUT A DECADE, FIRST AS A PRACTICING
PEDIATRICIAN ON THE FRONT LINE DEALING WITH THIS EVERY DAY. THEN I WORKED WITH A NUMBER OF
NATIONAL PROGRAMS THROUGHOUT THE COUNTRY. THEN ON TO ADVOCACY OF MY OWN
CHILDREN’S SCHOOLS AND NOW AS THE MEDICAL DIRECTOR OF LET’S
GO, A MULTI SECTOR APPROACH TO ADDRESSING CHILDHOOD OBESITY. NOW I’D LIKE TO TELL YOU ABOUT
THE STORY. SO THE MAIN STORY STARTS LIKE
MANY STORIES OF COMMUNITY ACTION ACROSS THE COUNTRY. HOWEVER, I THINK OURS HAS A BIT
OF A TWIST, THE TWIST BEING THAT THE MEDICAL COMMUNITY GOT
INVOLVED VERY EARLY ON BY ENGAGING COMMUNITY PARTNERS, THE
MAIN CDC, OUR PUBLIC HEALTH ENTITY IN MAINE. WHAT WE DID IS WE DEVELOPED
SIMPLE STEPS CLINICIANS CAN DO EVERY DAY TO START TO COMBAT THE
OBESITY EPIDEMIC. THEN IN 2006, THIS WORK EXPANDED
INTO ON HER SECTORS TO THE LET’S GO PROGRAM WHICH INITIALLY
STARTED IN GREATER PORTLAND. NOW IN 2010, LET’S GO HAS BEEN
DISSEMINATED TO SEVEN ADDITIONAL SITES AND REGIONS IN MAINE AND
WE ARE ACTIVELY PARTICIPATING WITH A CONVERGENCE PARTNERSHIP
AND THE LOCAL COMMUNITIES PUTTING PREVENTION TO WORK
RECIPIENTS. NOW WE WOULD LIKE TO SAY A FEW
WORDS ABOUT MYOC, ABOUT LET’S GO AND ABOUT SOME OF THE
OPPORTUNITIES THAT WE HAVE EXPERIENCED AND STILL LAY IN
FRONT OF US. SO THIS STARTED WITH A SIMPLE
MESSAGE, 5-2-1-0. IT STANDS FOR 5 SERVINGS OF
FRUITS AND VEGETABLES, 2 HOURS OR LESS OF TV TIME AND ZERO
SUGARY DRINKS. THIS MESSAGE IS ESSENTIAL TO THE
PRIME MINISTER PROVIDERS. I THINK AS YOU WILL SEE, 5-2-1-0
HAS BECOME A PER ZASIVE MESSAGE WHICH IS BEGINNING TO CHANGE THE
LANDSCAPE FOR KIDS IN MAINE. IN MYOC, WE HAD FIVE SPECIFIC
THINGS WE ASKED THEM TO DO. CREATE AWARENESS, HANGING A
POSTER, ASSESS THE PATIENT’S WEIGHT ACCURATELY, LISTEN TO
PATIENTS IN A RESPECTFUL MANNER USING THE 5-2-1-0 APPROACH. TO BE A ROLE MODEL, THAT WAS
CRITICAL. AND ALSO TO JOIN THE LEARNING
COMMUNITY, TO CONTINUE TO LEARN AND INNOVATE. HERE IS A PROVIDER TOOL KIT,
WHICH SHOWS MANY RESOURCES THAT HAVE BEEN USED, ADOPTED AND
ADAPTED THROUGHOUT THE COUNTRY. SO WHAT DO WE ACTUALLY DO IN
MYAC? WE DID IMPRESSIVE THINGS. WE ENGAGED 12 PHYSICIAN
PRACTICES, MAKING OFFICE SYSTEM CHANGES. HERE IS SOME OF THE DATA. WE LOOKED AT PHYSICIAN BEHAVIOR
BY MEASURING A NUMBER OF PROCESS OUTCOMES AT THE BEGINNING OF
MYAC AND THEN AGAIN AT THE BEGINNING OF 24 MONTHS. THE 5-2-1-0 QUESTIONNAIRE. FULL DISCLOSURE HERE, SOME OF
YOU MAY REALIZE THAT THERE’S NOTHING ON THE PRE-MYOC, RIGHT? THAT WAS ZERO. WE.DEVELOPED THE 5-2-1-0
QUESTION HEIR LATER ON. ENGAGEMENT OF THE CLINICIANS AND
IT WAS THE SINGLE MOST EFFECTIVE TOOL THE CLINICIANS HAD BECAUSE
IT CHANGED THE CONVERSATION FROM WEIGHT TO BEHAVIORS. BEFORE MYOC, ONLY ABOUT 25% OF
THE TIME CLINICIANS WERE DOCUMENTING BMI PERCENTILE FOR
AGE AND GENDER, EVEN THOUGH THEY KNEW THEY HAD TO DO IT, AND
