communities’ role in childhood obesity prevention: nutrition and … · 2019-07-30 · obesity...

Communities’ Role in Childhood Obesity Prevention: Nutrition and Physical Activity

Lorrene Ritchie, PhD, RDBiennial Childhood Obesity ConferenceJuly 17, 2019

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Ritchie et al. Am J Prev Med 2015;49:647-652.Pate et al. Am J Prev Med 2015;49:653-659.

Nutrition and Physical Activity Outcomes

Predictor

Community Programs &

Policies

Long-Term

Outcome

BMI

Medium-Term OutcomesMedium-Term Outcomes

Nutrition• added sugar• sugary drinks• energy-dense

foods• fast food• eating with TV

• fruits & vegetables• whole grains• fiber• lower-fat milk• breakfast• dinner with family

Physical Activity• Total PA• Moderate-to-vigorous PA• Neighborhood attributes

Nutrition


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HCS National RecommendedTotal added sugar 19.0 18.5 <10 tsp/daySugar from SSBs 7.0 7.0 ~0 tsp/dayEnergy-dense foods 2.0 1.3 Minimal times/dayFruit & vegetables 2.5 2.1 2.5 - 5.5 cup/dayWhole grains 0.7 0.7 2.5 - 4 oz/dayFiber 15.5 14.1 25 – 38 g/dayUsually 1%/non-fat milk 26.8 30.9 ~100%Breakfast 6.2 4.4 ~7 days/weekFast food restaurant 1.0 1.7 <1 days/weekDinner with family 5.0 5.1 ~7 days/weekEating with TV 39.2 39.5 ~0%

Nutrition: HCS vs Nationally


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DOSEMore Intense

• Duration longer

• Reach more children

• Strategy more policy, systems, or environmental

HOWMore Strategies

• Information

• Services

• Access

• Consequences

• Policy/systems

WHATMore Behaviors

• Fruit & vegetables• Whole grains • Sugary drinks• Water• Energy-dense

snacks/sweets• Fat• Calories• Breakfast• Fast food

Characteristics of Community Efforts


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WHAT Behavior

• Fruit & vegetables (69%)

• Energy-dense snacks/sweets (44%)

• Whole grains (40%)

• Sugary drinks (39%)

• Water (32%)

• Fat (29%)

• Fast food (27%)

• Breakfast (21%)

• Calories (18%)

HOW Environmental Strategy

• ↑ Availability of healthier (49%)

• ↓ Availability of less healthy (20%)

• ↑ Affordability of healthier (7%)

• ↑ Procurement from local farms (6%)

• ↓ Portion sizes (2%)

• ↓ Advertisement of less healthy (1%)

• ↑ Supermarkets/food retail (1%)

What and How are Communities Engaged

Webb et al. Pediatr Obes 2018;13 Suppl 1:103-112.


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More Intense: Higher Reach,

Duration, Strength

• ↑ lower-fat milk

More Strategies & Restricting

Availability of Less Healthy

• ↓ added sugar• ↓ sugary drinks• ↓ energy-dense

More Behaviors & Targeting Less

Healthy

• ↑ fruit/vegetables• ↑ fiber

Associations of Community Efforts over Past 6 years with Nutrition Outcomes

Ritchie et al. Pediatr Obes 2018;13 Suppl 1:14-26.Webb et al. Pediatr Obes 2018;13 Suppl 1:103-112.


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• Appears to take several years of sustained efforts for communities to reap benefits: no quick fix

• Different features of community efforts are important; there is no “single” or “simple” solution

• Increase intensity: broader reach, longer duration, multiple strategy

• 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


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• Simultaneously target multiple behaviors: don’t just focus on promoting more fruit, vegetables and whole grain – also limit less healthy options such as sugary drinks, sweets and fast food

• Giving information and enhancing skills should accompany change to food environments

• Environment changes that show promise: restricting the availability of unhealthy foods, and reducing portion sizes

Lessons Learned on Nutrition


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1010Place Matters

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 )

WHAT (behavior)

HOW (strategy)

More Healthy

• South

• Rural

Less Healthy

• West

Less Healthy

• South

• Low-income

• High African American

More Healthy

• Northeast

• West

• Higher-income

• High Hispanic


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1111Lessons Learned on Nutrition

Different considerations may be needed for childhood obesity prevention efforts

• Particularly in southern U.S. and rural communities

• To a lesser extent, depending on community income and race/ethnicity

Physical Activity


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1313Less PA in Girls, especially as Get Older

Age (years)

MVPA in past 7 days


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1414Associations of Community Efforts over Past 6 years with Physical Activity

Ritchie et al.. Pediatr Obes 2018;13 Suppl 1:14-26

• An index reflecting the 6-year history of the number of behavior change strategies used was positively associated with children’s moderate-to-vigorous physical activity

• This association was attenuated with adjustment for demographic factors

• Moderation analyses found that the association was positive among non-Hispanic, but not Hispanic, children


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1515Neighborhood Attributes in Relation to PA

Street Segment Near Child’s Home (Windshield Survey)• Burned, boarded up, or abandoned residential units

• Litter

• Quality and condition of residential units

• Busy thoroughfare

• Side street/cul-de-sac/dead end/one-way

• Sidewalks


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1616Neighborhood Attributes in relation to PA

Youth with no litter on their street reported significantly lower neighborhood-based PA

Youth living on a side street, cul-de-sac, dead-end, or one-way street reported greater neighborhood-based PA


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1717Lessons Learned on Physical Activity

Community programs and policies to promote physical activity in children may be more successful if they are sustained for several years and employ multiple behavior change strategies

Specific street quality attributes are associated with physical activity in youth


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1818Strengths & Limitations• Range of nutrition and physical activity measures

• First study to characterize naturally occurring community efforts in relation to child nutrition and physical activity outcomes

+

• Large number of comparisons

• Self-report of child nutrition and physical activity-

Thank you!

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communities’ role in childhood obesity prevention: nutrition and … · 2019-07-30 · obesity...

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