Nutrition and Fitness Quick Facts on Nutrition and Fitness According to a recent study published in Obesity, over $3.5 billion of medical expenses in Massachusetts are due to adult obesity 1 All CHNA 22 schools have some type of wellness policy in their respective districts, but wellness committee information was not readily available. In 2011, MA Black adults were 43% more likely to be obese, and Hispanic adults were more likely to be obese than White adults. 7 More than 1/2 of adults in Massachusetts are obese. 6 76% of high school students in MA are not eating the recommended 5 or more daily servings of fruits and vegetables 2 More than three-fourths of adults in MA are not eating the recommended 5 or more daily servings of fruits and vegetables 3 July 2010: An Act Relative to School Nutrition was signed into law, making the MDPH and other agencies responsible for developing standards related to nutritional standards for school meals and other related measures 4 1 of 16
Nutrition and Fitness: Introduction Overview: In 2011, the Greater Brockton CHNA (CHNA 22) Steering Committee identified Nutrition and Fitness as one of the four areas of priority based on the 2010 Greater Brockton CHNA Community Health Needs Assessment. This decision was supported by the following key findings from that report: A lower percentage of CHNA residents age 18 and older (21%) reported consuming at least five fruits or vegetables per day than residents of the state overall, in the same age group. Approximately 36% of tenth-graders in Brockton, 38% in West Bridgewater and 41% in Stoughton were overweight or obese during the 2008-2009 school year. Approximately 31% of tenth-graders in the state overall were overweight or obese in that same time period. In community impression sessions several themes related to nutrition and fitness emerged, including: eating unhealthy foods due to an inability to afford healthy food or low-quality produce available in supermarkets barriers to physical activity such as the expense of after school activities for children, parents not wanting to let children outside due to fears of needles and trash on the ground, stranger danger, and playgrounds in poor condition. Key informants outside of Brockton indicated issues of: obesity in youth and adults lack of exercise among youth and adults lack of sidewalks or sidewalks in poor condition children not engaging in unstructured play parents have no time to fix healthy meals due to being stressed, working, or otherwise busy In this section you will find some proxy measures for nutrition and fitness including data about local accessibility to healthy food and fitness opportunities. In addition, you will find data about diabetes, as obesity is a significant factor in diabetes rates. 2 of 16
Nutrition and Fitness: Introduction Definitions: Age Adjusted Rate: A way to compare rates while adjusting for (designed to minimize) the effects of differences in age distributions for different populations. Age-adjusted rates are typically reported as per 100,000 persons (mass.gov) Body Mass Index (BMI): a numerical value calculated based on an individual s weight and height to determine body fatness (cdc.gov) - When BMI is calculated for youth, age and sex are taken into consideration, as body fat amounts change with age and differ between genders (cdc.gov) Obese (adults, BMI): an adult who has a body mass index (BMI) of 30 or higher (cdc.gov) Overweight (adults, BMI): an adult who has a body mass index (BMI) between 25 and 29.9 (cdc.gov) 3 of 16
Nutrition and Fitness: Data Youth Overweight/Obesity in Children, By School District, Grades 1, 4, 7, 10: 20115 All included school districts in the Greater Brockton CHNA have obesity rates of over 25%. Avon, Holbrook, Stoughton and Whitman-Hanson all report youth overweight / obesity rates higher than the state average. Abington and East Bridgewater did not submit data and Brockton s data was selected for further assessment and was therefore not available. Avon shows the highest percentage of overweight/obese children with 44%, and Easton reports the lowest percentage at 29.2%. The table below highlights three CHNA communities where their is significant differences between the percentages of overweight / obese male and female students. In three districts there is large gap between the percentage of males and females reporting overweight / obesity. Being overweight or obese can put a person at risk for certain health problems. An overweight or obese youth has an increased risk of developing serious conditions, including type 2 diabetes, heart disease, high blood pressure, and orthopedic problems. Town % Overweight/Obese Males % Overweight / Obese Females Easton 33.9% 24.5% Holbrook 47.8% 38.7% West Bridgewater 34.0% 25.4% MA 33.9% 30.6% 4 of 16
Nutrition and Fitness: Data Youth Overweight / Obesity Data by Grade and Town - 2011 5 The charts below represent data broken down by community and grade. For Brockton, only 2009 data was available 17. It is presented below to give a sense of the issue in Brockton. In 2011 in Massachusetts the rates for obesity / overweight by grade were: All grades 1,4,7, 10): 32.3%; Grade 1: 28.3%; Grade 4: 34.9%; Grade 7: 34.1%; Grade 10: 32.1%. Avon 50% 30% 20% 10% 0% 44% 47.6% 46.8% 41% Grades 1,4,7,10 Grade 1 Grade 4 Grade 7 Grade 10 50% 30% 20% 10% 0% Bridgewater-Raynham 30.8% 33.8% 34% 30.2% 23.7% Grades 1,4,7,10 Grade 1 Grade 4 Grade 7 Grade 10 Bridgewater-Raynham also reported on childhood weight data in 2009. The rate for all grades (1,4,7 &10) was 31.1% obese/ overweight, a slightly higher percentage than in 2011. 50% 30% 20% 10% 0% Brockton (2009) 40.3% 38.2% 42.7% 43.8% 35.5% Grades 1,4,7,10 Grade 1 Grade 4 Grade 7 Grade 10 50% 30% 20% 10% 0% 29.2% 24.8% Easton 35.4% 22.8% 32.4% Grades 1,4,7,10 Grade 1 Grade 4 Grade 7 Grade 10 5 of 16
