Call to Order and Roll Call
Thefifth meeting of the Task Force on Childhood Obesity was held on Monday, October 31, 2011, at 1:00 p.m., in Room 129 of the Capitol Annex. Senator Katie Kratz Stine, Co-Chair, called the meeting to order at 1:20 p.m., and the secretary called the roll.
Guests: Andrea Plummer, Senior Policy Analyst, Kentucky Youth Advocates; Tonya Chang, Kentucky Director of Government Relations, American Heart Association, Great Rivers Affiliate; Carolyn Dennis; Ben Reno-Weber, Executive Director, Kentucky YMCA Association; Steve Tarver, CEO, YMCA of Greater Louisville; Gail Glasser, CEO, Central Kentucky YMCA; Dave Steele, CEO, Frankfort YMCA; Dr. Rachel Lowdenback, Pediatric Resident, Dr. Lauren Kostelnik, Pediatric Resident, Dr. Ashley Bowen, Pediatric Resident, Dr. Lori Huff, Pediatrics Chief Resident, Dr. Kim Northrip, Assistant Professor of Pediatrics, Dr. Janeth Ceballos, Assistant Professor of Pediatrics, and Dr. Stephanie Stockburger, Assistant Professor Pediatrics and Adolescent Medicine, University of Kentucky Department of Pediatrics; Wayne Young, KASA; Susan Zepeda, Foundation for a Healthy Kentucky; Meredith Evans and Jennifer Alvis, Commission for Children with Special Health Care Needs; Shannon Buzard, concerned citizen; and Jamie Sparks Kentucky Department of Education.
Approval of the Minutes of the October 25, 2011 Meeting
A motion to approve the minutes of the October 25, 2011 meeting was made by Senator Pendleton, seconded by Representative Wuchner, and approved by voice vote.
Complete Streets/Safe Routes to Schools
Andrea Plummer, Senior Policy Analyst, Kentucky Youth Advocates, stated that policies need to be changed to make children more active by walking and riding bikes. Everyone should be able to travel safely on roads and be active in communities. Many roads are built with only people in vehicles in mind, making streets sometimes unsafe for people using other modes of transportation. In response to unsafe conditions for users and in an effort to promote physical activity, many communities are adopting a complete streets approach. Complete streets are designed to accommodate everyone that uses the road, including pedestrians, bicyclists, motorists, and public transportation users of all ages and abilities. Everyone should be able to safely move along and cross a complete street. When complete streets are included in the early stages of transportation planning and design, there is often little to no cost to implement. Complete streets may include bike lanes, sidewalks, crosswalks, wide paved shoulders, pedestrian signals, special bus lanes, and roundabouts. A wide shoulder and/or a sidewalk may be enough to be a complete street in rural areas. Urban areas may need more elements due to heavier traffic on roads.
Complete streets allow traffic to flow more smoothly, motorists become more aware of other users of roads, and there is a reduced risk of accidents involving bicyclists and pedestrians. Community members are more likely to exercise and utilize active transportation options if there is an accessible and safe place to do so. Other complete streets benefits include reduced traffic congestions, attracting tourism, livable communities, encouraging safer routes to school, improved air quality, and lower transportation costs for families. Complete streets policies can be adopted in a variety of ways including state legislation, executive orders, public ordinances, resolutions, internal policies, and rewrites of manuals and standards. Currently, 25 states have committed to adopting complete streets policies. The Kentucky Transportation Cabinet has an internal policy which states that bicycle and pedestrian facilities will be considered if certain conditions are met. However, this is not considered a complete streets policy by the National Complete Streets Coalition.
Senator Pendleton stated that complete streets should be located closest to the higher populated areas.
Joint Use Agreements/School and Community Partnerships
Andrea Plummer, Senior Policy Analyst, Kentucky Youth Advocates, stated that a shared use agreement is a formal or informal partnership to share facilities between a local school district and other agencies such as city government, parks and recreation department, or the YMCA. The facilities can include, but are not limited to, outside tracks and fields, swimming pools, fitness centers, and gymnasiums. Children are more active when they have safe places to play. Communities with lower incomes, higher poverty rates, and higher proportions of racial and ethnic minorities who are the most at risk to be sedentary and overweight have the fewest community level physical activity related opportunities. KRS 160.293 allows a board of education to enter into agreements with public agencies to develop and maintain recreational facilities on school property for school and community purposes. KRS 162.05 allows a board of education to permit the use of the schoolhouse by any lawful public assembly of education, religious, agricultural, political, civic, or social bodies under rules it deems proper. All formal agreements must be approved through the Kentucky Department of Education, Division of Facilities Management. Most agreements are formed at the district level in partnership with the school principal and the community agency. Some districts handle all agreements and principals must allow the school facilities to be used. Other districts encourage principals to share the school facilities but do not require them to. Some district superintendents do not allow school facilities to be used by community agencies. The most commonly reported concerns were fear that school facilities would be damaged, liability, and security.
