Elizabeth StanleyChildhood Obesity NJ

ABSTRACT

Childhood obesity is now an epidemic. Per the CDC, the rate of obesity has

tripled in children and adolescents from 1980 to present day, specifically in low income

areas. Although there is no one reason why, one can assume that both behavioral and

environmental factors are to blame. The fight against childhood obesity became a

primary concern on the nation’s agenda when Michelle Obama initiated the “Let’s Move”

program in 2010 and shortly after, President Obama signed off on “The Healthy Hunger-

Free Kids Act”. Since then, programs have developed at both the federal and state

levels. New Jersey joined in with several interventions to combat the epidemic. It is very

hard to find present day studies on the rates of childhood obesity, and nearly impossible

to say that said rates have dropped because of an intervention. Program progress is

measurable, however, and one can assume that with healthier choices being instilled

into children’s daily lives, the epidemic will soon begin to decline.

This paper will first define childhood obesity, prevalence, causes, and effects.

Next, it will localize the epidemic by listing New Jersey statistics. Finally, a discussion

on “Let’s Move” and The Healthy Hunger-Free Kids Act as well as New Jersey’s

umbrella intervention, Partnership for Healthy Kids will be addressed. With program

Stanley 2

statistics trending toward success, one can assume that more children are learning and

adapting skills to lead healthy lives which will in turn stop an epidemic from getting any

worse.

INTRODUCTION: CHILDHOOD OBESITY DEFINITION, PREVALENCE, CAUSES,

AND THE LONGTERM EFFECTS

Childhood obesity is calculated using BMI or Body Mass Index measurements.

This is a simple calculation of total weight in kilograms divided by the square of height in

meters. BMI calculations are age and gender specific for children, and obesity

determinants are made by comparisons. A child is considered overweight if they range

at or above the 85th percentile. An obese child is above the 95th percentile. CDC growth

charts are the most commonly used indicator to measure these patterns. 1

As of 2013, 17% of American children are obese. If overweight children are

included in this figure, then 31.7% of American children and adolescents are affected by

this epidemic. This equates to more than 23 million American children being overweight

and over 12 million of these children being obese. Hispanic, Latino, and African

American low income families have the highest rates of obesity overall, which includes

childhood obesity.2

Stanley 3

1 "Childhood Obesity Facts." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 19 June 2015. Web. 17 Nov. 2015.

2 "CHILDHOOD OBESITY LEGISLATION - 2013 UPDATE OF POLICY OPTIONS." National Conference of State Legislature. National Conference of State Legislature, 1 Mar. 2014. Web. 17 Nov. 2015.

The following figure from the CDC MMWR January 21, 2011, shows the prevalence of

obesity in American children arranged by age, gender, and ethnicity. 3

CAUSES OF CHILDHOOD OBESITY

“Childhood obesity isn't some simple, discrete issue. There's no one cause we can

pinpoint. There's no one program we can fund to make it go away. Rather, it's an issue

that touches on every aspect of how we live and how we work.” --Michelle Obama

Obesity is caused by taking in more energy than one expels. Simply put, children

are eating too much and moving too little. There are many factors that go into this. First,

is unhealthy diets. Children are consuming sugary beverages and drinking less water.

Stanley 4

3 CDC Grand Rounds: Childhood Obesity in the United States." MMWR. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 21 Jan. 2011. Web. 17 Nov. 2015.

Children are eating calorie dense, minimally nutritious food like fast food and snacks.45

The majority are not consuming the recommended amounts of fruits and vegetables.

Portions have increased drastically.

The second big factor is inactivity. Children are spending drastically more time in

front of televisions, computers, tablets, phones, and video games. Roughly 20% of kids

walk to and from school in contrast to about 80% in the 1980’s. There are no federal

laws requiring physical education to be part of the American school curriculum. In 2011,

The National Association of Sports and Physical Education suggested that school

children participate in at least 150 minutes a week of physical education, and only 6

states adhered to that. 6

Third, socioeconomic factors play a huge role in childhood obesity. Although

children of all race and status are affected, obesity is most prevalent in low income

families. Obesity rates increased by 10% for all U.S. children 10 to 17 years old

between 2003 and 2007; but by 23% during the same time period for low-income

children.7 It should also be noted that low income children are two times as likely to be

Stanley 5

4 Office of the Surgeon General (US). The Surgeon General's Vision for a Healthy and Fit Nation. Rockville (MD): Office of the Surgeon General (US); 2010. Background on Obesity.

