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Healthy Eating and Obesity
Prevention
Healthy Eating Focus Area Process
Develop
statement of
the issue
• Local data
• Expert input
• Best practices
Determine what
is known through
scientific literature;
Quantify the issue
Develop key
messages and
recommendations
Adapted from “EvidenceBased Decision Making in
Public Health, Public Health
Management Practice, 1999.
Evaluate
program or
policy
Develop
action plan
Health Eating Data Within the
Social-Ecological Framework
Abundant fast food restaurants
Vending
machines
in schools
Individual
Behavior: e.g.
Fruit/veg intake;
Portion size;
Breastfeeding
Lack of
local
grocery
stores
Breastfeeding and Obesity Prevention


Breastfeeding is linked to decreased
risk of obesity, possibly due to
physiologic factors in human milk,
feeding and parenting patterns
associated with nursing.*
Breastfed infants are leaner at 1
year compared to formula-fed
counterparts. Early growth pattern
may influence later growth.**
•Prevention of Pediatric Overweight and Obesity, Policy Statement, American Academy of Pediatrics, Vol. 112, No. 2, Aug. 2003, pp. 424-430.
www.aap.org/policy/s100029.html.
•Breastfeeding: HHS Blueprint for Action on Breastfeeding, Dept. of HHS, Office of Women’s Health, 2000.
Other Individual Behavior Trends
Portion sizes increasing
 TV watching (especially
by children) increasing
 “Convenience foods”
more available in
supermarkets
 Less cooking at home

The “Obesogenic” Environment
or ‘Supply Side of Consumption’
in Washtenaw County
The ‘Obesogenic’ Society
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Hunter/gatherers ate 75% nuts, vegs, fruits; 25% lean game
We eat 17% fruits, vegs; 28% fatty meats; 55% carbos, sugars, etc
We would need to slow jog for 6-8 miles every day to exercise as
hunter/gatherers
Cheap, fast, low nutrition, high fat foods
Convenient stores
‘Drive-Throughs’ – not much ‘healthy’ food eaten in the car?
Perception of increased preparation time for fresh fruits and
vegetables
Decreased time available – e.g. Americans working more hours,
more single parent homes, etc.
The ‘Obesogenic’ Society
Linkages between exposure to grocery stores and
restaurants and overweight have not been firmly
established – but they’re coming…
 Sensible, but need to be creative about interventions and
approaches, evaluate well
 Anxious to examine Community Prevention Guide
recommendations regarding environmental approaches
regarding overweight and healthy eating

Relevant Research
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Lower prevalence of supermarkets and higher prevalence of
independently owned grocery stores in low-wealth neighborhoods
and greater proportion of households without access to private
transportation*
Fruit and vegetable intake increases significantly for each
additional supermarket in census tract**
Forty percent of American food budget spent on fast foods***
Low income communities have significantly fewer supermarkets
per capita than similar communities****
*Morland, K. et.al. “Neighborhood characteristics associated with the location of food stores and food service places.” AJPM.2002;22:23-29.
**Morland, K., et.al.“The Contextual Effect of the Local Food Environment on Residents’ Diets: The Atherosclerosis Risk in Communities Study.” AJPH. 2002;92:1761-1767.
***Dietz, W. “Obesity in Children” UM-SPH Presentation…
****Philadelphia Food Trust
*****University of California Cooperative Extension. July 2002
School Environment Trends

Local data based on Physical Activity and Healthy
Eating Asset Survey, April 2003
Questions based on CDC’s School Health Index for
Physical Activity & Healthy Eating
 53 of 114 schools in WC returned a survey (46%
response rate)

