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The Weight of the Nation is Out of Control and We Can Change ThatSandra Hoyt Stenmark M.D. May 2013
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WE BUILD A BRIGHTER FUTUREtogetherDisclosures
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
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WE BUILD A BRIGHTER FUTUREtogether
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.
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WE BUILD A BRIGHTER FUTUREtogether
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
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WE BUILD A BRIGHTER FUTUREtogetherMany Factors Drive and Shape Health
Family History and Genetics
30%
Environmentaland Social
Factors20%
Personal Behaviors 40%
Medical Care 10%
Drivers of Health
5
Source: McGinnis et al, Health Affairs, 2002
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WE BUILD A BRIGHTER FUTUREtogether
6
The Social Ecological Framework
Neighborhood /Community
Society
Individual / Family
Home / School /Worksite
Physical and Mental Health “Body, Mind and Spirit”
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WE BUILD A BRIGHTER FUTUREtogetherChildhood Overweight and
ObesityOn 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.
DenverPueblo
MontroseDelta
LarimerMontezuma
La PlataEl Paso
ArapahoeAdams
ColoradoLogan
MorganJeffersonFremont*
WeldSummitGarfield
EagleMesaElbertTellerRoutt
DouglasBroomfield
Boulder
0% 5% 10%15%20%25%30%35%40%45%
41%37%
36%36%
31%31%31%31%
29%29%
28%26%26%26%
24%20%20%20%20%
19%17%
16%14%14%
13%13%
Source: CDPHE: Health Statistics Section. 2010-2011 Child Health Surveys.
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WE BUILD A BRIGHTER FUTUREtogether
Obesity Prevalence Colorado Children 2-14 years 2008-10
White Hispanic Black0
5
10
15
20
25
30
35
40
obeseoverweight
Colorado Department of Health and Environment- Child Health Survey
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WE BUILD A BRIGHTER FUTUREtogether
Prevalence of Food Insecurity and Obesity in Colorado Children
<100% FPL 100-199% FPL
200-299% FPL
300%+FPL0
10
20
30
40
50
60
70
80
Food InsecureObesity
Health Statistics CDPHE, Child Health Survey 2010
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WE BUILD A BRIGHTER FUTUREtogetherMore than one in six Colorado
kids lived in poverty in 2011.
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0%
5%
10%
15%
20%
25%
17%
23%
10%
18%
United StatesColorado
3%
Children Living in Poverty
since 2010
Source: U.S. Census Bureau. 2000 and 2001 Supplemental Surveys, 2002-2011 American Community Surveys.
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WE BUILD A BRIGHTER FUTUREtogether
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
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WE BUILD A BRIGHTER FUTUREtogether
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
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WE BUILD A BRIGHTER FUTUREtogetherObesity is Expensive
Annual Medical costs of obesity•United States $147 billion•Colorado $874 millionwww.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 Mortalityand Morbidity Costs
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WE BUILD A BRIGHTER FUTUREtogetherCase I
5 yo 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?
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WE BUILD A BRIGHTER FUTUREtogether
Messaging and motivating behavior change
• Lack of awareness re weight status
• When parents made aware they are more motivated to action
livewellcolorado.org/
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WE BUILD A BRIGHTER FUTUREtogetherMessaging which engaged
Hispanic families
“Too much weight for his health”“Demasiado peso para su salud”
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WE BUILD A BRIGHTER FUTUREtogether
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
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WE BUILD A BRIGHTER FUTUREtogether5-2-1-0
Modifiable Behaviors
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WE BUILD A BRIGHTER FUTUREtogether
Colorado Children’s Daily Behaviors 2010-2011
5 Fruit & Veg 60 min PA One or more SSB05
101520253035404550
5-11 yrs12-14 yrs
http://www.chd.dphe.state.co.us/Resources/cms/hs/yrbs/ChildHealthCategories.html
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WE BUILD A BRIGHTER FUTUREtogether
Five servings of vegetables and fruits/day
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WE BUILD A BRIGHTER FUTUREtogether
Two Hours or Less of Screen Time/ Day
GENERATION M2: Media in the Lives of 8- to 18-Year-OldsKaiser Family Foundation Report 2010
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WE BUILD A BRIGHTER FUTUREtogetherOne Hour or More of Daily
Physical ActivityImproves:mood, cognition, fitness, bone strength, sleep quality
Lowers risk of:diabetes, heart disease, obesity, anxiety, depression, stress, colon & breast cancers
www.health.gov/paguidelines
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WE BUILD A BRIGHTER FUTUREtogetherTime Outdoors Increases
Physical Activity
Burdette Arch Pediatr Adol Med 2004;159:46-50.Cleland V, et al. Int J Obesity 2008;32:1685-93.
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WE BUILD A BRIGHTER FUTUREtogetherZero Sugared Beverages
Sugared beverages account for nearly half of all added sugar consumption in the average American diet. Dietary Guidelines of America 2010
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WE BUILD A BRIGHTER FUTUREtogether
Other Obesity Interventions
• Portion size• Breakfast• Diet quality• Food Insecurity• Sleep• Family meals• Eating out/ Take out
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WE BUILD A BRIGHTER FUTUREtogether
KPCO RD intervention results
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WE BUILD A BRIGHTER FUTUREtogetherCase 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?
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WE BUILD A BRIGHTER FUTUREtogether
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WE BUILD A BRIGHTER FUTUREtogetherBarriers to Walking-Photovoices
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WE BUILD A BRIGHTER FUTUREtogether
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WE BUILD A BRIGHTER FUTUREtogetherCase II
Mom discussed barriers during first 2 phone visits
On 3rd phone visit ready to goal set:• physical activity • sugared beverages
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WE BUILD A BRIGHTER FUTUREtogetherCommunity Resources
Fire up Your Feethttp://fireupyourfeet.org/ Outdoor Resourceshttp://www.getoutdoorscolorado.org/ Boys and Girls Clubshttp://www.bgca.org Let’s Moveletsmove.gov
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WE BUILD A BRIGHTER FUTUREtogether
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
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WE BUILD A BRIGHTER FUTUREtogether
Strengthen Schools as the Heart of Health
.
http://thrivingschools.kaiserpermanente.org/www.letsmove.gov
Accelerating Progress in Obesity Prevention- IOM May 2012
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WE BUILD A BRIGHTER FUTUREtogether
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/
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WE BUILD A BRIGHTER FUTUREtogetherCase III
15 yo female presents with BMI of 99% and the following growth chart
How do you engagepatient and family?
Next steps?
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WE BUILD A BRIGHTER FUTUREtogetherCase 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?
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WE BUILD A BRIGHTER FUTUREtogetherA Colorado Solution for
Hunger
Hunger Free Hotline
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Case V
10 yo male with BMI 99%
Mom concerned because he is being teased about his weight
Engage? Next Steps? Resources?
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WE BUILD A BRIGHTER FUTUREtogetherBullying Prevention
http://www.stopbullying.gov
• 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
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WE BUILD A BRIGHTER FUTUREtogether
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
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WE BUILD A BRIGHTER FUTUREtogether
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
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WE BUILD A BRIGHTER FUTUREtogetherThank you
Sandra.H.Stenmark@kp.org