Obesity Discussion Forums

[Obesity Discussion]

The Epidemic
55% of Massachusetts adults are overweight or obese. (CDC BRFSS, 2002)
18% of non-Hispanic white adults, 30% of non-Hispanic black adults, and 22% of Hispanic adults in Massachusetts are obese. (CDC BRFSS, 2002)
24% of Massachusetts high school students are overweight or at risk of becoming overweight. (CDC YRBSS, 2003)
The obesity rate among Massachusetts adults increased by 81% from 1990 to 2000. (CDC BRFSS, 1990, 2002)

Program Priorities
The Massachusetts Partnership for Healthy Weight has completed a 5-year statewide plan, The Health of Massachusetts: A Coordinated Response to Overweight and Obesity, focused on policy and system-wide approaches to increasing healthy eating and physical activity. An event is planned to publicize the plan’s release. New work groups are focusing on the following areas:

Infrastructure
Policy/advocacy curriculum development
School-based health centers and enhanced school health services
Worksites
The elderly
A report on the burden of obesity, The Health of Massachusetts: Impact of Overweight and Obesity, has also been completed.

One major intervention is currently underway:

5-2-1 Go! is a school-based overweight prevention initiative that uses the Planet Health curriculum and the School Health Index. The goal is to increase consumption of fruits and vegetables, decrease consumption of sugar-sweetened beverages, increase physical activity, and decrease time spent watching television and playing computer games. Baseline data have been collected on 95% of students enrolled in the program. Final data collection will be completed by June 2004.


Partners
American Cancer Society
American Heart Association
BlueCross/BlueShield of Massachusetts
Boston Medical Center
Boston Organization of Black Dietitians
Children’s Hospital
Greater Boston American Red Cross
Haitian Health Institute
Harvard Prevention Research Center
Harvard School of Public Health
Latino Health Association
Institute for Community Health
Massachusetts Academy of Pediatrics
Massachusetts Action for Healthy Kids
Massachusetts Association of Health, Physical Education, Recreation, and Dance
Massachusetts Bike Coalition
Massachusetts Department of Education
Massachusetts Highway Department
Massachusetts Parks and Recreation Department
Massachusetts Public Health Association
Massachusetts School Food Service Association
Massachusetts Rails to Trails
The Medical Foundation
National Park Service
REACH Community Health Foundation
Simmons College
Tufts University
United Way of Massachusetts Bay
University of Massachusetts Extension Service
YMCA Alliance
Walk Boston

Recent Accomplishments and Products
Compiled a directory of multidisciplinary pediatric overweight treatment programs across the state.
Completed 5-2-1 Go!, a 2-year school-based overweight prevention initiative in 13 public and private schools across the state.
Implemented Healthy Choices, a before/after school nutrition and physical activity program, in 12 schools.
Collaborated with MDPH Bureau of Substance Abuse Services to integrate nutrition and physical activity questions into a health survey administered to middle and high school students.
The Office of Child Care Services implemented regulations to include a requirement to increase physical activity of children in state-regulated child care sites.

Upcoming Events and Products
Award of mini-grants to 12 schools for Healthy Choices Programs to integrate use of the School Health Index Tool and improve the school nutrition and physical activity environment.
Development of a Web site devoted to the Partnership for Healthy Weight and the state plan.
Development of a community-based intervention to increase community walkways.
A conference sponsored by the Massachusetts School Food Service Association for school food service staff to raise their awareness of their role in overweight prevention.
Training for child care providers using the H.E.A.L.T.H.Y. KIDS curriculum.
Project Period: 2003–2008
Year First Funded: 2000
Funding Stage: Basic Implementation
Contact Person:
Maria Bettencourt, MPH, LN
Program Coordinator
Massachusetts Department of Public Health
Telephone: 617-624-5470
Fax: 617-624-5075
E-mail: maria.bettencourt@state.ma.us


Data Sources
CDC BRFSS — CDC’s Behavioral Risk Factor Surveillance System
CDC PedNSS — CDC’s Pediatric Nutrition Surveillance System
CDC YRBSS — CDC’s Youth Risk Behavior Surveillance System

http://www.cdc.gov/nccdphp/dnpa/obes...sachusetts.htm

[Obesity Discussion]

Hospital gets grant for diabetes, obesity
By Andrew Lightman/ Daily News Staff
Sunday, September 17, 2006

MILFORD -- The state has awarded Milford Regional Medical Center with a $200,000 grant, which the hospital will use to help boost its diabetes and obesity prevention programs.

The state Executive Office of Health and Human Services announced the grant Thursday, as part of a $38 million award to hospitals and community health centers across the state.

