The 2010 Dietary Guidelines: Lessons learned for 2015 Focus: Childhood obesity

Transcription

1 The 2010 Dietary Guidelines: Lessons learned for 2015 Focus: Childhood obesity Rafael Pérez-Escamilla, PhD Professor of Epidemiology & Public Health Yale School of Public Health New Haven, Connecticut 6 th Biennial Childhood Obesity Conference San Diego, June 29 th 2011

2 Talk Outline The 2010 DG s Process Applications Childhood obesity Early childhood obesity (first two years) Disparities & risk factors Lifecycle approach Implications for 2015 DG s

3 Slides provided by the USDA Center for Nutrition Policy and Promotion U.S. Department of Agriculture Center for Nutrition Policy and Promotion

4 Dietary Guidelines for Americans Click to edit Master title style Click to edit Master text styles Second level Third level History Fourth level» Fifth level U.S. Department of Agriculture Center for Nutrition Policy and Promotion 4

5 Focus of the Dietary Guidelines Purpose Provide science-based advice for ages 2 years and older Including those at increased risk of chronic disease Target audience Policymakers, nutrition educators, and health professionals Produced by USDA and HHS How often Updated every 5 years U.S. Department of Agriculture Center for Nutrition Policy and Promotion

6 Development of Dietary Guidelines Click to edit Master title style Policy and Communications DGAC Charter Click to edit Master text styles DGAC Chartered Phase 1 Second level Third level Fourth level» Fifth level DGAC Public Meetings: Review of Science DGAC Report Submitted to Secretaries of USDA & HHS USDA & HHS Develop Policy Document DG s Implemented through Federal Programs Phase 2 Phase 3 Phase 4 U.S. Department of Agriculture Center for Nutrition Policy and Promotion 6

7 Dietary Guidelines, 2010 Development Process Phase 1: Dietary Guidelines Advisory Committee 13 member Advisory Committee from academia and medical institutions Highly credentialed and experienced in public health Systematic evidence-based review methodology for 130 scientific questions Consistent and transparent process Data analyses, food pattern modeling analyses, and reviews of existing evidence-based reports Public comments received and reviewed throughout 445-page advisory report provided scientific basis U.S. Department of Agriculture Center for Nutrition Policy and Promotion

8 USDA s Nutrition Evidence Library (NEL) Created to conduct evidence-based reviews to inform Federal nutrition policy and programs Preferred foundation for policy development and guidance Meets Federal mandates requiring that all agencies ensure the quality, objectivity, utility, and integrity of information used to form Federal guidance Uses a systematic process that is rigorous, transparent, and minimizes bias U.S. Department of Agriculture Center for Nutrition Policy and Promotion

9 Evidence-Based Review Methodology 1. Develop research questions 2. Create and implement literature search and sort plans 3. Develop evidence portfolios 4. Synthesize the bodies of evidence 5. Develop conclusion statements and grade the evidence 6. Describe research recommendations Spahn JM, et al. The systematic review methodology used to support the 2010 Dietary Guidelines Advisory Committee. JADA. (In Press). U.S. Department of Agriculture Center for Nutrition Policy and Promotion

10 Grading the Strength DGAC grading criteria: Quality of studies of the Evidence Quantity of studies and subjects Consistency of findings across studies Magnitude of the effect or public health impact Generalizability to the population of interest Qualitative words used to describe the strength of the evidence: Strong, Moderate, Limited, Expert Opinion, and Grade Not Assignable U.S. Department of Agriculture Center for Nutrition Policy and Promotion

11 Dietary Guidelines, 2010 Development Process Phase 2: Review of and comment on DGAC Report Public comments 1159 written comments posted to public comments database between June 15 through July 15, organizations and individuals provided oral testimony on July 8, 2010 Staff reviewed and considered all public comments in development of policy document All comments available at for public view USDA and HHS agency review for program-specific policy implications U.S. Department of Agriculture Center for Nutrition Policy and Promotion

12 Dietary Guidelines, 2010 Development Process Phase 3: Drafting and review of DGA Writing team formed USDA and HHS nutritionists -- most worked closely with DGAC in developing their Report Structure for DGA followed the four main integrated findings identified in Report s Translation and Integration Chapter Reviews of drafts included USDA and HHS Agency review for policy implications Independent peer review for compliance with Quality of Information Act for clarity, technical accuracy, and consistency with Advisory Report Clearance by Departments in December 2010 U.S. Department of Agriculture Center for Nutrition Policy and Promotion

13 Childhood Obesity-Key issues Sugar sweetened beverages Nutrient density Caloric density Screen time Development of lifelong eating habits

14 Childhood Obesity- Key Framework Social-Ecological model Family School Community

15 Childhood Obesity-Lifespan Maintain proper weight across the life span Gestational weight gain Childhood Adolescence Adulthood

16 Childhood Obesity-Lifecycle promote healthy pre-pregnancy weight, appropriate weight gain during pregnancy, the initiation and maintenance of breastfeeding during infancy, and a return to health weight status postpartum can help prevent obesity throughout the lifespan. (2010 DG s, p. 58)

17 Prevalence of High Weight for Recumbent Length Among US Children From Birth to 2 Years of Age, a,b. Ogden, C. L. et al. JAMA 2010;303:

18 Odds of each childhood obesity risk factor in black and Hispanic participants, relative to white participants by American Academy of Pediatrics Taveras E M et al. Pediatrics 2010;125:

19 Health Disparities in Early Nutrition: Where the Problem Begins? ASN Minority Affairs Committee Symposium Tuesday April 12, :30 AM-12:30 PM Washington Convention Center, 151B Chair: R. Perez-Escamilla, Yale University Co-Chair: O. Bermudez, Tufts

20 The childhood obesity epidemic: A lifecycle framework Pre-pregnancy BMI Early childhood obesity risk Gestational weight gain Infancy weight gain rate Infant feeding practices Post-partum weight retention Neonatal predisposition

21 Integrate through 2015 Dietary Guidelines?

22 Recommendations: Life-cycle approach Integrate preconceptional, gestational, postpartum and infant feeding guidelines into Guidelines targeting childhood obesity prevention following lifecycle approach Social marketing framework Generate political support ( Let s Move! as an example) Mass media Inter-sectoral initiatives/programs WIC, school nutrition, SNAP-Ed, communities, etc

23 Recommendations: Monitoring & Evaluation Multi-component lifecycle indicator -e.g., proportion of women who: enter pregnancy with appropriate weight gain weight during gestation within recommendations return to pre-pregnancy weight by 6 months postpartum breastfeed their babies exclusively for 6 months introduce nutritious complementary foods at 6 months continue breastfeeding until child is one year old

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26 Hunger and Obesity: Understanding a food insecurity paradigm. IOM Workshop Report, 2011.

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