donor strategies to prevent childhood obesity: lessons from greater philadelphia

8/12/2019 Donor Strategies to Prevent Childhood Obesity: Lessons from Greater Philadelphia

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The Center for High Impact PhilanthropySchool of Social Policy & Practice | Universi ty of PennsylvaniaI n c o l l a b o r a t i o n w i t h a l u m n i f r o m t h e W h a r t o n S c h o o l

Dono r St rategies to PreventChi ldhood Obesi ty:Lessons from Greater Philadelphia


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T H E C E N T E R F O R H I G H I M PAC T P H I L A N T H R O P Y

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A B O U T T H I S G U I D E

Tis project was made possible through a grant awarded to Philanthropy Network Greater Philadelphia on behal othe Greater Philadelphia Food Funders rom the Convergence Partnership at the ides Foundation. Te partnershipis dedicated to achieving the vision o healthy people living in healthy places. Te national grant was matched withsupport rom six local unders: Claneil Foundation, Delaware Valley Regional Planning Commission, Te PhiladelphiaFoundation, Te Leo & Peggy Pierce Family Foundation, Pottstown Area Health and Wellness Foundation, and St.Christophers Foundation or Children.

A COLLABORATION AMONG:

AUTHORS

Carra Cote-AckahDirector of Par tnerships &

Strategic Ini t ia t ives

Center for High ImpactPhi lanthropy

Katherina RosquetaFounding Execut ive Director


Carol McLaughlinResearch Director


Daniel le WolfeSocial Impact Fel low


A B O U T T H E C E N T E R F O R H I G H I M PA C T P H I L A N T H R O P Y

Founded in 2006, the Center or High Impact Philanthropy has emerged as a unique and trusted authority or donorsaround the world who are seeking to maximize the social impact o their unds. In areas as diverse as closing theachievement gap in the U.S., providing basic needs to those most affected by the recent economic downturn, effectivedisaster relie a er Haitis earthquake, and major global public health issues such as malaria and child mortality,the Center translates the best available in ormation into actionable guidance or those looking to make the greatestdifference in the lives o others. Put simply, success to us means moving more money to do more good.

The Center for High Impact PhilanthropySchool of Socia l Pol icy & Pract ice | Univers i ty of PennsylvaniaI n c o l l a b o r a t i o n w i t h a l u m n i f r o m t h e W h a r t o n S c h o o l


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What is the scope of the problem?

Childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years. 1 In 2010, more

than one third o children and adolescents were overweight or obese.2

Recent news o stabilization or declines inobesity rates in certain populations is encouraging, and may be an early signal o effective prevention efforts startingto take root. However, the reality remains: childhood obesity among the general population is still alarmingly high,and even higher still in ethnic minority and low-income communities where multiple actors make it more difficult toaddress.3

Why invest in childhood obesity prevention now?

Obesity exacts a tremendous price on overweight children, leading to serious chronic health conditions, disability, andpsychological suffering.4 Te effects o obesity are not just elt on the individual, however. Society suffers considerably

rom the long-term impact o those children becoming an overweight population. Obesity is associated with healthcarecosts that average about 40 percent higher than those or normal weight individuals. 5 Obese workers miss more dayso work and cost employers more in medical and disability claims as well as workers compensation claims. Overall,obesity-related direct and indirect economic costs exceed $100 billion annually, and the number is expected to grow. 6 By working to prevent children rom becoming obese, donors help society avoid these economic, social, and personalcosts.

Given the human suffering, societal burden, and economic cost at stake, the question isnot WHETHER to invest in childhood obesity prevention, but HOW?

WHATS IN THIS GUIDE?

In this guide, we present:

Tree high-level strategies that represent critical levers or preventing the childhood obesity epidemic;

An analysis of ve obesity prevention approaches implemented nationwide, with examples of their implementationin Philadelphia , a city that may serve as a national model due to its decreases in childhood obesity among someo the most affected populations. Within each approach, we analyze an exemplary organization, its impact, costs,and cost-per-impact;

A list of additional promising approaches, as well as examples of organizations implementing those approaches;

An overview of treatment opportunities or overweight and obese children; and

A case study detailing particular actors and characteristics that may help explain Philadelphias decrease inchildhood obesity, and may highlight areas or improvement in other cities across the U.S.

As always, we hope this guide helps donors move rom good intentions to high impact.

W H Y C H I L D H O O D O B E S I T Y ?


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Table of Contents

I . METHODOLOGY 5

I I . OVERVIEW OF HIGH-LEV EL PREVENTIO N STRATEGIES 6

I I I . THE STRATEGIES IN ACTION: OPPORTUNIT IES FOR DONORS 7

Start early (earlier than you might think) 8

Increase access to:

healthy foods 12

opportunities for physical activity 16

Enable healthy choices:

eating habits 20

physical activity 24

I I I . TREATMENT OPPORTUNIT IES FOR OVERWEIGHT 28 OR OBESE CHILDRE N

IV. IMPROVING THE CURRENT LANDSCAPE 29

V. EXAMPL E ORGANIZ ATIONS MENTIONED IN THIS GUIDE 30

VI . SELECT NATIONAL PLAYERS 32

VII . CASE STUDY: WHY PHILADE LPHIA? 34

V I I I . A C K N O WL E D G E M E N T S 3 7


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Our multidisciplinary team collected the best available in ormation rom three sources: 1) research via a literaturereview o over 30 articles and monographs as well as a web scan and analysis o over 50 publicly available web-basedresources; 2) in ormed opinion via interviews with experts, acclaimed researchers, and a select subset o unders (e.g.

the Robert Wood Johnson Foundation and the National Institutes o Health); and 3) eld experience solicited romover 20 leading practitioners o obesity prevention and treatment.

In reading this guide, it is help ul to remember that childhood obesity is a relatively new phenomenon with a limitedevidence base as compared to other longstanding public health issues such as smoking. While data exist on individualpieces o the puzzlee.g. the link between walkable streets and increased exercise, and the link between exercise and

o provide smart, practical guidance to donors, the Center synthesizes the best available in ormation rom threedomains: research, in ormed opinion, and eld experience. By considering evidence rom these three sources, we seekto leverage the strengths while minimizing the limitations o each.

METHODOLOGY

decreased obesity ew, i any, programs have been operating long enough or atthe capacity and scale needed to conclusively link a particular program to theprevention o child obesity.

Given that context, it is not surprising that we ound no models with a detailedhistory o rigorous impact assessment. However, by drawing on the data that

do exist, in combination with in ormed opinion and eedback rom those onthe ground, we ound multiple promising practices worth considering. Tesestrategies are consistent with the elds current understanding o childhoodobesity and based on successes achieved in related public health efforts.

For those donors interested in learning more about how to right-sizeexpectations when evaluating available evidence, we suggest re erring to ourpublication Beyond Compliance , available on our website.
http://impact.upenn.edu/about/beyondcompliancehttp://impact.upenn.edu/about/beyondcompliancehttp://impact.upenn.edu/about/beyondcompliance


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HIGH-LEVEL STRATEGIES FOR PREVENTION

With the rise in obesity levels in recent years, much attention has been ocused on understanding actors that causeobesity. At the highest level, the direct cause o obesity is an energy imbalance: more calories consumed than expended.

A simple equation thats tough to solve

Ensuring that calories consumed are equal to calories expended is a simple equation. However, maintaining thatbalance can be tough, especially or individuals living in low-income, under-resourced communities. While obesitywas once thought to be little more than an un ortunate ailure o will and sel -restraint, it is clear that the epidemic hasmuch deeper and more complex roots. ransportation, physical environment, access to healthy oods, advertising,and education all play a role in an individuals ability to maintain her energy balance. Tese actors are even morecomplex or children, who o en have little or no control over choices that affect their health. Children rom low-income amilies experience especially signicant barriers to maintaining their energy balance and remaining healthy.

