September 2014





Today's parents less able to spot obesity in their kids

Aug. 25, 2014, HealthDay

By Dennis Thompson

Parents have become less able to realize when their child is overweight or obese, a new study finds.

In fact, parents interviewed between 2005–2010 were 24 percent less likely to spot a weight problem in their child than parents interviewed between 1988–1994, the researchers said.

The report was published online Aug. 25 in the journal Pediatrics.

“The society as a whole is stuck with a vicious cycle,” said senior study author Dr. Jian Zhang, an associate professor of epidemiology at Georgia Southern University in Statesboro. “Parents incorrectly believe their kids are healthy, they are less likely to take action, and so it increases the likelihood that their kids will become even less healthy.”

Obesity has more than doubled among children aged 6 to 11, rising from 7 percent in 1980 to nearly 18 percent in 2012, researchers said in background information.

Pediatricians will be key to breaking the cycle, said Amanda Staiano, director of the Pediatric Obesity and Health Behavior Laboratory at the Pennington Biomedical Research Center in Baton Rouge, La.

“Parents see doctors as an authority figure, and we see success with weight loss interventions and treatments when a pediatrician is involved,” said Staiano, who also serves as co-chair of The Obesity Society’s Public Affairs Committee. “It’s paramount that every time a child comes in for a visit, the pediatrician reviews the child’s height and weight, and discusses how they are doing with their parents.”

The new study relies on data gathered during the U.S. National Health and Nutrition Examination Survey, which has been conducted at regular intervals by the Centers for Disease Control and Prevention (CDC) since the early 1960s.

In the survey, parents of children aged 6 to 11 are asked whether they considered their child to be overweight, underweight, or just about the right weight. CDC technicians then measure the child’s weight and height, and use those to calculate their body-mass index (BMI).

Parents surveyed between 1988–1994 correctly perceived about 51 percent of the time that their child was overweight or obese. That number slipped to 44 percent for parents asked to assess their child’s weight status between 2005–2010.

More than three-quarters of parents interviewed in the 2005-2010 survey perceived their overweight children as “about the right weight” — 83 percent for boys and 78 percent for girls, researchers report. The advent of the childhood obesity crisis likely has made it more difficult for parents to perceive that their child has gained a potentially unhealthy amount of weight, Staiano said.

“We compare ourselves to the people we see around us,” she said. “If a child is in a class where most of the kids are overweight or obese, that becomes the new normal.”

In addition, medical definitions of obesity and overweight have become overly complicated, so much so that parents may have a hard time accurately applying the standard to their child, Zhang said. “The recommendation developed by the CDC is fairly complicated, and it can be very hard for parents to understand that,” he said.

Both Zhang and Staiano said parents also could be influenced by the stigmatization of obesity, and are reluctant to label their child as overweight or obese for fear the kid will suffer hurt feelings or face cruel taunts from others.

“Nowadays, parents may be concerned there is a stigma if they admit their child is obese,” Staiano said. “They also may not know what to do about it, so there may be a little bit of denial there as well.” Zhang agreed with Staiano that pediatricians are likely the only people who can effectively intercede.

“Practitioners are in an ideal position to help the parents and correct their misperception,” Zhang said. “Without help from professionals, the epidemic of childhood obesity cannot be reversed.”


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Publications & Tools

Food marketing: Using toys to market children’s meals

Food marketing has been shown to influence children’s food preferences, food choices, diets, and health. Nearly $2 billion is spent yearly by U.S. food and beverage companies to market products to children, with the majority of expenditures promoting less healthful foods and drinks. Policy makers, health authorities, and advocates are working on a number of initiatives to reshape unhealthy food marketing practices to reduce and prevent childhood overweight and obesity.

For restaurants, including toys with children’s meals is the leading form of food marketing directed at children by expenditure. In 2009, the top fast-food restaurant chains spent the majority (59 percent) of their marketing dollars to acquire toys, games, puzzles, or other premiums to distribute with children’s meals. The toys are often given away for free or at a minimal cost with the purchase of a meal.


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Toolkit highlights childhood obesity prevention strategies for rural communities

Few childhood obesity prevention strategies and interventions targeting policy, systems, and environmental change have been tested in rural settings. The recently released Childhood Obesity Prevention Strategies for Rural Communities toolkit provides a range of science-informed, promising or emerging prevention strategies to address childhood obesity in rural communities. Designed for rural health care providers, the toolkit focuses on five different sectors that serve children: early care and education; schools; out-of-school time; other community initiatives; and health care.


