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Combating Childhood Obesity

April 14, 2014, 09:00 AM
Combating Childhood Obesity
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Stunning new data showing a steep 48 percent decline in preschooler obesity has researchers feeling cautiously optimistic.

The data, published in the Journal of the American Medical Association, follows a general national decline in childhood obesity over the past two decades. This decline has been attributed to everything from Michelle Obama’s Let’s Move campaign to healthier school lunch programs. But individual states, like Texas, are seeing more modest declines in childhood obesity rates, or are simply holding steady.

“To those of us in the profession (of obesity research), any decline in the childhood obesity rate is good news,” says Steven Kelder, PhD, MPH, co-director of the Michael & Susan Dell Center for Healthy Living and professor of epidemiology for The University of Texas Health Science Center (UTHealth) School of Public Health Austin Regional Campus. “But we still have a very large obesity problem we need to continue to address.”

How large? Consider the stats: Texas has the seventh highest rate of obesity among adolescents at 24 percent. Nearly a quarter of fourth-grade children are obese. Obesity strikes poor and minority children at even higher rates — for example, a whopping 35 percent of Hispanic fourth-grade boys are obese. And recent data doesn’t show a significant decrease in childhood obesity in Texas, possibly due to the recession and a lack of financial support for childhood obesity interventions, say obesity experts.

But there’s also good news. Before the recession, obesity rates for children in the El Paso region decreased from 25.8 percent to 18.8 percent from 2000-2002 to 2004-2005, according to the Dell Center for Healthy Living’s School Physical Activity and Nutrition (SPAN) study. And students in the Travis County Dell Coordinated Approach to Child Health (CATCH) study had an 8.3 percent decrease in obesity from spring 2007 to spring 2008.

“In areas where we are able to implement obesity prevention school-based interventions and have community support, we have seen significant decreases in childhood obesity,” says Deanna Hoelscher, PhD, Dell Center for Healthy Living director and John P. McGovern Professor of health promotion at UTHealth School of Public Health Austin Regional Campus.

What works?

Since founding the Dell Center for Healthy Living in 2006, Hoelscher and Kelder have found success reducing childhood obesity when they implemented evidence-based, school-based health programs backed by parental and community support, similar to the Centers for Disease Control and Prevention’s (CDC) whole child model. Want to see the same changes in your community? Hoelscher and Kelder encourage parents and community members to become advocates and push for programs in their neighborhoods. Here’s how to make what’s working in other communities work for your community:

Target schools

“Schools are a great conduit for obesity programs,” Kelder says. “The kids are there for most of their day from kindergarten to high school. It is a perfect opportunity to address their nutrition and physical fitness during that time.”

One of the Dell Center’s most successful school obesity interventions is CATCH, or Coordinated Approach to Child Health. If you have a child in public school in Texas, you may know of the CATCH program from packing your child’s CATCH break — a healthy snack for school. But that’s just one component of the program, which is designed to promote physical activity and healthy food choices. The CATCH program provides in-depth materials about nutrition and physical activity for classroom teachers, child nutrition services staff, physical educators and families. CATCH also offers an early childhood program and after-school program.

The program has been a success in Texas. Since an initial study in El Paso in the 1990s helped lower the weight of low-income school children by 8 percent, follow-up studies have had similar results. A follow-up study in Austin reduced obesity by 7 to 8 percent. Since then, the program has been adopted by more than 9,000 schools in the United States and abroad.

Kelder says the program’s focus on energy balance — balancing the amount of foods you eat with enough exercise to burn off excess calories — is the key to the program’s success, together with family involvement.

Introduce healthy foods…and keep introducing them

“Many kids aren’t exposed to fresh fruits and vegetables,” Kelder says. “One way to solve that is to have taste testing. When you look at our tongues, they are hardwired for certain flavors. The most nutritious vegetables taste a little bitter. You need to have kids try the new food many times before they get used to the taste. It may take one bite, up to 15 times.”

To make that first bite happen, the Dell Center’s Brighter Bites program provides fresh fruit and vegetables to low-income families. The program, in collaboration with the Houston Food Bank, gives weekly bags of 50 servings of produce to families in areas identified as food deserts, combined with nutrition education for children and their families over a 16-week program.

Teaching kids to grow their own fruit and vegetables also increases exposure to healthy foods, and makes children more likely to eat them. Texas Grow! Eat! Go!, in collaboration with Texas Agrilife Extension Service and Texas A&M University, is teaching kids at 32 CATCH elementary schools in Texas how to become master gardeners. The pilot program was tested in three Nueces County elementary schools in the spring of 2012. Nearly 24 percent of boys in the program and 13 percent of the girls transitioned from an unhealthy weight to a healthy weight by the end of the pilot project.

“Results from the pilot study are very promising, suggesting that students participating in the study increased their fruit and vegetable intake and decreased their weight,” said Alexandra Evans, PhD, MPH, a Dell Center for Health Living researcher and associate professor of health promotion & behavioral sciences at UTHealth School of Public Health and the study’s principal investigator.

Get kids moving

Exercise is a key part of maintaining a healthy energy balance, but children are getting less of it, as schools increasingly focus on academics at the expense of physical education programs. The 2008 U.S. Physical Activity Guidelines recommend children engage in at least 60 minutes of moderate to vigorous physical activity every day. The CATCH program helps schools increase the amount of physical activity through its curriculum, including lessons on how kids can reduce sedentary behavior, like screen time, and engineer physical activity into their daily lives. The program also encourages the formation of school wellness teams, and encourages schools to look for opportunities for more physical activity, such as classroom activity breaks and “open gym” policies before and after school.

Involve the entire community

“For programs to work, we need other organizations supporting and assisting our schools in encouraging healthy dietary habits and activities that encourage physical activity, such as Boy Scouts and Girl Scouts and after school programs,” Kelder says, giving the example of the Texas Childhood Obesity Research Demonstration (CORD), a CDC-funded program that connects the dots between families, pediatricians, school and local youth organizations. Families in the program are referred from physician’s offices, take educational classes about cooking, healthy eating and physical activity at their local YMCA, and participate in sports teams at local YMCAs.

Other initiatives, such as farmers’ markets and community exercise classes, also help make a difference, and communicate the message that overall health is important. People can offer support by organizing community wellness efforts, meeting with school leaders about nutrition and physical education issues or getting involved with their local school district’s School Health Advisory Council (SHAC).

More work to do

While we are making progress in reducing childhood obesity, more remains to be done. Kelder compares the fight against obesity to efforts to curtail smoking.

“It is going to take some big societal changes to eliminate the problem of childhood obesity,” he says. “I am pleased that we are leveling off, but we still need to pay attention to childhood obesity, and focus our attention on reducing it.”

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