PUBLIC HEALTH ACROSS THE LIFESPAN
Federal Initiatives to Address Overweight/Obesity
PETER VAN DYCK: What you think she really is like behind the scenes, where she becomes a dynamo and a great advocate for nutrition programs and does a wonderful job promoting and getting resources for nutrition programs in a tough environment.
Denise, you do a great job.
I'm going to give you a point in time of the Bureau's nutrition activities. When I say Bureau's nutrition activities, it includes many of the things that you're doing in states, and so I just want to share some of these with you.
First, issues related to the Title V information system and other data. If we look at state priority needs, and on the Title V website, and again the easy address that I can always remember, because it's what I remembered from six years ago, mchdata.net. If you go to mchdata.net you get right to the Title V information system. You can query that system. What are, by key word, how many states have priority needs, if you key word search "obesity." And 15 states said obesity was a priority need, and there were 17 related priority needs in those 15 states.
That was last year. This year, 34 states with 41 priority needs identified related to the key word obesity. So there's clearly an emphasis in states building around priorities and programmatic efforts around obesity. If we look at state performance measures and do the same thing, we find 21 states that have 25 performance measures related to obesity. That was last year, and we don't have the full data yet for this year. I suspect it's in the same range.
You also report on nine health systems capacity indicators. It's self‑capacity indicator 9C which is the ability of you folks to monitor overweight and obesity. Just to feedback some information to you 47 of 59 of you participate in the YRBS. 60% of you, 35 of the 47, you have a sample size large enough for statewide estimates, 20% have a sample size too small, and 12% do not participate. 20% do not participate.
In the pediatric nutrition surveillance system, 40 of you participate and 36 the sample size is large enough for you to make statewide estimates. In four of the sample sizes too small and 19 of you do not participate in this survey.
In the WIC nutrition survey, 53 states participate out of the 59 states and territories. 48 have a sample size large enough for statewide estimates. Five the sample size is too small and only six do not participate in the WIC nutrition survey. So that's not bad, Pat, for participating in your survey.
Now, specifically the MCHB activities, the Maternal and Child Health Bureau does have a nutrition strategic plan. If you want it contact our nutrition folks and they'll be happy to share it with you. It has four elements. Breast feeding promotion, overweight obesity prevention and healthy lifestyle promotion. Public health nutrition leadership and training, and coordination and collaboration with federal, state and local partners. I'm going to go very quickly through elements that we're doing in each of these four categories.
First, breast feeding: We provide liaison to the United States Breast Feeding Committee in help for their strategic plan, and in help for their National Breast Feeding Coalition workshop, which is going to be held next year. We've convened expert work group meetings between the Maternal and Child Health Bureau and CDC related to oral health and breast feeding, and the safe and appropriate use of breast milk substitutes for the breast‑fed infant in the United States.
We provide hospital support through the Baby Friendly Hospital Project, trying to identify barriers to implementing the ten steps to successful breast feeding.
We provide work site support by development of a best start social marketing program to provide breast feeding support to employers and women returning to work or school.
We provide provider support through the Academy of Breast Feeding Medicine and the development of protocols and support for their annual meetings, and to the American Academy of Pediatrics, the AEP Breast Feeding Promotion in Physician Office Practices, and we're currently in phase 3. Phase 3 of that is a three‑year program to initiate sustained system wide changes in breast feeding management at all the national, state and community levels. Phase 1 was '97 to 2000. Phase 2, 2000 to 2004, and this phase 3 now that's begun will focus on educating and supporting future and practicing physicians and culturally effective breast feeding promotion support, hopefully towards helping us achieve our healthy people 2000 goal, and to help us achieve performance measures related to the percent of breast feeding infants that get breast fed after birth.
Also are helping on breast feeding curriculum for medical residency training programs and there's a website where you can get far more information, request materials that might be helpful for you as well in some of your programs.
Moving to the second area of overweight and obesity. Proposed in the nutrition state plan is the funding of interdisciplinary training for health providers working as a team to treat pediatric overweight and obesity and to develop prevention programs. And an area I'm going to talk about more now is maternal obesity is also an area of interest for us and in the strategic plan.
A task order was awarded last month, September 2005, to the Institute of Medicine to support a workshop on the impact of pregnancy weight and child and maternal health. The purpose of this two‑day workshop will be to describe what is known about recent trends in maternal weight prior to, during and after pregnancy. And what is the impact of maternal weight on the health of mothers and children up to 12 months of age for the infant.
It will be a 12 month study, with the end being a summary report that analyzes and synthesizes the workshop deliberations.
Now, the research questions that we've asked the panel to look at, what research and databases describe the distribution of maternal weight among different populations of women in the United States, what research and databases inform our understanding the effects of different weight patterns, including both overweight and underweight during pregnancy on maternal and child health, maternal and child health outcomes up to 12 months of age.
