Learning Objectives. Raising a Healthy Child: Tips for Healthy Eating and Physical Activity. Presenter Disclosure Information

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1 Presenter Disclosure Information 9:45 10:30am Raising a Healthy Child: Tips for Healthy Eating and Physical Activity SPEAKER Wendelin Slusser, MD, MS The following relationships exist related to this presentation: Wendelin Slusser, MD, MS: No financial relationships to disclose. Off-Label/Investigational Discussion In accordance with pmicme policy, faculty have been asked to disclose discussion of unlabeled or unapproved use(s) of drugs or devices during the course of their presentations. Raising a Healthy Child: Tips for Healthy Eating and Physical Activity Wendy Slusser, MD, MS, Associate Vice Provost, Healthy Campus Initiative Health Science Clinical Professor Director, UCLA FIT for Healthy Weight Program Mattel Children s Hospital UCLA UCLA Schools of Public Health and Medicine Learning Objectives Identify three strategies to promote healthy eating and physical activity among infants, children, adolescents and families. Identify three community strategies to promote healthy eating and physical activity among infants, children and adolescents and families. 25% Obese* Children in the U.S. (*BMI 95th percentile) 35.00% Obese and Overweight* Children 2-5 years old in the U.S. by race (*BMI 85th percentile) 20% 30.00% 25.00% 15% 10% 6-11 years old years old 20.00% 15.00% % 10.00% 0% & % Source: Ogden,CL et al., JAMA. 2010;303(3): ; JAMA. 2012;307(5): ; JAMA 2014;311(8): % All race Non-Hispanic White Non-Hispanic Black Non-Hispanice Asian Hispanic From: JAMA. 2010;303(3): ; JAMA. 2012;307(5): ; JAMA 2014;311(8):

2 30 Years Ago Coffee (with whole milk and sugar) COFFEE Today Mocha Coffee (with steamed whole milk and mocha syrup) Maintaining a Healthy Weight is a Balancing Act Calories In = Calories Out 45 calories 8 ounces Calorie Difference: 305 calories 350 calories 16 ounces How long will you have to walk in order to burn those extra 305 calories? Background of the Overweight Problem Rapid rate of increase of overweight over the last two decades Risk of an overweight child becoming an overweight adult Rise in co-morbidities Background of the Overweight Problem Rapid rate of increase of overweight over the last two decades Risk of an overweight child becoming an overweight adult Rise in co-morbidities Associated Morbidities Overweight children have higher risk of developing: non-insulin dependent diabetes gallbladder diseases sleep apnea asthma mental disorders high blood pressure Musculoskeletal complaints Poor school performance Focus is on basic healthy lifestyle eating and activity habits Minimize Sugar-sweetened beverages with a goal of 0**. Increase meals prepared at home**. Education and modification of portion sizes** Reduction of inactive time to < 2 hours/day and if less than 2 years old to 0 time**. Increasing active time for children and families to >=1 hour each day**. Involve the whole family in lifestyle changes. Cultural sensitivity ** = strong evidence From: Expert committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Pediatrics, 2007.

3 Focus is on basic healthy lifestyle eating and activity habits Increasing to 5 fruit and vegetable servings or more per day*. Reduction of 100% fruit juices*. Consume a healthy breakfast*. Reduce foods that are high in energy density *. Meal frequency and snacking *. Involve the whole family in lifestyle changes. Cultural sensitivity From: Expert committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Pediatrics, *weaker evidence, but may be important for some individuals Education and Support: the Blastoff! 5: or more fruit and vegetable servings per day 2: No more than 2 hours of screen time per day for 2 year olds and over and 0 time for under 2 1: year or more of breastfeeding with appropriate foods introduced at around 6 months. 0: sweetened beverages Blastoff: Move, be active and have fun! At least 5 fruit and vegetable servings per day Adolescent Fruit and Vegetable Servings by Frequency of Family Meals. Offer healthy choices at school, home, and team sporting events Model healthy eating behaviors Practice eating family meals From: choosemyplate.gov, accessed From: Neumark-Sztainer D, et al. J Am Diet Assoc. 2003;103(3): Mean Total Fruit and Vegetable Serving Frequencies in One Day Pre and Post Salad Bar Intervention in three LAUSD Elementary Schools From: Slusser WM, Cumberland WG, Browdy BL, Lange L, Neumann C. Public Health Nutr. 2007; 10(12): or less hours of television viewing Strategies Choose as a family 1-2 hours of television shows to watch and then turn off the TV when desired shows are finished Remove television and/or computer from child s bedroom From: Prevention of Pediatric Overweight and Obesity. Policy statement from the Committee on Nutrition PEDIATRICS Vol. 112 No. 2 August 2003, pp

