Improving School Nutrition in the Fight Against Childhood

Improving School Nutrition in the Fight Against Childhood Obesity: Williamson County, TN Lynn Tarkington, MPH Student Walden University PUBH 6165 -04 Dr. Stephen Arnold Summer 2009

Scope of Overweight and Obesity in Children in America: Childhood overweight and obesity is an epidemic problem in America. ◦ Definitions Overweight: Excess body weight for height. Measured by Body Mass Index (BMI): the ratio of weight to height squared (kg/m 2). Obesity is BMI greater than or equal to 95 th percentile of age and gender on CDC BMI growth chart. 85 to 94 th percentile are considered at risk for overweight and obesity ◦ Causes: Complex interacting factors of social, environmental, and policy areas leading to: Too little physical activity Non-healthy food choices Centers for Disease Control and Prevention (CDC), 2009 a. Health youth-childhood obesity. Retrieved January 8, 2009, from http: //www. cdc. gov/healthyouth/obesity/index. htm. Institute of Medicine (IOM), 2007. Committee on Progress in Preventing Childhood Obesity. (2007). Progress in Preventing Childhood Obesity; How Do We Measure Up? Washington, DC: National Academy Press.

National Statistics Prevalence of Obesity ◦ Age 6 – 11 has doubled in the past thirty years 17% ◦ Age 12 -18 has tripled in the past thirty years 17. 6% ◦ 32% of children age 2 -19 are overweight or obese ◦ 23 million children Impacts all categories of race, ethnicity, socioeconomic status (SES), locale ◦ Some lower SES, ethnic populations are at higher risk CDC, 2009 a. IOM, 2007. Healthy People 2010. (2009). Healthy People 2010, 2 nd Edition, Vol. 1. Retrieved January 18, 2009, from www. healthypeople. gov/about. Pekruhn, C. (2009). Preventing Childhood Obesity: A School Health Policy Guide. National Association of State Boards of Education, Center for Safe and Healthy Schools. Retrieved May 11, 2009, from www. nasbe. org.

National Statistics: Financial Impact 5 -7% of annual healthcare expenditures (Kaplan) 2004: ◦ $14 billion direct costs to treat obese children ◦ Medicaid spending: $6730 per obese child per year $2446 per normal weight child ◦ Total $98 - $129 billion on direct and indirect costs of obesity Health Affairs (2009) ◦ $125. 9 million in 2001 ◦ $237. 6 million in 2005 ◦ Nearly double number of hospitalizations with diagnosis of obesity. IOM, 2007. Pekruhn, 2009. Tennessee Department of Education, Office of Coordinated School Health. (2009). Childhood Overweight. Retrieved July 15, 2009 from www. tennessee. gov/education/schoolhealth/overweight/index. html. Trasande, Liu, Fryer, & Weitzman. (2009). Effects of Childhood Obesity on Hospital Care and Costs, 1999 -2005. Health Affairs 28(4), w 751 -760. doi: 10. 1377/hlthaff. 28. 4. w 751.

Health Impacts Second leading cause of preventable death (after tobacco) in the United States Immediate Impact - Diseases in Childhood ◦ Elevated blood pressure ◦ Abnormal lipid profiles ◦ Type 2 Diabetes Increased Health Risk as Adults ◦ ◦ ◦ Diabetes Cardiovascular Disease Stroke Cancer Osteoarthritis Healthy People, 2009. IOM, 2007. Must & Strauss. (1999). Risks and Consequences of childhood and adolescent obesity. International Journal of Obesity (23), Supplement 2, S 2 -11. Retrieved January 8, 2009. Trasande, Liu, Fryer, & Weitzman, 2009.

Psycho-social Impacts Low self esteem Poor body image Depression Overweight children feel stigmatized by their weight. School age girls report they want to lose weight due to media images. Body image impacts how children assess their abilities and those of other children. Children perceived their overweight peers as less smart, weak, incapable, and unlikeable IOM, 2007. Okie, S. (2005). Fed Up! Winning the War Against Childhood Obesity. Washington, DC: Joseph Henry Press. Pekruhn, 2009.

