U of L dean says $50 billion in annual health costs could be saved if Americans just walked more

Small changes in health behavior can have a huge impact on the public's overall health and well-being, and during National Public Health Week discussions last week, Dr. Craig Blakely, the new dean of the University of Louisville School of Public Health and Information Sciences, talked about the important role played by public health in promoting healthy behavior, preventing disease and saving both lives and money.

Blakely pointed to obesity as an example of an emerging health-related crisis, which can be addressed with behavioral changes that make a significant difference like adding more physical activity to your day, according to a U of L release.

“If we all took exercise seriously by just walking, we could save $50 billion in cardiovascular disease-related costs,” Blakely said. “A 10 percent weight loss equals a $5,000 savings in health-related complications. A typical desk worker could lose a pound a month by standing two hours a day.”

Blakely also addressed smoking bans, which are becoming popular in Kentucky, even though the state has the highest share of smokers (29 percent) of any state, leads the nation in high-school smokers (24 percent) and spends only a minuscule portion of its tobacco revenues to fight tobacco use, according to the Centers for Disease Control and Prevention.

If every state adopted comprehensive smoke-free policies, said Blakely, $2 billion would be saved in smoking-related deaths, lung cancer treatments and care for related health complications over the course of several years, says the release.

Blakely highlighted several other examples of public health’s potential return on investment. For example, says the release, every dollar spent on childhood immunizations saves $18 on vaccine-preventable disease-related costs, every dollar spent in prenatal care translates to $6 in health care cost savings and for every dollar spent on fluoridated water saves $20 in dental care.

Public health research will continue to find effective ways to generate these cost savings, such as finding researching how to modify environments to encourage exercise or how to send strong messages that promote regular physical activity (Read more)

Kentucky's well-being ranks next to last, just above West Virginia

Kentucky ranks next to last in the annual Gallup-Healthways Well-Being index, just ahead of West Virginia. The Bluegrass State ranked last in the index's Healthy Behaviors category, which measures the percentage of residents who smoke, exercise frequently and eat healthy daily.

The chart on the left shows Kentucky's score in each of the six categories. The state's rankings haven't changed much since last year, with the exception of the Work Environment index, which fell from 8th to 31st.  The colored chart on the right shows the state's overall and category rankings for 2011 and 2012 (1 is the highest rank and 50 is the lowest). Click here for the detailed report on Kentucky.


Left: Kentucky Well-Being Indexes     Right: Well-Being rankings of Kentucky among the states

West Virginia, with an index score of 61.3, had the lowest well-being for the fourth year in a row. The report shows West Virginians were the least likely to be thriving and also had the nation's worst emotional health. They had the lowest score in the Physical Health category, which reflects having the highest percentage of obese residents in the nation.

There were few changes from 2011 to 2012 among states with the highest and lowest well-being scores. Hawaii residents had the highest well-being for the fourth straight year, followed by Colorado, Minnesota, Utah, and Vermont.

The report shows a consistent regional pattern in well-being over the past five years. Western and Midwestern states earned seven of the 10 highest overall scores, while New England states held the other three spots. Southern states had the six lowest scores, and Southern states had eight of the 10 lowest well-being scores.

Kentucky Parent Survey: We could do a lot better on school meals, we're very much in favor of more health education

Fewer than 10 percent of Kentucky
parents report that their child has ever
walked or biked to school.

When asked, only about one in four Kentucky parents describe the meals served at their child's schools or day care centers as being nutritious. Fewer than 10 percent report that their child have ever walked or biked to school. And an overwhelming majority want information about sexually transmitted infections, human anatomy, abstinence education, birth control methods and condom use taught in Kentucky's high schools.

These are just a few of the surprising results from the first Kentucky Parent Survey conducted by the Foundation for a Health Kentucky, a random telephone survey of 1,006 parents of children under 18. The survey assessed the views of parents, step-parents, grandparents, foster parents and other legal guardians of children in Kentucky. The term "school" was used broadly in the survey as included (2 percent of total surveyed), as well those in pre-school and day care. The study took on nutrition, physical activity and health education.

Eighty-eight percent of parents reported that it was "very important" that meals at schools meet a minimum standard for nutritional value. Only about 1 in 4 parents currently thought their schools were meeting that standard. Only 11 percent are concerned that their younger children are getting too many "celebration-related" treats at their school.

While parents in the state reported that a little more than half (52 percent) of school-age children took physical education classes, that class was not a daily occurrence but met between one and four times a week. Only about 1 in 3 students took a daily course in P.E. That leaves 14 percent without a planned daily class during the school year.

On the topic of health education, parents reported that half of school-age children in the state took health classes, but again not daily. According to the FHK, "The Kentucky Parent Survey included a series of questions about dating relationships and sexual health to determine support for covering those topics...
At the middle school level, more than 8 in 10 parents would favor teaching communication skills (99 percent), human anatomy (91 percent), abstinence education (85 percent), and information about HIV and sexually transmitted infections (84 percent). At the high school level, more than 8 in 10 would favor teaching communication skills (99 percent), information about HIV and sexually transmitted infections (97 percent), human anatomy (97 percent), abstinence education (94 percent), birth control methods (87 percent), and condom use (84 percent)."

Future reports in the FHV series will address access to safe and effective health care for children, children's health behaviors and family routines and the places where parents turn for information on raising healthy kids.

Kentucky ranks third among the states in child obesity, a problem that has a broad scope and deep roots (first in a series)

(Photo by Tara Kaprowy for Kentucky Health News)

By Tara Kaprowy
Kentucky Health News

At every Girl Scouts meeting, Christmas concert, soccer field and swimming pool in Kentucky lies a trend that is easy to spot. It doesn't have to do with the Toms on the children's feet or the feathers affixed to their hair. It's the fact that every third child in Kentucky is overweight, and many of them are obese. As they stand in front of the crowd or struggle to swim to the other side, the problem is plain. Its consequences are not so plan, but are far-reaching.

Kentucky has the third-highest childhood obesity rate in the country and the seventh-highest rate in adult obesity, Trust for America's Health's "F as in Fat" report shows. Sixty percent of Kentucky women and 80 percent of men living the state are either overweight or obese.