4 AAP Recommendation 0-2 years old: no television >2 years old: <2 hours/day of TV and other entertainment media What can you do to support social justice and prevent obesity? Answer: Breastfeeding Support women who live in poverty to breastfeed: it provides equal opportunities for infants to grow and develop optimally. From: Children, Adolescents, and Television (RE0043), Committee on Public Education 4/1/ or more years of breastfeeding Key points for support: Pregnancy Newborn period 3-5 days of age One month old Mother going back to work Resource ding Infant Benefits from Breastfeeding Optimally Reduced Risk of Disease AHRQ, 2007 From: Gartner L, Eidelman A, and Pediatrics Section on Breastfeeding. Breastfeeding and the Use of Human Milk 2005;115; Biological Theories of Why Breastfeeding: Reduces the Risk of Childhood Obesity Infants-studies under way to evaluate: Infants self-regulate at the breast Different feeding patterns & maternal behavior Breastfeeding mothers are less controlling of the child s feeding at one-year Reduced risk for early growth acceleration Leptin, ghrelin, adiponectin considered to play a role Reduces the risk of obesity by 4% for each month of breastfeeding Conclusions The evidence for the association is nearly all epidemiologic, so it is difficult to tease-out true causality. Epidemiologic criteria: temporality, dose-response effects and reasonably good consistency of findings. Biologic explanation is more tentative. Communication with Larry Grummer-Strawn, PhD Chief Nutrition Branch, CDC, 2011 Dewey, K. Is breastfeeding protective against child obesity? J Hum Lact Feb;19(1):9-18; Ip S et al (2007) Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. accessed ; Miralles O et al A physiologic Role of breast milk leptin in body weight control in developing infants.obesity. 2006;14(8):

5 Pop quiz How can hospitals and employers save money, reduce hospital infection rates, reduce disparities, and attract new patients and employees? Answer: Baby Friendly Baby Friendly Hospital (220 BFH in US, 58 in CA) Baby Friendly Workplace Baby Friendly Daycare From: Institute of Medicine (IOM) Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press Baby Friendly Work Place sweetened drinks and Education and modification of portion sizes Set up lactation rooms USDA MYPlate From: choosemyplate.gov Focus on 1-2 changes/month Modification of fruit juice and sugary drink consumption Eliminate soda Limit juice to half a cup per day Reducing milk to 1% fat after 2 years old Limit high fat food Review portion size 4/1/ What can you do that: is fun makes you feel good improves your health makes you look younger is free Blastoff! families Increasing active time for children Access to Parks: ie safety, location, fitness zones CDC Recommendation 60 minutes of moderate exercise per day Aerobic activity Muscle Strengthening Bone Strengthening From:

6 Increasing active time for children and families Become a role model and incorporate physical activity into daily activities. Increasing active time at the work site Incorporate physical activity into daily activities From: Cultural Openess Strategies Follow the ABCs of counseling Active listening Body language (no barriers) Caring and open mind Parenting Skills: Giving Commands (try and exercise) Routines Praise From: Slusser W and Kroeger M (1992) in Woodward-Lopez G and Creer AE lactation Management Curriculum: A Faculty Guide for Schools of Medicine, Nursing, and Nutrition. Third edition, 1995 UCSD and start International. Nutrition During the Life Course Optimal Compromised Prenatal Breastfeeding education No breastfeeding education Infant Introduce solid foods at 6 months Continues to Breastfeed >= 1 year Toddler Change to 1% milk TV watching < 2 hours per day Preschool Drinks 1/2 cup of juice per day (2-5) Physical activity 60 minutes per day Elementary Infrequent soda consumption (6-12) Frequent family meals Middle & Infrequent fast food meals High School (13-18) Introduce solid foods at 4 months or younger No breastfeeding Continues to drink whole milk TV watching > 2 hours per day Drinks >1 cup of juice per day Physical activity 30 minutes per day Drinks 1 or more sodas per day Infrequent family meals Frequent fast food meals Health and Developmental Outcomes Healthy Campus Initiative Envisioned and Supported by Jane and Terry Semel Make the Healthy Choice the Easy Choice As Chancellor Block said in honor of UCLA going smoke free on Earth Day last spring: In order to take care of the Earth, we must take care of ourselves.

7 What are the Healthy Campus Initiative Core Values? High level wellness maximizing the potential of individuals Media Deans Organizations & Institutions Community/Neighborhood Friends/Family Law Chancellors Personal responsibility Diversity freedom and autonomy social groups define health differently; however they define it is right Public Parks Health Care Providers Coworkers Student, Staff, Faculty Friends Community Popular leaders Culture Equity strive to reduce health disparities as much as possible Neighbors Integrative Body, mind and spirit are mutually influencing and emerge in a communal context Family Culture Professors Family Farmers Employers Universities 51 Public Policies In order to Live we aim to: Integrate Integrate Educate Support Grow Inspire Mindwell, Eatwell, Bewell, Movewell, Breathwell Future and Current Leaders in our community. Our graduates who will lead us in the future to Live. And share our work with our local, state, national and international community. Healthful living through creating a campus where the healthy choice is the easy choice Breathe Be Move Live Mind Eat UCLA FI UCOP GFI UCLA Hospital System Medicinal Garden Planted in front of the Ronald Reagan Medical Center and the Mattel Children s Hospital, UCLA UCLA Vending Machine Evaluation 55

8 UC Global Food Initiative The UC Global Food Initiative addresses one of the critical issues of our time: How to sustainably and nutritiously feed a world population expected to reach eight billion by UCOP Global Food Initiative We are providing Mentorship Templates lessons learned from the past and on-going UCLA HCI experiences that include food procurement, menu preparation, healthy vending, and models from our collaborations within the LA Community. UC Global Food Initiative website We are collaborating with a wide array of campus units to work on research to policy endeavors. With realization of one s own potential and self confidence in one s ability, one can build a better world. Dalai Lama Haiku by Samuel Bruce, 3 rd Grader May 2002 Fruit comes from flowers Fruit is very good to eat I like to eat fruit