mass index screening
Transcripción
mass index screening
School based body mass index screening: The Arkansas experience Joseph p W. Thompson, p , MD,, MPH Surgeon General State of Arkansas Director, Arkansas Center for Health Improvement / RWJF Center to Prevent Childhood Obesity Associate Professor UAMS Colleges of Medicine and Public Health www.reversechildhoodobesity.org 2 Building Communities: RWJF Childhood Obesity Programs Action Advocacy Evidence Alliance for a Healthier Generation, Healthy Schools Communities Creating g Healthy Environments: Active Living g Research Healthy Kids, Healthy America (NGA Center for Best Practices) Faith-based Advocacy: Galvanizing Communities to End Childhood Obesity Healthy Kids, Healthy Communities Leadership for Healthy Communities: Advancing Policies o c es to Support Suppo t Healthy ea t y Eating and Active Living Pioneering Pi i H Healthier l hi Communities, YMCA of the USA Safe Routes to School (SRTS) National Partnership Mobilizing Health Care Professionals as Community L d Leaders in i the th Fight Fi ht A Against i t Childhood Obesity National Policy and Legal Analysis Network for Childhood Obesity Prevention Save the Children: Campaign for Healthy Kids 3 African American Collaborative Obesity Research Network (AACORN) Bridging the Gap Food Marketing and Youth Project, Rudd Center for Food P li & Obesity Policy Ob i Healthy Eating Research Salud America! The RWJF Research Network to Prevent Obesity Among Latino Children Obesity Trends* Among U.S. Adults BRFSS 1990, BRFSS, 1990 1998, 1998 2007 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1998 1990 2007 N Data No D t <10% 10% 10%–14% 10% 14% 15% 19% 15%–19% 20% 24% 20%–24% Source: CDC Behavioral Risk Factor Surveillance System. 25% 29% 25%–29% ≥30% Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes 1994 Obesity (BMI≥30) Missing Mi i D Data t 14.0 - 17.9% 22.0 - 25.9% 14 0% <14.0% 18.0 -21.9% ≥26.0% Diabetes Missing data 4.5 - 5.9% 7.5 - 8.9% <4.5% <4 5% 6.0 - 7.4% ≥9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes 1995 Obesity (BMI≥30) Missing Mi i D Data t 14.0 - 17.9% 22.0 - 25.9% 14 0% <14.0% 18.0 -21.9% ≥26.0% Diabetes Missing data 4.5 - 5.9% 7.5 - 8.9% <4.5% <4 5% 6.0 - 7.4% ≥9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes 1996 Obesity (BMI≥30) Missing Mi i D Data t 14.0 - 17.9% 22.0 - 25.9% 14 0% <14.0% 18.0 -21.9% ≥26.0% Diabetes Missing data 4.5 - 5.9% 7.5 - 8.9% <4.5% <4 5% 6.0 - 7.4% ≥9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes 1997 Obesity (BMI≥30) Missing Mi i D Data t 14.0 - 17.9% 22.0 - 25.9% 14 0% <14.0% 18.0 -21.9% ≥26.0% Diabetes Missing data 4.5 - 5.9% 7.5 - 8.9% <4.5% <4 5% 6.0 - 7.4% ≥9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes 1998 Obesity (BMI≥30) Missing Mi i D Data t 14.0 - 17.9% 22.0 - 25.9% 14 0% <14.0% 18.0 -21.9% ≥26.0% Diabetes Missing data 4.5 - 5.9% 7.5 - 8.9% <4.5% <4 5% 6.0 - 7.4% ≥9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes 1999 Obesity (BMI≥30) Missing Mi i D Data t 14.0 - 17.9% 22.0 - 25.9% 14 0% <14.0% 18.0 -21.9% ≥26.0% Diabetes Missing data 4.5 - 5.9% 7.5 - 8.9% <4.5% <4 5% 6.0 - 7.4% ≥9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes 2000 Obesity (BMI≥30) Missing Mi i D Data t 14.0 - 17.9% 22.0 - 25.9% 14 0% <14.0% 18.0 -21.9% ≥26.0% Diabetes Missing data 4.5 - 5.9% 7.5 - 8.9% <4.5% <4 5% 6.0 - 7.4% ≥9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes 2001 Obesity (BMI≥30) Missing Mi i D Data t 14.0 - 17.9% 22.0 - 25.9% 14 0% <14.0% 18.0 -21.9% ≥26.0% Diabetes Missing data 4.5 - 5.9% 7.5 - 8.9% <4.5% <4 5% 6.0 - 7.4% ≥9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes 2002 Obesity (BMI≥30) Missing Mi i D Data t 14.0 - 17.9% 22.0 - 25.9% 14 0% <14.0% 18.0 -21.9% ≥26.0% Diabetes Missing data 4.5 - 5.9% 7.5 - 8.9% <4.5% <4 5% 6.0 - 7.4% ≥9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes 2003 Obesity (BMI≥30) Missing Mi i D Data t 14.0 - 17.9% 22.0 - 25.9% 14 0% <14.0% 18.0 -21.9% ≥26.0% Diabetes Missing data 4.5 - 5.9% 7.5 - 8.9% <4.5% <4 5% 6.0 - 7.4% ≥9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes 