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B R E AK IN G T R ADIT ION :E ngaging P hys icians (Docs Adopt) in
S chool-bas ed Obes ity P revention
J anice D. K ey, MD
Director, MU S C B oeing C enter for C hi ldren’s Wel lnes s
T he MU S C B oeing C enter for C hildren’s Wel lnes swinning the 2 01 6 Healthcare Leader s hip C ouncil Wel lnes s Frontier s Award
T he MU S C B oeing C enter for C hildren’s Wel lnes s
B R E AK IN G T R ADIT ION :E ngaging P hys icians (Docs Adopt) in
S chool-bas ed Obes ity P revention• What is i t?
• How was it developed?
• What is work ing?
• Dis cus s ion
CDC S ocial E cological Approach to Obes ity P revention
http:/ / www.cdc.gov/ obes ity/ health_equity/ addres s ingtheis s ue.html
C hildhood Obes ity Toolk it with patients and famil ies
Docs Adopt S chool Health Initiative; S C P IT C
S C MA C hildhood Obes ity Tas kforce
S C DHE C Obes ity Action P lan
MUS C B oeing Center for Children’s Wellnes s :P rogram s and Activities
B ridge Walks and Wel lnes s C ommittees
B R E AK IN G T R ADIT ION :E ngaging P hys icians (Docs Adopt) in
S chool-bas ed Obes ity P revention What is i t?
• How was it developed?
• What is work ing?
• Dis cus s ion
Docs Adopt S chool Health Initiative©HE ALT HY S T R AT E G IE S AMON G
AWAR D WIN N IN G S C HOOLS2016-2017
S C HOOLSn=195/207(94%)
N (%)Fruit & vegetable tas tings 5 3 (2 7 % )
Water dr ink ing campaign 9 3 (4 8 % )
S chool garden 1 1 4 (5 8 % )Increas e phys ical activity 1 4 5 (7 4 % )
S mar t beverages 1 4 8 (7 6 % )
S mar t s nacks 1 2 1 (6 2 % )
Appl ied for wellnes s grant 1 2 5 (6 4 % )
S chool fundrais er for wel lnes s 1 2 7 (6 5 % )
S chool garden at Manning E arly Childcare, Clarendon 2 S chool Dis trict
Healthy Fundrais erS par tanburg 1 S chool Dis trict
K ines thetic Learning at Harborview E lementary
Charles ton County S chool Dis trict
S chool Wellnes s Checklis t 2 0 1 6 -1 7 Winners
B amberg 1 :R ichard Carroll E lementar y
B amberg 2 :Dis trict: Denmark-Olar High
S chool
Charles ton County S chool Dis trict:
Mar y Ford E lementar y
Clarendon County S chool Dis trict 2 :
Manning J unior High S chool
Colleton County S chool Dis trict: Colleton High S chool
Greenwood County S chool Dis tict5 0 :
Hodges E lementar y S chool
S chool Wellnes s Checklis t 2 0 1 6 -1 7 Winners
Dorches ter 2 : T ied: As hley R idge High & Flower town
High
B erkeley County: T ied – Wes tview Middle & S angree
E lementar y
Cherokee County: B lacks burg High
Potts town PA: (With Potts town Area Health & Wellnes s
Foundation)Ruper t E lementar y
R ichland 2 : (With Palmetto Health Children’s
Hos pital)B lythewood High
S par tanburg 1 :Landrum High
S chool Wellnes s Checklis t 2 0 1 6 -1 7 Winners
Florence 1 & 2(with McLeod Children’s Hos pital)
Florence 1 : S avannah Grove E lementar yFlorence 1 : S ouths ide Middle Florence 1 : Wils on High
Florence 2 : Hannah-Pamplico E lementar y/ Middle Florence 2 : Hannah-Pamplico High
B R E AK IN G T R ADIT ION :E ngaging P hys icians (Docs Adopt) in
S chool-bas ed Obes ity P revention What is i t?
How was it developed?
• What is work ing?
