MCHB 2006 Federal/State Partnership Meeting

Getting Adolescents Started in a Physical Activityand Nutrition Programs: New Roles for Public Health

October 15-18, 2006

BONNIE SPEAR: So you've got Vitamin A, niacin causes flushing. B6 is headaches and the GI symptoms. And you can see with Vitamin E is also very high fatigue. And you get this all time with people saying Vitamin E helps improve like athlete's endurance and that type of thing, and all of these together are very dangerous in high levels.

The next question, do amino acids supplements help? And what we found is that there's not a lot of evidence that a heavy doze of certain individual amino acids are helpful beyond the recommendations. I have been seeing metabolic imbalance from absorption problems. But the breakdown of protein, once again, requires two times the amount of fluids. So, you have high protein intake, you need more fluids. So what you need for heat, you add more fluids to this. So we're now up to six gallons a day. In some instances of-- if you add all these supplements together, so this is a real concern over excessive protein. And when you tell athletes that extra protein is stored as fat, sometimes that works.

The question about ergogenic aids, I couldn't resist this. This is Jason Giambi. Now, the picture on the left is his rookie year in baseball. The picture on the right was two years ago when he admitted to taking steroids, huge difference. But these are the role models that adolescents are looking up to and not the side effects of premature closure or the pivesal plates. It affects growth, it affects brain function, it's extremely dangerous, and until adolescents go through their growth spurt and have--especially males have enough testosterone to build muscles, it's even more dangerous. But I think this is a classic example of the role of steroids and he looks like such a wholesome kid on the left.

The number one supplement used by high school athletes is creatinine. It was introduced in 1992 and has annual sale of over $200 million. What is it? It's naturally occurring found in food. It's found in fresh fish and meat. It's excreted by the kidney where it's broken down to creatinine. And it's proposed effect--well, it's effect is it increases work capacity over brief repetitive exertion. Increasing the resting foster creatinine levels in the muscles. And what it does is it may delay fatigue of workouts for athletes and power sports such as weight lifting. But it's usually designed for activities lasting less than 30 seconds, 30 seconds to a minute of repetitiveness. With that, which most sports, don't do that if you're looking at football probably a down lineman and who just does a quick spurt maybe of benefit. But the fact that--but it does not improve endurance and in fact that long distance or runners or people that are going for longer periods of time, some of the weight gain that's associated with it is water retention. Sometimes it slows people down as opposed to giving them better effect. It's generally safe; there's not been a lot of adverse effects. Some of the renal problems that were seen are just reversed with stopping the utilization of it. The antidotal evidence from coaches is that it increases muscle cramping, increases stomach cramping, and muscle tears and muscle strains, and hydration issues. The instructions for taking is, is that when you take it, you have to drink fluids. So it increases your fluid intake again. Do you see a running theme here? So that if you don't drink the extra fluids when you take it then you're at risk for some of the other dangers. In fact, it's not banned by the International Olympic Committee but over 33 professional teams had banned its use. And the NCAA prohibits distribution within the training facilities of their colleges. We don't know of any high schools that have actually banned its use.

The next one is caffeine. Caffeine is a xanthene derivative. Other names, such as methyl xanthene and guarana, are what are now listed on labels because caffeine has gotten a bad rep, so you'll see these, it's exactly the same thing. You can see the sources of caffeine that most adolescents consume. We have coaches that give No Dose before games to make them do better. It appears to reduce the perception of fatigue. They perceive the fatigue less so they go more. The adverse effects is restlessness, nervousness, insomnia and dieresis. In fact, the research that is shown increases--performance have been done in research settings. Nothing has been done in competition. And we do know that the adrenaline effect of competition may outweigh the effects--the true effects of caffeine in true competition.

Caffeine, over a certain level, is banned. It is an attested drug by the International Olympic Committee and the NCAA. Anything over 250 milligrams per day can put you over the legal limit. And I'd like to look at number three, which is one-half of a tall Starbucks coffee puts you over the legal limit. So, you wonder why everybody craves Starbucks coffee.