CHILD OBESITY RATES from Trust for America's Health

Estimates show that one in three children who were born in the year 2000

will develop Type II diabetes at one point in their lives, in large part because of the food choices they make. "We're also seeing lots of heart indicators, like high-blood pressure, high lipids and cardiac changes, in kids that are overweight," said Dr. Christopher Bolling, a pediatrician in Kenton County. "And we're seeing a lot of other issues like liver disease and kids with orthopedic problems."

Obese children can also have breathing problems like sleep apnea and asthma. They struggle with low self-esteem and the depression that can result from it. And they are the first American generation expected to live a shorter life than their parents. "They're taking medicine we used to give to old people," said Duff Holcomb, the schools nurse in Laurel County. "They're 15 and 16, so what are they going to be like when they're 36?"

The issue stems from "a perfect storm" of factors, said Elaine Russell, the state's obesity prevention coordinator. "Our food is high in calories with little nutrients," she said. "A lot of physical education has been taken out of normal daily routines."

And food is everywhere, from billboards to unexpected places like cash registers at T.J. Maxx and Office Depot, Russell said. One study found kids see about 4,000 television commercials advertising food each year. During Saturday morning cartoons, they see a food ad nearly every five minutes, and about 95 percent are pushing food with poor nutritional value. "And it's not just TV," Russell said. "Look at all the billboards, look at the Internet, look at your packaging, with characters that say, 'Come see me and do the Web game.'"

The variety of food is also staggering, Russell pointed out. "Look and see how many Oreos there are. It's not just Oreo or double-stuffed. There's also ones with mint and peanut butter. How many different chips? How many different sodas? Our choices are so unlimited."

Halloween candy displays are already set up
in grocery stores, pharmacies and other stores
across the state. (Photo by Tara Kaprowy)

So, it's easy for children to make the wrong choices. Almost 40 percent of the total calories consumed by 2- to 18-year-olds are in the form of empty calories, meaning solid fat and added sugars. Next to Mississippi, Kentucky youth drink the most soft drinks in the country — up to 89 gallons per person, according to information researchers at the University of Kentucky's Nutrition Education Program compiled from the USDA's Food Environment Atlas. Meanwhile, just 17 percent of Kentucky high school students reported eating fruit and vegetables five times per day over a week's time, the amount recommended by the United States Department of Agriculture.

Children adopt bad eating habits from their parents, who "gatekeepers" of the kitchen, Russell said. "If Mom and Dad are feeding you [junk food] then you tend to eat that because that's what available to you."

Parents blame busy schedules and lack of time — and they are busier, in large part because both parents work in most households. Also, many of today's parents either don't like to cook, or can't.

Debra Cotterill teaches cooking classes for the University of Kentucky's Nutrition Education Program and is often shocked at the decline in cooking skills. "There's people out there who have said to me that they literally did not know how to boil water," she said. "I've also met people who live on candy and packaged chips because they don't know how to cook." Ginger Gray, director of food services in Kenton County Schools, was not surprised, saying many of today's parents "are a generation of microwave users."

Exacerbating the problem is a lack of exercise. Gone are the days of students heading to the change room to get ready for gym class. In Kentucky, elementary schools must offer some type of physical activity for 30 minutes each day, but that can include unsupervised recess. There are no physical education requirements in middle schools, and high-school students just need to take one half-credit of phys-ed to graduate. The decline in phys-ed is coupled with the fact that kids lead an increasingly sedentary lifestyle. In Kentucky, nearly one in three high school students watch three or more hours of TV each day and more than 60 percent of kids have a TV in their bedroom.

A lack of play time after school is another culprit, in large part because "There's a lot of media that say it's not safe to go outside and play," Russell said. In fact, just over 100 children are kidnapped in a stereotypical way each year in the U.S., according to the National Center for Missing & Exploited Children, and the number of violent crimes was lower last year than it has been in 40 years. Yet, fear of the unknown is embedded in parents, Gray said, who sees parents waiting in their running cars for their children to be dropped off at bus stops. "What a huge impact changing that attitude would make," she said.

(Photo by Tara Kaprowy, Kentucky Health News)

While the report "Shaping Kentucky's Future: A Community Guide to Reducing Obesity" estimates 33 percent of Kentucky children are already overweight or obese, there is no way of knowing how those numbers vary county to county, because there is no systematic collection of them. Body-mass index, a rough measure of fat to weight, is measured statewide only for children aged 2 to 4 in the Women, Infants and Children nutrition program. "Some individual school districts and counties are collecting more information, but it is spotty," said Sarah Walsh, senior program officer at the Foundation for a Healthy Kentucky.

Starting this school year, the state board of education started requiring that there be a place on the state health exam form that includes a student's BMI, though physicians are not required to fill it in. The exams are required when a student enters school in Kentucky, generally in kindergarten, and again when a student is about to enter the sixth grade. "I would say it's a start but this is not a mandate on students or parents or physicians or schools. This is an option," said Lisa Gross, spokeswoman for the Kentucky Department of Education. Still, the BMI information could be shared at the aggregate level if the Department of Public Health asked for it as part of an analysis, Gross said.

But regardless of what data is collected, there is a problem "showing us basically whatever age group you look at, you've got too high of a proportion of children who are overweight and obese," said Amy Swann, senior policy analyst for Kentucky Youth Advocates. Some data show obesity rates are higher in children living in the Appalachian part of the state. Many studies also correlate children from low-income families with higher obesity rates. Giving counties an idea of where they stand is essential to getting a handle on the fight. "There is an old adage that 'what gets measured gets done,' and it couldn't be more true in this case," said Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky. "Local communities need to know where they stand on this important health issue so they can track progress and really make changes with childhood obesity."

NEXT: What is being done in nationwide, in Kentucky, and in individual communities to address the problem.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

What is being done to fight child obesity in Kentucky, which ranks third nationally in the problem? (second in a series)

Students in Kenton County Schools sample kale chips
as part of an effort to incorporate more fruit and
vegetables into their diets. (School district photo)

By Tara Kaprowy
Kentucky Health News

Now that all schools are back in session, cafeterias in every corner of Kentucky are bustling with students sweeping through lunch lines, sitting down with their best friends and sampling their meal.

It's in these loud, boisterous rooms that the fight against childhood obesity, which is higher in Kentucky than in all but a few states, is beginning to take shape.

Many children eat more than half their calories at school, but schools are just one of the battlegrounds. Across the country and the state, there are initiatives that are gaining traction to take a bite out of the problem.