2004 Obesity (BMI≥30) Missing Mi i D Data t 14.0 - 17.9% 22.0 - 25.9% 14 0% <14.0% 18.0 -21.9% ≥26.0% Diabetes Missing data 4.5 - 5.9% 7.5 - 8.9% <4.5% <4 5% 6.0 - 7.4% ≥9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes 2005 Obesity (BMI≥30) Missing Mi i D Data t 14.0 - 17.9% 22.0 - 25.9% 14 0% <14.0% 18.0 -21.9% ≥26.0% Diabetes Missing data 4.5 - 5.9% 7.5 - 8.9% <4.5% <4 5% 6.0 - 7.4% ≥9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes 2006 Obesity (BMI≥30) Missing Mi i D Data t 14.0 - 17.9% 22.0 - 25.9% 14 0% <14.0% 18.0 -21.9% ≥26.0% Diabetes Missing data 4.5 - 5.9% 7.5 - 8.9% <4.5% <4 5% 6.0 - 7.4% ≥9.0% CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics National Childhood Obesity Trends Peercent Overrweight 25 20 15 10 US 12-19 yr 5 US 6-11 yr 0 1963-65 1971-74 1966 70 1966-70 1976 80 1976-80 1988-94 01-02 99 00 03-04 99-00 03 04 NHANES data sources: Ogden et al al. Prevalence and Trends in Overweight Among US Children and Adolescents, 1999-2000. JAMA 2002;288(14):1728-1732. Ogden et al. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555. Percentage of Children who are Obese Aged 10–17 Years by State (2003) Data for these maps were retrieved from the Child and Adolescent Health Measurement Initiative, 2003 National Surveys of Children's Health, Data Resource Center for Child and Adolescent Health website (accessed 10/03/08, www.nschdata.org). Robert Wood Johnson Foundation Center to Prevent Childhood Obesity Percentage of Children who are Obese Aged 10–17 Years by State (2007) Data for these maps were retrieved from the Child and Adolescent Health Measurement Initiative, 2007 National Surveys of Children's Health, Data Resource Center for Child and Adolescent Health website (accessed 5/26/09, www.nschdata.org). Robert Wood Johnson Foundation Center to Prevent Childhood Obesity Act 1220 A 1220: Arkansas Ak Child and d Adolescent Obesityy Initiative 84th General Assembly Act 1220 of 2003 An act to create a Child Health Advisory Committee; to coordinate statewide efforts to combat childhood obesity b it and d related l t d illnesses; ill t improve to i the th health h lth off the next generation of Arkansans; and for other purposes. Goals: • Change g the environment within which children g go to school and learn health habits everyday • Engage the community to support parents and build a system that encourages health • Enhance awareness of child and adolescent obesity to mobilize resources and establish support structures Act 1220 Requirements 1. Establishment of an Arkansas Child Health Advisory Committee 2. Vending machine content and access changes 3 Physical 3. Ph i l activity ti it / education d ti requirements i t 4. Requirement of professional education for all cafeteria workers 5. Public disclosure of “pouring contracts” 6 Establishment of local parent ad 6. advisory isor committees for all schools 7 Confidential child health report delivered 7. annually to parents with body mass index (BMI) assessment Amending Act 1220 – Acts 201, 719, & 317 off 2007 • Periodicity of BMI assessments change to every even year beginning in K thru 10th grade. • Parents must p provide a written refusal to keep p child from participating. • ADH nurses responsible for quality assurance to follow protocols. • Adds 5 members to CHAC CHAC. • Broadens CHAC scope to all school health. • Eliminates physical activity for all but K-5. Legislation regarding BMI Measurement • Act 201 of 2007 Changes g periodicity p y of BMI screening to every 2 years starting in K g 10th grade. g Parallels other screens – through vision, hearing and scoliosis – Parents have written opt p out capacity p y – Report sent to parents in new Health Screen format – Provides for enhances p policies and procedures p to secure privacy and uniformity in measurement Legislation Regarding Physical Activity • Act 317 An act to increase class time by y limiting mandated PA activity time in grades K-12 K 12 This bill provides for 60 minutes of PE weekly and 90 minutes of PA weekly for K-5 only only. No requirements for Physical