Fat Town: How characteristics of a town relate to obesity

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Interested in the how behavioral and environmental factors influence the diet of a preteen? These slides compiled by the National Initiative for Children’s Health Care Quality demonstrate how these factors affect obesity in our communities.

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  • Trainer Notes: Part of being a successful advocate is knowing your story and being able to convey your interest and passion in a compelling way. Take a few minutes to complete the exercise….
  • Trainer Notes: As healthcare professionals, you work with children and families on a daily basis who are struggling to live healthier active lives. Let’s look at the issue of obesity from a case in our office and see how it links back to the community. Clinical Reminders: Assessment of Obesity: Calculate, chart and classify BMI for all children 2-18 yrs at least yearly Assess dietary patterns Assess activity/inactivity Assess readiness for change Assess obesity related comorbidities Assess ongoing progress BMI based on age and gender and is a population based reference Underweight BMI<5% “ Normal weight” BMI 5%-84% Overweight BMI > 85%-94% (IOM classification) Obese BMI 95%-99% (IOM classification) Morbid (severe) obesity BMI>99% Stages of Intervention – Based upon Expert Panel Recommendations Pediatrics December 2007 Content of each stage builds on previous stage Intensity of intervention increases  Prevention  Prevention Plus  Structured Weight Management  Comprehensive Multidisciplinary Protocol  Tertiary Care Protocol
  • Model modified from: Childhood overweight: a contextual model and recommendations for future research. Davison KK, Birch LL. Obes Rev. 2001 Aug;2(3):159-71. With additions by S Hassink Trainer Notes: A great way to dissect the case is to break down the various risk factors and see how the environment in which this 12 year-old girl lives impacts her ability to be healthy. To do this we are going to use this sample socio-ecological model over the next couple of slides.
  • Trainer Notes: In your history, you learn that this little girl:  Skips breakfast (no time)  Eats pretzel and juice for lunch (not hungry for a regular lunch)  After school – soda and snack food (poor choices)  Dinner – Family eats out 3x week (too busy to cook)  Bedtime – Cereal (eating while watching TV) Now let’s look at the model and see the behavioral elements that influenced these choices.
  • Source: Childhood overweight: a contextual model and recommendations for future research. Davison KK, Birch LL. Obes Rev. 2001 Aug;2(3):159-71. With additions by S Hassink Trainer Notes: The yellow circles represents the behavioral factors that influence dietary patterns
  • Trainer Notes: Here we see the same dietary patterns but now let’s look at it through the lens of the environmental factors that influence this young lady’s ability to eat healthy.
  • Trainer Notes: The red circles highlight the environmental factors influencing this child’s food choices.
  • Trainer Notes: Now let’s quickly examine what you learned about her physical activity levels from her history: Let’s examine the behavioral factors.  No outdoor time (doesn’t want to go outside)  Computer, IM etc 3 hours/day (nothing else to do)  Homework 2 hours/day (prefers not to do homework at study period)  Weekends “TV all the time” (doesn’t know what to do if not watching TV)  Extracurricular activity Cheerleading 2x/week
  • Trainer Notes: The yellow circles represent the behavioral factors that influence physical activity.
  • Trainer Notes: Looking at these factors again let’s plot them in terms of environmental factors.
  • Trainer Notes: The red circles represent the environmental factors that influence this child’s physical activity.
  • Fat Town: How characteristics of a town relate to obesity

