Childhood Obesity. Part 2
The purpose of this paper is to provide the first evaluation of the short-term outcomes of Healthy for Life and explore its effect on the contributory causes of childhood obesity. It is hypothesized that there would be a significant difference between pre and post BMI, Rosenberg self-esteem scores, and eating and activity behaviors for participants.
Methods
Program Description
Healthy for Life focuses on three main areas: the school environment through the School Health Index (SHI), physical activity, and nutrition. The SHI is an instrument created by the CDC to guide schools in evaluating and improving opportunities for physical activity and healthy nutrition for their students (CDC, 2007). The implementation of the SHI is in its initial stage; thus only the physical activity and nutrition components will be presented in this paper.
The physical and nutrition education components are specifically tailored for children in preschool and elementary school and for adolescents in middle and high schools. The physical education component teaches students the importance of being physically active. The Sports, Play and Active Recreation for Kids (SPARK) curriculum is used for the preschool and elementary students with lessons incorporated into their school day. Game cones, nylon rope, scooters, beach balls, foam and koosh balls, paddles, hoops, a 20-foot parachute and a crawl tunnel are supplied to the younger students as part of the SPARK curriculum. For the middle and high school students, the program is offered as a graded physical education (PE) class and the Fitness for Life textbook is used as a base for the curriculum. The fitness equipment for middle and high schools includes body bars, dumb bells, jump ropes, lower body bands, exercise tubing and exercise balls. As part of the physical activity curriculum, a certified kickboxing instructor leads a kickboxing workout session twice a month for the students. Each school is provided with the fitness equipment required for the program at no cost.
The nutrition education component of the program is incorporated into the PE class and aims to equip the students with knowledge that will enable them to make healthier eating and lifestyle choices. In addition to the class, a registered dietician provides two hour-long nutrition presentations to the students after school.
For preschool and elementary students the presentations are specifically targeted for their parents who are encouraged to attend the lectures, offered in English and Spanish. The lessons and lectures are based on a variety of topics including the importance of eating breakfast daily, increasing vegetable and fruit consumption, methods on how to prepare cultural meals healthier, minimizing the consumption of foods that are high in fat and sugar, eating out healthy, how to read a nutrition label, and portion distortion. A laptop computer is provided to each participating middle and high school to ensure access to a computer.
Childhood Obesity. Part 1
The adverse physical and psychological impacts of childhood obesity are well established. Overweight/obese children are at an increased risk of developing chronic diseases such as type II diabetes, premature cardiovascular disease, hypertension, sleep apnea, orthopedic problems, hyperlipidemia and fatty liver disease (Körner et al., 2008). Childhood obesity is also highly correlated with psychological distress. Obese children are stigmatized by their peers, and even by parents and teachers, as early as age three (Puhl & Latner, 2007). Furthermore, children who are teased, because of their weight are two to three times more likely to have suicidal ideation and attempts compared to those who are not teased (Eisenberg, Neumark-Sztainer, & Story, 2003).
Obese adolescents who are rejected by their peers may also develop serious psychological distress, which manifests itself as low self-esteem, depressive symptoms, loneliness, anxiety, poor adjustment, and disruptive disorders (Prinstein, Boergers, & Vernberg, 2001; Storch & Masis-Warber, 2004).
The causal pathways of obesity are multifaceted and although sedentary lifestyles and excess caloric intake are the primary drivers of the epidemic, these are mediated by genetic, socioeconomic, and environmental variables (Barry, Brescoll, Brownell, & Schlesinger, 2009). Socioeconomic status, for instance, is an important predictor of childhood weight status. Adolescents aged 15-17 living in families below the federal poverty level have an obesity prevalence 50% higher than adolescents living above 200% of the poverty level (23.3% versus 14.4%, respectively) (Miech et al., 2006). Low socioeconomic status may influence weight status through a variety of environmental factors such as neighborhood safety, lack of access to parks and recreation, and the affordability and availability of healthy foods (McKay, Bell-Ellison, Wallace, & Ferron, 2007).
Schools are an ideal setting for obesity interventions because children spend a significant portion of their time in school. The school environment also has the potential to positively influence students’ dietary and exercise patterns, establishing behavior change, which may persist into adulthood (Lytle, Seifert, Greenstien, & McGovern, 2000). Researchers have proposed integrating obesity reduction programs into existing physical education programs (Sharma, 2006). Schools located in disadvantaged neighborhoods, however, may not possess the necessary resources to implement such programs and are often overlooked (Sharma, 2006). Healthy for Life, a school-based childhood obesity reduction program, is an innovative intervention that is offered at no cost to schools.