activity n grades 6-12. Legislation Regarding the Child Health Advisory committee • Act 719 of 2007 Calls for CHAC’s expanded role on Coordinated School health and adds new membership – CHAC will make recommendations concerning g the implementation of the Arkansas Coordinated School Health Program – expansion beyond physical activity and nutritional standards – 5 new members added (for a total of 25) – representation from • • • • Office of Minority y Affairs at DHHS Arkansas School Boards Association Arkansas Association of School Business Officials Arkansas Association for Supervision and Curriculum Deve. • A Classroom teacher AR Responses beyond Act 1220 • CDC School Health Initiative (DOE) ( ) • School, community and faith-based efforts • Development of first continuing medical education p program g for clinicians • Regionalization of specialty care • Elimination of fiscal barriers to reimbursement (Medicaid / SCHIP) • Increased awareness of physical activity needs (Mini (Mini-marathon) marathon) Arkansas Board of Education actions • Vending machines restricted until 30 minutes i t after ft lunch l h in i all ll schools h l – 12-ounce maximum beverage size – 50% healthy options required • No competitive foods in cafeterias • Cafeteria food service education • Nutrition and health curriculum changes • 30 minutes i t per d day physical h i l activity ti it (K-12 (K 12) 12 – 2007 change to accept activities (9-12 grades) AR Health Care Environmental Response • Local school, community and faith-based initiatives • Growth in farmers’ markets • Development of first CME program for clinicians • Regionalization of secondary and tertiary care (e g Fitness Clinic at AR Children’s Hospital) (e.g., • Elimination of fiscal barriers to reimbursement (M di id / SCHIP) (Medicaid • Increased awareness of physical activity needs (Mini-marathon) • Changes g to built environment – world’s longest g pedestrian bridge Child Health Report (2004) Source: Arkansas Center for Health Improvement, Little Rock, AR, 2004. Spanish Child Health Report (2005) EXAMPLE SCHOOL DISTRICT EXAMPLE SCHOOL NAME Address City, AR, ##### May 16, 2005 Parent Name «MailingAddress1» «MailingCity», «MailingState» «Zip» Estimados Padres: Esta carta importante se refiere a la salud de Example Student. Por favor léala toda. Muchos niños en Arkansas tienen problemas de salud debido a su peso. Recientemente, en la escuela de su niña, la estatura y su peso fueron medidos. Las medidas de peso y estatura, así como la edad y el sexo se usaron para calcular el percentil del índice de masa corporal (IMC). El IMC es una prueba inicial que sugiere si una persona tiene sobrepeso, está al riesgo de sobrepeso, tiene peso apropiado o está baja de peso. ¿Por qué se midió el IMC en la escuela? Las leyes del estado de Arkansas requieren que la escuela de su niña mida el IMC cada año y que se le envíe a usted un Si un niña está pasada de peso peso, usualmente se debe a que tiene un exceso de grasa corporal corporal. Las niñas que tienen reporte sobre b riesgo los l de resultados. lt d de salud E Enque llas l pesod de A Arkansas k Las niñas ttambién bié se practican ti pruebas b iiniciales i i l para b buscar problemas bl exceso de grasa corporalt tienen más tener problemas las escuelas niñas con un apropiado. que están pasados de peso o en riesgo de estar pasados de peso son mas propensos a ser adultos obesos o con con lapuede vista yenfermedades la audición de diabetes, los niños. Medir eldelIMC de sobrepeso. La obesidad causar tales como alta presión, problemas corazón así su comoniña es otra manera de ayudarle a cuidar su salud. Acciones otros problemas de salud. Las niñas bajas de peso también pueden tener problemas de salud. que se tomen ahora pueden ayudar a disminuir el riesgo de desarrollar enfermedades serias cuando crezca su niña. Así Raramente, la IMC de un niño puede estar alta (sobrepeso o al riesgo de sobrepeso) debido a que el niño sea muy que, es importante medir el IMC cada año para ver si su niña está creciendo y desarrollando de una manera saludable. muscular. Al ser muy muscular no aumentan los problemas de la salud en el niño. Solamente puede decir un doctor si la IMC está alta a causa de mucha grasa corporal. Según la información en esta carta, seria bueno que hablara con el doctor de su niña. ¿Es el peso de su niña un problema de salud? El pasado dla escuela? 