AFTER MYOC ABOUT 90% OF THE ENCOUNTERS HAD A BMI DOCUMENTED. OVER THE COURSE OF MYOC, THE
WEIGHT CATEGORIES INCREASED. HERE, ADDITIONAL, THERE WAS AN
INCREASE OF PROVIDER BEHAVIOR IN THE KEY AREAS OF EVALUATING
OVERWEIGHT WITH PATIENTS AND FAMILIES AND SCHEDULING
FOLLOW-UP VISITS. SO THE LESSONS LEARNED WERE
5-2-1-0 WAS EASILY UNDERSTOOD BY CLINICIANS AND PATIENCES AND
FAMILIES. STARTING TOMORROW, THERE WERE
SIMPLE THINGS THAT THE CLINICIANS COULD DO. SO THEN IN 2006, A GROUP OF
LOCAL BUSINESSES AND HEALTH CARE LEADERS IN THE GREATER PORTLAND
AREA IDENTIFIED ON THIS SLIDE CAME TOGETHER AND MADE A
SUBSTANTIAL INVESTMENT IN THE PREVENTION OF CHILDHOOD OBESITY. THEY FORMED A UNIQUE PROFIT AND
NONPARTNERSHIP PROGRAM CALLED LET’S GO. LET’S GO USES THE LESSONS AND
TOOLS SXRE SOURCES DEVELOPED IN MYAC USED. LET’S GO WORKS IN SIX KEY
SETTINGS, CHILD CARE, SCHOOL, COMMUNITIES, WORKPLACE, AFTER
SCHOOL AND HEALTH CARE. SURROUNDING THIS WORK IS A
ROBUST MEDIA CAMPAIGN FOCUSING ON 5-2-1-0. THE CORPORALS OF LET’S GO ARE
HERE. THEY’RE ENVIRONMENTAL AND POLICY
CHANGE WHICH ARE KEY TO INFLUENCING THE BEHAVIOR CHANGE. THE INCIDENTER CONNECTIVITY
ACROSS SECTORS IS CRUCIAL. STRATEGIES ARE EVIDENCE BASED
AND CONTINUALLY BEING EVALUATED. NOW I’D LIKE TO TAKE A FEW
MINUTES AND TALK ABOUT A COUPLE OF THE SECTORS. THIS FIRST ONE, THE SCHOOL
COMPONENT OF LET’S GO IS CALLED 5-2-1-0 GOES TO SCHOOL. THE PROGRAM TAKES SCHOOLS FROM
WHERE THEY ARE AROUND HEALTH AND PHYSICAL ACTIVITY AND NUTRITION
TO WHERE THEY WANT TO GO. WE USE TEN KEY STRATEGIES WHICH
FOCUS ON SUSTAINABILITY ENVIRONMENTS ON POLICY CHANGE. THESE TEN STRATEGIES ARE LISTED
HERE AND YOU CAN SEE THAT THERE IS A BROAD RANGE FROM
ENCOURAGING HEALTHY CHOICES FOR SNACKS AND CELEBRATIONS TO
INCLUDES COMMUNITIES ORGANIZATIONS AND WELLNESS
PROGRAM AND INCORPORATING PHYSICAL ACTIVITY INTO THE
SCHOOL DAY. NOW WE’D LIKE TO TALK ABOUT OUR
WORK IN EARLY CHILDHOOD. WE ARE WORKING ON FITTING
5-2-1-0 INTO THE HOME, AND IT’S A HOME-BASED CHILD CARE SPIKE. WE WERE WORKING ON THE
DEVELOPMENT OF STATEWIDE LICENSING, REGULATION AND
REWARDS. IN OUR COMMUNITY WORK, WE HAVE
INCLUDED TRAIL DEVELOPMENT AND INNOVATIVE WORK XWIEBDING HEALTH
AND LITERACY BY IMPLEMENTING SOMETHING CALLED STORY WALK. STORY WALK TAKES THE BOOK AND
MAKES THE PAGES COME ALIVE ALONG A PATH, SCHOOL, LIBRARY OR
COMMUNITY TRAIL. IT’S ONE OF MY FAVORITE THINGS
THAT WE DO. WE HAVE A ROBUST EVALUATION PLAN
WHICH FOCUSES ON QUANTITATIVE AND QUALITATIVE DATA ALONG WITH
HUNDREDS OF STORIES. AND THE STORIES ARE SO
COMPELLING. CURRENTLY, WE ARE TRACKING LOCAL
OBESITY RATES, BEHAVIOR CHANGES AND ENVIRONMENTAL AND POLICY
CHANGES. AS MANY OF YOU KNOW, IT TAKES
YEARS TO SEE SYNDROMES IN OBESE AT THE RATES. THEREFORE, WE FEEL IT IS
CRITICAL TO TRACK OUR PROGRESS WITH THE ENVIRONMENTAL AND
POLICY CHANGES AS WELL AS THE BEHAVIOR DATA PRECURSORS TO