5 Sahoo, Krushnapriya et al. “Childhood Obesity: Causes and Consequences.” Journal of Family Medicine and Primary Care 4.2 (2015): 187–192. PMC. Web. 17 Nov. 2015.

6 National Association for Sport and Physical Education & American Heart Association. (2012). 2012 Shape of the Nation Report: Status of Physical Education in the USA. Reston, VA: American Alliance for Health, Physical Education, Recreation and Dance

7 Singh, Gopal K. et al. “Dramatic Increases in Obesity and Overweight Prevalence and Body Mass Index Among Ethnic-Immigrant and Social Class Groups in the United States, 1976–2008.” Journal of Community Health 36.1 (2011): 94–110. PMC. Web. 20 Nov. 2015.

obese. Low income children are less likely to have access to high quality foods such as

fresh produce. Many low income families reside in food deserts, where grocery stores

are inaccessible by foot or public transit. Therefore, they are forced to shop at local

convenience stores and bodegas for their food. These businesses do not provide fresh

produce and healthy options because they are too expensive.

EFFECTS OF AN EPIDEMIC

“If we continue to have these rising trends of childhood obesity, this generation of

children will be the first generation of American kids to live sicker and die younger than

the previous generation.” - Dr. Dwayne Proctor

Today’s children are growing up with diseases once thought to only affect adults.

Perhaps the biggest concern is the cardiovascular system8. Doctors are now finding

arteriosclerosis and hypertension in children as young as early school age. There have

been epidemiological studies done showing that this generation of children has the

highest blood pressure measurements in many decades. The early onset of heart

disease will impair children’s ability to be physically active and live long lives.9

Metabolic disorders such as dyslipidemia (high cholesterol stemming from

diabetes), and diabetes are also being diagnosed in children. Type 2 diabetes was

8 Daniels, Stephen R. “The Consequences of Childhood Overweight and Obesity”. The Future of Children 16.1 (2006): 47-67 Web. 17 November 2015.

9 Reversing Childhood Obesity: Signs of Progress.Steve Adubato. Youtube, 2014. Film. Web. 17 November 2015

Stanley 6

originally called Adult Onset diabetes, but as more children were developing this chronic

condition, the name was changed to Type 210. This type of diabetes is not insulin

dependent and can be managed or sometimes reversed with proper diet.

The flowing graph shows trends in childhood obesity from 1963 to 2008, paired with the

rise of juvenile diabetes from 2002 to 2005.

There have been cross-sectional studies done that possibly correlate pulmonary

disorders such as asthma to obesity. The rate of asthma has increased in the past few

decades, a parallel to rising obesity rates. While there is no direct correlation yet,

obesity does cause inflammation and also creates more work for vital organs because

10 Daniels, Stephen R. “The Consequences of Childhood Overweight and Obesity”. The Future of Children 16.1 (2006): 47-67 Web. 17 November 2015.

Stanley 7

of pressure from adipose tissue. These two factors could contribute to the increased risk

of asthma.11

Psychosocial effects of childhood obesity are also prevalent. Depression is a

common diagnosis in adolescents. Body dissatisfaction, especially in girls, and the

inability to relate to peers are common problems stemming from obesity.

Economically, the effects of Childhood obesity present a huge burden. Roughly

$150 to $190 billion is spent annually on obesity related health issues, whether directly

or indirectly. About $15 billion of that is related to childhood obesity2.

The physical, mental, and economic effects of childhood obesity do not dissipate

as children mature. All of these problems are carried into adulthood and exacerbated,

making obesity one of the largest burdens on the healthcare system today.

