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Unformatted text preview: Taking a Bite Out of Taking a Bite Out of Childhood Obesity By Joseph Clark, Katie Platt, Ralph Pignataro, Kevin Carey, & Rachel Wallace Background Information A Rising Epidemic in Children A Rising Epidemic in Children From the statistical sourcebook “A Nation at Risk: Obesity in the United States” From the statistical sourcebook “A Nation at Risk: Obesity in the United States” From the statistical sourcebook “A Nation at Risk: Obesity in the United States” The Problem A Big Fat Problem A Big Fat Problem
Policy Problem: Should the State of New Avery implement a policy to require the reporting of students’ Body Mass Index (BMI) on report cards as a measure to reduce childhood obesity? Analyst’s Problem: Determine the effectiveness of BMI report cards in reducing childhood obesity & increasing parental awareness and involvement.
– – – – Examine Alternative Policies Evaluate Costs & Benefits Determine Possible Implementation Problems and Externalities Investigate the Political Acceptability Legislative History The Law Gains Weight The Law Gains Weight
First Federal legislation – the year 2003 39 states have never considered BMI Legislation Considered in Alaska, Connecticut, Georgia, Iowa, Maine, New Jersey, New York, North Carolina, Oregon, South Carolina, & Texas Enacted in Arkansas, West Virginia, & Tennessee Political Environment What’s at Steak? What’s at Steak?
American Obesity Association Concerned Parents Worried Legislators Sociologists Pro BMI
Surgeon Generals Outspoken Governors Advocates for Nutrition & Activity, Public Health, & Health Policy Institutes Research Objectives Objectives Objectives
1. 2. What are the major causes of childhood obesity? Determine the effectiveness of implementing BMI report cards. 3. 4. 5. 6. 7. Identify alternative policies & examine their effectiveness. What are the individual, monetary, and social costs & benefits of requiring schools to include students’ BMI’s on report cards? What are the difficulties in implementation? What are the externalities and spillover effects of BMI’s? Do BMI report cards violate student rights to privacy? Is obesity reduced in children? Do parents become more involved? Are BMI tests accurate enough to properly categorize students who are measured? Research Design Outline of Informational Needs
Data Type – Background characteristics of obese children, the magnitude of the problem, causes & costs of childhood obesity, costs and benefits of BMI report cards, analysis of alternative policies, statistical charts, tables, graphs, news articles, empirical research, and program evaluations Research Design Research Design Sources of Data American Obesity Association, Archives for Pediatric and Adolescent Medicine, the Marshfield Clinic Research Foundation, Center for Disease Control & Prevention, the Deacon Hill Institute Research Design Methods Methods 1. 2. 3. 4. 5. 6. 7. Identify the factors causing childhood obesity using accredited medical sources. The effectiveness of BMI report cards in reducing childhood obesity and raising parental awareness by comparing the stated objectives before and after implementation. Evaluate the effectiveness of alternative policies by comparing the statistical results before and after implementation. Evaluate costs & benefits using data from previous BMI programs. Identify the implementation problems associated with BMI report card by scrutinizing previous programs. Discover the externalities by extrapolating information from previous BMI programs. Determine whether privacy rights of children are violated by critiquing previous legal arguments and ramifications of the BMI programs. Research Design Evaluative Criteria Evaluative Criteria
For BMI report cards to be considered effective, the stated results of the studies must show an increase in parental awareness of at least 30%, reduce the rate of childhood obesity by 3%, and an accuracy level of at least 70%. In order for alternative policies to be considered effective, obesity levels must decrease by 3% and BMI levels must decrease by 0.03%. Objective 1: Causes of Childhood Obesity Reporting of Results; Reporting of Results; Results Objective 1: Causes of Childhood Obesity
Eating Habits – over consumption of highcalorie foods, eating when not hungry, eating when watching TV or right before bed Physical Activity – lack of regular exercise Sedentary Behavior – frequent television viewing, computer usage, video game usage, other similar behavior Socioeconomic Status – low family income, nonworking parents Environment – overexposure to advertising of unhealthy foods & lack of recreational activity Reporting of Results Reporting of Results Results Review of Empirical Studies The Following Studies Were Evaluated:
1. 2. 3. 4. 5. 6. 7. Analysis; Analysis; Promoting Healthy Weight Among Elementary School Children via a Health Report Card Approach, by the Weill Cornell Medical College Wisconsin Health & Health Policy Institute Evaluation of Lincoln and Jefferson Elementary School, East Penn School District (Lehigh County), by the Pennsylvania advocates for Nutrition and Activity Screening and Family Education Overweight Prevention Pilot Study, in Cambridge, MA School Nutrition Dietary Assessment Study II, United States Department of Agriculture; Food and Nutrition Services Reducing Obesity Via a Nutrition Intervention Physical Education in Elementary School & Body Mass Index: Evidence from the early childhood longitudinal study Results Reporting of Results Reporting of Results
BMI: Parental Involvement Quasi Experimental Field Trial surveyed 793 families involved in BMI program Parents were 25% more likely to plan for and seek medical help and planning after BMI report cards were issued 91% of parents with overweight children sought reading materials and health information on their child after the BMI report cards Inconclusive results pertaining to the effect on the level of childhood obesity
Increases parental involvement by 44% Results Reporting of Results Reporting of Results
