Soraya Ghebleh

CHILDHOOD OBESITY IN AMERICA:

STRATEGIES AND POLICY OPTIONS FOR PREVENTION AND REDUCTION

¡  1 out of 3 children in the United States are overweight ¡  Rates of childhood obesity have tripled since the 1960s ¡  17% of children have a BMI over the 95th percentile ¡  Hospital costs associated with childhood obesity are upwards

of $150 million a year ¡  Total costs of obesity, both child and adult, are estimated to

be over $100 billion annually ¡  Children who are obese are more prone to develop high-risk

diseases such as type II diabetes, elevated blood pressure, and other diseases that can be life threatening and lead to poor quality of life

SCOPE OF THE PROBLEM

Conclusions and Priorities determined by the IOM

INSTITUTE OF MEDICINE: PROGRESS REPORT

While the country has responded to the obesity epidemic, the current level of

investment does not match the scale of the problem

Various entities are implementing programs, policies, and interventions, but

researchers need to produce evidence-based approaches that will guide national

action.

Evaluation needs to occur at multiple levels and settings. This layered

information will help guide improvements to childhood obesity efforts. Surveillance,

monitoring, and research are all components of evaluation.

Current evidence is not sufficient to complete a comprehensive assessment of

the progress that the nation has made. Researchers should use best practices in the short term with the goal of developing

a larger evidence base with which to develop initiatives that can be used in

various settings.

We need short term, intermediate, and long term evaluation in order to have a sustained improvement of the childhood obesity epidemic.

¡  Lack of physical activity ¡  Improper diet ¡  Socioeconomic factors ¡  Education on healthy behaviors and diet is often minimal ¡ Marketing of unhealthy foods to children ¡  Sedentary lifestyles ¡  Built environment ¡  Cultural determinants ¡ Modeling of unhealthy habits ¡  Poor physical education education in schools

CONTRIBUTING FACTORS TO CHILDHOOD OBESITY

STRATEGIES

Regulate Food Sales

Encourage Healthy

Behavior

Education and

Prevention

¡  Studies and surveys have demonstrated that consumers support menu labeling, available nutrition information provided in restaurants is inadequate and insufficient, and menu labeling is consistent with requiring producers to disclose product information and any other potentially harmful facts about products.

¡  Eating outside of the house increases

calorie intake and can lead to poorer nutrition and that fast-food consumption is associated with risk for poor nutrition and obesity.

Citation: Roberto, C. A., M. B. Schwartz, et al. (2009). "Rationale and evidence for menu-labeling legislation." American journal of preventive medicine 37(6): 546-551.

REGULATE FOOD SALES: MENU LABELING

¡  Food stamps have the potential to result in excessive caloric intake and it has been suggested that food stamp recipients consume more sugar and fat than eligible non-recipients, indicating the need for a potential re-evaluation of the food stamp distribution method.

C i t a t io n : B aum , C . L . ( 2 01 1 ) . " T h e e f fe c t s o f fo o d s t am ps o n o be s i t y. " S out h e rn Econom ic Jou rna l 77 ( 3 ) : 6 2 3 -6 51 .

REGULATE FOOD SALES: RESTRICT FOOD STAMPS

¡  Decreased access to foods leading to obesity and increased access to healthy foods may combat obesity. 

¡  Sugar-sweetened beverages are directly linked to excessive weight gain and reducing SSB consumption has been shown to reduce baseline body weight.

C i t a t io ns : de Ruy te r, J . C . , M . R . O l t ho f , e t a l . ( 2 01 2 ) . " E f fe c t o f sugar - swe ete ne d beve rage s on body we ig h t i n c h i ld re n : de s ig n and bas e l ine c harac te r i s t i cs o f t he Doub le -b l ind , Random iz e d IN te r ve n t ion s tudy in K ids . " C o nte m po ra r y C l in i c a l Tr ia l s 3 3 ( 1 ) : 247 -2 57.

REGULATE FOOD SALES: REGULATE FOOD IN THE RETAIL ENVIRONMENT

¡  Exposure to food environments and retail spaces that have poor-quality foods are associated with adolescent eating patterns and the propensity to become overweight. Limiting the proximity of fast-food restaurants to schools could help reduce adolescent obesity.

Citations: Davis, B. and C. Carpenter (2009). "Proximity of fast-food restaurants to schools and adolescent obesity." Journal Information 99(3).