How donors can help

Donors can help bring an end to the childhood obesity epidemic by implementing one or more o the ollowinginterlocking prevention strategies:

Start early (earlier than you think)

Early-li e inuences, beginning in the womb and continuing through the rst ew years o li e, affect the trajectoryo weight gain and body mass throughout a persons li e. Low-income mothers and their amilies o en lack accessto quality pre- and post-natal care and the in ormation and resources that acilitate healthy choices. By investing inprograms that start early, donors can set children on the right path to leading healthy lives. Example approach analyzed:

Provide support and education to pregnant and new mothers through nurse home visitation (page 8)

Increase access to healthy foods and physical activity

o ensure healthy caloric intake, kids must have access to healthy oods. o ensure these calories are expended, kidsmust have opportunities or physical activity. Un ortunately, children in low-income communities o en have lessaccess to healthy oods and ewer sa e places to play and exercise. For example, household ood is o en purchasedat the neighborhood convenience store, which offers ew resh items, and nearby open play-spaces, when they exist,are o en unsa e or in disrepair. By investing in programs that increase access to healthy oods and physical activity


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options, donors can ensure that low-income children have as equalan opportunity to lead healthy li estyles as their peers in wealthiercommunities. Example approaches analyzed:

Increase availability of fresh fruits andvegetables in stores serving low-incomecommunities (page 12)

Improve health policies and practices ofschools to include physical activity offerings(page 16)

Enable healthy eating and physical activitychoices

Even with access to healthy ood and physical activities, or manychildren, it can seem like an uphill battle to make healthy choices:

Families may lack knowledge o how to maintain a healthy li estyle, particularly in communities thatlack resources like gyms, pools, community centers, playgrounds, and where public spaces are unsa eor in disrepair;

elevision, media, and exposure to other mass marketing can have a pro ound inuence towardglamorizing less healthy options; and

Positive inuences that encourage good nutrition and physical activity are ew and ar between.

By investing in programs that enable healthy choices, donors can children learn about and adopt healthy habits thatwill stay with them throughout the course o their lives. Example approaches analyzed:

Provide comprehensive nutrition education that promotes healthy eating habits at the individual, family, and school levels (page 20)

Support developmentally focused sports programs that boost condence and cultivate lifelonghealthy physical activity habits (page 24)

The strategies in action

In the ollowing section, we explore these strategies by discussing specic promising approaches in which donorscan invest nationwide. Beneath each eatured approach, we proled an exemplary model an organizationimplementing the approach in the Greater Philadelphia region, which has seen decreases in childhood obesity in

several demographic groups, including some o the most affected populations like A rican-American males, Hispanicemales, and low-income youth.

Start Early

Increase Access

Enable Healthy Choice

Childhood Obesity Prevention Strate


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START EARLY (EARLIER THAN YOU MIGHT TH INK)

Early li e inuences can have a pro ound effect onchildrens health and development, including theirlikelihood o maintaining a healthy weight. A mothershealth choices while pregnant are the earliest inuenceso all, presenting an opportunity to give children a healthystart rom the very beginning. Helping pregnant mothersavoid smoking and maintain healthy weight and bloodsugar levels during pregnancy can improve etal nutritionand decrease the likelihood o obesity as the baby grows.Factors a er birth can play a role as well. In ants whodont sleep enough or who gain weight too rapidly are ata higher risk o obesity later in li e, and breast ed in antsmay have a lower risk. Programs that support mothersduring pregnancy and a er birth can take advantage othis critical window or risk reduction, potentially stoppingobesity be ore it starts. 7

PROMISING APPROACH: Provide supportand education to pregnant and new momsthrough nurse home visitation

Exemplary model: Nurse Family Partnership

Te nonprot Nurse-Family Partnership (NFP) targetslow-income mothers pregnant with their rst child.Participating mothers are partnered with a registerednurse early in pregnancy, and receive in-home supportand guidance through their childs second birthday.Trough the NFP model, mothers receive support or keypregnancy behaviors shown to reduce their childrens risk

or obesity: good nutrition to manage weight and bloodsugar, prenatal checkups to ensure that mothers withhigh blood sugar get appropriate medical treatment, andsmoking cessation. A er the childs birth, NFP nursescoach parents in providing care or their newborn, in ant,and toddler. Coaching can include breast eeding supportand strategies to manage an in ants weight and sleeppatterns appropriately, potentially reducing their risk orobesity later in li e.

Whats the impact?

Since NFP was not originally designed as an obesityprevention program, evidence o the models direct effecton childhood obesity is still developing. However, theprogram has demonstrated the ability to change obesity-linked behaviors in pregnant women and new mothers.At one site, participating mothers reduced their smokingby an average o 2.5 cigarettes per day, and increased thepercentage o recommended nutrients in their diet by ourpercentage points. 8 Participating mothers also demonstratehealthier behaviors a er the birth o their children. A 2008evaluation ound that children o participating motherswere 32% less likely to visit an emergency room in theirsecond year o li e.9 In Pennsylvania in 2012, 65 percento low-income mothers participating in Nurse-FamilyPartnership initiated breast eeding, compared to 42 percent

o mothers receiving support rom Women, In ants, andChildren (WIC), a ederal supplemental nutrition programor low-income women with children, a population similar

to Nurse-Family Partnerships key demographic. 10

What does it cost to implement?

Te costs o providing Nurse-Family Partnership vary bylocation due to differences in regional cost-o -living. An


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analysis by the Washington Institute or Public Policyestimated the per- amily cost or two-year programdelivery in Washington State to be approximately $9,600in 2011 dollars. 11 NFP is unded through a combinationo public and private revenue: as o 2012, philanthropiccontributions rom oundations and individual donorsmade up 38% o total unding. Tese contributions o ensupport capacity building projects, such as data system andreporting improvements, and ongoing program researchand evaluation. 12

Cost-benet:

Studies have ound the program provides an excellent

return on investment or society: For every one dollarinvested, the program returned $5.70, providing a netbenet to society o over $34,148 per high-risk amilyserved. NFPs signicant net benet comes romthe positive impacts it has on children, amilies, andsociety over time. For example, children whose mothersparticipate in NFP have shown a 67% reduction inbehavioral and intellectual problems at age six, and a59% reduction in arrests by age een. In addition, theprogram demonstrated an 83% increase in labor orceparticipation among mothers. 13

ake action:

NFPs online mapping tool is help ul in locating programsand their local implementing partners. o nd other home visitation and outreach programs in your area, contactyour local community health center or public healthdepartment, which can identi y good local nonprots.

Enabling factors

In the late 1990s, the Commonwealth ofPennsylvania made a strategic decision todirect funds into research-based programmingto provide a comprehensive system of provenprevention and intervention services targetingits most vulnerable citizens. As part of thisplan, in 2001 the Commonwealth made a$20 million, four-year investment to replicateNurse-Family Partnership. This investmenthas positioned thousands of Pennsylvanianstoward a stronger start in life and may help toexplain some of the states positive progress inreducing childhood obesity.

Image provided by Nurse-Family Partnership.
http://www.nursefamilypartnership.org/locationshttp://www.nursefamilypartnership.org/locations


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Below is a list of other organizations implementing our featured approach to Starting Early.While we have not analyzed their work in as much detail as the exemplar model, they use similarpractices to serve pregnant and new moms.

Featured Approach Examples in Greater Philadelphia

Provide support andeducation to pregnant andnew moms through nursehome visitation

Maternity Care Coalition provides community-based homevisitation to support and educate pregnant and new momsthrough their MOM Mobile and Cribs for Kids programs.

Philadelphia Healthy START provides case management, homevisiting, and health education to help low-income pregnantwomen get the care they need to have healthy babies.

Below is a list of o ther promising approaches for Starting Early, along with examples oforganizations implementing these approaches in the Greater Philadelphia region. This listincludes organizations whose models are consistent with what we currently understand can workin addressing childhood obesity. All are established nonprofits addressing the issues and capableof accepting philanthropic support.

Other Promising Approaches Examples in Greater Philadelphia

Build stronger connectionsbetween families andhealth care professionalswho can provide educationand resources for healthydevelopment

Healthy Steps for Young Children (Lehigh Valley) in Allentown, PAprovides core services for developing infants and toddlers to first-time pregnant women and families.

Encourage employersto support and promotebreastfeeding

Breastfeeding Friendly Philadelphia is a partnership between GetHealthy Philly and Maternity Care Coalition that helps employerscustom-design and implement workplace lactation programsincluding breaks for breastfeeding mothers, a private lactationspace, and a lactation policy that is communicated to all staff.

Provide comprehensive

nutrition education topreschool students and theirfamilies

The Food Trust s Preschool Ini tia tive provides nutrit ion education

to preschoolers, preschool staff, parents, and caregivers to buildhealthy lifelong habits and encourage young chi ldren to makehealthy choices.

St. Mary Medical Centers Kinder Connection (Bucks County) is a six-week program for children ages 3-5 and their families that teacheshealthy eating and encourages physical activity.


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Advocate for improvedhealth care and resources forlow-income mothers

Nurse Family Partnerships model has a proven record of effectiveoutcomes, and uses this research to advocate for preventiveinterventions through evidence-based public policy.

Maternity Care Coalition advocates at the local, state, and federallevels on issues of maternal and child health and early educationand care. Maternity Care Coalition also aims to raise communityawareness of these issues.


