of diseases, including diabetes, cardiovascular disease, and cancer. Diabetes-related deaths climbed every year between 1996 and 2000 while overall …
JOINT INFORMATIONAL HEARING
ASSEMBLY COMMITTEE ON HEALTH
ASSEMBLY COMMITTEE ON EDUCATION
ASSEMBLY COMMITTEE ON HOUSING AND COMMUNITY DEVELOPMENT
Tackling the Childhood Obesity Epidemic
February 8, 2005
1:30 pm
State Capitol, Room 4202
This hearing will examine a range of strategies and model programs to
address the epidemic of childhood obesity in California through schools,
health providers, and communities
Background
According to the federal Health and Human Services Department, 64 of
Americans approximately 1296 million people are overweight or obese
Obesity is considered a risk factor for a number of diseases, including
diabetes, cardiovascular disease, and cancer The Center for Disease
Control and Prevention CDC released a study in 2004 that found that
obesity and smoking contributed to the largest number of preventable death
in the United States The difference in the two, however, is that obesity
is rising in numbers According to the study, poor diet and
inactivity
caused 15 of deaths approximately 365,000 people in the United States in
2000 Results from the 1999-2002 National Health and Nutrition Examination
Survey NHANES indicate that 16 of children and adolescents ages six to 9
years are overweight This represents a 45 increase from the overweight
estimates obtained from NHANES III 1988-94 According to a national
study of costs attributed to being overweight and obesity, medical expenses
accounted for 91 of total US medical expenditures in 1998 and may have
reached as high as 785 billion 926 billion in 2002 dollars Obesity
and being overweight are chronic conditions, and result from a variety of
factors including behavior, environment, and genetics The two factors
that play the largest roles in obesity are behavior and environment, which
are also considered the best areas for prevention and treatment
According to the California Center for Public Health Advocacy CCPHA, the
numbers of overweight and inactive children have reached an all-time high
in California CCPHA found that statewide, approximately 27 of children
are overweight and 40 are unfit They reported that legislative districts
that have higher diabetes-related
death rates also tend to have a higher
prevalence of overweight and unfit children Diabetes-related deaths
climbed every year between 1996 and 2000 while overall mortality in the
state declined over the last decade Researchers and the medical community
agree that this may be an indication of the long-term effects of growing
rates of obesity In 2002, the Select Committee on California Childrens
School Readiness and Health held a series of hearings where it was reported
that healthy children attend school more regularly; and students
absenteeism rates appear to have a direct correlation to their academic
performance Additionally, the Select Committee found that active, well-
nourished children are more likely to attend school and be more prepared
and motivated to learn There are several areas that present opportunities
for addressing obesity in Californias children This hearing will focus
on three: school-based and after-school programs; health providers; and
communities
School and After-School Programs
Children benefit from moderate physical activity on most, if not all, days
of the week According to the CDC, children should have between 15 to 45
minutes of physical activity
per day depending on the intensity
Increasing the frequency, intensity, and time of the activity in a measured
way can bring more health benefits
California law requires schools to provide students with physical education
for 200 minutes every ten school days in grades one through six and for 400
minutes every ten school days in grades seven through 12 A study
published by RAND in September 2004 found that expanding physical education
programs in schools, in the form in which they currently exist, may be an
effective intervention for combating obesity in the early years, especially
among girls However, due to an increased emphasis on core academic work
and financial constraints, these requirements are not enforced and many
schools do not meet them, especially in urban and low-income communities
Schools that do offer physical education classes do not necessarily teach
fitness-building skills that children can integrate easily into everyday
life and take into adulthood For instance, many schools still use team
sports such as football or baseball as a core component of their physical
education programs These types of sports are more difficult for children
to duplicate outside of
school, as they require large numbers of children
to play School programs that offer more diverse curriculum for students,
such as biking, skating, swimming, and running offer children more options
to be active on their own
In those cases where limited resources prohibit schools from offering
physical education classes, after-school programs and/or park and
recreation centers are often the only source for physical activity
According to a 2000 CDC report, less then 10 of elementary, junior high,
middle and high schools surveyed nationwide provided daily physical
education In terms of other overall health indicators, low-income
communities have higher percentages of uninsured individuals and greater
health disparity gaps According to a 2002 Public Health Institute report,
low-income communities, and especially Latino children, are most at risk
for being overweight Physical activity needs are of particular concern to
low-income communities where options for affordable programs and
competitive leagues are extremely limited
Health Provider Role
The dramatic increase in the prevalence of childhood obesity and the fact
that it is associated with significant health risks prompted the
American
Academy of Pediatrics AAP to develop a number of policy statements on
childhood obesity prevention efforts In 2003, the AAP proposed strategies
for the prevention and early identification of overweight and obese
children The AAP recommended that, as part of their health supervision,
pediatricians take a well-rounded approach to prevention, including:
Identifying and tracking patients at risk by virtue of family history,
birth weight, or socioeconomic, ethnic, cultural, or environmental
factors
