Progress in Preventing Childhood Obesity How Do We Measure Up? (2007) / Chapter Skim
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6 Communities
6 Communities
Pages 228-279
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From page 228... ...
. Communities across the nation are increasingly aware of the childhood obesity epidemic, and this awareness is being transformed into active efforts to improve community access to foods and beverages that contribute to a healthful diet and increase opportunities for regular physical activity.
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The chapter concludes with recommendations for guiding communities to assess their progress in establishing promising childhood obesity prevention efforts. KEY ELEMENTS OF COMMUNITY-BASED STRATEGIES Although communities may vary widely in their demographics and resources, efforts to engage communities in promoting healthy lifestyles generally involve active grassroots efforts that build on the strengths of the residents and the locale.
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To implement this recommendation: • Private and public efforts to eliminate health disparities should include obesity prevention as one of their primary areas of focus and should support community based collaborative programs to address social, economic, and environmental barriers that contribute to the increased obesity prevalence among certain populations. • Community child- and youth-centered organizations should promote healthful eating behaviors and regular physical activity through new and existing pro grams that will be sustained over the long term.
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Health care professional organizations, insurers, and accrediting groups should support individual and population-based obesity prevention efforts. To implement this recommendation: • Health care professionals should routinely track body mass indices, offer rele vant evidence-based counseling and guidance, serve as role models, and provide leadership for obesity prevention efforts in their communities.
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Because childhood obesity prevention is central to the health of the community's children and youth, the development of community coalitions is a particularly relevant means of addressing this issue. The characteristics of successful coalitions include focusing on a welldefined and specific issue, determining common goals, and keeping the coalition focused on providing leadership and direction rather than micromanaging the solutions (Kreuter et al., 2000)
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Focus on Safety Safety is an important construct of the social environment that is likely to influence childhood obesity prevention efforts (Lumeng et al., 2006)
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The opportunity in these communities is to identify and support efforts that can produce many potential benefits; for example, improving playgrounds and recreational facilities may enhance safety, reduce crime, increase physical activity, and improve quality of life. Finding common ground may serve as a key element in garnering sufficient investment for sustained efforts.
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Mobilizing Communities Communities that promote healthy lifestyles and that actively engage their citizens in improving access to opportunities for healthful eating and regular physical activity draw on the talents, resources, and energies of multiple community stakeholders. As noted earlier, efforts to prevent childhood obesity compete with many other efforts to address health and social priorities for the scarce resources that are available at the local level.
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A number of national youth-related organizations are working with their multiple local chapters to incorporate obesity prevention efforts and goals into their programs, often with the support of foundation or corporate sponsors. For example, Girl Scout councils have developed partnerships with community parks and recreation departments, sports organizations, as well as schools and colleges for physical activity instruction and facilities.
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From page 237... ...
. Researchbased efforts are evaluating the effectiveness of faith-based approaches to obesity prevention; for example, a program called Healthy Body Healthy Spirit is an intervention funded by the National Heart, Lung, and Blood Institute to increase physical activity and the levels of consumption of fruits and vegetables among African Americans recruited through churches (Resnicow et al., 2005)
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; America on the Move® (2006) , a nonprofit organization that promotes small lifestyle changes to increase physical activity and reduce calorie intake, with multiple sponsors including PepsiCo and Cargill; and the Women's National Basketball Association's Be Smart - Be Fit - Be Yourself program for youth (WNBA, 2005)
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initiative funds several community demonstration projects to implement programs promoting physical activity and healthful eating in six low-income communities
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One of the strengths of local, statewide, and regional foundations is their familiarity with the cultural assets and demographic characteristics of the areas they serve and their ability to focus grants and funding opportunities on innovative projects that build on local assets. The committee, through its three regional symposia, had the opportunity to learn more about the community-based obesity prevention programs and initiatives funded by the Kansas Health Foundation, the Sunflower Foundation, the Healthcare Georgia Foundation, the Missouri Foundation for Health, the Robert Wood Johnson Foundation, and the W
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The efforts of groups and individuals with many diverse areas of expertise are needed to move obesity prevention efforts forward and can have a synergistic effect when coordinated. Community coalitions relevant to childhood obesity prevention often focus on broader but related issues, such as encouraging healthy lifestyles or preventing chronic diseases, such as type 2 diabetes, in children, youth, and adults.