"It's intended to improve the financial health of hospitals and community health centers across the state," said Health and Human Services spokesman Dick Powers. "I don't think you'll find one (hospital) that would say they couldn't use it."



With the money, Powers said many health care providers will be able to boost their technology to, for example, allow doctors to file electronic prescriptions.

Other hospitals may use the money to keep pace with increased patient demand and changes to the state's health care system, brought on by the state's new universal health care coverage law, Powers said.

Milford Regional Medical Center President and CEO Frank Saba said his hospital will put the money to good use.

"We have a number of programs that deal with chronic illnesses like diabetes and obesity, and we are hopeful to use those funds to help with those issues," Saba said. "A lot of them are education and disease management (programs) on how to live a healthier life."

Saba said Milford Regional applied for the money at the end of August, with the expectation it would be notified quickly. After getting the news Thursday, Saba said he was very pleased.

"As you might imagine, we are grateful to (state) Rep. (Marie) Parente and (state) Sen. (Richard) Moore for helping us secure those funds."

Obesity Grant

[Obesity Discussion]

Food fight: How can parents battle obesity when junk is at every turn?
By Theresa DeFranzo/northshore@cnc.com
Friday, March 09, 2007 - Updated: 01:22 PM EST




Does this sound familiar? You’re setting out with your kids for an afternoon at the park. You know they’ll want a snack, so you pack water bottles and yogurt. You get to the park only to find that many of the other parents packed snacks too – Munchkins, chips and cupcakes, to be exact.
Your child gravitates to one of these families, starring at their snacks. These parents do what most parents do; they offer to share. Oh, well. Maybe you’ll eat healthy tomorrow.
Kim Trigilio, a Beverly mother of two young boys, has lived that experience. She tries to shop for organic food and to have her children snack on healthy choices, but it’s not always easy.
“We will be at the park and other kids are eating Munchkins,” she says. “I try to bring a lot of healthy choices. I don’t give them a lot of that.”
As any parent knows, it’s hard to compete with doughnuts and chips. They taste good. And brownies are easy. That’s probably why every time we get our kids together — whether it’s at Girl Scouts, play dates or school functions — you’ll find store-bought baked goods instead of cut fruit.
It’s also hard to be known as the “carrot mom” — the one brandishing carrot and celery sticks when most other parents are serving Pop Tarts and Pringles.
However, putting aside how our kids’ friends refer to us behind our backs, if you take a look at the childhood obesity numbers, chances are you’ll run to the produce department of your nearest market. We clearly need to make some changes with the way we are feeding our children.
Obesity in kids is now an epidemic in the United States. The number of children who are overweight has doubled in the last two to three decades; currently one child in five is overweight. The increase is in both children and adolescents, and in all age, race and gender groups, according to the National Institutes of Health website.
“Obese children now have diseases like type 2 diabetes that used to only occur in adults,” notes the NIH. “And overweight kids tend to become overweight adults, continuing to put them at greater risk for heart disease, high blood pressure and stroke. But perhaps more devastating to an overweight child than the health problems is the social discrimination. Children who are teased a lot can develop low self-esteem and depression.”
There’s also, of course, the anecdotal evidence.
“I do my own casual observations,” says Sharon McCabe, the director of the Saugus public health department. “It looks like kids are chunky at younger ages. In the second or third grades there used to be one or two kids, now it’s more.”
Busy lifestyles, video games and television are the main reasons health care professionals say today’s kids are overweight. With mom and dad working it’s much easier to have fast food for dinner than it is to come home and make a nutritious meal.
But beyond that, the fact of the matter is that food is part of our lives. You know you can’t show up empty handed at someone’s home when you go on one of your dozens of prescheduled play dates, just as much as you know they would rather you show up with something sweet and gooey instead of a bag of carrots.
Food is a big part of how we socialize. So striking up a balance between the good and the not-so-good is difficult.
“Food is present at every part of life,” says Linda Bassett, who teaches culinary courses at North Shore Community College, including one on culinary history. “You have food to celebrate a wedding or a birth. It’s at the movies and the ballpark. It started out just for fuel. Now it has become social.”
Bassett says we have to strike a balance. She also says we have to do something we might not want to: spend a weekend day cooking healthy meals for your family that you can freeze and heat up during the week. The other benefit of this is that you can control the amount of sugar and salt you want your kids eating.
Bassett knows that the thought of giving up a Sunday afternoon sounds terrible to some, but she says it’s necessary.
“We are eating stuff (made) out of chemicals on top of chemicals,” she says. “Kids have no idea what real food is.”

