Next Steps in Childhood Obesity Work Dianne S. Ward, Director Children’s Healthy Weight Research Group
Some things are working October, 2019 : Robert Wood Johnson Foundation
Changes in Obesity/Overweight Among Children in WIC The national obesity rate among 2- to 4-year-olds who participate in WIC declined significantly, from 15.9% in 2010 to 13.9% in 2016. This marked the second consecutive survey period(jamanetwork.com) in which obesity rates declined in this age group, and the decline was statistically significant across all racial and ethnic groups surveyed. .
Refocus on Behavior Healthy Eating and Regular Physical Activity
Broaden Obesity to CV Health
Behavioral Priority Areas 1. Smoking: Low rates of smoking:10.8% (YRBSS); new threat – e-cigarettes 2. Healthy Diet: 1.0 % US children have idea diet score; 91%-poor; consistent finding 3. Physical Activity: 20% children meet PA guidelines 4. BMI: Obesity rates: 17% overall For non-Hispanic whites, 17.5 percent of males and 14.7 percent of females. For non-Hispanic blacks, 22.6 percent of males and 24.8 percent of females. For Mexican Americans, 28.9 percent of males and 18.6 percent of females.
BMI Related to Both Diet and Physical Activity
Healthy Eating Research Brief, 2016 National Physical Activity Plan, 2016
Feeding Infants and Toddlers Study, 2016
Intervention Targets & Settings TARGETS SETTINGS Child Teachers or caregivers Parents and/or other family members Policies and environment o Early care and education (formal & informal) Administrators: center directors, principals, park directors Staff: teachers, aides, cooks, leaders Public policies o School (public & private) o Afterschool
Ages and Stages of CVH Development Conception & Gestation K-Grade 2 (5y-8y) Infant (birth – 12 mo) Grades 3-5 (8y-11y) Toddler (13 mo-36 mo) Middle school/Junior High: 11y-14y Preschool (3y -5y) High school: 14y-18 y
Early Years: birth to age 5 61 % (12.5 million) of children 5 are in some kind of regular child care arrangement 1.5 million in family child care home (FCCH) Quality infant/toddler care is limited and expensive but may be the best place to focus our efforts However, a large number of children in non-licensed care (relative, neighbor, faith-based) Adverse childhood experience (ACE) has serious negative consequences; may need trauma-informed care
ECE Intervention Targets
What is Needed? ECE-Based Intervention Research for CVH
Improve Interventions Develop multi-level interventions (e.g., individual, interpersonal, & organizational) Consider newer approaches ( e.g., social marketing; consumer informatics) Measure intervention fidelity (i.e., did the intervention fail or the implementation?) Be aware of potential for stigma (especially related to weight-related outcomes) Remember the equity lens and do not increase health disparities
Design for Implementation “Start with the end in mind”¹; interventions must consider how knowledge translation will occur Must engage community partners PRIOR to developing or implementing interventions and THROUGHOUT process Policy and environmental studies needed Evaluate cost-effectiveness Implementation and dissemination research ¹ Klesges L. et al. Beginning with the application in mind: designing and planning health behavior. Annals Beh Med, 2005
Unpack Black Box of Intervention
Use a Systems Approach Develop multi-setting interventions (e.g., school & home; ECE & clinical) ECE organizational interventions that leverage systems (e.g., licensing, QIRS) Whole of (ECE) school research - Must have integration of education and health - Fit into institutional priorities (e.g., educational outcomes) - Create expectation and demand for healthy environments where kids live and “work” (i.e., school) - Exposure to healthy food/eating environments with regular PA opportunities - Consider both quality and quantity of foods and physical activity
Improved Research Design Studies that test intervention components (effect size) for MOST-based trials (fractional factorial); may need diff. funding mechanism Test for the intervention’s “active ingredient” (“special sauce”) Use alternative designs, such a SMART or SMART with adaptive randomization, when response heterogeneity is expected Rigorous analytical approaches that include repeated measures for longer follow-ups, control for confounding, and test effect modification and heterogeneity Use cluster-randomized trials, individually randomized group trials, stepped wedge designs, or regression discontinuity designs (from Vulnerable Population workshop)
Improved Research Designs Increase power through larger enrollments and longer intervention periods Require measurement and reporting of process evaluation data Rigorous analytical approaches that include repeated measures for longer follow-ups, control for confounding, and test effect modification and heterogeneity Power where possible to test for subgroup analysis (including boys vs. girls, race/ethnicity, age) Need rigorous, comprehensive systematic reviews that assess several outcomes, report strength of evidence, & risk profile of participants
Coming soon Federal and state elections which could signal renewed interest in ECE (e.g., universal pre-K)2020 US Dietary Guidelines to include infants Increased use of funding from the Child Care Block Grant to addressing improvements in ECE environments (see model in Nebraska) Models of collaborations among child care and public health groups to address children’s healthy weight (e.g., work in DPH in NC; Better Together project in 3 states (MS, AZ, AK) Need to define “physical activity quality” (not just quantity) Address staff health as important to child and family health Role of social-emotional health for children, families & providers
Stay with it. Kids need us.