Recommendations are to provide schools and districts technical assistance in forming joint-use agreements, to limit liability for schools in order to encourage schools and districts to share school facilities with community agencies, to create a venue for schools and districts to hear how others have created successful partnerships with community agencies, and to help schools identify funding opportunities that would help them form joint-use agreements.
In response to a question by Representative Riner, Ms. Chang stated that the Kentucky recreational user statutes would hold up to a court challenge.
Senator Pendleton stated that the burden of change cannot be placed totally on the school, but parents also need to take responsibility and change the cycle of unhealthy eating and sedentary lifestyles. A change needs to be made in the Supplemental Nutrition Assistance Program (SNAP) that would not allow electronic benefits transfer (EBT) cards to be used to buy unhealthy foods. Ms. Chang stated that the changes would have to come from the federal government. In response to a statement by Senator Pendleton, Ms. Chang stated that it will take both legislation and education to make changes.
Policy Prospective: What Other States are Doing to Address Obesity
Tonya Chang, Kentucky Director of Government Relations, American Heart Association, Great Rivers Affiliate, stated that 66 percent of adult Kentuckians are overweight or obese. Nearly ten percent of all medical spending is related to obesity. On average, individuals who are obese spend almost $1,500 more on health care per year. In 2005, legislation passed that required nutrition standards for competitive food sales in schools, nutrition education for school food service personnel, district reports on the status of the school nutrition and physical activity and an annual report from the Department of Education on physical activity in elementary schools. It also restricted access to fast food and contained a provision that allows elementary schools to count up to 30 minutes of daily physical activity as part of the instructional day. The Department for Public Health within the Cabinet for Health and Family Services provides staff for the Partnership for a Fit KY, a statewide coalition focused on obesity, but the group’s work is very limited due to a lack of resources.
Kentucky is one of 20 states along with Washington, D.C. that have stricter school nutrition standards than the USDA. Kentucky is one of 35 states along with Washington D.C. that have nutritional standards for competitive foods. California, Oregon, and North Carolina prohibit the use of trans fat oils in food preparation in schools. Twenty-six states and Washington, D.C. have some kind of Farm to School program. Some programs are statewide; others cover a portion of a state or certain schools. Florida, Alabama, Louisiana, Montana, and Oregon require 150 minutes of physical education per week in grades K-6. Alabama, Louisiana, Utah, Montana, and Oregon require 150 minutes of physical education per week in middle school. About 11 states require schools to provide physical activity or recess during the school day. Twenty states have requirements for body mass index (BMI) screening or other weight-related assessments. Several states have passed laws to address the treatment and management of diabetes in at school.
South Dakota and North Carolina have passed laws that clarify liability rules for the use of school-owned recreational facilities by other government and non-governmental entities for the purpose of physical activity. It is recommended that Kentucky strengthen its liability laws. The National Conference of State Legislators (NCSL) identified five policies that encourage biking and walking: incorporating sidewalks and bike lanes into community design, funding for biking and walking in highway projects; establishing safe routes to school, implementing traffic-calming measures designed to slow traffic, and creating incentives for mixed-use development. California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Oregon, Rhode Island, Vermont, Washington, and Wisconsin have passed complete street laws. According to the National Complete Streets Coalition, more than 250 complete streets policies have been passed by states, counties, regional governments, and cities. Several states, including Kentucky have considered legislation that would provide tax incentives to offset some of the employers’ costs for implementing comprehensive worksite wellness programs. The nutrition and physical activity standards for daycare centers are areas that also need to be studied.
Senator Stine stated that everyone would benefit from complete streets. It would save transportation expenses to roads, promote economic development and tourism, and encourage families to exercise.
Senator Higdon stated that Kentucky should petition the federal government to change the requirement that SNAP recipients receive 52 checks per year instead of 12.
