# Presentation: 684916

## Slide 1

**Notes:**
Good morning.  It is great to be back at the NCEP to provide you with an overview of the work of the NHLBI Obesity Education Initiative. 
Today, I will share with you:
the most recent prevalence data on overweight and obesity in the U.S.,  
the new products that put the Obesity Clinical Guidelines into action for the clinician.
And finally our population-based efforts through a program called Hearts N’Parks 

## NHLBI Obesity Education Initiative 

- Two pronged strategy:
- High-risk strategy: targets individuals experiencing or at high risk for adverse health effects and medical complications with overweight/obesity
- Population-based strategy: focuses on the prevention of overweight/obesity and physical inactivity

**Notes:**
From the onset of the Obesity Education Initiative, experts advised NHLBI that the program should have both a high risk strategy and a population based strategy. We know that we have a lot to do to combat the many forces in the environment that encourage overeating and a sedentary lifestyle.
The high risk strategy is one that targets individuals experiencing or at high risk for adverse health effects and medical complications because they are overweight or obese. The development of clinical practice guidelines to help primary care providers treat overweight and obese patients became the foundation of the high risk strategy. 
The population strategy tackles the problem from the standpoint of prevention of overweight and physical inactivity. This strategy involves the development of messages and programs encouraging all people to increase physical activity and improve nutritional habits in order to help avoid overweight and obesity. 

## OEI Web Page...www.nhlbi.nih.gov

**Notes:**
All of our efforts can be found on the OEI’s Web page, “Aim for a Healthy Weight”, shown here.  It is segmented by information for health professionals and information for patients and the public.  
Two items that have been of particular interest since we put up the site is the interactive BMI calculator and the menu planner.   The BMI calculator was the second most popular page on the entire NHLBI website.  

## The Clinical Guidelines

**Notes:**
The Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: Evidence Report,  released by NHLBI in cooperation with NIDDK in June 1998,  form the foundation of our high risk strategy.  They were the first evidence based guideline issued by the Federal govt. dealing with this issue. 

For the most part the guidelines have been available for sale at $8.00 a copy.  We marketed them primarily to  three groups of physicians (internists, general practice and family physicians) as well as allied health practitioners.  To date, approximately 30,000 copies of the guidelines have been disseminated. 

It also was published as the September Supplement in Obesity Research  and serves as the basis for all of the various products and new tools created for health professionals and patients.

## The Practical Guide/ Electronic Textbook

**Notes:**
As you may recall, soon after completion of the evidence report, we developed The Practical Guide to the Identification, Evaluation, and Treatment of Overweight and Obesity as an abbreviated version of the Clinical Guidelines.  The preprint came out quickly after the full guideline in September 1998.   The final publication came out in October 2000.  All AAFP members received a copy of the Practical Guide from the North American Association for the Study of Obesity who codeveloped the guide with us.  
NHLBI has also disseminated 55,000 copies to date. 
The electronic textbook shown here is our latest edition of the guidelines which is Web-based so it is easy to navigate, searchable, has specific web addresses for the various pages.  

## The Practical Guide

- 10-step plan to treating overweight and obese patients in primary care
- 2-page tear out algorithm to assess, classify, and treat patients (ACT)
- Behavioral assessment of patient readiness
- Quick guide to selecting treatment options
- Reproducible patient materials including low calorie menu plans, weight goal/physical activity log, tips for choosing lower calorie foods and increasing physical activity.

**Notes:**
This slide gives you some idea of the tools contained in the Practical Guide. They include: 
a 10-step plan to treating overweight and obese patients in primary care
2-page tear out algorithm to assess, classify and treat patients (ACT)
Behavioral assessment of patient readiness
Quick guide to selecting treatment options
Reproducible patient materials including low calorie menu plans, food and physical activity diary, tips for choosing lower calorie foods and increasing physical activity. 