CHANGES AND THE WEIGHT STATUS IN THE POPULATION. THE FOLLOWING IS OUR MOST UP TO
DATE EVALUATION. AS I SAID, IT’S VERY IMPORTANT
FOR US TO HAVE LOCAL DATA, BUT TO HAVE LOCAL DATA, YOU HAVE TO
GO OUT AND GET IT. IT DOESN’T JUST GET GIVEN TO
YOU. DO YOU THINK DATA GATHERED FROM
PEDIATRICIAN’S OFFICES, WE HAVE DETERMINED A BASELINE OVERWEIGHT
AND OBESITY PREVALENCE WEIGHT. THE LOCAL DATA IS HERE IN LIGHT
BLUE AND THE 2006 HANES DATA IS IN DARK BLUE. OUR LOCAL DATA MIRRORS THE
NATIONAL DATA WITH THE EXCEPTION OF THE YOUNGEST CHILDREN, WHICH
ARE SIGNIFICANTLY HEAVIER THAN THEIR NATIONAL PEERS. WE ARE ON TRACK TO REPORT 2009
DATA IN LATE FALL AND THEN WE WILL MONITOR THIS ON A PERIODIC
BASIS. WE HAVE ALSO BEEN TRACKING
KNOWLEDGE, ATTITUDE AND PERCEIVED BEHAVIOR CHANGES
THROUGH A RANDOM DIGITAL SURVEY TO PARENTS IN THE GREATER
PORTLAND AREA. THERE IS AN INCREASE IN THE
AWARENESS OF LET’S GO AND 5-2-1-0 FROM 2007 CO-2009. ALTHOUGH THIS SLIDE DOESN’T
DESPICKET IT, WE SEE A FAVORABLE RESPONSE TO THE MESSAGE. IF A PARENT IS EXPOSED TO THE
5210 MESSAGE, THEY ARE MORE LIKELY TO BE MORE FAVORABLE,
MORE LICKLY TO IDENTIFY ALL FOUR OF THE HEALTHY BEHAVIORS. OF NOTE HERE IS THAT FROM 2007
TO 2009, THERE WAS AN IMPRESSIVE INCREASE OF 27% IN PERCEIVED
BEHAVIOR CHANGE IN THREE OUT OF THE FOUR 5210 BEHAVIORS. IN SCHOOLS, WE ARE BEGINNING TO
SEE THE ENVIRONMENTAL POLICY CHANGES AND THE MAJORITY OF THE
ADMINISTRATORS REPORT AN INCREASE IN PHYSICAL ACTIVITY
AND HEALTHY EATING OPTIONS. IN THE GREATER PORTLAND AREA,
OVER 90% OF OUR SCHOOLS HAS REPORTED MAKING AT LEAST TWO OR
MORE ENVIRONMENTAL CHANGES DURING THE 208 TO 2009 SCHOOL
YEAR. TO DATE, 5210 HAS MADE PROGRESS
IMPLEMENTING THIS STRATEGY. THE SCHOOLS ARE VERY MUCH
APPRECIATIVE OF THE MESSAGE, THE SUPPORT OF LET’S GO AND THE
MULTI SECRETARY TO RECALL APPROACH. POLICY AND ENVIRONMENTAL CHANGE
IS DISCREDIT KAL TO THE LONG-TERM SUPPORT OF BEHAVIOR
CHANGE. LET’S GO WE START TO EXPAND
STATEWIDE AND BY JUNE 2010 WE ARE REACHING OVER 80,000
STUDENTS IN 262 SCHOOLS, 40 CHILD CARE SITES CARING FOR
THOUSANDS OF CHILDREN, MORE THAN 50 POSITION OFFICES, NUMEROUS
AFTER SCHOOL PROGRAMS SUPPORTING MORE THAN 2,500 YOUTH MEMBERS. SIX OF PORTLAND’S LARGEST
EMPLOYERS ARE INVOLVED AND EIGHT REGIONS ACROSS THE STATE ARE —
WE WERE ACTUALLY PARTICIPATING WITH. THIS IS A MAP SHOWS WHERE 5210
IS. WE’RE IN 149 TOWNS. WE ARE ACTUALLY IN MORE TOWNS,
BUT THEY OVERLAP THE DOT THE SO I JUST HAVE TO SAY THAT. WE’VE BEEN ABLE TO USE OUR TOOLS
AND WE’VE PROVIDED TECHNICAL ASSISTANCE TO MANY OF THESE
SITES. NOW I’D LIKE TO TAKE A MINUTE
AND TALK ABOUT THE CHALLENGES AND OPPORTUNITIES AHEAD OF US. OUR FIRST CHALLENGE WAS TO BUILD
THE EVIDENCE. WE HAD BEEN ENCOURAGED BY MANY
OF YOU IN THIS AUDIENCE, DR. BILL DIETZ, I MIGHT SAY, TO
INNOVATE, TRY NEW THINGS, BUILD THE EVIDENCE. GO AHEAD, TORI, DO IT. HOWEVER, MANY FUNDERS AREN’T
