1. Community Outreach and Education Program “From the Bench to the Public Educating to Prevent Disease” NIEHS Center for Research on Environmental Disease Science Park - Research Division Virginia Harris Cockrell Cancer Research Center

2. Why Are We Concerned About Children Who Are Overweight? The prevalence of overweight children is increasing. Overweight children are more likely to be overweight adults, and being overweight has been shown to be a risk factor for many diseases. Overweight in children is largely preventable with good eating habits and incorporation of daily physical activity. 1.Centers for Disease Control and Prevention (CDCP). National Center for Health Statistics. " Prevalence of Overweight Among Children and Adolescents: United States, 1999". Accessed October 11, 2002. 2.Strauss RS, Pollack HA. "Epidemic Increase in Childhood Overweight, 1986-1998". JAMA 2001;286(22):2845-2848. 3.Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. "Predicting Obesity in Young Adulthood from Childhood and Parental Obesity" N Engl J Med 1997;337(13):869-73. 4.DRAFT, Strategic Plan for the Prevention of Obesity in Texas, presented at the Stakeholders' Conference, Texas Department of Health, August 8, 2002. The final Texas State Plan for Childhood Obesity will be presented at the State Obesity Summit, hosted by the Texas Department of Health, on February 13-14, 2003 in San Antonio, Texas. For more information, contact Claire Heiser, RD or (512) 458-7444, ext 2298. 5.Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, Savoye M, Rieger V, Taksali S, Barbetta G, Sherwin RS, Caprio S. "Prevalence of Impaired Glucose Tolerance among Children and Adolescents with Marked Obesity". N Engl J Med 2002;346(11):802-10. [erratum appears in N Engl J Med 2002 May 30;346(22):1756.] 6.Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. "Annual Deaths Attributable to Obesity in the United States". JAMA 1999;282(16):1530-1538. 7.Wang G, Dietz WH. "Economic Burden of Obesity in Youths Aged 6 to 17 Years: 1979-1999". Pediatrics 2002;109(5):e81. The Journal can be accessed online at http://www.pediatrics.org 8.Dietz WH, Gortmaker SL. "Preventing Obesity in Children and Adolescents" Annu Rev Public Health 2001;22:337-53. 9.Deckelbaum RJ, Williams CL. "Childhood Obesity: The Health Issue" Obes Res 2001;9:239S-243S. 10.McGinnis JM. "Diabetes and Physical Activity: Translating Evidence into Action" Am J Prev Med 2002;22(4S):1-2. From: http://childobesity.tamu.edu Childhood Obesity Prevention in Texas. A collaborative effort of the Texas Cooperative Extension and Texas Tech University

3. BMICondition Below 18.5Underweight 18.5-24.9Normal weight 25-29.9Overweight 30 and higherObese To lose weight at a rate of one pound per week, you’ll need to reduce calories by 500 per day. (One pound of body fat equals about 3,500 calories.) Try eating 250 calories less per day and exercising enough to burn 250 calories— like walking about 2.5 miles each day. The easiest way to cut back on calories is to watch your portion sizes. Source: American Cancer Society To calculate your Body Mass Index, take your weight (in kilograms) and divide by your height (in meters) squared. BMI = kg/m 2 What is BMI?

4. Obesity in the U.S. Results from the 1999-2000 National Health and Nutrition Examination Survey (NHANES) show: 64% of U.S. adults are either overweight or obese 31% are obese (have a BMI of 30 or greater) Among children and teens ages 6-19, 15%, (almost 9 million) are overweight Causes: Sedentary lifestyle, lack of physical activity Consumption of high calorie foods (high in calories and fat) From NCI website: Obesity and Cancer: Questions and Answers, Cancer Facts. http://cis.nci.nih.gov/fact/3_70.htm

5. Texas Children Among the Most Obese Conclusions of a study released by the University of Texas School of Public Health found that 22 percent of fourth-graders, 19 percent of the state's eighth-graders and nearly 16 percent of its 11th graders were overweight.