Help is on the way
Anyone who has ever tried to lose weight — and we’re not just talking about those five pounds so you can fit into your favorite pair of jeans — knows how difficult it can be. If your child is the one in five who is overweight, know that there are people who want to help. Beverly Hospital is one health care organization that has a program in place.
At Beverly Hospital’s Hunt Center, overweight or over-fat children can take part in the FUNdamental Family Fitness Program run by the Lifestyle Management Institute (LMI). The program is available through a pediatrician’s referral to any overweight or obese child, 8 years of age or older, and their parents interested in improving their health.
Dyan Dal Pozzo, the manager of the LMI, says they were already running a successful program for adults when several pediatricians came to them and said, “What are you going to do for the kids?” This program began in July 2005 and since that time 50 kids have participated, Dal Pozzo says.
This family-centered program begins with a comprehensive evaluation by a fitness team. There are two phases to the program. The first phase is a six-week program. Here, kids and their parents come to the center twice a week for educational classes and sessions. These sessions are designed to improve knowledge of how to live a healthy lifestyle. The participants also use the exercise room.
At the end of the six weeks, the family can either continue on its own or use the services provided by LMI. What’s important is that the family works on this together, says Laurel Kapferer, an exercise physiologist.
“We keep data on all the kids. The parents who do participate in the exercise or follow through ... they have the best outcomes.”
The reverse is true as well. As Dal Pozzo says, “Our children mimic what we do. We have to lead by example.”
And parents also have to realize that an overweight child faces more than just health risks. There is the self-esteem issue as well. Annette Knight, an R.N. and a certified diabetic educator, says an overweight child may not want to take his shirt off to go swimming. Then they miss out on that activity on a social level as well as physical level. Riding a bike may not be easy, so they give up on that too, she says.
“This program doesn’t look at one factor. We look at several factors,” she says. “We look at what is going on at home. What are they eating. How much screen time is there. We look at the things that can be controlled, modified and changed.”
The town of Saugus is also trying do something about this nationwide epidemic. McCabe says the town received a $5,000 grant last year to find ways to target juvenile diabetes and obesity. She says the Exercise Your Spirit Committee worked with the assets in the community.
Specifically, the committee worked with the 11 houses of worship in Saugus and created a walking route connecting them. Walkers can choose to walk a five-mile loop or one of the shorter loops. Outside each house of worship the churches have picked a Biblical scripture that talks about walking.
“We wanted to talk about living a balanced lifestyle,” McCabe says. “It’s physical, mental, spiritual, emotional and social. Each is important to achieve a healthy lifestyle.”
McCabe says there are a number of reasons kids are overweight these days. The biggest reason, she says, is inactivity.
“We don’t go out and play. You are waiting to be driven somewhere. Then there’s the tech age. We are strapped to all the games,” McCabe says. “I think Americans are tipping the scales not so much because of the food but because of the inactivity level. I think food is part of every social event. It should be. It’s a good time to indulge and enjoy. (But) it should not be done every day.”
Healthy choices
If you’re a parent who wants to do more to provide your child with healthy eating choices, then read on.
Bassett says one piece of advice she has is to take your children to the local farmer’s market. She says the market in Marblehead is “spectacular.” In addition to the food for sale, there’s also entertainment. Letting kids pick out their favorite fruits and vegetables may be a way to get them to eat them more often, Bassett says.
Another suggestion she has is when you have kids over to play or for birthday parties, let them make their own food. For example, she says, let the kids make hamburgers. Put out all the usual condiments as well as lettuce, tomatoes, onions, and peppers to put on top, and some kids may choose foods they typically don’t.
Judy DiPaola, a registered dietician with Beverly Hospital/Hunt Center Lifestyle Management Institute, also has some advice for parents looking to help their families live a healthier life.
First of all, DiPaola says, don’t always rely on the convenience of the school lunch. Oftentimes this is not the healthiest choice, so she recommends that you pack your child’s lunch. Also, she says, stay away from soda and juice.
“Water is the best beverage,” DiPaola says.
Make sure you eat as a family. When you don’t, she says you are more likely to grab something to eat instead of sitting at the table with a healthy, balanced meal.
In other words, keeping food from taking over every aspect of your kids’ lives takes thought, time and planning. And a thick skin over being called the carrot mom.
Editor’s note: For more information about the FUNdamental Family Fitness Program, call 978-774-4400.

[Obesity Discussion]

Promising Results Shown In Childhood Obesity Intervention

12 May 2007

Shape Up Somerville: Eat Smart. Play Hard.™ a community-based environmental change intervention to prevent obesity in culturally diverse, early elementary school children reduced weight gain over one school year. The multi-faceted program was designed and implemented by researchers from the Friedman School of Nutrition Science and Policy at Tufts University and the Tufts University School of Medicine in close collaboration with the community. The first year results reflect efforts of children, parents, teachers, school food service providers, health care providers and policy makers, as well as city departments, before-and-after school programs, restaurants, and local media outlets to provide and promote healthy eating options and physical activity among elementary school-aged children in Somerville, Massachusetts.