School Environment Trends
Junk food accessibility
Nationally
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26.3% elementary, 62% Middle/JRHS, 94.9% HS (2001) students
have access to vending machines at school
26.8% elementary, 39.4% Middle/JRHS, 59.3% HS have school
store, canteen or snack bar
Washtenaw County
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18% of elementary schools, 25% of middle schools, and 69% of
high schools allow the sale of junk foods at school
29% of schools have policies regarding availability of low fat
foods in school
School Environment Trends
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Curriculum
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Locally, only 14% of schools teach all 18 healthy
eating curriculum topics recommended by the School
Health Index
Milk Consumption
Nationally, student milk consumption has decreased
40% since 1977
 Locally, 91% of schools offer either low-fat or skim
milk in their school meals

ounces per day
Teens’ Consumption of Milk and Non-diet Soft
Drinks (ages 12-19)
20
18
16
14
12
10
8
6
4
2
0
Milk
Soft Drinks
Boys
Boys
Girls
Girls
1977-78 1994-96 1977-78 1994-96
Teens’ Consumption of Milk and Non-diet
Soft Drinks (ages 12-19)
ounces per day
20
Teens average 1 glass
18 milk per day
16
14
12
10
8
6
4
2 boys
90% girls, 70%
fail to meet
0 daily
calcium recommendation
Boys
Milk
Drinks
Teens drink 2X asSoft
much
soda as milk, providing
many with 15-20%
of their calories
Boys
Girls
Girls
1977-78 1994-96 1977-78 1994-96
Common Messages Across
Populations (1)
Prepare more meals at home – more
cooking.
 Focus on what we are drinking
(sweetened beverages). Define what is
a healthy beverage.
 Promote community and school gardens

Common Messages Across
Populations (2)
Increase fiber intake; more fruits and
vegetables; support plant-based diet
 Cut unnecessary sugar and fat
 Define “healthy snacking” & replace junk
food snacking with healthy snacking
 Good dine out/fast food options
 Portion size *
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Nutrition, Physical Activity, and
Obesity Prevention Program
Kim Bandelier, MPH, RD/LD
Program Coordinator
Program Staff
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Kim Bandelier, MPH, RD/LD
 Lesli Biediger, MPH, RD
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Kristy Hansen, M.Ed., CHES
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Physical Activity Coordinator
Brett Spencer
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Chronic Disease Nutrition Consultant
Partnership Coordinator
8 Regional Nutritionists
Funding
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CDC Cooperative Agreement
(~$450,000)
State Nutrition and Physical Activity
Programs to Prevent Obesity and Related
Chronic Diseases
 5 year award, currently starting year 3
 Capacity building level
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State general revenue (~$800,000)
Required Focus Areas
Caloric Balance
Nutrition
Breastfeeding
Fruits and
Vegetables
Physical Activity
Reduced TV
Strategic Plan for the Prevention
of Obesity in Texas

Originally released in 2003
 Currently revising to include
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All age groups
5-year goals
Breastfeeding and reducing TV viewing
Specific strategies for communities
Final will be released on April 24, 2006 at
Texas Public Health Association convention
Demonstration Communities
Project
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In 2004, 2 communities chosen
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Corpus Christi (urban) & Ft. Stockton (rural)
Collected baseline data
 Conducted visioning workshops and
stakeholder interviews
 Completed strategic/action planning
process
 Currently implementing interventions
 UT-Austin manages project
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Corpus Christi, TX

CCAPWell (Coordinated Community
Approach to Wellness) coalition

2005 Summer Scorecard Program
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~300 children
IN MOTION End of Summer Celebration
 Next interventions will be worksite wellness
and breastfeeding promotion
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Ft. Stockton, TX
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Ft. Stockton Lifestyle Coalition
Hosted Family Play-Day on June 18, 2005
 Conducted worksite wellness pilot in Ft.
Stockton ISD
 Future plans include continuing worksite
wellness with FISD, website development,
and expanding physical activity programs
for teens
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Model for Dissemination
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Skill-Building Workshops
Teaching communities skills needed to
promote nutrition and physical activity
through a community coalition or
collaborative
 Using lessons learned from demonstration
communities
 Regional Nutritionist hosting workshops for
interested but not organized or newly
organized community coalitions
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Skill-Building Workshops
3 Pilot workshops conducted in 2004
 5 workshops conducted in 2005
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Partnership between NUPAOP and Goal A
of the Texas Strategic Health Partnership
 14 communities, 110+ attendees
 3 new coalitions formed
 2 existing coalitions trained
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Future of Program
Increase CDC funding from Capacity
Building to Basic Implementation