## Palm OS Devices 

**Notes:**
The latest technology offers us new opportunities to have information in the palm of our hand. Our latest entry into the arena of education is through the use of the Palm applications. 
One of the first applications we tried was the BMI calculator and it was received with overwhelming success.  Since our information is in the public domain, various palm related sites were very interested in putting up our programs for people to download.  The BMI calculator is now on 8 sites in addition to NHLBI’s site. To date, 76,000 copies were distributed.
Our latest interactive Palm OS application is information from the full guideline and practical guide which allows the provider to enter patient information and then be directed to weight loss goals and treatment options.  This application has also received some very good reviews from a number of Palm Handheld sites such as Palm Gear, SazEz and Tucow.   
Overall approximately 120,000 copies of the Palm Os applications were distributed.
A email publicity announcement about the program was sent by email to 95 health editors who write about Palm OS devices and medicine. 

## Primary Care Provider Education Kit

**Notes:**
Our latest product which was just completed this spring is a Primary Care Provider Education Kit contains the full Guideline, the Practical Guide and the items I will share with you now.  Everyone should have a flyer on the kit in your folders.  
The front of the kit highlights 3 key questions: 
Do you note your patient’s BMI and waist circumference?
Do you know your patient’s obesity related disease risks?
Do you know how to start a conversation with your patient on overweight and obesity. 
And just in case they don’t know how.. the kit includes this Pocket Guide that provides 3 steps to help practitioners initiate discussion about weight management with their patients.

## Patient Education Materials

**Notes:**
The kit also contains patient education materials as tear sheets for providers to use with their patients.
Your Weight and Health Profile sheet allows providers to note BMI, waist circumference, other risk factors and discuss a patient’s overall risk. The patient is asked if they are ready to lose weight and if so what are their weight loss goals.
The other sheet includes Tips for Weight Loss Success that covers Being a Smart Planner, Keeping An Eye on the Size, questioning the amount of physical activity, and the need to balance your Food Checkbook.
To date, almost 700 copies of the kit (18.00) have been disseminated.

## Slides and CME Modules

**http://www.nhlbi.nih.gov/obesitycme/**

**Notes:**
The slide show is also a very popular site and contains 150 slides separated into 6 different sections complete with notes.
Clinical Guidelines Core Set,
Evidence-Based Methodology, 
Background Data, 
Practical Tips, 
Special Considerations, 
Future Research. 
Presenters are able to focus their presentations accordingly. The slides can be downloaded for use in computer slide shows, conventional slide presentations, or for online viewing via the website.   They are available as a PDF or Powerpoint97 version.
We have just completed on two CME modules in cooperation with NAASO; One deals with assessment and the other deals with treatment of the overweight . It offers free 2 hours of category I CME credits for each module.  A card on the CME is in your folders.  
Since launching the site in March, approximately 2000 people have registered for the courses, and over 900 have taken the course for CME credits.

## Menu Planner

**Notes:**
A popular item for the public is our menu planner.  
It contains foods based on the Exchange Lists from the American Diabetes Association/American Dietetic Association.  
It provides the person the chance to record their intake for each meal by the number of servings consumed, and keep track of the number of  calories consumed in the course of the day, compared with meal plans ranging from1200-2000 calories.  
It was accessed over 73,000 times in March 2001...again one viewer could use up to one 100 hits.  

## Slide 12

**Notes:**
This cartoon featuring Cathy pokes fun at a typical problem for health conscious consumers.  Portion sizes are out  of control.  It compares the size of the muffins, cookies, sodas being consumed in the 1990s versus the 1950s.  And, in the last frame since Cathy is on a diet and eating a salad, the main concern is a low fat dressing not the portion size. It is no wonder that obesity is increasing. 

## Portion Distortion:

**Portion Distortion:**
**Do You Know How Food Portions Have **
**Changed in 20 Years?**

**Notes:**
So, this past year, the Institute launched a new web page called....portion distortion, Do you know how portion sizes have changed in 20 years? 

I encourage each of you to take out a pencil and paper and take the quiz. I will ask how many people answered correctly.

## FRENCH  FRIES 

**20 Years Ago**

**Today**

**210 Calories**
**2.4 ounces**

**How many calories are **
**in these fries?**

**610 calories**
**6.9 ounces**

**Calorie Difference: 400 calories**

** *****Based on 160 pound person**

- How  long will you have to
-  walk to burn* 400 calories?

