Com m unities Role in Childhood Obesity Prevention: Nutrition and - PowerPoint PPT Presentation

Com m unities’ Role in Childhood Obesity Prevention: Nutrition and Physical Activity Lorrene Ritchie, PhD, RD Biennial Childhood Obesity Conference July 17, 2019

2 Nutrition and Physical Activity Outcom es Medium -Term Outcom es Medium -Term Outcom es • Click to edit Master text styles Nutrition • fruits & vegetables – Second level • added sugar Long- • whole grains • sugary drinks Predictor • fiber Term • energy-dense • Third level • lower-fat milk foods Outcom e • breakfast • fast food Community • dinner with family – Fourth level • eating with TV Programs & BMI » Fifth level Policies Physical Activity • Total PA • Moderate-to-vigorous PA • Neighborhood attributes Ritchie et al. Am J Prev Med 2015;49:647-652. Pate et al. Am J Prev Med 2015;49:653-659.

Nutrition

4 Nutrition: HCS vs Nationally HCS National Recom m ended Total added sugar 19.0 18.5 < 10 tsp/ day • Click to edit Master text styles Sugar from SSBs 7.0 7.0 ~ 0 tsp/ day – Second level Energy-dense foods 2.0 1.3 Minimal times/ day • Fruit & vegetables 2.5 2.1 2.5 - 5.5 cup/ day Third level Whole grains 0.7 0.7 2.5 - 4 oz/ day – Fourth level Fiber 15.5 14.1 25 – 38 g/ day » Fifth level Usually 1% / non-fat milk 26.8 30.9 ~ 100% Breakfast 6.2 4.4 ~ 7 days/ week Fast food restaurant 1.0 1.7 < 1 days/ week Dinner with family 5.0 5.1 ~ 7 days/ week Eating with TV 39.2 39.5 ~ 0%

5 Characteristics of Com m unity Efforts DOSE HOW W HAT • More I ntense More Strategies More Behaviors Click to edit Master text styles – • Duration longer Second level • I nform ation • Fruit & vegetables • W hole grains • Third level • Reach more children • Services • Sugary drinks • W ater – Fourth level • Energy-dense • Strategy more policy, • Access systems, or snacks/ sw eets » Fifth level environmental • Fat • Consequences • Calories • Breakfast • Policy/ system s • Fast food

W hat and How are Com m unities Engaged 6 W HAT HOW Behavior Environm ental Strategy • Click to edit Master text styles • ↑ Availability of healthier (49% ) • Fruit & vegetables (69% ) – Second level • Energy-dense snacks/ sweets (44% ) • ↓ Availability of less healthy (20% ) • Third level • Whole grains (40% ) • ↑ Affordability of healthier (7% ) – • Sugary drinks (39% ) Fourth level • ↑ Procurement from local farms (6% ) • Water (32% ) » Fifth level • ↓ Portion sizes (2% ) • Fat (29% ) • ↓ Advertisement of less healthy (1% ) • Fast food (27% ) • ↑ Supermarkets/ food retail (1% ) • Breakfast (21% ) • Calories (18% ) Webb et al. Pediatr Obes 2018 ;13 Suppl 1:103-112.

Associations of Com m unity Efforts over 7 Past 6 years w ith Nutrition Outcom es More Strategies & More I ntense: More Behaviors & Restricting • Higher Reach, Targeting Less Click to edit Master text styles Availability of Less Duration, Strength Healthy Healthy – Second level • ↑ lower-fat milk • ↓ added sugar ↑ fruit/ vegetables • • Third level • ↓ sugary drinks ↑ fiber • – Fourth level • ↓ energy-dense » Fifth level Ritchie et al. Pediatr Obes 2018;13 Suppl 1:14-26. Webb et al. Pediatr Obes 2018;13 Suppl 1:103-112.

Lessons Learned on Nutrition 8 • Appears to take several years of sustained efforts for • Click to edit Master text styles communities to reap benefits: no quick fix – Second level • Different features of community efforts are important; • Third level there is no “single” or “simple” solution – Fourth level • Increase intensity: broader reach, longer duration, multiple strategy » Fifth level • More effort needed to change some behaviors, such as eating from a fast food restaurant, eating dinner with family, and eating while watching TV

Lessons Learned on Nutrition 9 • Simultaneously target multiple behaviors: don’t just • Click to edit Master text styles focus on promoting more fruit, vegetables and whole grain – also limit less healthy options such as sugary – Second level drinks, sweets and fast food • Third level • Giving information and enhancing skills should – Fourth level accompany change to food environments » Fifth level • Environment changes that show promise: restricting the availability of unhealthy foods, and reducing portion sizes

Place Matters 10 10 W HAT HOW • Click to edit Master text styles ( behavior) ( strategy) – Second level More Healthy Less Healthy More Healthy Less Healthy • Third level – • • • Fourth level South West Northeast • South » • Fifth level West • Rural • Higher-income • Low-income • High Hispanic • High African American Woodward-Lopez et al. Community characteristics modify the relationship between obesity prevention efforts and dietary outcomes in children in the Healthy Communities Study. Ped Ob (i i )

Lessons Learned on Nutrition 11 11 Different considerations may be needed for • Click to edit Master text styles childhood obesity prevention efforts – Second level • • Third level Particularly in southern U.S. and rural communities – Fourth level » Fifth level • To a lesser extent, depending on community income and race/ ethnicity

Physical Activity

13 13 Less PA in Girls, especially as Get Older • Click to edit Master text styles – Second level MVPA in • Third level past 7 days – Fourth level » Fifth level Age (years)

Associations of Com m unity Efforts over 14 14 Past 6 years w ith Physical Activity • An index reflecting the 6-year history of the number of • behavior change strategies used was positively associated with Click to edit Master text styles children’s moderate-to-vigorous physical activity – Second level • Third level • This association was attenuated with adjustment for demographic factors – Fourth level » Fifth level • Moderation analyses found that the association was positive among non-Hispanic, but not Hispanic, children Ritchie et al.. Pediatr Obes 2018;13 Suppl 1:14-26

15 15 Neighborhood Attributes in Relation to PA Street Segment Near Child’s Home (Windshield Survey) • Click to edit Master text styles – Second level • Burned, boarded up, or abandoned residential units • Third level • Litter – • Quality and condition of residential units Fourth level » • Busy thoroughfare Fifth level • Side street/cul-de-sac/dead end/one-way • Sidewalks

16 16 Neighborhood Attributes in relation to PA Youth with no litter on their street reported • Click to edit Master text styles significantly lower neighborhood-based PA – Second level • Third level – Fourth level Youth living on a side street, cul-de-sac, dead-end, » Fifth level or one-way street reported greater neighborhood- based PA

Lessons Learned on Physical Activity 17 17 Community programs and policies to promote physical • Click to edit Master text styles activity in children may be more successful if they are – Second level sustained for several years and employ multiple • Third level behavior change strategies – Fourth level Specific street quality attributes are associated with » Fifth level physical activity in youth

18 18 Strengths & Lim itations • Range of nutrition and physical activity measures + • Click to edit Master text styles • First study to characterize naturally occurring – community efforts in relation to child nutrition and Second level physical activity outcomes • Third level – Fourth level » Fifth level - • Large number of comparisons • Self-report of child nutrition and physical activity

Thank you! For more info: Lritchie@ucanr.edu