THAT INTERESTED IN FUNDING INNOVATION. THE SECOND CHALLENGE IS TO
MANAGE THE EXPECTATIONS OF THE PARTNERS WHO WANTED TO SEE RAPID
CHANGES. NATIONALLY, WHEN VAULT THE
CHANGE, IT IS DIFFICULT TO GET INFORMATION TO CHILDREN. OUR NEXT CHALLENGE IS RELATED TO
CONDUCTING RESEARCH IN THE COMMUNITY. IT CAN BE VERY DIFFICULT TO GET
COMMUNITY DATA. MANY COMMUNITIES PARTNERS ARE
WEARY OF RESEARCH. THEY THINK IT’S GOING TO TAKE
TOO MUCH TIME. THINK WONDER HOW THE DATA IS
GOING TO BE USED. WILL IT AFFECT ANY STATE OR
FEDERAL FUNDING. COLLABORATION IS ESSENTIAL, BUT
THERE ARE ALWAYS TURF ISSUES AND PARTNERS MAY HAVE DIFFERENT
AGENDAS. THEY MAY HAVE DIFFERENT FUNDING
STREAMS AND THIS MAY BE AN ADDITIONAL COMPLICATION. SOLO THE CHALLENGES MAY HAVE
SEEMED DAUNTING, THEY HAVEN’T PREVAILED. THERE’S A GROWING NUMBER OF
TINTS THAT HAS ALLOWED US TO SUCCEED AND CONTINUED TO BE
OPTIMISTIC. AS WE AWAIT THE BIG CHANGES, IT
IS THE SMALL CHANGES THAT KEEP THE PROGRESS GOING. IT’S CHANGING REWARDS FROM
CHILDREN FROM FOOD TO PHYSICAL ACTIVITY. CHANGING THE HEALTHY OPTIONS,
CHANGING WHAT HAPPENS IN THE CHILD CARE SETTING AND ENGAGING
ALL SECTORS HAS ALLOWED AN INTERESTING NUMBER OF PARTNERS
TO COME TO THE TABLE. AND WORKING IN A SMALL, RURAL
STATE HAS ITS CHALLENGES. BUT WE HAVE ACCESS TO LOCAL AND
STATE LEADERS AND THIS IS CRITICAL FOR OUR WORK. THE COLLABORATION OF COMMUNITIES
PUTTING THE PROGRAMS TO WORK HAS BEEN VERY, VERY HELPFUL IN
KEEPING OUR WORK UP TO DATE AND HAS RE-ENERGIZED THE STAFF. ACTUALLY, I WANT TO LEAVE YOU
WITH ONE LAST SLIDE AND ONE LAST WORRY. MAINE IS KNOWN FOR A NUMBER OF
THINGS, BUT TO ME, IT’S KNOWN FOR ITS COMMON SENSE APPROACH OF
HANDLING MANY DIFFERENT PROBLEMS. HARD WORKING PEOPLE, INNOVATION,
AND A QUIRKSY SENSE OF HUMOR. IN THE EARLY DAYS HOCH THIS
WORK, WE WERE WORKING IN THE DOC’S OFFICES. WE DIDN’T HAVE A CAMPAIGN AND WE
WERE TRYING TO GET THE 54210 PLAN OUT. THIS IS HIS IDEA AND THIS IS HIS
CAR AS HE TRAVELS AROUND THE STATE. SO THANK YOU VERY MUCH. >>THANK YOU. I THINK WE’RE NOW OPEN FOR
QUESTIONS OR COMMENTS. PLEASE USE THE MICROPHONES THAT
ARE DOWN IN THE MIDDLE OF THE AUDITORIUM. >>EXCELLENT AND I’M TERRY
BODRICK, OFFICE OF SMOKING AND HEALTH. GIVEN THE INFORMATION ABOUT
DYNAMIC LOCAL ACTION, I APPRECIATE THE PANEL DISCUSSING
THE PROS AND CONS OF ACCEPTING PREEMPTION TO LOCAL ACTION TO
GETTING A NATIONAL CHANGE, SUCH AS MENU LABELLING AND — WHICH
PREEMPTED LOCAL ACTION. PROS AND CONS. >>I CAN START ON THAT. CAN PEOPLE HEAR ME? >>YEAH. >>SO I THINK TWO THINGS I’D
SAY. ONE IS YOU NEVER GET TO NATIONAL
ACTION OR RARELY DO YOU GET TO NATIONAL IMPACT WITHOUT FIRST
STARTING WITH LOCAL INNOVATION. SO ALL OF THOSE IMPORTANT STEPS
ON MENU LABELLING AND CITIES AND STATES WERE WHAT GOT US TO
NATIONAL ACTION. AND I THINK IT IS ONE OF THESE