When school started this year, the 556,000 Kentucky kids who get their lunch from school cafeterias may have noticed a more apples and oranges on their plates. With the goal of creating a healthier school environment, the United States Department of Agriculture has revamped school lunch regulations for the first time in 15 years. Many of the changes involve what some see as the saviors of kids caught in the obesity epidemic: fruit and vegetables.

In order for lunches to qualify for School Lunch Program funding, students now must have at least one serving of fruit or vegetables on their plate by the time they reach the cash register. And "vegetable" no longer just means French fries. And at least once each week, schools must serve a green, leafy vegetable like broccoli or spinach, plus an orange or red vegetable like carrots, and a legume like lentils or chickpeas, which are a good blend of protein and carbohydrates with very little fat.

Food service directors are optimistic elementary students
will adjust to school lunch changes, but high schoolers
are a different story. (Kenton County Schools photo)

Will students actually eat those foods? Julia Bauscher, food service director at Jefferson County Public Schools, is optimistic about elementary school students. So is Ginger Gray, director of food services in Kenton County, who has been serving such vegetable dishes as broccoli parmesan and kale chips for several years.

"Kids are more open to trying new things than adults realize." Gray said, but "It takes persistence. You can't just say I tried it once and kids didn't eat it so you don't try it again." 

High school students are a harder sell. Sylvia Moore, child nutrition and food service director at Mercer County Schools, said lunch participation rates have dropped by about 5 percent since the beginning of the school year. "Just this week I was up at the high school to stand at the garbage can. I was just there a minute when a girl came and tossed her totally-untouched orange in front of me," she said. "We are already making healthier garbage cans," not healthier students, she added.

The media angle

Another nationwide effort involves what children see on TV, which could have a big impact. A 2009 study found they average more than 32 hours a week. Excessive TV viewing is linked to a sedentary lifestyle, and American children see about $1.6 billion a year worth of food and beverage marketing. "It's a double-whammy," said Josh Golin, associate director for the Campaign for Commercial-Free Childhood. "It's the combination of not moving, and being urged to consume unhealthy food."

(Kentucky  Health News photo)

By 2015, that will change on channels of the Walt Disney Co., which will no longer put ads for products like Capri Sun and Kraft Lunchables (left), as well as a variety of candy, sugared cereal and fast food.

The television show iCarly, popular on Nickelodeon, is approaching the issue differently, encouraging viewers to create their own wacky veggie dish and submit the recipe for the "iCarly iCook with BirdsEye" intiative. Spots on the channel show the kinds of dishes the contest wants, like a "veggie sundae," which consists of a scoop of carrots, cauliflower and broccoli in a banana split dish.

A 2006 study showed 88 percent of the food ads on Nickeldeon promoted unhealthy food. A year later the channel announced its characters like Dora the Explorer and SpongeBob SquarePants would be licensed to sell only healthy foods; that's why Dora appears on packages of frozen edamame -- green soybeans, often in their pods.

Teaching the basics, and behaviors

Statewide programs are also infiltrating directly into communities. One involves cooking classes, with teachers from the University of Kentucky's Nutrition Education Program setting up demonstrations everywhere from public housing to women's crisis centers to church basements.

For 10 weeks, the teachers educate low-income adults about the basics of cooking with the hope they will change the way they feed their families. "We talk to them about how to use coupons, how to use dried beans instead of canned beans, how to use those leftovers and how to stretch their food dollars so they can provide good-tasting and nutritious food," said Debra Cotterill, the program's director.

The 43-year-old program was created to teach people how to use government commodities, like big blocks of cheese, that they received in the 1970s. Since obesity has become so prevalent, Cotterill said the emphasis has changed and interest in classes is up dramatically. In fact, Cotterill said the extension program's whole mission has expanded.

"It is not enough to share information, we also have a responsibility to help change behaviors," she said. "Now, all agents do some type of nutrition education in their work somewhere or other, even the ag agents, because it's become such a problem in our counties."

State regulations lack some specificity

Since many children entering kindergarten are already overweight, state government is examining preschools and daycare centers to see what policies they have in place when it comes to nutrition and physical activity. Though there are state regulations for licensed child care centers, "the language is not specific," explained Elaine Russell, the state's obesity prevention coordinator. For example,  regulations say bread should be served with meals, but don't specify the type of bread, such as whole grain or whole wheat, and don't prohibit high-fat snacks or sugar-sweetened beverages.

As part of a pilot program, state workers went to nine facilities each in Northern Kentucky, the lower Green River region and the Barren River region to assess their policies, teach directors and staff about obesity in Kentucky and discuss goals with directors and staff about their goals.

They also taught them the program 5-2-1-0, a catchy way of reminding students they should have five servings of vegetables each day, no more than two hours of screen time, at least one hour of physical activity and drink zero sugary beverages. The program is being pushed by pediatricians and at offices where poor mothers sign up for the Women, Infants and Children nutrition program. "Our goal is to make sure our parents hear this from more than one spot," Russell said. "We can change these policies but unless parents understand why we're making them, they probably won't stick."

Many facilities in the pilot program didn't have wellness policies before the process, but all did afterward. However, Russell would also like to see child-care centers adopt the standards for nutrition and physical activity as suggested in Caring for Our Children: National Health and Safety Performance Standards, which have stronger guidelines that promote active play every day and follow minimum standards as recommended by the USDA's Child and Adult Care Food Program. "Some states require at least two hours of physical activity a day, she said. "Physical activity is encouraged in Kentucky, but it's not specified. Kentucky rules do limit screen time, but kids are still allowed to watch two hours a day."

An early start

Some programs focus on even younger children, including infants, and pregnant women. "A lot of times when we talk about childhood obesity, we kind of default into talking about school-age kids," said Amy Swann, senior policy analyst for Kentucky Youth Advocates. "But if we're going to take a really multi-faceted approach, what we now know is it actually starts with the mother's nutrition while she's pregnant."

(University of Louisville Hospital photo)

That idea is behind the Kangaroo Care Initiative, which promotes skin-to-skin contact with new mothers and their babies in order to promote breastfeeding and bonding. Among other benefits, breastfeeding can help reduce the risk of obesity. One study showed children who were breastfed were 22 percent less likely to be overweight by age 14, said Marlene Goodlett, Kentucky's breastfeeding coordinator.

