background in june 2007, an international conference was held in toronto, on, to examine issues...
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BackgroundBackground
• In June 2007, an international conference was held in Toronto, ON, to examine issues related physical activity and obesity in children
• The conference was attended by nearly 1000 delegates from 35 countries
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• review the most current scientific evidence concerning the problems of obesity and physical activity in children and youth
• Explore what can be done
• Summarize Promising Practices for community-based interventions
Overview of this PresentationOverview of this Presentation
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Defining Obesity in ChildrenDefining Obesity in Children
• A weight to height ratio (kg/m2) known as the Body Mass Index (BMI) is most commonly used
• Contrary to adults, BMI changes with sex and age in children
• Sex- and age-specific values based on standard growth charts should be used
• Insufficient evidence for use of waist circumference in children
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Childhood Obesity in CanadaChildhood Obesity in Canada
In Canada,
• 25% of children and youth (2-17 y) are overweight /obese
• 41% of Aboriginal children living off-reserve are overweight/obese
• 55% of Aboriginal children living on reserve are overweight/obese
Data Sources: CCHS 2004; First Nations Regional Longitudinal Health Survey 2002/2003
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HOW DID WE GET HERE?HOW DID WE GET HERE?
What are the causes of the Obesity Epidemic What are the causes of the Obesity Epidemic in Children?in Children?
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• genetics
• maternal health
• in utero growth
• low birthweight
• parent obesity
• parenting styles
• personality traitsand many more …
Many contributors to Childhood ObesityMany contributors to Childhood Obesity
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Food & NutritionFood & Nutrition
• Shifts in Food Practices
food availability, portion size, consumption of
soft drinks, frequency of family meals
• The Cost of Calories
• Mass Marketing
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Average Number of Steps Per DayAverage Number of Steps Per Day
Source: CFLRI
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2007 Report Card Indicators
PHYSICAL ACTIVITY / INACTIVITY
Physical Activity LevelsGrade: F(2006 Grade D)
Screen TimeGrade: D-(2006 Grade D-)
Sport ParticipationGrade: C(2006 Grade C-)
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Number of students who participate in 60 minutes of moderate to vigorous Physical Activity
on 5 or more days per week
Lower levels of PA among:
• girls
• new Canadians
• low SES
Courtesy of Dr. M. Tremblay
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Changes in Time (min/week) Spent in Activities by Changes in Time (min/week) Spent in Activities by Children Ages 3-5 years in USA:Children Ages 3-5 years in USA:
Change from 1981-1997Change from 1981-1997
Strum R. Public Health Practice and Policy. 2:1:1-9, 2005Data from University of Michigan:Hofferth SL & Sandberg JF. 2001
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Friedman. Room For Thought. 2005
“Recreation has gone from
spontaneous to organized and
regimented activity: parents
exercise at the gym while the
young play soccer and hockey
in leagues with schedules
rather than in the backyard or
the street in front. More time is
often spent preparing for and
getting there rather than on
the activity itself.”
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We must think about physical activityWe must think about physical activity
over the WHOLE DAY rather than just over the WHOLE DAY rather than just
sports, exercise, or recreation. sports, exercise, or recreation.
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Time spent in various types of activityTime spent in various types of activity
Sedentary Sedentary 459.9 min/day
56%
LightLight341.6 min/day
41%
Moderate Moderate 18.1 min/day18.1 min/day
2.2%2.2%
Vigorous Vigorous 5.6 min/day
0.7%
TAAG study, USA
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HOW SHOULD WE APPROCH THE HOW SHOULD WE APPROCH THE PROBLEM?PROBLEM?
What does the evidence suggest?What does the evidence suggest?
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There is No Single Cause There is No Single Cause
• It is impossible to identify a single cause of the current obesity epidemic
• It is likely explained by a broad range of changes that have occurred together throughout the past 20-30 years
Therefore, SOLUTIONS must also be multi-faceted!
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To address the
problem we will have
to examine both our
biology and our
environment.
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Small amounts of physical activity
Large amounts of
physical activity
optimum growth
Prevention is easier than TreatmentPrevention is easier than Treatment
Bo
dy
Wei
gh
t
Time
excessive growth
Energy Gap
Developed by: Dr. William Haskell, 2007
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Three Common Behavioral Settings Three Common Behavioral Settings for Youthfor Youth
HOMEHOME SCHOOLSCHOOLCOMMUNITYCOMMUNITY
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The Physical EnvironmentThe Physical Environment
Everything we - see - hear - touch - smell - taste
Rules, norms,expectations
Socialhierarchies
Factors thatinfluence howwe respond tothe physicalenvironment
The Social EnvironmentThe Social Environment
Behavioral Settings
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Influences on Health BehaviorInfluences on Health Behavior
IndividualBiological
PsychologicalBehavioral Skills
InterpersonalFamily, Friends, Social Networks
Policy Context
Physical & Social EnvironmentHome, School, Community
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One-dimensional interventions may be One-dimensional interventions may be ineffective…ineffective…
Narrow Focus
WHY?
… Combined efforts can become multi-level
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Young People have to:
• Want to
• Think they can
• Overcome barriers
• Be reinforced
IndividualIndividual
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Families (Interpersonal)Families (Interpersonal)
Family interventions have not been greatly successful despite good evidence that support from parents, siblings, and peers is related to youth physical activity
Other approaches need further study:
• Reducing sedentary behaviours
• Transporting and paying for
activity programs
• Walking/cycling to school
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Physical & Social EnvironmentPhysical & Social Environment
“If you build it, they will come”…?
