What s on the menu at the Ministry?

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1 What s on the menu at the Ministry? Dr Harriette Carr Public Health Medicine Specialist Ministry of Health PREPARED BY Dr Harriette Carr, Louise McIntyre, Diana O Neill, Virginia Mills, Martin Dutton, Elizabeth Aitken, Barbara Lusk

2 Ministry Menu Entrée: Nutrition The bread and butter (in moderation): Food and Nutrition Guidelines for: Healthy Children and Young People, and Healthy Older Adults o accompanied by a side order of Health Education Resources Seasonal Fare: Vitamin D and Sun Exposure Tasting Platter: Choking Review, Baby Bottles, Accompanied by the WHO Code of Breastmilk Substitutes

3 Ministry Menu continued Main: Obesity Latest Statistics (super-sizing available) Maternal and Child Nutrition and Physical activity RFP Other work - smorgasbord Dessert: Physical Activity Physical Activity Guidelines for Older Adults an old favourite Green Prescription as kiwi as pavlova

4 Entrée: Nutrition

5 Food and Nutrition Guidelines Latest Guidelines: Healthy Children and Young People 2012 Reviewed and updated Merged 2 earlier Guidelines Healthy Older People 2013

6 Average sugar and energy levels in fruit juice, flavoured milk, sugary drinks and sports drinks Type of drink Serve Sugar Energy (kj) g per 100 ml g per serve tsp per serve* Per 100 ml Per serve Fruit juice Glass (250 ml) Flavoured milk Glass (250 ml) Powdered fruit drink^ Glass (250 ml) Cordial^ Glass (250 ml) Fizzy drink Can (355 ml) Bottle (600 ml) Energy drink Can (250 ml) Bottle (600 ml) Sports drink Bottle (750 ml) Flavoured waters Bottle (700 ml) Source: Various (supermarket visit, New Zealand Food Composition Tables, websites) * 1 teaspoon of sugar = 4 grams (Athar et al 2006) ^ Made according to instructions on label.

7 Sugary drinks in children and young people Fruit Juice/Fruit drink 73% have fruit juice and fruit drinks 1+ /week One in 5 have fruit juice 7+/week Fizzy/soft drinks/energy drinks 51% have these 1+/week 14% of 5-9 year-olds 3+/week 25% of year-olds 3+/week 42% of year-olds 3+/week

8 Influence of the Home Environment Not just what we eat but how we eat Guidelines include practical advice for parents and caregivers Minimise distractions while eating e.g. TV Parental modelling of a healthy diet is associate with better diet in children including eating together as a family Involve children and young people in growing and preparing food -> improvements in quality of intake Regular household eating routine helps regulate appetite Portion Size Type of food available

9 Young People Behaviours change with age Increase High fat, sugar and/or salty foods such as takeaways High-sugar fizzy/soft drinks and energy drinks Meals in front of TV Alcohol Screen time Decrease Water and milk Breakfast Fruit Sandwiches/filled rolls Evening meal with others in household Mod/vig PA

10 Guidelines for Healthy Older People Updated with statistics from the 2008/09 Adult Nutrition Survey and published in hardcopy Focuses on the issues specific to older people Protein requirements increase with age Bread was the principal source of energy in the 2008/09 NZANS Older people more prone to the adverse effects of alcohol (changes in metabolism and influence of chronic illness) Includes considerations for Maori, Pacific and Asian older people Sections on micronutrients, frail elderly, food safety, and chronic disease

11 Evaluation of the Food and Nutrition Guidelines Series Completed end of 2011 Guidelines well received but opportunities to improve access and advice Developing plan/future design of guidelines Module based issue focused Prioritised based on new evidence and public and political interest External Advisory Group Currently developing shorter summary documents

12 Vitamin D and Sun Exposure General Population advice March 2012 Pregnancy and Infancy April 2013 Key Points Vitamin D impt for bone health Deficiency - rickets in children; osteoporosis and osteomalacia in adults Sources Sun, some foods, supplements Some sun exposure eg outdoor PA recommended (general population): between 10am -4pm May -August, before 10am or after 4pm Sept April High Risk partic darker skin or avoiding sun exposure; breastfed babies with darker skin, or a vit D deficient mother or sibling; pre-term babies. Supplements for those at high risk

13 Food-related choking in young children 0-2 Guidelines partially updated to include new choking advice. New section on MOH website on choking Always make sure babies and young children sit down while they eat, and that someone is with them while they are eating or drinking. Offer food that matches their chewing and grinding abilities. Be aware of foods which are more likely to cause choking and how to prepare them to reduce risk Parents and caregivers need to learn choking first aid and CPR.

14 WHO International Code of Marketing of Breast-milk Substitutes NZ government a signatory since 1983 Aim: safe and adequate nutrition for infants by protecting and promoting breastfeeding, and ensuring proper use of breast milk substitutes when necessary via adequate information and appropriate marketing and distribution. Evaluation: Evaluation completed in November 2012 Reports and summary of next steps available on MOH website:

15 Main: Obesity

16 2011/12 New Zealand Health Survey (Dec 2012) Over 1 million adults (>15yrs) in NZ now obese (28% of all adults) Rate steadily increased since 1997

17 New Zealand Health Survey Continuous Survey obesity statistics will be reported on an annual basis Regional results published on MOH website on 18 April 2013 Survey also collects data on fruit and vegetable consumption, TV watching and active transport in children.

18 Maternal and Child Nutrition and Physical Activity RFP

19 Office of Auditor General Performance Audit Undertaking a performance audit of childhood obesity Overarching question: Is the public service effectively working towards preventing and reducing obesity to improve children s health now and into the future? First part: Looks at how the Ministries of Health and Education and Sport NZ understand the extent of childhood obesity and what they are doing to prevent and reduce it Outcome a Report will be tabled in parliament June 2013 Second part will look at interventions delivered by these agencies

20 Proposed Work Weight Management Guidelines for Pregnant Women Links Weight Management Guidelines for Adults (excl pregnancy) and for Children

21 Dessert: Physical activity

22 Physical Activity Guidelines for Older Adults (Jan 2013) Based on review of evidence and key stakeholder consultation Recommendations: Be as physically active as possible and limit sedentary behaviour. Consult a health practitioner before starting or increasing PA Start off slowly and build up PA level Aerobic activity 5+/wk for > 30mins (mod intensity) and/or > 15mins (vigorous) Flexibility and balance x3 sessions, and muscle strengthening x2 sessions/wk Frail older adults may benefit from vitamin D tablets

23 Green Prescriptions GRx (including GRx Active Families) funding and management devolved to DHBs - July 2012 Ministry still provides national overview and administers annual satisfaction surveys Ministry receives DHB reports quarterly Adult referral target of 30,000 on track to be met or exceeded Children referred target of almost 700 will be met or exceeded Half of DHBs have included GRx in their 2013/14 annual plans under health promotion and education services and/or improving health behaviour

24 Thank you PREPARED BY Dr Harriette Carr, Louise McIntyre, Diana O Neill, Virginia Mills, Martin Dutton, Elizabeth Aitken, Barbara Lusk

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