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The Weight of the Nation is Out of Control and We Can Change That

The Weight of the Nation is Out of Control and We Can Change That Sandra Hoyt Stenmark M.D. May 2013. Disclosures. School-Based Health Center: Conference: Strengthening the Core

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The Weight of the Nation is Out of Control and We Can Change That

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  1. The Weight of the Nation is Out of Control and We Can Change That Sandra Hoyt Stenmark M.D. May 2013

  2. Disclosures • School-Based Health Center: Conference: Strengthening the Core • Speaker: Sandra Hoyt Stenmark M.D. Physician Lead for Pediatric Cardiovascular Health at Kaiser Permanente in Colorado • Date: May 2013 • Disclosures: NONE

  3. WHO definition of Health • Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

  4. Objectives • 1. Identify health and economic consequences • of obesity • 2. Analyze factors contributing to obesity and • poor cardiovascular health • 3. Construct interventions which will decrease • obesity and improve cardiovascular health

  5. Many Factors Drive and Shape Health Drivers of Health Personal Behaviors 40% Family History and Genetics 30% Environmental and Social Factors 20% 10% Medical Care Source: McGinnis et al, Health Affairs, 2002

  6. The Social Ecological Framework Physical and Mental Health “Body, Mind and Spirit” Individual / Family Home / School /Worksite Neighborhood / Community Society

  7. Childhood Overweight and Obesity On average, between 2010 and 2011, 28 percent of all Colorado children ages 2 to 14 were overweight or obese, up from 26 percent in 2008-2010. Source: CDPHE: Health Statistics Section. 2010-2011 Child Health Surveys.

  8. Obesity Prevalence Colorado Children 2-14 years 2008-10 Colorado Department of Health and Environment- Child Health Survey

  9. Prevalence of Food Insecurity and Obesity in Colorado Children Health Statistics CDPHE, Child Health Survey 2010

  10. More than one in six Colorado kids lived in poverty in 2011. Children Living in Poverty 3% since 2010 Source: U.S. Census Bureau. 2000 and 2001 Supplemental Surveys, 2002-2011 American Community Surveys.

  11. Effects of childhood obesity • Increased rates of premature death in adults • -NEJM 2010;362:485-93 • Adverse levels of lipids, insulin and blood pressure • -Pediatrics 1999;103:1175-82 • Fatty streaks and lesions in coronary arteries in young adults • - NEJM 1998;338:1650-6 • Fatty liver and liver fibrosis in children • -J Ped 2003;143:500-5

  12. Emotional and social impacts of childhood obesity • Weight bias begins in preschool • Higher BMI -more frequent and intense victimization • Source of bias: peers, teachers, parents • Impacts: poor self esteem, depression, less likely to be chosen as friend, increased suicidal ideation • -Puhl, Psychological Bulletin 2007, Vol 133, No 4, 557-80

  13. Obesity is Expensive • Annual Medical costs of obesity • United States $147 billion • Colorado $874 million • www.cdc.gov/obesity/causes/economics.html • United States medical costs + loss of productivity costs • Overweight- $72 billion • Obese- $198 billion • Source: 2010 Society of Actuaries:Obesity and its Relation to Mortality • and Morbidity Costs

  14. Case I • 5yo Ethiopian male with BMI 99.1% in for CPE • How do you bring up weight? • How do you engage patient and parent? • What evidenced based family behaviors are important to address?

  15. Messaging and motivating behavior change • Lack of awareness re weight status • When parents made aware they are more motivated to action livewellcolorado.org/

  16. Messaging which engaged Hispanic families • “Too much weight for his health” • “Demasiado peso para su salud”

  17. KPCO RD Intervention • # 3 phone visits and 1 in person visit 9/2012-1/2013 • Topics addressed: • daily active play • fruit & vegetable intake • sugared beverages • portions • healthy snacks

  18. 5-2-1-0 Modifiable Behaviors

  19. Colorado Children’s Daily Behaviors 2010-2011 http://www.chd.dphe.state.co.us/Resources/cms/hs/yrbs/ChildHealthCategories.html

  20. Five servings of vegetables and fruits/day

  21. Two Hours or Less of Screen Time/ Day GENERATION M2: Media in the Lives of 8- to 18-Year-Olds Kaiser Family Foundation Report 2010

  22. One Hour or More of DailyPhysical Activity • Improves: • mood, cognition, fitness, • bone strength, sleep quality • Lowers risk of: • diabetes, heart disease, obesity, anxiety, depression, stress, colon & breast cancers www.health.gov/paguidelines

  23. Time Outdoors Increases Physical Activity Burdette Arch PediatrAdol Med 2004;159:46-50. Cleland V, et al. Int J Obesity 2008;32:1685-93.

  24. Zero Sugared Beverages Sugared beverages account for nearly half of all added sugar consumption in the average American diet. Dietary Guidelines of America 2010

  25. Other Obesity Interventions • Portion size • Breakfast • Diet quality • Food Insecurity • Sleep • Family meals • Eating out/ Take out

  26. KPCO RD intervention results

  27. Case II • 11 yo Hispanic male with BMI 99%, persistent asthma presents at CPE • Neighborhood without safe places to play or walk and no easy access to fruits and vegetables. • How do you engage family? • What resources would you consider?

  28. Barriers to Walking-Photovoices

  29. Case II • Mom discussed barriers during first 2 phone visits • On 3rd phone visit ready to • goal set: • physical activity • sugared beverages

  30. Community Resources • Fire up Your Feet • http://fireupyourfeet.org/ • Outdoor Resources • http://www.getoutdoorscolorado.org/ • Boys and Girls Clubs • http://www.bgca.org • Let’s Move • letsmove.gov

  31. Safe Routes to School Reduces Injury • The annual rate of school aged pedestrian injury during school-travel hours decreased 44% in census tracts with SRTS interventions. http://www.saferoutespartnership.org/ Pediatrics 2013;131:290–296

  32. Strengthen Schools as the Heart of Health Accelerating Progress in Obesity Prevention- IOM May 2012 • . http://thrivingschools.kaiserpermanente.org/ www.letsmove.gov

  33. Community Weight Loss Resources • Kaiser Permanente Resources • www.kphealthyme.com • MEND • Http://us.mendcentral.org/ • Por Tu Familia • http://www.diabetes.org/in-my-community/local- • offices/denver-colorado/por-tu-familia-colorado.html • Weigh and Win for Adults • www.weighandwin.com/

  34. Case III • 15 yo female presents with BMI of 99% and the following growth chart • How do you engage • patient and family? • Next steps?

  35. Case IV • What questions would you ask if you saw this child between ages of 10-16 years? • What interventions took place when he was 16 yo?

  36. A Colorado Solution for Hunger • Hunger Free Hotline

  37. Case V • 10 yo male with BMI 99% • Mom concerned because he is being teased about his weight • Engage? Next Steps? Resources?

  38. Bullying Prevention • Encourage kids to speak to a trusted adult • Encourage friendships and hobbies • Website with tips and strategies for staying safe and stopping bullying • Promote an environment in which all individuals are treated with respect • http://www.stopbullying.gov

  39. KPCO School Initiatives • State Legislation: • Hunger assistance • Breakfast after the bell • Beverage Standards • Physical Activity Standards • Complete Streets • Grants: • Live Well Communities • Fire Up Your Feet • Thriving Schools • National Safe Routes to School • Playworks • KP Educational Theater Program

  40. We Can Fix It School based health centers have an important role in identifying, preventing and treating obesity School policies, programs and environments can promote health Engaging students, parents, school officials and community members will increase success

  41. Thank you • Sandra.H.Stenmark@kp.org

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