Steve Kelder on Child Obesity

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  • Steve Kelder on Child Obesity

    1. 1. CATCH School & Family Health Education Deanna M. Hoelscher, PhD, RD, LD, CNS Director, Michael & Susan Dell Center for Advancement of Healthy Living University of Texas School of Public Health, Austin Regional Campus Steven H. Kelder, PhD, MPH Co-Director, Michael & Susan Dell Center for Advancement of Healthy Living University of Texas School of Public Health, Austin Regional Campus
    2. 2. Trends in U.S. Youth Obesity 1 1 Obesity is > 95th Percentile for BMI by Age/Sex Sources: Ogden et al., 2006; Ogden et al., 2008 HP 2010 Goal
    3. 3. Relationship Between Weight Gain in Adulthood and Risk of Type 2 Diabetes Mellitus Relative Risk Weight Change (kg) Willett et al. N Engl J Med 1999;341:427. Men Women -10 -5 0 5 10 15 20
    4. 4. Increase in Healthcare Costs Among Obese Compared with Lean (BMI <25 kg/m2) Patients* Increase in Cost Compared with Lean Subjects (%) BMI 30-34 kg/m 2 BMI > 35 kg/m 2 Quesenberry CP Jr et al. Arch Intern Med . 1998;158:466-472. *HMO Setting: Northern California Kaiser Permanente. Healthcare visits Pharmacy Laboratory tests All outpatient services All inpatient services Total healthcare
    5. 5. Tracking of physiologic variables % Remaining +- one quintile Source: Kelder et al, Preventive Medicine (in press) 2002
    6. 6. Effective Obesity Prevention: CATCH & Community
    7. 7. Coordinated Approach To Child Health (CATCH) Classroom Curriculum Physical Education School Food Service Family
    8. 8. <ul><li>Pilot 1987-91 8 schools </li></ul><ul><li>Trial 1991-94 96 schools </li></ul><ul><li>Tracking 1994-97 51 schools </li></ul><ul><li>Maintenance 1998-99 88 schools </li></ul><ul><li>Dissemination 1998-2006 1900 + schools </li></ul><ul><li>Catch Kids Club 1999-2001 16 schools </li></ul><ul><li>Homocysteine 2000-2001 25 schools </li></ul>Intervention Efficacy
    9. 9. Intervention Dissemination <ul><li>EXPORT 2003-2007 LRGV </li></ul><ul><li>Pass & CATCH 2004-2007 8 schools </li></ul><ul><li>RWJ Policy 2005-2008 150 schools </li></ul><ul><li>Harris County 2005-2007 430 schools </li></ul><ul><li>CDC SIP 11,15,18 2005-2008 32 schools </li></ul><ul><li>Dell CATCH 2006-2010 97 schools </li></ul>
    10. 10. Physical Education <ul><li>Students will be involved in MVPA for 50% of class time </li></ul><ul><li>Students are provided many opportunities to participate and practice skills </li></ul><ul><li>Students enjoy physical activity </li></ul><ul><li>Students are encouraged to be physically active outside of school </li></ul>
    11. 11. Classroom Curricula <ul><li>K-5th grades (7-24 sessions/year) </li></ul><ul><li>Objectives are for students to be able to: </li></ul><ul><ul><li>Identify, Practice, & Adopt healthy eating & physical activity behaviors </li></ul></ul><ul><li>Focus on: </li></ul><ul><ul><li>Knowledge </li></ul></ul><ul><ul><li>Modeling: cartoons/peers </li></ul></ul><ul><ul><li>Skills training & </li></ul></ul><ul><ul><li>Self-monitoring </li></ul></ul><ul><ul><li>Social skills (tobacco refusal) </li></ul></ul><ul><ul><li>Social norm setting </li></ul></ul>
    12. 12. Family Program <ul><li>Homework done by child with parent/grown-up assistance </li></ul><ul><ul><li>Focus on skills development & changing family norms </li></ul></ul><ul><ul><li>Complements the curricula </li></ul></ul><ul><li>Family fun nights </li></ul><ul><ul><li>Health fairs with parent/child & community participation </li></ul></ul>