BALANCING ACTS. AND BEFORE, I THINK WE SHOULD
ACCEPT PREEMPTION, WE SHOULD MAKE SURE THAT A NATIONAL
STANDARD IS AS STRONG AS WE POSSIBLY CAN GET THERE. AND I THINK IT’S UP TO ADVOCATES
AND POLICYMAKERS TO PUSH AS HARD AS THEY CAN. AND THEN ULTIMATELY, I THINK IN
MANY CASES, WE END UP HAVING TO ACCEPT IT BECAUSE IT GETS THAT
CHANGE TO PLACES WHERE SIMPLY THERE ISN’T THE CAPACITY OF
ADVOCATES OR NO OTHER POLITICAL WILL TO MAKE THE CHANGE HAPPEN. >>HI. DR. JEWEL CRAWFORD. I’M AT ATCR IN ENVIRONMENTAL
MEDICINE. AND THE QUESTION AND THE COMMENT
THAT I HAVE, HERE IN DeKALB COUNTY, WHERE WE ARE RIGHT NOW,
THERE’S A REAL SCARCITY OF PLACES FOR KIDS TO PLAY. WE DON’T HAVE A LOT OF
PLAYGROUNDS OR PUBLIC PARKS. I MEAN, THEY HAVE PARKS, BUT
PEOPLE HAVE TO DRIVE TO THEM AND PEOPLE HAVE TO PAY, LIKE SOME
MOUNTAIN PARKS, YOU HAVE TO PAY TO GET IN THERE. AND IT’S NOT LIKE OTHER CITIES
THAT I’VE BEEN IN, NEW YORK, PORTLAND, OREGON, WHERE CHILDREN
CAN WALK TO PLAYGROUNDS AND PARKS. AND ALSO LACK OF SIDEWALKS. SO I MEAN, THAT IS RIGHT HERE
WHERE CDC IS. BUT ANY SUGGESTIONS, YOU KNOW,
FOR HOW TO GO ABOUT GETTING MORE PLAY SPACES? BECAUSE THERE REALLY AREN’T A
LOT OF PLACES FOR THE KIDS TO GO OUTSIDE AND SAFELY PLAY, FROM
WHAT I CAN SEE. >>THANKS FOR THAT QUESTION. WE’RE VERY INTERESTED IN MAPPING
PLAY DESERTS IN THE SAME WAY FOOD DESERTS HAVE BEEN MAPPED. IT’S MORE CHALLENGING AND WE’RE
NOT THERE YET, BUT THAT IS STEP ONE. STEP TWO, IN MY OPINION, THE
ATLANTA BELT LINE IS PROBABLY THE MOST IMPORTANT PUBLIC HEALTH
INTERVENTION IN ATLANTA SINCE POTABLE BECAUSE WATER BECAUSE
IT’S GOING TO CONNECT COMMUNITIES, BUILD PARKS, IT’S
GOING TO HAVE WALKING TRAILS, PERHAPS LIGHT RAIL BIKE TRAILS. AND THAT IS WHAT THIS CITY
NEEDS. THIS CITY WAS NOT PLANNED IN A
VERY RESPONSIBLE WAY. I MEAN, IT WAS JUST SPREAD OUT
ALONG PEACHTREE WITH THE ADVENT OF CARS AND WE’VE BEEN CAR
DEPENDENT EVER SINCE. SO I THINK SUPPORT FOR THE BELT
LINE AND AS THE BELT LINE COMES IN, MAKING SURE THAT IT CONNECTS
PEOPLE TO PLACES SO THAT THEY CAN USE ALTERNATIVE FORMS OF —
PHYSICAL FORMS OF TRANSPORT I THINK IS GOING TO BE A KEY
OUTCOME AND IT’S GOING TO BE ACCOMPANIED BY PLACES FOR
CHILDREN TO PLAY. >>THANK YOU. >>THOMAS MORRIS, DSLR. JUST TO MAKE A NOTE, I’M
PROBABLY ONE OF THOSE RARE PEOPLE THAT ACTUALLY GREW UP IN
ATLANTA AND I HAD A VERY CLOSE RELATIONSHIP WITH MY BIKE. IN FACT, I WAS THE BIKE RACER AT
ONE TIME. I FIND THE STREETS HERE
APPALLINGLY RESISTANT AND NARROW FOR TRYING TO BIKE. ON THE SIDEWALKS ARE PEDESTRIAN,
GLASS, CREEKS, THINGS LIKE THAT AND AS A DRIVER, THERE ARE
HARDLY TWO RAINS FOR SOME OF THESE VEHICLES, ESPECIALLY
AROUND HERE. >>HOW IS THE PHYSICAL EDUCATION
OF THIS WORK WITH NO CHILD LEFT BEHIND AND THE COMPLETION OF
TEST SCORES WHICH MEANS GETTING THOSE KIDS TO SIT STILL AND
LEARN SOMETHING. >>GREAT QUESTION. THERE IS SO MUCH DATA THAT HAS