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Progress on children eating more fruit, not vegetables

The August 2014, Vital Signs, a publication of the Centers for Disease Control and Prevention, reports that the amount of whole fruit children, ages 2 to 18, ate increased by 67 percent from 2003–2010 and replaced fruit juice as the main contributor of fruit to children’s diets.

Experts recommend that most fruit come from whole fruit, rather than juice. The amount of vegetables children ate did not change from 2003–2010. Moreover, in 2007-2010, children did not meet recommendations for the amount of fruit and vegetables they should eat.

About 60 million U.S. children are enrolled in child care or school, where their experience with food can affect their health and lifelong food choices. Since 2010, new national efforts like Let’s Move! and new school nutrition standards support healthy eating.


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Nearly one-quarter of U.S. adults consume one or more sugar-sweetened beverages daily

The Centers for Disease Control and Prevention (CDC) found that approximately one in four adults report consuming regular soda, fruit drinks, or both one or more times daily. Using data from the 2012 Behavioral Risk Factor Surveillance System, CDC assessed adults in 18 states and found that daily, regular soda and fruit drink consumption was most common among those aged 18 to 34, men, non-Hispanic blacks, and Hispanics. In addition, states with the highest prevalence of daily consumption of regular soda, fruit drinks, or both were Mississippi and Tennessee.


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Childhood Obesity Research & News

Children’s hospitals issue recommendations on obesity

Aug. 20, 2014, The Courant

By Lisa Chedekel

With obesity rates rising among children, leaders of the nation’s top children’s hospitals are recommending that primary care pediatricians help to identify and treat four related medical conditions, previously found in adults, that may be overlooked.

The leaders, including Elizabeth Estrada, director of the Pediatric Obesity Center at Connecticut Children’s Medical Center, issued recommendations this month that call on pediatricians to screen for and treat lipid abnormalities, abnormal liver enzymes, hypertension, and polycystic ovary syndrome (PCOS) in children with obesity. The recommendations, developed in collaboration with the Children’s Hospital Association, include guidelines on when to involve specialists in the care of a child.

“In providing a core set of user-friendly consensus statements on screening and treatment plans…we are not only empowering the primary pediatrician to address diseases that are rapidly spreading among children with obesity, we hope to motivate families to address these serious health conditions with a provider (with) whom they’ve held a longstanding relationship,” Estrada said.

The group cited recent studies indicating that approximately one-third of children in the United States are obese or overweight, putting them at higher risk for obesity-related conditions including hypertension, sleep apnea, diabetes, and fatty liver disease.

While the number of children with those conditions has climbed, primary care pediatricians often are underequipped to deal with those comorbidities, instead referring patients to specialists. But such specialists are in short supply, the hospital leaders said, prompting the push for pediatricians to take on more responsibility.

Currently, there are no specific evaluation criteria for children with obesity who are at greater risk for certain medical conditions, and no guidelines on how pediatricians should proceed with abnormal laboratory results. Practice patterns vary greatly, depending in part on access to subspecialists, the hospital group said.

By issuing guidelines, the Children’s Hospital Association hopes to “address the conditions at the first line of defense — the primary care physician,” said association president and CEO Mark Wietecha.

The guidelines came out of discussions among pediatric obesity experts from 25 obesity centers around the country. They were authored by experts from nine hospitals, including Connecticut Children’s [Hospital].


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Pittsburgh Public Schools to offer free lunches to all students, regardless of income

Aug. 21, 2014, Pittsburgh-Post Gazette

By Kate Mishkin

If an apple a day keeps the doctor away, imagine what a free breakfast and lunch will do.

Starting with the 2014-2015 school year, all students in Pittsburgh Public Schools will receive free breakfasts and lunches regardless of family income, courtesy of the Community Eligibility Provision.

Though the program is new to Pennsylvania, it has been in a pilot stage in 10 states and Washington, D.C., since the Healthy, Hunger-Free Kids Act passed in 2010. The act aimed to provide nutritious food to the 32 million students who eat lunch and 12 million students nationwide who eat breakfast at school each day, according to the U.S. Department of Agriculture (USDA).

This is the first year the program will be available nationwide to eligible schools. Prior to the change, only low-income students or students from families receiving federal assistance received free breakfasts in the Pittsburgh district, which includes 25,548 students in 56 schools from pre-k through 12th grade.

Vonda Cooke, state director of the Child Nutrition Program, said the Community Eligibility Provision is simply a “much more streamlined approach to determining eligibility.”