The last one is ephedrine or ephedra. It's the botanical name for that is ma huang. It's often found in combination with guarana, which is the herbal form of caffeine. It's serious cardiovascular and nervous system advance anxiety, ventricular, dysrhythmias, hypertension, hallucination, seizure, stroke, and death. Those are pretty significant side effects. And it is potentiated by the use of caffeine with it. This was banned by the FDA in 2004. Why are we still talking about it? Because what was banned was the levels of what they were putting in there. That is, now most of these companies have reformulated their products. It's still available but in just in smaller amounts. And Joe was telling me that there is a movement to repeal the ban on this as well. So, we need to still look at it and can't talk about it. But what are we looking at beyond sports? As Joe's already said that up at grade 12, 40 percent of kids get insufficient physical activity. We have regular physical activity can control what we've already talked about, and the next few slides come from a presentation developed by the Association State and Territory health officers. It's an excellent presentation to utilize. It's available free from them. I suggest you go to their website to download it, but I'm just giving you some excerpts from it.

I'm kind of rotating back and forth, but the Action for Healthy Kids also looked at what schools, schools that didn't have a high percentage of students who did not engage in vigorous physical activity do poor on test scores. That's the only way you're going to get administrators to pay attention is it affects test scores. Students who skip breakfast do worse on tests and have poor concentration. Physical activity programs are linked to stronger academic achievement, increasing concentration, and improved math, reading and writing scores. All of these are available on the fact sheets and the information available for the actionforhealthykids.org website.

We also know that obesity, which is a nutrition and physical activity related is estimated 117 billion in Medicaid cost in the year 2000, probably much higher by now.

What can state health agencies do? They can provide information. I think you're looking at the policy level or working as the Future Search things as who do you bring together? And fortunately, in Alabama, as we started doing this, the one group that we hadn't thought about was the tourism. In fact, they have jumped on this and if you--the Alabama, the year of the outdoors in Alabama. And they have partnered with our state parks in offering free days for families and doing a mini blitz, the last one was at a park near my house and 25,000 people showed up for it. So, thinking of different ways to different partners that you might not come in contact with. The head agency can coordinate these stakeholders. The convener or the planner in bringing people together, promote statewide, inter-agency collaborations around the topics such as physical activity or nutrition. They can maintain knowledge. Often, communities want to do something but they're not really sure, so if you provide technical assistance to communities of how to implement different things. But they can't do it alone and they have to partner with communities in schools. And then, but one thing I want to do is talked about changing the environment. In schools, there's a decrease in physical activities. It seems to be the first thing cut when their budget cuts. And there's an increase access to marketing of high-energy dense foods. And communities are decreased safe areas to play and, again, the marketing. You now, you've hit my pet peeve of vending. So I'm going to just spend a little time on that. The cartoons, "We better get to class. Yeah, we're late for Health." Vending, if you look at and listen to the detractors, is that kids will go home and eat anyway, the products so why should we limit it in school? It only counts for three percent of the teenage eating occasions but 78 percent of this occurs at school.

Ninety-eight percent of high schoolers have access to vending machines during the school day, and 74 percent at middle school. And this is vendings in the school, not only is it vending--inappropriate vending, but it's also marketing. You've looked at Coke. Kids get branded. The first product, if you were raised on Pepsi, you like Pepsi. If you're raised on Coke, you like Coke. So kids get branded. So this is what the marketers are after, is branding. One simple thing that we did was that these are the only things that you can put on the cover of a vending, no matter what's in there, they can have water on them. So you brand them with water, that was a simple thing, it did not cut into revenues, but just a small policy change. We're also looking at school cafeterias and coming up with healthier snacks. It's hard to touch that revenue income from it, but what are some other things? Partners that have done it have shown that kids will buy whatever you put in there, There's an initial depth but then the product has come back. One recent school system implemented it and the vending went down, but the school lunch participation went up. So, these are some just examples of healthy snacks that can go in vending machines.

UNIDENTIFIED SPEAKER: Tennessee passed a legislation from years ago to change our vending from--for the Gatorade to healthy choices but actually the revenue went up. So, if you need some information you just contact Tennessee and they'll probably do things (inaudible)--

DR. BONNIE SPEAR: And that's something that we need to share because that's such a--and I think you're saying that Minnesota, Tennessee, there are few schools that have shown that and because of--the great fear is that you're going to loose the revenue. And if we can show programs that are doing that, I think that's critical. You're absolutely correct. But when you tell kids, they can still eat teddy grahams and they can still eat animal crackers, that sometimes you can leave off the Snickers.