Urgency in the Era of Economic Crisis Economic pressure drives down commodity products prices and increases prices of health option like fresh fruits and vegetables. ◦ Fast – food driven Per capita kcal intake up Physical activity down ◦ Economic priorities – road construction (even less need for physical activity) ◦ No sidewalks, bike paths School budget restrictions ◦ Cut PE programs and after school sports Increased time with the TV, computer games, internet Blumenthal, Hendi, & Marsillo. (2002). A public health approach to decreasing obesity. Journal of the American Medical Association, 288(17), 2178. Retrieved April 17, 2009. Carter, R. (2002). The impact of public schools on childhood obesity. Journal of the American Medical Association 288(17), 2180. Retrieved April 17, 2009. CDC, 2009 a. IOM, 2007. Ludwig, D. & Pollack, H. (2009). Obesity and the economy: From crisis to opportunity. The Journal of the American Medical Association, 301(5), 533 -535. Retrieved July 15, 2009. Okie, 2005.

Tennessee and Williamson County 4 th highest rate of childhood overweight and obesity in America at 20% of ages 10 to 17. 43% of Tennessee children are at risk for overweight or obesity 2007 data for high school students: ◦ 17% were obese ◦ 18% ate recommended fruits and vegetables ◦ 46% drank soda at least once per day Available in school vending machines ◦ 32% of food is consumed away from the home Usually higher fat foods and beverages & less nutritional value Tennessee Department of Education, Office of Coordinated School Health. (2009). Childhood Overweight. Retrieved July 15, 2009 from www. tennessee. gov/education/schoolhealth/overweight/index. html.

Current Programs in Tennessee Department of Health - Initiative to Improve Adolescent and Young Adult Health by 2010: ◦ Reduce the proportions of high school students who are overweight or obese to 5. 0% from the 2005 baseline of 14. 6%. Department of Education – Office of Coordinated School Health Action for Healthy Kids ◦ Improved nutrition and increased physical activity Recharge! Program Healthy School Recognition Program (2004 -2005) Get Fit TN. (2009). Get Fit TN. Retrieved January 10, 2009, from www. getfittn. com/index. aspx. Tennessee Department of Education, 2009. Tennessee Healthy Weight Network. (2004). Eat smart-move more-tune in. Retrieved February 7, 2009, from www. tnhealthyweight. org.

Williamson County Schools Mission: “To cultivate the ability, intellect, and character of each student. ” (2009). Wellness Policy and Guideline – 2006: ◦ “Good health fosters student attendance and education” School Health Councils Nutritional Quality of Foods and Beverages Sold and Served on Campus Nutrition and Physical Activity Promotion Physical Activity, Physical Education, and Health Education Opportunities Pekruhn, 2009. Williamson County Schools. (2006 -2009). Williamson County School District – Wellness Policy and Guideline. Retrieved July 15, 2009, from www. williamsoncounty-tn. gov.

Farm to School Program Farm to School programs incorporate healthy, nutritious, local produce into school lunches and snacks. Combine with nutritional education, farm visits, school gardens, and classroom education. Various methods of Federal or State sponsorship/support: ◦ USDA ◦ DOD US Department of Agriculture, Food and Nutrition Services. (2005). Eat Smart-Farm Fresh. Retrieved from www. usda. gov.

Farm to School Program Three basic steps: Assess possible distribution models: Popular foods include: ◦ Determine what and how much you need. ◦ Coordinate with local farmers. ◦ Have the food delivered to schools. ◦ ◦ Direct local purchase Farmer cooperative Farmers’ market Local purchase through traditional wholesaler ◦ ◦ ◦ Salad greens Sweet potatoes Tomatoes Melons Apples Strawberries US Department of Agriculture, 2005.

