REDUCING CHILDHOOD OBESITY Public Policy And BroadBased Strategies

REDUCING CHILDHOOD OBESITY: Public Policy And Broad-Based Strategies Philip M. Bonaparte, MD Chief Medical Officer Horizon NJ Health March 31, 2007 Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

• Obesity Definitions – High amount of body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or higher • Overweight – Body Mass Index between 25 and 29 • Children Overweight – BMI is > 95 th percentile according to the age and gender * Source: CDC, 2005 Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

BMI • Measure of a person’s weight in relation to height • Adults and children – Weight in kilograms divided by the square of his or height in meters. * Source: CDC, 2005 Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

National Center For Health Statistics • Children – 16% of children and teens (over 9 million) aged 6 -19 years are considered overweight • Adults – 65% overweight or obese – 30% of U. S. adults 20 years of age or older (60 million) are obese Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

NJ Behavioral Risk Factor Surveillance System Overall Gender Males Females Race/ethnicity White, non-Hispanic Black, non-Hispanic Percent Overweight Obese 36. 7 17. 7 47. 8 26. 5 18. 2 17. 2 35. 7 42. 5 38. 3 17. 0 25. 0 19. 5 *Source: NJ Dept. of Health and Human Services Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Kids ROCK Program • Kids Reaching Out to Create Healthy Kids • HNJH Pilot Program Ø 5 -13 yrs old Ø 3 Physician groups: Husband wife PCP, North Hudson Community Action and Cam. Care Ø Children >85 th percentile • Collaboration between Physician and HNJH Diabetes DM Program Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Kids ROCK Program • Goals- No increase in weight. Make life style changes • AAP Policy Statement • CDC guidelines: BMI • Outcomes Measures- Life Style Survey. BMI changes Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Kids ROCK Program Member education materials – How to Read a Food Label – Portion Control visual scale of What is a Portion (uses palm of hand, thumb, fist) – TV Zombies and Soda Monsters – Member incentives include: jump ropes, frisbees, H 2 O bottle, pedometer Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Kids ROCK Program Physician Support : • Reinforcement of physician education • Encourage members to keep visits • Link members to community resources including mental health, family counseling, nutritional education Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Kids ROCK Program • Over 108 children registered • Majority of children did not keep follow up appointments (about 90%) • Incorporated, “Dancing To Your health” Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Energy Imbalance • Weight gain – Calories consumed > Calories used • Weight loss – Calories consumed < Calories used • No weight change – Calories consumed = Calories used Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Causes • • Poor diet Lack of or insufficient physical activity Family history Poor choices Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Unhealthy Nutrition • Bigger portion sizes • More fast foods • Advertisements – Encourages fast foods – Soft drinks – Sweets – Sugar loaded foods like breakfast cereals Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Unhealthy Nutrition • Large meal=less cost Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Fast Foods • Mc. Donalds – – – 4 pieces chicken nuggets 12 fl. Oz. Coca Cola Cheeseburger Small French Fries Cookies 2 oz bag Hot fudge sundae Calories 210 c 110 c 330 c 210 c 230 c 360 c Fat 13 g 0 g 14 g 10 g 8 g 12 g Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Fast Foods Calories Fat • Cinnabon – Classic Cinnabon Cinnamon Roll • Pizza Hut – 1 slice cheese pan pizza – 1 slice cheese thin’n crispy • KFC – Drumstick – Mash potatoes – Macaroni & cheese – Baked beans 816 32 285 14 210 9 140 120 180 190 8 6 8 3 Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Age at first visit to Mc. Donald’s, Burger King or Wendy’s 5 and under 6 -12 13+ Never ate there Mc. Donald’s 54% 26% 19% 1% Burger King 36% 24% 36% 2% Wendy’s 28% 24% 45% 4% Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Lack Of Physical Activity • • • Fewer PA classes at school Lack of safe areas Television Computer Video games Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Childhood Obesity Causes & Effects Type II Diabetes Social Issues Heart Disease Childhood Obesity Low Self-Esteem Stress On Psychological Issues Pediatric Hypertension Joints Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

What Changes Are Needed? • • • Teach parents and children to read labels Warn against the dangers of Trans Fat Safer neighborhoods Increase PE at school PSA campaign on Healthy Lifestyle Open dialogue with Fast Food Chain Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Read The Label Start here Check calories Quick guide to %Daily Value 5% or less is low 20% or more is high Limit these Get enough of these Footnote Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

When It’s Time To Eat… • • Offer a variety of foods Regular schedule Set a good example Turn OFF the TV Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Give Them Less… • • • Doughnut French fries Regular chips Soda Fried chicken nuggets Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Who We Need? • • Parents Schools Government Healthcare Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Increase Physical Activity • Make it fun! • 30 minutes at once or 10 minutes at a time • Start at a moderate level and gradually increase • Make it a family or friends activity! Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Healthy People 2010 • Reduce the prevalence of children and adolescents (6 -19 y/o) who are overweight to 5% Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Obesity - A Global Epidemic • Worldwide, more than a billion people, 10% of whom are children, are obese or overweight • It is the sixth most important risk factor in the overall burden of disease • No coordinated obesity prevention efforts Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Obesity - US • The US has the highest rate of overweight and obese people • Set to overtake smoking as the main preventable cause of illness and early death • Obesity shortens life and increases the risk of developing heart disease and stroke, diabetes, arthritis and certain types of cancer Source: The Lancet Medical Journal Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Risk: Lack of Parental Concern • Many healthcare providers assume that parents are eager to make changes to help their children lose weight • Not all parents open to making lifestyle changes even if they could help their overweight children shed pounds – Of 151 parents studied, 44 % of parents were not planning on making lifestyle changes any time soon Source: Pediatrics, July 2005 Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*

Risk: Lack of Parental Concern • Parents more open to change if they viewed themselves as overweight • Study included mostly African American and Hispanic families seen at a Philadelphia pediatric practice • The children were between the ages of 2 and 12, and all were either overweight or at risk of becoming so Independent licensees of the Blue Cross and Blue Shield Association* Horizon NJ Health, a product of Horizon HMO*