Call to Order and Roll Call
Thethird meeting of the Task Force on Childhood Obesity was held on Tuesday, September 20, 2011, at 10:00 a.m., in Room 154 of the Capitol Annex. Representative Tom Riner, Co-Chair, called the meeting to order at 10:07 a.m., and the secretary called the roll.
Members:Senator Katie Kratz Stine, Co-Chair; Representative Tom Riner, Co-Chair; Senators Tom Buford, Jimmy Higdon, Alice Forgy Kerr, and Joey Pendleton; Representatives Bob M. DeWeese, David Watkins, and Addia Wuchner.
Guest Legislators: Senator Julie Denton, and Representatives Wilson Stone and John Will Stacy.
Guests: Major General D. Allen Youngman, US Army (Ret.), Mission: Readiness; Therese Sirles, M.S., R.N., CPN, Director of Child Advocacy, Dr. Brooke Sweeney, Director, Health for Life, Dr. Maria Bowling, and Dr. Jordan Huskins, Kosair Children’s Hospital; Deann Allen, Ph.D., Instructional Supervisor, Clay County School System; Melinda J. Ickes, Ph.D., and Heather Erwin, Ph.D., Department of Kinesiology and Health Promotion, College of Education, University of Kentucky; Elizabeth Schmitz, Executive Director, and Merin Roseman, Kentucky Environmental Education Council; Shannon Buzard, parent; Ruth Ann Shepherd, Department for Public Health, Cabinet for Health and Family Services; Meredith Evans and Jen Alvis, Commission on Children with Special Health Care Needs; Wilson Sean, Superintendent Association; Carolyn Dennis, Health Advocate; Elaine Russell, Department for Public Health, Cabinet for Health and Family Services; Jim Thompson, Education and Workforce Development Cabinet; Andrea Plummer, Kentucky Youth Advocates; Bill Doll, Kentucky Medical Association; Jodi Mitchell, Kentucky Voices for Health; Wayne Young, Kentucky Association of School Administrators; and Susan Zepeda, Foundation for a Healthy Kentucky.
A motion to approve the minutes of the August 16, 2011 meeting was made by Senator Pendleton, seconded by Representative Wuchner, and approved by voice vote.
Too Fat to Fight Report: Retired Military Leaders Want Junk Food Out of America’s Schools
Major General D. Allen Youngman, US Army (Ret.), Mission: Readiness, stated that the United States military remains the best in the world, not because we have the most sophisticated weapons and equipment, but because of the young men and women who step forward each year to serve in uniform. It is the course and commitment of these soldiers, sailors, airmen, and Marines that have enabled the United States to sustain two major wars and meet countless other worldwide commitments with an entirely volunteer force. Despite the strains of repeated deployments, all of the services continue to meet their recruiting goals each year. The 230 retired generals, admirals, and other senior military leaders of Mission: Readiness have warned Congress that approximately one in four 17- to 24-year olds in the United States is too overweight to serve in the military. Obesity rates among children and young adults have increased so dramatically that it threatens not only the overall health of America, but also the future strength of the military. One survey found that Kentucky has the highest proportion of overweight or obese young adults in the nation. In 2010, the Healthy, Hunger-Free Kids Act was enacted by Congress. The United States Department of Agriculture proposed a set of new regulations aimed at improving the nutrition in school breakfast and lunches. The new regulations will help children replace bad eating habits with healthy ones that can last a lifetime. Congress needs to ensure schools get needed equipment for better food preparation and updated training for food service workers.
The situation has major implications across a wide range of issues including the viability of our healthcare system as well as the quality of life for millions of Kentuckians. Everyone dealing with this matter needs to understand that being able to maintain a strong, healthy military is very important. Every year military recruiters have to turn away thousands of young men and women who want to join the armed forces and are otherwise qualified but cannot meet the military height and weight standards. Military service has been the door to a better life for millions of Americans, especially in Kentucky. Because of bad choices early in life, that opportunity has been taken away from thousands of Kentuckians.
If children are not encouraged at school to participate in physical activities that build strong, healthy bodies, they will pay the price later in life. Sedentary lifestyles of children cause bones and muscle development to be inadequate to avoid injuries caused by the demands of initial entry training. Regular exercise can make an enormous difference not only whether a young person grows up to be healthy later in life, but also has a lot to do with how well they learn at school.
The United States military stands ready to protect the American people, but if everyone does not help ensure that future generations grow up to be healthy and physically fit, that will become increasingly difficult. The health of our children and national security are both at risk.