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In February 2006, the Task Force received a five-year grant from Kaiser Perma nente to implement the Healthy Eating Active Living-Community Health Initiative in two local communities, South Park and Southwest Santa Rosa. Phase 1 of the project will involve the development of a community action plan, and Phase 2 will implement and evaluate the plan over four years.
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: The consor tium began as a community-based effort of Children's Memorial Hospital fo cused on obesity prevention in children ages 3 to 5 years. CLOCC now in volves multiple community partners and provides resources and connections for children, their caregivers, and those who work with their parents and care givers.
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is a recent outgrowth of these efforts and involves the consideration of Latino culture in the development of urban properties and land use plans. Promoting Physical Activity Communities are becoming more aware of the need to enhance healthy lifestyles for children and youth by offering safe and attractive places in neighborhoods for recreation and play and by promoting active travel.
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; and the efforts by the Winnebago Tribe's (Nebraska) efforts to increase physical activity and develop plans to improve the built environment (Box 6-6)
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. The daily trips that children and youth make to and from school have received considerable attention in many communities as a way to increase students' physical activity levels (WHO, 2002)
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Alternative strategies are also being developed to increase the availability, affordability, and access to foods, beverages, and meals that contribute to healthful diets throughout neighborhoods and communities. Community gardens are moving beyond rural and suburban communities into urban areas.
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. System-level tools can also be used to assess changes in the food system that will increase the availability of
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. A systematic assessment of the progress by the health care sector regarding childhood obesity prevention efforts has not yet been conducted.
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During the first year of the project nearly 150 "physician champions" were identified. In 2006, 250 physician champions were being trained to become educators and advocates for healthy eating and physical activity in schools and communities throughout the state.
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. Kaiser Permanente has also expanded its Community Benefit Program to focus on obesity prevention efforts through its Healthy Eating, Active Living (HEAL)
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Few mechanisms exist to provide accountability for the various components of the health care system in obesity prevention efforts. The committee encourages health care providers and organizations to provide greater leadership in addressing issues related to promoting healthful eating and regular physical activity.
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It is not realistic for each community program to reduce children's BMI levels in a short time frame, nor is this expected; instead, the focus should be on assessing progress toward short-term outcomes (e.g., changing institutional, local, or state policies to support obesity prevention) and intermediate outcomes such as increasing the proportion of children or youth involved in physical activity on a daily basis, increasing the percentage of physical education or recess periods that children or youth spend in moderate or vigorous physical activity, increasing the number of miles of bicycle and walking trails, and increasing access to affordable fresh fruits and vegetables for families (e.g., through the provision of farmers markets in low-income communities and community or school gardens)
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• Cognitive, behavioral, and social outcomes relevant to the commu nity sector include the formation of relevant community coalitions, the acquisition of information gained on how to engage in healthy lifestyles by families, increases in the levels of physical activity, and improved nutritional intake. • The health outcomes at the community level, as in other sectors, are focused on healthy children and youth and reductions in the preva lence of obesity and its associated morbidities.
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capital improvements. Crosscutting Factors FIGURE 6-1 Evaluating community efforts to increase active transport to school for children and youth.
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Crosscutting Factors FIGURE 6-2 Evaluating community efforts to increase community gardening.
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A greater coordination of efforts and communication about the range of efforts has the potential to leverage these efforts to reach more individuals and families and can also encourage other groups to initiate nutrition and physical activity interventions. Leadership can also be shown in the organizational modeling of fitness and nutrition policies and practices.
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Increasingly, it is recognized that tools are needed to assist communities with conducting their evaluations. For example, CDC's Physical Activity Evaluation Handbook is based on other program evaluation efforts in public health and on the work of the Task Force on Community Preventive Services (CDC, 1999, 2002; Martin and Heath, 2006)
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. Each year CDC also sponsors a set of physical activity and public health courses operated by the University of South Carolina Prevention Research Center.
