Task Force on Childhood Obesity Summary

Monday, February 15, 2010

Children’s Physical Activity, BMI, and Fitness

Senator Purcell, Co-Chair

Representative Yongue, Co-Chair-Presiding

Paula Card-Higginson, Deputy Director, Center on Childhood Obesity, Robert Wood Johnson Foundation Paula opened her presentation by referencing obesity trends, mainly in the south, where 20 percent of the children ages 10-17 are classified as obese. An in depth overview of the 2003 Arkansas Child and Adolescent Obesity Initiative was highlighted. This legislation created a Child Health Advisory Committee to coordinate statewide efforts to combat childhood obesity and related illnesses and to improve the health of the next generation of Arkansans. The bill included requirements that included changes to vending machine contents and access, added physical activity and education requirements, required professional education for all cafeteria workers, included public disclosure of contracts, established local parent advisory committees for all schools and provided a confidential child health report annually to parents with their child’s body mass index assessment (BMI). All students statewide would be included in the screening. Student data was collected for a six–year period on 201,669 students the first year and 216,871 in the final year. The 2008-2009 results indicated that while males ranked the highest in the obese category (20.4 percent), Hispanic males ranked highest in the overweight category (31.2 percent). In the evaluation of the legislation, it was noted that parent’s awareness of obesity-related health problems increased, students reported purchasing more healthy drinks, increased innovation in schools and communities regarding food and nutrition, and more support for improved nutrition standards in school cafeterias. The Arkansas Board of Education also took action by placing restrictions on the use and contents in vending machines, no competitive foods in cafeteria, provided cafeteria food service education, made nutrition and health changes in the curriculum and required 30-minutes per day physical activity in grades K-12, but amended to K-5 in 2007.  The remainder of the presentation was dedicated to an overview of the work of the Robert Wood Johnson Foundation, Center to Prevent Childhood Obesity. Federal, State, and local strategies were presented for consideration for healthy eating (discourage consumption of sugar-sweetened beverages and improve access to fresh drinking water), physical activity (joint use agreements and increase opportunities for physical activity in preschool, school, afterschool and child-care programs in a safe environment), and marketing (media campaigns to promote healthy eating and active living). Committee members’ questions included implementation costs, data collection, responsibilities for agencies other than the schools, and guidelines affecting collaboration with local farmers.

Philip Bors, MPH, Project Officer, Active Living by Design & Healthy Kids, Healthy Communities, NC Institute for Public Health The Active Living By Design program funded through Healthy Kids, Healthy Communities, supports local efforts to improve access to affordable healthy foods and opportunities for physical activity for children and families. The Robert Wood Johnson Foundation has awarded multi-year grants across the country as part of a landmark national program located at Chapel Hill to reverse the childhood obesity epidemic by 2015. Currently there are 50 community sites in more than half of the states. Access to facilities like parks and time outdoors is associated with more activity for both children and adolescents and parental concerns about traffic and stranger danger are clearly linked to children’s activity levels, school concerns and liability.  Several recommendations were presented for sites in North Carolina:   1) Increase safe opportunities for active travel-(i.e. walking/bicycling) and 2) Increase safe opportunities for play and physical activity. A total of six goals included:  more walkable destinations, safer routes to/from school, safer routes in the community, create and maintain parks and open spaces, create and maintain trails and greenways, and shared use of schools after hours/weekends.

Dr. Kelly Evenson, PhD, Research Associate Professor, Gillings School of Global Public Health, University of North Carolina presented a series of charts highlighting the areas of the state that have Pedestrian Plans, Bicycle Plans or a combination of Pedestrian/Bike Plans. The summary of recommendations included: 1) Work with local planners to identify incentives and promising legislation for healthy land use practices, 2) Continued support of Safe Routes to School program within DOT ($15 million in federal funds), consider state funding in addition to federal funds, 3) Update school site selection guidelines and incentives to favor walkable/bikeable schools, 4) Continued support to Complete Streets policy at DOT, consider ways to assist localities with implementation/funding, and continued support DOT ped/bike plans (existing plans will need to stay current.)  Finally, 4) Funding for new parks and trails, park renovations, maintenance and preserving rail corridors for potential greenways, support parks/greenway master plans and implementation, encourage subdivision regulations to include parks, trails, and greenways, stronger incentives for schools and parks to share space, and schools to open to the public after hours, explore liability protection for schools and create mechanisms to help offset the added costs of extended use of school facilities were also part of the recommendations for  physical activity.

Dr. Elizabeth Tilson, MD, MPH, Medical Director, Community Care of Wake and Johnston Counties presented an overview of the Community Care program, which provides local clinical care coordination for Carolina Access Medicaid enrollees to improve the care of the Medicaid population, while controlling costs. There are 14 networks statewide with more than 3,500 primary care physicians to assist the 985,000 + Medicaid enrollees in the areas of chronic disease management initiatives, prevention and pharmacy initiatives, nurse and social worker care management, and physician engagement. She highlighted the efforts of the Childhood Obesity Initiative in Wake and Johnston Counties funded by the KB Reynolds grant, to provide clinical tools (blood pressure and BMI charts, diet and exercise questionnaire, etc.), nutritionist, community links and resources, and care management strategies. She emphasized the importance of recognizing that obesity is a social, environmental, and family issue. Members were interested in the cost of establishing a larger network of the Wake/Johnson program. Funding for each unit is approximately $40,000.

