The Childhood Obesity Epidemic

>>> 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.