Overweight/Obesity: Weighty Issues for the

MCH Population

Susan Steinberg: Thank you. I’m very glad to be here. For one reason as most of you read the newspapers know, the state of California had to scrape together its few pennies to send at least two of us here to the meeting, so we’re fortunate in that regard. It’s interesting also about the state fair, because I didn’t bring a slide of it, but I had a similar slide that I’ve used in other presentations. We had at our state fair, as the premier food item, deep fried Twinkies. So that’s sort of in the same category, I guess. We have, in California, attempted to recognize, I think, early on, and to address on a state level, the issue that we saw approaching us, and that is, as we’ve heard this morning, the obesity epidemic. I’m going to talk a little bit about the scope of obesity in California, some innovative, I think, and some recent legislation about some of the statewide programs, and most importantly of all, about some of the local programs in our partnerships with the local MCH programs in our jurisdictions. Again, it’s a slide here showing the level of obesity. You’ve seen this previously, in the different age groups, and of course, across different ethnic and racial backgrounds. I’m showing the slide in a slightly different way than the one that was previously shown, but the interesting thing here, and my colleagues, in MCH, the nutritionists, spent a long time re-educating me on overweight and obesity and that sort of thing, but forgive me if I slip back. Old habits die hard. But essence, as we heard previously, the blue areas here are those in the 95^th percentile of children in California. This is in California. And the interesting thing you see here is that the level of children who are overweight, who are above the 95^th percentile, are, has now crossed that line for those children that are at risk for overweight. And those would be the children in the 85^th percentile. And here again, is a way to look again at the same kinds of things, and again we see that the level of those children that are exceeding the 95^th, at the 95^th percentile, or exceeding it, has now crossed the line of those who are at risk. We have, oops, that’s not a good sign, is it. We have looked at this through a variety of different ways in California, and I want to say at this point in time, that there were handouts, but due to those usual technical difficulties, they did not get into your packet of material. However, they are being copied off and you will have copies of these slides. The reason I was anxious that you have copies of the slides, not because of my, your wanting to keep forever my very astute words, but because I have a lot of websites on here where you can access, in total, the information that I’m going to touch on briefly. One of the things that I wanted to show you, both the Senate in California, and the Assembly, commissioned a study of children, overweight children, in their respective districts. The Assembly districts and the Senate districts. That is, I’m not sure how many other states have done that kind of thing, but I thought that was, and this was done a couple of years ago, which showed that our legislative body had begun to become very interested in this issue of obesity long before it began to hit the news media and the New York Times. And this is just to show you some of the maps that are inside of those booklets. You can get those booklets by accessing the website that you will see. Based on what had been talked to the legislative folk about, and some of the studies that we provided and were provided through the booklets that I just showed you, recent proposed and signed legislation in California, dealing with specifically the interest, or the issue of obesity, have, all of these have now been passed by the legislature, and signed into law by the governor, whoever that governor might be. If you want to access again, and that’s why I think it’s important that you have a copy of these, if you want to access the actual working of these bills, you can do so through the website for the legislature in California. Senate Bill 65, school boards must give parents written notification before entering into contracts for the sale of non-nutritious foods and beverages as well as carbonated beverages. This gets back to the issue we just heard about related to the sale of these materials in schools. Parents must be offered the opportunity to comment on such contracts before signing. In other words, a school board and the school administration before entering into a contract with a vendor, must obtain approval, or must at least put out for a sunset, or a sunrise, depending on how you look at it, the contracts that they’re going to use in the vending machines in the schools. It prohibits that these contracts will include a confidentiality clause requiring the board to make the contract accessible and public. The staff wanted to put this in. It may be a little hard to read, but it gets to the issue of a family issue, and the education that we’re providing in the schools. However, on the say home from school, when the child starts talking about the Body Mass Index, the parent says, sort of shut up, and let’s pick up our Happy Meal, and go on home. Senate Bill 78, another one of our bills, requires the Department of Education to encourage schools to provide quality physical education, develops knowledge, attitudes, skills, and behaviors to promote the habit and the life style of physically fit for life. Encourages the schools to provide extracurricular activity, physical education, through using school facilities, to encourage programs and clubs that utilize the swimming pools in schools and the gyms and so on for physical activity and for clubs and promotion of physical activity. The idea here was to promote, as we heard previously, non-competitive types of physical activity for school children. And this is, again, the same thing. Assembly