What research has been conducted to describe the individual community and healthcare system factors that don't let compliance occur with recommended gestational weight guidelines, what opportunities exist for us in Title V to build on this knowledge to help child‑bearing women achieve and maintain recommended weight and five what future research and data collection efforts could improve the efforts of our programs to support women from all different background in their efforts to comply with the recommended weight guidelines.
And hopefully this review then over the next year, which will be published in a study and analyzed, will provide the foundation for a future study to examine the pregnancy weight gain guidelines for different groups of women. So look for this to occur over the next year.
Now, still related to child and adolescent health, the needs assessment was conducted and published in 2002 that was looking at the current practices of pediatricians, nurses and dietitians in the assessment and treatment of child overweight and obesity. Again, this was a partnership effort. And using the findings from that needs assessment, an expert panel was convened in February of 2005 to develop recommendations for prevention and treatment of child and adolescent overweight obesity. And again you can see this as a partnership, partnership with MCHB, CNMA and many other key professional organizations are involved.
Four papers will come from this expert panel over the next year and a half. One related to prevention, assessment, treatment and an overall summary.
Still related to obesity, the Maternal and Child Health Nutrition staff serve on the Obesity Institute, which is an initiative that encourages members to ‑‑ and again this is related to the National Business Group on Health and corporate leaders across the country ‑‑ to help them raise awareness in their business sites about the health and cost consequences of obesity to identifying test solutions that hopefully will help them understand that an investment in prevention in obesity in the work site will lead to positive outcomes. Positive to them often mean saving money, but they're very interested in saving money but also improving work site productivity.
We've also helped the National Business Group on Health develop an employer tool kit addressing among employees and their kids. This is available on the National Business Group on Health website. An issue brief, there's a PowerPoint presentation, family fact sheet. There's tip sheets. There's wonderful information that you would find helpful. It is available to you also in printed form, and provides a wonderful resource, I think, to help employers, whether they're large or small, create a friendly environment around overweight and obesity prevention.
Another new initiative or ongoing but with new components is the innovative approach to promote a healthy weight in women. And again this is aimed towards reducing the prevalence of overweight or obesity in women. And it targets women and communities with limited access to preventive health services, particularly for those at risk who often are disproportionately affected. This is a grant program. Approaches must be substantive in nature, must also link women when appropriate with Title V and other relevant services.
There are seven grantees currently. They get about 150,000 a year for three years. Those three grantees were awarded in 2004. There were four grantees funded in 2005. Arizona, Florida, Wisconsin and Delaware. And we're running another competition this next year, which you should look and preview for when it gets published, or continue to visit our websites. There will be three more awards in this cycle.
So there's a website. There's the project officer, Lisa King. Lisa, are you here? In case people want to find you. She has been here and probably will be here again.
So look for that as an award. Moving on to nutrition leadership. The development of a national nutrition blueprint for action again was a partnership. And that blueprint for action, nutrition and physical activity, corner stones of a healthy lifestyle produced its stakeholder consensus document that brings focus and urgency to critical goals and strategies that we hope will frame nutrition and physical activity for the future.
It is meant to be an umbrella document that can be adapted to reflect local and state needs, to document to use ‑‑ the document is able to be used at all levels to educate decision makers on priority actions. And it's a document that fosters joint efforts for greater impact with well utilized resources. The initial meeting for the blueprint for action was in April 2004, and again involved experts from all across the public and nonprofit organization community.
The second meeting was in April 2005, and the document we expect to be released sometime in mid to late 2006. So look for this. Blueprint for action, nutrition and physical activity corner stones of a healthy lifestyle.
You certainly heard about the Bright Futures and you know about Bright Futures for Nutrition. You know about the Bright Futures for Women that you heard on Sunday which has a major component for trying to increase physical activity and prevention of obesity in women.
Now, the fourth level of the strategic plan is around training. And the Maternal and Child Health Bureau supports nutrition discipline training in public health and pediatrics. We funded seven MCH Centers of Excellence in nutrition in 2005. Those awards range from 100 to $200,000 a year. And there's been developed a collaborative effort or a project of all the seven grantees, which will focus on developing a website to make obesity‑related materials, PowerPoint presentations and the like available to all of you. And that is in the process of being developed.
And we continue our coordination and collaboration and have a commitment to it with the other partners that you see here and with other partners that are on the stage, and we're continuing to meet on these issues and hopefully will make good progress.
I think that's my last slide. So it's really been a pleasure for me to share the activities that you have taken part in your return of data to us, but also activities within the bureau. And you can certainly contact the nutrition staff for further information about all of these efforts. Thank you very much.