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INCREASE ACCESS TO HEALTHY FOODS

Nearly 30 million people in the U.S. live in low-incomeareas with limited access to supermarkets. 14 Without easyaccess to supermarkets, people in a ood desert have to

travel to purchase healthy ood options, a trip that manylow-income residents cannot afford. And ood deserts arenot just a problem or the urban poor. Nearly 8% o therural population in the U.S. lives in communities lackingaccess to healthy ood options.15 Te residents o these

ood deserts o en turn to ast ood and neighborhoodconvenience stores, which are more accessible but offer

ewer nutritious oods.

Increasing access to healthy oods in underservedcommunities can have an impact on health outcomes.Studies suggest that living closer to healthy ood retail outletsis associated with better eating habits as well as decreasedrisk or obesity and other diet-related diseases. 16

PROMISING APPROACH: Increase availabilityof fresh fruits and vegetables in storesserving low-income communities

Exemplary model: Te Food rusts Healthy CornerStore Initiative

Based in Philadelphia, Te Food rust has become anationally-recognized nonprot that aims to ensureaccess to nutritious ood and in ormation to make healthydecisions. Te Food rust piloted its Healthy Corner StoreInitiative in 2004, and partnered with the PhiladelphiaDepartment o Public Health in 2010 to expand themodel to more than 660 corner stores. Choices at cornerstores are o en limited to packaged ood and very little

resh produce. Children requently purchase snacks atcorner stores be ore and a er school, and in Philadelphia,student purchases average more than 350 calories perstore visit.17 29% o Philadelphia students shop at cornerstores twice a day, ve days a week, consuming almost apounds worth o additional calories each week.18

Te program provides corner store owners with nancialincentives and equipment to sell and market healthyoptions, links them with resh ood suppliers, and offers

training and technical assistance on making healthyoptions protable. Te initiative also includes educationalgoals, and each store is equipped with signage thathelps shoppers learn about the nutritional value o the

oods they consume. Te Food rust has expanded the

program into Camden, New Jersey and Norristown,Pennsylvania, and has worked to ound and convenethe National Healthy Corner Store Network o similarprograms across the country.

Whats the impact?

89% o the 660 enrolled corner stores introduced our ormore healthy products. Many stores introduced ar morethan the required our new healthy products. Acrossthe network, the average per store was 46 new healthyproducts, more than our times the minimum number onew healthy products required by the program managers.89% o storeowners received at least one business skillstraining on how to introduce and maintain healthychanges.19 Te result: Philadelphia amilies shopping atenrolled corner stores now have access to approximately27,000 additional healthy products citywide. 20


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Enabling factors

In 2003, Pennsylvania created the nationsfirst statewide economic developmentinitiative aimed at improving access tohealthy food in underserved rural and urbancommunities. Out of this effort came theFresh Food Financing Initiative (FFFI), whichsupports the development of new stores in

underserved urban and rural communitiesacross Pennsylvania. Philadelphia has seenan increase of 18 grocery stores due to theFFFI fund.

Modeled after FFFI, the Healthy Food FinancingInitiative accomplishes similar goals at thefederal level.

Te Food rust has partnered with the PhiladelphiaDepartment o Public Health and emple UniversitysCenter or Obesity Research to conduct studies on the

impact o introducing healthy options into low-incomeneighborhoods. Results have yet to be released.


Using data provided by Te Food rust, we estimate itcosts approximately $1,000 per corner store participatingin the basic program. Costs include management timespent providing technical assistantance to stores on howto introduce at least our new healthy oods into theirstore. Costs also include marketing materials and training

or each store owner on business management and theprotable sale o healthy perishable oods and materials.Related programs at Te Food rust also exist to urtherincrease availability o perishable items within cornerstores, including a program to support mini-conversionso stores with more shelving and re rigeration.21

Cost-per-impact:

Based on an evaluation report conducted by empleUniversity and University o Pennsylvania researchers,conversations with the researchers, and documentsprovided by Te Food rust, we estimate it costsapproximately $25 to introduce a new healthy productinto a corner store in neighborhoods with limitedaccess to such ood. Since stocking healthy, perishableitems may require more labor or have more risk due tospoilage, this number will likely be higher or introducingand maintaining an ongoing stock o a resh ruit, suchas apples, compared to introducing and maintaing otheritems considered healthy, such as bottled water or wholewheat bread.

For more in ormation on our approach to cost-per-impact, visit our website .

ake action:

Visit The Food Trust to learn more about the HealthyCorner Store Initiative, to make a donation, and learn

about other opportunities to address communityood access. o learn more about corner store

efforts across the country, visit the Healthy Corner

Stores Network .
http://www.impact.upenn.edu/about/cost-and-impact/linking_cost_and_impacthttp://thefoodtrust.org/http://www.healthycornerstores.org/http://www.healthycornerstores.org/http://www.healthycornerstores.org/http://www.healthycornerstores.org/http://thefoodtrust.org/http://www.impact.upenn.edu/about/cost-and-impact/linking_cost_and_impact


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Below is a list of other organizations implementing our featured approach to Increase Access toHealthy Foods. While we have not analyzed their work in as much detail as the exemplar model, theyuse similar practices to increase access to healthy foods.


Increase availabilityof fresh fruits andvegetables in storesserving low-incomecommunities

Philabundance Fare and Square program founded a nonprofit grocerystore located in Chester, a food desert since 2001, to improve access tohealthy foods for households in need.

Below is a list of o ther promising approaches for Increase Access to Healthy Foods, along withexamples of organizations implementing these approaches in the Greater Philadelphia region. Thislist includes organizations whose models are consistent with what we currently understand can workin addressing childhood obesity. All are established nonprofits addressing the issues and capable ofaccepting philanthropic support.

Other PromisingApproaches

Examples in Greater Philadelphia

Increase access tofarmers markets and farm

shares that accept foodstamps in low-incomecommunities

Working in Nor th Philadelphia, Farm to Families facilitates thepurchasing, packaging, and distribution of fresh, local, affordable

produce; provides food and nutrition education; and leads policy changeefforts to make fresh food available in food deserts.

Get Healthy Philly works with The Food Trust to expand the number offarmers markets in low-income communities, and has established ninenew farmers markets since inception.

Greensgrows Mobile Markets program brings trucks o f affordable freshfood into underserved and economically disadvantaged neighborhoodsin Camden and West Philadelphia.

Support growth of urbangardening networks

that provide low-incomecommunities with freshproduce

The Pennsylvania Horticultural Society Growers Alli ances City Harvestprogram brings together volunteer community gardeners to donate food

to local food pantries.

The Lehigh County Community Gardens Program operates twocommunity garden sites, supporting production of healthy food for thecommunity and promoting sustainable gardening practices.


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Improve the nutritionalvalue of food offered atthe institutions wherechildren spend their time(schools, communitycenters, out-of-school-time programs, churches,etc.)

WISE SNAC (profiled on page 16) crafts policies and practices to supporthealthy eating and physical activity within district public schools,and provides training and technical assistance to community basedorganizations and municipal programs that support healthy schools.

The Coordinated Approach to Child Health (CATCH) is a coordinatedschool health program for preschool through 8th grade designed topromote physical activity, encourage healthy food choices, and preventtobacco use in children.

School Food FOCUS is a national collaborative that leverages theknowledge and procurement power of large school districts to makeschools meals more healthful, regionally sourced, and sustainablyproduced.

Alliance for a Healthier Generation works with schools, companies,community organizations, healthcare professionals, and families toachieve the environmental conditions that lead to healthier kids.

The Food Trust s Farm to School Ini tiative connects schools and earlyeducation settings with local food producers to serve local, healthy foodsin schools.

Common Market connects institutional wholesale customers (schools,hospitals, grocers, and workplaces) to local area farmers who can offerhealthy, fresh products

Support programs thatextend food budgets ofvulnerable families

Philly Food Bucks encourages ACCESS/food stamp recipients to purchasefresh produce by providing coupons that can be redeemed for $2 worthof fruits and vegetables for every $5 spent at all participating farmersmarkets.

Fair Food Phillys Double Dollars program encourages food stamprecipients to purchase fresh produce by providing coupons that can beredeemed for $5 worth of fruits and vegetables for every $5 spent at theprograms Fair Food Farmstand.

Benefits Data Trust seeks to improve the efficiency of enrollment inbenefits, such as SNAP, for low-income people.