Nutrition and Fitness: Data Holbrook 50% 30% 20% 10% 0% 48.2% 43.4% 46.2% 42.9% 35.2% Grades 1,4,7,10 Grade 1 Grade 4 Grade 7 Grade 10 50% 30% 20% 10% 0% Stoughton 45% 38.7% 41.5% 32.2% 35.8% Grades 1,4,7,10 Grade 1 Grade 4 Grade 7 Grade 10 Stoughton also reported on childhood weight data in 2009. The rate for all grades (1,4,7 & 10) was 38.7% obese/overweight, the same percent as in 2011. 50% 30% 20% 10% 0% West Bridgewater 38.1% 29.9% 26.1% 26.4% 27.4% Grades 1,4,7,10 Grade 1 Grade 4 Grade 7 Grade 10 West Bridgewater also reported on childhood weight data in 2009. The rate for all grades (1,4,7 &10) was 38.7% obese/overweight, the same percent as in 2011. 50% 30% 20% 10% 0% Whitman-Hanson 38.7% 43.5% 39.6% 33.1% 38.2% Grades 1,4,7,10 Grade 1 Grade 4 Grade 7 Grade 10 6 of 16
Nutrition and Fitness: Data Adults Overweight/Obese Adults, Age 18 and Older, 2008-2010 8 CHNA including Brockton State Rates of overweight/obesity among adults in the CHNA area are similar to the State rates. Diabetes Several indicators for Diabetes are included in this section of the assessment. Diabetes is included as a way to consider the consequences related to poor nutrition and lack of physical activity, as these are both risk factors for pre-diabetes and Type II Diabetes. Moreover, good nutrition and physical activity are important factors in managing diabetes. Ever Diagnosed with Diabetes, Adults 18 and Older, 2007-2009 /2008-2010 11 2007-2009 2008-2010 A slightly greater percentage of individuals (age 18 and older) among the CHNA have been diagnosed with diabetes when compared to the state from 2008-2010. Between 2007-2009 the percentage of adults ages 18 and older in the Greater Brockton CHNA area ever diagnosed with diabetes was approximately 8%, as was the state average. Since that time, the rate among CHNA residents has increased to 9.4%, an 18% increase (2008-2010). In the past ten years, the percentage of adults with a diabetes diagnosis in Massachusetts has increased 28% (5.8% in 2000 vs. 7.4% in 2010). 10 7 of 16
Nutrition and Fitness: Data Hospitalizations for Diabetes, All Ages, 2007-2009 9 2006-2008 2007-2009 Between the years of 2007 and 2009, hospitalizations for diabetes among Brockton and the other CHNA towns were higher when compared to the state s overall numbers. The City of Brockton has experienced an increase in hospitalizations for diabetes when compared to the previous 2-year time period of 2006-2008 as shown in the table below. The rates for the rest of the CHNA and the State overall decreased in that same time period. All rates are Age Adjusted per 100,000. 8 of 16
Nutrition and Fitness: Data Emergency Department Visits for Diabetes, Greater Brockton CHNA, All Ages, 2006-2008 / 2007-2009 12 2006-2008 2007-2009 Emergency department visits for diabetic individuals were also higher for individuals in Brockton than the remainder of the CHNA towns as well as the state. Similar to hospitalizations, between the years of 2007 and 2009, emergency department visits for diabetes among Brockton and the other CHNA towns were higher when compared to the state s overall numbers. The City of Brockton has experienced an increase in emergency department visits for diabetes when compared to the previous 2-year time period of 2006-2008 when the rates for the rest of the CHNA and the State overall decreased in that same time period. All rates are age adjusted per 100,000. Hospitalization for Diabetes by Race/Ethnicity, All Ages, 2006-2008 / 2007-2009, Greater Brockton CHNA 13 2006-2008 2007-2009 Disparities exist when examining hospitalization rates for diabetes by race / ethnicity as there have been increases in hospitalizations for diabetes for all groups except White Non-Hispanics. 9 of 16
Nutrition and Fitness: Key Informants What are Key Informants saying about Nutrition and Fitness? Obesity was identified as a top community concern in the 2012 Good Samaritan Medical Center Population Health Improvement Report by both survey respondents and focus group participants 14 CHNA focus group participants and Good Samaritan focus group participants both identifies limited availability of fresh and healthy foods as a local challenge to proper nutrition Good Samaritan focus group participants identified the need for increased availability of public benefits to address the food availability issue Both the Brockton COA and VNA offer blood glucose screenings Brockton and Stoughton have higher incidences of diabetes when compared to the nation In Avon, some children have never eaten healthy foods, such as clementines. Stoughton COA offers specialty workshops on diabetes Abington: diabetes is a prevalent issue among seniors Holbrook has the second highest rate of obese and overweight students within the CHNA 22 service area - a lack of funds has made it difficult to replace broken/worn out equipment, making it difficult for students to participate in physical activity 10 of 16 Whitman has experienced an increase in the prevalence of diabetes.