Healthy for Life is designed to emphasize lifelong fitness and promote healthy eating behaviors among children and adolescents regardless of their weight status. The program was first launched as PE4ME by the American Academy of Pediatrics, CA Chapter 4 in 2004 in three schools. In 2008, PE4ME was implemented as Healthy for Life and was expanded to 51 schools through a partnership with St. Joseph Health System (SJHS). SJHS is a 15 hospital non-profit Catholic healthcare system that is driven by the long-term goal of ensuring that the communities it serves are among the healthiest in the US. The initial approach to achieve this goal is to address the childhood obesity epidemic through the implementation of Healthy for Life in schools across Orange County, CA.
Childhood Obesity. Introduction
Childhood obesity is a growing public health concern in the United States that disproportionately affects disadvantaged youth. The purpose of this study is to evaluate the effect of the Healthy for Life program on childhood overweight and obesity and its impact on lifestyle behaviors that promote lifelong fitness and healthy eating among children and adolescents. The program was offered as a physical education class mostly in schools in underprivileged areas across Southern California. Classes were specifically tailored for children in preschools, elementary, middle, and high schools. In addition to an initial screening physical conducted by a physician, program staff conducted anthropometric measurements three times in the school year. Lifestyle behaviors and self-esteem were also evaluated. Fifty-one schools and 1,469 students enrolled in the program. BMI decreased significantly for students at or above the 85th percentile. Students also demonstrated significant improvements in self-esteem scores and indicators for lifestyle behavior. Healthy for Life has important implications for health practitioners. The program has the potential to improve the health of underprivileged youth whose neighborhoods are unsafe and often lack facilities for exercise. Furthermore, it provides a safe, accessible, no cost, and effective method to minimize some of the causal factors of obesity.
The proportion of children in the United States who are overweight or obese has reached alarming rates. According to the Centers for Disease Control and Prevention (CDC, n.d.), overweight is defined as a sex specific body mass index (BMI)-for-age between the 85th and 94th percentile and obese as the 95th percentile and above. Results from the National Health and Nutrition Examination Survey (NHANES) indicated that from NHANES II (1976-1980) to NHANES 2003-2004, the prevalence of overweight for children aged 2–5 years increased from 5.0% to 13.9%; for those aged 6–11 years, prevalence increased from 6.5% to 18.8%; and for those aged 12–19 years, prevalence increased from 5.0% to 17.4% (National Center for Health Statistics, 2006). It is currently estimated that 33.6% of children are considered overweight or obese with 17.1% of these classified as obese (Ogden et al., 2006). The childhood obesity rate in California mirrors that of the nation. The California Health Interview Survey (CHIS, 2007) indicated that 27.7% of adolescents aged 12-17 years are overweight or obese and 11.2% of children under the age of 12 are obese.
Obesity in childhood, particularly in adolescence is a key predictor for obesity in adulthood (Mamun, Hayatbakhsh, O'Callaghan, Williams, & Najman, 2009). Obese children have a 70% chance of becoming obese adults, which increases to 80% if one or more parents are obese (U.S. Department of Health & Human Services, 2009). It is also more prevalent among racial/ethnic minority groups and low-income groups. For instance, an estimated 41.4% of Mexican American children aged 2-19 are overweight or obese, of which 20% are obese (Ogden et al., 2006). In addition, Mexican American children have greater increases in body weight over the course of development relative to other racial/ethnic grou
The Future of Naturopathic Medicine.
This is a monumental success for the naturopathic profession. The federal government now officially recognizes naturopathic medicine as one of 965 recognized occupations and defines the key features of this “occupation” by using a standardized, measurable set of variables. The outdated Department of Labor definition of “Naturopathic Doctor” is now null and void. This independent data will be updated on a regular basis for employers, prospective students, and educators. The new defi¬nition will stand as a cornerstone for our work to advance the profes¬sion in the following ways.
••Advocating for inclusion in all federal loan repayment programs, on par with graduates of conventional medical programs, to support naturopathic medical graduates as they pursue opportu¬nities to support underserved populations. Legislation enumer-ating inclusion in the Indian Health Service loan repayment program is now moving forward in Congress.
••Advancement of state licensing efforts. Efforts in Pennsyl¬vania, New York, Massachusetts, and a host of other states will continue in 2010 and beyond as we aggressively seek regulation in all 50 states.
••Expansion of Scope of Practice. In the past 2 years several licensed jurisdictions have been successful in expanding the naturopathic scope of practice, and these efforts will continue.