Why Should Williamson County Consider a Farm to School Program? Agriculture is important to our state and county: ◦ Almost 80, 000 farms in Tennessee. ◦ In 2004, Tennessee ranked 4 th in the US in tomato and snap bean harvests, 24 th for peaches, and 28 th for apples. ◦ Multiple farms in Williamson County with bountiful fruit and vegetable crops, and a superb Farmers’ Market in Franklin. Tennessee Department of Agriculture, 2009.

First Steps: Research: ◦ What, Where, and Who? ◦ Find collaborators: Department of Agriculture Other State or County Departments Partners for funding ◦ Research potential regulatory hurdles. Plan for incorporating educational component for students. Start Small!

Concluding Comments Epidemic of childhood overweight and obesity is a major public health concern in our country today leading to: ◦ ◦ Chronic illness Poor quality of life Decreased productivity High health care costs Williamson County, Tennessee should show leadership in assisting the children trusted to our educational system.

Thank You

References: Blumenthal, S. , Hendi, J. , & Marsillo, L. (2002). A public health approach to decreasing obesity. Journal of the American Medical Association, 288(17), 2178. Retrieved April 17, 2009. Carter, R. (2002). The impact of public schools on childhood obesity. Journal of the American Medical Association 288(17), 2180. Retrieved April 17, 2009. Centers for Disease Control. (2009 a). Health youth-childhood obesity. Retrieved January 8, 2009, from http: //www. cdc. gov/healthyouth/obesity/index. htm. Centers for Disease Control and Prevention. (2009 b). Obesity trends among US Adults. Retrieved July 15, 2009, from http: //www. cdc. gov/brfss. Get Fit TN. (2009). Get Fit TN. Retrieved January 10, 2009, from http: //www. getfittn. com/index. aspx. Healthy People 2010. (2009). Healthy People 2010, 2 nd Edition, Vol. 1. Retrieved January 18, 2009, from www. healthypeople. gov/about. Institute of Medicine, Committee on Progress in Preventing Childhood Obesity. (2007). Progress in Preventing Childhood Obesity: How Do We Measure Up? Washington, DC: National Academy Press.

References: Ludwig, D. & Pollack, H. (2009). Obesity and the economy: From crisis to opportunity. The Journal of the American Medical Association, 301(5), 533535. Retrieved July 15, 2009. Must, A. , Strauss, R. S. (1999). Risks and consequences of childhood and adolescent obesity. International Journal of Obesity (23), Supplement 2, S 211. Retrieved January 8, 2009. Okie, S. (2005). Fed up! Winning the war against childhood obesity. Washington, DC: Joseph Henry Press. Pekruhn, C. (2009). Preventing childhood obesity: A school health policy guide. National Association of State Boards of Education, Center for Safe and Healthy Schools. Retrieved May 11, 2009 from www. nasbe. org. Tennessee Department of Agriculture. (2009). Statistics. Retrieved July 15, 2009 from http: //tennessee. gov/agriculture/html. Tennessee Department of Education, Office of Coordinated School Health. (2009). Childhood Overweight. Retrieved July 15, 2009 from http: //tennessee. gov/education/schoolhealth/overweight/index. shtml Tennessee Healthy Weight Network. (2004). Eat smart-move more-tune in. Retrieved February 7, 2009, from http: //www. tnhealthyweight. org.

References: Trasande, L. , Liu, Y. , Fryer, G. , Weitzman, M. (2009). Effects of childhood obesity on hospital care and costs, 1999 -2005. Health Affairs 28(4), w 751 -w 760. doi: 10. 1377/hlthaff. 28. 4. w 751. United States Department of Agriculture, Food and Nutrition Services. 2005. Eat Smart – Farm Fresh. Retrieved from http: //www. usda. gov. Williamson County Tennessee. (2006). Williamson County School District – Wellness Policy and Guideline. Retrieved July 15, 2009, from http: //www. williamsoncounty-tn. gov. Vieweg, V. , Johnson, C. , Lanier, J. , Fernandez, A. , Pandurangi, A. (2007). Correlation between high risk obesity groups and low socioeconomic status in school children. Southern Medical Journal 100(1): 8 -13.