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INCREASE ACCESS TO OPPORTUNITIES FOR PHYSICAL ACTIVITY

Te U.S. Surgeon General recommends that childrenengage in at least 60 minutes o moderate physicalactivity most days o the week, but today ewer than halo children ages 6 to 11 are doing so.22 In low-incomecommunities, lack o physical activity has a direct link tothe nature o the built environment. Substantial scienticevidence gained in the past decade has shown that variousaspects o the built environment can have pro ound,directly measurable effects on physical health outcomes,particularly adding to the burden o illness among ethnicminority populations and low-income communities. 23 Lack o sidewalks, bike paths, and recreational areas insome communities discourages physical activity andcontributes to obesity; in those low-income areas thatdo have such amenities, the threat o crime keeps manypeople inside. 24

Schools used to be a regular source o physical activity orchildren, but in recent years, there has been a signicantdecrease in physical activities incorporated into schoolschedules. Up to 40% o U.S. school districts have reducedor eliminated recess in order to ree up more time or coreacademics, and one in our elementary schools no longerprovides recess to all grades.25 Increasing physical activityin schools can have a signicant impact on the health o

children in low-income communities that otherwise lackaccess to sa e places to exercise and play.

PROMISING APPROACH: Improve healthpolicies and practices of schools to includephysical activity offerings

Exemplary model: Wellness Initiative for the SchoolEnvironment: Smart Nutrition and Activity Collaborative(WISE SNAC)

Founded in 2005 by the Health Promotion Council(HPC), WISE SNAC was modeled a er the nationallyrecognized, evidence-based Coordinated School HealthProgram (CSHP) developed by the Centers or DiseaseControl and Prevention. Te CSHP model engagesmultiple stakeholders within the school environmentto holistically address childhood obesity. Componentsinclude:

Increasing opportunities or physical activity be ore,during, and a er school (e.g. training teachers toincorporate 10 minutes o physical activity into theirclassroom time)

Improving access to healthy oods (e.g. augmentinglunch menus to include more ruit and vegetableoptions)

Delivering nutrition education or students andworkshops or parents on how to achieve health andwellness goals

Developing and implementing wellness policies thatmeet ederal mandates

Identi ying and disseminating emerging bestpractices to staff and administrators

Coordinating communication across districts toencourage consistent health messaging

With unding support rom the North Penn CommunityHealth Foundation, HPC implemented the WISE SNACinitiative in 35 elementary and secondary schoolsthroughout the North Penn, Souderton Area, andWissahickon School Districts. While the rst programterm ended in 2012, HPC is currently seeking additional

unds to begin new WISE SNAC programs in additionalschool districts.


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The WISE SNAC approach

WISE SNAC uses the CSHP model, whichengages stakeholders from eight keyareas within the school enviornment toholistically address childhood obesity.

Whats the impact?

According to an internal report produced by HPC,school districts that received WISE SNACs interventionimproved the school ood environment while increasingopportunities or physical activity be ore, during, anda er school. 55% o students in intervention schoolsparticipated in physical activity or at least 30 minutesor more at least ve days per week. 26 Tis is in starkcontrast to the trend that several researchers have notedover the last decade: in the ace o pressures to improvestudent achievement and control costs, many schoolshave decreased or cut physical education and recesstime, particularly in urban, low-income communities.For example, the National Center or EducationStatistics ound that the average American child getsonly 26 minutes o recess per dayand schools thatserve primarily low-income children clock in with evenlower numbers, some below 20 minutes per day. 27

Because WISE SNAC is a comprehensive school healthprogram, its impact goes beyond increased accessto opportunities or physical activity. For example,

WISE SNACs Souderton Area School District programreported impact on both soda drinking and vegetableconsumption:

Only 8% now report drinking soda three or moredays per weeka sharp decline rom 59% at baseline

92% o students now report eating ruit and vegetables three or more days a weekup rom just71% at baseline 28

In addition, the North Penn region supported byWISE SNAC services saw a statistically signicant 2%decrease in the percent o school-aged children that wereoverweight or obese ( rom 30% to 28%) between 2005 and

2011.29

While this rate drop is not directly attributable tothe WISE SNAC intervention, the decline in the obesityrate among students could mean that environmentalsupport or healthy habits can help turn the tide in theght against childhood obesity.


Using cost data rom the Health Promotion Council,we estimate program costs associated with staff time ortraining, technical assistance, and project evaluation areapproximately $3,200 per school building per year. Tisunit cost, and the programs design, did not vary widelybetween different-sized schools or the grades served. 30

Cost-per-impact

Extrapolating results rom the Souderton area schooldistrict, the 2012 Health Promotion Council report,and costs provided by the program, we estimate thatthe cost-per-impact is approximately $10 - $25 oreach incremental student demonstrating the ollowinghealthy behaviors: exercising regularly (ve days/week) or an

additional 10 - 30 minutes a day decreasing soda consumption to less than three

days/week eating ruits and vegetables three or more days a

week.


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Below is a list of other organizations implementing our featured approach to Increase Access toPhysical Activity. While we have not analyzed their work in as much detail as the exemplar model,they use similar practices to increase access to opportunities for physical activity.

Featured Approach Examples in Greater Philade lphia

Improve health policiesand practices of schoolsto include physicalactivity offerings

The Coordinated Approach to Child Heal th (CATCH) is a coordinatedschool health program for preschool through 8th grade designed topromote physical activity, encourage healthy food choices, and preventtobacco use in children.

Launched in 2013, The Independence Blue Cross Foundations HealthyFutures initiative is a three-year school wellness program that leveragespartners like the Vetri Foundation and the Childrens Hospital ofPhiladelphia to provide the training, programming, and resources schoolsneed to create a healthy environment.

Since the Souderton results are sel -reported bystudents, they lack the rigor o externally validatedresults; outside o an institutional setting such as ahospital where ood is strictly controlled, it is difficult

to monitor everything a child eats and drinks. However,these results, when added to the statistically signicantdecline in childhood obesity observed in the NorthPenn region and the apparent increase in healthychoices among children, as reected in their responses,point to the promise o this program.

For more in ormation on our approach to cost-per-impact, visit our website .

ake action:

o nd out more about WISE SNACs previousimplementation, visit the North Penn Community HealthFoundations website .

o inquire about how to support a new program cycle, visit the Health Promotion Council .
http://www.impact.upenn.edu/about/cost-and-impact/linking_cost_and_impacthttp://npchf.org/strategic-initiatives/wise-snachttp://www.hpcpa.org/http://www.hpcpa.org/http://npchf.org/strategic-initiatives/wise-snachttp://www.impact.upenn.edu/about/cost-and-impact/linking_cost_and_impact


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Below is a list of o ther promising approaches for Increase Access to Physical Activity, along withexamples of organizations implementing these approaches in the Greater Philadelphia region. Thislist includes organizations whose models are consistent with what we currently understand can work

in addressing childhood obesity. All are established nonprofits addressing the issues and capable ofaccepting philanthropic support.



Increase opportunitiesfor physical activityin out-of-school-timeprograms

Healthy Kids, Healthy Communities provides tools and assistance to helpcommunities sustain systems, polici es, and environmental changes thatsupport healthy eating and active living.

Alliance for a Healthier Generation works with schools, companies,community organizations, healthcare professionals, and families to

achieve the environmental conditions that lead to healthier kids.

Advocate for theintegration of bikingand walking as methodsof transportation

The Bicycle Coalition of Philadelphia engages in advocacy fo r all forms ofactive transportation, including the connection of communities with saferroads and trails across the region.

Feet First Philly, supported by the Clean Air Council, is a pedestrianadvocacy group that raises awareness of issues f acing pedestrians in theCity of Philadelphia. Goals include improving the pedestrian environmentand encouraging walking as a mode of transportation, exercise, andrecreation.

The Safe Routes to School program is a federal initiative, supported locally byGet Healthy Philly, that promotes walking or bicycling to and from school.

Support communityorganizations andprojects that ensurelow-income familieshave access to safeplaces to exercise andplay

Get Healthy Philly is a city-wide public health initiative that bringstogether community-based organizations, researchers, and privatesector leaders to promote healthy, active environments for Philadelphiaresidents. One of the first projects included creating safer, moreconnected streets and trails throughout the city.

KaBOOM! helps communiti es build playgrounds, shares knowledge andtools, and advocates for the importance of play for children.

In Philadelphia, Boys and Girls Club facilities offer a variety of sportsprograms and leagues that focus on improving Club members knowledgeof healthy habits.

The Philade lphia Eagles Youth Partnership hosts an annual playgroundbuild to improve play spaces for schools in low-income communities.

Philadelphia Freedom Valley YMCA provides faciliti es and equipment forkids and their families to play, exercise, and practice sports.


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Most children do not consume a healthy, balanceddiet. Only 2% o school-aged children consume therecommended daily number o servings rom all ve

major ood groups.31

In addition to unhealthy eatinghabits, children are now consuming more calories romsugary drinks than ever be ore due to actors such asmarketing strategies, proli eration o sugary drinks instores, and peer inuence.

