In Iowa, focus on nutrition, environmental factors

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DES MOINES — When working with obese children, nutrition is the first place to start, according to Stacey Milani, a pediatrician at a MercyOne pediatric clinic in Pleasant Hill.

Milani is working on her certification as a physician in obesity medicine. She has experience working with patients struggling with health issues related to obesity. For the youngest, getting parents on board to work on health behaviors is sometimes difficult.

Milani Stacey

Stacey Milani

“It’s always a bit of an issue whether or not the parent is even going to accept that there’s a problem,” she said.

“Obviously with children it’s the parent who decides something needs to be done and makes the changes.”

Working with parents to manage a child’s nutrition can be challenging because pediatricians see patients in a short timeframe that doesn’t allow for detailed discussions. Insurance companies often don’t pay for consultations with nutritionists, Milani said.

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Childhood obesity can lead to a host of health problems, including high blood pressure, early heart problems and type 2 diabetes, she said.

As of 2019, Iowa’s childhood obesity rate is slightly higher than the national average. Among high school students, the state’s obesity rate is 17%, compared to a national rate of 15.5%, according to data from the Centers for Disease Control and Prevention.

Among children ages 10 to 17, 16.9 percent are obese, according to the State of Childhood Obesity. Iowa ranks 18th out of 50 states for this age group.

The rate in Iowa as measured by the CDC has increased over the past decade. The obesity rate was 13.2% in 2011 and 15.3% in 2017.

State initiatives

Iowa has several nutrition, fitness, and food insecurity initiatives aimed at reducing childhood obesity.

One of the most important is 5-2-1-0: Healthy Choices Matter. The program, which originated in Maine, came to Iowa in 2016 as the Central Iowa Healthy Kids Coalition sought to create simple messages. Today, the program is promoted by the Iowa Department of Public Health, the Healthiest State Initiative, and dozens of nonprofits and schools statewide.

The campaign encourages children to follow four simple guidelines: Eat five servings of fruit or vegetables a day; do not use screens for more than two hours a day; engage in physical activity for one hour a day; and consume sugar-free drinks.

It’s based on proven ways to improve health and reduce obesity, said Healthiest State Executive Director Jami Haberl. The Healthiest State Initiative is a nonprofit organization whose goal is to make Iowa the healthiest state in the nation.

“5-2-1-0 is evidence-based,” she said. “We know that people in Iowa don’t eat enough fruits and vegetables, and that goes for kids and adults alike.”

The program has sites in schools, workplaces and daycares in 83 counties in Iowa. Over the past three years, the state has awarded grants to 16 communities for the prevention of childhood obesity to create “sustainable and equitable environmental and policy change that supports active living and healthy eating,” according to one. 2021 report.

Five more cities in Iowa will begin receiving funding in 2022.

“Work Together, Iowa [Department of Health and Human Services] and the Healthiest State Initiative are providing strategic leadership, stakeholder engagement, community funding, and evaluation of the initiative,” said Iowa HHS spokeswoman Sarah Ekstrand.

When it comes to making healthy choices, how Iowa compares to the rest of the nation depends on the metrics.

In 2019, according to the CDC’s High School Youth Risk Behavior Survey, Iowa students scored lower than their national peers on most nutritional parameters. They were more likely to have eaten no fruit or vegetables in the past seven days and to have drunk soda or several servings of soda per day.

On measures of physical activity, Iowa students generally performed better than national averages. They were more likely to have participated in physical activity for at least 60 minutes on one or more days in the previous week. They were also less likely to have played video games or used a computer for three or more hours a day, and less likely to have skipped physical education class for one or more days.

Federal aid

Like other states, Iowa participates in federal programs that provide nutritional assistance to low-income families and children.

Iowa’s obesity rate for children ages 2 to 4 participating in WIC, a federal nutrition assistance program for women, infants, and children, was 15.8% in 2020, according to the CDC.

In 2019, 58,064 Iowa residents were enrolled in WIC, according to a State of Childhood Obesity report. The report found that 46.8% of aid-eligible residents participated in 2016.

The state also administers the federal Supplemental Nutrition Assistance program, with 144,000 children participating in 2018, or 43.4% of those eligible.

The Healthiest State initiative also offers a “Double Up Food Bucks” program that allows SNAP recipients to increase the purchasing power of their fresh produce aid at participating stores. SNAP recipients can get up to $10 more per day to spend on products.

“They can go to a participating location, whether it’s a farmers’ market or a grocery store…and they can use their SNAP EBT card to buy fresh fruits and vegetables, and for every fresh fruit and vegetable they buy, they can receive a dollar from Double the Food Dollars,” Haberl said.

Social, environmental factors

Looking at the causes of childhood obesity, Jessica Nelson, United Way’s Health Community Impact Coordinator, said it helps to understand the social determinants of children’s health, including environmental factors.

Nelson said obesity rates aren’t just about eating healthy foods and being active. The prevalence of childhood obesity also depends on the environment in which children live. The prevalence of sidewalks, green spaces, and the availability of food in a neighborhood are all correlated with health and obesity. Such things can be changed by policy changes, not necessarily by individual actions.

“How do we make sure people understand the importance of this, that it’s not just about making these healthy choices and choosing an apple over crisps, but really, do they have the option apple in their community?” she says. “Do they have walkable and safe communities where they can be active?

Nelson said the 5-2-1-0 campaign moved to view childhood obesity through this lens, seeking to influence systems for better health. Grants awarded under the program in recent years have gone towards setting up water filling stations in schools and parks and setting up “story walks” to encourage the ‘physical activity.

“It really started with looking at those messages that impact individual behavior, but it’s moved to more looking at environments and systems that can help create healthy communities,” Nelson said. .

These problems also arise in clinical settings. Milani, the Pleasant Hill pediatrician, often asks parents to worry about their child getting enough exercise because they don’t have a garden or there isn’t a convenient way to exercise. activity outside the home. Some families live in food deserts and do not have easy access to fresh produce.

Milani said her office asks about food insecurity on intake forms, asking if a family needs help getting food or other essentials.

“We have health workers who will examine them and then try to help people who are struggling and who might need extra food or might need help with certain social situations,” she said.

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