Dr. Jennifer Moore
Section Head
Family and School Health
Learning objectives
• Examine 1. The evidence and demographic trends which have led to the HAAD identifying childhood obesity as a public health priority in Abu Dhabi
2. The reason for a whole‐system strategic approach 3. What the strategy is comprised of including
•
•
•
•
•
Population trend measurement, Baseline setting and target setting. Workforce development to implement the strategy
Identification of individual children who are overweight or obese and the care pathway for intervention including nutritional advice and support
Measures put in place to prevent obesity such as the promotion of breast feeding, work with the food industry, spatial planning, school interventions and social marketing
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© Health Authority – Abu Dhabi (2009)
Childhood obesity is public health priority
¾ Children are becoming increasingly vulnerable to overweight and obesity around the world.
o According to the International Obesity Task Force, one in ten school‐age children worldwide are overweight, a total of 155 million.
o in USA, childhood obesity has doubled and adolescent obesity has tripled over the last 10 years (NHNES,2007)
o In the US, overweight adolescents have a 70% chance of becoming overweight or obese adults. This increases to 80% if one or more parent is overweight or obese.
¾ We are facing a similar challenge in Abu Dhabi
o 68% of adults screened in the Weqaya program were overweight or obese
o Currently, almost 1 in three school children in the Emirate of Abu Dhabi are overweight or obese with 14% classified as overweight and 16% obese
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© Health Authority – Abu Dhabi (2009)
Overview of the
numbers
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© Health Authority – Abu Dhabi (2009)
HAAD Public Health priorities
2011
Priority areas for initiatives
1
CVD prevention and management
High
1
3
2
6
1.2 CVD Prevention: Obesity
1.3 CVD Prevention: Diabetes 1.4 CVD Prevention: Hypertension
Middle
1.5 CVD Management
1.5 CVD Management 8
4
5
7
9
10
Low
Achievable
e impact on Abu Dhabi*
1.1 CVD Prevention: Unhealthy lifestyle
Harder
Medium
Easier
2
Road safety
3
Tobacco control 4
Cancer control: Breast colon and cervix
Cancer control: Breast, colon and cervix
5
Mental health
6
Mother, infant and school health
7
Musculoskeletal
l k l l health
h lh
8
Chronic respiratory disease, including asthma
9
Infectious diseases: MDRO and surveillance
Relative ease of implementation
Relative ease of implementation
Oral health
Oral health
10
* “Achievable impact” combines prevalence, severity, gap between current Abu Dhabi and international best practice, and availability of (an) evidence‐based intervention(s)
© Health Authority – Abu Dhabi (2009)
www.haad.ae
5
100
90
80
70
60
50
40
30
20
10
0
Male Obese and Overweight Prevalence Rates
Overweight
Obese
Perce
entage
Perce
entage
Weqaya Results: Prevalence of Obesity and Diabetes
100
90
80
70
60
50
40
30
20
10
0
Female Obese and Overweight Prevalence Rates
Overweight
Obese
100 Male Diabetes and Pre‐diabetes Prevalence Rates
90
80
70
60
50
Pre‐diabetes
40
30
Diabetes
20
10
0
Percentage
Percentage
Figure 1. A comparison of rates of Obesity and Overweight for males (overall 68.64%) and females (overall 66.87%) 100
90
80
70
60
50
40
30
20
10
0
Female Diabetes and Pre‐diabetes Prevalence Rates
Pre‐diabetes
Diabetes
Figure 2. A comparison of rates of Diabetes and Pre‐diabetes for males (overall 43.9%) and females (overall 43.2%)
Source: Weqaya Data; n=173,000;Obesity in females 38%, males 32%, Nationals
© Health Authority – Abu Dhabi (2009)
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O
Over the fifth of Abu Dhabi population is younger than the age of 19
th fifth f Ab Dh bi
l ti i
th th
f 19
© Health Authority – Abu Dhabi (2009)
Obesity in Abu Dhabi – a concerning picture
• The upwards trend in obesity with age is very concerning
80
• One in three school age children is overweight or obese
70
60
36
50
40
30
20
10
16
34
14
0
School
Adult
% Overweight
% Obese
This affects their growth, affects their growth,
• This
development, academic achievements and self esteem
Research has shown that 70% has shown that 70%
• Research
of overweight adolescents become overweight or obese adults
It is imperative that we act
• It is imperative that we act now to address this trend
Data sources:
School: HAAD School Health Data Reporting, pilot schools 2009/2010
Adult: HAAD Weqaya Data 2009‐2010 (nationals only)
Adult: HAAD Weqaya Data, 2009‐2010 (nationals only)
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© Health Authority – Abu Dhabi (2009)
Overall Student BMI Assessments (n-6957)
(n 6957)
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© Health Authority – Abu Dhabi (2009)
9
27.5% of g
girls and 33.3% of boys
y meet or exceed the CDC
criteria for overweight or obese >85th.