Nutrition and Fitness: Data While physical activity is not restricted to the gym, looking at the number of fitness centers and gyms may give a sense for access to places to exercise. What is not included are costs of gyms and if scholarships or reduced cost memberships are available. It was beyond the scope of this report to analyze available green spaces or even safe sidewalks in communities where individuals can walk, run and play. However, these issues were addressed by focus groups and key informants. Gyms and Fitness Centers, Greater Brockton CHNA Town Number of Gyms Residents per Gym Abington 3 5,328 Avon 0 n/a Bridgewater 5 1,568 Brockton 8 11,726 Easton 9 2,568 East Bridgewater 5 2,759 Holbrook 3 3,597 Stoughton 7 3,852 West Bridgewater 3 2,305 Whitman 0 n/a 11 of 16
Nutrition and Fitness: Data Food Deserts in the Greater Brockton CHNA Area This map illustrates areas that are designated as Food Deserts in the Greater Brockton area. A Food Desert is defined by the United States Department of Agriculture (USDA) as a low-income census tract where either a substantial number or a share of residents has low access to a supermarket or a large grocery store. 15 Areas in green represent low-income census tracts where a significant number or share of residents is greater than 1 mile (in urban communities) from the nearest supermarket. The areas in blue represent census tracts with a poverty rate of 20% or higher, or tracts with a median family income of less than 80% of median family income for the state or metropolitan area. According to a February 2011 report Food for Every Child by the Food Trust, Brockton was identified as an area that was in crisis due to the lack of fresh, healthy food. In a statewide survey, only twenty percent of the population in the Greater Brockton area percentage of reported that they consumed at least five servings of fruits or vegetable per day than the state overall (20.9% vs 26.9%). 16 Farmer s Markets in the Greater Brockton CHNA Area Dates WIC Accepted EBT/SNAP Accepted Abington Farmer s Market Every other Saturday, July-September No No Brockton City Hall Plaza Fridays, July-October Yes Yes Brockton Fairgrounds Saturdays, July-October Yes No Easton Farmer s Market Tuesdays and Saturdays, May-October Yes Yes Stoughton Farmer s Market Saturdays, June-October Yes Yes Both Brockton and Stoughton are deemed high-risk towns by the Women, Infants and Children program (WIC) which provides nutrition assistance to low-income families with young children. 17 12 of 16
Nutrition and Fitness: Focus Group Themes Participants identified Barriers to Healthy Eating: Cost Geography/proximity to healthy food options Time: Go for what is quickest and it s not always the healthiest Lack of education on how to shop, prepare produce; portion sizes Learning how to figure out carbs and sugars Participants identified things that make it easier to be Physically Active: Love of walking Availability of parks and sidewalks Support of peers and family (to be physically active) Culture of walking in one s neighborhood Participants identified Barriers to Physical Activity: (Not having) Self-motivation and discipline Time: I work two jobs, [there s] not enough time or I m too tired Poor sidewalks, no safe place to walk: We actually drive to the high school to walk the track 13 of 16
Nutrition and Fitness: Policy Change Local Examples of Policy Change for Nutrition and Fitness Town Area of Focus Policy Change Abington Nutrition Farmer s Market Avon Physical Fitness BOKS program before school to increase student physical activity Brockton Nutrition Farmer's Market accepts WIC and EBT/SNAP at one of the city s markets Physical Fitness Nutrition Nutrition Hillstrom Farm Park clean up and revitalization as blueprint for claiming undeveloped and vacant parts of the city for safe recreation Community Gardens Project VNA and COA offer blood glucose screenings Easton Nutrition Farmer's Market accepts WIC and EBT/SNAP Nutrition / Physical Activity Nutrition Collaboration between Children s Museum and Signature Healthcare/ Brockton Hospital for exhibits on healthy eating and increasing physical activity for children and families No vending machines in schools except for water Physical Activity Envision Easton, Easton s Master Planning Process includes plans for increasing walkability