Transcript IOM Presentation - Progress in PReventing Childhood Obesity

Progress in Preventing Childhood Obesity:
How Do We Measure Up?
Eduardo Sanchez, M.D., M.P.H.
Director, Institute for Health Policy
University of Texas School of
Public Health
[email protected]
November 3, 2006
Discussion Points
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Background
Obesity prevalence and related health trends
Conclusions
Elements of an effective response
Evaluation framework and approach
Recommendations
Next steps
Background
2004
• Congressional request
• Sponsors – DHHS (CDC, NIH, ODPHP),
• RWJF
• 19-member IOM committee
• Blueprint for comprehensive action plan
2006
• Sponsor – RWJF
• 13-member IOM committee
• Assess progress in preventing
childhood obesity
• Conduct 3 regional workshops
IOM Committee on Progress in
Preventing Childhood Obesity
JEFFREY KOPLAN (Chair)
Emory University
ROSS BROWNSON
St. Louis University
ANN BULLOCK
Health and Medical Division,
Eastern Band of Cherokee Indians
SUSAN FOERSTER
California Department of Health Services
JENNIFER GREENE
University of Illinois Urbana-Champaign
DOUGLAS KAMEROW
RTI International
MARSHALL KREUTER
Georgia State University
RUSSELL PATE
University of South Carolina
JOHN PETERS
Procter & Gamble Company
KENNETH POWELL
Georgia Division of Public Health
THOMAS ROBINSON
Stanford University
EDUARDO SANCHEZ
Texas Department of State Health
Services
ANTRONETTE YANCEY
UCLA School of Public Health
Consultants
SHIRIKI KUMANYIKA
University of Pennsylvania
DONNA NICHOLS
Texas Department of State Health
Services
IOM Staff
VIVICA KRAAK, CATHY LIVERMAN,
SHANNON WISHAM, JON SANDERS
IOM Regional Symposia
• Three regional symposia
• June 2005, Wichita, KS – Focus on schools
• October 2005, Atlanta, GA – Focus on communities
• December 2005, Irvine, CA – Focus on industry
• Discuss current and promising initiatives
• Identify barriers and assets to sustainability and
evaluation of interventions
• Identify areas of convergence and next steps for
stakeholders and sectors
Definitions
• Obesity refers to children and youth who have a BMI
for age at or above the sex-specific 95th percentile of
the BMI charts developed by the CDC in 2000.
• At risk for obesity refers to children and youth BMI
for age at or above the sex-specific 85th percentile but
less than the 95th percentile of the CDC BMI charts.
• In most children, BMI values ≥ 95th percentile indicate
elevated body fat and reflect the presence or risk of
related diseases.
• U.S. has no BMI-for-age references for children < 2
years.
CDC uses overweight instead of obesity for children and youth.
National Obesity Prevalence for
Children and Youth
• One third (33.6 percent) of 2- to 19-year olds are
obese or at risk
• Obesity (defined as BMI ≥ 95th percentile) for based on
NHANES data:
• 13.9 percent in 1999–2000
• 15.4 percent in 2001–2002
• 17.1 percent in 2003–2004 (obese); 16.5 percent (at risk)
• By 2010, an estimated 20 percent of U.S. children and
youth in the United States will be obese if the current
trajectory continues
Sources: Ogden et al. (2006); Sondik (2004)
U.S. Obesity Epidemic Trends for Children and
Youth by Age and Time Frame, 1963-2004
20
17
12
10
5
11
11
7
7
5
16
4
5
4
6
5
0
2-5y
1963-1970 NHES
1988-1994 NHANES III
12-19y
6-11y
1971-1974 NHANES I
1999-2004 NHANES
1976-1980 NHANES II
Source: Ogden et al., 2006
U.S. Childhood Obesity Epidemic Trends by
Sex and Race/Ethnicity, 2003-2004
Boys ages 2-19 yrs
Girls ages 2-19 yrs
45
40
35
30
25
20
15
10
Obese
(BMI ≥ 95th percentile)
At Risk ( 85th percentile ≥
BMI < 95th percentile)
Combined
Total
Mexican
Americans
Blacks
Whites
All
Mexican
Americans
Blacks
Whites
All
Mexican
Americans
Blacks
0
Whites
5
At Risk + Obese
Source: Ogden et al., 2006
Obesity in Diverse Populations
• NHANES 2003-2004, non-Hispanic African
American and Mexican-American children and
adolescents, 2-19 years, have a greater obesity
prevalence than whites.