    1. 1. Fat Town Identify characteristics of the town that related to obesity
    2. 2. Socio-ecological Model of Obesity <ul><li>Multiple factors affecting childhood obesity </li></ul><ul><ul><li>Behavioral perspective </li></ul></ul><ul><ul><li>Environmental perspective </li></ul></ul><ul><li>Multiple avenues for influence and change </li></ul>
    3. 3. Making the Link: Practice and Community <ul><li>Case Study </li></ul><ul><li>A 12 year-old girl </li></ul><ul><ul><li>At her 12 year well check mother reports her daughter’s increasing comments about her weight and being “fat”. </li></ul></ul><ul><ul><li>BMI = 23, 90 th percentile for a 12 year-old girl </li></ul></ul><ul><ul><li>Identified as overweight </li></ul></ul>
    4. 4. Community/Social/Demographic Parenting Styles Child Characteristics Child’s Weight Status gender age Dietary Intake Decision Making family genetics Sedentary Behavior Physical Activity Schedule Child Feeding Practices Peer/ Sibling Interactions Foods Available In House Nutritional Knowledge Parent Dietary Intake Parent Food Preferences Parent Weight Status Parent Encouragement of Activity Parent Activity Patterns Parent Monitoring of TV Family TV Viewing School Schedule School Lunch Program Ethnicity Work Hours School Environment Availability of Recreational Activities Accessibility of Convenience Foods & Restaurants Family Leisure Time Corner Store School Physical Education Programs Crime Rates General Safety Socioeconomic Status Activities At Home
    5. 5. 12 Year-Old Girl Dietary Patterns – Behavioral Perspective <ul><li>Skips breakfast (no time) </li></ul><ul><li>Eats pretzel and juice for lunch (not hungry for a regular lunch) </li></ul><ul><li>After school – soda and snack food (poor choices) </li></ul><ul><li>Dinner – Family eats out 3x/week (too busy to cook) </li></ul><ul><li>Bedtime – Cereal (eating while watching TV) </li></ul>
    6. 6. Community/Social/Demographic Parenting Styles Child Characteristics Child’s Weight Status gender age Dietary Intake Decision Making family genetics Sedentary Behavior Physical Activity Schedule Child Feeding Practices Peer/ Sibling Interactions Foods Available In House Nutritional Knowledge Parent Dietary Intake Parent Food Preferences Parent Weight Status Parent Encouragement of Activity Parent Activity Patterns Parent Monitoring of TV Family TV Viewing School Schedule School Lunch Program Ethnicity Work Hours School Environment Availability of Recreational Activities Accessibility of Convenience Foods & Restaurants Family Leisure Time Corner Store School Physical Education Programs Crime Rates General Safety Socioeconomic Status Activities At Home
    7. 7. 12 Year-Old Girl Dietary Patterns – Environmental Perspective <ul><li>Skips breakfast (school start time/availability of school breakfast) </li></ul><ul><li>Eats pretzel and juice for lunch (school lunch) </li></ul><ul><li>After school – soda and snack food (corner store) </li></ul><ul><li>Dinner – Family eats out 3x/week (fast food availability) </li></ul><ul><li>Bedtime – Cereal (TV in bedroom) </li></ul>
    8. 8. Community/Social/Demographic Parenting Styles Child Characteristics Child’s Weight Status gender age Dietary Intake Decision Making family genetics Sedentary Behavior Physical Activity Schedule Child Feeding Practices Peer/ Sibling Interactions Foods Available In House Nutritional Knowledge Parent Dietary Intake Parent Food Preferences Parent Weight Status Parent Encouragement of Activity Parent Activity Patterns Parent Monitoring of TV Family TV Viewing School Schedule School Lunch Program Ethnicity Work Hours School Environment Availability of Recreational Activities Accessibility of Convenience Foods & Restaurants Family Leisure Time Corner Store School Physical Education Programs Crime Rates General Safety Socioeconomic Status Activities At Home
    9. 9. 12 Year-Old Girl Physical Activity Patterns - Behavioral Perspective <ul><li>No outdoor time (doesn’t want to go outside) </li></ul><ul><li>Computer, IM etc 3 hours/day (nothing else to do) </li></ul><ul><li>Homework 2 hours/day (prefers not to do homework at study period) </li></ul><ul><li>Weekends “TV all the time” (doesn’t know what to do if not watching TV) </li></ul><ul><li>Extracurricular activity - Cheerleading 2x/week </li></ul>
    10. 10. Community/Social/Demographic Parenting Styles Child Characteristics Child’s Weight Status gender age Dietary Intake Decision Making family genetics Sedentary Behavior Physical Activity Schedule Child Feeding Practices Peer/ Sibling Interactions Foods Available In House Nutritional Knowledge Parent Dietary Intake Parent Food Preferences Parent Weight Status Parent Encouragement of Activity Parent Activity Patterns Parent Monitoring of TV Family TV Viewing School Schedule School Lunch Program Ethnicity Work Hours School Environment Availability of Recreational Activities Accessibility of Convenience Foods & Restaurants Family Leisure Time Corner Store School Physical Education Programs Crime Rates General Safety Socioeconomic Status Activities At Home
    11. 11. 12 Year-Old Girl Physical Activity Patterns - Environmental Perspective <ul><li>No gym this session (school schedule) </li></ul><ul><li>No recess (school schedule) </li></ul><ul><li>No outdoor time (neighborhood safety) </li></ul><ul><li>Computer, IM etc 3 hours/day (family entertainment environment) </li></ul><ul><li>Homework 2 hours/day (family scheduling) </li></ul><ul><li>Weekends “TV all the time” (family activity) </li></ul><ul><li>Extracurricular activity Cheerleading 2x/week </li></ul>
    12. 12. Community/Social/Demographic Parenting Styles Child Characteristics Child’s Weight Status gender age Dietary Intake Decision Making family genetics Sedentary Behavior Physical Activity Schedule Child Feeding Practices Peer/ Sibling Interactions Foods Available In House Nutritional Knowledge Parent Dietary Intake Parent Food Preferences Parent Weight Status Parent Encouragement of Activity Parent Activity Patterns Parent Monitoring of TV Family TV Viewing School Schedule School Lunch Program Ethnicity Work Hours School Environment Availability of Recreational Activities Accessibility of Convenience Foods & Restaurants Family Leisure Time Corner Store School Physical Education Programs Crime Rates General Safety Socioeconomic Status Activities At Home

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