COME OUT OVER THE LAST FIVE YEARS ABOUT THE ASSOCIATION
BETWEEN PHYSICAL ACTIVITY AND ACADEMIC SCORES. AND THAT NEEDS TO BE A CRITICAL
LINK. I DO A LOT OF TALKING TO SCHOOL
BOARDS ABOUT THIS. THERE’S ALSO THE SAME LINK WITH
HEALTHY EATING AND ACADEMIC SCORES. THERE’S BEEN SOME CREATIVE WORK
THAT HAS HAPPENED WITH SCHOOLS WHERE KIDS ARE NOT SITTING
STILL. THEY’RE SITTING ON THOSE
EXERCISE BALLS AND THEY’RE ACTIVELY MOVING AND THE TEACHERS
ARE SAYING THEIR CLASS IS SO MUCH MORE CONTROLLABLE BECAUSE
KIDS ARE ALLOWED TO DO WHAT THEY NEED TO DO WHEN THEY’RE FIRST
AND SECOND GRADERS. I WOULD MAKE THE SAME CASE THAT
THAT COULD BE WITH ALL OF THOSE CHILDREN. SO WE HAVE A LINK SHOWING
PHYSICAL ACTIVITY WILL IMPROVE THE SCHOOL SCORES. >>GOOD MORNING. SO PLAYING OFF THE LOCAL
INNOVATION IDEA, WHERE DO WE GET — WHAT SUGGESTIONS DO YOU
HAVE FOR FUNDING TO CREATE LOCAL GRASSROOTS PROGRAMS SUCH AS, FOR
EXAMPLE, BRINGING A NUTRITIONIST TOGETHER AND A TRAINER TOGETHER
AND BRINGING THEM INTO A PARK, A FACILITY OR SOMETHING AND
GETTING FUNDS TO REALLY PUT TOGETHER A PROGRAM FOR CHILDREN
WHERE THEY CAN PLAY, EDUCATE THEM ON EATING HABITS. YOU KNOW, YOU HAVE THEM FOR A
COUPLE OF HOURS AND INCLUDE THE PARENTS. WHERE CAN WE GET MONEY TO FUND A
PROGRAM SUCH AS THIS? >>WELL, THERE ARE NUMBERS OF
FOUNDATIONS ENGAGED IN THIS WORK. SO THE ROBERT JOHNSON HAD A $25
MILLION OBEITY PROGRAM AND THEY ARE FUNDING ACROSS THE COUNTRY. WE ARE HOPING SOME OF THE
DOLLARS WILL BE USED TO FOCUS INNOVATION. THERE IS ADVOCACY TO BE DONE
WITH CITY BUDGETS TO MAKE SURE THAT PARKS AND RECREATION ARE
ADEQUATELY FUNDED AND TO MAKE SURE THAT THERE’S AN
UNDERSTANDING IN THAT LINK BETWEEN HEALTH AND PHYSICAL
ACTIVITY. >>I WOULD JUST ADD TO THAT,
THAT START WITH YOUR LOCAL INSTITUTIONS. I MEAN, IF YOU HAVE CHILDREN IN
CHILD CARE, THAT’S ONE PLACE TO START. IF YOU HAVE CHILDREN IN SCHOOLS,
THAT’S A SECOND PLACE TO START. THAT CHARACTERIZES A LOT OF
TORI’S EARLIER EXPERIENCE WITH THESE ISSUES. >>THE OTHER THING I’LL ADD IS
THAT IS FANTASTIC. SOME OF THOSE MONIES ARE
DIFFICULT TO FLOW DOWN. AND WE’VE DONE A LOT OF ON THIS
WORK. THE LOCAL COMMUNITY GROUPS THAT
GET TOGETHER, WHETHER IT’S THE LOCAL ROTARY CLUBS OR THE
DIFFERENT KIND OF CLUBS GETTING TOGETHER OFTENTIMES ARE LOOKING
FOR THIS. THIS DOESN’T HAVE TO BE A LOT OF
MONEY. THE OTHER THING WE’VE DONE IS
PARTNERING WITH OUR LOCAL HIGH SCHOOLS. ALL THE HIGH SCHOOLS NEED TO DO
COMMUNITY SERVICE AT LEAST IN A NUMBER OF THE STATES. YOU CAN USE LOCAL HIGH SCHOOL
STUDENTS TO DO SOME OF THIS WORK. THERE’S A LOT OF THINGS YOU CAN
DO AND SOMETIMES BY THAT SUCCESS YOU HAVE THE OPPORTUNITY TO GO
ON AND APPLY FOR A LARGER GRANT. GETTING STARTED KIND OOH MOVES
YOU IN THAT DIRECTION. >>THANK YOU. IS MY QUESTION IS ACTUALLY TO
ALL OF YOU, BUT LIKELY MORE FOR BILL. IT’S PRETTY EVIDENT THAT THE