    13. 13. Eat Smart Program (School Food Service) <ul><li>CATCH Eat Smart provides children with tasty lower fat, saturated fat, and sodium school meals while maintaining required levels of essential nutrients and student participation. </li></ul><ul><ul><li>Menu Planning </li></ul></ul><ul><ul><li>Food Purchasing </li></ul></ul><ul><ul><li>Food Production </li></ul></ul><ul><ul><li>Promotion </li></ul></ul>
    14. 14. WHOA Highest fat and sugar SLOW Higher in fat and sugar, more highly processed GO Lowest in fat, no added sugar, whole grains, fruits & veggies skim whole
    15. 15. Motivational Enhanced Interviewing <ul><li>Motivational Interviewing is an evidence-based intervention that enhances motivation to change behavior. </li></ul><ul><li>Parents will be contacted via telephone to discuss the pros and cons of their child’s TV watching. </li></ul><ul><li>The parent’s importance for changing TV behavior and their confidence to make these changes in their home are used as strategic intervention tools. </li></ul>
    16. 16. CATCH Pre-K <ul><li>To increase the number of fruits, vegetables and whole grain foods consumed by pre-K children. </li></ul><ul><li>To increase MVPA among pre-K children. </li></ul><ul><li>Newsletters for parents of children in daycare. </li></ul>
    17. 17. Does CATCH Work? <ul><li>Reduced total fat and saturated fat content of school lunches. </li></ul><ul><li>Increased moderate-to-vigorous physical activity (MVPA) during P.E. classes. </li></ul><ul><li>Improved students’ self-reported eating and physical activity behaviors. </li></ul><ul><li>Effects persisted over three years without continued intervention. </li></ul><ul><li>CATCH reduced prevalence of obesity in El Paso trial </li></ul><ul><li>Luepker R, et al (1996). JAMA , 275 (10), 768-76. </li></ul><ul><li>Nader P , et al (1999). Arch Pediatr Adolesc Med , 153 (7), 695-704. </li></ul><ul><li>Coleman , et al. (2005). Arch Pediatri Adolesc Med </li></ul>
    18. 18. Moderate to Vigorous PA (Percent of Lesson Time) Healthy People 2010 Objective 1.9 Semester
    19. 19. CATCH Dietary Outcomes 3 Years Post-Intervention (8th Grade) Dietary Fat, % of Energy School Grade CATCH Source: Nader et al., 1999
    20. 20. El Paso CATCH replication. Risk of Overweight or Obesity in Girls ( > 85 th % BMI) * * Source: Coleman et al., 2005; * Significantly higher than 3 rd grade (baseline). 11%, 3 year effect size
    21. 21. Pass & CATCH improves Stanford math scores * * * Murray (UTSPH), unpublished At Risk : adaptability, social skills, leadership, study skills, functional communication
    22. 22. A Public Health Approach to Obesity Prevention Intervention Efficacy Public Health Impact!! Population Reach X
    23. 23. Diffusion of an Effective Program <ul><li>Advantages : Well studied, Approved by State Board of Education, Texas Department of Health, Texas Department of Agriculture. Endorsed by professional associations. </li></ul><ul><li>Compatibility : Most schools have PE and food service and health education requirements. CATCH meets CDC and State guidelines. Parents, teachers, and students like the program. </li></ul>
    24. 24. Diffusion of an Effective Program <ul><li>Complexity: CATCH modifies rather than replaces. </li></ul><ul><li>Trial ability : Program is not expensive (Start up expenses $2-5 per pupil). </li></ul><ul><li>Observeability: Visible environmental changes. Principal receives positive reinforcement; school health is apparent. Assist in accountability. </li></ul>
    25. 25. Percentage of PE class time 3 rd , 4 th , and 5 th grade students engaged in MVPA (n = ~103 class observations). Travis County CATCH Project. a, b b, c [a: p = .023; b: p = <.001; c: p = .001.] HP 2010 Goal
