2. Childhood Obesity… Let’s “Step” Towards A Healthier Future! Shelley Francis Diabetes Community Consultant Union of NB Indians ANTEC 2010

3. Childhood Obesity…Sad Facts In Canada, over 26% of children and youth (1.6 million children) are considered overweight or obese If this trend continues, 46 % of school-aged children will be overweight or obese by 2015 In 20 years, 70% of 35-44 year olds will be obese as compared to 57% who are currently obese Aboriginal children are at higher risk due to genetic and lifestyle factors

4. Childhood Obesity…Sad Facts 55% Obesity rate in First Nation Communities (CMA, 2007) Chronic disease rates are higher (and some are in epidemic proportions) among Canada’s Aboriginal population Mental health issues are abundant among Aboriginal People – slowing our progress towards healthier communities

5. Childhood Obesity…Sad Facts Unfortunately most obese children and youth do not outgrow their weight problem….in fact most people tend to gain weight as they age.

6. What is Childhood Obesity Childhood Obesity is a medical condition that affects children and teenagers. It happens when too much fat is stored in the body, causing a weight that is not proportional to the child’s height. The primary cause of CO is eating too much and not getting enough exercise

7. Risk Factors to Childhood Obesity Most children who are affected: Consume food and drinks that are high in sugar and fat on a regular basis such as fast food, candy, baked goods, pop and other sugar-sweetened beverages Are not physically active each day Watch a lot of TV and play a lot of video games, computer use Eat to help deal with stress or problems

8. Risk Factors to Childhood Obesity Live in an environment where healthy eating and physical activity are not encouraged Come from a family of overweight people where genetics may be a factor, especially if healthy eating and physical activity are not a priority in the family Come from a low-income family who do not have the resources or time to make healthy eating and active living a priority Have a genetic disease or hormone disorder such as Prader-Willi syndrome or Cushing's syndrome

9. Long-term Obesity = Long-term Health and Social Problems!

10. What Happened?? Lack of physical activity programs in schools and in the community Lack of grassroots stuff to do – or unwillingness to do them Video and computer game access Lack of time at home – families are VERY busy! Lack of knowledge of the importance healthy eating Access to food is incredible and convenient!!

11. Consequences of Childhood Obesity Chronic diseases: diabetes, heart disease, cancer Bone & joint dysfunction High blood pressure and elevated cholesterol Earlier than normal puberty or menstruation Liver problems – due to ongoing fat digestion Eating disorders such as bulimia and anorexia Respiratory problems such as asthma, shortness of breath etc. Skin infections due to excessive perspiration trapped in skin folds Sleep apnea Fatigue

12. Consequences of Childhood Obesity Negative body image Depression Teasing, bullying, social marginalization More likely to bully others Poor self-esteem and may feel socially isolated Increased risk for depression Poorer social skills High stress and anxiety May have behaviour and/or learning problems as a result of psychological difficulties related to childhood obesity

13. ADI Diabetes Prevention & Healthy Lifestyle School Program   Community-based school program   Vision…to create an awareness of the growing incidence of Diabetes among Aboriginal People in Canada – and how to prevent it and other chronic diseases   Addresses healthy lifestyle issues such as nutrition and physical activity   Addresses the devastating childhood obesity epidemic facing our Youth

14. Health Promotion in Schools… School Food Policy Implementation Nova Scotia (2006) – staged implementation began New Brunswick (2007) – staged implementation began Eel Ground School (2008) – full implementation began Sept. 2008

15. Eel Ground School Nutrition Policy Objective “This policy establishes the minimum requirements for healthy foods and regular physical activity in the Eel Ground School by setting standards for awareness of healthy foods, food options available in schools and sale of foods in and through the school system.”

16. Eel Ground School Nutrition Policy Awareness began 2003 Planning through wellness committee in summer of 2007 Approval of Chief & Council and education committee Staged approach until Sept.2008, then policy fully implemented Breakfast and Hot lunch programs

17. ADI School Screening Program Began in 2004 Eel Ground First Nation was first school involved with screening With parental consent, each student grades K-8 tested with blood sample Generally well-tolerated Students screened annually

18. Screening Results Blood Glucose Testing INDICATOR200320052008 %% Impaired Glucose Tolerance (PC glucose >11.1 mmol/l) 0%0%0% Impaired Fasting Glucose (AC glucose > 5.7) 9%5%0% Normal Blood Glucose (pre meal < 7 and post meal < 9 mmol/l) 91%95%100%

19. Screening Results Body Mass Index (2005) Indicator # Students % BMI>95 th Percentile(=Obesity) 1632% BMI 85-95 th Percentile (Overweight - risk for obesity) 1327% BMI 50-85 th Percentile 918% BMI 3-50 th Percentile 1122% BMI<3 rd Percentile 2<1%

20. Screening for Type 2 Diabetes Risk Factors in Children & Adolescents Identify children 10 years and greater who are most at risk of developing Type 2 Diabetes in the future Parent Questionnaire and consent Initial screening for diabetes risk factors did not involve any blood glucose testing, avoiding unnecessary blood samples.

