Stopping Childhood Obesity: Building the Evidence for Community Interventions
A Comparison of 4 Major Obesity Prevention Projects and
Discussion of Lessons Learned Over Time
Presenters
• Robert W. Dudley, MD, MEd, FAAP, Community Health Center, Inc.
• Jayme Hannay, PhD, MPH, Community Health Center, Inc.• Paula Leibovitz, MS, RD, CDE, Program Coordinator,
Living Smart, Living Fit, Community Health Center, Inc.• Marie Russell, MS, Project Manager, Food and Fitness DPH
Grant, Community Health Center, Inc.• Cindy Crusto, Consultation Center• Mary Farnsworth, Manager, Community Health and
Wellness Program, Community Health Center, Inc.
Consequences of Obesity
Obese children and adolescents are at risk for immediate health consequences and may be at risk for weight-related health problems in adulthood. These include:– Cardiovascular: high
cholesterol levels, high blood pressure
– Pulmonary: worse asthma, sleep apnea
– Endocrine: abnormal glucose tolerance, type 2 diabetes
– Gastrointestinal: hepatic steatosis
– Psychosocial: social stigmatization, low self-esteem
CDC Data
Prevalence of Obesity
Remember Your Mother?
Now, sweetheart, eat your Brussell sprouts! They’re good for you…
A New Medical Model
Go outside of the traditional medical setting to engage the community and families in lifestyle changes that lead to healthy choices
Obesity Prevention Programs of the Community Health Center,
Inc.•Healthy Macdonough
– Robert Wood Johnson Foundation– Ecological: environmental and policy
change in elementary school
•Food Smart and Fit – Office of Women’s Health– Chronic Care Model/Self-management
goals
•Healthy Tomorrows– MCHB/AAP HT Partnership grant– Hybrid—Youth Leadership
•Food and Fitness– CT Department of Public Health (CT
Cancer Partnership)-Testing 4-evidence based HEPA curricula in
4 Middletown elementary schools and 4 rural schools through CT (DPH-funded)
Obesity Prevention Programs of the
Community Health Center, Inc.
Healthy
Macdonough 06/07
Food Smart and Fit06/08
Healthy
Tomorrows
07/12
Food and
Fitness08/09
Similarities between Programs
• Culturally sensitive• Income sensitive• Have both healthy
eating and physical activity
• Evidence-Based Models
• Community Partners
Healthy Macdonough
Philosophy of Grant
“Address policies, environments and systems that affect
children’s behavioral choices
rather than the behaviors
themselves”
Healthy Macdonough
Grant Details• Robert Wood Johnson
Foundation Funded• 1 Year exploratory
grant• 1 Middletown
Elementary School• Focus on Policy and
Environmental Changes to prevent obesity and engage kids, parents and community in healthy eating/activity
• 240 children ages 5-11
Activities/Evaluation• Planning: Survey,
interviews, parent team, partnership building
• Promotion: Healthy Block Parties and danceathon; media coverage
• Programs: Recess Rocks, Wesleyan Class, Summer lunch program
• Policy Changes: District/school wellness team
The Food Smart and Fit Program
Grant Details• Funded by: Office of Women’s
Health• Grant Length: 2 years• Location: Meriden CHC• Target: Young minority women• Focus: Weight maintenance
and self management goal setting
Activities/Evaluation• Develop, expand or
sustain effective obesity-related programs in order to effect lifestyle changes and prevent Type 2 diabetes (OWH)
• Utilizing principles of Self-Management goal setting
• Not a weight loss program: education for long term maintenance
• Let participants know they’re part of bigger project-participatory approach
The FoodSmart and Fit Program:
An Overview
Six Educational Sessions, graduation and three maintenance sessions
Each Session: –Educational component–A physical activity component: NIA, swing dancing, “Shake your Soul”
–Weigh-In–Reliable websites/internet exploration–Goal setting/action plan–Self-report action plan/problem solving
Self-Management Goal Setting: Stanford Model
Integral part of each group.Goals/Action Plans established by each
participant and shared with the group.◦ Effective Goals are:
Specific Attainable Forgiving-(less than Perfect)
Goals recorded by the participant and the leader.