REGULATE FOOD SALES: REGULATE LOCATION OF FAST FOOD RESTAURANTS

¡  Schools are a consistent source of nutrit ion for most children regardless of their home environment and is a location that can be ef fectively uti l ized to provide children with nutrit ious food that does not lead to obesity or poor caloric intake.1

¡  Changes to school food environments by removing sugar-sweetened

beverages from school food stores and snack pars, improving a la carte choices, and reducing the frequency of of fering french fr ies lead to improved dietary behaviors among children and adolescents.1

¡  State mandates to require daily physical education and quality nutrit ion education in all primary and secondary schools can reduce obesity.2

C i t a t io ns : 1 . B r ie fe l , R . R . , M . K . C re p ins e k , e t a l . ( 2 0 0 9 ) . " S c hoo l food e nv i ronme nt s and p rac t i ce s a f fe c t d ie t a r y be hav io r s o f US pub l i c s c hoo l c h i ld re n . " Jou rna l o f t he Am e r i can D ie te t i c As s oc ia t ion 10 9( 2 ) : S 91 -S 107. 2 . H ayne , C . L . , P. A . Moran , e t a l . ( 2 0 0 4 ) . " Re g u la t ing e nv i ronm e nt s to re duce obe s i t y. " Jou rna l o f Pub l i c He a l t h Po l i c y 2 5 ( 3 -4 ) : 3 -4 .

REGULATE FOOD SALES: REGULATE FOOD IN SCHOOLS

¡  Despite the constitutional impediment of free speech, efforts can be made to reduce direct marketing of unhealthy foods to children and should be seriously considered in any policy approach that is interested in reducing obesity in children.

ENCOURAGE HEALTHY BEHAVIOR: RESTRICT/CONTROL MARKETING TO CHILDREN

¡  Taxing sugar-sweetened beverages and other food items that have high fat content can be done to deter unhealthy eating habits by means of economic disincentive.

C i t a t io ns : McGu inne ss , S . A . ( 2 01 2 ) . " T ime to Cu t t he Fa t : T he Case fo r Gove rnme nt An t i -Obe s i t y Le g i s la t ion . " JL & H e a l t h 2 5 : 41 .

ENCOURAGE HEALTHY BEHAVIOR: TAX CERTAIN FOODS

¡  Increased access to healthy food in areas with higher poverty can reduce obesity and encourage healthy choices. Development of supermarkets in areas that only have convenience stores that do not carry healthy, fresh foods can improve outcomes for those neighborhoods.1

¡  Obesity prevalence increases as food and vegetable consumption decreases with increasing distance to supermarkets in metropolitan areas suggesting that increased access to supermarkets that carry healthy foods can improve consumption of healthier foods.2

Citations: 1. DeMattia, L. and S. L. Denney (2008). "Childhood obesity prevention: successful community-based efforts." The ANNALS of the American Academy of Political and Social Science 615(1): 83-99. 2. Michimi, A. and M. C. Wimberly (2010). "Associations of supermarket accessibility with obesity and fruit and vegetable consumption in the conterminous United States." International Journal of Health Economics.

ENCOURAGE HEALTHY BEHAVIOR: TAX BREAKS FOR HEALTHY INITIATIVES

¡  After-school programs can improve physical activity levels and contribute to reduction in weight gain.1

¡  Standards-based reform in physical education must involve maximum physical activity of much more than 20 min of physical education per day and physical activity must involve more pedagogical training, involving goal setting and focused performance outcomes for given grade levels.2

Citations: 1. Beets, M. W., A. Beighle, et al. (2009). "After-school program impact on physical activity and fitness: a meta-analysis." American journal of preventive medicine 36(6): 527-537. 2. Erwin, H. E. and D. M. Castelli (2008). "National physical education standards: A summary of student performance and its correlates." Research quarterly for exercise and sport 79(4): 495-505.

ENCOURAGE HEALTHY BEHAVIOR: ENCOURAGE PHYSICAL EDUCATION

¡  Greater access to recreational facilities and living in environments where physical activity is part of the “built” environment is associated with lower obesity rates.

C i t a t io ns : S a lo i s , M . J . ( 2 01 2 ) . " Obe s i t y and d iabete s , t he bu i l t e nv i ronme nt , and t he ‘ l oca l ’ food e conomy in t h e Un i te d S t a te s , 2 0 07. " Econom ics & H um an B io log y 10 ( 1 ) : 3 5 -4 2 .

ENCOURAGE HEALTHY BEHAVIOR: BUILT ENVIRONMENT, “SMART GROWTH LAWS”

¡  Education and prevention strategies should be incorporated into the school environment where both children and adults can benefit and be reached out to

¡  Education should also be a part of other interventions because it can ensure the success of interventions and improve outcomes if those participating have a higher level understanding

EDUCATION AND PREVENTION