Bill 195, what they tried to do is build partnerships between our HMOs, which are the most prevalent type of private, if you will, not publicly provided, insurance for most of the population in California, to provide, as part of their programs, to mandate that they provide education to families about obesity prevention of diabetes, and to work with the schools, so actually some of our HMOs like Kaiser, and Health Net and so on, are actually going into the schools and providing education, providing classroom training on some of these issues. Another little slide related to the cafeteria issue that you mentioned, students are looking at the cafeteria menu, and deciding that when veggie day comes, maybe it’s a good day to be sick. The Senate Bill 677, another one of our bills, Childhood Obesity Prevention Act, effective July 1, 2004, permits only the sale of specified healthy beverages in elementary, middle schools and prohibits the sale of sodas in these schools. Now if you look at the bill, it outlines, and my staff worked very hard with the legislature on outlining what were actually unhealthy beverages. We fought very hard to get this extended into high school, but we were unsuccessful in that regard. We could not get it into the high schools. And here it shows you again, probably some of the other speakers are going to have something similar, just from soft drinks alone, the amount of calories and sugar, and this is a slide that’s a couple of years old now, it’s even more, I think, at the present time. The issue that I just want to mention briefly related to the schools, just to reiterate, I have staff members of mine who are on a statewide panel working with educators on, and this would be representatives from the school boards, representatives from the individual schools administrations, superintendents in schools, also on this advisory council, there are parents, parent representatives, as I said, representatives from my department, from MCH branch, and the Department of Health, as well as the department of education. There are also students represented on this panel. One of the things that we have heard over and over, that school boards and school administrations are fighting like a tiger, to keep the option of vending machines and the kinds of programs that we just heard about in the school cafeteria, because they are a cash cow for the school. As pointed out previously, they are discretionary, they bring discretionary monies in the school, they’re used to support some of the sports activities, and this is the argument we hear. They’re used to support the band, they’re buying uniforms for the band, and so on. Also in the schools, what we see are booster clubs that have concessions, if you will, in the school, where a great deal of the material that’s being sold to fund the basketball team, the football team, for away games and so on, these foods are candy bars, they’re the bagged chips and so on, they’re the sodas and that sort of thing. And we have not been extremely successful in talking the administrators and the boards of education into a concept that would bring some of these things out of the schools and rather encourage a more healthy kind of offering of food and snacks in school. As California’s TITLE V plan, one of the state’s selected performance indicators, is to reduce the rate of childhood obesity and overweight. In our particular division, which is Primary Care and Family Health, it shows you some of the partnership we have. In our division, we have WIC, we have children with special health care needs, CHDP, maternal child health, the office of family planning, rural health, migratory health, the Indian health service, and so using all of these venues, we have introduced some of the interventions in all of those different programs. California, through a CDC grant, has what’s called a COPIE program, or the COPIE grant, it takes you forever to learn what all of these things are. I was there quite awhile before I figured out what COPIE meant, but nonetheless, this is a pilot project in California, that is being used in a variety of different jurisdictions. Looking at physical education programs, and particularly this project is looking at what we call low-resource schools. These are schools in environments an neighborhoods with a lot socio-economic student base. They have developed a comprehensive, coordinated state-wide obesity prevention plan and a mission statement and goals. They have done a considerable amount of research, and I didn’t bring all of it here, obviously, because of the time frames, but they have done a great deal of research on TV viewing, who’s viewing TV. Part of the issue that they’ve looked at is inner-city children, where it’s unsafe for children to be out exercising, out walking, running, jogging, where there are no green belts and so on. The only place for kids to play are under the interstate highway bridges, and so on. And here again, comes to the issue of TV viewing and the issue of the snacking during the TV viewing, and also the inactivity. Department of Health Services, the California Department of Health Services, has developed an obesity policy and an obesity strategic plan. And we are looking at, and similar to what we heard earlier on a strategic plan, we’re looking at a five-year strategic plan dealing with the issue of obesity. We have, and these are just different bullet points, physical activity health initiatives, we have the Fit WIC program, healthy eating in childhood through USDA grants, California project (inaudible) leaders, encouraging activity and nutrition, and again, on the slide, at the bottom, and also on the handouts, you will see the website where you can get more information on these programs. One of the things that we’ve done related to our WIC program, we’ve partnered with WIC and the Department of Social Services, using some of the USDA money related to education for food stamps, recipients, we’ve used