• Children and youth at highest risk for obesity often
experience other social, economic, and health
disparities concurrently and do not live in
environments that support healthy behaviors.
Adverse Childhood Experiences
(ACE) Study
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As a follow-up, Kaiser Permanente & CDC conducted As
a follow-up, Kaiser Permanente
& CDC conducted ACE study
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Study involved 19,000 mostly middle class, middle aged adults
•
Results show childhood abuse & household dysfunction led to chronic diseases
decades later
•
Traditionally viewed as public health problems, behaviors may also be coping
mechanisms
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•
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ACE study
Study involved 19,000 mostly middle class, middle aged adults
Results show childhood abuse & household dysfunction led to chronic diseases decades
later
Traditionally viewed as public health problems, behaviors may also be coping mechanisms
•
Other Health Trends
• Doubling of type 2 diabetes among children and youth
over past decade
• SEARCH for Diabetes in YOUTH Study (2006)
provides population-based sample for type 1 and type
2 diabetes
•
Prevalence lower for children ages 0-9 years (.79 cases/1,000)
•
10-19 year olds (2.8 cases/1,000)
•
Type 2 diabetes found in all racial/ethnic groups but less common than
type 1 except for American Indian youth
• One million 12- to 19-year-olds have the metabolic
syndrome (3 of 5 metabolic abnormalities)
U.S. Adult Obesity Prevalence
• CDC has tracked adult obesity trends in 50 states
from 1985 to present
• CDC Maps for U.S. Adult Obesity Trends
(BRFSS), 1985 to 2004
• U.S. adult obesity rates
• 2004: 15-19% in 7 states, 20-24% in 33 states &
25 percent or more in 9 states
• 2003-2005: rates exceeded 20% in 43 states & DC
(Trust for America’s Health, 2006)
Conclusions from IOM Report
Health in the Balance
• Childhood obesity is a serious nationwide health problem
with multi-factorial causes requiring a population-based
prevention approach and a comprehensive response.
• The goal is energy balance—healthy eating behaviors and
regular physical activity to achieve a healthy weight while
protecting health and normal growth and development.
• Preventing childhood obesity is a collective
responsibility—multiple sectors and stakeholders must be
involved in societal changes at all levels.
Sectors to Involve in Childhood
Obesity Response
• Government (federal, state, local)
• Industry (food, beverage, restaurant, food
retailers, entertainment, recreation, leisure)
• Media (unpaid and paid)
• Communities (nonprofits, foundations, faithbased groups, child- and youth-related
organizations, health care sector)
• Schools (e.g., preschool, after school, child care)
• Home (families and care providers)
 Government
 Communities
 Public Health
Social Norms
and Values
 Worksites
 Health Care
 Health Care
 Agriculture
Sectors of
Influence
 Schools and
Child Care
 Education
 Media
 Home
 Land Use and
Transportation
Behavioral
Settings
 Demographic
Factors (e.g.,
age, sex, SES,
race/ethnicity)
 Psychosocial
Factors
 GeneEnvironment
Interactions
 Communities
 Foundations
Individual
Factors
Food &
Beverage Intake
Energy Intake
 Industry
Food
Physical
Activity
Energy Expenditure
Beverage
Retail
Leisure and
Recreation
Entertainment
 Other Factors
Energy Balance
Conclusions from IOM Report
How Do We Measure Up?
• Marked underinvestment in childhood obesity
prevention interventions - current investment does
not match extent of problem.
• A robust evidence base is needed to identify
promising practices so effective interventions can be
scaled-up and supported in diverse settings
• Need for collective responsibility and collective
action.
• Evaluation of ongoing efforts is needed - adequate
resources need to be committed to evaluation.