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• Use a solution-based approach - focus on solution rather than problem
• Connect science with advocacy efforts- i.e. frame issue as a story, backed up
with data
• Tailor communications to emphasize short-term benefits for policy-makers
PolicyPolicy
Policies have broad reach - housing, transportation, environment, economic
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Marrying Research and PracticeMarrying Research and Practice
Researchers and Practitioners need each other!!Researchers and Practitioners need each other!!
BEST PRACTICESBEST PRACTICES
EVALUATION
EVALUATION
Research
Promising Practices
Public Health
Promising Practices
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PROMISING PRACTICESPROMISING PRACTICES
Who or What Should We Target?Who or What Should We Target?
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Who and What Should We Target?Who and What Should We Target?
• Girls (& boys?)
• Mothers & Infants
• Pre-school children
• Active Play
• Active Transport
• Organized Activities
• Physical Education
• Sedentary Behaviours
WHO?WHO? WHAT?WHAT?
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The Home EnvironmentThe Home Environment
• Changing home environments to increase PA is challenging
Children should be encouraged to:
• go outdoors
• use active transport
• reduce screen time
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The School EnvironmentThe School Environment
Offers Several Opportunities for PA:
• School grounds
• After-school sports and activities
• Physical education programs, facilities
• Travel to and from
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• Crime (stranger danger, gangs, bullying)
• Too much traffic (school, neighbourhood)
• Cars drive too fast through neighborhood
• Inadequate sidewalks/bikeways on the route to school
• School is too far away
• Not enough time
• Child would be walking/biking alone to school
• Easier to drop off child on the way to work
• Child does not want to/like to walk or bicycle to school
Challenges to Active Commuting Challenges to Active Commuting
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The Community EnvironmentThe Community Environment
• Youth PA is influenced by urban design, especially proximity to destinations
More PA if youth live close to recreational facilities and school
• Venues and physical features of a location matter in determining:
What activity occurs Intensity of activity
• Novelties (e.g. markings, equipment, signs) can increase PA
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Social Factors are Potential MultipliersSocial Factors are Potential Multipliers
Creating activity-friendly environments may not be enough,…
But, more activity-friendly environments should
make individual programs more effective!
Social factors determine when and whether people will be exposed to specific physical environments
• e.g. Public spaces (parks, schoolyards) are used more when organized activities are available
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Support Healthier ChoicesSupport Healthier Choices
Create home and community environments thatCreate home and community environments that make healthful choices easy. make healthful choices easy.
AndAnd motivate and educate people to make those motivate and educate people to make those choices. choices.
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Create ‘Optimal Defaults’Create ‘Optimal Defaults’
Consider:Consider:
• Abundance – lots of opportunities
• Convenience – cost, proximity, etc.
• Choice – appealing to target group
Make Healthy Choices The Easy ChoiceMake Healthy Choices The Easy Choice
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VS.VS.
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VS.VS.
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Many Potential AlliesMany Potential Allies
HealthHealth• Emphasising benefits• Addressing costs
EconomicEconomic• Appraisal of health impacts
Transport / PlanningTransport / Planning• Alignment with targets e.g. road safety, congestion
IndustryIndustry• Alignment with product design, architecture, etc.
Climate ChangeClimate Change
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Community Capacity BuildingCommunity Capacity Building
• Leadership
• Organizational structures
• Partnerships
• Skilled workforce
• Resources
Creates ownership
Creates ownership
Improves sustainability
Improves sustainability
Helps decreaseHelps decrease
inequalities inequalities
Community capacity to promote PA
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Need many targets for intervention
• e.g. increasing physical activity and decreasing sedentary time are both recommended
Need multiple, complimentary approaches
• The complex interactions between social and built environments provide strong support for multi-level action
Need to aim for sustainability
• Involve many partners
Keys to SuccessKeys to Success
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What Impact Can You Expect?What Impact Can You Expect?
Certainty of Certainty of EffectivenessEffectiveness Population ImpactPopulation Impact
High
Moderate
Low
Low Moderate High
*** **** *****
** *** ****
* ** ***
* = least promising; ***** = most promising
Swinburn et al. Obesity Reviews 2005
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EvaluateEvaluate Process Process
EvaluateEvaluate Outcome Outcome
• Why was it successful/unsuccessful?
• Appropriate outcome measures?
• What are other implications of intervention?
• Were there unintended consequences?
• How can future interventions be improved?
Evaluate!Evaluate!
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SUMMARYSUMMARY
• Look for opportunities to be active throughout the ENTIRE day
• Make HEALTHY choices the EASY choices identifying the barriers to physical activity in your community
• Consider ways to target multiple “levels of influence”
• Improving physical structures alone may not change physical activity
• Social structures need to be in tune with physical changes
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• Don’t be discouraged by obstacles
• Small changes are good
• ‘Lighthouse’ interventions can be valuable
• Develop future programs based on best available evidence
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Physical Activity is Physical Activity is about having fun…about having fun…
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……this should not be lost!!this should not be lost!!
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ADDITIONAL ADDITIONAL RESOURCESRESOURCES
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more info available at: www.phe.queensu.ca/epi/obesity/index.htmwww.phe.queensu.ca/epi/obesity/index.htm
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Thanks to:Thanks to:
Canadian Fitness and Lifestyle Research Institute