that and we have provided funding for our local MCH jurisdictions to actually bring on board nutritionists in their local jurisdiction programs, not all of them, unfortunately, because we didn’t have enough money, but in certain select programs where our demographic maps outlined what we call hot spots for the issue of obesity and overweight children. And so we’re going to have actually education and nutritional education out there in our programs. I put this slide in. It’s not oral health, but I just liked the slide, so there you are. Some of the programs that we have and some of the issues that we partnered with other organizations are, and this is dealing with some of the advocacy we did particularly related to the legislation on soda, and public education on that kind of thing. Again, the schools have been encouraged to use their facilities after school hours and for not actual school-promoted activities, but to bring families and so on into the schools to use the facilities. Food on the run goals, again, one of our partner programs, is aimed at conducting adolescent-focused programs for both parents, local policy makers, community people, and of course, the adolescents themselves. We have 11 of our jurisdictions, or 11 of our counties, not all of our jurisdictions are counties, but this should really read 11 jurisdictions on their five-year needs assessment have listed obesity prevention and have provided to us their plans, their strategic plans, looking forward on different aspects on how they, in their local community, will be working on their own identified need to deal with this problem. The issue that we have also promoted, you know, you’re all familiar, or most of you are familiar with the literature related to obesity and breastfeeding. We also have a very aggressive breastfeeding program in California and that has become an important part of our Title V programs. We’ve looked at the issue of overweight and obesity. We are doing data linkages between our newborn screening program, pre-maturity, treatment, and initiation of prenatal care in the first trimester, as we’ve heard, how important the intra-utero activities of that portion of a child’s life may be, in deciding on health outcomes later on, particularly obesity, perinatal weight, body mass index, body image weight control methods, healthy eating choices, physical activity, and what we have not only in newborn screening, which you can see up at the top where we’re data linking with that, but we also have something in California, the MIH, which is Maternal and Infant Health Assessment, which is another survey where we’ve linked data, and we’re linking the data through all three of these, and then the women’s health survey, which asks the question of women related to the issues listed below. And we’re trying to link this data to try to figure out some of the issues that we heard about before. How does this all fit together? The MCH programs we’ve targeted certain of our groups that appear to be at higher risk for diabetes and obesity, the Black Infant Health Program, the AFLP program, and the Sibling Program, we actually constructed, and the staff developed a cookbook, and I have a copy of it, but I couldn’t bring you all copies because they cost of $2.50 apiece, and we’ve been so poor. But in any event, this is for the adolescents in our AFLP program, which indicates to them what the issues are in healthy eating. We did the same thing for our Black Infant Health Program, we do the same thing in our Comprehensive Peri-natal services program, where we have an entire program related to obesity as part of the peri-natal services. We’re attempting to reduce the number of low birth weight babies, and which we feel increases the incidence, or the life risk for obesity, and this is just to show you one of our kids, a premature child born at seven months gestation. This is the same child at 11, 12 years of age, and after being enveloped in one of our education programs and so on, this is the same boy, slimmed down, and hopefully changed for life. I’m going to skim through these because I got the five-minute notice, but this is, these will all be in your handouts. Related to some of the things we’ve looked at again, it’s the breastfeeding program that we have in California. This is an interesting thing. You’ll all laugh. This happened in Berkeley. This is a breast-feeding gathering and we are now in the Guinness Book of Records, 1153 women all gathered in Berkeley, breastfeeding at the same time, which is awesome. Where else, but in Berkeley? And of course, we see that our prior Surgeon General, Dr. Satcher, was there. This was promoted by one of my staff and one of our local MCH directors in Berkeley. I talked about the policy letter. Some of the collaborative efforts that we’ve done looking at different kinds of programs through the university center, and some of the training programs that the universities have developed for us to use in our programs. We have our diabetic program, you’ve heard about our diabetes in overweight. I’m going through these quickly now, but this one I want to talk about just briefly. The Adolescent Latino Diabetes prevention collaborative. Family centers, and this is through one of our jurisdictions in Fresno with the partnership, again, with the University of Fresno. And is to speak to the issue of what a culturation and what some of the issues are involved in getting the message to a different populations related to that and some of the partners in this are the University System. We actually are partnering with a university in Baja California, Mexico, as part of the continuum of that program. And last, we had the diabetic, or the California Childhood Obesity conference in California in 2003, 1,100 participants, and a very successful, I think, conference related to looking at the issue of childhood obesity. Now the minutes and the printouts from this conference are also available on our website