David Gardner, Section Chief, Healthy Schools, NC Department of Public Instruction briefly outlined the focus of the Healthy Schools section to improve the health of students and staff by coordinating school health components in health and physical education, Child Nutrition, Health, and Mental Health Services, school environment, and family and community involvement. The section provides support for the Healthful Living Standard Course of Study, Driver Education, Athletics and Sports Medicine, and administers the Youth Risk Behavior Survey, School Health Profiles and Healthy Active Children surveys. The scope and sequence of instruction for K-12 was reviewed and the requirements for health and physical education were highlighted in elementary, middle and high school grades. The Healthy Active Children Policy and the results of the report were discussed. In the 2009 report, 106 of 112 LEAs responded to the survey, 86 percent of the School Health Advisory Councils have representatives and 38 percent meet quarterly. The 150 minutes of PE per week requirement for elementary schools is not being followed statewide with fewer than 38 percent of the LEAs reporting their children see a certified PE teacher. Only 50 percent of the middle schools are providing the required 225 minutes per week of health and physical education with a certified teacher. A majority of the schools reported that the moderate to vigorous physical activity is done during recess in elementary schools.  Several factors contribute to the physical activity limitation including: time, inadequate facilities and equipment, other school priorities, and not enough qualified teachers. Options were discussed to increase the opportunities for more physical activity including an Assessment and Accountability Plan for Healthful Living Education, establish a health data management system, establish a Healthy Schools Coordinator, provide grants to establish obesity reduction and prevention initiatives, enact policies to encourage joint use agreements, and reinstitute the Physical Education Consultant at DPI.

Tim Hardison, Program Director, Moving Adolescents with Technology to Choose Health

(MATCH) Dr. Suzanne Lazorick, MD, Brody School of Medicine, East Carolina University

The factors influencing childhood obesity are complex and include environment, healthier food choices, and more physical activity. Tim said the answer is simple, education is the key and individuals must choose to modify their behavior.  The Motivating Adolescents with Technology to Choose Health (MATCH) is a 14 week cross curricular wellness course in 7th grade. Match was chosen as a middle school intervention pilot. At 18 months after the start of the program 42 percent of overweight students had decreased to a healthy weight. There is an 87 percent difference in the health costs between an overweight person and one who is normal weight. As part of an RTI study it was suggested, if MATCH were implemented statewide the estimated cost savings would be between $13 and $22 million per year.  Funding for this program was provided by Blue Cross Blue Shield. Lessons were coordinated with the NC standard course of study and all class subjects involved 30 minutes of physical activity daily.  The initiative also develops EOG Test Skills and works with NCWISE. It also used incentive-based rewards based on personal goals and teaches students life-skills to make healthy decisions. The five “ates” of MATCH are: Evaluate, Educate, Motivate, Participate, and Celebrate. Dr. Lazorick provided the results and explanation of the evaluation of the program. The possible policy implications included accountability for middle school Healthful Living curriculum, enforcement of existing 30 min. daily physical activity in middle school; optimizing PE class, enhancing school facilities for age-appropriate physical activity, and improving nutritional offerings to support healthy choices. The conclusion was that more study is needed, but MATCH appears to be effective for obesity prevention and for intervention for children already overweight. It may also have positive academic effects and can be implemented largely using existing resources.

Col. Kevin Shwedo, Deputy Commanding Officer, United States Army, Basic Combat Training Center presented information on the impact of obesity on our military recruits. The number of overweight and obese children and adults in the United States continues to rise at a rapidly growing rate and is a barrier to the military service, because it shrinks the pool of qualified individuals. By 2015, the available population for military service could decline significantly.  The implications of overweight/obesity include: reduction in ability to perform required tasks, increased health care costs, more injuries, and a higher risk of attaining a related disease (diabetes, cardiovascular diseases). Over half of 20-44 year olds are overweight or obese. The most concentrated areas of obesity are in the mid-west and south-central regions of the United States with North Carolina ranking 5th in the nation in the number of 13-17 year olds who are obese. The military is making significant changes in their meals served (types of food) and their physical exercise program to adjust to the changing population of recruits. A program 20/20 Lifestyles used by Microsoft in Washington State has shown a 48 percent success rate of participants keeping the weight off after three years compared to other obesity treatment programs. This program could be piloted in NC to determine if it would have the same success.  The presentation concluded with a review of several weight loss programs and strategies used by the military and emphasizing the importance of educating the community regarding the obesity issue.

Next Meeting: Tuesday, February 23, (10:00 am – 3:00 pm) Food Industry

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