We know that children are not making healthy eating anddrinking choices, but what do we do about it? Along withincreasing access to healthy oods, it is critical to enablechildrens healthy choices. Healthier choices come whenchildren are knowledgeable about good nutrition andencouraged to practice healthy eating habits. A childspeer group can be particularly effective in inspiringbehavior change. Te bulk o the evidence suggests thatchildren as young as two learn ood pre erences romtheir peer group. 32 Children who attend school areexposed to peers in eating situations every day. Teseinteractions may be prime opportunities or promotingthe transmission o healthy ood pre erences.

PROMISING APPROACH: Providecomprehensive nutrition education thatpromotes healthy eating habits at theindividual, family, and school levels

Exemplary model: Te Food rusts KindergartenInitiative

Te Kindergarten Initiative (KI) is an evidence-basedintervention designed to promote healthy eating habits inkindergarten students through nutrition and agricultureeducation, parent engagement activities, and communitysupport. In KI schools, nutrition concepts are integratedinto the regular kinder garten classroom curriculum,and healthy ruit and vegetable snacks grown by local

armers are provided to the students. Tese schools alsoorganize arm eld trips to expose children to the processo growing ood and allow them to taste-test ruitsand vegetables. For parents, KI uses newsletters andsurveys, a Farm Store, and special events, like cookingdemonstrations by local che s, to rein orce healthy eatingat home.

ENABLE HEALTHY CHOICES EATING HABITS

Whats the impact?

An evaluation o the Kindergarten Initiatives pilotprogram showed positive results in its integratedapproach towards better nutrition or young students.During the nine-month evaluation period, KindergartenInitiative participants demonstrated improvementsin their knowledge o a healthy diet (recommendednumber o daily servings o ruits and vegetables,portion sizes o oods to eat), their awareness o where

ood is grown, and the number o ruits they consumedper day. 33 For example:

Children enrolled in the initiative were ound toconsume ruits and nuts seven times per week,while the control groups average was six times,with nuts being a particularly signicant difference.Kindergartners who participated in the initiativeate nuts more requently throughout the program

and their consumption increased ollowing theprogram, while students behaviors in the controlgroup remained unchanged. Researchers suspectthe shi in nut consumption may be attributedto the act that nuts are typically stocked in localcorner stores where access to resh vegetables islimited.


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In schools that offered nutrition education, thepercentage o children who could identi y ood thatthey should only eat occasionally increased two old

rom 31% to 62%, when compared to a 10% increasein correct responses rom students in control schools.

More than 90% o kindergarten parents elt that theyhad changed the way they shop or groceries, preparemeals, or talk to their children about ood.

Tis evaluations results inspired the passage o thePennsylvania Healthy Farms Healthy Schools Act in 2006,which allocated grant money to school districts, charterschools, and nonpublic schools to integrate agricultureand nutrition education into curricula. 34


Using Te Food rusts data, we estimate that the programcosts approximately $3,700 per class. Tese costs includea $1,200 average cost or materials or 33 kindergartnersto implement the program, and a $2,500 estimate orrelated, incremental administrative and managementcosts to support each class (including parents). 35

Cost-per-impact:

Based on cost data provided by Te Food rust and romthe Kindergarten Initiative Evaluation Report (2007),we estimate it costs less than $120 or each incrementalstudent now consuming 17% more ruits and nuts perweek.

For more in ormation on our approach to calculatingcost-per-impact, visit our website .

ake action:

Visit The Food Trust to make a donation and learn aboutother opportunities to support nutrition education inschools.

Enabling factors

As part of the Supplemental Nutrit ion

Assistance Program (SNAP), SNAP-Ed is afederal and state partnership that providesnutrition education for SNAP recipients. Corecomponents of The Food Trusts KindergartenInitiative are a part of a SNAP-Ed program inPennsylvania.

The success of the Kindergarten Initiative alsoinspired Pennsylvania to pass the HealthyFarms and Healthy Schools Act in 2006.

Although not currently funded in the statebudget, the act enables any Pennsylvaniaschool district, charter school, or privateschool with a kindergarten program to applyfor the Healthy Farms and Healthy Schoolsfunds (a maximum of $15,000 per program).
http://www.impact.upenn.edu/about/cost-and-impact/linking_cost_and_impacthttp://thefoodtrust.org/http://thefoodtrust.org/http://www.impact.upenn.edu/about/cost-and-impact/linking_cost_and_impact


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Below is a list of other organizations implementing our featured approach to Enable Healthy Choices- Eating Habits. While we have not analyzed their work in as much detail as the exemplar model, theyuse similar practices to enable childrens healthy eating habits.

Featured Approach Examples in Greater Phi ladelphia

Provide comprehensivenutrition education thatpromotes healthy eatinghabits at the individual,family and school levels

Eat.Right.Now improves nutrition education through lessons and follow-up activities in Philadelphia public and charter schools.

Nutrition for Life provides nutrition education and outreach in communityand school-based settings in and around the Philadelphia area. Nutritionfor Lifes approximately 2,000 consumers are low-income children andadults who are patients of the City of Philadelphia Department of PublicHealth (PDPH) Family Health Centers.

The Weller Center sends health educators into schools in Pennsylvania

and New Jersey to offer preventive health education sessions for studentson topics like healthy eating and exercise, bullying prevention andmental health, safety, addiction prevention, and human growth anddevelopment.

The Kellyn Foundation (Lehigh Valley) implements a variety of nutritioneducation programs in schools, including workshops on healthy eatingand gardening.

Below is a li st of othe r promising approaches for Enable Healthy Choices - Eating Habits, along withexamples of organizations implementing these approaches in the Greater Philadelphia region. This

list includes organizations whose models are consistent with what we currently understand can workin addressing childhood obesity. All are established nonprofits addressing the issues and capable ofaccepting philanthropic support.



Provide technicalassistance and resourcesto improve nutritioneducation programs inschools

WISE SNAC (profiled on page 16) crafts policies and practices to supporthealthy eating and physical activity within district public schools,and provides training and technical assistance to community basedorganizations and municipal programs that support healthy schools.

Launched in 2013, The Independence Blue Cross Foundations HealthyFutures initiative is a three-year school wellness program that leveragespartners like the Vetri Foundation and the Childrens Hospital ofPhiladelphia to provide the training, programming, and resources schoolsneed to create a healthy environment.


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Encourage children to

develop healthy eatinghabits by reinventingschool meal time

Eatiquette creates a school lunch environment that nurtures social

interaction and communication among peers and adults, encouragesteamwork, and presents kids with opportunities to try new foods.

Teach chi ldren andtheir families how tobudget for healthy foodpurchases and how tocook easy, healthy meals

Working in North Philadelphia, Farm to Families facilitates the purchasing,packaging, and distribution o f fresh, local, affordable produce; providesfood and nutrition education; and leads policy change efforts to makefresh food available in food deserts.

The Heal th Promotion Council s Food and Nutrition Educators providecooking lessons and demonstrations at SHARE food cupboards andcommunity gardens to teach participants how to grow, store, and cookfresh vegetables.

The Campbells Healthy Communities program offers nutrit ion educationfor families that includes workshops on healthy shopping and cooking.

Encourage purchasingof fruits and vegetablesby providing coupons atfarmers markets

Philly Food Bucks encourages ACCESS/food stamp recipients to purchasefresh produce by providing coupons that can be redeemed for $2 worthof fruits and vegetables for every $5 spent at all participating farmersmarkets.

Fair Food Phillys Double Dollars program encourages food stamprecipients to purchase fresh produce by providing coupons that can beredeemed for $5 worth of fruits and vegetables for every $5 spent at the

programs Fair Food Farmstand.

Increase knowledgeof healthy foods byexposing studentsand families to urbangardening

Bartrams Garden hosts school age children and families for programsfocused on health and gardening education, and provides space forcommunity gardening.

Agaston UNIs food education programs introduce children and adults tolocally grown, fresh, and nutritious food options through activities likegarden clubs and cooking demonstrations.

Empower youth tobecome stewards of

healthy communities

Teens 4 Good, a program of the Federation of Neighborhood Centers, isa youth-led entrepreneurial farm and nutrition business that transforms

vacant lots into urban gardens and farms.

HYPE is a youth campaign that encourages middle and high schoolstudents to form Youth Wellness Councils and involve their peers inmaking healthy changes in their schools and communities.


