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Childhood Overweight: Community Mobilization

Part 4: Coming Together to Improve Health

Volume 8, Number 3 - April/May, 2004

Editors: Carol A. Rice, Ph.D., RN, Professor and Extension Health Specialist, and Janet M. Pollard, MPH, Extension Associate-Health

Download PDF version of this newsletter and 2 handouts

Inside HealthHints....

Childhood Overweight: Community Mobilization -- Coming together to improve health

"When there are no safe places for children to play, or for adults to walk, jog, or ride a bike, that's a community responsibility. When lunchrooms or workplace cafeterias don't offer healthy and appealing food choices, that's a community responsibility. And when we don't require daily physical education in our schools, that is also a community responsibility."
 -- Former Surgeon General David Satcher
(from Thomas, E. (2004) Childhood Obesity Crisis: What Can Communities Do? [on-line]. Available: http://www.naco.org/Content/ContentGroups/Publications1/County.)

While our nation seems to become ever more overweight, "at the same time, there are fewer opportunities in daily life to burn calories: children watch more television daily; many schools have replaced or cut back on physical education; many neighborhoods lack sidewalks for safe walking; the workplace has become increasingly automated; household chores are assisted by labor-saving machinery; and walking and cycling have been replaced by automobile travel for all but the shortest distances (Center for Weight and Health, 2004)."

While parents struggle with modeling healthy behavior in their increasingly busy and automated lives, and children are inundated with opportunities to eat fast, nutrient empty foods and enticed by technology-savvy sedentary activities, our nation, our state, our counties, our local communities, our families are threatened by the imminent health costs and consequences that come with overweight and obesity. This leaves us, as individuals and as community educators with one question..."what can we do?"

Outside of a commitment to model and foster healthful behaviors for our own families and loved ones, as community educators, there is much that can be done to help mobilize local communities to prevent and intervene in issues of childhood overweight.

This issue of HealthHints will focus on best practices for mobilizing communities to prevent and intervene in childhood overweight by fostering healthy lifestyles.

Where Do We Begin?
Seven strategies for public health efforts

Beginning to develop efforts to prevent and intervene in the area of childhood overweight on a community level can seem a daunting task. There is so much to be done, it can seem overwhelming to even comprehend program efforts that could help with such a major issue. The "Spectrum of Prevention" is a framework recommended by the University of California's well-known Center for Weight and Health to help community agencies conceptualize, implement, and coordinate program efforts related to public health. Seven strategies (below) are suggested, which can guide us in developing effective program efforts in regards to childhood overweight.

Influence Policy and Legislation

"Legislation and other policy initiatives have proven to be among the most effective strategies for achieving broad public health goals (Rattray, et. al., 2002)." Whether it is a law or a local ordinance, "formal and informal policies have the ability to affect large numbers of people by improving the environments in which they live and work, encouraging people to lead healthy lifestyles, and providing for consumer protections (Rattray, et. al., 2002)." Laws have been effective in prohibiting smoking in public places, while local ordinances requiring swimming pool areas be fenced have been effective in impacting health and safety.

Mobilize Communities

We can no longer follow a medical model where a provider-expert is at the center of public health activities. Sending a medical provider or other professional or "expert" to a neighborhood to talk with them about eating their fruits and vegetables is ineffective and goes unheard, when more urgent concerns face them, such as violence, unemployment, or struggles to keep their family together. Instead, community agencies must come together to share goals and agendas and prioritize community concerns (Rattray, et. al., 2002). This is a place where the Texas AgriLife Extension Service can already succeed in inviting key community members and organizational representatives to share in the events and results of Texas Community Futures Forums.

Using the "Spectrum of Prevention" framework, one successful project that mobilized a community was a program where a Healthy Neighborhoods Project was instigated and community agencies worked with community residents to identify neighborhood assets, develop a list of priority activities to improve the neighborhood quality of life, and made an action plan. The results -- increased access to recreation and exercise by cleaning up parks littered with trash; creation of healthy environments around schools by removing tobacco billboards and installing stop signs, speed bumps, and traffic lights; and working with local law enforcement to provide increased police patrol and a reduction of violence in the streets (Rattray, et. al., 2002).