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© Health Authority – Abu Dhabi (2009)
10
Overall Student BMI Assessment by Age
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11
Overall Student BMI Assessment By Grade School Year
¾ Trend shows relationship between grade school year and BMI.
p
g
y
¾ Does not indicate causation for the obesity problems in school children in Abu Dhabi
However.
o 15% of children between grade 5‐8 are overweight
o 16% are obese
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© Health Authority – Abu Dhabi (2009)
Prevalence of overweight and obesity by region
¾No significant differences noted in the overall BMI analysis by region.
¾No significant differences noted in the overall BMI analysis by region.
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© Health Authority – Abu Dhabi (2009)
13
And the problem is increasing…
Obesity trends among U.S. Adults
1999
1990
2008
No Data
<10%
10%–14%
*BMI ≥30, or about 30 lbs. overweight for 5’4” person
© Health Authority – Abu Dhabi (2009)
15%–19%
20%–24%
25%–29%
≥30%
Primary causes of weight gain ‐
y
g g
increased calorie intake Drink carbonated soft drinks ≥ 2 per day
• 14% of school
children are
overweight
• 16% of school
children are obese
Yes=26%
Yes
26%
Increased calorie intake
Ate at a fast food restaurant three or more of the past seven days
Yes=18%
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© Health Authority – Abu Dhabi (2009)
Primary causes of weight gain ‐ decreased physical activity
Spent ≥ 3 hours per day doing sitting activities during a typical or usual day
i ii d i
i l
ld
• 14% of school
children are
overweight
• 16% of school
children are obese
Yes = 39%
Decreased physical p
y
activity
Physically active for at least one hour per day
Yes=20%
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© Health Authority – Abu Dhabi (2009)
HAAD s Childhood
HAAD’s
Obesity Strategy
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© Health Authority – Abu Dhabi (2009)
What works – evidence on obesity risks
Convincing ↓ risk
• Regular PA
Convincing ↑risk
• Sedentary lifestyles
• High intake of energy dense foods
Probable ↓ risk
• Home and school environments that support healthy eating and physical support healthy
eating and physical
activity choices
Probable ↑ risk
• Heavy marketing of energy dense foods and fast food outlets
and fast food outlets
• High sugar drinks
• Low socioeconomic status
Possible ↓ risk
↓
• Breastfeeding
WHO Draft Consultation Report, 2002
© Health Authority – Abu Dhabi (2009)
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There are many key contributing causal factors to weight gain
Community
Facilities available for physical activity
Canteen food
Extra‐curricular physical activity
Parent weight
Family meals
Availabi
lity of healthy f d
food
School and Peers
Family
Calorie C
l i
intake
Amount of Amount
of
physical activity
Proximity of fast food outlets
Availability of healthy food
Family TV watching practices
Availability of daily physical exercise
Health Family level of education Amount of Parenting style
activity and Child
about eating sedentary physical exercise
y
healthily and p
healthily and activity (e g TV Breakfast habits activity (e.g. TV Genetic factors
G
ti f t
physical watching)
and syndromes Portion sizes
activity
Gender
Family eating Parent as role Peer out habits (e.g. influences
model
Family eating fast food))
H lh
Health habits at home
curriculum
Competitive food
Vending Parks
machines
Pedestrian and cycle paths
© Health Authority – Abu Dhabi (2009)
Leisure time
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Life Course Approach
Neonatal
Life
maternal
nutritional
status &
obesity,
foetal
growth
Infancy and
Childhood
nutrition
diseases
linear growth
obesityy
Adolescence
obesity
lack of PA,
diet,
smoking
established
t bli h d adult
d lt
risk factors
(behavioural/biological)
Accumulated
AccumulatedRisk
risk
Age
Source: Copyright by the American Society for Nutrition (2005)
© Health Authority – Abu Dhabi (2009)
Adult Life
Environment
• Advocating for the protection of green space and provision of an environment that is conducive to physical activity
• Developing of a data base of recreational opportunities and sporting clubs/ facilities in Abu Dhabi
• Maximize all media and community opportunities for healthy lifestyle promotion
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© Health Authority – Abu Dhabi (2009)
HAAD’s Weqaya
focused at the adult population :
y program
g
1. Weqaya reports • Individual reports are sent to home addresses with an overall Weqaya Score and individual risk
with an overall Weqaya Score and individual risk factors
2. Interactive website
• Access to Personal Data
Access to Personal Data
• Interactive, personal recommendations based on risk level
3. Helpline (80061116) to:
3
Helpline (80061116) to:
• Book appointments at series of clinics (sms reminders & re‐call)
• Answer queries
Supported by Health Promotion activities and population level interventions
• Health policy agenda
• Creating market pressure
Creating market pressure
• Routine surveillance and monitoring
© Health Authority – Abu Dhabi (2009)
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Child and Healthcare Services
• Capacity building of primary care staff to provide:
– Antenatal nutrition advice
Antenatal nutrition advice
– Provide advice and early intervention
– Management of childhood obesity
Management of childhood obesity
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© Health Authority – Abu Dhabi (2009)
Antenatal and Pre-School
