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Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons Learned Over Time

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Page 1: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

Stopping Childhood Obesity: Building the Evidence for Community Interventions

A Comparison of 4 Major Obesity Prevention Projects and

Discussion of Lessons Learned Over Time

Page 2: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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.

Page 3: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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

Page 4: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

CDC Data

Page 5: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

Prevalence of Obesity

Page 6: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons
Page 7: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

Remember Your Mother?

Now, sweetheart, eat your Brussell sprouts! They’re good for you…

Page 8: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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

Page 9: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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)

Page 10: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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

Page 11: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

Similarities between Programs

• Culturally sensitive• Income sensitive• Have both healthy

eating and physical activity

• Evidence-Based Models

• Community Partners

Page 12: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

Healthy Macdonough

Philosophy of Grant

“Address policies, environments and systems that affect

children’s behavioral choices

rather than the behaviors

themselves”

Page 13: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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

Page 14: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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

Page 15: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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

Page 16: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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.

Page 17: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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%

Page 18: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

• 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

Page 19: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

Our First Group

Program Program Graduation:Graduation:

Group 3-Our Final Group

Graduation:Graduation:

Page 20: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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

Page 21: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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%

Page 22: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

• 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

Page 23: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

– 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

Page 24: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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

Page 25: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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)

Page 26: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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

Page 27: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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/

Page 28: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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

Page 29: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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

Page 30: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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/

Page 31: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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

Page 32: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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

Page 33: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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

Page 34: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

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

Page 35: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

• 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

Page 36: Stopping Childhood Obesity: Building the Evidence for Community Interventions A Comparison of 4 Major Obesity Prevention Projects and Discussion of Lessons

What have we learned from all this?