POLICY AND ENVIRONMENTAL CHANGE ARE VERY APPEALING. WHEN YOU CHANGE A SIDEWALK, YOU
ARE HELPING EVERYBODY, ALL RACES, ALL ETHNIC GROUPS, ALL
SOCIOECONOMIC BACKGROUNDS. HOWEVER, GIVEN THE FACT THAT OUR
COLLEAGUES FROM CHS BROUGHT SOME RELEVANT DATA, HIS PANIC KIDS
AND AFRICAN-AMERICAN GIRLS, IS THERE ANY ROOM FOR TARGET
INITIATIVES OF THOSE SPECIFIC POPULATIONS, BILL? >>I’M GOING TO ASK YOU, MS.
BELL, TO RESPOND TO THIS, AS WELL. I THINK THOSE DISPARITIES, THE
GENDER DISPARITIES TO SPEAK A CULTURAL DETERMINANT OF OBESITY. FRANKLY, I DON’T THINK WE
UNDERSTAND ENOUGH ABOUT WHY THAT DISPARITY EXISTS AND HAS BEEN A
COMMUNITY. I THINK WE HAVE ANECDOTAL
EVIDENCE, BUT FROM THE MESSAGING POINT OF VIEW, I THINK IT’S
TERRIBLY IMPORTANT. HOW DO WE TALK TO HIS PANIC
PARENTS ABOUT PARENTING PRACTICES THAT LEAD TO
DIFFERENTIAL LEVELS OF PHYSICAL ACTIVITY OR DIFFERENT PATTERNS
OF PARENTING AROUND FOOD INTAKE AND HIS PANIC FAMILIES. AND THAT IS ONE OF THE AREAS
THAT I’M NOT SURE RESPONDS EASILY TO A POLICY INITIATIVE AS
MUCH AS A MESSAGING OR COMMUNICATIONS ISSUE. >>I THINK WE HAVE TO TARGET
SOME OF THESE RESOURCES. BECAUSE WHEN YOU LOOK AT
COMMUNITIES, WHAT YOU SEE IS THAT FOR PEOPLE TO MAKE THE
HEALTHY CHOICE IN LOW INCOME COMMUNITIES, IT’S FAR HARDER
THAN IT IS IF YOU’RE IN A MIDDLE OR HIGH INCOME COMMUNITY. THAT’S WHY THE DEY DATA LOOKS
THE WAY IT DOES, I THINK. THINK ABOUT THE DATA I SPOKE
ABOUT IN TERMS OF RURAL MISSISSIPPI. IF YOU’RE NOT NEAR A SUPER
MARKET, YOU’RE NOT GOING TO EAT AT HEALTHY. WE FOUND THAT THAT WAS TRUE
REGARDLESS OF INCOME YOU WERE. SO IF YOU LIVED IN A
CONCENTRATION OF FAST FOOD AND CONVENIENCE STORES, YOU HAD AUTO
HIGH PREVALENCE OF DIABETES. THERE’S NO QUESTION THE
ENVIRONMENT MATTERS AND THAT SPEAKS TO TARGETING CHANGES IN
THE ENVIRONMENTS THAT NEED THEM THE MOST. >>THIS WILL BE THE LAST
QUESTION. >>GOOD MORNING. MY NAME IS MICHELLE. THANK YOU ALL SO MUCH. I’M WONDERLING, WHAT IS THE ROLE
OF MENTAL HEALTH FOR THE OBESITY EPIDEMIC? IT JUST SEEMS ASIDE FROM THEIR
INCOME LEVELS WHERE THEY MIGHT HAVE MORE OPPORTUNITIES TO HAVE
SAFE PLACES TO EXERCISE, THERE ARE STILL GREATER AMOUNTS OF
OBESITY. I’M JUST WONDERING WHAT IS THE
GOAL FOR MENTAL HEALTH? >>YOU ARE ALL JUMPING AT THIS
ONE. I THINK THERE’S THE RELATIONSHIP
WITH MENTAL HEALTH IS FASCINATING. FOLKS WHO MAY BE STRUGGLING WITH
MENTAL HEALTH ISSUES AND MAY BE ON MEDICATION MAY PUT THEM AT
MORE RISK FOR WEIGHT ISSUES. THAT’S ONE COMPONENT THAT
CLEARLY NEEDS TO BE ADDRESSED. THE OTHER SIDE OF IT, THERE IS A
LOT OF DAETS IN QUALITY OF LIFE WHEN THEY’RE OBESE AND THE
SEVERE OBESITY GREATER THAN THE 97th PERCENTILE IS VERY POOR AND
IT NEEDS TO BE ADDRESSED. WE WORK A LOT WITH CLINICIANS ON
THAT. I THINK THE ROLE FROM MY POINT
OF VIEW IN WORKING WITH THE COMMUNITY IS THAT YOU NEED TO BE