3/1/05 su niña 3/1/05, iñ ffue medida did y pesada d en ¿Por qué se midió el IMC en Las leyes del estado de Arkansas requieren que la escuela de su niña mida el IMC cada año y que se le envíe a usted un la escuela. EXAMPLE midió 4 pies con 8 pulgadas reporte sobre los resultados. En las escuelas de Arkansas también se practican pruebas iniciales para buscar problemas con la vista y la audición de los niños. Medir el IMC de su niña es otra manera de ayudarle a cuidar su salud. Acciones y pesó libras, lo que le daenfermedades un IMCserias que que se tomen ahora pueden 137.4 ayudar a disminuir el riesgo de desarrollar cuando crezca su niña. Así que, es importante medir el IMC cada año para ver si su niña está creciendo y desarrollando de una manera saludable. sugiere que ella pueda estar sobrepeso. ¿Es el peso de su niña un problema de salud? El pasado 3/1/05, su niña fue medida y pesada en la escuela. EXAMPLE midió 4 pies con 8 pulgadas y pesó ó 137.4 13 4 libras, lib llo que lle d da un IMC que sugiere que ella pueda estar sobrepeso. El IMC de su Niña ¿Qué debe hacer usted? Bajo de peso Peso apropiado En riesgo de estar sobrepeso Sobrepeso El IMC de su Niña Bajo de peso Peso apropiado En riesgo de estar sobrepeso Sobrepeso La línea demuestra como el IMC de su niña se compara con el de otros niños en las escuelas de Arkansas. La línea demuestra como el IMC de su niña se compara con el de otros niños en ¿Qué debe hacer usted? las escuelas de Arkansas. Dado que el IMC de EXAMPLE sugiere que ella está sobrepeso, seria bueno que hablara con el doctor de su niña. Por favor enséñele esta carta al doctor (EXAMPLE’s BMI was 30.8 or 97.4 percentile). Su doctor verificara el IMC de su niña y se asegurara que las medidas que se tomaron en la escuela son las correctas. Además, su doctor puede informarle acerca de una alimentación saludable y actividades físicas para su niña. Por ejemplo, la Academia Americana de Pediatría es un grupo de médicos que atienden a niños y sugieren i que su ffamilia ili d debe b d de: Ofrecer bocadillos saludables tales como frutas, verduras y otras comidas bajas en azúcar y sal. Beber menos sodas y tomar más agua, leche desgrasada o bebidas bajas en calorías. Limitar a dos horas diarias el tiempo viendo televisión o jugando videos. Hacer ejercicios con sus niños tales como corriendo, caminando o usando la bicicleta. Los hábitos saludables empiezan a una edad temprana. Por favor, esté conciente que la alimentación y la actividad física afectarán la salud y vida de su niña. Gracias, EXAMPLE SCHOOL NAME Para mayor información, visite www.achi.net. Source: Arkansas Center for Health Improvement, Little Rock, AR, 2005. Percent by Gender and Ethnic Group (2005–2006) Data source: ACHI. The Arkansas Assessment of Childhood and Adolescent Obesity—Tracking Progress (Year 3 Fall 2005–Spring 2006). Little Rock, AR: ACHI; September 2006. Percent at risk for overweight or overweight by gender ethnicity, gender, ethnicity and grade (’05–’06) (’05 ’06) F Females l Males 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% Hispanic African American White 10% Hispanic African American White 10% 0% 0% PK K 1 2 3 4 5 6 7 8 9 10 11 12 PK K 1 2 3 4 5 6 7 8 9 10 11 12 Source: ACHI. The Arkansas Assessment of Childhood and Adolescent Obesity—Tracking Progress (Year 3 Fall 2005– Spring 2006). Little Rock, AR: ACHI; September 2006. Percentage of students classified as g overweight or at risk for overweight by Arkansas public school district (’05 ’06) (’05–’06) Source: ACHI. The Arkansas Assessment of Childhood and Adolescent Obesity—Tracking Progress (Year 3 Fall 2005–Spring 2006). Little Rock, AR: ACHI; September 2006. National and Arkansas Childhood Obesity Trends 22.0 25 21.5 21.0 20 20.0 19.5 15 AR grades d 7-12 7 12 AR grades K-6 20.5 AR grades K-6 AR grades 7-12 7 12 03-04 N=981 03-04 N=2,159 19.0 2004 2005 2006 2007 10 US 12-19 12 19 yr 5 US 6-11 yr 0 1963-65 1971-74 1966-70 1976-80 Avg N=150,881 Avg N=212,011 1988-94 01-02 04 06 99-00 03-04 05 07 NHANES data sources: Ogden et al. Prevalence and Trends in Overweight Among US Children and Adolescents, 1999-2000. JAMA 2002;288(14):1728-1732. Ogden et al. