CHILDHOOD OBESITY PREVENTION & THE EDUCATION SECTOR: A CARIBBEAN PERSPECTIVE

1. CHILDHOOD OBESITY PREVENTION & THE EDUCATION SECTOR:A CARIBBEAN PERSPECTIVE Dr. Fitzroy Henry Caribbean Food and Nutrition Institute (PAHO/WHO) Presentation to the PAHO / PAHEF WORKSHOP, ARUBA JUNE 14-16, 2012

2. OUTLINE OF PRESENTATION CHILDHOOD OBESITY & THE CHALLENGE FOR THE EDUCATION SECTOR TARGET 1-4: SCHOOL TARGET 5: COMMUNITY TARGET 6: PUBLIC CRITICAL STRATEGIES FOR THE CARIBBEAN

3. POOR NUTRITION (UNDERNUTRITION /OBESITY) POOR EDUCATIONAL ACHIEVEMENT VICIOUS CYCLE OF EDUCATION & NUTRITION

4. OBESITY & LEARNING Obesity is significantly associated with cognitive impairment, specifically learning and memory functions.

7. NUTRITIONAL STATUS OF CARIBBEAN CHILDREN11-13 YEARS OLD (2008)

8. ADULT OVERWEIGHT/OBESITY TRENDS IN THE CARIBBEAN

9. Traditional strategies will continue to fail Traditional View: Obesity is a personal disorder that needs treatment Current View: (i) Obesity is a normal response to an abnormal Environment (ii) The Environment is complex but mainly obesogenic

10. The Complexity Of Healthy Eating& Childhood obesity

11. REDUCING THE COMPLEXITY - FOR INTERVENTION AVAILABLE HEALTHY FOODS ACCESSIBLE HEALTHY FOODS ~ COST . MARKET PRESSURE MEDIA, FRANCHISES PEERS CHILDHOOD OBESITY KNOWLEDGE OF WHAT TO EAT / HOW TO EXERCISE VS CULTURAL PREFERENCES PHYSICAL ACTIVITY SPACES AVAILABLE, ATTRACTIVE & SAFE FOOD PREP P0RTION SIZE LABELS

12. WHAT CAN THE EDUCATION SECTOR DO TO COMBAT CHILDHOOD OBESITY? TARGETS FOR POLICY: 1. SCHOOL FEEDING 2. SCHOOL VENDING 3. PHYSICAL EDUCATION 4. CLASSROOM EDUCATION 5. COMMUNITY EDUCATION 6. PUBLIC EDUCATION

13. TARGET 1: SCHOOL FEEDING PROGRAMS

14. SCHOOL FEEDING - KEY QUESTIONS? • Programs aim to target socio-economically and nutritionally challenged children - Should this be our main target? • Programs do not have strict targeting criteria (self selection and perceived needs by teachers) - Are we contributing to the child obesity problem? • Meals usually do not include foods from most of the food groups - Are we using scientific methods or guesswork? MAJOR QUESTIONS Are we using existing resources effectively? Do countries have written policies?

15. ONLY 47% OF STUDENTS 11-13 yrs old eat breakfast every morning A PARENTAL OR GOVERNMENTAL RESPONSIBILITY?

16. Nutrient Standards based on Recommended Dietary Allowances Notes: • Use the RDA to determine nutrient requirements / needs • Help to correct under- and control obesity • Use culturally appropriate local foods/meals

17. From Nutrients to Meals

18. CRITICAL STRATEGIES – T1SCHOOL FEEDING PROG’MS • Define the target groups and their needs • Establish nutrient standards and convert to meal standards • Organize local farmers to supply food items to school feeding programs • Provide adequate budgets to meet these healthy options • Implement menu with standard meals and manage resources accordingly • Develop Dietary Guidelines for school nutrition programs • Monitor and adjust according to evaluation

19. TARGET 2: SCHOOL VENDING

20. TARGETS FOR INTERVENTION

21. WHAT ARE STUDENTS EATING?

22. FOOD PRICE & DEMAND USA – 12 SCHOOLS + 12 WORK 55 Vending Machines - 12 Months LOW FAT SNACKS

23. Why a School Vending Machine Policy • Usually stocked with high fat, sugar and salt foods • May undermine what children are taught in the classroom about healthy eating

24. A vending machine policy must be linked to a wider school nutrition policy which takes into account the school community, the school curriculum, health services, access to food that is safe and meets nutrient requirements.