Recommendations
• Lead and commit to childhood obesity prevention
• Evaluate policies and programs and build
evaluation capacity
• Monitor progress and conduct research
• Disseminate promising practices
Promising and Best Practices
Promising Practices
• Interventions likely to reduce childhood obesity and have
been evaluated but lack sufficient evidence to link it to
reducing childhood obesity and co-morbidities
• Promising practices always have evaluation components
Best Practices
• Interventions with sufficient evidence to provide certainty
that they are linked to reducing childhood obesity and
co-morbidities
• Very few best practices available to guide childhood
obesity prevention efforts
Characteristics of
Effective Interventions
• Evaluation built into interventions from the outset
• Consider diverse perspectives and attend to
community and population context
• Link with other programs to produce synergistic
effect
• Include relevant outcome measures given the
scope of intervention
• Range of interventions across all sectors and all
types of outcomes should be measured
Obesity Prevention
Evaluation Framework
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Sectors
Resources and inputs
Strategies and actions
Continuum of outcomes
• Policy (e.g., structural, institutional, systemic)
outcomes
• Environmental outcomes
• Social and cognitive outcomes
• Behavioral outcomes
• Health outcomes
IOM Evaluation Framework for Obesity Prevention
Policies and Interventions
SECTORS
Government
Industry
Communities
Schools
Home
RESOURCES & INPUTS
Leadership
Strategic Planning
Political Commitment
Adequate Funding and
Capacity Development
OUTCOMES
STRATEGIES &
ACTIONS
• Programs
• Policies
• Surveillance
and Monitoring
• Research
• Education
• Partnerships
• Coalitions
• Coordination
• Collaboration
• Communication
• Marketing
and Promotion
• Product
Development
• New
Technologies
Structural,
Institutional,
Systemic
Outcomes
Environmental
Outcomes
Cognitive
and Social
Outcomes
Behavioral
Outcomes
• Dietary
• Physical
Activity
Cross-Cutting Factors that Influence the Evaluation of Policies and Interventions
Age; sex; socioeconomic status; race and ethnicity; culture; immigration status and acculturation;
biobehavioral and gene-environment interactions; psychosocial status; social, political, and historical contexts.
Health
Outcomes
Reduce BMI
Levels in
the
Population
Reduce
Obesity
Prevalence
Reduce
ObesityRelated
Morbidity
Examples of Promising Practices
Government
• USDA and DoD Fresh Fruit and Vegetable Program
• CDC’s 5-year VERB campaign had positive evaluation
results in promoting physical activity among tweens
(funding discontinued in 2006).
• CDC’s Nutrition and Physical Activity Program to
Prevent Childhood Obesity and Other Chronic Diseases
($16 million to 28 states in 2005-06 provided to increase
capacity to implement programs and evaluations).
• Federal Safe Routes to School Program (initiated in
2005) has evaluation underway.
Examples of Promising Practices
Industry & Media
• Changes by food, beverage, restaurant, recreation and
entertainment companies based on company market
testing and consumer marketing research.
• Companies developed new or reformulated products,
changed packaging (100-calorie packs), expanded
meals to help consumers adhere to DGA.
• Most evaluations not publicly available & many
innovative interventions not evaluated.
• Media - Small Step (PSA awareness); Coalition for
Healthy Children (2 evaluations).
Examples of Promising Practices
Communities
• Coalitions are tracking changes in policies and
programs to promote physical activity and expand
access to healthier foods and beverages (built
environment).
• HHS Steps to a Healthier US Initiative (Steps Program)
supports 40 communities nationwide ($35.8 million
provided for FY 2004-2006) and has evaluation
underway.
• Community-academic partnerships
• Public-private partnerships (implement statewide
obesity prevention action plans – GA, WV, NC, TX).