THE NATION RESPONDS

"The physical and emotional health of an entire generation and the economic health and

security of our nation is at stake."- First Lady Michelle Obama at the Let’s Move! launch on

February 9, 2010

The state of America’s health, including healthcare programs and funds, is one of

the most prevalent issues being addressed during the Obama administration, with

childhood obesity at the forefront for First Lady Michelle Obama. In 2010, the First Lady

Stanley 8

11 Han, Joan C., Debbie A Lawlor, and Sue Y.S. Kimm. “Childhood Obesity-2010: Progress and Challenges.” Lancet 375.9727 (2010); 1737-48. PMC. Web. 17 Nov 2015.

launched Let’s Move!, a “comprehensive initiative”12,designed to combat childhood

obesity by implementing interventions at the federal and local levels.

Following the initiative, The Healthy Hunger-Free Kids Act was passed. The

Healthy Hunger-Free Kids Act of 2010 allows funding for healthy food for low-income

children. The bill reauthorizes child nutrition programs for five years and includes $4.5

billion in new funding for these programs over 10 years. Many of the programs do not

have an expiration date, but are reviewed yearly for refunding. This reauthorization

presents an opportunity to strengthen programs designed to make American children

healthier.

The Healthy Hunger- Free Kids Act allows the USDA to set nutritional standards

on food given at schools. Schools that meet the new nutritional guidelines are given

more money for federally subsidized breakfast and lunches. It helps communities build

Farm to School programs, school gardens, and expands the availability of drinking

water13.

Stanley 9

New Jersey: An Epidemic Hits Home

12 Letsmove.gov13 “Child Nutrition Reauthorization Healthy Hunger-Free Kids Act of 2010”. Whitehouse.gov. Let’s Move. Web. 17 Nov 2015

“It wasn’t easy to produce a generation of overfed kids— but it might well have been

inevitable.” Time magazine, 2008

Rutgers Center for State and Health Policy, or RCHSP, began a five-year study

in 2009, funded by the Robert Wood Johnson Foundation, to provide vital statistics

needed to create and implement interventions to effectively reverse the childhood

obesity epidemic particularly found in low income families. The areas of study are

Camden, Newark, New Brunswick, Trenton, and Vineland. The first statistics were

presented in 2010. All five cities were found to have high obesity rates among school

age children, with Trenton having the highest.

Children from all five cities were more likely to be overweight and obese than

their national peers. The majority of these children did not meet the national

recommendations from the FDA for fruit and vegetable consumption. They often drank

sugary beverages and ate calorie-dense and minimally nutritious food such as fast food.

Most parents shopped at supermarkets, although many Hispanic parents shopped at

local corner stores. The majority of parents reported that there was limited availability of

fresh produce and low fat foods. The cost of fresh food and the access to the stores

were two main barriers to healthy eating.

The majority of children did not meet the daily physical activity guideline of 60

minutes per day. Many children spent more than two hours per day watching television

Stanley 10

or playing video games. Most children didn’t walk or bike to school. Many of the

neighborhoods didn’t have sidewalks, some didn’t have working street lights, and many

neighborhoods didn’t have parks. Additionally, many parents felt that the parks and

recreation areas that were available to their children, were not safe14.

Despite the evidence, the majority of parents were not concerned with the weight

of their children. Though they did believe that it would be better to have healthier food

options and better recreational outlets, the majority felt their kids were healthy. This

means that truly effective interventions would have to take place primarily in school,

where children spend the majority of their time. Interventions would have to focus on

education for parents and caretakers on healthy eating habits and physical activity.

Interventions would also have to provide community areas for fresh fruit and vegetable

access and recreational facilities.

New Jersey Takes Initiative: PARTNERSHIP FOR HEALTHY KIDS

“We’re testing the idea that if we’re going to whip [childhood obesity], there are going to

be some policy issues that are national and some that come out of state government.

And, more and more, we’re also starting to think a lot of progress is made [by] getting

communities to see the importance and value of creating healthier environments.” -

Stanley 11

14 "New Jersey Childhood Obesity Study: New Brunswick Chartbook." RWJF. Rutgers Center for State and Health Policy,1 July 2010. Web. 17 Nov. 2015.