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worked together to design a program, Table Talks, that was presented in English and Spanish. The program provided information on family meal preparation and physical activity and nutrition classes.
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. Furthermore, efforts to improve the geographic coding of the data on physical activity and health collected through surveillance systems such as the National Health and Nutrition Examination Survey, could provide further information to assist with examination of the impacts of changes in the built environment (TRB and IOM, 2005)
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. Only a limited number of national surveys of childhood obesity prevention efforts have provided data that are aggregated at the regional or city level (Chapter 4 and Appendix D)
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. An increased emphasis is needed on tracking policy change at the local level that impact access to foods and beverages that contribute to a healthful diet and opportunities for physical activity (Schmid et al., 2006)
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In 2000, the Michigan Department of Community Health; the Governor's Council on Physical Fitness, Health, and Sports; the Prevention Research Center of Michigan; and the Michi gan State University began recognizing communities that support physical activity. They developed an assessment tool that allows communities to evaluate them selves on a range of policy change and program implementation issues, including policies and planning for non-motorized transportation, zoning policies, bike path availability, sidewalk policies, community resources for physical activity, work sites, schools, and public transportation (Promoting Active Communities, 2006)
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that will assist communities with examining multiple factors relevant to healthy communities. This type of community health index tool could include modules on the availability, accessibility, attractiveness, affordability, and safety of places for physical activity and healthier food choices for community members; the involvement of community organizations; and the measurement of the collective efficacy of a community.
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. Presentation of the data visually to community stakeholders has the potential to be an important tool in engaging and tracking community obesity prevention efforts, particularly because they can be focused on a local geographic area.
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Encourage the Measurement of Risk and Protective Factors As discussed in Chapter 3, obesity prevention efforts do not occur in a vacuum, and it is important to consider the larger socioeconomic and cultural contexts in implementing programs and conducting evaluations. These contextual factors (e.g., poverty, extent of social capital, cultural assets and barriers, and mentoring programs)
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Furthermore, focus groups were held with Wichita residents to identify factors that motivate physical activity as well as those that were barriers to physical activity. SUMMARY AND RECOMMENDATIONS Communities are where the efforts of government, industry, health care systems, foundations, schools, nonprofit organizations, and many other groups come together to provide increased opportunities for physical activity and enhanced access to foods and beverages that contribute to a healthful diet.
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Recommendation 2: Policy makers, program planners, program imple menters, and other interested stakeholders -- within and across relevant sectors -- should evaluate all childhood obesity prevention efforts, strengthen the evaluation capacity, and develop quality interventions that take into account diverse perspectives, that use culturally relevant approaches, and that meet the needs of diverse populations and contexts. Implementation Actions for Communities Community stakeholders should strengthen evaluation efforts at the local level by partnering with government agencies, foundations, and academic institutions to develop, implement, and support evalu ation opportunities and community-academic partnerships.
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Recommendation 4: Government, industry, communities, schools, and families should foster information-sharing activities and disseminate evaluation and research findings through diverse communication chan nels and media to actively promote the use and scaling up of effective childhood obesity prevention policies and interventions. Implementation Actions for Communities Community stakeholders should partner with foundations, govern ment agencies, faith-based organizations, and youth-related organi zations to publish and widely disseminate the evaluation results of community-based childhood obesity prevention efforts.
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2005. Energizing community health improvement: The promise of micro grants.
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2006. Communities of Excellence in Nutrition, Physical Activity, and Obesity Prevention (CX3)
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. Evaluating Youth Engagement and Leader ship in a Multi-Site Initiative to Change Community Food and Physical Activity Envi ronments.
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2006. Inequality in the built environment underlies key health disparities in physical activity and obesity.
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2002. The effectiveness of interventions to increase physical activity.
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2006. A six-step model for evaluation of community-based physical activity programs.
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2004. Considerations for using a geographic information system to assess environmental supports for physical activity.
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2006. The role of built environments in physical activity, eating, and obesity in childhood.
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2004. Using electronic step counters to increase lifestyle physical activity: Colorado on the Move™.
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