Shaping Kentucky’s Future Collaborative
Carolyn Dennis said that the members of Shaping Kentucky’s Future Collaborative (SKFC) are a loose affiliation of corporate, community, and family foundations that, working under auspices of the Blue Grass Community Foundation, represent a resource for Kentucky. Working within the framework of the Shaping Kentucky’s Future policy brief developed by the Partnership for a Fit Kentucky, SKFC identified three priority policy areas: sound nutrition and healthy physical activity in school settings; sound nutrition and healthy physical activity in early childhood settings; and complete streets with safe space for pedestrian and bicycle traffic. In 2006, a collaboration of national funders created the Healthy Eating Active Living Convergence Partnership, with the goal of changing policies and environments to better achieve the vision of healthy people living in healthy places. In 2010, a two-year $150,000 grant was received from the Tides Foundation on behalf of Healthy Eating, Active Living Convergence Partnership to provide consultative support to SKFC. The Tides Foundation also provided a $30,000 grant to SKFC to match the local funder’s investment. The Foundation for a Healthy Kentucky committed $100,000 for each of two years, matched dollar for dollar by four of Kentucky’s community foundations, for a total of $400,000, thereby leveraging the original $150,000 investment by the Tides Foundation for a total of $550,000. Ongoing partnerships include the Kentucky League of Cities, Partnership for a Fit Kentucky, Kentucky Voices for Health, and Kentucky Youth Advocates. Recipes for Change: Healthy Food in Every Community, found at www.ConvergencePartnership.org, addresses examples of policy change in healthy food in schools and child care settings. Transportation and Health 101 Toolkit presents an overview of transportation policy and planning, the connections between transportation and health as well as policy opportunities to create healthy transportation options.
Susan Zepeda, Ph.D., President and CEO of the Foundation for a Healthy Kentucky provided the members with information on the foundation, results of the Healthy Kentucky 2010 Kentucky Health Issues poll, and a DVD titled More Than Child’s Play, Why Physical Activity Matters produced by Kentucky Education Television (KET).
Ben Reno-Weber, Executive Director, Kentucky Alliance of YMCAs, stated that the core strength of the YMCA is the ability to convene community partnerships at the local, state, and national level to address critical issues in the communities. The mission of the YMCA is to put Christian principles into practice through programs that build a healthy spirit, mind, and body for all. The Y extends beyond its Christian heritage to create programs that are welcoming, inviting, and accessible to all people. The YMCA has partnerships with schools, community organizations, government, and leaders across the state. The YMCA has partnered with the Transportation Cabinet, Tourism, Arts, and Heritage Cabinet, and Department of Education to put a healthy message in areas statewide that it is most effective. The YMCA has created partnerships with Anthem, United Healthcare, CDC, and the Robert Wood Johnson Foundation to bring people who need access to health facilities to the YMCA and help them develop healthier lifestyles. Anyone who works with children needs to be held to higher standards. Complete Streets and Safe Routes to School continue to be high priorities in promoting a healthy lifestyle, healthy family life, and addressing issues of child care providers. State licensure requirements for out-of-school care should be updated to continue increasing focus on health issues.
Steve Tarver, CEO, YMCA of Greater Louisville, stated that positive health outcomes have to be associated with families, and economic and housing issues. The role of the YMCA is to provide physical infrastructure to support the sale of fresh fruits and vegetables and provide training and support. There are not enough grocery stores in some neighborhoods to provide healthy food, so the YMCA has received funds to help open stores that will help serve some of these communities. The YMCA has partnered with schools, districts, and foundations to implement the Y-5210 program that focuses on that every day children eating five fruits or vegetables, two hours or less of screen time, one hour of physical activity, and zero sugar sweetened beverages. The program is delivered to over 8,000 children per day in Jefferson, Hardin, and Hopkins counties. A significant increase in healthy behaviors due to the program has been noticed. The new practical living standards are very consistent with the components of Y-5210. The Kentucky Pediatric Society has partnered with the YMCA and Anthem Healthcare to provide a referral program in Lexington, Louisville, and Northern Kentucky. Using existing infrastructure, the YMCA is changing eating habits at the grassroots level. The problem goes beyond obesity and affects a child’s self-esteem.