21. Screening for Type 2 Diabetes Risk Factors in Children & Adolescents Parent Consent and Questionnaire completed and sent back to school. Children were screened for the following 3 risk factors: Aboriginal Descent, BMI>95%, 10 years of age or older If all 3 risk factors were present…

22. Screening for Type 2 Diabetes Risk Factors in Children & Adolescents …And they had one or more of the following risk factors, their risk would be assessed as high and further screening needed to be completed: Mother with Gestational Diabetes Family members with diabetes Acanthosis Nigricans High blood fats Hypertension Polycystic Ovary Disease

23. Screening for Type 2 Diabetes Risk Factors in Children & Adolescents (2008) Indicator # Students % BMI>95 th Percentile(=Obesity) 2542% Elevated Blood Pressure 915% Mothers With Gestational Diabetes 712% Acanthosis Nigricans 39%

24. Health Promotion in Schools… Kindergarten Class Canada Food Guide display at Miramichi Regional Hospital

25. Project Outcomes Healthier learning environment for school Increased awareness of Diabetes epidemic Increased staff involvement in healthy lifestyles Ownership of the project by the students Enhanced communication and partnerships between health programs on and off reserve Healthier children! Follow up continues…..parents more involved Pride for the students, staff and community

26. ADI School Program Partnerships Community First Nation School Community Health Nurse/CHR Local businesses Provincial Health Department Regional Hospital Health Authority Pharmaceutical Industry University Faculty of Nursing & Kinesiology Brighter Futures Program FNIHB staff - Dental Therapist, Nutritionist, Physical Activity Specialist etc.

27. Where Are We Going? Continue with annual screening clinics Partner with helping organizations Continue to do classroom education with the students Continue to support school staff in making the school environment healthy Promotion of School Food Policy 4 Steps to better health in Children

28. 4 Simple Steps to Better Health in Children ONE Hour of Physical Activity Per Day! FIVE Fruits & Vegetables Per Day! TWO Hours or Less of Screen Time Per Day! ZERO Sugar Sweetened Beverages Per Day!

29. What Can Families Do? Be active as a family Involve children in household activities Be knowledgeable about health Eat meals together at home Teach your children basics – like cooking Lead by example Start early in your child’s life Don’t set child up for failure (junk foods in the kitchen cupboards) Do not talk “diets” – focus on healthy lifestyles Be supportive, not critical!

30. What Can Communities Do? Limit sale of sugar sweetened beverages (SSB’s) at community events, municipal buildings, schools, public areas etc. Offer food skills programs (cooking classes, healthy grocery shopping tours) Support adoption of school food policies Be an active community with walking trails, subsidized activity fees etc.) Offer support through health programs

31. What Can Government Do? What Can Government Do? Fund more treatment centres for obese and overweight children Support research and evaluation of ongoing childhood obesity programs to improve services and accessibility Improve access to affordable fruits and vegetables and healthy foods in general Support ongoing and new initiatives such as Winteractive, Summeractive, CPNP, ADI, Headstart - ensure that these programs target the children and youth in preventing obesity and other chronic diseases

32. What Are We Going To Do? Lobby Chiefs and Councils local and national governing bodies to support the cause Educate School staff to enlist their support Become educated ourselves Ensure a constant presence wherever kids are Be there for students, families and staff Be role models for all community members Persistence is the key to success… DON’T GIVE UP!!!

33. Children’s Pride & A Brighter Future are in Our Hands!

34. Questions? Questions? Shelley Francis, BNRN, CDE Diabetes Community Consultant Union of NB Indians (506) 458-9444 shelley@unbi.org Ann Gottschall, RNMN Diabetes Community Consultant Union of NS Indians (902) 863-8455 ann.gottschall@ns.sympatico.ca

35. Questions? Questions? Margie Gray BSc.RD Diabetes Community Consultant MAWIW Council Inc. (506) 476-4014 margieg@nb.sympatico.ca Tara MacKinnon, PDt., CDE Diabetes Community Consultant Confederacy of Mainland Mi’kmaq (902) 895-6385 adi@cmmns.com