A Weighty Proposition

A Weighty PropositionWhat is Known Regarding

Childhood ObesityLearning Session #1

A Review of Literature

• Summations of Evidence for Findings in the Following Settings:– Surveillance– Clinical– Schools– Community– Education

Method

• Searched for manuscripts and documents which systematically reviewed the evidence presented in a variety of peer-reviewed research journals

• Present the overall findings based on settings for the delivery of the service

• Highlight areas on the CHIP to CHIRP model

Levels of Prevention

• Tertiary Prevention – interventions to slow down or reverse the increase in BMI

• Secondary Prevention – prevention efforts including the identification and intervention of asymptomatic children who are at risk for overweight

• Primary Prevention – prevention efforts occurring before individuals are overweight

Surveillance • Although BMI is a measure

of relative weight rather than adiposity (fat), it is recommended widely for use among children and adolescents to determine overweight and is the currently preferred measure

• BMI may have limited validity for racial / ethnic minorities (Whitlock et al)

Surveillance Need

• It is suggested that there are three critical periods for the development of overweight in children

1. Intrauterine or early infancy2. 5 to 7 years of age3. Adolescence• Approximately one half of over weight school-age

children and three quarters of overweight teenagers grow up to be obese adults (ADA Report)

Figure 1. Potential Research and Community Project Activities through Blending Community Health Development and Research

Health Resource Setting

Community Setting

Types of Research

Action Research Policy Research

Types of Research

Health Disparities Research Implementation Research Program Monitoring/ Utilization Research Diffusion Research

Types of Research

Health Education Research Health Services Research Comparative Effectiveness Research Clinical Trials Practice-based Research Translational Research

LINK

Health Issues Identified by Community

Education “N of 1” - Knowledge - Attitudes - Beliefs

- Screening + Early Detection

Diagnosis and Treatment - Secondary/ Tertiary Prevention - Patient Education - Behavior Change

Clinician/Staff Education + Evidence-based Guidelines + Practice Redesign + Patient Safety + Best Practices + Student Training

Projects & Programs - Health Workforce & Training - New Health Resources - New Projects - Special Populations + Outreach + Interventions

- Government + City + County * Public Health * Mental Health + Districts * School * Health/Hospital * Recreation - Organizations * Workplace * Social Institutions

Types of Research

Surveillance Research Epidemiological Research

Community Health Improvement & Research Partnership (CHIRP)

Clinic Hospital Public Health Population-based Health

Policy Increase Availability and Accessibility of Resources

Primary Prevention + Public Information + Education Campaigns

Health Measures + Local Data + State Data + National Goals

Improved Community Health

Clinical• Limited research is available

on effective, generalizable interventions for overweight children and adolescents that can conducted in primary care settings or through primary care referrals (Whitlock et al)

• Recommendations include application of behavioral choice theory (Epstein et al)



Community Setting

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Position of the American Dietetic Association

• Reviewed only programs that included an outcome measure of weight status or adiposity (body weight, BMI, skinfold thickness, percent body fat)

Definitions

• Dietary Counseling / Nutrition• Physical Activity Counseling / Education• Sedentary Activity Counseling / Education• Behavioral Counseling• Family Counseling• Parent Training• Parent / Family Involvement• Physical Activity Environment• School Food Environment

What Works

• Two specific kinds of overweight interventions: a) multi-component, family based programs for children age 5-12 years and b) school-based programs for adolescents

• Multi-component programs include behavioral health counseling, promotion of physical activity, parent training/modeling, dietary counseling /nutrition education



Community Setting

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Schools

• Active Education: Physical Education, Physical Activity and Academic Performance

RWJ Active Living Research – Research Brief 2009

Schools

Studies consistently show that more time in physical education and otherschool-based physical activity does not adversely affect academic performance.

In some cases, more time in physical education leads to improved grades andstandardized test scores.

Physically active and fit children tend to have better academic achievement. Evidence links higher levels of physical fitness with better school attendanceand fewer disciplinary problems.

There are several possible mechanisms by which physical education and regularphysical activity could improve academic achievement, including enhancedconcentration skills and classroom behavior.

Pre-School / After School

• Preventing Obesity Among Preschool Children: How Can Child-Care Settings Promote Healthy eating and Physical Activity?

Source: RWJ Healthy Eating Research and Active Living Research- Research Synthesis October 2011

Pre- School

Research in child-care settings has identified opportunities to improve the nutritional

quality of foods provided to children, mealtime behaviors of caregivers, and theprovision of nutrition education.

Regulations regarding nutrition and physical activity practices in child-care settingsare limited and vary widely among and within U.S. states. Many preschool children enrolled in child care are not meeting recommendationsfor physical activity. Child-care practices and policies relating to 1) the amountof time allocated for physical activity; 2) required training and supportive staffbehaviors; and 3) appropriate physical settings for play have the potential toinfluence physical activity levels.

Pre School (Cont)There is some evidence of a relationship between use of informal child-carearrangements (e.g., relative care) and increased risk for obesity. Researchexamining the relationship between children’s weight status and use of formalchild-care arrangements (e.g., licensed family child-care homes, child-carecenters, Head Start programs) has produced mixed results. Opportunities for parent education and involvement may be limited in many childcaresettings, and only a few studies have examined parent perceptions relevant tonutrition and physical activity environments. Existing evidence indicates the following may be successful strategies for promotinghealthy eating and physical activity in child-care settings: integrating opportunitiesfor physical activity into the classroom curriculum; modifying foodservice practices;providing classroom-based nutrition education; and engaging parents througheducational newsletters or activities. At this time, it is not clear which combinationsof specific strategies are effective for reducing obesity among preschool children.



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Community

• CDC Strategies July 24, 2009 MMWR

Community Strategies

• Strategies to Promote Availability of Affordable Healthy Food and Beverages

• Strategies to Support Healthy Food and Beverage Choices

• Strategy to Encourage Breastfeeding• Strategies to Encourage Physical Activity or Limit

Sedentary Activity• Strategies to Create Safe Communities that

Support Physical Activity



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Education / Knowledge

• We have yet to find a comprehensive evaluation of multiple education intervention in comparison with each other. We are continuing to search.



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Documents

A Weighty Proposition