Calculating and plotting body mass index BMI once a year in all
children and using changes in BMI to identify rate of excessive weight
gain relative to linear growth
Encouraging parents and caregivers to promote healthy eating patterns
by offering nutritious snacks, encouraging childrens autonomy in self-
regulation of food intake, and modeling healthy food choices
Promoting physical activity, including unstructured play at home, in
school, in child care settings, and throughout the community
Recommending limiting television and video time to a maximum of two
hours per day
For the treatment of obese children,
the AAP recommends that children with
a BMI greater than or equal to the 85th percentile with complications of
obesity or with a BMI greater than or equal to the 95th percentile with or
without complications undergo evaluation and possible treatment The AAP
states that the primary goal of obesity therapy should be healthy eating
and activity, and that treatment should begin early, involve the family,
and institute permanent changes in a stepwise manner Key to the AAP
recommendations is that parent involvement is the foundation for successful
intervention that puts in place gradual, targeted increases in activity and
reductions in high-fat, high-calorie foods They recommend that health
care providers offer ongoing support for families after the weight-
management program is initiated to help families maintain new behaviors
Recent studies show that multidisciplinary, chronic care models enable
patients with diabetes to modify their diet and that a similar model may be
successful for managing childhood obesity The chronic care model puts the
family in charge of making permanent behavior changes in their lives,
instead of short-term diets or exercise programs for rapid weight
loss
Key principles of the model include:
The family must be ready for change and all family members and
caregivers are involved
The role of the health-care provider is to help the family make small,
gradual changes
Health care should be provided by a multidisciplinary team composed of
dietitians, psychiatrists, social workers, health educators, and
exercise scientists
The health care provider should give support by scheduling frequent
visits at a time convenient for the family
Community Design
Through the first quarter of the last century, the United States developed
in the form of compact, mixed-use neighborhoods The pattern began to
change with the emergence of modern architecture and zoning and a rise in
the numbers of automobiles After World War II, a new system of
development was implemented, replacing neighborhoods with a separation of
uses known as conventional suburban development Conventional zoning
separates residential, retail, commercial, and industrial development into
areas away from each other and hinders mixed-use development
A study published in the American Journal of Health Promotion in 2003 found
that
people living in counties marked by sprawling development are
likely to walk less and weigh more than people who live in less sprawling
counties The study concluded that people living in the most sprawling
areas weigh six pounds more than people in the most compact counties and
that there was a direct relationship between sprawl and high blood
pressure According to the US Department of Transportation, between 1975
and 1995, the average adult took 42 fewer trips on foot and walking trips
for children dropped by 37 The distance from a persons home to work and
other daily destinations, the safety of communities and roads for
pedestrians and bicyclists, the availability of facilities for physical
activity, and the time spent commuting in cars all contribute to how often
a person partakes in physical activity
Several studies have shown that when a community is built to encourage
physical activity, people use it in that way Three major components to
incorporating physical activity and community design are mixed-use
development, placing residential, retail, office, and school facilities in
close proximity; encouraging multi-modal transportation public transit,
walking, and biking;
and safe routes to schools bicycle and pedestrian
safety projects There are numerous model walkable communities that
allow residents to incorporate activity into daily tasks by safely walking
to school, workplaces, recreational facilities, retail and commercial
centers, and mass transit New Urbanism is a community design model that
was developed partly in response to urban sprawl, and is meant to create
human-scale, walkable communities The model takes a wide variety of
approaches, including infill projects development projects on existing
urban city/neighborhood lots, transit-oriented development, and the
transformation of suburbs At the heart of the New Urbanism approach are
specific design requirements, such as:
Creating a discernible center to the neighborhood either a square,
green or transit stop with most dwellings within a five minute walk
of the center;
Locating schools so that children can walk to them; and
Designing relatively narrow streets that are lined by trees to slow
traffic and encourage pedestrian and bicycle use
Conclusion
In the simplest terms, the cause of obesity at any age is easy to explain:
there is an imbalance
between the amount of energy food consumed compared
to the amount of energy expended through physical activity The American
diet has changed, with high-calorie and high-fat foods eaten as a major
part of the typical meal At the same time, Americans have become much
more sedentary These simple changes in lifestyle have led to an epidemic
that threatens the health of our children and has great costs for our
communities Although the cause of the epidemic may be simple, addressing
the problem may not be so straightforward A number of factors contribute
to a childs ability or inability to eat well and exercise regularly, such
as socio-economic status, cultural and linguistic factors, and the
financial state of a childs school and community There are a number of
pathways to approach this problem and reduce the prevalence and costs of
the diseases related to obesity Change in behavior comes as a result of a
number of groups working together Schools, parents, communities, health
providers, and policymakers should all take an active role in promoting
healthy eating and living for Californias children