Corresponding author Christina Economos, PhD, assistant professor and New Balance Chair in Childhood Nutrition at the Friedman School, and colleagues used a measure called BMI-z score (or BMI-for-age percentile)* to report a reduction in weight gain among children who participated in the Shape Up Somerville (SUS) intervention, as compared to children in two socio-demographically similar communities in Massachusetts who did not receive the intervention.

"On average, SUS reduced approximately one pound of weight gain over eight months for an eight-year-old child. This may seem small for an individual, but on a population level this reduction in weight gain, observed through a decrease in BMI z-score, would translate into large numbers of children moving out of the overweight category. Such a reduction is important given today's obesigenic environment where the shifts continue to be observed in the opposite direction," says Economos.

A key element of the intervention was the work done in collaboration with Somerville schools. Economos and her team planned and implemented a range of initiatives designed to provide and promote healthy eating options and physical activity. These included:

* Work with the school food service director to offer healthier foods, develop more healthful recipes, and promote consumption of new foods through interactive education programs in the cafeteria

* An after-school curriculum that included creative cooking, cooperative games, yoga, soccer, and field trips, including a farm visit to learn how food is grown

* An in-class curriculum with all first through third grade teachers that included daily "cool moves" sessions, weekly nutrition and physical activity lessons, and fun and healthy giveaways

* Evaluation and expansion of school wellness policies, such as those that impact school health and physical education environments, and pedestrian safety

The intervention went well beyond the Somerville schools. Parents and community members were encouraged to participate through school, after- school, and community events. There were parent forums to engage members of the four major language communities in Somerville: English, Spanish, Portuguese, and Haitian-Creole, newsletters with health tips, walking contests, traffic calming campaigns, and coupons for healthy foods. The SUS team also worked with school and community officials to establish a city employee fitness and wellness benefit. School nurses, pediatricians, and family physicians were trained to address issues of overweight and obesity among children. SUS also collaborated with 21 local restaurants to develop the SUS stamp of approval, which indicates that the restaurant offers healthy menu options.

"If this seems like a very large number of activities, it is" says Dr. Economos, "but we believe that it is the sum of these efforts that will guide children to form habits that prevent excess weight gain as they move into their teenage and adult years. Many programs offer nutrition and physical activity education, but SUS also worked with individuals and community organizations that shape a child's environment, improving the chances that the healthful changes they make will last."

Community interventions such as SUS are not without challenges, says Economos. "SUS researchers spent several years building relationships within the Somerville community before the intervention could be implemented." The researchers were only able to measure and follow BMI z-scores for approximately 60 percent (385/631) of students assigned to the intervention community mainly because children moved out of the area. Economos concludes, however, that "Creating programs like SUS for communities is essential as the US obesity rates have more than tripled in children in the last three decades. Furthermore, given the intractable nature of the condition once established, proactive strategies that begin during childhood are needed to prevent overweight."

###

Co-authors are Raymond R. Hyatt, Jeanne P. Goldberg, Aviva Must, Elena N. Naumova, and Miriam E. Nelson, all of Tufts University, and Jessica J. Collins, formerly the project manager on the Shape Up Somerville: Eat Smart. Play Hard.™ study, which was largely funded by the Centers for Disease Control and Prevention. Additional support was provided by Blue Cross and Blue Shield of Massachusetts, Inc. and Blue Cross and Blue Shield HMO Blue of Massachusetts, Inc., United Way of Massachusetts Bay, the United States Potato Board, Stonyfield Farm, and the Dole Food Company. The New Balance Chair in Childhood Nutrition at the Friedman School is funded by the New Balance Foundation.

*Body mass index (BMI) is the relationship between height and weight. (BMI)-for-age, expressed as a z-score or percentile, indicates the relative position of the child's BMI number among children of the same sex and age. A BMI z-score between the 85th and 95th percentile is considered at risk for overweight, while a BMI z-score at or above the 95th percentile is considered overweight. Standardized BMI z-scores and the corresponding percentiles were constructed by the Centers for Disease Control and Prevention based on historical child heights and weights.

Economos CD, Hyatt RR, Goldberg JP, Must A, Naumova EN, Collins JJ, Nelson ME. "A Community Intervention Reduces BMI z-Score in Children: Shape Up Somerville First Year Results." Obesity. (May) 2007;15(5).



Obesity Programs