Presentation - Colorado Association for School
advertisement
The Weight of the Nation is Out of Control and We Can Change That Sandra Hoyt Stenmark M.D. kp.org/communitybenefit May 2013 Disclosures together WE BUILD A BRIGHTER FUTURE 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 kp.org/communitybenefit WHO definition of Health together WE BUILD A BRIGHTER FUTURE Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. kp.org/communitybenefit Objectives together WE BUILD A BRIGHTER FUTURE 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 kp.org/communitybenefit Many Factors Drive and Shape Health together WE BUILD A BRIGHTER FUTURE Drivers of Health Personal Behaviors 40% Environmental and Social Factors 20% Family History and Genetics 30% 10% Medical Care Source: McGinnis et al, Health Affairs, 2002 kp.org/communitybenefit 5 The Social Ecological Framework together WE BUILD A BRIGHTER FUTURE Physical and Mental Health “Body, Mind and Spirit” Individual / Family Home / School / Worksite Neighborhood / Community Society kp.org/communitybenefit 6 Childhood Overweight and Obesity together WE BUILD A BRIGHTER FUTURE On 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. Boulder Broomfield Douglas Routt Teller Elbert Mesa Eagle Garfield Summit Weld Fremont* Jefferson Morgan Logan Colorado Adams Arapahoe El Paso La Plata Montezuma Larimer Delta Montrose Pueblo Denver 13% 13% 14% 14% 16% 17% 19% 20% 20% 20% 20% 24% 26% 26% 26% 28% 29% 29% 31% 31% 31% 31% 36% 36% 37% 41% 0% 10% 20% 30% 40% 50% kp.org/communitybenefit Source: CDPHE: Health Statistics Section. 2010-2011 Child Health Surveys. Obesity Prevalence Colorado Children 2-14 years 2008-10 together WE BUILD A BRIGHTER FUTURE 40 35 30 25 obese overweight 20 15 10 5 0 White Hispanic Black Colorado Department of Health and EnvironmentChild Health Survey kp.org/communitybenefit Prevalence of Food Insecurity and Obesity in Colorado Children together WE BUILD A BRIGHTER FUTURE 80 70 60 50 40 Food Insecure Obesity 30 20 10 0 <100% FPL 100-199% FPL 200-299% FPL 300%+FPL Health Statistics CDPHE, Child Health Survey 2010 kp.org/communitybenefit More than one in six Colorado kids together lived in poverty in 2011. WE BUILD A BRIGHTER FUTURE Children Living in Poverty 3% 23% 25% 20% since 2010 17% 18% 15% 10% 10% United States Colorado 5% 0% Source: U.S. Census Bureau. 2000 and 2001 Supplemental Surveys, 2002-2011 American Community Surveys. kp.org/communitybenefit Effects of childhood obesity together WE BUILD A BRIGHTER FUTURE • 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 kp.org/communitybenefit Emotional and social impacts of childhood obesity together WE BUILD A BRIGHTER FUTURE • 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 kp.org/communitybenefit Obesity is Expensive together WE BUILD A BRIGHTER FUTURE Annual Medical costs of obesity • United States $147 billion • Colorado $874 million www.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 Mortality and Morbidity Costs kp.org/communitybenefit Case I together WE BUILD A BRIGHTER FUTURE 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? kp.org/communitybenefit Messaging and motivating behavior change together WE BUILD A BRIGHTER FUTURE • Lack of awareness re weight status • When parents made aware they are more motivated to action livewellcolorado.org/ kp.org/communitybenefit Messaging which engaged Hispanic families “Too much weight for his health” “Demasiado peso para su salud” kp.org/communitybenefit together WE BUILD A BRIGHTER FUTURE KPCO RD Intervention together WE BUILD A BRIGHTER FUTURE # 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 kp.org/communitybenefit 5-2-1-0 Modifiable Behaviors kp.org/communitybenefit together WE BUILD A BRIGHTER FUTURE Colorado Children’s Daily Behaviors 2010-2011 together WE BUILD A BRIGHTER FUTURE 50 45 40 35 30 25 20 15 10 5 0 5-11 yrs 12-14 yrs 5 Fruit & Veg 60 min PA One or more SSB http://www.chd.dphe.state.co.us/Resources/cms/hs/yrbs/ChildHealth