and biking in the community Stoughton Nutrition Farmer's Market accepts WIC and EBT/SNAP Nutrition/Physical Activity Physical Activity Diabetes Prevention Class is offered at the local YMCA; individuals can be referred by physicians Expansion of walking paths at Halloran Park / CAPP playground Physical Activity Nutrition Physical Activity Storywalk Trail implemented in town conservation area to increase family use of trails Community Gardens Project at Youth/Senior Center and Low Income Housing Complex Creation of the Transportation Task Force to address local issues of walkability and biking and align with Stoughton Master Planning process Whitman Nurtrition Schools are following all state dietary / nutritional guidelines for student meals. 14 of 16
Nutrition and Fitness: Conclusions Access to Healthy Foods: Individuals in focus groups discussed access to healthy foods, including geography and proximity as issues. These comments are validated, particularly in Brockton by the map of food desert areas and lack of grocery stores in low income areas. This is an area of need that could be addressed through collaborations and environmental change. Between July and October, the Brockton Farmer s Markets may provide increased access to healthy foods for residents that live in food desert areas. Culture: An area of need for additional data and exploration is the role of culture in nutrition and physical activity for local residents as there are many different cultures in the CHNA 22 area. Youth Data: The Youth Risk Behavior Survey (YRBS) is an instrument that collects data on youth nutrition and physical activity habits, including screen time. See the discussion in the section on Substance Abuse for additional recommendations related to this survey tool. Currently only two communities reported YRBS data to the CHNA: Avon and Stoughton. This data could be examined alongside BMI data that is collected by school districts to look for links between nutrition and physical activity habits and rates of overweight / obesity. Community Planning: Both rural and urban communities are represented in CHNA 22. These differing types of communities present different issues in terms of perception of safety and safety issues, green space, access to gyms, access to supermarkets and other strategies. Individual communities, through Master Planning Processes, community coalitions, etc. are beginning to look at including walking and biking in road and transportation planning, as well as safe routes and connections to schools, parks and local businesses. Currently the Towns of Stoughton and Easton are engaged in Master Planning Processes and both include components that are related to walkability, bike ability, and green spaces and recreation as well as other community planning components. 15 of 16
Nutrition and Fitness: Notes 1. Trogdon, JG, et al. 2012 2-3. 2011 MA BRFSS (Behavioral Risk Factor Surveillance Survey) 4. An Act Relative to School Nutrition. (2010, July 30). In Session Laws: CHAPTER 197 of the Acts of 2010 - malegislature.gov. Retrieved February 13, 2013, from http://www.malegislature.gov/laws/ SessionLaws/Acts/2010/Chapter197 5. Information extracted from The Status of Childhood Weight in Massachusetts, 2011: Preliminary Results from Body Mass Index Screening in Massachusetts Public School Districts, 2009-2011. December 2012. 7. 2011, Massachusetts BRFSS 6. Massachusetts Department of Public Health, 2013 8, 9, 11-13. MassCHIP Data. Retrieved in 2013 from The Official Website of the Executive Office of Health and Human Services. Copyright 2014, Commonwealth of Massachusetts. 10. 2000 and 2010 MA BRFSS 14. 2012 Population Health Improvement Report. Generated by Good Samaritan Medical Center, a Steward Family Hospital 15. Information extracted from United States Department of Agriculture, Economic Research Service, Food Access Research Service Retrieved March 25, 2014 from: http://www.ers.usda.gov/data-products/ food-access-research-atlas/go-to-the-atlas.aspx#.uzhzqtzjruo 16. 2011 Food for Every Child. Retrieved 2013 from: http://www.mphaweb.org/documents/ FoodforEveryChild_Massachusetts.pdf 17. 2010 Greater Brockton Community Health Needs Assessment. Retrieved 2013 from: www.chna22.org 18.2009 The Status of Childhood Weight in Massachusetts, 2009. Massachusetts Department of Public Health