vending machines and health systems
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Vending Machines and Health Systems. Controversies and Concerns Diane Dooley MD. Obesity is on the rise. Pediatric Nutrition Surveillance 2008. Percent overweight and obese Contra Costa County children 2 – 19 years. 12/08/09. 2. Health Disparity Emerges. - PowerPoint PPT PresentationTRANSCRIPT
Vending Machines and Health Systems
Controversies and ConcernsDiane Dooley MD
12/08/09 2
Obesity is on the rise
15
32.2
43.8 45.3
0
10
20
30
40
50
% Overweight/Obese
19712-4 years5-11 years12-19 years
Percent overweight and obese Contra Costa County children 2 – 19 years
Pediatric Nutrition Surveillance
2008
15
40.135.1
46.3
0
10
20
30
40
50
% Overweight/Obese
1971WhiteBlackHispanic
Contra Costa children ages 5-8 by ethnicity
Pediatric Nutrition Surveillance
2008
Health Disparity Emerges
Vending machines in hospitals
7% of all US vending machines in hospitals and nursing homes
California laws do not regulate nutritional content
Profit pressures correlate with quality Beverage vending agreements vs. food vending agreements
Vending machines at CCRMC
Patient access machines located in Richmond, Pittsburg Health Centers, CCRMC cafeteria
Unknown profit No contract County provides electricity,
space, disposal of waste, associated cleaning costs
Vending machines standards
• County Healthy Vending policy passed 2004
50% “Healthy” drinks, snacks
Public health audit 2007- 20% compliance
Best selling items: Cheetos, Doritos, Lays Classics, soda, candy
Vending Machine survey
• “Smart Choices” are marked by green star• Most survey participants did not notice the
smart choices posters on the machines• ½ of Spanish speakers thought green stars
meant item was cheaper• Majority had purchased items from the machines in the last few visits
Pittsburg Health Center
“They are often eating chips in am clinic visits”
WIC Survey:-Cookies, chips and sweetened drinks are commonly brought to WIC
Pittsburg Health Center
43.7 of Fifth graders are overweight
Pittsburg Unified School
District 5th graders
Healthy Kids Survey2006
Obesity Efforts Pittsburg Health Center
• 80% of providers report counseling almost all patients to avoid sweetened drinks
• Soda Free Summer campaign• Prenatal Sweet Success program• Diabetes registry• Pediatric Obesity QIP• FIT resident grant• NEW Kids program
Obesity Efforts Pittsburg Health Center
• WIC social marketing campaigns
• Have Fun and Be Healthy• Have Fun and Be Active• Healthy Drinks
New food package introduced October 2009:More breastfeeding supportLess juiceMore fruits and vegetables
12/08/09 12
Soda – Should we sell it?
Increases likelihood of being overweight or obese
Density of fast food restaurants and convenience stores correlates with obesity and diabetes
Highest consumption among children from low income families, Latino
12/08/09 13
Soda – Should we sell it?
Concord 44.2Richmond 46.1San Francisco 36.9Bakersfield 60.1
• 49% of California children consume one or more sweetened soda daily
• Childhood consumption increasing annually
• Soda, fruit juice and sweetened beverages provide an average of 270 extra kcal/day (10-15% total)
Percent of Children and Adolescents 2-17 years drinking one or more sodas per day
12/08/09 14
Health impacts for childrenDental caries associated
with frequent consumption of sugary foods
Higher rates of fractures, osteoporosis
Highest risk groups: low income, Latino, African -American, uninsured
Snacks
170 Calories/11 grams fat/serving
120 calories/ 20 ounce bottle 280 calories/
14 grams fat/serving
Sweetened Drinks survey
100% of health professionals surveyed felt sweetened drinks were a problem
Most providers discuss the harmful effects of sugar and sippy cups
Inadequate time, parental disinterest and easy access to junk food limit counseling effectiveness
Culturally appropriate tools and vending machine restrictions would assist providers in addressing this issue
Counseling Patients
Barriers Top Five: Parental disinterest/overwhelm in setting limits for
children Parental disinterest/overwhelm in promoting
health Lack of adequate time to counsel Lack of culturally relevant, up to date educational
materials/counseling tools Awareness that families may not have the
resources to buy healthy drinks
Food Marketing to Children
“Constant assault of marketing these drinks to kids makes me a voice in the wilderness”
A study of McDonald’s restaurants in Children’s Hospitals showed correlation with increased fast food purchasing by parents and a more positive perception of the healthiness of McDonald’s food.
“..food and beverage marketing influences the preferences and purchase requests of children”-IOM
• Department of pediatrics worked with Public Health and CCRMC dietary department in 2008 to develop 100% Healthy vending policy
• Based upon SB 965, SB 12 School standards• Passed by MEC as part of the pediatric
obesity quality improvement initiative October 2008
• Implemented by CCRMC cafeteria vending machines October 2009
100% Healthy Vending Policy
“A supportive environment helps individuals make positive behavioral changes and models the importance of healthy lifestyle choices for patients and families”
Nutritional Environment
• Food environment may influence health and nutritional choices
• Formula and the perinatal unit, • Cigarettes and smoking at health centers
Make the healthy choice the easy choice
Conclusion
Vending machines in clinics provide convenient foods to patients and profit to the health system.
Providers in the clinic are actively educating patients about the hazards of soda and unhealthy snacks but feel undermined by the presence of machines in the lobby selling junk food
Our health system should move towards a 100% healthy vending policy in all patient access machines and model a healthy nutritional environment our patients