Fund raising, also. In Alabama, the Board of Education said that all fund raising has to be healthy. So we also gave them fund raising ideas that were 100 percent profit. My favorite is the rent a team, where they have to do physical activity for money, which was very fun. The other thing is most people don't know about porridge rights contracts, especially parents. These are contracts with the school administration of sole source contracting with the beverage industry. This does not have to appear in their budget anywhere, it is discretionary money for the school administration. It promotes soft drinks, so the more they drink the higher your profits, and it markets to the students.

So, let's talk about marketing. We can do marketing on school buses. Everybody seen the scoreboard with--that's marketing, absolutely. The Baskin-Robbins sign is in the gym of the high schools. Every time you run, Baskin-Robbins, Baskin-Robbins, Baskin-Robbins. Free textbook covers are Gatorade, fruit gum, this fundraisers. Fast-food restaurants; the highest time for fast food is immediately after school, if you can see in the background is the high school. There is a gate that leads from the high school to the McDonald's. This is the number one grossing McDonald's in the state of Minnesota.

But marketers are not stupid. This is ingenious. You put these products out and parents buy them for their children. So, you market on bottles. You market--you sell McDonald's at McDonald's Stores. Parents buy these for $40. You market your Happy Meal Play-Doh sets, your Lunchable Play-Doh sets. So, what do kids do when they see them in the store? This is what they want. Then you've got your games, your puzzles. You do a puzzle for Oreo and you walk down the cookie aisle and you want Oreos. You have counting books. On the Internet, these are young-child friendly. But then you go to the Twinkie store. You shop the Twinkie place. You go to the Nabisco, they're great. Some have really interesting nutrition facts or games that you can play but it's totally marketing. You've got Neopets where you adopt a pet and you run through it but then you have to feed your pet because it gets very hungry and you can go to McDonald's. You can go to Burger King. Your pet actually dies if you don't feed them or he shuts down. I have one. You have to play with this. But there are some things--these are fun games. As we said in adolescence, not sex, drugs, or rock and roll, but it's marketing.

A contest that you bought this product and you win something. Yeah, how many of you have won something from--the question is, does this advertising affect eating behaviors? Well, what we do know is it must because--and since 1994, the new products targeted to adults has made stable. New products targeted to children and youth have increased exponentially. We also know from Hastings of--review that marketing does influence has a strong evidence of influencing preferences, a strong evidence on purchasing but it may not be that strong for consuming. So, we know they prefer--we know they purchase it but we can't guarantee they'll eat it, yeah.

So, in closing, what we wanted to do is I'm going a little bit higher. The recommendations for teenagers are actually 60 minutes of activity per day. Ten minutes more of the time and agreeing with the 20 minutes of vigorous, at least two to three times a week. So, what are we talking? Thirty minutes of walking is 140 calories. Thirty minutes of hiking, 185. Bicycling for 30 minutes at less than 10 miles per hour is 145, more than 10 is 295. Basketball is 220 for 30 minutes. And you can see for players, for high school players that play basketball for two and three hours, how many calories they're burning in the court needs that they have? Jogging for 30 minutes, almost 300. Dancing, which is a very hot topic for adolescent females, is 165. We have just put in, in our lab--our waiting room for adolescent clinic a DDR. Are you all familiar with that Dance, Dance Revolution, which I have no clue how many calories that burns per hour if you get going, but it's more popular with the boys than the girls. With that and it's an excellent way to exercise in their home units as well with them. Swimming is 225. Aerobic activity, we're talking about true aerobics. This is about 240 calories. And actually walking up the stairs burns five times more calories than riding an elevator. I mean, City CED did this and they put signs on this elevator, "Walk Up One, Down Two." And what they did, and this is something that if you have a tall building in your facility, is they put spies in the hallway and gave out prizes. So, if you're found walking up and down the stairs on certain days, you would get a prize. So, which really encourage people, too, to increase that.

So, while we're talking about state agencies have a vital role in helping communities, but as a convener, and I'm bringing people together and working in the policy area.