7. 19911995 2000 No Data <10% 10%-14% 15-19%  20% Source: Mokdad A H, et al. JAMA 1999;282:16, 2001;286:10. Obesity* Trends Among U.S. Adults BRFSS, 1991, 1995 and 2000 (*BMI  30, or ~ 30 lbs overweight for 5’4” person)

8. Cancers Associated with Obesity Breast (postmenopausal) Endometrium Cervical Uterine Ovarian Colorectal Kidney Liver/ Gall Bladder Pancreatic Esophageal Hematopoietic Prostate Stomach Colorectal Kidney Liver/Gall Bladder Pancreatic Esophageal Hematopoietic In MenIn Women Polednak, AP, Can. Detect and Prevent., 2003; Calle, et al., NEJM,2003 The NCI estimates that in 2002, 41,000 new cases of cancer were due to obesity.

9. Body Weight and Risk of Cancer Source: J. Nutr. 132: 3451S–3455S, 2002 Relative risk overweight vsobese vs Cancer sitenormal weightnormal weight Breast 1.12 1.25 Colon 1.15 1.33 Endometrium 1.59 2.52 Prostate 1.06 1.12 Kidney 1.36 1.84 Gallbladder 1.34 1.78

10. Obesity Associated with Increased Cancer Mortality in Women

11. Obesity Associated with Increased Cancer Mortality in Men

12. Reversing the Trend 1. Increased physical activity and exercise Reintroduce and/or increase physical education classes and recess in schools. 2. Change in diet to incorporate more fruits, vegetables and grains and less processed food Substantially reduce or remove high calorie and fat laden food choices in school lunches and vending machines. 3. Incorporation of educational programs that teach school children about healthy lifestyles and disease prevention Incorporate educational programs aimed at increasing under- standing and knowledge of healthy behaviors.

13. Benefits of Fruit, Vegetables and Grains Watermelon and tomatoes - contain the antioxidant lycopene which may prevent certain cancers. Berries - contain antioxidants (anthocyanins, ellagic acid), Vitamin C and fiber, which may reduce risk of cancer. Green Vegetables - contain chemopreventives like sulphorane, indole-3-carbonal, carotenoids (also in carrots) and lutein that may help prevent cancer. Fiber - reduces risk of colon cancer. Spices - Turmeric and chilies contain the chemopreventive curcumin. Garlic, onions and leeks contain the antioxidant diallyl sulfide.

14. Educational Programs That Teach School Children About Healthy Lifestyles and Disease Prevention 1.GIMME 5 - A school based curriculum to help 4th grade students eat more fruits and vegetables. Emory University School of Public Health 2.MIDAS - Models of Implementation and Dissemination of environmental health and science Across Subjects. The FIVE Minute Lesson - Do’s and Don'ts for staying healthy and unhurt. www.Veggie-Mon.org - a health promotion website for 4th-8th graders. UT MD Anderson Cancer Center, CRED COEPwww.Veggie-Mon.org 3. Energy In Energy Out - NIH Curriculum for elementary students 4. Eating for Your Health - 6th-8th grade curriculum. Wayne State University, COEP 5. My Health My World- Food & My World, Baylor College of Medicine.

15. Fat Intake and Mammary Carcinogenesis Source: Preventive Medicine 22:750-766, 1993

16. Obesity and Breast Cancer Incidence Source: Lancet Oncol Franca Bianchini, Rudolf Kaaks, and Harri Vainio 2002; 3: 565–74

17. Source: Carroll KK. Carbohydrate and Cancer. In: Alfin-Slater RB, Kritchevsky D, eds. In human nutrition. A comprehensive treatise. Vol 7; Cancer and Nutrition. New York: Plenum; 1991. p. 97. Dietary Carbohydrates and Breast Cancer

18. Relation Between National Per Capita Fat Intake and Breast Cancer Mortality Rate Source: Journal of Internal Medicine 249: 395-411

19. Obesity and Breast Cancer Source: Lancet Oncol Franca Bianchini, Rudolf Kaaks, and Harri Vainio 2002; 3: 565–74 Pre-menopausal Post-menopausal