The effort started in 2007 with the University of Louisville's Hospital Center for Women and Infants. This year, U of L partnered with the WIC program to train all 51 birthing hospitals in the state. Now, 84 percent of them have implemented Kangaroo Care. One of the first hospitals on board was Flaget Memorial Hospital in Bardstown, where breastfeeding rates increased to 61 percent from 49 percent.

Community lessons

From a walking trail mowed on land owned by the community hospital in Winchester, to the Hopkinsville farmers' market accepting food stamps, there are local efforts to combat obesity in place that, inch by inch, are causing change.

(Photo by Steve Patton, UK College of Agriculture)

These success stories are detailed in the report "Shaping Kentucky's Future: A Community Guide to Reducing Obesity," funded in part by the state health department, which illustrates ways Kentucky communities are making policy, environmental and systems changes.

One of these is the Better Bites program in Lexington, a revamp of how food is sold at swimming-pool concession stands in Lexington. "We learned you could exercise at the pool for two hours, go to the concession and get a standard hamburger, fries and soft drink combo and you would actually take in more calories that you're burning. That was a shocking statistic for us and really propelled us along," said Brian Rogers, deputy director of enterprise at Lexington Parks and Recreation. Organizers introduced menu items like yogurt and fresh fruit, replaced hot dogs with turkey dogs, standard popcorn with low-fat popcorn and sold only baked chips at two public swimming pools in the city starting last year. This summer, candy sales went down 20 percent. and the Better Bites menu items constituted 15 to 20 percent of all sales, up from 10 percent last summer, Rogers said.

Berea is concentrating its efforts on environmental change with its Complete Streets project, which is aimed at making the city's streets more accessible to walking and biking. Two major projects — a bridge project that includes sidewalks and bike lanes and a three-mile trail that connects downtown with the Indian Fort Theatre — are opening up much more territory to pedestrians. The city has coupled these efforts with simple changes like making walkways more visible, installing bike racks around town, and changing the timing on lights to give pedestrians more time to cross the road.

Mayor Steve Connelly said the effort is about culture change. "I do think that we have perhaps by accident created these barriers to walk and bike largely since the 1950s when America really fell in love with the Interstate, franchise restaurants, the suburbs and the automobile," he said. "Really, we need to get back to walking as second nature." With each installation of more sidewalks and trails, though, that is exactly what is happening, Connelly said. "It's the classic when you build it, they're out there using them," he said.

Still a way to go

While progress is being made, experts say the nation is just beginning to round the corner on the problem. Though some studies show childhood obesity and overweight rates may be leveling off, many kids are simply graduating from the overweight to the even more unhealthy obese category, said Dr. Christopher Bolling, a Kenton County pediatrician.

After a visit this fall to school cafeterias to document changes that are happening there, perhaps reporter Lenny Bernstein said it best in The Washington Post: "If we don't yet know how well we're doing in this battle, we are at least figuring out how to develop our weapons."

NEXT: Why the obesity epidemic is such a difficult problem to solve.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Child obesity is a complex problem, intimidating to those who are fighting it (last in a series)

Dr. Christopher Bolling prepares to see a patient.

By Tara Kaprowy
Kentucky Health News

Nearly every weekday, pediatrician Christopher Bolling starts his day by scooping up his lap top and stepping into one of his cheerfully-appointed exam rooms. After greeting his young patients, who are generally passing the time by playing games on their parents' cell phones, Bolling begins his examinations. During his 21 years of practice, those exams have increasingly ended with Bolling counseling parents about their children's weight.

"I tell them I'm not worried about this as a cosmetic issue, I'm worried about this as a health issue," he said in an interview. "This isn't about your child being ugly or undesirable, we talk about them being healthy and not healthy."

But, though dedicated to his cause, Bolling, of Crestview Hills in Kenton County, said he is keenly aware that his counseling is not nearly enough to help his patients overcome the weight that is impeding their health. "What makes this problem unique is it is so multifactorial, there are so many pieces to it," he said. "It's food, it's activity, it's portion size, it's fruit and vegetables, it's screen time and safety. And it makes it really intimidating to know what to do with it."

"We're swimming upstream in a flooded river," agreed Debra Cotterill, director of the Nutrition Education Program at the University of Kentucky. "Even for people who know it, it's still hard. Weight is an issue I have to address every single day of my life and I understand how it is for people. You're talking about change of behaviors."

It's like smoking, but it's different

But a sweeping change in behavior is going to be what it takes to turn the tide of the obesity epidemic, experts say, and that is one reason fighting obesity is often likened to the battle against smoking. The fact that it is just as, if not more, deadly is another parallel, as is the fact that it is just as, if not more, far-reaching.

But there are key differences in battling the two problems, Judith Graham noted in a story for Kaiser Health News. First, other than an increase in health-care costs, there is no compelling argument that implies that another person's weight adversely affects others, like second-hand smoking does for smoking, or drunk driving does for drinking to excess. "The notion that my behavior as a smoker can have an effect on you and can make you sick was critically important in accelerating people's intolerance of smoking and their willingness to see the government take action," Michael Ericksen, director of the Institute of Public Health at Georgia State University, told Graham.

Compounding the issue is there is nearly no end to the variety of food that can contribute to the problem. Unlike Big Tobacco, the food industry also cannot be demonized as easily, Graham points out. But most importantly, "unlike alcohol and tobacco, you can't go cold turkey on food," Bolling said. "You have to keep eating."

But if there is consensus on how to approach the issue, it is to take a lesson from the battle against smoking, which is to focus on changing the environment that encourages bad habits. "It's about changing our culture," explained Elaine Russell, Kentucky's obesity prevention coordinator. "We need an environment where the healthy choice is the easy choice."

That involves policy change, setting up systems that support the policy changes, and environmental change, Russell said, all of which have to happen together. "There's no one solution that's going to do it," she said. "If we embed it in our policies, but we don't embed it into our environment, how do we make the healthier choice? If we just educate people but we don't provide them with a healthy environment, then how do they make those healthy choices? We could do an educational campaign at our worksite, but if we have unhealthy vending machines there, how can you make the changes?"

Local action is needed

Russell said change needs to happen at the local level, since every community has different needs and "starts with high-level partners really being engaged," she said. "We need to pull together those leaders and ask them what the highest priority is, ask them what feasibly can be done and start checking them off."