25. Perspective 1 – Provide Healthy Choices Only • Research shows that children, especially young children, are less likely to make nutritious choices when other choices are available (USDA, 2005) • Schools provide clear rules for course of study and dress code and the same should go for meals

26. Perspective 2 – Allow students to Exercise Choice • Students learn to make better decisions if they are provided with a wide assortment of food choices • Concern about the stigma attached to those foods that are labeled as ‘bad’ for health since all foods can fit into a healthy diet

27. Policies in the Caribbean • Most countries are yet to develop a policy • In a draft document for Barbados titled ‘Nutritious and Healthy Foods in Schools – National and Practical Guidelines for Barbados 2009’ it is recommended that ‘schools should ensure that all sales of snacks, foods and drinks, including those sold from vending machines, fit into the whole-school food policy’

28. Policies in the Caribbean • The document goes further to provide specific guidelines: • Drinks-vending machines should be stocked with 100% fruit juices, fresh low fat (1%) or fat free (skimmed) milk and flavoured milks or soy beverages with less than 10% added sugar • Vending machines at schools should always provide water and fruit as options

29. Recommended/Policy Initiatives • All vending machine policies should have as their foundation the FBDGs • National governments should have an approved policy on school health that includes access to healthy foods at schools including availability of vending machines.

30. Recommended/Policy Initiatives • Vending machines should only be included in schools/countries where it is possible to have a variety of healthy options to promote appropriate nutritional status and cognitive development • Access to the vending machine should be at usual school designated break times – recess times and lunch times

31. Recommended/Policy Initiatives • Food items should be nutritious and healthy and meet the nutritional requirements of adolescents without putting them at risk for obesity and other chronic diseases

32. CRITICAL STRATEGIES - T2SCHOOL VENDING • Establish specifications for school canteen tenders. • Implement an inspection process to ensure food service providers comply with nutrient-based standards • Establish a meal pricing policy to blend nutrients with preferences • Integration of school foodservice and nutrition curriculum & training (staff & Students) • Regular evaluation with feedback from caterers and students • Require vending machines to stock bottled water, appropriate sized fruit juices and low sugar beverages.

33. TARGET 3: PHYSICAL EDUCATION

37. Fitness Test – Flexibility ‘Trunk-lift’ Females Males

39. Fitness Test – Muscular StrengthMean # of Push-Ups Females Males

40. SIT - UPs

41. Fitness Test – Muscular EnduranceSIT-UPs

42. CRITICAL STRATEGIES - T3 PHYSICAL EDUCATION • Create an environment where play and exercise are actively enabled and encouraged. • Make compulsory - physical education to enable 60 mins of moderate PA most days of the week • Introduce innovative & fun-oriented PA programs not only for the athletically gifted • Encourage children to drink water as the most appropriate rehydration fluid • Provide incentives to the private sector to invest in swimming pools and safe recreational spaces & facilities

43. TARGET 4: CLASSROOM EDUCATION & INFORMATION

44. INCORRECT ANSWERS (%)

46. CRITICAL STRATEGIES – T4 EDUCATION / INFORMATION • Establish in each school zone a qualified dietitian / nutritionist to plan, coordinate, train and monitor activities • Make mandatory - training for school meal providers and teachers so children will receive consistent information about healthy eating • Schools should provide guidance to parents on nutritionally appropriate packed lunches • Train food service providers on innovative ways to offer fat free, and low calorie nutritious meals • Make school staff positive role models in their own food selection and attitude to physical activity • Tailor advertisement (media) to change the thinking and practices of children towards healthy diets and food choices

47. TOWARDS HEALTH PROMOTING SCHOOLS SCHOOL FEEDING HEALTHY EATING HEALTH PROMOTING SCHOOLS A NEW APPROACH NEEDED

48. Conceptualization Design Planning Teams Project Management Teaching methods and Materials Training of Teachers Teacher Motivation Standards Nutrient, meal, menu Monitoring & Evaluation Resources Disruptions Policy Desired Ideal, based on the research Reality What actually happens Suggest What we would recommend or do differently 12 LESSONS LEARNT

49. School–based Behavioural Intervention in Four Caribbean Countries

50. Specific Project Objectives PROJECT GOAL REDUCE OBESITY THROUGH BEHAVIORAL INTERVENTION • IMPROVED DIET AND PHYSICAL ACTIVITY PATTERNS • SUSTAINABLE LIFESTYLE INTERVENTIONS KEY PROJECT STRATEGY PROMOTE HEALTY LIFESTYLE BEHAVIOURS FOR 3 YRS TO A COHORT FROM GRADES 7-9 (Forms 1-3).