1. Healthy Eating and Moving More: Why is it important and what works? Steven H Kelder, PhD, MPH Beth Toby Grossman Professor in Spirituality and Healing Michael & Susan Dell Center for the Advancement of Healthy Living University of Texas School of Public Health Austin Regional Campus

2. Healthy Eating and Moving More: Why is it important and what works? Steven H Kelder, PhD, MPH Beth Toby Grossman Professor in Spirituality and Healing Michael & Susan Dell Center for the Advancement of Healthy Living University of Texas School of Public Health Austin Regional Campus

4. Action Framework For A Comprehensive Public Health Strategy To Prevent Heart Disease And Stroke Fatal CVD Complications/ Decompensation Unfavorable Social and Environmental Conditions Adverse Behavioral Patterns Major Risk Factors First Event/ Sudden Death Disability/ Risk of Recurrence The Present Reality Good Quality of Life Until Death Social and Environmental Conditions Favorable to Health Behavioral Patterns that Promote Health Low Population Risk Few Events/ Only Rare Deaths Full Functional Capacity/ Low Risk of Recurrence A Vision of the Future Policy and Environmental Change Behavior Change Risk Factor Detection and Control Emergency Care/Acute Case Management Rehabilitation/ Long-term Case Management Intervention Approaches End-of-Life Care PREVENTION

5. Action Framework For A Comprehensive Public Health Strategy To Prevent Heart Disease And Stroke Fatal CVD Complications/ Decompensation Unfavorable Social and Environmental Conditions Adverse Behavioral Patterns Major Risk Factors First Event/ Sudden Death Disability/ Risk of Recurrence The Present Reality Good Quality of Life Until Death Social and Environmental Conditions Favorable to Health Behavioral Patterns that Promote Health Low Population Risk Few Events/ Only Rare Deaths Full Functional Capacity/ Low Risk of Recurrence A Vision of the Future Policy and Environmental Change Behavior Change Risk Factor Detection and Control Emergency Care/Acute Case Management Rehabilitation/ Long-term Case Management Intervention Approaches End-of-Life Care TREATMENT

7. Energy IntakeEnergy Expenditure Energy Balance Individual Factors Behavioral Settings Social Norms and Values Communities Worksites Health Care Schools and Child Care Home Demographic Factors (e.g., age, sex, SES, race/ethnicity) Psychosocial Factors Gene- Environment Interactions Other Factors Government Public Health University Health Care Agriculture Education Media Land Use and Transportation Communities Foundations Industry Food Beverage Retail Leisure and Recreation Entertainment Physical Activity Sectors of Influence Food & Beverage Intake IOM Comprehensive approach for preventing and addressing childhood obesity SOURCE: Institute of Medicine, Progress in Preventing Childhood Obesity, 2007, pg 20.

8. The Public Health System of the 21 st Century Mgmt Care Orgs Home Health Parks Economic Development Mass Transit Employers Nursing Homes Mental Health Drug Treatment Civic Groups CHCs Laboratory Facilities Hospitals EMS Community Centers Doctors Health Dept Churches Philanthropist Elected Officials Tribal Health Schools Police Fire Corrections Environmental Health SOURCE: Dr. Lloyd Kolbe, personal communication, 2007

9. Elementary, My Dear Dr. Watson l Promote exposure to fruits, vegetables, grains, and calcium rich foods l Reduce consumption of unhealthy foods l Promote physical activity l Reduce screen time l Promote breastfeeding Energy Balance ~ 500 calories per day

10. Dietary Guidelines for Americans Aim for Fitness Aim for a healthy weight Be physically active each day Build a Healthy Base Let the Pyramid guide your food choices Choose a variety of grains daily, especially whole grains Choose a variety of fruits and vegetables daily Keep food safe to eat

11. Dietary Guidelines for Americans Choose Sensibly Choose a diet that is low in saturated fat and cholesterol and moderate in total fat Choose beverages and foods to moderate your intake of sugars Choose and prepare foods with less salt If you drink alcoholic beverages, do so in moderation

12. Other Plant-based Foods l 7 or more servings of other plant-based foods such as whole grains and legumes l Whole grains are higher in fiber, vitamins, minerals, and phytochemicals than refined grains

13. New for 2005 l Specificity of recommendations –At least 30 minutes to reduce risk of chronic disease –Up to 60 minutes of moderate to vigorous physical activity may be needed to prevent gradual weight gain that occurs over time –60 to 90 minutes of moderate-intensity physical activity to sustain weight loss l Recommendations for specific populations

15. l Informational –Community-wide campaigns –Point-of-decision prompts l Behavioral and social –School-based PE –Social support in community settings –Individually adapted behavior change l Environmental and policy –Enhanced access with outreach –Community-scale urban design –Street-scale urban design/land use Evidence-based Interventions to Promote Physical Activity

17. Policy Categories l Healthy food l Recreation l Breast feeding l Built Environment l City Planning/Transportation l Education l Media l Industry l Wellness

18. Sectors to involve l Federal/State l Media l Schools l Faith-based organizations l City l County l Worksites l Health-care

19. Potential population impact (certainty of effectiveness) l Effective: Policy option was tested in one or more well-designed scientific studies and found to affect nutrition and or nutrition behavior. l Promising: Policy was tested in one or more well-designed scientific studies and results of effectiveness are ongoing. l Untested: Policy is potentially a great idea, but is untested or does not have definitive results.

20. The World According to Steve l Start young – school based programs work. Children can be found at school. Young parents, preschool. l Physical activity quickly declines as young girls enter middle school and high school l Promote calcium consumption and weight bearing physical activities to women and girls l Reinforce school lessons at home and in the community. l Promote use of community parks and recreation. l Create social events; eating and PA are social behaviors l Where: worksites, point of purchase, church, school l Stay in it for the long haul.

21. Michael & Susan Dell Center for Advancement of Healthy Living Promoting a Future of Healthy Children We will strive to become one of the leading national research institutions with a focus on improving healthy living in communities, homes, and schools by addressing: –The childhood obesity epidemic, –Child and adolescent development, –Community programs and policies supporting these efforts.

22. Contact Information l Steven H. Kelder, MPH, PhD Michael & Susan Dell Center for Advancement of Healthy Living UT School of Public Health, Austin Regional Campus 313 E. 12 th St., Suite 220 Austin, TX 78701 512-482-6167 512-482-6185 (fax) http://www.sph.uth.tmc.edu/dellhealthyliving/home.asp http://www.sph.uth.tmc.edu/dellhealthyliving/home.asp l Website for CATCH: http://www.sph.uth.tmc.edu/catch/ http://www.sph.uth.tmc.edu/catch/ l Website for SPAN survey: http://www.sph.uth.tmc.edu/DellHealthyLiving/default.asp?id=4061 http://www.sph.uth.tmc.edu/DellHealthyLiving/default.asp?id=4061