Categories.html kp.org/communitybenefit Five servings of vegetables and fruits/day kp.org/communitybenefit together WE BUILD A BRIGHTER FUTURE Two Hours or Less of Screen Time/ Day together WE BUILD A BRIGHTER FUTURE GENERATION M2: Media in the Lives of 8- to 18-Year-Olds Kaiser Family Foundation Report 2010 kp.org/communitybenefit One Hour or More of Daily Physical Activity Improves: mood, cognition, fitness, bone strength, sleep quality Lowers risk of: diabetes, heart disease, obesity, anxiety, depression, stress, colon & breast cancers www.health.gov/paguidelines kp.org/communitybenefit together WE BUILD A BRIGHTER FUTURE Time Outdoors Increases Physical Activity together Burdette Arch Pediatr Adol Med 2004;159:46-50. Cleland V, et al. Int J Obesity 2008;32:1685-93. kp.org/communitybenefit WE BUILD A BRIGHTER FUTURE Zero Sugared Beverages together WE BUILD A BRIGHTER FUTURE Sugared beverages account for nearly half of all added sugar consumption in the average American diet. Dietary Guidelines of America 2010 kp.org/communitybenefit Other Obesity Interventions together WE BUILD A BRIGHTER FUTURE • • • • • • • Portion size Breakfast Diet quality Food Insecurity Sleep Family meals Eating out/ Take out kp.org/communitybenefit KPCO RD intervention results together WE BUILD A BRIGHTER FUTURE kp.org/communitybenefit Case II together WE BUILD A BRIGHTER FUTURE 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? kp.org/communitybenefit together WE BUILD A BRIGHTER FUTURE kp.org/communitybenefit Barriers to Walking-Photovoices together WE BUILD A BRIGHTER FUTURE kp.org/communitybenefit together WE BUILD A BRIGHTER FUTURE kp.org/communitybenefit Case II together WE BUILD A BRIGHTER FUTURE Mom discussed barriers during first 2 phone visits On 3rd phone visit ready to goal set: • physical activity • sugared beverages kp.org/communitybenefit Community Resources together WE BUILD A BRIGHTER FUTURE Fire up Your Feet http://fireupyourfeet.org/ Outdoor Resources http://www.getoutdoorscolorado.org/ Boys and Girls Clubs http://www.bgca.org Let’s Move letsmove.gov kp.org/communitybenefit 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 kp.org/communitybenefit together WE BUILD A BRIGHTER FUTURE Strengthen Schools as the Heart of Health . together WE BUILD A BRIGHTER FUTURE Accelerating Progress in Obesity Prevention- IOM May 2012 http://thrivingschools.kaiserpermanente.org/ www.letsmove.gov kp.org/communitybenefit Community Weight Loss Resources together WE BUILD A BRIGHTER FUTURE • Kaiser Permanente Resources www.kphealthyme.com • MEND Http://us.mendcentral.org/ • Por Tu Familia http://www.diabetes.org/in-my-community/localoffices/denver-colorado/por-tu-familia-colorado.html • Weigh and Win for Adults www.weighandwin.com/ kp.org/communitybenefit Case III together WE BUILD A BRIGHTER FUTURE 15 yo female presents with BMI of 99% and the following growth chart How do you engage patient and family? Next steps? kp.org/communitybenefit Case IV together WE BUILD A BRIGHTER FUTURE 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? kp.org/communitybenefit A Colorado Solution for Hunger together WE BUILD A BRIGHTER FUTURE Hunger Free Hotline kp.org/communitybenefit Case V together WE BUILD A BRIGHTER FUTURE 10 yo male with BMI 99% Mom concerned because he is being teased about his weight Engage? Next Steps? Resources? kp.org/communitybenefit Bullying Prevention together WE BUILD A BRIGHTER FUTURE • 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 http://www.stopbullying.gov kp.org/communitybenefit KPCO School Initiatives together WE BUILD A BRIGHTER FUTURE 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.org/communitybenefit • KP Educational Theater Program We Can Fix It together WE BUILD A BRIGHTER FUTURE • 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 kp.org/communitybenefit Thank you Sandra.H.Stenmark@kp.org kp.org/communitybenefit together WE BUILD A BRIGHTER FUTURE