- How to burn* 400 calories:
- _Walk leisurely for 1 hr 10 Minutes_

## SODA

**20 Years Ago**

**Today**

** ****85 Calories**
** ****6 1⁄2 ounces**

**Calorie Difference: 165 calories**

**How many calories are in this soda?**

** ****250 calories**
** ****20 ounces**

** *****Based on 160 pound person**

**How**** ****long would you have**
**to garden to burn 165 calories?**.

- How to burn* 165 calories:
- _Garden for 35 Minutes_

## TURKEY SANDWICH

**20 Years Ago**

**Today**

** ****320 calories **

**Calorie Difference: 500 calories**

**How many calories are in **
**this turkey sandwich?**

** ****820 calories**

** *****Based on 130 pound person**

- How long would you have to bike
- to burn up 500 calories?

- How to burn 500 calories:
- _Bike for 1 hour and 25 minutes_

## Hearts N’ Parks 

**Collaborative Program of...**
- The National Heart, Lung, and Blood Institute
- The National Recreation and Park Association
- Local park and recreation agencies and community partners
- American Dietetic Association (2002)
- State Health Departments (2002)

**Notes:**
Collaborative Program of...
The National Heart, Lung, and Blood Institute 
The National Recreation and Park Association.... And, their motto is “Play Pays”. 
Local park and recreation agencies and community partners
American Dietetic Association (2001) 
State Health Departments (2001)

## Hearts N’ Parks

- Provides a unique venue for children, adults, and seniors to learn about heart healthy lifestyles.
- Demonstrates the impact that park and recreation depts. have on behaviors.
- Mobilizes community assets.
- Is fun and flexible.

**Notes:**
Our Hearts N’Parks project attempts to deal with overweight and obesity from a population based perspective. The overall purpose of Hearts N’Parks is
We feel that Hearts N’Parks is unique. 
It provides a different venue for children, adults, and seniors to learn about heart healthy lifestyles, to eat better and be more physically active, and to improve upon the skills they need to actually begin to make changes.
Demonstrates the impact that park and recreation depts. can have in the community on influencing behaviors.
Mobilizes community assets.
Is fun and flexible in order to meet the needs of different types of communities.
  Show video

## A Little Bit o’ History

- 1999--1st pilot site in 13 counties in North Carolina with the help of NC State University.
- 2000--Arlington County, VA adopted Hearts N’Parks and launched with a big media event.
- 2002--50 magnet centers in 10 states and 6 Marine Corp bases start up!
- Over 1,400 groups have received the Hearts N’Parks Community Mobilization Guide.

**Notes:**
The history behind Hearts n’Parks takes us to : 
1999-- 1st pilot site in 13 counties in North Carolina in the summer of 1999 with the help of NC State
Arlington County adopted the initiative in spring 2000 and launched with a big media event (Lots of important people came including the former Surgeon General Dr. David Satcher and Olympic skater Michael Weiss)
January 2002--50 magnet centers and 6 Marine Corp bases start up!
Over 1,400 groups have received the Guide

## Magnet Center Sites

**NV**

**NC**

**SC**

**GA**

**MI**

**OH**

**IN**

**IL**

**MO**

**FL**

**AZ**

**NM**

**MD**

**HI**

- Responsibilities Include:
-  A three year commitment to the Hearts N’ Parks program
-   Administer the pre and post-test measures to personnel and     	  participants
-  Evaluate the program’s sustainability and growth annually
-  Report progress annually
-  Utilize an extranet to communicate to other sites
-  Serve as ambassadors for other sites interested in Hearts N’ Parks
-  Expand heart-healthy programming efforts each consecutive year

## Community Mobilization Guide

- This Guide is divided into 5 Ps
**P**EOPLE
**P**ROGRAMS
**P**UBLIC VISIBILITY
**P**ARTNERING
**P**ERFORMANCE INDICATORS

**Notes:**
The 5 Ps of Hearts N’Parks are nicely described in the Community Mobilization Guide. It provides community planners with the tools they need to implement the 5 Ps of Hearts N’Parks, namely people, programs, public visibility, partnering and performance measures

In addition, the guide also includes background information on CVD, reproducible materials on heart-healthy eating and physical activity, strategies for forming partnerships with local organizations such as hospitals and restaurants, tips for working with the media, and assessment tools to measure program performance.   