Some of those changes can be as easy as placing bananas and apples at the front of the pool concession stand so children see them first, as they did in Lexington. The same is being done in school cafeteria lines. But others cost money that communities don't necessarily have, as the Healthy Children's Task Force learned in Laurel County when trying to assess students' body-mass index, a rough measure of fat to weight.

In 2005, the task force started collecting BMIs of a select group of children in kindergarten to see where the county stood. It found 37 percent were either overweight or obese, and quickly decided the goal should be to bring that number down to 31 percent, the statewide average at the time. Using a grant from the parent company of the local hospital, they talked to parents, hired gym teachers, had schools incorporate 10 minutes of physical activity in the classroom periodically during the day, talked to kids about nutrition, and got them to cook and sample fruit and vegetables from a mobile demonstration kitchen.

The overweight rates of the children, who were repeatedly assessed each year, did decrease by the targeted 6 percent, but when funding ran out, the program faltered. For a few years, part of the effort was restored, but the task force has disbanded. "You get real gung-ho on it and something else comes along," said school nurse Duff Holcomb, who led the effort. "It makes me feel terribly guilty, but that is just the way it is. We proved what works."

After a recent analysis showed 12 states, including Kentucky, have adult obesity levels over 30 percent, Jeffrey Levi, executive director of Trust for America's Health, acknowledged the financial problem: "We're not investing anywhere near what we need to in order to bend the obesity curve and see the returns in health and savings."

(Photos by Tara Kaprowy)

More regulation is one option, a move that is generally cheap in cost but can be politically expensive. New York City Mayor Michael Bloomberg is learning that, after proposing a ban in New York City on the sale of supersize sodas and other sugary drinks by restaurants, movie theaters and street carts. Residents are deeply divided on the issue — 60 percent oppose the ban — and critics have lambasted Bloomberg, accusing him of running a "nanny state."

But limiting food and drink choices may have an effect on people's health, a recent study indicates. The removal of trans fats from many processed and fast foods like French fries and cookies probably reduced the proportion of kids with high cholesterol in the past decade, researchers think.

More regulation, particularly in how food is marketed to children, is what Josh Golin, associate director for the Campaign for Commercial-Free Childhood, would like to see. "We can't rely on the companies to self-regulate or develop their own policies," he said. "We see a lot of self-serving regulations that vary from company to company. What we really need is to level the playing field and make the rules enforceable."

In addition, Bolling suggested "there are several organizations that advocate that we could make a big impact on childhood obesity by placing an excise tax on sodas." A report by the Rudd Center for Food Policy and Obesity at Yale University indicated that a 10 percent tax on soft drinks would result in about an 8 percent reduction in consumption. Studies on alcohol and tobacco taxes indicate similar findings. A Rudd Center calculator shows a 1-cent tax on each ounce of sugar-sweetened beverages sold in Kentucky could result in nearly $200 million in revenue for the state.

Whether regulation or investing more money in the problem are part of the solution, Bolling said solving the problem will take time and a variety of efforts. "We have to solve everything together," he said. "It's about personal responsibility, but it's also about supportive families, it's about primary care medical people knowing what to say to their patients, it's about workplaces and schools creating good environments and it's communities providing opportunities to be healthy. I think we're going to turn the tide. We've done it before with seat belts, with bicycle helmets, with smoking. While this problem is complicated, we already see people really waking up to it."

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Kentucky's obesity rate and ranking are better than last year, but the figures may not be truly comparable

The percentage of Kentucky adults who are obese is smaller than its was, but the state is still 10th in the country, according to a new, influential analysis by Trust for America's Health and the Robert Wood Johnson Foundation. The report found 30.4 percent of Kentucky adults are obese, an improvement from last year's 31.5 percent and the state's sixth-place ranking. The numbers do not include the percentage of adults that are merely overweight.

The statistics are based on data collected through telephone surveys by the Centers for Disease Control and Prevention. The surveys this year included people who only have cell phones, not land lines. Such people tend to be younger, so officials warned about putting too much stock in comparing this year's ranking from last year, reports Barb Berggoetz for the Indianapolis Star.

Mississippi has the highest obesity rate in the country at 34.9 percent, followed by Louisiana (33.4) and West Virginia (32.4). Twenty-six of the 30 states with the highest rates are in the Midwest and South.

"Obesity has contributed to a stunning rise in chronic disease rates and health care costs. It is one of the biggest health crises the country has ever faced," said Jeffrey Levi, executive director of Trust for America's Health. "The good news is that we have a growing body of evidence and approaches that we know can help reduce obesity, improve nutrition and increase physical activity based on making healthier choices easier for Americans. The bad news is we're not investing anywhere near what we need to in order to bend the obesity curve and see the returns in terms of health and savings."

In 2006, obesity-related medical costs were $147 billion or the equivalent of 10 percent of total medical spending, a 2011 study in Health Affairs found. Most of it is spent on treating diseases related to obesity, like diabetes.

The ranking is the first part of the 2012 "F as in Fat" report, which analyzes state obesity rates and efforts to address the problem. It will be released in full in September. For the first time, the report will include forecasts about obesity rates in 2030 in each state. It will also look at the potential impact of a 5-percent reduction in body mass indices. (Read more)

Doctors' letter to the editor about the importance of physical activity is worthy of consideration from all Kentucky newspapers

Given its timeliness and message, Kentucky Health News encourages editors of Kentucky newspapers to consider publishing this compelling letter.

Physical activity — a daily staple

To the editor:

The 2012 London Olympics were a feast. Nobody with a hunger for sports, national rivalries or stories of individual struggles and accomplishment should have left the table unsatisfied. The Games served up a bounty of the very best.

After the feast, though, we need good, daily nutrition. Seeing the world's best athletes break records and vie for top honors, we can take their example and weave physical activity, exercise and sport into our daily lives. There's only one Usain Bolt, but millions of us run full-tilt through our careers and family life. The gymnastic magic of Gabby Douglas can inspire our headlong tumble through competing obligations and the flexibility to get it all done.

Translating Olympic activities into everyday life is more than a metaphor. With sedentary lifestyles linked to one in four deaths from non-communicable diseases, and with preventable conditions consuming unsustainable portions of health care costs, we must act individually and as a society to keep ourselves fit and healthy.