    26. 26. >2,000 Texas elementary schools Thousands nationally and worldwide 950,800 children; 33% of Texas students Dissemination of CATCH <ul><li>Other </li></ul><ul><li>Adopters: </li></ul><ul><ul><li>Dept of Def </li></ul></ul><ul><ul><li>Florida </li></ul></ul><ul><ul><li>California </li></ul></ul><ul><ul><li>Illinois </li></ul></ul><ul><ul><li>New York </li></ul></ul><ul><ul><li>New Mexico </li></ul></ul><ul><ul><li>Maine </li></ul></ul><ul><ul><li>Delaware </li></ul></ul><ul><ul><li>Kansas </li></ul></ul><ul><ul><li>New Jersey YMCA </li></ul></ul><ul><ul><li>Nat’l Parks & Rec </li></ul></ul>
    27. 28. Trends in Prevalence of Youth Overweight 1 United States Compared to Texas 1 Overweight is > 95th Percentile for BMI by Age/Sex Sources: Hoelscher et al., 2004; Ogden et al., 2006; SPAN, 2004-2005 HP 2010 Goal
    28. 29. Efficacy X Reach = Public Health Impact *Obesity is > 95th Percentile for BMI by Age/Sex 2000-2002 2004-2005 4th Grade Prevalence of Overweight* by Health Service Region, SPAN, 2000-2002 to 2004-2005
    29. 30. What Caused the Decrease in Overweight Among 4 th Graders in Regions 9 & 10? <ul><li>Paso del Norte Health Foundation </li></ul><ul><ul><li>CATCH initiative </li></ul></ul><ul><ul><ul><li>8 years </li></ul></ul></ul><ul><ul><ul><li>Resources, support </li></ul></ul></ul><ul><ul><li>Qué Sabrosa Vida </li></ul></ul><ul><ul><li>Walk El Paso </li></ul></ul><ul><li>Legislation </li></ul><ul><ul><li>Senate Bills 19, 42, 530 </li></ul></ul><ul><li>Other Policies </li></ul><ul><ul><li>Texas Public School Nutrition Policy </li></ul></ul>
    30. 31. CATCH Implementation Training <ul><li>Required school staff: Administration, classroom, PE, School Food Service </li></ul><ul><li>Focus on planning and teamwork </li></ul><ul><li>Brief review of program components </li></ul><ul><li>Individual component training </li></ul><ul><li>Follow-up visits </li></ul>
    31. 32. Determinants of CATCH Implementation Success <ul><li>Administrative support </li></ul><ul><ul><li>State Agencies (Education, Agriculture, Health) </li></ul></ul><ul><ul><li>School District Administration (PE, Nutrition, Health Education) </li></ul></ul><ul><ul><li>School Campus (Principal, Asst Principal) </li></ul></ul><ul><li>On-site CATCH Champion </li></ul><ul><ul><li>Physical Education, Nurse, School Food Service, Classroom teacher, Counselor </li></ul></ul><ul><li>Parent Teacher Organization </li></ul>
    32. 33. Taking it to Scale Implementation Costs <ul><li>Per school </li></ul><ul><ul><li>K-5 Curriculum: $635 </li></ul></ul><ul><ul><li>PE equipment: varies by # kids and inventory, $300-5,000 </li></ul></ul><ul><ul><li>In school marketing: $300 </li></ul></ul><ul><ul><li>After school: $195 </li></ul></ul><ul><ul><li>Training: varies by number of schools trained, $300-2,500 </li></ul></ul><ul><li>Per district </li></ul><ul><ul><li>Personnel: 1-4 coordinators/100 schools </li></ul></ul><ul><ul><li>Assuming district has PE, SFS, curriculum, SHAC </li></ul></ul><ul><li>Per state </li></ul><ul><ul><li>Regional coordinator (s) </li></ul></ul>
    33. 34. Summary <ul><li>Childhood obesity is a major public health problem </li></ul><ul><li>Causes (and solutions) will be multi-factorial </li></ul><ul><ul><li>Both societal level solutions (e.g., policy) and individual level solutions (e.g., prevention and treatment programs) will be necessary </li></ul></ul><ul><li>In Texas, we have seen reductions in child obesity due to a combination of policies, programs (CATCH), and community-based initiatives </li></ul><ul><ul><li>These efforts need to be maintained! </li></ul></ul>