• Dis cus s ion
B ackground:• Effective obesity prevention must go beyond traditional
health care and address today’s “obesogenic” environment through policy, systemic and environmental (PSE) changes targeting improved nutrition and increased exercise.
• Childhood obesity prevention must be centered in schools as the “heart of health”
• Many health care organizations recommend that physicians become involved these public health efforts including the AMA, IOM, CDC, HRSA, AAP, and AAFP
• However implementation of school-based programs is difficult and including physicians even more so
GOAL 4 : E xpand the role of health care providers …in obes ity
prevention
“ Health care providers s hould increas e the s uppor t … for achieving better population health and obes ity prevention. …advocate for improved phys ical activity and diet oppor tunities in their patients ' communities . ”
GOAL 5 : Make s chools a national focal point for obes ity prevention
1 . Require quality phys ical education and oppor tunities for phys ical activity
2 . E ns ure s trong nutritional s tandards for all foods & beverages
3 . E ns ure food literacy
Public Health Approach for Obesity Prevention:IOM Accelerating Progress in Obesity Prevention 2012
Public Health Approach for Obesity Prevention:IOM Accelerating Progress in Obesity Prevention 2012
Com munity-bas ed P rogram Developm ent
Charles ton County Medical S ociety S chool Health Com mittee S outh Carolina Medical As s ociation Com munity Health Award 2 0 1 2
“ Enhancing school-based obesity prevention programs by including services for teachers” NIC HQ 2 0 10
7 S teps Works hop# 1 IDE N T IFY K E Y S TAK E HOLDE R S
Superintendent
Principal
Food Service
Teachers
School Nurse
PTA President
Parents
Others
# 6 E S TAB LIS HME NT OF A WE LLNE S S T E AMSet date with at least1 key s takeholder to as s is t in S HI
Decide which modules to com plete
Meet to review and establish next s tep
Hold regular scheduled meetings
< 1 hour
Provide HEALTHY snacks
Identify specific goals, activities & outcom es
CUMULATIVE ENROLLMENTIn wellness assessment
Teachers
Students
Family
Teachers
PAS
Annu
al M
eetin
gs, M
ay 2
-5, 2
009,
Bal
timor
e, M
D
B MI
2%
18%
25%
55%
Underweight HealthyOverweight Obese
1%12%
11%
21% 25%
30%
Underweight HealthyOverweight Obese IObese II Obese II
TEACHERS(n=207)
Mean 30 (16-58)*143/207 (69%)
Overweight/Obese*
STUDENTS(n=321)
Mean 22 (12-53)*138/321 (43%)
Overweight/Obese**p < 0.0001
Presented at the Pediatric Academic Societies 2009
PAS
Annu
al M
eetin
gs, M
ay 2
-5, 2
009,
Bal
timor
e, M
D
B LOOD P R E S S UR E
VariableStudentsN=300
TeachersN=204 p
SystolicMean (range)
109 (63-167) 124 (94-169) <0.0001
DiastolicMean (range)
67 (40-114) 79 (52-114) <0.0001
Normal# (%)
250 (83%) 66 (32%) <0.0001
S & D > 95%# (%)
5 (2%) 16 (8%) 0.0007
Presented at the Pediatric Academic Societies 2009
C OMP LI AN C E with 5 -2 -1 -0
0
5
10
15
20
25
30
35
40
% P
artic
ipan
ts
>5Fruits/Vegs
/ Day
<2 HoursScreen
Time / Day
>1 Hr PhysActivity /
Day
0 sugarsweetened
drinksStudents Teachers
Presented at the Pediatric Academic Societies 2009
WE IGHT LOS STeachers
(% that los t weight)
3 Months 7 1 % Overweight
6 0 % Obes e
6 Months 6 7 % Overweight
3 5 % Obes e
S tudents
(% that had decreas e B MI Z s core)
3 Months 6 5 % Overweight
7 2 % Obes e
6 Months 8 6 % Overweight
6 7 % Obes e
B as is of Docs Adopt S chool Health Initiative© S chool level wellnes s committees
Committees s hould include many types of members
Wellnes s programs / s trategies s hould: B e evidence-bas ed Include s everal areas ( ie nutrition & phys ical activity) Include ever yone at the s chool (teachers & s taff & s tudents