• Nutritional advice for potential mothers
• Care pathway for obese women
Care pathway for obese women
• Importance of breastfeeding
• Maternal and child nutrition
Maternal and child nutrition
• Healthy food guidelines for kindergartens
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© Health Authority – Abu Dhabi (2009)
The new Schools for Health framework is based on global best practice
The new Schools for Health framework is based on global best practice
Monitoring & evaluation
Partnerships
p
Data
Healthy kids, healthy lives
Policyy
Social & Physical environment
Health Services
Learning and capacity building p
y
g
through training
Clear Strategy with defined priorities and Clear
Strategy with defined priorities and
measurable outcomes
Family & Community y
involvement
Good Governance
Good Governance
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© Health Authority – Abu Dhabi (2009)
Page 25
Schools
• Electronic reporting of the annual BMI screening
• School canteen guidelines
• Implementation of the Eat Right and Get Active Campaign
• Capacity building for School Nurses for counseling of students and parents >85th percentile
• Standard on the clinical management of childhood obesity
• Advocate for increased physical activity in and outside the curriculum
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© Health Authority – Abu Dhabi (2009)
Schools for Health launched a new e‐notification system for screening and vaccination data
d
• E‐notification was developed and launched in academic year 2009/ 2010
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Nutrition Guidelines/Standards
Nutrition Guidelines/Standards
•
Developed the School Canteen Guidelines with ADEC & p
ADFCA
•
Provide ongoing observation for Nutrition Standards in Abu Dhabi schools
Dhabi schools.
•
Nutrient standards are the required minimum levels of calories and key nutrients to meet the nutrition goals for specific age or grade groups of children for breakfast and lunch menus.
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© Health Authority – Abu Dhabi (2009)
Training for school nurses on BMI screening and counseling of
parents and students
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© Health Authority – Abu Dhabi (2009)
HAAD has launched the Eat Right & Get Active Campaign in Schools
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© Health Authority – Abu Dhabi (2009)
Eat Right & Get Active Campaign
• The Eat Right & Get Active campaign was launched in January 2011
• Collaborative approach working with partners from ADEC, ADFCA and SEHA School Health Services Collaborative approach working with partners from ADEC, ADFCA and SEHA School Health Services
(AHS)
• The campaign is currently been run in 30 pilot schools for four months, and will then be rolled out to include more schools
include more schools
• Model is based on the WHO Health Promoting Schools model where the school is equipped and trained to identify the gaps in their school and form an action plan to address these gaps
• Schools were given a training manual and training
• The pilot schools are now being supported by a HAAD team of Health Promotion experts
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© Health Authority – Abu Dhabi (2009)
The Eat Right Get Active manual and its provided supporting
materials will assist schools in the following:
• Increase awareness and knowledge regarding Healthy Eating, for grades 1‐5
• Promote appropriate physical activity for school children during PE class’s, recess time and after‐school activities.
• Provide practical steps for children, adolescents and parents to eat a healthy diet and do enough physical activity
• Create opportunities for students and their parents to implement the knowledge and skills they have learned.
• Encourage and enable schools to engage students and their guardians’ to participate in maintaining their health and well being.
• Create a cultural and behavioral change towards eating a healthy diet and being physically active.
© Health Authority – Abu Dhabi (2009)
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The food pyramid was adapted for the campaign
• The food dome was adapted for the campaign
The food dome was adapted for the campaign
• Outlines the nutritional needs for children and adolescents
• Emphasizes what to eat and the importance of physical activity
• The food types reflect the local culture in terms The food types reflect the local culture in terms
of preferred food (e.g. Arabic bread)
• Developed in English and Arabic www.haad.ae
© Health Authority – Abu Dhabi (2009)
Evaluation and monitoring
Baseline
developed:
• Food frequency
questionnaire
• School evaluation
• WHO Nutrition
friendly schools
Surveys repeated:
5 months
• Food frequency
questionnaire
• School evaluation
• WHO Nutrition
friendly schools
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© Health Authority – Abu Dhabi (2009)
Schools For
Health Website
www.haad.ae/schoolsforhealth
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© Health Authority – Abu Dhabi (2009)
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© Health Authority – Abu Dhabi (2009)
Conclusion
Children are our future
It is fundamental that we act now to ensure their health and prosperity
We need you to be involved as health advocates
Get involved – change happens one individual, one family, one school and one community at a time!!
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© Health Authority – Abu Dhabi (2009)
Thank you
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© Health Authority – Abu Dhabi (2009)