In response to a question by Senator Stine, General Youngman stated that when weight problems combined with educational deficits, criminal records, and other disqualifiers such as asthma or drug abuse, 75 percent of Americans 17 to 24 years old are unable to join the military for one or more reasons.
Evidenced Based Activities
A Proactive Approach to Pediatric Obesity- The Role of Kosair Children’s Hospital
Therese Sirles, M.S., R.N., CPN, Director of Child Advocacy, Dr. Brooke Sweeney, Director, Healthy for Life, Dr. Maria Bowling, and Dr. Jordan Huskins, Kosair Children’s Hospital, stated that Kosair Children’s Hospital is Kentucky’s only free-standing pediatric hospital. In 2010, 516 inpatients had a primary or secondary diagnosis of obesity, there were 47 had newly diagnosed diabetic admissions, and 348 outpatients had a primary or secondary diagnosis of diabetes. Kosair Children’s Hospital is one of twenty-five children’s hospitals participating in the National Association of Children’s Hospitals “Focus on a Fitter Future.” The responsibilities are to understand current trends, build support and partnerships among colleagues in the field, build consensus on practice improvement, and participate in evidence-based activities.
Within Kosair Children’s Hospital, studies are being done to assess structures, policies, and procedures that impact obesity or deficiencies in optimal health. Proactive changes that have occurred include: 1) collecting and interpreting Body mass index (BMI) on all patients admitted to the hospital to help health care professionals develop a plan of care for pediatric patients; 2) enhancing nutritional services and registered dietitian consultations to patients with increased BMI or those who may have a chronic condition that is exacerbated or complicated by obesity, like diabetes or asthma; and 3) collaborating with community partners to open community lactation centers in Norton Healthcare facilities in greater Louisville and area public health departments. The hospital’s Children’s Hospital Foundation Office of Child Advocacy works in conjunction with the Pediatricians Urging Safety and Health (PUSH) advocacy group to develop prevention programs for a community outreach initiative called the Fun-tastic Fitness Formulary. Advocates at the hospital put together a tool kit that includes a family-centered instructional booklet, fitness tips, nutritional information, family focused recipes, and a fitness DVD.
Kosair Children’s Hospital provides subject experts to present continuing medical education on childhood obesity and tactics for prevention to primary care physicians and other health care providers. Physicians are taught to identify children who are overweight or at risk of becoming obese and teaches them how to have the difficult conversation with the child and his or her family and how to formulate a plan to begin the path to a healthy lifestyle.
Kosair Children’s Hospital, Office of Child Advocacy, provided a grant to start a pedometer program to encourage physical activity in ten Jefferson County elementary schools, six Clay County elementary schools, three schools in Owensboro, and two school districts in Indiana. Students in the pedometer program take part in an entire educational curriculum surrounding the nutritional component of a healthy lifestyle, including learning how to make healthy food choices. In addition to healthy lifestyle education, the program incorporates a full complement of mathematics, history, geography, reading and writing skills lessons to improve academic performance. It is very important to actually marry the physical activity with education activity.
Healthy for Life Clinic opened in April 2009. State of the art care is a multidisciplinary treatment program that includes a physician, nurse practitioner, dietitian, psychologist, and exercise physiologist. The mission is to help children grow up healthy, and happy. Over 1,000 patients have been seen at the clinic since it opened.
Benefits of the Clay County Pedometer Program
Deann Allen, Ph.D., Instructional Supervisor, Clay County School System, stated that the pedometer program has encouraged students to want to meet short- and long-term goals. For students who are raised in generational poverty, being able to set and meet a goal can become the beginning of a lifetime of change. Families are beginning to make healthier choices because students are going home and encouraging their families to become more active. Teachers use the pedometers in classroom instruction. Teachers and students have developed a good repoire.
In response to a question by Representative DeWeese, Dr. Sweeney stated that a most of the parents of obese children are also obese themselves, but the children are more adversely affected because they started becoming obese at an earlier age than their parents. While some parents have given up on themselves, they have not given up on their child.
In response to questions by Senator Stine, Dr. Sweeney stated that the partnerships are the key to success. There are many physical activities that teachers could incorporate into lesson plans. Dr. Allen stated that it is important that educators realize that students who are active do better with their academic success.
Senator Pendleton stated that the obesity problem has been around for generations but the cycle can be broken by educating people to live healthier lifestyles.