20. Prevalence of overweight and obesity (25 kg/m 2 or more) among females aged 20 years and over: 2002 Source: National Heart, Lung, and Blood Institutes. Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults, The Evidence Report, NO. 98-4083, 1998 White---------------------------49.2% Black----------------------------65.8% Mexican-American-----------65.9%

21. http://www.usatoday.com/news/health/2003-11-17-europeans-obese_x.htm *Children: 6-13 years old, **20 years or older Children*Adults** USA15%31% Italy36%22% Spain30%13% England22%11% Denmark18%10% France18%9% Sweden18%9% Finland13%9% Overweight population: Europe vs. USA

22. Body weight and risk of cancer Source: J. Nutr. 132: 3451S–3455S, 2002

23. Risk factors for breast cancer that can be changed Birth control pills Studies have found that women now using birth control pills have a slightly greater risk of breast cancer. Women who stopped using the pill more than ten years ago do not seem to have any increased risk. Hormone replacement therapy Most studies suggest that long-term use (5 years or more) of HRT (especially estrogens together with progesterone) for relief of menopause symptoms may slightly increase the risk of breast cancer. Five years after stopping HRT, the risk appears to drop back. Breast feeding Many studies have shown that breastfeeding lowers breast cancer risk. This could be because breast feeding lowers a woman’s total number of menstrual periods. Alcohol Use of alcohol is clearly linked to an increased risk of getting breast cancer. Diet Being overweight is linked to a higher risk of breast cancer. Exercise Studies suggest that exercise protects against breast cancer. Source: American Cancer Society

24. Age The chance of getting breast cancer goes up as a woman gets older. Genetic risk factors About 1 case of breast cancer in 10 is linked to changes (mutations) in certain genes (i.e., BRCA1 and BRCA2). Family history Breast cancer risk is higher among women whose close blood relatives have this disease. Personal history-breast cancer A woman with cancer in one breast has a greater chance of getting a new cancer in the other breast. Race White women are slightly more likely to get breast cancer than are African-American women. But African-Americans are more likely to die of this cancer. Earlier breast biopsy Certain types of abnormal biopsy results can be linked to a slightly higher risk of breast cancer. Earlier radiation treatment Women who have had chest area radiation treatment earlier have a greatly increased risk of breast cancer. Menstrual periods Women who began having periods early or went through menopause after the age of 50 have a small increased risk of breast cancer. Risk factors for breast cancer that you cannot change Source: American Cancer Society

26. From J. Internal Med. 251(4):286, 2002

28. Study in Houston Wong, William - bill Hollier, David - HOUSTON ISD Myres, Dawnell - BCM/CNRC Fraley, Kennard - BCM/CNRC Smith, O'Brian Klish, William - BAYLOR COLLEGE OF MED Submitted to: Pediatric Research Publication Acceptance Date: January 20, 2001 Publication Date: April 28, 2001 Abstract only Body weights and heights of students attending five elementary schools and one middle school within the Houston Independent School District (HISD) were measured in duplicate, using electronic scales and stadiometers. The HISD was chosen because it is the largest public school district in Texas (>210,000 students) representing diverse ethnic and socioeconomic backgrounds. Body weights and heights were converted to body mass indexes (BMI, kg/m2=weight/height2). Students were classified as overweight when their BMI exceeded the 85th percentile or obese when their BMI exceeded the 95th percentile of the Centers for Disease Control and Prevention's age and gender specific BMI criteria. The BMI of 3,726 subjects (1,853 boys and 1,873 girls) from five elementary schools and one middle school were studied. The results indicated that 39.0% of the children were overweight and 21.3% were obese. The percentage of children who were overweight or obese was higher among minority children (African Americans: 42.0% were overweight and 23.4% were obese; Hispanics: 46.1% were overweight and 28.4% were obese) than Caucasians (29.1% were overweight ad 13.2% were obese). The prevalence of childhood obesity in Texas is much higher than that reported in NHANES III irrespective of ethnicity. The results imply that the prevalence of childhood obesity in Texas has reached epidemic proportion. Furthermore, the assumption can be made that the children, particularly African American and Hispanic children, are at increased risk of developing chronic diseases associated with obesity.