Role of Foundations
• Many public-private partnerships involve support
from corporate or private foundations
• Foundations are becoming important leaders in
the response to childhood obesity
• Foundations have several advantages:
• Greater flexibility in their funding mechanisms than
government agencies
• Support to explore untested or promising approaches and
evaluation of natural experiments
• Important funding source for grantees at the community
level and often require the submission of an evaluation
plan to accompany a grant application
Examples of Promising Practices
Foundations
• Corporate Foundations
• Produce for Better Health Foundation, General Mills
Foundation, PepsiCo Foundation, IFIC Foundation, Aetna
Foundation
• Private Foundations (national, regional, state)
• W.K. Kellogg Foundation, William J. Clinton Foundation,
California Endowment
• Sunflower Foundation, Healthcare Georgia Foundation,
Kansas Health Foundation
• Robert Wood Johnson Foundation
• Active Living by Design and Active Living Leadership
initiatives
• Healthy Eating Research initiative
• Ad Council’s Coalition for Healthy Children
Examples of Promising Practices
Schools
• School nutrition standards
• Awards programs for healthy schools (e.g., Utah Gold
Medal Schools Program)
• Public-private partnerships
• Alliance for a Healthier Generation has evaluation
underway
• After-school programs
• CATCH Kids Club, Georgia Fit Kid Project, SPARK
• Need to systematically evaluate school wellness
policies as they are adopted and promoted
• Kansas Coordinated School Health Program
• Local school wellness policies
Examples of Promising Practices
Home
• Fit WIC, pilot-tested in 4 states in 1999, evaluated
parents’ behaviors to reduce obesity in preschoolers.
Parents who participated were more likely to
introduce positive behaviors to their children.
• Hip Hop to Health Jr., a preschool intervention with
low-income African-American children in Head Start
provided incentives to parents to encourage healthy
eating behaviors and physical activity in children.
• Stanford’s Student Media Awareness to Reduce
Television classroom curriculum reaches parents to
reduce 3rd-4th graders’ leisure screen time.
Next Steps for Addressing the Childhood
Obesity Epidemic
Government
• Establish high-level task forces (federal, state,
local) to identify priorities for action, coordinate
public-sector efforts, and establish effective
interdepartmental collaborations.
• Provide sustained commitment and long-term
investment in childhood obesity prevention
initiatives and surveillance efforts.
Next Steps for Addressing the Childhood
Obesity Epidemic
Industry & Media
• Support and market product innovations and
reformulations.
• Independent and periodic evaluations of industry’s
efforts.
• Develop and strengthen public–private partnerships
• Share proprietary data that can expand understanding of
consumer purchasing and marketing trends.
• Evaluate progress in developing and communicating
storylines and programming that promote healthy
lifestyles.
Next Steps for Addressing the Childhood
Obesity Epidemic
Communities
• Develop community health index toolkit through
government–academic–community partnerships
to help examine factors relevant to creating
healthy communities.
• Expand collection and dissemination of local data
• Compile and widely share community-based
evaluation results, lessons learned, and
community action plans.
Next Steps for Addressing the Childhood
Obesity Epidemic
Foundations
• Community stakeholders (including private and
corporate foundations) should establish and
strengthen the local policies, coalitions, and
collaborations needed to create and sustain healthy
communities.
• Industry (including corporate foundations) should use
the full range of available resources and tools to
create, support, and sustain consumer demand for
products and opportunities that support healthy
lifestyles including healthful diets and regular physical
activity.
Next Steps for Addressing the Childhood
Obesity Epidemic
Foundations
• Community stakeholders should partner with
foundations, government agencies, faith-based
organizations, and youth-related organizations to
strengthen evaluation efforts at the local level and
support community-academic partnerships.
• Schools and school districts should partner with state
and federal agencies, foundations, and academic
institutions to develop, implement, and support
evaluations of all school-based programs and publish
and widely disseminate the evaluation results of
school-based childhood obesity prevention efforts and
related materials and methods.
Next Steps for Addressing the Childhood
Obesity Epidemic
Schools
• Elevate the priority placed on sustaining a healthy
school environment.
• Increase resources for technical assistance to
evaluate changes in schools (physical activity and
diet).
• Expand surveillance and data collection efforts
• Compile and widely share school-based
evaluation results and lessons learned.
Next Steps for Addressing the Childhood
Obesity Epidemic
Home
• Families should assess the home environment to
ensure that foods and beverages supporting a
healthful diet are consumed by children and youth
at home and served in reasonable portion sizes.
• Families should emphasize physical activity as a
family priority and establish rules or guidelines
that limit leisure screen time (e.g., television,
DVDs, videos, movies, videogames, and
computers).
For More Information
• Fact sheets
www.iom.edu/obesity/
Read the book online or purchase the report
www.nap.edu
• RWJF TV Health Series