To be eligible, 40 percent of a school’s or a school district’s population must come from families receiving federal assistance through the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF). They may also be homeless or come from foster homes.

Though a complete list of participating schools across the state will not be available until after Aug. 31, the Pittsburgh and Philadelphia school districts both meet the 40 percent threshold and will participate in the program. In Pennsylvania, compensation to the districts will come from both USDA and the Pennsylvania Department of Education.

Officials said the new program should alleviate problems that existed when only a portion of students received free meals, including large amounts of paperwork and the burden of having to collect money from students. Last year, $25,000 of debt remained with Pittsburgh schools because some students did not pay for their meals.

Curtistine Walker, food service director for the city schools, said the program will also eliminate the stigma of “overidentification” — students will not be able to tell who qualifies for federal aid programs like SNAP and TANF.

Neither Cooke nor Walker could estimate what the program will cost in Pennsylvania because a total list of the schools participating is not yet available.

“It’s a unique opportunity for schools to cut down on the stigma of which students get meals and which students don’t. It’s seamless, and there’s no distinction,” said Kevin Concannon, USDA undersecretary for food, nutrition, and consumer services.

“The staff who have to spend some of their day doing counts on who pays and who doesn’t pay [can] be more focused on how we’re providing this meal and which steps to make sure they’re consuming it.”

Concannon said that when schools provide breakfast, fewer students go to the school nurse with complaints of headaches and stomachaches. He also said attendance picks up.

According to Walker, the Community Eligibility Provision offers equal opportunity to all students to receive breakfast and lunch, and she anticipates an increase in participation in both.

“I feel that providing free meals across the board gives every child the opportunity to receive nourishment and well-balanced meals that contribute to overall learning,” Walker said. “Just because a child doesn’t qualify [for federal aid] doesn’t mean there’s not a hunger issue there.”

Breakfast at the Pittsburgh Public Schools will consist of a whole grain bread option, milk, and fruit, of which students are required to take at least half a cup.

For lunch, students are offered a serving of protein, fruits and vegetables, and milk. There are special meal items for students with allergies and various needs. As time goes on, Walker anticipates a wider variety in the menu and an opportunity to provide diverse options.

The primary focus of the program, Cooke said, is the kids. “We want them to succeed. And in order for a child to succeed educationally, they need their needs met. Ensuring all students have access to healthy meals is important to the USDA and the Department of Education here in Pennsylvania. The program provides greater opportunity to access those meals, and it makes it more streamlined for the families and the schools and to the additional administration in the school,” she said.


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Start of the school year brings big changes to physical education in Highline

Aug. 25, 2014, Highline Times

Physical education (PE) teachers from across Highline School District received special training … on an innovative PE curriculum that will launch on the first day of school. The goal is to build students’ lifelong fitness and health.

The training is part of a comprehensive approach to improving access to physical activity for all Highline students—based on a recognition that physical activity is essential to helping students achieve academically.

Highline’s new policy places greater emphasis on getting students to be more active throughout the school day; makes PE more accessible for all students; and provides on-line access to fitness progress for students, parents, and teachers.

Only one in four students in Highline are getting the recommended 60 minutes of daily physical activity they need to be healthy. Yet, schools can make a difference in the health of their students, as shown by a recent drop in obesity rates in several low-income King County school districts that participated in an obesity prevention initiative.

“The changes taking place in Highline are a great example of schools and Public Health coming together to improve the health of our young people,” said Patty Hayes, director of Public Health—Seattle & King County (PHSKC). “A growing body of research shows that physical activity can improve student learning and boost academic achievement as well as improve health.”

Improvements in physical activity to expect this fall:

  • More active time for all students during PE class and throughout the day
  • Activities that focus on motor skills they can apply to a variety of activities
  • Knowledge and skills to make healthier food and fitness choices
  • Additional focus on teamwork, sportsmanship, and responsible behavior
  • New activities that meet student interests such as yoga or backpacking

“Now more than ever, we must all do our part to help children establish healthy habits early on. I’m thrilled to see our district launch this innovative approach to physical activity that will equip students with the knowledge and skills they need for lifelong health and fitness,” said Nichole Calkins, PE & Health Instructional Specialist for Highline Schools.

The changes were supported, in part, by a Centers for Disease Control and Prevention Community Transformation Grant within the Affordable Care Act’s Prevention and Public Health Fund. The initiative is a collaborative effort between PHSKC, Seattle Children’s, and the Healthy King County Coalition (HKCC). …


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