Fostering Coalitions and Networks

One of the most important messages is that you don't have to take the task of childhood overweight prevention and intervention on alone. "Coalitions and networks, composed of community organizations, policy makers, businesses, health providers, and community residents working together, can be powerful advocates for legislation and organizational change. Coalitions and networks also provide an opportunity for joint planning, system-wide problem solving and collaborative policy development to ensure that the voices of all community sectors are represented in public health prevention programs (Rattray, et. al., 2002)."

There are numerous examples of effective, successful coalitions and networks. One such program was a partnership between cancer organizations, a health department, community medical providers, women's groups, the faith community, cancer survivors, and other diverse community organizations in the Contra Costa area of California who worked with providers to implement a new state-funded breast cancer screening program for low income women. They also developed strategies to increase breast cancer screening, especially in minority communities (Rattray, et. al., 2002). (See section entitled A Model Program from the Field for examples specific to Extension childhood overweight prevention.)

Changing Organizational Practices

"Advocating for organizational change at agencies such as law enforcement, schools and health departments can result in broad impact on community health (Rattray, et. al., 2002)." To change organizational practices involves modifying the internal practices and policies of an agency or organization. These modifications should be directed at improving health and safety for the staff of the organization, better services for the clients, and a healthier community environment. Two successful examples of these types of changes included: 1) programs set up to establish a relationship with a county's Employment and Human Services Department to provide discount coupons for fruits and vegetables to thousands of food stamp recipients, and 2) developing a practice of having the state highway patrol report to the press whether people injured or killed in an automobile accident were wearing their seatbelt -- thus, also sending out a public health message (Rattray, et. al., 2002). Another example would be efforts to change food services in schools to provide more nutritionally sound food choices to students or lessoning days in which "snack bar" or "a la carte" choices are available.

Educating Providers

"By educating providers to identify and intervene in public health issues, professionals, paraprofessionals and community activists working with the public can become front-line advocates for public health (Rattray, et. al., 2002)." This strategy reaches an influential group of people -- in and out of the health field -- who have daily contact with large numbers of people at risk for injury and disease, and who can encourage adoption of healthy behaviors, screen for health risks, contribute to community education, and advocate for policy and legislation. One successful example includes Contra Costa California's Family, Maternal and Child Health Program who educated prenatal providers to promote breastfeeding (potentially beneficial in overweight prevention) and screened prenatal patients for substance abuse. Another effective program trained the staff of churches and other community based organizations to identify signs of tuberculosis infection among their clients and encourage them to seek immediate medical attention (Rattray, et. al., 2002) -- this is a good example of educating those outside of the health field to act as advocates for health and disease prevention. (See section entitled A Model Program from the Field for an example on Acanthosis Nigricans and its relationship to childhood overweight prevention.)

Promoting Community Education

"The goals of community education are to reach the greatest number of individuals possible with health education messages, as well as to build a critical mass of people who will become involved in improving community health (Rattray, et. al., 2002)." AIDS prevention and tobacco cessation are familiar community education campaigns in many cities across the nation. One very important part of community education campaigns can be media advocacy -- the use of mass media in shaping the understanding of health issues among the population. For example, using media to help increase the use of bicycle helmets and car safety seats, paired with community events with bicycle safety rodeos/courses or car safety seat inspections have been effective (Rattray, et. al., 2002).

Strengthening Individual Knowledge and Skills

Strengthening knowledge and skills among individuals for public health can use a classic approach, wherein public health nurses, health educators, Extension agents, and other trained members of the community work directly with clients in the home, community setting, clinics, schools, etc. providing health information to promote child and family health. Topic-specific programs, health fairs, school and other community events are just a few of the places to strengthen individual knowledge and skills. Mass media can also be paired with these events to disseminate important messages about nutrition, physical activity, diabetes, smoking, and other health issues.