** Chartbooks for Trenton, Camden, Vineland, and Newark also referred to”

William Lovett, Director of New Jersey Partnership for Healthy Kids and Executive

Director of the YMCA State Alliance

New Jersey Partnership for Healthy Kids, or NJPHK, is a statewide program

funded by the Robert Wood Johnson Foundation with technical assistance and direction

provided by the New Jersey YMCA. The following are the six NJPHK policies for

improving nutrition and physical activities that provide a basis for program development:

1. Ensure that all foods and beverages served and sold in schools meet or exceed the

most recent dietary guidelines.

2. Increase access to high-quality, affordable foods through new or improved grocery

stores and healthier corner stores and bodegas.

3. Increase the time, intensity and duration of physical activity during the school day and

out of school programs.

4. Increase physical activity by improving the built environment in communities.

5. Use pricing strategies – both incentives and disincentives – to promote the purchase of

healthier foods.

6. Reduce youth exposure to unhealthy food marketing through regulation, policy and

effective industry self-regulation15.

Stanley 12

15 Assessing the Local Partnership for Healthy Kids in Camden, Newark, New Brunswick, Trenton, and Vineland. New Brunswick, NJ: Rutgers Center for State Health Policy, 2011.

New Jersey Partnership for Healthy Kids has three components: local activities

sponsored by local coalitions to combat childhood obesity, technical assistance to these

coalitions, and state-level activities to support policy changes that will support local

activism15. The three components work together for one cause, to stop the childhood

obesity epidemic. The program works with coalitions in Camden, Trenton, Newark, New

Brunswick and Vineland, with the hope that proven success in these cities will spark

change across the state and nationally.

Camden’s Partnership for Healthy Kids is supported by The Campbell Soup

Company, which gave a $10 million grant to enhance school wellness, physical activity

and community food access with the goal of reducing the Camden childhood obesity

rate by 50% over ten years. It is also supported by the Burlington and Camden county

YMCA and The United Way of Philadelphia and Southern New Jersey. The

collaborative initiative launched in 2011. Within the first 2 years, health and wellness

policies have gone into effect in all 26 Camden city schools, 12 day-care centers, and

several faith- based organizations. Camden school district has been recognized as one

of the top 20 districts in New Jersey having the highest number of eligible children

eating breakfast16.

Under the umbrella of New Jersey Partnership for Healthy Kids, New Brunswick

created the Community Food Alliance15, a council committed to enforcing adequate

Stanley 13

16 Moynihan, Michael. New Jersey Partnership for Healthy Kids Camden. Amazonws,com. N.p., n.d. Web. 18 Nov. 2015

access to healthy food in stores and schools as well as developing community gardens.

July 2015, marked the launch of The New Brunswick Community Farmer’s market,

giving many low income families access to fresh fruit and vegetables. The market

supports the “Market Bucks Program”17, a return on EBT purchases from farmer’s

markets. Consumers using food stamps to purchase groceries from the farmer’s market

get 50% back on the EBT card.

One of Trenton’s largest programs under The New Jersey Partnership for Healthy

Kids is The Healthy Food Network, a coalition helping neighborhood stores promote

healthy food purchases such as fruit, vegetables, and whole grains. The Partnership for

Healthy Kids supplied the Healthy Food Network with labels, billboards, and baskets for

shopping. Stores agreed to run promotions like “buy 5 healthy foods - get one for free”15

Live Healthy Vineland18, is a partnership of organizations whose goal is to make the

city of Vineland a healthy place to “live, work, and play” An extension of Partnership for

Healthy Kids, Live Healthy Vineland invests in initiatives to create healthier schools,

parks and other recreational areas for children. Vineland has created bike lanes and

cleaned up many parks and recreation areas to provide children with safer places to

play. Newark’s New Jersey Partnership for Healthy Kids reached out to the state

chapter of the American Academy of Pediatrics for help with their efforts. The New

Jersey chapter of The Academy began implementing Let’s Move!, First Lady Michelle

Stanley 14

17

18 Livehealthyvineland.org

Obama’s throughout pediatrician offices. The Newark program is called Let’s Move in

the Clinic15, and it aims to educate both medical staff and families about obesity and

how to combat it.