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In addition to having less access to physical activity,children are now exposed to new technology andmedia that encourages sedentary behavior. In the

ten-year period rom 1999 to 2009, the amount otime eight to eighteen year olds spent in ront o atelevision screen has increased rom three hours and 47minutes to our hours and 29 minutes. 36 And its not just television viewing that occupies childrens time;American children spend an estimated seven hours and38 minutes consuming media each day, which is nearlythe equivalent o a ull-time job.37 echnology andmedia are entertaining pastimes, but physical activitycan also be un or children depending on how theyare introduced to it. By demysti ying what it means to

be active, helping a child engage with peers around asport or playtime, and encouraging positive sel -esteem,programs can change that childs long term physicalactivity habits.

PROMISING APPROACH: Supportdevelopmentally-focused sports programsthat boost confidence and cultivatelifelong healthy physical activity habits

Exemplary model: Girls on the Run Philadelphia

Founded in 1996 in Charlotte, North Carolina, Girlson the Run is an international running program thataims to improve physical capability, commitment tophysical activity, and body image in girls in 3 rd through8th grades. Combining training or a 5k runningprogram with curricula ocused on social-emotionaldevelopment, Girls on the Run aims to give participantsthe tools needed to embrace individual strengths andbuild a long-lasting, positive relationship with physicalactivity. Since its inception, Girls on the Runs network

o councils has expanded to over 200 cities in NorthAmerica, serving over 130,000 girls.38 Girls on the RunPhiladelphia became an independent council in 2012.

How it works:

Girls on the Run places girls into teams o 15 with onetrained coach or 12 weeks o training. Te 12-week

ENABLE HEALTHY CHOICES PHYSICAL ACTIVITY

program integrates running training into a curriculumthat covers personal and team development andcommunity engagement. Trough these topics, girlslearn sel -care, problem-solving skills, and how they caninteract positively in teams and with their communities.Te 12-week program culminates in participation in a5k.39

Whats the impact?

Starting in 2002, Girls on the Run International hasconducted evaluations o program efficacy that ocus ongirls sel -esteem, commitment to physical activity, andattitudes towards ood and eating. Over the years, theseevaluations have shown consistently positive trends inbody-image and healthy habits or girls who participatein Girls on the Run.

In a 2007 study, researchers conducted a longitudinal,quasi-experimental study to evaluate the interventioneffects among 1,065 Girls on the Run participants across33 different sites. In a measure o physical activityover seven days, participants reported an 9% increasein moderate-to-vigorous physical activity rom pre-intervention to the ve month ollow up. 40 Currently,Girls on the Run is implementing a longitudinal study


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aimed at evaluating the effectiveness o the program onpositive youth developmental outcomes, as aligned withtheir mission statement.


Using cost data rom Girls on the Run Philadelphiaand other national-level data, we estimate that it costsapproximately $3,500 to $5,500 per team o 15 girlsto increase their participation in physical activity. Tetotal cost depends on urban or suburban location;startup or mature program site; supply and demand orscholarships; and utilization o a paid ull-time executivedirector. 41 Tese costs exclude the modest ee some

participants pay (i not covered by ull scholarships).

Cost-per-impact:

Combining Girls on the Run Philadelphia cost data withimpact in ormation rom the 2007 study, we estimatethat it costs between $235-$365 to increase by 9% thenumber o days a girl is engaged in moderate to vigorousactivity. As mentioned above, this range depends onlocation o the site, phase o the program, scholarships,and staffing choices.

Enabling factors

The Philadelphia Youth Sports Collaborativewas launched in 2009 to augment theimpact of local nonprofit organizations thatuse sports to benefit children and youth,particularly those from under-resourcedenvironments. By sharing ideas, combiningresources, identifying common areas o f need,and leveraging support, PYSC facilitatescommunication and cooperation betweenthese organizations and strengthens thepositive impact they have on youth, families,and communities.

For more in ormation on our approach to calculatingcost-per-impact, visit our website .

ake action:

Visit Girls on the Run Philadelphia to donate or to inquireabout volunteering as a coach.

Image provided by Girls on the Run International.
http://www.impact.upenn.edu/about/cost-and-impact/linking_cost_and_impacthttp://www.gotrphiladelphia.org/http://www.gotrphiladelphia.org/http://www.impact.upenn.edu/about/cost-and-impact/linking_cost_and_impact


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Below is a list of other organizations implementing our featured approach to Enable Healthy Choices -Physical Activity. While we have not analyzed their work in as much detail as the exemplar model, theyuse similar practices to enable childrens healthy physical activity habits.


Support developmentallyfocused sports programsthat boost confidence andcultivate life-long healthyphysical activity habits

Students Run Philly Style pairs students with mentors to build the work ethic,determination, and physical endurance necessary to complete either a halfor full marathon.

iRun4Life combats obesity within elementary schools by establishingnon-competitive running programs that focus on physical fitness,nutrition education, and community service.

Squash Smarts works with 5th through 12th grade students to develop

their physical abilities and keep them on track for graduation byusing squash to build on ideas of sportsmanship, hard work, andcommitment.

Philly Girls in Motion is a volunteer-driven organization that hostsrunning clubs, group exercise classes, and nutrition education for girlsand their families.

Healthy Kids Running Series is a national five-week running programfor kids from Pre-K to 8 th grade. The series is designed to motivatekids to be healthy and ac tive, while providing a fun environment toimprove their self-esteem.

Below is a list of other promising approaches for Enable Healthy Choices - Physical Activity, along withexamples of organizations implementing these approaches in the Greater Philadelphia region. Thislist includes organizations whose models are consistent with what we currently understand can workin addressing childhood obesity. All are established nonprofits addressing the issues and capable ofaccepting philanthropic support.


Teach chi ldren play ski llsthat make peer interactions

during recess and onplaygrounds fun andengaging

Playworks conducts hands-on professional development workshopsand consults for schools and youth organizations. Playworks goal

is to share best practi ces in youth development that can create anenvironment on the playground in which every child has a place.

Encourage families toexercise together andincorporate physical activityinto their daily routine

Philadelphia Freedom Valley YMCA has unique programming, such asfamily nights and family swim time, designed to bring families closer.


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Support community eventsto encourage physicalactivity for families

The Campbells Healthy Communiti es program works to increasephysical activity by bringing partner programs like CATCH (mentionedon pages 15 and 18) and spor ts leagues to high-need areas.

Get Out! Lehigh Valley is a healthy outdoor activi ty program thatprovides safe, fun activities for families such as walking, hiking,cycling, and paddling.

Support programs thatprovide technical assistanceand training to providersof programs that promotephysical activity

Alliance for a Healthier Generation (also mentioned on page 19)works with schools, companies, community organizations, healthcareprofessionals, and families to achieve the environmental conditionsthat lead to healthier kids.

Philadelphia Youth Spor ts Collaborative shares ideas and resources,identifies common areas of need, and leverages support in order toaugment the impact of local nonprofit organizations that use sports tobenefit low-income youth.


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Our guide primarily ocuses on promising approaches to obesity prevention. However, treatment programs are alsohelping to reduce the epidemic. While prevention efforts avoid the enormous psychological, economic, and societaltoll o childhood obesity, success ul treatment programs can help communities lower costs o health care and other

obesity-related expenses while improving the health and reducing the suffering o already severely overweight or obesechildren.

Similar to preventative care, the treatment o childhood obesity encourages better diets, more physical activity, higherquality ood options, and less screen time. However, treatment programs provide more requent, more intenseinterventions along with social, psychological, and emotional supports or patients to address causal actors. Teseprograms generally leverage medical practitioners and counselors to work one-on-one with severely overweight orobese children and their amilies.

While there is limited quality data, reviews have shown that multicomponent li estyle interventions, such as thosebelow, can be effective in treating childhood obesity. 42 In particular, the American Academy o Pediatrics recommendsinterventions that include requent office visits, goal-setting, parental involvement, and other components addressing

the whole child and his or her environment. 43 Un ortunately, even success ul interventions may have small effects atthe individual level or instance, slowing weight gain rather than reversing it and those improvements may notbe sustained over the long term. 44 Tis relative lack o clarity on effective treatment underscores the need to ocus onearly-li e prevention o obesity, particularly in the vulnerable populations who bear a disproportionate impact o thechildhood obesity epidemic. 45

TREATMENT OPPORTUNITIES FOR OVERWEIGHT OR OBESE CHILDREN

Below is a list of approaches to obesity treatment along with examples of organizationsimplementing these approaches in the Greater Philadelphia region. This list includesorganizations whose models are consistent with what we currently understand can work inaddressing childhood obesity. All are established nonprofits addressing the issues and capable ofaccepting philanthropic support.

Promising Approaches Examples in Greater Philadelphia

Regular visits for child andfamily members with medicalpractitioners and specialiststo encourage weight loss andadoption of healthier habits

The Healthy Weight Clinic at the Childrens Hospital o fPhiladelphia works with families to make healthy lifestylechanges by assessing weight-related medical issues andhelping children manage their weight through a family-basedapproach that is customized for each child and each family.