& families ) B e s elected by the s chool to meet identified needs
Financial “ award” given directly to wellnes s committee Focus group targeted $ 1 ,0 0 0 and competition
P hys icians are interes ted in limited, nonclinical but effective role
(1) DOCS-ADOPT• Recruit local physicians to join school wellness committees• Collaborate with local medical organizations if available• Train physicians & school staff in obesity prevention efforts• Provide ongoing support for physicians• Display signage indicating participation of the doctor
(2) SCHOOL WELLNESS CHECKLIST©• Obtain district level support• Provide password protected web access for each school• Assist schools in establishment of wellness committees• Encourage school needs assessment (School Health Index/ Alliance for a Healthier
Generation)• Provide Checklist of evidence-based PSE changes from which schools can select
based on their needs assessment• Make it easy and free for schools to implement some strategies• Hold year end districtwide Wellness Achievement Celebration• Award incentive ($1,000) directly to wellness committees for schools with > 50
points (> 30 points for first year participants)• Award first prize to overall winning school ($2,000 & trophy)• Monitor Checklist activities and use of incentive awards• Evaluate and report results annually to districts and schools
School Wellness Checklist©
• Evidence-based strategies• Starts with SHI needs
assessment• 7 categories required
• Getting Started• Nutrition• Physical Activity• Stress Management• Wellness Culture• Employee Connections• Sustainability
• Online password protected site
• Wellness Achievement Celebration
• Annual awards ($1,000)• Overall winner ($3,000)
Together these form the Docs-Adopt School Health Initiative©
+
Par ticipating s chools2 0 0 8 -2 0 0 9
n= 1 1 CCS D
Par ticipating s chools2 0 0 9 -2 0 1 0
n= 1 1 CCS D
Par ticipating s chools that achieved award2 0 1 0 -1 1
n=2 3 CCS D
Par ticipating s chools that achieved award2 0 1 1 -1 2
n=5 4 CCS D
Par ticipating s chools that achieved award2 0 1 2 -1 3
n=9 3 (7 2 CCS D, 1 2 B CS D, 9 DD2 )
Par ticipating s chools that achieved award2 0 1 3 -1 4
n=1 1 3 (6 9 CCS D, 2 2 B CS D, 2 2 DD2 )
2 0 1 3 -2 0 1 7 R FP E xpans ion P lan for the Docs Adopt S chool Health Initiative©
C ur rent E xpans ion P lan: Local community s uppor t for l icens ing fees & awards .
C ontact the MU S C B oeing C enter for C hildren’s Wel lnes s for more infor mation or to ar range a pres entation to an interes ted community s uppor ter
2 01 6 -2 01 7 :1 3 Dis tr icts2 7 5 S chools total2 07 S chools par ticipated1 9 5 S chools ear ned an award
E xamples of s trategies s elected by par ticipating s chools
Students at B elle Hall gather around their school garden
Devon Forest Healthy School P ledge driveD2 SD Water-Drinking C ampaign
Tasty Tuesday fruit cups
Dr. Jane C harles, adopting physician at Stall High School with Wellness Leader Danny Ilagan and school nurse,Treva Mardis.
Use of $1000 Wellness Awards
Fitnes s E quipment,
4 5 %
Health E d/ S creenin
g, 4 5 %N utr ition,
3 0%
I ncentives , 3 0%
Walk ing P rograms ,
1 8 %
Hos ting a Health E vent,
1 1 %
Docs Adopt School Health Initiative Operational TimelineAnnual training of doctor s and s chool wel lnes s leader s
Docs -Adopt P hys ician Training 2 0 1 4 E pidemiology and caus es of
obes ity
Recommendations for effective inter ventions
His tor y and replication
Components of Docs -Adopt S chool Health Initiative
Outcomes
S ucces s es Dr. Mike B owm anJennie Moore E lem entar y
2 0 1 3
www.mus c.edu/ leanteam
B R E AK IN G T R ADIT ION :E ngaging P hys icians (Docs Adopt) in
S chool-bas ed Obes ity P revention What is i t?