## Programs

**In 2002 - 68 Hearts N’ Parks programs**
**34 – 1,232 children:7 wks **
**8 – 156 adolescents; 10 wks**
**26 – 531 adults; 12 wks**
**For existing heart-healthy programs**:
**Exercise class ******** monitor pulse**
**Sports camp ******** introduce healthy snacks and non-competitive play**
**For existing programs that are not heart-healthy**:
**Use health quizzes, tip sheets, brochures**
**Teach new health-related skill**
**Introduce healthy snacks **

**Notes:**
In 2002, the first year for the Magnet Centers,  68 programs were conducted and assessed:
 34 – children lasting on average 7weeks
 8 – adolescents, lasted closer to 10 weeks 
26 – 531 adults averaging about 12 weeks in length. 7 were for employees and 1 in Poplar Bluffs served disabled individuals.
1,900 participants—Significant improvements were demonstrated from pre to post test in almost all indicators of heart healthy eating knowledge, attention and behavior.                                                                                                                                                                                                                                                                                                                                                                                                     
From the pre and post survey instruments that queried participants, we found that:
 Children significantly improved their knowledge of heart healthy eating, their eating behaviors, their intention to eat healthy, and their attitude toward physical activity. They learned on average 5 activities and got better at 6.9 activities. Knowledge improved by about 8% points, although it was high to begin with at 74% correct and 82%,  behavior by 14% (62%), and intention 19% (63%)
Adolescents showed the most improvement in eating behavior and intention. Physical Activity scores and heart healthy eating knowledge increased slightly since it was fairly high at the beginning 
Adults reported having more knowledge about nutrition, overweight, and physical activity.  By the end of the program, respondents considered healthy eating habits to be somewhat important or very important to them.  At the post test they less likely to make excuses for not engaging in physical activity and the self reported FIT scores suggest that they were significantly more active; while the SIT scores suggest that they spending 8 fewer hours/wk being sedentary

##  Activities

-  Activities

- Potential

**Notes:**
In summary, Hearts N’Parks is all about communities....communities in ACTION.
It provides a rallying cry around heart health.  It is evident in t-shirts, water bottles, baseball hats, frisbees that feature the Hearts N’Parks identifier.
It is touching the lives of many people across the U.S.  From screenings and health fairs, to  summer day camps for children and youth, and to programs targeting seniors or the disabled. 
It is all about partners coming together to make a difference. 
Hearts N’Parks provides communities with “potential”.  
Heart healthy messages are now available in an environment previously not tapped...and it is a rich environment with a lot of energy and a lot of potential.

## DHHS & NRPA MOU

- Signees include:
- NHLBI, NRPA, ODPHP, NIDDK
- CDC and the PCPFS

-  Improve public health by encouraging physical activity and healthy eating.
-  Create community
- programs
-  Remove          environmental barriers

**Notes:**
One outgrowth of our successful relationship with NRPA was the recent signing of a memorandum of understanding between NRPA and DHHS. In addition to NHLBI, other signatories included ODPHP, NIDDK, CDC and the President’s Council on Physical Fitness and Sports.  
The intent of the MOU is to bring the signees together in order to: 
Improve public health by encouraging physical activity and healthy eating.
 Create community programs for children, seniors and families
 Remove environmental barriers to physical activity such as those for the disabled.

## Future OEI Activities

**Healthy Weight Community Outreach Initiative – FY’04**
- Create a national health education action plan on reducing overweight/ obesity and on promoting a healthy weight.
- Create key messages appropriate to convey important issues on body weight to the respective target audiences.
- Create community-based activities that target health care providers, patients and the public.
- Explore the potential role of environmental change.
**Comprehensive Patient Education Materials based on Obesity Clinical Guidelines and ATP III**

**Notes:**
Plans for our immediate future in FY 04 include the development of a Healthy Weight Community Outreach Initiative that will include:
 a national health education action plan on reducing overweight/obesity and on promoting a healthy weight.   Through this action plan we hope to increase the level of awareness of community organizations, especially those involved in parks and recreation and the public, particularly those at high risk, about the increased risks associated with overweight and obesity and the health benefits of maintaining a healthy weight. 
Create key messages appropriate to convey important issues on body weight to the respective target audiences.
	Create community-based activities that target health care providers, patients and the public.
	Explore the potential role of environmental change.

Comprehensive Patient Education Materials based on Obesity Clinical Guidelines