AWARE THAT THE MENTAL HEALTH ISSUES ARE THERE. >>I’D LIKE TO CLOSE BY THANKING
THE PANELISTS WHO DECIDED, CYNTHIA, JUDITH AND TORI, THANK
YOU VERY MUCH FOR YOUR PARTICIPATION. >>WE HAVE VERY VERY QUICK
ANNOUNCEMENT AND THAT IS BECAUSE WE HAVE RECEIVED SO MANY
REQUESTS FROM COLLEAGUES OUTSIDE OF CDC AND OUR EXTERNAL VIEWERS
TO MOVE THE TIME OF THESE SESSIONS TO A TIME WHEN PEOPLE
ON THE WEST COAST AND OTHER PARTS OF THE WORLD CAN WATCH
THEM. WE ARE GOING TO DO THAT EITHER
IN AUGUST OR SEPTEMBER. OUR NEXT SESSION IN JULY IS
GOING TO STAY AT THE SAME TIME BECAUSE WE EXPECT A LOT OF
COLLEAGUES FROM EUROPE AND AFRICA WILL BE INTERESTED IN
GLOBAL HEALTH AND CHILD SURVIVAL. SO STARTING IN AUGUST AND
SEPTEMBER, WE’RE LIKELY GOING TO START AROUND NOON. THANK YOU SO MUCH FOR COMING OUT
IN THIS LARGE NUMBER IN PERSON. SEE YOU IN FOUR WEEKS, SAME
TIME, SAME PLACE.

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  1. @cw505 no, it's not that easy. Yes, getting proper exercise is a big part of it but take a look at what's available in the stores and you will see that 99% of what is there is processed garbage full of sugars and fats. It's not like you can just stop eating. Organic unprocessed food without GE, hormones, etc.are not that simple to come by nor are they cheap. We need to demand more from our food providers. Until we get better food available to us, this will not go away anytime soon.

  2. Children and Adults are Obese because even bread has HIGH FRUCTOSE CORN SYRUP and what do MEDICATIONS add to That??? Yes, "We are from the government we are here to help you." Sit on a TWINKIE !!!

  3. Childhood obesity is an epidemic in the United States due to its increased prevalence in the country. Since 1980, obesity prevalence among children and adolescents has almost tripled. Approximately 17% of children and adolescents (12.5 million) ages 2-19 in the United States are obese.

  4. As the incidence of obesity continues to increase, the development of effective therapies is a high priority. The endocannabinoid system has emerged as an important influence on the regulation of energy homeostasis. The endocannabinoids anandamide and 2-arachidonoylglycerol act on cannabinoid receptor-1 (CB1) in the brain and many peripheral tissues causing a net anabolic action. This includes increasing food intake, and causing increased lipogenesis and fat storage in adipose tissue and liver. The endocannabinoid system is hyperactive in obese humans and animals, and treating them with CB1 antagonists causes weight loss and improved lipid and glucose profiles. Although clinical trials with CB1 antagonists have yielded beneficial metabolic effects, concerns about negative affect have limited the therapeutic potential of the first class of CB1 antagonists available.

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