215GO! is a clinic that was established at Philadelphia PublicHealth Centers to identify, prevent and treat childhood obesityand related complications by promoting positive lifestylebehavior and motivating patients toward a healthier weight.

Bariatric treatment and post-surgery follow-up

Note: this approach appropriateonly in cases of severe obesity

The Healthy Weight Clinics Adolescent Bariatric Programaddresses the medical, psychosocial and emotional needs ofteens and young adults for whom bariatric surgery is appropriate.


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Since the childhood obesity epidemic is relatively new, the eld has a limited understanding o success ul preventionand treatment approaches. Tere ore, donors interested in unding beyond direct service efforts can make a valuablecontribution. Te opportunities below help increase our understanding o the issue, develop even better solutions, and

strengthen the implementation o current interventions: Build systems to learn, improve, and collaborate toward more effective prevention and treatment programs

Programs that help to build systems o eedback and learning across the eld can be a valuable investment. Forexample, the publicprivate partnership Shaping Americas Youth (SAY) recently developed a registry o programs

or child health and nutrition to acilitate in ormation and best-practice sharing across the sector. Te registry isnow approaching 2,500 program entries. SAY hopes to use this in ormation to oster community dialogue andultimately develop a national action plan. As part o this effort, the group has held meetings in Philadelphia area toincorporate community input. Programs like the Alliance or a Healthier Generation and Communities CreatingHealthy Environments also help to build systems that support a national action plan toward obesity prevention.

Invest in research and development to innovate for the futureBy supporting research into what works and the development o new technologies, donors can enhance ourunderstanding o obesity and potentially replace the approaches we proled with even better and more cost-effective tools. Donors can invest in evaluation efforts, research institutes, university-based centers, and childrensteaching hospitals that ocus on obesity. Examples include the Centers or Disease Control and Prevention, theNutrition Obesity Research Center at Harvard, and the Yale Rudd Center. Several nonprot organizations, suchas ChildObesity180 and Te Food rust, are also engaged in evaluation efforts and testing new models.

Advocate for increased funding and other policy change

Public policies and related public unding play a major role in shaping whether communities and environmentspromote healthy eating and active li estyles. For example, this guide has eatured several organizations workingto implement change that aligns with new school health policies, or improved access to healthy oods throughprograms like SNAP. We also have highlighted several enabling actors in Pennsylvania that have shi ed thepolicy dynamic toward more integrated and productive outcomes or residents. While program implementors playa critical role, so too do the advocates whose efforts o en make program delivery possible. Donors can partnerwith other unders and can invest in nonprots that are changing the dialogue and calling or necessary re orms atthe local, state, and national levels, including groups such as PolicyLink and Active Living By Design.

All paths lead to impact

Your choice to invest in one approach or build a port olio o integrated approaches will depend on multiple actorsincluding your tolerance or risk, existing relationships you can leverage, and your time horizon or seeing meaning ul

differences in any childs li e. Whether you support high impact approaches that have already achieved results,strengthen promising approaches to enhance their effectiveness, invest in research and development so we have bettertools in the uture, or support sector-wide systems or eedback and learning, the ultimate desired impact is the same:healthier children who are better able to achieve their ull potential, and a stronger society or us all.

I M P R O V I N G T H E C U R R E N T L A N D S C A P E


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E X A M P L E O R G A N I Z AT I O N S M E N T I O N E D I N T H I S G U I D E

S T A R T E A R L Y

I N C R E A S E A C C E S S

Nurse-Family Partnership

Maternity Care Coalition

Philadelphia Healthy START

Healthy Steps for Young Children

Breastfeeding Friendly Philadelphia

The Food Trust s Preschool Ini tiative

St. Mary Medical Centers Kinder Connection (Bucks County)

The Food Trust s Healthy Corner Store Init iative

Philabundance Fare and Square program

Get Healthy Philly

Greensgrows Mobile Markets

The Pennsylvania Horticultural Society Growers Alli ance

The Lehigh County Community Gardens Program

WISE SNAC

CATCH

School Food FOCUS

The Food Trust s Farm to School Ini tiative

Common Market

Philly Food Bucks

Fair Food Philly

Benefits Data Trust

Independence Blue Cross Foundations Healthy Futures

Healthy Kids, Healthy Communities

The Bicycle Coalition of Philadelphia

Feet First PhillySafe Routes to School

KaBOOM!

Philadelphia Eagles Youth Partnership

Philadelphia Freedom Valley YMCA
http://www.nursefamilypartnership.org/http://www.maternitycarecoalition.org/http://www.phila.gov/health/mcfh/healthystart.htmlhttp://healthysteps.org/http://maternitycarecoalition.org/professionals/public-policy/breastfeeding/http://www.thefoodtrust.org/what-we-do/schools/nutrition-educationhttp://www.stmaryhealthcare.org/KinderConnectionhttp://www.thefoodtrust.org/what-we-do/corner-storehttp://www.fareandsquare.org/http://www.phila.gov/health/commissioner/CPPW.htmlhttp://www.greensgrow.org/mobile-marketshttp://phsonline.org/index.php/greeninghttp://www.lehighcounty.org/departments/agriculturallandpreservation/communitygardenplots/tabid/1246/default.aspxhttp://www.npchf.org/strategic-initiatives/wise-snachttp://www.catchusa.org/http://www.schoolfoodfocus.org/http://www.thefoodtrust.org/what-we-do/schools/farm-to-schoolhttp://www.commonmarketphila.org/http://www.thefoodtrust.org/what-we-do/farmers-markets/philly-food-buckshttp://www.fairfoodphilly.org/http://www.bdtrust.org/http://www.ibxfoundation.org/http://www.healthykidshealthycommunities.org/http://www.bicyclecoalition.org/http://www.feetfirstphilly.org/http://www.saferoutesphilly.org/http://www.kaboom.org/http://www.philadelphiaeagles.com/community/eagles-youth-partnership.htmlhttp://www.philaymca.org/http://www.philaymca.org/http://www.philadelphiaeagles.com/community/eagles-youth-partnership.htmlhttp://www.kaboom.org/http://www.saferoutesphilly.org/http://www.feetfirstphilly.org/http://www.bicyclecoalition.org/http://www.healthykidshealthycommunities.org/http://www.ibxfoundation.org/http://www.bdtrust.org/http://www.fairfoodphilly.org/http://www.thefoodtrust.org/what-we-do/farmers-markets/philly-food-buckshttp://www.commonmarketphila.org/http://www.thefoodtrust.org/what-we-do/schools/farm-to-schoolhttp://www.schoolfoodfocus.org/http://www.catchusa.org/http://www.npchf.org/strategic-initiatives/wise-snachttp://www.lehighcounty.org/departments/agriculturallandpreservation/communitygardenplots/tabid/1246/default.aspxhttp://phsonline.org/index.php/greeninghttp://www.greensgrow.org/mobile-marketshttp://www.phila.gov/health/commissioner/CPPW.htmlhttp://www.fareandsquare.org/http://www.thefoodtrust.org/what-we-do/corner-storehttp://www.stmaryhealthcare.org/KinderConnectionhttp://www.thefoodtrust.org/what-we-do/schools/nutrition-educationhttp://maternitycarecoalition.org/professionals/public-policy/breastfeeding/http://healthysteps.org/http://www.phila.gov/health/mcfh/healthystart.htmlhttp://www.maternitycarecoalition.org/http://www.nursefamilypartnership.org/


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E N A B L E H E A L T H Y C H O I C E S

T R E A T M E N

T

Kindergarten Initiative

Eat.Right.Now.

Nutrition for Life

The Weller Center

The Kellyn Foundation

Eatiquette

Farm to Families

Health Promotion Councils Food and Nutrition Educators

The Campbells Healthy Communities program

Bartrams Garden

Agaston UNI

Teens 4 Good

HYPE

Girls on the Run

Students Run Philly Style

iRun4Life

Squash Smarts

Philly Girls in Motion

Boys and Girls Clubs of Philadelphia

Playworks

Philadelphia Freedom Valley YMCA

Get Out! Lehigh Valley

Alliance for a Healthier Generation

Philadelphia Youth Sports Collaborative

The Healthy Weight Clinic215GO!