SIGNS OF PROGRESS

“We’ve been a boots-on-the ground effort to try and achieve change, and now we are

seeing really great results from the [places] where we’ve worked most closely.” -William

Lovett

The New Jersey Partnership for Healthy Kids claims to have made strides in the

fight against child obesity. Environmental signs of progress include bike lanes in

Trenton and Newark and new playgrounds built in Trenton and Camden. Policy

changes include district-wide wellness programs in Camden County and Complete

Street Policies in four of the five targeted cities. As of 2013, the five targeted cities have

raised more than $4 million in public and private funding for their local activities. By the

end of 2013, New Jersey Partnership for Healthy Kids recognized the following as its

greatest achievements:

- Enrolled 50 corner stores and bodegas in a healthy foods initiative

- Trained 100 health care providers in advocacy to address childhood obesity

- Engaged 525 volunteers in building playgrounds and parks

- Exposed 3,500 children to healthy nutrition through improved school wellness

policies and breakfast in the classrooms

Stanley 15

- Exposed 500,000 residents to safer streets and environments conducive to

physical activity19

THE FUTURE: WILL THESE INTERVENTIONS WORK?

“If we’re going to have a culture of health in America, we’ve got to take care of the

epidemic of childhood obesity. And if we can reverse childhood obesity—and we’re

seeing lots of signs of progress—that’s proof positive that we can have a culture of

health in America.” – Dr. Dwayne Proctor

The childhood obesity epidemic is still prevalent in New Jersey even though

progress has been made. The Robert Wood Johnson Foundation issued two grants in

2013 and 2014, which will expand The New Jersey Partnership for Healthy Kids

strategies to build healthy communities and change policies. One future goal is to take

The Healthy Food Network and its partner, The Healthy Corner Store Initiative state-

wide. New Jersey Partnership for Healthy Kids will partner with the U.S. Department of

Agriculture to build on school wellness policies and strengthen coalitions in order to

keep the progress going even after Robert Wood Johnson Foundation funding ends20.

Stanley 16

CONCLUSION

19 "Declining Childhood Obesity: Where Are We Seeing Signs of Progress?" Robert Wood Johnson Foundation. Robert Wood Johnson Foundation, Feb. 2015. Web. 17 Nov. 2015.

20 Robert Wood Johnson Foundation. New Jersey Partnership for Healthy Kids: Communities Making a Difference to Prevent Childhood Obesity. 2013 Progress Report. Robert Wood Johnson Foundation. May, 2015. Web. 17 November 2015.

"Reversing obesity is not going to be done successfully with individual effort. We did not

get to this situation over the past three decades because of any change in our genetics

or any change in our food preferences. We got to this stage of the epidemic because of

a change in our environment and only a change in our environment again will allow us

to get back to a healthier place.” – Thomas R. Frieden, Director of the CDC

Obesity is one of the leading causes of sickness and disease in the United

States. With $150 to $190 billion spent annually on obesity and its related issues, it is

one of the largest healthcare costs. $19 billion of that money is spent annually on

childhood obesity. If this continues, the United States will have a population of sick

people. The promising part: Obesity, especially childhood obesity is preventable. It is a

behavioral problem that requires a change in environment and behaviors.

With interventions such as The New Jersey Partnership for Healthy Kids showing

signs of progress, one can see that the fight against the obesity epidemic is making

headway. However, more needs to be done to spread awareness about the implications

of the epidemic as well as education on how to correct it. It has to be an “all hands on

deck” effort. Public Health officials and enthusiasts can aid in the fight against obesity

by ensuring that low income families have access to healthy food and by helping the

general public and stakeholders understand the impact of obesity and how important

policy and planning changes are. There is no one way to end child obesity, however

Stanley 17

educating oneself on the successful interventions implemented thus far, a reverse of an

epidemic could be in sight.

WORKS CITED

Assessing the Local Partnership for Healthy Kids in Camden, Newark, New Brunswick, Trenton, and Vineland. New Brunswick, NJ: Rutgers Center for State Health Policy, 2011. Web 17 Nov 2015

"CDC Grand Rounds: Childhood Obesity in the United States." MMWR. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 21 Jan. 2011. Web. 17 Nov. 2015.

