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Michelle Rimer, MS, MPH, RD, LDN
   Solmaz Institute on Obesity
           Hickory, NC
Overview
• Socioeconomics & obesity
• Environmental factors
• Weight Management Program
  – working with the entire family
• Women’s unique roles impacting childhood
  obesity
A Framework to Prevent &
       Control Overweight & Obesity
                                                                      Food & Beverage Industry
                             SOCIAL NORMS & VALUES                    Agriculture
                                                                      Education
                                                                      Media
                                 SECTORS OF INFLUENCE                 Government
                                                                      Public Health Systems
   Home & Family                                                      Healthcare Industry
          School                   BEHAVIORAL SETTINGS                Business & Workers
     Community                                                        Land Use & Transportation
       Work Site                                                      Leisure & Recreation
      Healthcare                                                      Community & Faith-based
                                         INDIVIDUAL                    Organizations
              Genetics                     FACTORS                    Foundations & Other Funders
          Psychosocial
Other Personal Factors
                               Food and           Physical
                             Beverage Intake      Activity


                         Energy Intake         Energy Expenditure


                                                                    Adapted from Preventing Childhood Obesity,
                                    ENERGY BALANCE                  Institute of Medicine, 2005
County-level Estimates of Obesity among Adults aged ≥ 20 years:
                                 United States 2008




                                               Age-adjusted percent
                                                     0 - 19.4
                                                     19.5 - 23.8
                                                     23.9 - 27.0
                                                     27.1 - 30.7
                                                     > 30.8

www.cdc.gov/diabetes
County level estimates of Poverty
      United States 2008
Socioeconomics of Obesity
                                                       Women & Poverty


  •      In 2010, 17 million women lived in poverty
  •      Single mothers account for >40% of those living in
         poverty
  •      Low income families more likely to live in areas
         with:
       o      Fewer recreational opportunities
       o      Reduced access to healthy foods



2010 Census Data-National Women’s Law Center. Accessed Sept 9, 2012
Lindsay,AC, et al. The Future of Children, Volume 16, Number 1, Spring 2006, pp. 169-186
Socioeconomics of Obesity
                  Poverty & Obesity


• A lower income and poverty is associated with
  higher Body Mass Index (BMI)

• Lower Activity is associated with higher BMI

• Low fruit and vegetable intake is associated with
  higher BMI
Environmental Factors:
              Physical Activity
•   Communities not bike or walk friendly
•   Limited Access to recreation facilities
•   Safety Concerns
•   Less daily physical activity in schools
•   Increased attraction to sedentary behaviors
A Family Connection
• Parental obesity is one of the strongest risk
  factors for childhood obesity
• Parents provide the genes and the family
  environment
     – Parenting style
     – Food availability
     – Physical activity

KL Whitaker, et al . Am J Clin Nutr. May 2010
Stang J, et al. J Am Diet Assoc.2011 Sep;111(9):1301-5.
Like Mother, Like Daughter….
 • Children’s food preferences are more strongly
   correlated with the mother
 • Mother’s food decisions influence daughter’s
   food choices
 • Mother’s who are preoccupied with dieting
   may influence daughter’s habits
 • Stronger association with maternal weight
       – Especially with daughters
1. Keery et al. Psychosom Res. 2006 July; 61 (1) : 105-111
2. Cutting et al. Am J Clin Nutr. 1999;69:608–13.
Like Grandma, like grandchild
   BEFORE            AFTER
Family Based Interventions
• Counsel the mother as the family health
  leader
• Family Based versus Parent Only
     – Parent only interventions




Janicke, DM, et al. Arch Pediatr Adolesc Med. 2008;162(12):1119-1125
Advice to mothers in
   our program:

1. Model healthy behaviors
2. Create opportunities for your child to make
   healthy food and physical activity choices
3. 5-4-2-1- almost none
4. Make it a family affair

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Obesity and Women presentation by Michelle Rimer, MS, MPH, RD, LDN