Food for thought

The facts are undeniable, and the evidence continues to mount. As the Games were poised to begin, no less an authority than The Lancet published a series of articles that underscore the extraordinary peril of physical inactivity for global health and national economies. Experts from Harvard, the Centers for Disease Control and Prevention, and around the world made the case for urgent action: "In view of the prevalence, global reach, and health effect of physical inactivity, the issue should be appropriately described as pandemic, with far-reaching health, economic, environmental, and social consequences."

The reality is that the United States will not be able to grow it economy fast enough or large enough to pay for the treatment of rising levels of highly avoidable diseases and conditions, many of which are related to low levels of physical activity. This calls for collective action to encourage and enable all people to become and remain more active, whether through activities of daily living, exercise or sports.

On an individual level, we will each benefit from meeting at least minimum guidelines for physical activity. The payoff is improved health and quality of life for the individual, greater productivity in the workplace, and lower health costs for all of us. The alternative is unthinkable.

That's food for thought, indeed. As we push back from the table, still savoring a 17-day feast of athletics and achievement, let's make a menu of physical activity part of our daily lives. Anything less is too hard to swallow.

Janet Walberg Rankin, president, American College of Sports Medicine
Dr. Robert Sallis, chair, "Exercise is Medicine" Global Initiative

Kentucky students will get extra education in nutrition, exercise

Kentucky children will get extra nutrition education at school starting Oct. 1, thanks to a $6 million federal grant intended to instill better eating and physical-activity habits in families eligible for food stamps.

The education will be provided by local health departments. It will encourage students to:
• Fill half their plates with fruits and vegetables; drink fat-free or low-fat milk; and make sure they eat whole grains.
• Increase physical activity and cut down on sedentary behaviors.
• Consume the appropriate amount of calories for their age.

Kentucky students will get more nutrition education
aimed at getting those eligible for the Supplemental
Nutrition Assistance Program to make healthy food
choices. (Photo from The Lane Report)

Details about how many children will benefit from the education and how many minutes of instruction they will receive per week have not yet been ironed out, said Beth Fisher, spokeswoman for the Cabinet for Health and Family Services.

"Sometimes children can be the best teachers, so our hope is that they will pass on to their parents some of what they have learned at school about the importance of nutrition and physical activity," said Teresa James, acting commissioner of the Department of Community Based Services. "If children ask their parents to serve more fruits and vegetables, or take a walk instead of watching TV and the parents comply, this effort can benefit the entire household — just look at the influence children have had on recycling." (Read more)

143 groups in state working to improve health, directory lists

A directory that lists all the local groups working on health-related issues in the state has been released by the Foundation for a Healthy Kentucky. It identifies 143 groups — at least one impacting each county — and lists the primary contact person at each location.

"These are local residents working on solutions to health issues in their cities and towns," said Susan Zepeda, CEO of the foundation. "As these groups work to make their community a healthier place to live, work, study and play, they are improving the overall health of our state."

Whether in the form of coalitions, collectives, consortia, associations or networks, the groups are working to improve the health of their communities. Some are looking at ways to increase access to healthy food and physical activity, others are planning screenings and education for people with chronic diseases like diabetes, and others are working toward getting smoke-free ordinances passed.

The directory can be viewed by clicking here. It will be updated periodically.

Kids needs to cut out an average of 41 calories a day to stop gaining weight

Children and teens need to cut their food intake an average of only 41 calories a day in order to stop gaining weight, a new study has found. If they don't do that, they'll end up weighing even more than they do now — four more pounds across the board, say the researchers from  Columbia University, the Harvard School of Public Health and the Robert Wood Johnson Foundation.. (Photo: iStockphoto.com)

Without reducing consumption, more than one in five children will be obese nationwide, researchers concluded. In Kentucky, 37.1 percent of children were overweight or obese in 2007, numbers by theNational Conference of State Legislature show.

While cutting 41 daily calories is significant, that number will only stop children from getting heavier. "The federal government really wants children to be slimmer than they are now," reports Nancy Shute for NPR. In order to lower the childhood obesity rate to just 5 percent, children would have to cut an average of 120 calories a day — 33 calories for preschoolers, 149 calories for grade-schoolers, and 177 calories a day for teens.

In order to do so, teens would have to jog at least 30 minutes per day or cut out a 16-ounce soft drink.

The study's "numbers are based on population averages; individuals' experiences will be different," Shute reports. "But the numbers show that the public health world has a lot of work to do to help children keep or reach a healthy weight."

According to a nutrition chart by the American Heart Association, children should consume an average of 900 calories at age 1 and 1,000 calories at age 2. Girls should consume 1,200 calories a day from ages 4 to 8; 1,600 calories from ages 9 to 13; and 1,800 calories a day from ages 14 to 18. Boys should consume 1,400 calories from ages 4 to 8; 1,800 calories ages 9 to 13; and 2,200 calories ages 14 to 18. (Read more)

Video systems like Wii Fit not working against child obesity: study

Video games designed to encourage children to exercise don't do anything to prevent obesity, a study has concluded. It found that children either find a way to trick the games "into thinking they are moving around, or they make up for exercise by vegging out more later," reports Maggie Fox for the National Journal.

"It doesn't appear that there's any public-health value to having active video games available in stores — simply having those active video games available on the shelf or at home doesn't automatically lead to increased levels of physical activity in children," said Dr. Tom Baranowski.

Baranowski and his Baylor College of Medicine team studied 78 children, whom they gave the video system Wii to play with. "It's not clear whether those in the study group were more active as a result of the video games but compensated by being less active later, or if they found a way to manipulate the instruments to minimize the amount of physical activity," he said.

Other studies have shown the video systems are beneficial to some age groups, including seniors, Fox reports. The study is published in the journal Pediatrics. (Read more)

Kentucky ranks next to last, Fifth Congressional District dead last in national healthiness and happiness survey

(Click on images for larger versions)

Kentucky was again next to last among the states in happiness and healthiness of its residents in 2011, ranking above only West Virginia, though precise rankings are uncertain. Eastern Kentucky's Fifth Congressional District ranked at the very bottom of the 436 districts — falling in last place in the categories of life evaluation, emotional health and physical health.