References Skinner AC, Perrin, EM, Skelton JA. Prevalence of obesity and severe obesity in US children, 1999‐2014. Obesity, 2016 May;24(5):1116-23. Wang et al. What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obes Rev, 2015 Langford et al. Obesity prevention and the Health Promoting Schools framework: essential components and barriers to success. IJBNPA, 2015 Stevens, Pratt, Boyington et al. Multilevel Interventions Targeting Obesity: Research Recommendations for Vulnerable Populations. Am J Prev Med. 2017 Ward et al. Strength of obesity prevention interventions in early care and education settings: A systematic review. Prev Med. 2017 Sission et al., Obesity prevention and obesogenic behavior interventions in child care: A systematic review. Prev Med, 2016. Khambalia et al. A synthesis of existing systematic reviews and meta-analyses of school-based behavioural interventions for controlling and preventing obesity. Obes Rev., 2011 Salter & Kothari. Using realist evaluation to open the black box of knowledge translation: a state-of-the-art review. Implement Sci. 2014. Straus et al. Defining knowledge translation. Canadian Medical Ass J, 2009. Reynolds et al. Spectrum of Opportunity. ducation/pdf/TheSpectrumofOpportunitiesFramework May2018 508.pdf
Dianne S. Ward Children’s Healthy Weight Research Group @DianneSWard firstname.lastname@example.org www.gonapsacc.org Friend us on Facebook! Follow us on Twitter! @GoNAPSACC https://www.facebook.com/GoNAPSACC
Prevalence of obesity and severe obesity in US children, 1999‐2014. Obesity, 2016 May;24(5):1116-23. Wang et al. What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obes Rev, 2015 Langford et al. Obesity prevention and the Health Promoting Schools framework: essential components and barriers to .
A glossary of terms relevant to childhood obesity. A list of acronyms relevant to early childhood obesity. North Carolina Taking Steps to Address Childhood Obesity, a recent press release from the NC Department of Health and Human Services. An annotated bibliography of research studies related to childhood obesity with an
of early childhood obesity. The report includes the following briefs: Brief 1 summarizes research on the growing problem of childhood obesity and early childhood obesity in particular. The brief summarizes key causes and consequences of the problem. Brief 2 focuses on the problem of childhood obesity in North Carolina with a focus on
Childhood Obesity Childhood obesity has both immediate and long-term effects on health and well-being. The increas-ing number of children who are obese has led federal policymakers to rank childhood obesity as a critical health threat. Multiple approaches are necessary to address the challenge of childhood obesity, and health profes-
1.1 Childhood obesity 13 1.2 Key global strategies related to obesity prevention 13 1.3 WHO Forum and Technical Meeting on Population-based Prevention Strategies for Childhood Obesity 15 1.4 Purpose and structure of the document 15 Guiding principles for the development of a population-based childhood obesity prevention strategy 16
rapid increase in the child obesity among children ages 2 to 19. It is also important to highlight that as the childhood obesity is increased to 18.5%, the obesity among adults also increased to an alarming percentage of 39.6%. The family and the environmental factors are the key factors that are contributing in the childhood obesity.
that obesity and extreme obesity rates have declined among low-income preschool children. If the current trends in childhood obesity can be reversed, children will have greater opportunities for healthier lives with better results. This document examines childhood obesity in Pennsylvania and efforts made by stakeholders, such as philanthropists,
4 INDI Submission to the Joint Oireachtas Committee on Children and Youth Affairs on Tackling Childhood Obesity. May 2018. CHILDHOOD OBESITY: NATIONAL AND INTERNATIONAL POLICY AND GUIDANCE Such is the extent of the global problem of childhood obesity, researchers and experts around the world have issued guidance on its prevention and management.
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