  • 1. Michelle Rimer, MS, MPH, RD, LDN Solmaz Institute on Obesity Hickory, NC
  • 2. Overview • Socioeconomics & obesity • Environmental factors • Weight Management Program – working with the entire family • Women’s unique roles impacting childhood obesity
  • 3. A Framework to Prevent & Control Overweight & Obesity Food & Beverage Industry SOCIAL NORMS & VALUES Agriculture Education Media SECTORS OF INFLUENCE Government Public Health Systems Home & Family Healthcare Industry School BEHAVIORAL SETTINGS Business & Workers Community Land Use & Transportation Work Site Leisure & Recreation Healthcare Community & Faith-based INDIVIDUAL Organizations Genetics FACTORS Foundations & Other Funders Psychosocial Other Personal Factors Food and Physical Beverage Intake Activity Energy Intake Energy Expenditure Adapted from Preventing Childhood Obesity, ENERGY BALANCE Institute of Medicine, 2005
  • 4. County-level Estimates of Obesity among Adults aged ≥ 20 years: United States 2008 Age-adjusted percent 0 - 19.4 19.5 - 23.8 23.9 - 27.0 27.1 - 30.7 > 30.8 www.cdc.gov/diabetes
  • 5. County level estimates of Poverty United States 2008
  • 6. Socioeconomics of Obesity Women & Poverty • In 2010, 17 million women lived in poverty • Single mothers account for >40% of those living in poverty • Low income families more likely to live in areas with: o Fewer recreational opportunities o Reduced access to healthy foods 2010 Census Data-National Women’s Law Center. Accessed Sept 9, 2012 Lindsay,AC, et al. The Future of Children, Volume 16, Number 1, Spring 2006, pp. 169-186
  • 7. Socioeconomics of Obesity Poverty & Obesity • A lower income and poverty is associated with higher Body Mass Index (BMI) • Lower Activity is associated with higher BMI • Low fruit and vegetable intake is associated with higher BMI
  • 8. Environmental Factors: Physical Activity • Communities not bike or walk friendly • Limited Access to recreation facilities • Safety Concerns • Less daily physical activity in schools • Increased attraction to sedentary behaviors
  • 9. A Family Connection • Parental obesity is one of the strongest risk factors for childhood obesity • Parents provide the genes and the family environment – Parenting style – Food availability – Physical activity KL Whitaker, et al . Am J Clin Nutr. May 2010 Stang J, et al. J Am Diet Assoc.2011 Sep;111(9):1301-5.
  • 10. Like Mother, Like Daughter…. • Children’s food preferences are more strongly correlated with the mother • Mother’s food decisions influence daughter’s food choices • Mother’s who are preoccupied with dieting may influence daughter’s habits • Stronger association with maternal weight – Especially with daughters 1. Keery et al. Psychosom Res. 2006 July; 61 (1) : 105-111 2. Cutting et al. Am J Clin Nutr. 1999;69:608–13.
  • 11. Like Grandma, like grandchild BEFORE AFTER
  • 12. Family Based Interventions • Counsel the mother as the family health leader • Family Based versus Parent Only – Parent only interventions Janicke, DM, et al. Arch Pediatr Adolesc Med. 2008;162(12):1119-1125
  • 13. Advice to mothers in our program: 1. Model healthy behaviors 2. Create opportunities for your child to make healthy food and physical activity choices 3. 5-4-2-1- almost none 4. Make it a family affair

Hinweis der Redaktion

  1. Lower-cost foods make up a greaterproportion of the diet of lower-incomeindividuals (23). In U.S. Department ofAgriculture (USDA) studies, female recipientsof food assistance had more energydensediets, consumed fewer vegetablesand fruit, and were more likely to beobese. Healthy Eating Index scores are inverselyassociated with body weight andpositively associated with education andincome (24). DIABETES CARE, VOLUME 31, NUMBER 11, NOVEMBER 2008, Influence of Race, Ethnicity, and Culture onChildhood Obesity: Implications forPrevention and TreatmentA consensus statement of Shaping America’s Health and the ObesitySocietySONIA CAPRIO, MD1STEPHEN R. DANIELS, MD, PHD2ADAM DREWNOWSKI, PHD3,4FRANCINE R. KAUFMAN, MD5,6
  2. Comparing maternal and paternal intergenerational transmission ofobesity risk in a large population-based sample1–4Katriina L Whitaker, Martin J Jarvis, Rebecca J Beeken, David Boniface, and Jane Wardle First published April 7, 2010, doi: 10.3945/​ajcn.2009.28838 Am J ClinNutr May 2010 ajcn.28838 J Am Diet Assoc. 2011 Sep;111(9):1301-5.Parenting style and child feeding practices: potential mitigating factors in the etiology of childhood obesity.Stang J, Loth KA.
  3. Importance of making a difference for moms, even if goal is to reach the kids – women are key in preventing obesity from a family systems perspective – new research….