BMI: Accuracy Marshfield School District 2500 student’s body mass indexes were measured. Study takes into account the frequency of error in BMI measuring BMI as a result of health and weight measurement errors. Children who would otherwise be categorized as having a healthy weight status were shuffled into unhealthy categories as a result of measurement errors. 80% accuracy level in detecting weight changes as little as 2% Results Reporting of Results Reporting of Results
BMI: Obesity Levels Evaluation of 6500 students in 2002 Prevalence of childhood obesity and overweight were measured in two elementary schools. The district witnessed a 2.86% drop in the number of overweight students (above the 98th) since the BMI report cards were initiated. 2.86% drop in the number of overweight students Results Reporting of Results Reporting of Results
BMI: Parental Involvement Evaluation of 1600 families whose children received BMI report cards: 81% of parents wanted more information provided to them annually along with the reporting of their child’s BMI. 92% of parents claimed they read some or all of the information provided to them in order to remain informed on the issues surrounding childhood obesity after BMI report cards were issued. 58% of parents with children that were classified as overweight or at risk of becoming overweight set a 2 hour limit on watching television after BMI report cards were issued. 73% of parents with overweight children ensured one hour of physical activity for their children Results Reporting of Results Reporting of Results
Alternative: Nutrition The School Nutrition Dietary Assessment Study II was designed to improve the nutritional quality of school meals provided to children by providing schools with the necessary resources to prepare healthy meals. – In 19981999 lunches in elementary schools provided 33% calories from fat, which was very close to the School Meals Initiative (SMI) standard of no more than 30% Effectively reduces obesity causing food in lunch meals Results Reporting of Results Reporting of Results
Alternative: Nutrition Reducing Obesity Via a Nutrition Intervention Over a two year period girls in schools without nutritional intervention saw obesity increases from 21.5% to 23.7% Results Alternative: Physical Education
Physical Education in Elementary School & Body Mass Index
Estimated change in BMI from students in kindergarten to 2nd grade after a one hour increase in physical education per week Reporting of Results Reporting of Results Children that were already at risk at becoming overweight experienced a 0.068 average decrease in their BMI & normal weight children experienced a 0.041 decrease in their BMI Results Costs & Benefits Costs & Benefits
Monetary Benefits: potential reversal of the country’s, unsustainable costs associated with childhood obesity facilitated by greater parental involvement and overall education pertaining to a child’s weight status Substitutes locally applied and funded program for more bureaucratic and federally based coordination Results Costs & Benefits Costs & Benefits
Monetary Costs: hired trained BMI experts, available school nurses, sending out report cards, coordinating medical facilities Arkansas BMI report card program cost $1 million to the taxpayers Needed revenue will require more taxation in the long run Social Benefits: greater coordination between schools, health providers, and parents Parents are more informed and thus seek more elaborate information pertaining to their child’s health and weight status Social Costs: potential for isolation, humiliation, and alienation of child who receives a BMI report card Children may be unable to adjust and deal with the reality that they are branded based on their weight BMI report card programs blur the line between health advocacy and the implied right to privacy Results Implementation Problems Implementation Problems
Accuracy of the BMI test Difficulties with coordination Parental opposition Prior training for nurses Administrative overload Proper school diplomacy Results Policy Externalities
POSITIVE Increased community involvement and concern Needed motivation for schools to coordinate with community health services Health advocates and schools focusing on preventative care in relation to children NEGATIVE Increased attention on a child’s weight leading to selfesteem issues Possible triggering of eating disorder behavior Hostilities towards nurses and school administrators especially among family’s with a high prevalence of obesity Conclusions Proposed Policy Conclusion Conclusion The causes of childhood obesity: unhealthy diet, poor eating habits, lack of physical activity, and genetics BMI report cards were effective in increasing parental awareness by 44% and proved to be accurate, which met part of our evaluative criteria, however they failed to reduce childhood obesity. Conclusions Alternative Policy
NutritionBased Interventions: Proved effective in reducing the amount of obesitycausing foods and reducing obesity levels in children who experienced intervention Physical Education Interventions: Even in slight increases in supervised physical education resulted in obesity decreases among children. Both these alternative policies met the evaluative criteria. Conclusion Conclusion Recommendations Recommendations Recommendations
BMI report cards sent home quarterly for all elementary school students. Nutrition interventions in school cafeterias that substitutes nutritious foods instead of unhealthy foods. Physical education program that designates at least an hour a week of physical activity. Greater parental involvement and education with a healthier school environment for children and an overall reduction in childhood obesity. Recommendations Recommendations Recommendations
It is recommended that Senator Gong works to implement BMI report card programs coupled with nutrition interventions and increased supervised physical activity for elementary students from grades 18 in New Avery. After a period of three years an evaluation committee should perform an expost evaluation to determine if this policy meets the evaluative criteria that was set in this report. ...
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- Fall '06