The Healthy Weight Clinics Adolescent Bariatric Program
http://www.thefoodtrust.org/what-we-do/schools/nutrition-educationhttp://localhost/var/www/apps/conversion/tmp/scratch_10/webgui.phila.k12.pa.us/offices/n/nutritionhttp://www.hpcpa.org/programs/nutrition-lifehttp://www.wellercenter.org/http://www.kellyn.org/http://www.vetrifoundation.org/what-we-do/eatiquettehttp://www.scfchildren.org/archives/programs/farm-to-families-initiative-2http://www.hpcpa.org/http://csr.campbellsoupcompany.com/csr/pages/neighbors/overview.asphttp://www.bartramsgarden.org/http://www.urbannutrition.org/http://localhost/var/www/apps/conversion/tmp/scratch_10/teens4good.orbius.comhttp://www.foodfitphilly.org/healthy-youth/hypehttp://www.gotrphiladelphia.org/http://www.studentsrunphilly.org/2011/index.phphttp://www.irun4life.com/http://www.squashsmarts.org/http://www.phillygirlsinmotion.org/http://www.bgcphila.org/http://www.playworks.org/http://www.philaymca.org/http://www.lvhn.org/wellness_resources/classes_support_groups_and_events/events/get_out_lehigh_valleyhttp://www.healthiergeneration.org/http://www.sp2.upenn.edu/ostrc/pyschttp://www.chop.edu/service/healthy-weight-program/clinical-carehttp://www.chop.edu/export/download/pdfs/articles/nutrition-department/42-b-06.pdfhttp://www.chop.edu/service/healthy-weight-program/clinical-care/adolescent-bariatric-program.htmlhttp://www.chop.edu/service/healthy-weight-program/clinical-care/adolescent-bariatric-program.htmlhttp://www.chop.edu/export/download/pdfs/articles/nutrition-department/42-b-06.pdfhttp://www.chop.edu/service/healthy-weight-program/clinical-carehttp://www.sp2.upenn.edu/ostrc/pyschttp://www.healthiergeneration.org/http://www.lvhn.org/wellness_resources/classes_support_groups_and_events/events/get_out_lehigh_valleyhttp://www.philaymca.org/http://www.playworks.org/http://www.bgcphila.org/http://www.phillygirlsinmotion.org/http://www.squashsmarts.org/http://www.irun4life.com/http://www.studentsrunphilly.org/2011/index.phphttp://www.gotrphiladelphia.org/http://www.foodfitphilly.org/healthy-youth/hypehttp://localhost/var/www/apps/conversion/tmp/scratch_10/teens4good.orbius.comhttp://www.urbannutrition.org/http://www.bartramsgarden.org/http://csr.campbellsoupcompany.com/csr/pages/neighbors/overview.asphttp://www.hpcpa.org/http://www.scfchildren.org/archives/programs/farm-to-families-initiative-2http://www.vetrifoundation.org/what-we-do/eatiquettehttp://www.kellyn.org/http://www.wellercenter.org/http://www.hpcpa.org/programs/nutrition-lifehttp://localhost/var/www/apps/conversion/tmp/scratch_10/webgui.phila.k12.pa.us/offices/n/nutritionhttp://www.thefoodtrust.org/what-we-do/schools/nutrition-education


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Healthy Eating Active Living Convergence Partnership expands opportunities for healthy lifestyles byinvesting in community initiatives focused on environmental and policy change. The Partnership wasco-founded by multiple funders including The Robert Wood Johnson Foundation, the W.K. KelloggFoundation, and Kaiser Permanente.

Grantmakers in Health generates information, policies, and strategies to guide grantmakingorganizations interested in improving nutrition and physical well-being.

The Blue Cross and Blue Shield Association (BCBSA) works with communities to combat childhood

obesity through its Good Health Club and other nationally developed, locally administered programs.

Robert Wood Johnson Foundation (RWJF) supports research, advocacy, and policy efforts to reversethe obesity epidemic and create a healthy environment for children.

Lets Move is an initiative launched by First Lady Michelle Obama to address the incidence of childhoodobesity through a multi-pronged strategy of increasing education, access to healthy food, and physicalactivity.

Women, Infants, and Children (WIC) works with states to increase low-income families access tosupplemental food stamps and nutrition education.

The Supplemental Nutrition Assistance Program (SNAP) provides funding to ass ist low-incomefamilies in purchasing food. The program also provides nutrition education to families via SNAP-Ed.

The United States Department of Agriculture administers the National Lunch Program, the School BreakfastProgram, and other food programs that work in schools to provide healthy meals for students.

National Institutes of Health generates critical research on childhood obesity. The Institutes havealso created a national initiative called We Can! that draws upon families, health professionals, themedia, and other partners to help 8 to 13 year-olds maintain a healthy weight.

Harvards Nutrition Obesity Research Center promotes nutrition research and scientific collaborationto improve understanding of the issues most critical to progress in the field.

Yale Rudd Center for Food Policy and Obes ity creates a connection between policy and scienceresearch to improve the worlds diet and reduce obesity.

Active Living Research supports and shares research to promote physical activity in the U.S.,particularly among low-income children and children of color.

F U N D E R S

G O V E R N M E

N T P R O G R A M S

R E S E A R C H

Childhood obesity is an issue o national concern, and there are many governmental, private sector, and institutional actorsworking to stem the epidemic. Te chart below presents a number o key players in the philanthropic sector, government,and the research, policy, and direct service arenas. Tis list is not exhaustive, but represents a sample o power ul potential

partners whose work donors can leverage or increased impact.

SELECT NATIONAL PLAYERS IN CHILDHOOD OBESITY PREVENTION
http://www.convergencepartnership.org/site/c.fhLOK6PELmF/b.3917533/k.F45E/Whats_New.htmhttp://www.gih.org/http://www.bcbs.com/healthcare-partners/good-health-club-toolkit/good-health-club-physician.htmlhttp://www.rwjf.org/http://www.letsmove.gov/http://www.fns.usda.gov/wic/women-infants-and-children-wichttp://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program-snaphttp://www.fns.usda.gov/school-meals/child-nutrition-programshttp://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/http://www.norccentral.org/harvard.dohttp://www.yaleruddcenter.org/http://activelivingresearch.org/http://activelivingresearch.org/http://www.yaleruddcenter.org/http://www.norccentral.org/harvard.dohttp://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/http://www.fns.usda.gov/school-meals/child-nutrition-programshttp://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program-snaphttp://www.fns.usda.gov/wic/women-infants-and-children-wichttp://www.letsmove.gov/http://www.rwjf.org/http://www.bcbs.com/healthcare-partners/good-health-club-toolkit/good-health-club-physician.htmlhttp://www.gih.org/http://www.convergencepartnership.org/site/c.fhLOK6PELmF/b.3917533/k.F45E/Whats_New.htm


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S Y S T E M S B U I L D I N G A N D M O B I L I Z A T I O N

A W A R E N E S S & A D V O C A C Y

Obesity Action Coalition , an alliance of nearly 5,000 organizations, seeks to educate citizens abouthealthy choices and encourage policymakers to address obesity-related issues.

STOP Obesity Alliance brings together consumers, health care providers, government, labor, business,insurers, and other stakeholders in order to suppor t obesity prevention and treatment strategies.

Campaign to End Obesity unites health-care professionals, academics, and public health workerswith policymakers and their advisors to guide decision-makers in building effective policies aroundchildhood obesity.

National Institute for Chi ldrens Healthcare Quality promotes sustainable obesity-related policies andimprovements in early childhood education and care.

Partnership for a Healthier America is a coalition of public, private, and nonprofit leaders focused onmaking healthier choices more affordable and accessible to families and children across the countrythrough partnerships with organizations like Play Streets, Reebok, Nike, and the YMCA.

ChildObesity180 supports research, policy, and advocacy efforts to combat child obesity and improveour understanding of what works. Programs include: Active Schools Acceleration Project, Healthy KidsOut of School, and the Restaurant Initiative.

Shaping Americas Youth (SAY) is a public-private partnership that engages families to promotehealthy eating and physical activity among children and adolescents.

Communities Creating Healthy Environments works to increase access to healthy food and safe

recreational spaces for impoverished communities.

Wholesome Wave connects local farmers with underser ved communities, improving access to healthyfood purchasing options.

Voices for Healthy Kids has a variety of programs, ranging from improving the quality of school mealsto increasing access to parks and playgrounds.

The Food Trust , based in Philadelphia, is a national leader in improving food access and nutritioneducation, advocating for policy change, and conducting research and evaluation.
http://www.obesityaction.org/http://www.stopobesityalliance.org/http://www.obesitycampaign.org/http://www.nichq.org/http://ahealthieramerica.org/http://www.childobesity180.org/http://americaspeaks.org/projects/topics/health-care/shaping-americas-youth/http://ccheonline.org/http://wholesomewave.org/http://www.heart.org/HEA

donor strategies to prevent childhood obesity: lessons from greater philadelphia

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