Dave Steele, CEO, Frankfort YMCA, the Frankfort YMCA received a $60,000 Pioneering Healthy Communities grant. A coalition has been formed that include community representatives from the local hospital, county and state health departments, Kentucky State University, county parks, and both school systems. In 2010, the first project was to institute the Take 10 program that provided 185 notebooks to all kindergarten through fifth grade classes in Franklin County. One requirement of the grant is that funds have to be spent in the community not at the YMCA. In the two-year community action plan two projects are to work with the YMCA-Crayon Club to do a community healthy living survey and sharing new after-school healthy eating and physical guidelines developed through the YUSA-University of Massachusetts College of Nursing and adopted by National Institute on Out of School Time.
Gail Glasser, CEO, Central Kentucky YMCA, stated that the YMCA teaches real life strategies. The YMCA is the largest child care provider in the United States with 25 million children per day, with 20,000 of these children in Kentucky. The YMCA’s role is both energy balanced and provides opportunities for physical activities. Children spend 20 percent of the time in age-appropriate physical activities. YMCA employees have to be role models of healthy living. The YMCA creates community-wide opportunities for physical activity and family strengthening. Approximately 83 percent of children in Fayette County ride to school by bus or are taken by a parent, and because 50 percent of them live within a mile or less of school, they could walk or ride a bicycle. Complete Streets and Safe Routes to School are vital to help ensure children are healthy. Easy access is an important part of making healthy choices. Healthy choices require good options. The YMCA can connect existing funding and programs to local communities.
In response to a question by Representative Wuchner, Mr. Tarver stated the YMCA has programs in 72 of the 120 counties. The YMCA partners with schools in eastern Kentucky.
In response to a question by Representative Riner, Mr. Tarver stated the YMCA has been in existence in Kentucky for 158 years.
Prevention, Treatment and Costs: University of Kentucky Department of Pediatrics
Dr. Ashley Bowen, Pediatric Resident, stated that one-third of the children in the United States are overweight or obese and two-thirds of adults are overweight or obese. Body mass index (BMI) is calculated using a child’s height and weight, age and sex-specific percentiles. If a child is obese in adolescence, there is a 90 percent chance of being an obese adult. Thirty-one percent of Kentucky children age 10 to 17 are considered either overweight or obese. Thirty-two percent of children ages two to five years from low-income families participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) are obese or overweight. Medical costs paid for people who are obese were $1,429 higher than those of normal weight.
Dr. Lauren Kostelnik, Pediatric Resident, stated that forty percent of the entire healthcare budget is spent on obese-related medical conditions. A child has a 79 percent chance of becoming obese if there is one obese parent. While genes play a role in obesity, it does not account for the dramatic increase in prevalence of obesity. In 2007, only 18 percent of students in grades 9-12 met the recommendation of at least 60 minutes of aerobic physical activity daily. The medical consequences of obesity are hypertension, type 2 diabetes, coronary artery disease, hypercholesterolemia, obstructive sleep apnea, increased asthma severity, mechanical stress on joints, pseudotumor cerebri, hepatic steatosis or fatty liver, and gastrointestinal problems. The mental health consequences of obesity are social stigma, depression, low self esteem, bullying, and early puberty.
Dr. Rachel Lowdenback, Pediatric Resident, stated that the CDC strategies for preventing obesity are to address physical activity and nutrition through a coordinated school health program, maintain an active school health council and designate a school health coordinator, assess the school’s health policies and programs and develop a plan for improvement, strengthen the school nutrition and physical activity policies, implement a high quality health promotion program for school staff, implement a high quality course of study in health education, implement a high quality course of study in physical education, increase opportunities for students to engage in physical activity, implement a high quality school meals program, and ensure appealing, healthy choices outside of the school meal program. Physical activity improves fitness and lowers the risk of obesity. Children who take breaks from classroom work to be physically active during the school day are often better able to concentrate on school work and may do better on standardized tests. In many schools, physical education classes and recess have been squeezed out because of increasing educational demands and tough financial times.
In response to a question by Senator Pendleton, Dr. Janeth Ceballos, Assistant Professor of Pediatrics, stated that culture has changed over the years, and because of the decrease in physical activity and bad food choices, there is a higher prevalence of obesity.
In response to questions by Representative Riner, Dr. Lowdenback stated that 35 percent of an office visit is educating parents about important issues. Dr. Bowen stated that the number one recommendation would be to increase physical activity in schools to teach children healthy lifestyles that can help them establish good health habits throughout their lives.
There being no further business, the meeting was adjourned at 3:25 p.m.