••Inclusion in employer-funded, state-sponsored, and federal healthcare programs. The expansion of Medicaid, creation of ©2009 Natural Medicine Journal 2(1),state-based insurance programs with the pending insurance reform legislation, and the expansion of wellness programs by self-insured employers will create enormous demand for the skills of naturopathic physicians who are perfectly qualified to provide primary care and address the needs of people suffering from chronic disease.
Each of the individual professions in the field of integrative medicine has similarly worthy and essential legislative and regulatory agendas. And we now have a unique opportunity to pursue a parallel intention that reflects our interconnectedness and vision. If you see the glass as half empty on the eve of passage of “insurance reform” legislation, you might fear we’ve lost our chance for real reform where everyone has uniform, cost-effective coverage for services that will improve their health. While very far from perfect, this legislation sets the stage for creating the new paradigm we seek—over the long term. And while we have virtually no control over the result of this effort, one thing is absolutely certain: Each of us as individuals, our professional associa¬tions, and indeed the collective commitment of our united collabora¬tions have an obligation to be the voice of sustainable healthcare and personal empowerment—for the sake of generations to come.
The Future of Naturopathic Medicine. Introduction
Throughout 2010, the American Association of Naturopathic Physi¬cians (AANP) celebrates its 25th Anniversary. Looking forward in this New Year, one must wonder what future the US Congress is divining as it struggles to reform our current healthcare system. It is likely that the Senate and House of Representatives will successfully complete a conference on healthcare reform legislation and send President Obama a bill to sign into law. Will this bill be good for patients, or has compro¬mise forced decisions that will do little to effect change?
If you have a glass half-full mentality, you understand that the virtue of patience can yield amazing opportunities. This can be the first step on the road to reform. Perhaps forcing millions more into a failing system will accomplish two things. First, people will not be at risk for losing life savings, they will no longer avoid going to the doctor for life-threatening conditions, nor will they be forced to rely on their local emergency room for healthcare. Second, in the matter of a few short years, the experts who continue to assert that our system is unsustain¬able might be proven correct. It is likely we will witness a collapse that will force legislators into implementing true change. Regardless, the public is demanding ownership of their health and a return to wellness. A final vote in the House and Senate is not likely to quell their voice, nor will it fulfill the objectives of the American Association of Naturo¬pathic Physicians (AANP).
The AANP’s vision is to transform the healthcare system from disease management to health promotion by incorporating the prin¬ciples of naturopathic medicine. The mission of the AANP is to serve our members by advancing the profession of naturopathic medicine and preserving its integrity. The question of how the AANP shows up in the world, with our long-term commitment to creating sustainable healthcare, lies at the heart of each naturopathic physician’s practice and the work of the association itself.
While the number of licensed naturopathic physicians continues to grow, the AANP is working to further empower our public policy efforts by developing strong collaborative relationships with like¬minded organizations representing practitioners, patients, products, and environmental interests. Our external partnerships are diverse in nature and universal in intent.
The power of the AANP’s relationships enables pursuit of a broader agenda, one more fitting to the naturopathic philosophy. Working with likeminded groups adds voice to a larger, less parochial agenda. By teaming with this larger audience, we seek to establish a voice in the larger reform effort and the reengineering of healthcare reform proposals to embody a wellness model. In partnership with the associations in the natural products realm, the AANP actively advocates for passage of food stamp legislation and other public health initiatives aimed at significantly impacting health status for at-risk populations. As a leader in the Coali¬tion for Patient Rights, whose membership of 35 organizations repre¬sents more than 3.3 million providers, the AANP is advancing a unified message to expand consumer choice and access to qualified providers.
Our purpose for engaging in partnership is to support the rights of consumers to access highly qualified practitioners of their choice. The AANP honors the credentials of each of our partners, and we are strong advocates for practitioners’ rights to practice to the full extent of their abilities, education, qualifications, and legal authority. Our commitment to establishing standards for naturopathic medi¬cine is evidenced by our work to gain licensure in all 50 states and our efforts to establish recognition at the federal level. This fall, the US Department of Labor released a new definition of “naturopathic physician” in its Occupational Information Network System (the replacement for the old Department of Labor Dictionary of Occu¬pational Titles). The 2009 Department of Labor custom report for naturopathic physicians now defines members of our profession as as people who:
“Diagnose, treat, and help prevent diseases using a system of prac¬tice that is based on the natural healing capacity of individuals. May use physiological, psychological or mechanical methods. May also use natural medicines, prescription or legend drugs, foods, herbs, or other natural remedies.
Sample job titles include Naturopathic Physician, Naturopathic Doctor, Physician, and Doctor of Naturopathic Medicine.” (Occu-pational Information Network, 2009)