In response to questions by Senator Higdon, Dr. Sweeney stated that her program is a Medicaid-special program through Passport, and she sees patients who have different insurance plans. Medicaid pays for all the needed services where the other insurance plans do not. The vast majority of patients in the clinic participate in the free school breakfast and lunch program and their parents receive food stamps. Ms. Sirles stated that during the nutritional classes that the child advocates at Kosair Children’s Hospital teach not only to parents but also to students, visual demonstrations of the amount of sugar in a can of soda helps children understand the problem better. Children are taught that water and low-fat milk are the healthy choices to quench thirst. Parents need to be taught new behaviors in order to teach their children. Dr. Sweeney stated that the culture and policies in schools need to be changed to where healthy choices become the first choice. Studies have shown that children will drink more water out of a pitcher than a fountain.
In response to questions by Representative Wuchner, Dr. Sweeny stated that the Y5210 program is five fruits, two hours of less screen time, one hour of fitness, and zero beverages sweetened with sugar or artificial sweeteners. The reimbursement rate for pediatricians for obesity-related problems has improved unfortunately because children are becoming sicker.
Senator Denton stated that technology, processed foods, and both parents working have created obesity problems. Access to fresh produce is limited in some areas. Today’s society needs immediate gratification, and people need to see immediate changes in order to continue the different lifestyle.
In response to a question by Representative Stacy, Dr. Sweeney stated that not all diabetes or diabetes-related programs will work in all counties and have to be individualized county by county. Genetic factors in obesity are different by culture and have to have different approaches. In response to a question by Representative Stacy, Dr. Allen stated that freezers, workspace, deep fryers, and remodeling kitchens are all areas that need to be updated and it takes time and money. School cooks need to professional development training to help prepare healthier food choices for students.
Senator Kerr questioned if the Kentucky Department of Education enforces guidelines set forth in Senate Bill 172 from the 2005 Regular Session relating to health and nutrition in schools.
Senator Buford stated that because canned foods served at schools have a high sodium content, schools need to serve more fresh fruits and vegetables.
Representative Riner stated that hospitals need to be examples and provide healthier food choices.
Physical Activity and Academic Performance
Melinda J. Ickes, Ph.D., and Heather Erwin, Ph.D., Department of Kinesiology and Health Promotion, College of Education, University of Kentucky, stated that healthier students are better learners. School health programs can help improve students’ education outcomes. Helping young people stay healthy is a fundamental part of the mission of our schools. Physical activity impacts obesity, heart disease, mental health, musculoskeletal disorders, hyperactivity, inattentiveness, and behavior. The Association Between School-Based Physical Activity, Including Physical Education, and Academic Performance Report by the Centers for Disease Control and Prevention reported that studies showed increasing or maintaining time for physical activity does not appear to adversely impact academic performance. There is substantial evidence that school-based physical activity can help improve academic achievement, including grades and standardized test scores, and have a positive impact on cognitive skills and academic behaviors. One reason school administrators are against more physical activity in schools is they are held accountable for standardized test scores.
Senate Bill 172 enacted in 2005 requires up to 30 minutes a day of instructional time toward physical activity. Efforts must assist schools with meeting their objectives to be cost effective, unobtrusive, user friendly, and sustainable. Let’s Move in School is a comprehensive school physical activity program. The goal of the program is to ensure that every school provides a comprehensive school physical activity program with quality physical education as the foundation so that youth will develop the knowledge, skills, and confidence to be physically active for a lifetime. Strategies for implementing classroom physical activity should vary instructional areas within each classroom and should include hands-on learning. Recess allows time for social interaction, physical activity, and to be a kid, and also a break from academics. Effective strategies for recess are added equipment and materials, playground markings such as hopscotch, activity zones, teacher involvement, and activity of the week cards. A number of simple, low-cost strategies can be implemented to maximize the amount of recess time students are allotted. Physical activity impacts student behavior, attention, and cognition.
Green and Healthy Schools
Elizabeth Schmitz, Executive Director, Kentucky Environmental Education Council (KEEC), stated that the Council was established by the legislature in 1990 to coordinate environmental education in the Commonwealth. KEEC’s mission is to help Kentuckians develop the skills necessary to solve current environmental problems, prevent new ones, and maintain a balance between the economy and the environment for future generations. In 2007, KEEC piloted the Kentucky Green and Healthy Schools program. The Kentucky Green and Healthy Schools program is designed to empower students and teachers to create safer, healthier, and more sustainable schools. Currently, over 200 schools across the Commonwealth enrolled in the program. The program is free of charge, open to all K-12 schools, and correlated to state learning standards. Students investigate school environment, then design and implement small but significant school improvement projects based on research findings. Students feel empowered to make a difference at their school and in the community. A benefit of the program is that it can build confidence and self-esteem in students. By participating in the program, students often become more physically active and more confident.
There being no further business a motion to adjourn at 12:05 p.m. was made by Senator Higdon, seconded by Representative Riner, and approved by voice vote.