How was it developed?
What is work ing?
• Dis cus s ion
Outcome E valuation:Focus Groups
Teachers• P hys icians attended
meetings infrequently
• P hys ician involvement ver y impor tant
• Ver y s atis fied with phys ician involvement
Doctors• Not able to attend many
meetings
• Not s ure if contributed s ignificantly
• Ver y s atis fied with involvement
Outcome E valuation:Par tners hip with medical organizations
• In counties with medical organizations, the Initiative collaborated with the local medical society in implementation of the Docs-Adopt component.
• Outcome evaluation found more rapid implementation and more physician participation when there was collaboration with a local medical society
Key J, Mar tin C, K ramer L , L inds trom C. R apid adoption of a s chool-bas ed obes ity prevention initiative that targets pol icy, s ys temic and environmental changes to improve nutr ition and increas e exercis e. The Obes ity S ociety, November 2 0 1 4 .
Dr. B ill Lom ax, Als ton Middle S chool- DC2 S D
There was s ignificantly m ore phys ician involvem ent in com munities that had a m edical organization
Docs-Adopt School Health Initiative©Summary of Outcomes
Increas ed s core over time (p<0 .0 2 2 )
Reduction in variance in T itle 1 s chools (p<0 .0 3 9 )
Increas ed s cores with phys ician adoption (p<0 .0 5 )*
Increas ed s cores as s ociated with healthier B MI (p<0 .0 5 )**
Increas ed s tudent attendance (p<0 .0 0 0 5 )
Decreas ed office referrals (p<0 .0 0 0 6 )
More rapid implementation when s uppor ted by a local medical organization (p<0 .0 5 )***
1 / 3 les s obes ity, improved behavior and attendance****
*Key et al PAS 2 0 1 3 ; **K ing et al PAS 2 0 1 4 , ***Key et al TOS 2 0 1 4****K ing et al PAS 2 0 1 5
The Docs-Adopt School Health Initiative©:
• Is a simple school-based intervention that is readily accepted by schools and physicians
• Leads schools to make many PSE changes targeting both healthy nutrition and increased physical activity
• Is unique in promoting physician involvement in school-based obesity prevention efforts
• Involves more physicians when there is support from a community medical organizations
Conclus ions :
References Key J, B r yne J, S aito A, P rendergas t M, Chambers J, S purlock D. The Docs -Adopt
S chool Wellnes s Initiative: An innovative program to involve doctors in s chool-bas ed obes ity prevention effor ts . Journal of the South C arolina Medical Association, Vol 1 1 0 (No3 ):9 4 -9 7 , 2 0 1 4 .
Key J D, Oexmann MJ, and Rus s ell AM. Community and s chool-bas ed inter ventions to prevent obes ity in children and adoles cents . Journal of the South C arolina Medical Association 1 0 5 :5 9 -6 3 , 2 0 0 9 .
Key J, Mar tin C, Oexmann MJ, S purlock D, Huls ey T. The Lean Team: E nhancing s chool-bas ed obes ity prevention programs by including s er vices for teachers . National Initiative for Children’s Healthcare Quality Annual Forum for Improving Children’s Healthcare and Childhood Obes ity Conference 2 0 1 0 .
Key J, Moore J, Mar tin C, K ing L . “ Docs -Adopt” : P hys ician par ticipation enhances s chool wellnes s initiatives . Pediatric Academic S ocieties , April 2 0 1 2 Abs tract 7 5 0 7 2 6 .
B R E AK IN G T R ADIT ION :E ngaging P hys icians (Docs Adopt) in
S chool-bas ed Obes ity P revention What is i t?
How was it developed?
What is work ing?
Dis cus s ion
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