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Millicent Fleming-Moran, PhD Applied Health Science Indiana University, Bloomington

Healthy School Environments: State legislatures’ and policy makers roles in promoting nutrition and activity in school populations. Millicent Fleming-Moran, PhD Applied Health Science Indiana University, Bloomington. A growing problem…. (obese)

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Millicent Fleming-Moran, PhD Applied Health Science Indiana University, Bloomington

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  1. Healthy School Environments: State legislatures’ and policy makers roles in promoting nutrition and activity in school populations. Millicent Fleming-Moran, PhD Applied Health Science Indiana University, Bloomington

  2. A growing problem… (obese) • The percentage has nearly tripled in past 30 years

  3. A growing problem…The national picture of child obesity • 15% of U.S. adolescents 12-19 exceed 95th percentile BMI for gender/age • 1980 – 2000: Doubled rate: Overweight 6 - 11 yr-olds Tripled rate: Overweight teens NHANES: Obesity Prevalence, 12-18 yr olds 1971-2000

  4. Overweight health effects… • Earlier sexual maturation • Social stigma • Altered lipid, glucose and blood pressure risk factors 25% of 5 -10 year-olds have high cholesterol, high blood pressure, or other early risks for heart disease. Type 2 diabetesincrease -- Cincinnati teen study 1982-94 NIDDM incidence increases 10-fold

  5. 2004 IOM report: Child Obesity Diabetes Estimated 30 % of boys & 40 % of girls risk NIDDM diagnosis at some point in their lives.. Economic impact Tripled youth obesity-related hospital costs 1979-99: $35 M to $127 million.

  6. Another Health disparity: Youth Obesity • 12% White youths • 20%+ of African American & Hispanic youth

  7. The continuing legacy… • Overweight adolescents have a 70-80% chance of becoming overweight or obese adults.

  8. And the ultimate risk:Obesity challenges smoking… • #2 leading cause of preventable death

  9. National trends in youth nutrition & activity Only 2% of children eat a healthy diet 3-in-4 teens don’t eat the recommended 5-a-day servings of fruits and vegetables 3-in-4 children get more saturated fat than recommended 35% are physically inactive

  10. Known risk factors: Less aerobic activity, More recreational inactivity, Greater sugar / fat % of calories Increased hours of TV /day = A net positive energy balance, above energy required for rapid growth in this age group

  11. The current child obesity environment… Media: Targets families with kids for high fat, snack, and “fast foods”. • Meals: Americans eat 2 out of 3 away from home. Increased frequency of fast-& prepared foods. • Schools Sell commercial foods – to generate income; Pressures to reduce activity during & after school hours. • Reliance on car transport • Sedentary pass-times

  12. Obesity: < 5% youth Diet: 75% youth have 2+ fruits /day 3 + vegetables / day Activity: Vigorous= 20 min 3+ days/wk Moderate= 30 min 5 days /wk TV hours: <2 hrs/ day Healthy People 2010 Goals – a long way to go….

  13. Indiana “figures” on obesity …. • Indiana #2 in US for obese/overweight youth • 1990-present: IN adult obesity rates exceed US averages • Part of the national “stroke belt” • Increasing NIDDM rates in minority youth & teens

  14. Legislators bring youth obesity bill to General Assembly, 2002-03 Dept of Education /ISDH get CDC- funds for Comprehensive School Health Program. Dept of Health Commissioner Drafts state chronic disease plan. Targets obesity/ SMK Some IN policy results: 2003-04

  15. IN evolution of child obesity Legislation.. National Governors’ Association grant to develop State Chronic Disease Plan- prevention & management - ISDH Depts. of Education & Health – CDC funding for “Comprehensive School Health Program” Executive Branch:

  16. IN evolution of child obesity Legislation.. Legislative Branch: ISDH Minority Health office created Disparities in NIDDM; CVD; obesity documented 2002-03 Gary Legislator – proposes eliminating school vending machines (fails) 2003-04 Budget Session: Revised HB 1017 adds activity, nutrition guidelines & BMI monitoring. Enrolled in Senate. No Action due to Budget debates. Interim Study Commission: takes up school health bills November 2004: “State Obesity Summit” Legislature Session 2004-05: Re-introduced Bill…..

  17. HB 1017 Proposals: 1. New DoE Division of School/ Community Nutrition Developrecommendations re: School Meal Nutritional Content; Policies, using current nutrition science evidence to promote: (A) control of youth weight gain; (B) safe weight loss practices; (C) healthy eating habits; and (D) safe diet habits to avoid diseases. Tailored programs to K-6, middle and high school students

  18. HB 1017: Dept of Education, cont… Nutrition Provisions: Food Sales Defines “Healthy” food for vended items: < 30% total Kcals from fat, (ex. nuts / seeds). < 10% total Kcals from saturated fats. Provides 10% + of USDA daily value of at least 1 one of: Vitamin A or C; Calcium, Iron Protein, Fiber “Healthy beverage”:Water, Milk, Fruit / Vegetable drinks (at least 50% juice) Except Items in : Areas inaccessible to students; Sold after school hours. In current vending contracts thru 2004. But can’t be renewed.

  19. HB 1017 Proposals: Nutrition Provisions: Food Sales, cont.. At least 50% of vended foods must qualify as healthy foods (USDA standards). Non-healthy Foods not compete with School Lunch/Breakfast meals. Competitive prices for Healthy foods

  20. HB 1017 Proposals: Physical Activity Provisions At least 30 min/ day of Physical Activity for K-6 Can include recess time. Indoor alternatives to be used in inclement weather

  21. Evaluation: Student Health outcomes.. With the State Department of Health: Develop & disseminate model policies to measure student BMI Student's BMI : Disclosed to the parent on request, but not be included on report card.