Group leader called or emailed participants each week.
Report back to the group. Problem solving.
Participant CharacteristicsAverage Age 36
Avg BMI 40
Health status “good” 64%
Completed grade 12 59%
Hispanic 41%
Family member w/ diabetes
68%
Family member w/ HT 77%
• Use of self-management goal setting effective• Keep in touch with participants • Use a participatory approach rather than
didactic • Appreciate the cultural norms• Connect with the community• Attracting participants to activities surrounding
food/nutrition/physical activity is a challenge.• Emphasize feeling good about you….not
necessarily being healthy!• Stress the fun….not the learning.
Lessons Learned
Our First Group
Program Program Graduation:Graduation:
Group 3-Our Final Group
Graduation:Graduation:
The Healthy Tomorrows Program
Grant Details• Funded by: MCHB/AAP• Grant Length: 5 years
(continuing)• Location: 1 New Britain High
School• Focus: Youth Development
(Emphasis on assets/leadership potential)
• Target: adolescent girls (grades 9-12)
Activities/EvaluationOur Model: Youth
Development (Emphasis on assets/leadership potential)
Addresses both the individual behavioral and environmental dimensions of risk with a youth leadership model.
• Empowers girls to mentor their peers and advocate for a school environment where healthy choices are available
• Uses focus groups as planning, intervention, and evaluation tool and to give teens voice in shape of program
CHC’s ApproachTarget Group
Target Population Girls in grades 9-12 (3,266 in high school)
English as second language
69%
Obesity/Overweight 35%
Teen Pregnancy Rate 18%
Hispanic, Black, Caucasian
49%, 17%, 31%
Reduced Price Lunch 46%
Drop Out Rate 25%
• Culture and context influenced body image perceptions in school.)
• Providers should emphasize looking/feeling good
• Opinions about school-based PE were negative
• Girls preferred non-traditional activities
• Combining physical exercise with a purpose
• Program participation strengthened leadership skills
Focus Group Findings
– Individual nutritional counseling– Free memberships and access to YWCA fitness
programs.– An “Ambassadors” program to nurture leadership
skills– Community service projects to satisfy NBHS
guidance requirement– Special projects: HRSA National Women and Girls
HIV/AIDS grant: skit– Thursday night cooking/conversation, yoga at the
YWCA – College mentors from Wesleyan University who
facilitate programs and build ongoing relationships with participants.
– Programming for mothers and daughters at Spanish Speaking Center (new in 2009)
– Summer youth employment opportunities for HT participants (new in 2009)
– Pregnant and parenting teens (under development for 2009-10, a component of LSLF)
Look Good—Feel Good—Do Good!Listening to teen voices to define a portfolio
The Food and Fitness Program
Grant Details• Funded by: CT
Department of Public Health (CT Cancer Partnership)
• Grant Length: 1 year evaluation grant
• Location: 10 elementary schools across CT both urban and rural
• Focus: implementation of nutrition physical activity curricula
• Target: 600 children
Activities• Implemented and evaluated
4 different curricula at 10 elementary schools
• Introduced lessons from curricula 1-2 times per week for 10-15 weeks
• Yale Consultation Center Evaluators conducted participatory evaluation
Program ParticipantsGrades K-3
Suburban/Rural SchoolsSaint Bridget School
Cheshire
Lewin E. Joel ElementaryClinton
Saint Mary SchoolBranford
K.E. Goodwin ElementaryOld Saybrook
Our Lady of Mercy SchoolMadison (control only)
Urban SchoolsFarm Hill Elementary
Middletown
Lawrence ElementaryMiddletown
Spencer ElementaryMiddletown
Snow ElementaryMiddletown
Wesley ElementaryMiddletown (control only)
Food and Fitness Curricula Evaluated
• Food is Elementary – 50 hands on cooking/tasting lessons in the classroom
