Childhood Obesity: Strategies to Halt a Growing Epidemic (and a few words on trans fats)

Childhood Obesity: Strategies to Halt a Growing Epidemic

(and a few words on trans fats)

Lynn Silver, MD, MPHAssistant Commissioner and

Mary T. Bassett, MPH, MDDeputy Commissioner Health Promotion and Disease PreventionNew York City Department of Health and Mental Hygiene

US Conference for MayorsWashington DC

January 25, 2007

Overview

• The New York City Experience– Building a healthy environment

• Access to healthy foods• Opportunity for physical activity

– Regulatory Approaches• Physical Activity and Nutrition Requirements in

Day Care• Calorie Labeling• Restriction of Trans Fat

Obesity Trends* Among U.S. AdultsBRFSS, 1985

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)


No Data <10% 10%–14%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19% ≥20



(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%



No Data <10% 10%–14% 15%–19% ≥20%



No Data <10% 10%–14% 15%–19% 20%–24% ≥25%



No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Begins EarlyOnly Half of NYC’s Elementary School Children

Are at a Healthy WeightUnderweight

4%

Obese24%

Overweight19%

Normal Weight

53%

More than 4 in 10 are overweight or obese in Grades K-5

Percentage of High School Students Who were Overweight (selected U.S. states)

YRBS, 2005

Why worry about childhood obesity?• Strong predictor of obesity in adulthood• Major early risk factor for much of adult

morbidity and mortality – diabetes has doubled• Health problems associated with obesity:

– Type 2 diabetes (hyperinsulinism, insulin resistance, IGT)– Cancer– CVD (hypercholesterolemia, dyslipidemia, htn)– Depression, low self-esteem– Asthma, sleep apnea– Osteoarthritis

SOURCES: American Academy of Pediatrics, 2003; Dietz & Gortmaker, 2001

Policy Approaches to Address Obesity

• Obesity is not just a problem of the individual, but also a problem rooted in environmental and community factors

• 2001 Surgeon General’s “Call to Action to Prevent and Decrease Overweight and Obesity” declared obesity a national priority

SOURCES: U.S. DHHS, 2001; Galvez, Frieden & Landrigan, 2003

The New York City Experience

• Building a healthy environment– Access to healthy foods– Opportunity for physical activity

• Regulatory Approaches– Day care physical activity and nutrition– Calorie labeling– Trans fat (addresses heart disease risk)

Make it easier to make healthy choices!

• Schools– More physical activity– No soda/vending machines– 1% milk

• Day Care Centers– More physical activity– No sugar sweetened drinks, 1% milk only– Limited TV

• Community Environment– Shape-Up programs in parks – Access to fresh fruits and vegetables – Improving the built environment

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Overall Daycare Population in NYCDay Care Facility Type

Total Facilities*

Setting Law/Regulation

Approx.Capacity**

Group Day Care (GDC) – Permit

2,072 Non-residential NYC Health Code (Article 47)

98,696

Group Family Day Care (GFDC) – License

2,232 Home of an unrelated family

18 NYCRR (part 416)

30,742

Family Day Care (FDC) – Registration

3,775 Home of an unrelated family

18 NYCRR (part 417)

103,942

School Age (SA) – Registration

1,192 Non-residential 18 NYCRR (part 414)

121,966

TOTAL, all facility types

9,271 355,346

* 2006 data ** 2002 data

Group Day Care Population in NYC

• There are 2,072 Group Day Care programs

• Serve about 100,000 infants, toddler and early childhood (ages 2 to 5).

Daycare regulations and the NYC Health Code: A Bit of History

• First day nursery in US opened in NYC in 1854• Day care was regulated within the Sanitary Code of

the City of New York, beginning approx. 1910• Compliance with these regulations was not

mandatory until 1943.• As a side note, the regulations of 1943 required 2

hours of outdoor play and a hot meal at noon and a "daily allowance of at least a pint of milk a day".

• The Health Code was adopted March 23, 1959.• New requirements to address obesity effective

January 2007

Day Care:Physical ActivityRegulations

• Establishes a required minimum number of physical activity minutes daily:– For ages 12 mos. and up, at least 60 min./day– For ages 3 and older, at least 30 min. of that

time must be structured & guided activity SOURCES: CDC; National Association for Sport and Physical Education

Day Care:Limits on TV

• Establishes limits on TV & video viewing:– No TV, video and other visual recordings for

children under two years of age

– For ages 2 and older, limits TV, video and other visual recordings to no more than 60 minutes per day of educational programs or programs that engage child movement

SOURCES: American Academy of Pediatrics; Institute of Medicine

Provide guidance on: – Appropriate kinds of foods & beverages - no

sugar sweetened beverages allowed. 1% milk only after age 2.

