Healthy Eating and Moving Healthy Eating and Moving More: Why is it important More: Why is it important and what works?and what works?

Steven H Kelder, PhD, MPHSteven H Kelder, PhD, MPHBeth Toby Grossman Professor in

Spirituality and Healing

Michael & Susan Dell Center for the Michael & Susan Dell Center for the Advancement of Healthy LivingAdvancement of Healthy Living

University of Texas School of Public HealthUniversity of Texas School of Public Health

Austin Regional CampusAustin Regional Campus

Healthy Eating and Moving Healthy Eating and Moving More: Why is it important More: Why is it important and what works?and what works?

Steven H Kelder, PhD, MPHSteven H Kelder, PhD, MPHBeth Toby Grossman Professor in

Spirituality and Healing

Michael & Susan Dell Center for the Michael & Susan Dell Center for the Advancement of Healthy LivingAdvancement of Healthy Living

University of Texas School of Public HealthUniversity of Texas School of Public Health

Austin Regional CampusAustin Regional Campus

Action Framework For A Comprehensive Public Health StrategyTo Prevent Heart Disease And Stroke

Fatal CVD Complications/ Decompensation

Unfavorable Social and Environmental Conditions

Adverse Behavioral Patterns

Major Risk Factors

First Event/ Sudden Death

Disability/ Risk of Recurrence

The Present Reality

Good Quality of Life Until Death

Social and Environmental Conditions Favorable to Health

Behavioral Patterns that Promote Health

Low Population Risk

Few Events/ Only Rare Deaths

Full Functional Capacity/Low Risk of Recurrence

A Vision of the Future

Policy and Environmental Change

Behavior Change

Risk Factor Detection and Control Emergency

Care/Acute CaseManagement

Rehabilitation/ Long-term Case Management

InterventionApproaches

End-of-Life CarePREVENTION

Action Framework For A Comprehensive Public Health StrategyTo Prevent Heart Disease And Stroke

Fatal CVD Complications/ Decompensation

Unfavorable Social and Environmental Conditions

Adverse Behavioral Patterns

Major Risk Factors

First Event/ Sudden Death

Disability/ Risk of Recurrence

The Present Reality

Good Quality of Life Until Death

Social and Environmental Conditions Favorable to Health

Behavioral Patterns that Promote Health

Low Population Risk

Few Events/ Only Rare Deaths

Full Functional Capacity/Low Risk of Recurrence

A Vision of the Future

Policy and Environmental Change

Behavior Change

Risk Factor Detection and Control Emergency

Care/Acute CaseManagement

Rehabilitation/ Long-term Case Management

InterventionApproaches

End-of-Life Care

TREATMENT

Energy Intake Energy Expenditure

Energy Balance

Individual Factors

Behavioral Settings

Social Norms and Values

Communities

Worksites

Health Care

Schools and Child Care

Home

Demographic Factors (e.g., age, sex, SES, race/ethnicity)

Psychosocial Factors

Gene-Environment Interactions

Other Factors

Government

Public Health

University

Health Care

Agriculture

Education

Media

Land Use and Transportation

Communities

Foundations

Industry

Food

Beverage

Retail

Leisure and Recreation

Entertainment

Physical Activity

Sectors of Influence

Food & Beverage Intake

IOM Comprehensive approach for preventing and addressing childhood obesity

SOURCE: Institute of Medicine, Progress in Preventing Childhood Obesity, 2007, pg 20.

The Public Health System of the 21st Century

Mgmt Care Orgs

Home Health

Parks

Economic Development

Mass Transit

Employers

Nursing Homes

Mental HealthDrug

Treatment

Civic GroupsCHCs

Laboratory Facilities

Hospitals

EMS Community Centers

Doctors

Health Dept

Churches

Philanthropist

Elected Officials

Tribal Health

Schools

Police

Fire

Corrections

Environmental Health

SOURCE: Dr. Lloyd Kolbe, personal communication, 2007

Elementary, My Dear Dr. Watson Promote exposure to fruits, vegetables, grains,

and calcium rich foods Reduce consumption of unhealthy foods Promote physical activity Reduce screen time Promote breastfeeding

Energy Balance

~ 500 calories per day

Dietary Guidelines for Americans

Aim for Fitness Aim for a healthy weight Be physically active each day

Build a Healthy Base Let the Pyramid guide your food choices Choose a variety of grains daily, especially whole

grains Choose a variety of fruits and vegetables daily Keep food safe to eat

Dietary Guidelines for Americans

Choose Sensibly Choose a diet that is low in saturated fat and

cholesterol and moderate in total fat Choose beverages and foods to moderate your

intake of sugars Choose and prepare foods with less salt If you drink alcoholic beverages, do so in

moderation

Other Plant-based Foods

7 or more servings of other plant-based foods such as whole grains and legumes

Whole grains are higher in fiber, vitamins, minerals, and phytochemicals than refined grains

New for 2005 Specificity of recommendations

– At least 30 minutes to reduce risk of chronic disease

– Up to 60 minutes of moderate to vigorous physical activity may be needed to prevent gradual weight gain that occurs over time

– 60 to 90 minutes of moderate-intensity physical activity to sustain weight loss

Recommendations for specific populations

Informational– Community-wide campaigns– Point-of-decision prompts

Behavioral and social– School-based PE– Social support in community settings– Individually adapted behavior change

Environmental and policy– Enhanced access with outreach– Community-scale urban design– Street-scale urban design/land use

Evidence-based Interventions to Promote Physical Activity

Policy Categories

Healthy food Recreation Breast feeding Built Environment City Planning/Transportation Education Media Industry Wellness

Sectors to involve Federal/State Media Schools Faith-based organizations City County Worksites Health-care

Potential population impact (certainty of effectiveness)

Effective: Policy option was tested in one or more well-designed scientific studies and found to affect nutrition and or nutrition behavior.

Promising: Policy was tested in one or more well-designed scientific studies and results of effectiveness are ongoing.

Untested: Policy is potentially a great idea, but is untested or does not have definitive results.

The World According to Steve Start young – school based programs work. Children can

be found at school. Young parents, preschool. Physical activity quickly declines as young girls enter

middle school and high school Promote calcium consumption and weight bearing

physical activities to women and girls Reinforce school lessons at home and in the community. Promote use of community parks and recreation. Create social events; eating and PA are social behaviors Where: worksites, point of purchase, church, school Stay in it for the long haul.

Michael & Susan Dell Center for Advancement of Healthy LivingPromoting a Future of Healthy Children

We will strive to become one of the leading national research institutions with a focus on improving healthy living in communities, homes, and schools by addressing:

– The childhood obesity epidemic, – Child and adolescent development, – Community programs and

policies supporting these efforts.

Contact Information Steven H. Kelder, MPH, PhD

Michael & Susan Dell Center for Advancement of Healthy Living

UT School of Public Health, Austin Regional Campus313 E. 12th St., Suite 220Austin, TX 78701512-482-6167512-482-6185 (fax)http://www.sph.uth.tmc.edu/dellhealthyliving/home.asp

Website for CATCH: http://www.sph.uth.tmc.edu/catch/

Website for SPAN survey: http://www.sph.uth.tmc.edu/DellHealthyLiving/default.asp?id=4061