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555. Arkansas data source: Arkansas Center for Health Improvement, Little Rock, AR, September 2007. UAMS College of Public Health Evaluation of Act 1220 (2006) • Parents’ awareness of obesity-related obesity related health problems increased (1/3 recognized problem > 2/3) • 95% of parents read some or all of the Child Health Report and 67% found the report helpful • No feared consequences of BMI measurements • Students reported purchasing more healthy drinks, such as water and other unsweetened beverages • Innovations in schools and communities across the state – taste tests in cafeterias cafeterias, curriculum changes • Support of continued improvements to nutrition standards in school cafeterias Fay W. Boozman College of Public Health. Year Two Evaluation Arkansas Act 1220 of 2003 to Combat Childhood Obesity. http://www.uams.edu/coph/reports/Act1220Eval.pdf. Accessed 27 March, 2006. What iis the Wh h iimpact off obesity b i on children’s healthcare? Average Annual Total Use by Age Group 10 –2% 21% p=<.0001 8 8.7 8 7.2 8.9 8 8..4 9.2 9 9.4 4 9.0 9 6 8.7 8 Days of Serv vice 3% 6% p=.04 p .04 2 0 All Normal 5-9 yr 10-14 yr 15-19 yr Overweight Contact days of services for outpatient, inpatient, other place of service, and dental visits. Significant p values for within-group t-test are shown. Average Annual Total Cost by Age Group $1,400 $1 200 $1,200 9% $1,01 16 $1,166 $1,0 080 $934 4 $400 $945 5 $600 $1,1 101 $800 $1 1,310 –1% $1,00 08 To otal Cos st $1,000 29% p=<.0001 8% p=.02 $200 $0 All Normal 5-9 yr 10-14 yr Overweight Total payments for outpatient, inpatient, pharmacy, and dental claims. 15-19 yr Adult Average Annual Total Risk Cost No Risks $2,382 O O+P P $3,441 $4,158 $3,169 Obese $3,679 Physically Inactive $3 643 $3,643 C+O+P C+O $4 432 $4,432 $3,529 Daily Cigarette Users $3,081 C+P $3,257 C $2 690 $2,690 O =Obese P =Physically Inactive C =Daily Cigarette Use Annual Average Total* Costs Linked to Obesity $4,500 Pharmacy Medical $3,000 Total difference $1,238 $1,297 (54%) $785 $1,500 $2,441 $1,597 $0 No Risk Obese *Includes medical (inpatient and outpatient) and pharmacy costs for 18-84 year old state employees. $8,860 $ Average Annual Total* Costs Linked to Obesity compared with No Risk by Age Group $10,000 No Risk $ $9,000 $5,391 $8,000 $2,000 $3,266 $2,409 1,991 $1 $2,160 $ $1,23 30 $3 000 $3,000 $1,38 82 $4,000 $1,857 $5 000 $5,000 $2,801 $6,000 $3,7 765 $7 000 $7,000 $4,338 $ Obese $1,000 $0 18-24 25-34 35-44 45-54 55-64 65-74 *Includes medical (inpatient and outpatient) and pharmacy costs for state employees. $4,522 $4 522 (104%) What Next? Immediate Opportunities • Align education education, health, health and financing options to support parents and communities in making change – Update and expand school nutritional guidelines in accordance with IOM recommendations - Child Nutrition Act (Congressional reauthorization 2009) – Incorporate financial coverage for childhood obesity SCHIP (reauthorization 2009)/Medicaid Rules & Regs – “No “N Child Left L ft Behind” B hi d” K-12 K 12 education d ti reauthorization th i ti Consider personal physical performance goals – Non Non-motorized motorized transportation investments – Transportation (SAFETY-LU) reauthorization 2009 • Local and state investments in food access, built environment, and multi-facet strategies for impact • Consider Medicare Medicare’s s future financial risk to support current prevention programs www.reversechildhoodobesity.org Robert Wood Johnson Foundation Center to Prevent Childhood Obesity Contact information • Joseph p W. Thompson p MD,, MPH • 501.526.2244 • [email protected] thompsonjosephw@uams edu