  22. Population-based evaluation, not individual

  23. Barriers in Legislative Change:The vending contract NASSP survey of principals: • 1/3rd report “school funding worse than 5 years ago” • 92% agree school-business partnerships “enhance educational programs”. • 62% developed soft drink contracts to generate revenue. • Large high schools can earn $2,000 a month. • Seattle district: $330,000/year vending contracts.

  24. Areas funded with soft-drink money… 66% Sports and PE equipment 59% After school activities 48% Instructional materials 46% Field trips 44% Arts Programs 42% Computers/Technology

  25. Food fights: USDA, Schools & Vendors….. • USDA rules vs selling “Competitive foods”-- Beverage industry sues to open schools to vending machines. • Food services prohibited from selling soft drinks, but can “give-away” pop with other food purchases. • 1985 – ‘97. National school milk purchases decline 30%; • Soda-pop increased by 1,100% *

  26. 45 45 40 40 35 35 Milk 30 30 25 25 20 20 15 15 10 10 Juice 5 5 0 0 1970 1970 1975 1975 1980 1980 1985 1985 1990 1990 1995 1995 Changes in beverage consumption Gal/ person/ year Soft Drinks Diet Soft Drinks USDA, Economic Research Service Statistical Bulletin No. 939, 1997

  27. Nationally, schools with vending or canteen access to soft-drinks • 43% of K-6 schools, • 89.4% of middle schools • 98.2% of high schools

  28. The vendors point of view.. • Pepsi Bottling Group Inc.: “School sales make up < 1 % of total Pepsi revenue”. • Coca-Cola Co. spokeswoman: "We are in the schools because the schools are asking us to be there." • Business Analyst: "Soft drink & other food companies are in schools to make sales now and… cultivate brand loyalty..”

  29. The other side of the obesity equation:Physical Education / Activity CDC guidelines: At least 30 min/day of PA for school kids: < 25% get even 20 minutes/day, 56% get “some” PE, 25% have no PE classes. 48 states mandate P.E. for some students, but Only 11 require P.E. for graduation. Only 6 - 8 % of US schools provide recommended daily PE class to all students.

  30. Recent state PE changes.. • Budget shortfalls & federal NCLB funding forces “choice” between academics and physical health (NASSP principals survey) • Dropped PE requirements (OK, CO) • Dropped recess periods (GA) • Substitutions: Band; Sports (NM, FL, AK) • PE requirements left to local level

  31. Trends in PE legislation • States begin with non-legislative options: Interim studies, resolutions, pilot programs or model bill (AL, WA, NM, MS) • Usually do not start with a mandate for PE classes: e.g. require hour(s) toward graduation credit (CT; FL)  Current legislative successes: -- TX- require 30-60 min/day of physical activity -- CN- require a “daily period” of activity -- LA - increased PE to required 30 min/day for K-6

  32. Remove: Vending machines – only AR (2003) Non-nutritious itemsfrom machines: NYC. Restrict: Vending access in schools (CO 2004; 23 states) Substitute: Nutritious items; milk/water/juice (FL; HI) Items meet Education Code nutrition standards (CA, 2004) 2003-04 State Nutrition legislation strategies…

  33. 2003-04 State Nutrition legislation strategies • Taxnon-nutritious items (14 states) SodaTax replaces schools’ vending funds (NC, MI) Junk food tax: 1% on items with < 20% RDI (AK) • Divert Revenue: “Competitive foods”, sold during food service support school food service, or student activities. (NM) • Incentive pricing: Healthy options sold at a lower prices (OK)

  34. 2003-04: Other Legislative Strategies to reduce school age obesity.. • Specify school meal nutrition (12 states) • Adjust PE requirements (11 states) • Track BMI/ Parent notification (1 state) • Encourage safe walking/biking to school

  35. Children with regular activity perform better academically. FL: Children w/ higher GPAs had 3+ days activity/week NH: Obese children have lower grades The bottom line:

  36. References Nestle, M. Food Politics, UC Press. CDC School Health Policies and Programs Study (SHPPS) 2000 survey Institute of Medicine, 2004 Preventing Childhood Obesity: Health in the Balance National Conference of State Legislatures www.ncsl.org, NCSL: Health Policy Tracking Service Issue Briefs Summary, April 1, 2003 Nutrition and Obesity 2004 Reuters Health July 14,2003. School Vending Machines 'Out' with Health Advocates Dietary Guidelines for Americans. Pinhas-Hamiel O, et. al. “Increased Incidence of Non-insulin-dependent Diabetes Mellitus among Adolescents.” Journal of Pediatrics 1996, 128: 608-615. Kann L, et al. Youth Risk Behavior Surveillance - United States, 1999. Morbidity and Mortality Weekly Report 2000, 4( SS-5): 1-96. Agricultural Research Service, US Department of Agriculture. Food and Nutrient Intakes by Children 1994-96, 1998 (1999). <http://www.barc.usda.gov/bhnrc/foodsurvey/home.htm> on August 17, 2001. Freedman DS, et al. “The Relation of Overweight to Cardiovascular Risk Factors Among Children and Adolescents: The Bogalusa Heart Study.” Pediatrics 1999, 103: 1175-1182. Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. “Natural History of Aortic and Coronary Atherosclerotic Lesions in Youth; Findings from the PDAY Study.” Arteriosclerosis and Thrombosis 1993, 13: 1291-1298. Wang G, Dietz W. "Economic Burden of Obesity in Youths Aged 6 to 17 Years: 1979-1999." Pediatrics 2002, 109: e81.

  37. Thank you!

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