paired with nutrition lessons
• Family Cook Productions – 12 hands on cooking/tasting lessons in the classroom for
each grade paired with gardening and information for families on healthy eating
• SPARK (Sports, Play, and Active Recreation for Kids)– Recreation equipment paired with 100’s of PE lessons
• Recess Rocks (A Community Health Center Program)– Recess Dance classes paired with curricular tie ins using
movement
Family Cook Productions
• Teaches basic nutrition & culinary skills
• Encourages children to try and families to prepare new, healthy foods
• Takes a holistic approach to creating healthy eating habits with the entire family Founder and Curricula Consultant: Lynn Fredericks
http://www.familycookproductions.com/
Food is Elementary
• Provides basic nutrition & culinary skills to children
• Provides life skills of food preparation through hands-on interactive experiences
• Encourages children to enjoy new, healthy foods
Founder & Curricula Consultant: Dr. Antonia Demas http://www.foodstudies.org
Recess Rocks
• Movement & dance provided at recess by instructors hired from within the community, to lead activities such as yoga, tai chi, Nia, DDR, & hip hop
• Teacher training for incorporating movement into the school day
• Curricular tie-ins for movement
Curricula Consultant: Kim Renee ThibodeauCommunity Health Center Programhttp://www. CHC1.com
Sports, Play and Active Recreation for Kids
(SPARK)• Trains PE teachers and
classroom teachers in activities, skills, and strategies to maximize moderate to vigorous physical activity
• Fun, non-competitive activities enhance each students’ skills and physical activity level
• Provides PE equipment for lessons
Curricula Consultant: Donna BoydTrainers: John Hitchwa & Joan Gillamhttp://www.sparkpe.org/
Food & FitnessFood & FitnessNutrition and Physical Activity Nutrition and Physical Activity
Program Program Preliminary Evaluation Findings Preliminary Evaluation Findings
Cindy A. Crusto, Ph.D., Dawn Sugarman, Ph.D., & Tejal Patel, B.A.
Yale University School of MedicineThe Consultation Center
Evaluation Plan• Goal of the evaluation
– To assess the process and outcomes of the 4 curricula
– To develop recommendations for the successful implementation of nutrition and/or physical activity curricula in schools
• Evaluation approach– The evaluation is conducted from a
participatory evaluation approach and includes a range of stakeholders
• Four Components– Needs Assessment– Process Evaluation– Outcome Evaluation– Sustainability Assessment
Findings: Process Evaluation• 5 urban schools and 5 rural/suburban schools
• 8 of 10 schools had intervention and comparison classes
• 32 intervention classrooms, 32 comparison classrooms
• 1174 (558 intervention, 616 comparison) k-grade 3 children participated
• one-quarter of the children in each of the 4 grade levels
• 563 (48%) boys, 609 (52%) girls; mean age 6.8 yrs
• 72% white; 10% black; 8% Asian American.; 8% Latino, 2% American Indian, .6% other/unknown
• 98% spoke English as primary language in the home
Preliminary Focus Group Findings
• Training that is hands-on and relevant– Didactic and experiential– Classroom management techniques
• Clear manual, all supporting materials are needed– All materials required for the lesson incorporated– More support materials needed
• Ongoing support is needed– Technical assistance from program developers– Peer support, networking, communication, and
sharing
• Clear linkage of curriculum to standards
• Clear fit of curriculum to what teachers already do fosters buy-in
• Significant preparation time was needed– Significant amount of time spend on lesson
preparation– Prior years of teaching/experience was helpful– Recommended for more experienced teachers
• Despite some challenges, children enjoyed the programs
Preliminary Focus Group Findings
What have we learned from all this?