    34. 35. State = 169 schools R10 = 10 schools R11 = 8 schools
    35. 36. Aim 1: Awareness SB19 Requirements (2005-2006) <ul><li> State R10 EP R11 BV </li></ul><ul><li>Physical Activity + CSHP* 96% 92% 100% </li></ul><ul><li>30 min day;135 min/week 97% 100% 100% </li></ul><ul><li>Required CSHP </li></ul><ul><ul><li>Health Education 88% 92% 100% </li></ul></ul><ul><ul><li>Physical Education 88% 92% 100% </li></ul></ul><ul><ul><li>School Food Service 84% 92% 100% </li></ul></ul><ul><ul><li>Family Involvement 59% 75% 88% </li></ul></ul><ul><li>Who Informed you </li></ul><ul><ul><li>School district 68% 75% 50% </li></ul></ul><ul><ul><li>Professional education 8% 8% 13% </li></ul></ul><ul><li>* CSHP: Coordinated School Health Program </li></ul><ul><li> </li></ul>
    36. 37. Aim 1: Action (2005-2006) <ul><li>PE Planning State R10 R11 </li></ul><ul><ul><ul><ul><ul><li> EP BV </li></ul></ul></ul></ul></ul><ul><ul><li>District issued PE policy stmt 69% 58% 63% </li></ul></ul><ul><ul><li>PE in Campus Improvement Plan 40% 42% 38% </li></ul></ul><ul><ul><li>HE in Campus Improvement Plan 27% 42% 25% </li></ul></ul><ul><li>Required district SHAC* </li></ul><ul><ul><li>Aware SHAC Requirement 49% 75% 75% </li></ul></ul><ul><ul><li>District have SHAC? 33% 58% 38% </li></ul></ul><ul><ul><li>School have SHA committee? 33% 83% 88% </li></ul></ul><ul><li>* SHAC: School Health Advisory Council </li></ul>
    37. 38. Reported PE and Recess Min per Week 135 min per week PE days - log 4.83 4.41 PE days – child 4.23 3.46 Recess days – log 4.16 1.18 R10-R11 = 82 min/week
    38. 39. Direct Observation of PE Class (SOFIT; n = 19 schools) HP 2010 objective MVPA = % of PE class time where students are engaged in movement to vigorous physical activity
    39. 40. Health Education (2005-2006) <ul><li>Program Adoption State R10 R11 </li></ul><ul><ul><ul><ul><ul><li> EP BV </li></ul></ul></ul></ul></ul><ul><ul><li>Any Program 57% 100% 75% </li></ul></ul><ul><ul><li>Unsure 64% 0% 12% </li></ul></ul><ul><li>Among adopters, what program </li></ul><ul><ul><li>CATCH 75% 91.7% 75% </li></ul></ul><ul><ul><li>Great Body Shop 16.7% 8.3% 0% </li></ul></ul><ul><ul><li>Health and Wise 7.3% 0% 0% </li></ul></ul><ul><ul><li>Bienestar 7.3% 0% 0% </li></ul></ul><ul><ul><li>Other 3.1% 8.3% 0% </li></ul></ul>
    40. 41. Trends in Prevalence of Youth Overweight 1 United States Compared to Texas 1 Overweight is > 95th Percentile for BMI by Age/Sex Sources: Hoelscher et al., SPAN, 2004-2005 HP 2010 Goal
    41. 42. Change in Prevalence of Overweight Among Texas Health Service Regions, SPAN, 2000-2002 to 2004-2005, 4 th Grade *Statistically significant difference (CI do not overlap) HSR 2000-2002 CI 2004-2005 CI 1 20.0 17.0-23.3 23.0 18.6-28.0 2-3 21.1 17.0-25.8 20.9 19.4-22.5 4-5N 21.3 18.9-23.9 20.6 18.0-23.6 6-5S 28.5 18.8-40.6 22.6 13.8-34.7 7 23.3 20.2-26.6 23.5 19.5-28.0 8 30.3 24.9-36.3 28.7 24.0-34.0 9-10* 25.8 23.5-28.3 18.8 15.1-23.3 11 25.8 21.8-30.3 30.6 26.8-34.7
    42. 43. Average BMI
    43. 44. Why the difference? <ul><li>Higher PE time in EP: 14-22 min/week </li></ul><ul><li>Higher PE time in EP: 60 min/week </li></ul><ul><li>Higher MVPA: 10% </li></ul><ul><li>Higher adoption CSHP: 25% </li></ul><ul><li>Higher district central planning: 20% </li></ul><ul><li>5 year, 10 million investment by Paso del Norte Health Foundation; CATCH funding ended in 2005 </li></ul>

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