– Appropriate portion sizes for children(while remaining consistent with federal CACFP policy for meal & snack reimbursement)

Day Care:Nutrition Standards

SOURCES: Child and Adult Care Food Program; U.S. Dietary Guidelines for Americans, 2005

Implementation/Support• Nutrition training efforts

– to day care inspectors – to nutrition staff in

community through the bureau of daycare

• Educational materials disseminated to children and parents through daycare staff

• SPARK training in early childhood settings

SPARK!• Since 2003, DOHMH has partnered with

the Sports, Play and Active Recreation for Kids! (SPARK) program

• Goal – train and equip all daycare centers (17% trained so far), schools, K-2 teachers, and after-schools in highest risk communities

• Since November 2003, SPARK training and equipment provided to over 2500 staff from more than 600 sites.

Healthy Bodega InitiativeBrooklyn survey: Access to healthy foods– Conducted among 2 of the poorest neighborhoods

in NYC• 84% of food stores are bodegas• 6% of food stores are supermarkets• 28% provide limited fresh fruit, if any at all• 33% sell reduced fat milk, but at higher prices• 6% of bodegas sell any type of leafy vegetables• Health food access is extremely poor

– Similar findings in other high risk areas

Healthy Bodega Initiative• Healthy Bodegas Initiative

– 1% milk campaign • Partnership with bodegas to stock 1% milk, offer

discounts and distribute health information

– Fruits & vegetables campaigns (Pilot project)• Bodega owners are provided with a free shipment of pre-

packaged ready-to-eat apples and carrot snacks, if interested they can re-order from distributor

• Bodegas received a toolkit containing bi-lingual promotional items

• HD will conduct outreach and education to local schools, day cares and WIC centers

NYC Health Code Calorie Labeling

• Requires certain FSEs to post calorie content on menu boards and menus next to each menu item

• Applies to FSE who provide standardized menu items and for which calorie information is publicly available on or after March 1, 2007

• Does not apply to FSEs that have not made calorie information publicly available

• FSEs have six months to comply - July 1,2007

Partial Phase-Outof Trans Fat in RestaurantsAmendment to the NYC Health Code Approved December 2006

Phase I: July 2007 – Frying Oils and Spreads

Phase II: July 2008 - All other uses

Trans Fat Increases Heart Disease Risk 5% or more of cardiac events due to trans fat

More Dangerous than Saturated FatNo one will miss it

Good (HDL) Bad (LDL) Cholesterol Cholesterol

Trans fat

Saturated fat

Major Food Sources of Artificial Trans Fat for U.S. Adults

Cakes, Cookies, Crackers,

Pies,Bread,

etc.51%

Margarine22%

Salad Dressing

4%

Breakfast Cereal

1%Household Shortening

5%

Potato Chips, Corn Chips,

Popcorn6%

Fried Potatoes

10%

Candy1%

Data Source: http://www.fda.gov/fdac/features/2003/503_fats.html

Trans Fat Use Did Not Decline Despite Voluntary Campaign

50%50%

0%

25%

50%

75%

100%

2005 2006

% R

esta

uran

ts U

sing

Tra

ns F

atin

Oils

and

Spr

ead

Whe

re U

se C

ould

Be

Det

erm

ined

Health Bulletin to 200,000 people Info & tools to

food suppliers and to >20,000 NYC restaurants

7,800 restaurant operators trained

9,000 FSEs received additional info

Effective Public Health Requires Government Action

• Precedents: – Removing Lead – like trans fat it was unnecessary,

repleaceable, and is not missed– Adding Folate– Seatbelt requirements– Limit exposure to second-hand smoke

• Individual action alone is not enough:– Can’t tell if food contains transfat– Poor judgement of calorie content – For many, exercise opportunities are limited – Access to healthy foods is not a personal choice

We are getting a lot of questions

• California• Florida• Connecticut• Massachusetts• New Jersey• Pennsylvania• Washington State

• Ohio• Oregon• Michigan• Washington DC• Illinois• West Virginia• Virginia

Strategies for Consideration• Create the Environment

– Increase access to healthy foods for everyone• Target poor, high risk areas/neighborhoods • Improve public procurement• Regulate & improve food service in schools, day care

centers, after-school, camps• Encourage more drinking of water and no use of sugar

sweetened beverages– Increase access to physical activity

• Structured physical activity and facilities in schools, communities, workplace

• Built environment modifications provides opportunity for safe and convenient exercise

– Calorie labeling– Soda Tax

Thank you!

Childhood Obesity: Strategies to Halt a Growing Epidemic (and a few words on trans fats)

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Transcript of Childhood Obesity: Strategies to Halt a Growing Epidemic (and a few words on trans fats)