The Gallup-Healthways Well-Being Index is based on a continuing national survey that asks respondents about their overall sense of well-being, physical health, happiness, job satisfaction and other factors related to quality of life.

Of the 190 cities ranked, Lexington was 95th and Louisville 152nd. Kentucky's well-being score was 63.3 out of a possible 100 points. Hawaii again ranked first, at 70.2. West Virginia's score was 62.3. Because there were fewer than 10 points between first and last place, the rankings are not precise. Kentucky ranked lowest in the country in emotional health, which is based on feelings of happiness and sadness. Respondents were also asked about "physical health (chronic health conditions, obesity); lifestyle behaviors (smoking, diet and exercise); emotional health (feelings of happiness, sadness); work environment (relationship with supervisors); basic access (health care, food); and life evaluation (how they rate their lives)," reports Nanci Hellmich of USA Today.

Results were based on telephone interviews conducted between Jan. 2 and Dec. 29, 2011, producing a random sample of 353,492 adults. The margin of sampling error for most states is plus or minus 1 to 2 percentage points, but as high as plus or minus 4 points for states with small populations such as Wyoming, North Dakota, South Dakota, Delaware and Hawaii. (Read more)

Michelle Obama announces nationwide contest to fight childhood obesity; $500,000 in prizes

As part of her Let's Move initiative to fight childhood obesity, First Lady Michelle Obama announced a contest today that will give away $500,000 in prizes. The Active Schools Acceleration Project will reward the most "creative, impactful and scalable school-based programs and technological innovations that promote physical activity for children," a press release reads.

"We know there's so much good work going on all across this country to get our kids up and moving every single day," Obama said. "So we want to find the best school programs and technology ideas that increase physical activity for kids — and then help them reach even more children throughout America."

The competition features two categories: school programs and technology innovation. Teachers, schools or entire districts can submit their in-school activity programs, which could include a curriculum, activity, environmental modification, event or other initiative. The technology innovation category can include devices, tracking and measurement systems, software applications, social media, gaming and smart phones that encourage kids to be physically active.

Applications will be accepted through April 2. For more information, click here.

41 Kentucky high schools receive grants for nutrition, exercise, tobacco prevention to be planned by students

More than 40 Kentucky high schools will receive grants to improve student nutrition, increase physical activity or prevent tobacco use. The "Students Taking Charge" program will have students assessing their school environment and coming up with and implementing an action plan to create healthy changes.

"We have to create programs that get our young people involved in the process and on the path to lifelong health and wellness," said Victoria Greenwell, administrator for the state Department of Public Health's Coordinated School Health program and co-chair of Kentucky Action for Healthy Kids. "If we wait until children are grown to introduce them to healthy environments or sensible eating and exercise plans, it's often too late. We have to act now to instill the values of leading a healthy lifestyle."

Just 16.7 percent of Kentucky students reported eating five servings of fruit and vegetables every day and under 40 percent of students said they had been active for an hour on five days during a week, the 2011 Youth Risk Behavior Survey found. The survey also found nearly 1 in 3 students said they'd used a tobacco product in the past 30 days.

To see which schools received a grant and for more information, click here.

Don't let food take control of your Valentine's Day!

Trying to avoid, or at least over-indulging in, chocolate and candy on Valentine's Day? Steer clear of making the day about food, experts say.

"Focus on spending quality time with your friends and loved ones," suggests Cristina Harder, a licensed dietician at the Loyola Center for Fitness. "Trying a new activity together is a great way to share time with family and friends."(VirtualChocolate.com photo)

When it comes to eating, cook at home rather than go out to a restaurant, and get some exercise, reports research-reporting service Newswise. In one hour, a person can burn:
• 200 calories walking, ballroom dancing or bowling
• 500 calories playing racquetball
• 600 calories playing tennis

If the celebration just isn't complete with some indulgence, keep track of what it is. Five Hershey's Kisses just have 100 calories, as do 30 plain M&Ms and three Dove dark chocolate hearts. "They will satisfy a sweet tooth without killing a diet," Harder said. "If you do over-indulge, just get back on track as soon as you can," Harder added. "A minor dietary mishap is only a bump in the road and should not derail your efforts." (Read more)

Certified personal trainers give tips on how to revive New Year's health resolutions or keep them going

By Tara Kaprowy
Kentucky Health News

As the resolve of New Year's resolutions fades with January passing into February, fitness experts Sheila Kalas and Laura Coombs, right, offered some useful tips for how to stay motivated about getting healthy on KET's "One to One" program with Bill Goodman last week.

The first thing, they said, is to come up with a realistic plan — and trash the one in place if it's set up for failure. "One of the things that I think is a mistake is if you jump into action in January and say, 'I'm going to get up, and I'm going to work out at 6 every morning' and you're really not a morning person. Chances are, that's going to fade," said Kalas, owner and founder of Fitness Plus in Lexington.

The trick is to come up with a plan that works, along with 10 reasons for why it's imperative to stick to it this year. "That way, you're more invested," said Coombs, a certified athletic trainer.

The cornerstones of good health are a nutritious diet and an exercise regime, which, Kalas pointed out, is unavoidable. "It's OK for you not to like exercise," she said. "But it really doesn't get you off the hook from needing to do it." As such, it's important to remove the biggest barrier that stands in the way of a fitness regime: a lack of time, which is often only a perceived barrier, and can be removed if there is a commitment to devote proper time to exercise, Kalas said.

Also important is coming up with activities that are entertaining or even practical. Coombs described a "fit deck," playing cards that each describe a different kind of exercise. The goal is to draw five cards a day and perform the exercise in turn. For those uninterested in formal exercise, Kalas suggested getting a post office box to which a person would have to walk each day to get mail. She added that one of the best tools to use is a pedometer, which allows people to monitor how much they've walked that day and alter their workouts and menus accordingly.

Coombs advises being active seven days a week for 30 minutes each day, whether that involves walking, gardening or playing with the dog. "If I only have to do something three days a week, I'll do it on Monday," she said. "Then on Tuesday, I'll be so proud of myself, I'll put it off." If the exercise doesn't get done by later in the week, the tendency is to just put it off to the following week, Coombs said. Consistency of exercise is more important than the kind of exercise being done, she said.