“Child Nutrition Reauthorization Healthy Hunger-Free Kids Act of 2010”. Whitehouse.gov. Let’s Move. Web. 17 Nov 2015

"Childhood Obesity Facts." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 19 June 2015. Web. 17 Nov. 2015.

"CHILDHOOD OBESITY LEGISLATION - 2013 UPDATE OF POLICY OPTIONS." National Conference of State Legislature. National Conference of State Legislature, 1 Mar. 2014. Web. 17 Nov. 2015.

Daniels, Stephen R. “The Consequences of Childhood Overweight and Obesity”. The Future of Children 16.1 (2006): 47-67 Web. 17 November 2015.

"Declining Childhood Obesity: Where Are We Seeing Signs of Progress?" Robert Wood Johnson Foundation. Robert Wood Johnson Foundation, Feb. 2015. Web. 17 Nov. 2015.

"Farm To School." Farm To School. Web. 17 Nov. 2015.

"Food Marketing: Can "Voluntary" Government Restrictions Improve Children’s Health?" CDC Moynihan, Michael. New Jersey Partnership for Healthy Kids Camden. Amazonws,com. N.p., n.d. Web. 18 Nov. 2015.

National Association for Sport and Physical Education & American Heart Association. (2012). 2012 Shape of the Nation Report: Status of Physical Education in the USA. Reston, VA: American Alliance for Health, Physical Education, Recreation and Dance

"New Jersey Childhood Obesity Study: New Brunswick Chartbook." RWJF. Rutgers

Center for State and Health Policy,1 July 2010. Web. 17 Nov 2015

"New Jersey Childhood Obesity Study: Vineland Chartbook." RWJF. Rutgers Center for State and Health Policy, 1 July 2010. Web. 17 Nov. 2015.

"New Jersey Childhood Obesity Study: Trenton Chartbook." RWJF. Rutgers Center for State and Health Policy, 1 July 2010. Web. 17 Nov. 2015.

"New Jersey Childhood Obesity Study: Camden Chartbook." RWJF. Rutgers Center for State and Health Policy, 1 July 2010. Web. 17 Nov. 2015.

"New Jersey Childhood Obesity Study: Newark Chartbook." RWJF. Rutgers Center for State Health Policy, 1 July 2010. Web. 17 Nov. 2015.

Ogden, PhD, Cynthia, Margaret Carroll, MSPH, Brian Kit, Md. MPH, and Katherine Flegal, PhD. "Prevalence of Childhood and Adult Obesity in the United States, 2011-2012." Journal of the American Medical Association 311.8 (2014): 806-14. JAMA NETWORK. American Medical Association. Web. 17 Nov. 2015.

Office of the Surgeon General (US). The Surgeon General's Vision for a Healthy and Fit Nation. Rockville (MD): Office of the Surgeon General (US); 2010. Background on Obesity.

Robert Wood Johnson Foundation. New Jersey Partnership for Healthy Kids: Communities Making a Difference to Prevent Childhood Obesity. 2013 Progress Report. Robert Wood Johnson Foundation. May, 2015. Web. 17 November 2015.

Reversing Childhood Obesity: Signs of Progress.Steve Adubato. Youtube, 2014. Film. Web. 17 November 2015

Sahoo, Krushnapriya et al. “Childhood Obesity: Causes and Consequences.” Journal of Family Medicine and Primary Care 4.2 (2015): 187–192. PMC. Web. 17 Nov. 2015.

Skelton, Joseph A. et al. “Prevalence and Trends of Severe Obesity among US Children and Adolescents.” Academic pediatrics 9.5 (2009): 322–329. PMC. Web. 17 Nov. 2015.

U.S. Department of Health and Human Services. The Surgeon General’s Vision for a Healthy and Fit Nation. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General, January 2010. Web. 17 Nov. 2015

Washington. Center For Disease Control, 31 May 2011. Web. 17 Nov. 2015.

Han, Joan C., Debbie A Lawlor, and Sue Y.S. Kimm. “Childhood Obesity-2010: Progress and Challenges.” Lancet 375.9727 (2010); 1737-48. PMC. Web. 17 Nov 2015.