Walk to School Day, Scituate, MA

Fighting the Epidemic No

One is Talking About!

A.A.A.S. Understanding Obesity and Childhood Nutrition Town Meeting

Boston, MAFeb. 2008

My comments:

• Restating the problem and brief rant about the “epidemic.”

• Answering, “How much is enough?”

• Overcoming the stickiness problem.

• Creating stickier schools.

• Hear from you!

US “Obesity Epidemic”Ogden et. al. (JAMA 288, 14; Oct. 2002)

10

15

20

25

30

35

1960 1970 1980 1990 2000

% O

bese

(BM

I>30

)America’s looming chronic

disease apocalypse . . .

“Supersize Me?”

Diabetes Prevention Program (DPP; New.Eng.J.Med., Feb. 7, 2002)

Compared three treatments for nationwide cohort (3,000+) at risk for developing diabetes (elevated fasting glucose).

1. Control: Standard exercise and nutrition counseling; placebo.

2. Standard plus drug treatment: Metformin

3. Intensive lifestyle change: Nutritional training, 150 min./week physical activity.

Diabetes Risk Reduction(Diabetes Prevention Program; NEJM, Feb. 7, 2002)

0.31

0.58

0%

20%

40%

60%

80%

100%

Metformin Lifestyle

Relative to Control Group (standard intervention)

% R

ed

uc

tio

n o

f R

isk Risk Reduction

A thought:Change the conversation. It’s not just an obesity epidemic. It’s an epidemic of physical inactivity and poor nutrition.

My somewhat unique

perspective . . .

How much physical activity is recommended by the US Surgeon General

for adults to reduce risk for chronic disease and an early death?

1. 20 min. at least 3 days a week2. 20 min. every day3. 30 min. at least 5 days a week4. 45 min. at least 4 days a week5. 60 min. at least 3 days a week6. 60 min. most days of the week

The Activity Diamond

Health:30 min. a day.

Fitness:20+ min.

hard, 3+ days.

Weight loss:60+ min., 5+ days.

ACSM fitness recommendation,

1978-2000.

USDA Dietary Guidelines,

2005.

Surgeon General’s Report on Physical

Activity & Health, 1996.

Physical activity recommendation for adolescents:(Pediatric Exercise Science 6(4), 1994)

• Physically active every day as part of lifestyle (at least 60 minutes, variety, moderate intensity).

• Some vigorous activity; at least 20 minutes, three days/week.

For a pedometer-wearing adult, how many steps per day are recommended

for long term health?

1. 5,0002. 10,0003. 12,0004. 15,0005. 20,0006. 24,000

20% Boost Pedometer ApproachFrom Pedometer Walking by Fenton & Bassett (2006)

< Like this, level and in line with the knee.

Not like these. >

Wear your pedometer all day, every day:

www.pedometers.com

S M T W Th F Sa

20% Boost Pedometer ApproachFrom Pedometer Walking by Fenton & Bassett (2006)

Key to Success: Keep a record!

S M T W Th F Sa

3,254 3,759 3,588 4,506 2,127 3,901 8,316

20% Boost Pedometer ApproachFrom Pedometer Walking by Fenton & Bassett (2006)

Total = 29,451 Daily average = Total / 7 = 4,207

Daily average x 1.2 = 5,048

5,048 = Next week’s daily goal!

How many steps?

Health:~10,000 steps/day.

Fitness:3,000 steps

fast.

Weight loss:~12-15,000 steps/day.

Have you experienced any of the following examples of the stickiness

problem in your life? (pick for yourself or someone close to you)

1. Joined a health club, but don’t go often.2. Bought a treadmill or bike, but don’t use it much.3. Joined walking program, but stopped walking

when program ended.4. Signed up for walk/run event; didn’t keep at it.5. Lost 10 pounds, but gained it back.6. Got a Wii; now family spends more time inside.

Exercise Participation StudyEffect of Short Bouts, Home Treadmills

(Jakicic et.al., JAMA 282, 16)

60

120

180

240

0 6 12 18

months

Exe

rcis

e (m

in/w

eek)

LB

SB

SBT

?

First 6 months: Prizes, reminders, support.Months 6-18: Subjects left to their own devices.

60

120

180

240

0 6 12 18

months

Exe

rcis

e (m

in/w

eek)

LB

SB

SBT

Self-help vs. CommercialWeight Loss Programs

(Heshka et.al., JAMA 289, 14; April 9, 2003)

-7

-6

-5

-4

-3

-2

-1

0

0 6 12 18 24months

Wei

gh

t C

ha

ng

e, k

g

Self-help

Commercial

Did these people “exercise?”

It’s about dramatic decreases in routine, daily physical activity!

Lowell Nat’l Hist. Park, Lowell, MA

Plimouth Plantation

So, what makes stickier places? Answer “yes” to four questions:

• Destinations within walk & bike distance?

• Sidewalks, trails, bike lanes, crossings?

• Inviting settings for routine activity?

• Is it safe?

Stickier for kids:Safe Routes to School.• Engineer safer facilities;

sidewalks, paths, crossings.• Educate for safe bike,

pedestrian, & driver skills.• Enforce safe speeds, better

behavior, pick-up/drop-off.• Encourage. Walking school

busses, bike trains. Walks at school: before, after, & recess.

• Evaluate and improve.

www.saferoutes.org

Speed table, Berkshire St., Cambridge

Which of the following would you most favor implementing in your school or community?

1. Rewards for walk, bike, transit to work2. Walking school buses3. Improved sidewalks, pathways, bike racks4. Warm-weather clothing donations for kids5. No withholding recess as a punishment6. Build physical activity into curricula7. Physically active field trips8. More regular PE classes9. Reverse lunch and recess10. Extending the school day

Massachusetts pilot program: Extended Learning Time schools.

• 19 E.L.T. schools in 2007, lengthening day by about 90 minutes.

• Increased contact time; project based, hands on learning.

• More time for exploration: languages, electives, art, music, drama.

• More planning, collaboration, advising.• Schedule flexibility for PE, recess,

physical activity in the curriculum.

www.mass2020.org/elt

Are you in favor of increasing the program of extending the school day

by 60 to 90 minutes (now a pilot program) to more schools in

Massachusetts?

1. Yes2. No

Stickier Communities

Sticks: Costly parking &

roadway fees, congestion

charges.

Transportation carrots: Underwrite transit, improved, sidewalks, crossing, & bike

lanes, worksite incentives (e.g., health insurance discounts).

www.completestreets.org

Which of the following cutting edge policies would you most favor for the city of Boston to enhance

physical activity in the population at large?

1. Improved open space, parks, & playing fields2. Performance based health insurance3. Reduced or free transit for active commuters4. Increased parking costs5. Privatize major roadways (e.g. tolls)6. Peak hour congestion charges7. Adopt a complete streets policy8. More pathways, bicycle parking, safety education9. Reduced price health clubs

• School board• Planning & Zoning• Parks, Recreation• Historical Society• Public Health & Safety• Chamber of Commerce • Economic Development• Neighborhood Associations• Conservation Commission

Get out of the comfort zone, attend other meetings, learn, & speak up!

Bridgewater T station

Build activity intoyour life (esp. walk & bike).

Invite others; getpeople to simply move.

The simple prescription?

Make yourcommunity

activity-friendly.

Why it really matters . . .