As for eating, both Kalas and Coombs said it's important to monitor food intake carefully, particularly when it's coupled with a new exercise regime. "Beginner exercisers reward themselves for a single bout of exercise that day," Kalas explained. That person will decide, for example, that, since they've walked on the treadmill that day, they deserve to have dessert. But then they'll decide, "I'm going to walk tomorrow so I'm going to eat more tonight," Kalas said. "A lot of time there's one bout of exercise and two rewards built in."

As for what to eat, choose items that come "from the earth that are not prepackaged," Coombs said. "We have to be sensible and stop looking for shortcuts and stop looking for magic foods and magic numbers," she said. Kalas also suggested counting calories using phone applications or referring to the book, "Eat This, Not That," which suggests swapping one food for another at restaurants in order to avoid excessive calorie intake.

To get children motivated, the best thing to do is to remove sedentary activities by setting limits on TV and computers. And it's important to start introducing the importance of fitness and nutrition while kids are still young. "If the household values healthy eating and exercise, it will trickle down to your children," Kalas said.

Ultimately, when it comes to being successful at making changes, a person needs to accept responsibility for their choices and that they're "the only person that can make it better or worse," Kalas said. "If you're going to have the French fries, the only person that's going to have to burn off the calories is you."

To watch the program online, click here. For the full program archive, go here.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky. 

Tai chi classes make exercise accessible to people of all fitness levels

Few things are as important to maintaining overall health as getting regular exercise. Physical activity helps a person keep unwanted pounds away and it works out the cardiovascular system, which reduces the risk of heart disease.

Still, many people find it difficult to find activities that suit their interests or ability levels. For these individuals, tai chi exercises may be just the thing they need to maintain their health without forcing them into uncomfortable situations.

Tai chi exercises involve slow, calculated movements that are done while trying to achieve a calm state of mind. Because the workout is so low-impact, just about anyone can participate, including seniors and individuals who have not exercised for many years.

Just because the workout regimen is low-impact does not mean that is has little effect on a person's health. In fact, it is just the opposite. Participating in tai chi classes often leads to major cardiovascular and respiratory benefits. Furthermore, individuals are less likely to experience mental disorders like depression. Practitioners say the workout has a profound effect.

"It keeps you fit. I think it creates a lot more energy for me," Terry Lorenz, who recently started a tai chi club in Georgia, told the Savannah Morning News. "I was never a runner or lifted weights. I played baseball all my life and I was looking for something to replace that. It's worked well."

He added that most workout regimens focus on building specific muscles. Individuals will lift weights or do other thing to target each muscle of the body separately. However, tai chi is different in that it seeks to improve the fitness of the body as a whole. For this reason, exercises involve the entire body.

These types of benefits may be particularly important for seniors, who often have difficultly participating in vigorous physical activities. Tai chi can provide them with another option that is just as effective a workout but is less strenuous physically.

While most people think that they need to work themselves hard in order to gain any benefit from exercising, this is simply not the case. Low-impact workouts like tai chi exercises can enable individuals to gain the same physical health benefits of more intensive workouts like running or biking without the heavy demands on the body.

In this way, even individuals who previously thought they were not fit enough for exercise can gain the important health benefits of physical activity.

Dahn Yoga is one of the largest yoga and tai chi companies in the world with its own unique style and brand of yoga. Dahn Yoga is rooted in the rich history of an ancient Asian mind-body practice, Sun Do, and in the wisdom of the Chun Bu Kyung.

The common 'fat gene' can be overcome with a little exercise

Even if they've inherited "the fat gene," people don't have to be overweight if they have a relatively small amount of physical activity, such as walking their dog, a study has found. (Getty Images photo)

The research, published this month in the journal of PLoS Medicine, reviewed dozens of studies about the fat mass and obesity-associated gene, which is very common. "By most estimates, about 65 percent of people of European and African descent and perhaps 44 percent of Asians carry some version of the FTO gene," reports Tara Parker-Pope of The New York Times.

But physical activity, even a small amount, may counter the effects of the gene, reducing reduced the effect of the FTO by 30 percent. "While that still leaves 70 percent of the potentially fat-encouraging effect of the gene intact, the consequences of physical activity on the workings of this single gene seem to be substantial enough to perhaps allow someone who otherwise would become seriously overweight to maintain a normal waistline," Parker-Pope reports.

Scientists are still stumped by how the FTO encourages weight gain, but know the gene is particularly active in the the regions of the brain "that regulate the balance of energy intake and expenditure," said Dr. Lu Qi, assistant professor in the department of nutrition at the Harvard School of Public Health. "The loss of energy balance is the basis of development of obesity."

Physical activity, though, my counteract that. "Biologically, it is possible these two factors, genes and physical activity, may interact in affecting energy balance," Qi said. And exercise might affect how the FTO gene works, influencing "whether it expresses certain proteins or remains quiet," Parker-Pope reports.

Though researchers are being cautiously optimistic, they hope the implications of the findings will be encouraging. "Often people feel that obesity runs in the family or that obesity is in their genes, and therefore feel they have no control over their weight issues," said Dr. Ruth Loos, a program leader at the Institute of Metabolic Science in Cambridge, England. "Our study shows that physical activity plays a role in weight control, even in those who are genetically predisposed." (Read more)

September is national Childhood Obesity Awareness Month

September has been proclaimed national Childhood Obesity Awareness Month, with President Obama asking Americans to "take action by learning about and engaging in activities that promote healthy eating and greater physical activity by all our nation's children."

The U.S. childhood obesity rate has tripled since the 1970s, with 1 in 3 American children now either overweight or obese. As such, experts say one third of "children born in 2000 will develop Type 2 diabetes during their lifetime, with many others at risk of obesity-related illnesses including heart disease, high blood pressure, cancer and asthma," reports Julian Pecquet of congressional newspaper The Hill.

Childhood obesity is especially prevalent in Kentucky. The state has the the seventh highest obesity rate nationwide and the fourth highest rate of childhood obesity. Reporters can find by-county obesity rates by clicking here, but by-county childhood obesity rates are not available because counties are collecting data in different ways and at different ages, Sarah Walsh of the Foundation for a Healthy Kentucky said recently.

While the problem is a big one, there are initiatives underway to tackle it, including first lady Michelle Obama's "Let's Move," which helps communities make healthy food and exercise choices. It also includes a partnership with grocery stores to increase food choices in areas that do not have easy access to healthy foods. (Read more)