People and their Behavior: Simple Steps to Preventing Childhood Obesity Steven Gortmaker, Ph.D. Harvard School of Public Health.

People and their Behavior: Simple Steps to Preventing

Childhood Obesity

Steven Gortmaker, Ph.D.Harvard School of Public Health

Overview

• We need simple behavioral targets to focus on: example of 5-2-1-0

• We need to change our environments to make these behaviors easy!

• Ideas to improve local environments

• Lack of environmental change in disadvantaged communities is leading to growing disparities

Some Simple Behavioral Targets

Planet Health Behavioral Targets

Carter J, Wiecha J, Peterson KE, Gortmaker SL. Planet Health. Champaign, Illinois: Human Kinetics Press, 2nd Edition 2007.

- Eat 5 fruits and vegetables (combined) per day- Limit screen time to no more than two hours per day- Be physically active every day - Eat foods low in saturated fat and no trans fat - Eat more whole grains and less added sugars

First Simple Target: Avoid Soda and Sugar Added

Beverages

Youth in the US now consume on average more than 300 kcal per day

of sugar sweetened beverages

Wang YC, Bleich S, Gortmaker S. Pediatrics, in press.

“For each additional serving of sugar-sweetened beverage consumed, both BMI (0.243 kg/m2; P=0.03), and incidence of obesity (odds ratio 1.60; P=0.02) increased.”

Ludwig DS, Peterson KE, Gortmaker SL. Lancet 2001, 357:505-8

Soft Drink Consumption as a Cause of Youth Obesity

Environmental Change Strategy:Get sugar sweetened beverages out of schools and don’t bring them home

Reported Consumption of Servings (12 oz) per Day of Sugary Drinks, Boston High School Youth - Before and

After Implementation of School Beverage Policy

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2004 Pre 2006 Post

Change P<0.001

1.68 1.40

Boston Youth Survey data were collected via a collaboration between the City of Boston and Harvard School of Public Health. N=1079 in 2004 and 1223 in 2006

A school-based randomized controlled intervention found that intake of carbonated drinks could be decreased, and that this change was accompanied by a decrease in percentage of overweight and obese children (-7.7%; 95% confidence interval 2.2% to 13.1%)

James J, et al. BMJ 27 April 2004.

Reducing Intake of Sugar Sweetened Beverages Can Reduce Overweight

Among Youth

Second Simple Target: Limit screen time to no more

than two hours per day

Hypothesized Impact of Television Viewing on Obesity

ObesityTelevisionViewing

DietaryIntake

Inactivity

“…children currently view as many as 40,000 commercials on television and cable per year.”

“Finding: Children are exposed to extensive advertising for high-calorie and low-nutrient foods and beverages and very limited advertising of healthful foods and beverages during their daily television viewing.”

J. Michael McGinnis, Jennifer Appleton Gootman, Vivica I. Kraak, Editors. Food Marketing to Children and Youth: Threat or Opportunity? Institute of Medicine of the National Academies. The National Academies Press. Washington, D.C. 2006.

Evidence for the Impact of Television Viewing on Obesity

4 Randomized Controlled Trials

1) Epstein et al. Health Psychol 1995.

2) Robinson. JAMA.1999.

3) Gortmaker et al. Arch Pediatr Adolesc Med. 1999.

4) Epstein et al. Arch Pediat Adolesc Med 2000.

Effects of Planet Health

• Obesity among females in intervention schools was reduced compared to controls (odds ratio 0.48; P=0.03)

• Reductions in TV; both boys & girls• Among girls, each hour reduction of TV => reduced

obesity (odds ratio 0.86/hour; P=0.02)

• Gortmaker SL, Peterson K, Wiecha J, Sobol AM, Dixit S, Fox MK, Laird N. Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Archives of Pediatrics and Adolescent Medicine. 1999;153:409-18.

Impact of Planet Health on Disordered Weight Control Behaviors: Females

“…girls in intervention schools were less than half as likely to report purging or using diet pills at follow-up compared with girls in control schools (odds ratio, 0.41; 95% confidence interval, 0.22-0.75).”

Austin SB, Field AE, Wiecha J, Peterson KE, Gortmaker SL. The impact of a school-based obesity prevention trial on disordered weight-control behaviors in early adolescent girls. Arch Pediatr Adolesc Med. 2005 Mar;159(3):225-30.

Cost-Effectiveness

An independent economic analysis of Planet Health

found: • An estimated program cost of $14/student/year• Planet Health is more cost-effective than

commonly accepted preventive interventions, such as screening and treatment for hypertension.

• $4300 per QALY (quality adjusted life year)

Wang LY, Yang Q, Lowry R, Wechsler H. Economic analysis of a school-based obesity prevention program. Obes Res. 2003 Nov;11(11):1313-24.

Environmental Change Strategy:- Focus on reducing screen time (replace with other activities)- Schools curricular are useful- Take TV’s out of rooms where children/youth sleep

Third Simple Target: Participate in at least one hour

or more of physical activity every day

But remember - children (and adults) DO NOT NEED Sugar water to be physically active!

Environmental Change Strategy:- More Physical Education in schools- More Recess- More active afterschool- More community physical activity opportunities

Final Simple Advice: We need change in multiple social

and environmental settings

ACTIVATE AMERICA

The Gulick Project

Directly helping individuals and

families lead healthier lives

Community Leadership

Strengthening YMCAs’

capacity for community

leadership in support of

healthy living

Strategic Partnerships

Magnifying

the YMCAs’ impact

through

strategic partnerships

Built on a solid foundation:

A 150 year commitment to health in spirit, mind, body .

Closing Thoughts

• It’s not just individual choice

• We need to focus on behavioral targets linked clearly to obesity, and then improve the food and activity environments of children and youth.

• Make it simple to make a healthy choice.

Closing Thoughts

• We need partnerships within multiple social and environmental settings: e.g. schools, pre-schools, after schools, primary health care, worksites, neighborhoods and homes.

• Supportive change in many such physical activity and eating environments will be needed to halt the obesity epidemic.

• The lack of change in these environments in disadvantaged communities is a major cause of growing disparities.