"Another part of strengthening individual knowledge and skills involves building the capacity of community members to use new approaches and to educate other individuals in their communities (Rattray, et. al., 2002)." These endeavors may include working with youth and/or adults to build their capacity in areas such as media advocacy, community mobilization, and work with policy makers to affect positive changes in health in their communities...encouraging residents to become more active advocates for community health concerns, get involved in local policy issues, or press for organizational change (Rattray, et. al., 2002).

Seven Strategies

In regards to these seven strategies and childhood overweight prevention...
Remember, childhood overweight is a major issue of health concern - efforts will likely not happen overnight. Networking and partnering with others with shared goals and vision can bring community efforts and community health to fruition over time. Following these seven strategies can guide you in your brainstorming and planning as you move forward into action. To see the "Spectrum of Prevention" in its entirety, go to http://www.cchealth.org/public_health/pdf/model4PH.pdf.

A Model Approach from the Field:
Talma Benavides, Maria Gutierrez and Nueces County make great strides on the road to childhood overweight prevention

Nueces County, with the leadership of Talma Benavides (County Extension Agent - Family & Consumer Sciences) has had a vision for childhood overweight prevention for a number of years. The approach Ms. Benavides and Nueces County have taken can be a guide for how other counties might approach this major issue.

Shared vision for prevention...

During the last Texas Communities Futures Forum (TCFF) cycle in 1999 the number one critical issue identified for Nueces county was "preventive health." At that time, the visionary Family & Consumer Sciences Advisory Committee decided to focus on childhood overweight prevention as its number one goal. That committee, which has been renamed the CCAPWell (Coordinated Community Approach to Promote Wellness) Committee has comprised key community members, including:

These are just some of the people who have been a part of this collaboration.

Among these groups, joint planning brought forth shared visions already underway:

These were some of the original projects/agendas that allowed this group to come together with a shared vision and continue their motivation to today.

The CCAPWell Committee continued their efforts by designing strategic plans, which follow the Texas Department of Health (TDH) State Strategic Plans (see http://www.tdh.state.tx.us/phn/obesity-plan.pdf), and action plans.

From building awareness to behavior modification...

Following these initial steps, some of the first programs presented were programs that helped community members make the connection between maintaining (or reducing) body weight and the prevention or delayed onset of type 2 diabetes -- an area of great concern in the county.

The CCAPWell committee first sponsored an awareness event on Acanthosis Nigricans -- a Greek word meaning a rough, textured mass -- which manifests around the neck, knuckles, knees, groin area, etc., and is often a precursor or "warning light" that an individual is on the road to diabetes because insulin levels in the body are high. The goal of this educational event was to raise awareness and send the message that improving diet and increasing physical activity reduces these markings (Acanthosis Nigricans), and in so doing, reduces the individuals risk for developing type 2 diabetes.

Promotion of this program was made through:

An important thing to note here is that because type 2 diabetes is a concern felt by this community, the CCAPWell community has been able to foster awareness about childhood overweight while meeting the needs of their community regarding type II diabetes. Over 125 people attended this program.

The CCAPWell committee's next strategy was to present a training to HeadStart staff. This training was designed to help the staff identify children who might have or be on the road to developing type 2 diabetes. This training was visionary, as it was done prior to the time when screenings were required by law. This step also moved the committee closer to their targeted population -- children.

CATCHing the vision for childhood overweight prevention along with heart disease and diabetes prevention...

The next step was taken by Talma Benavides, as she took a program on Acanthosis Nigricans (designed by Courtney Schoessow, Extension Associate - Health Education) on the road. Wherever Ms. Benavides had an invitation to speak and deemed it appropriate, she took the message of Acanthosis Nigricans and the importance of improving diet, and increasing physical activity to maintain or reduce weight.

Ms. Benavides' leadership in this area brought her an invitation from the American Heart Association to serve on a committee that would strategize ways (specifically the review of programs/curricula) to reach underserved populations with the goal of preventing the development of heart disease and type 2 diabetes. This committee ultimately decided that their focus, too, should be on children. Thus, using an AHA-sponsored program known as CATCH (Coordinated Approach To Child Health), the committee identified one underserved, at-risk elementary school in the county and began to implement CATCH with the goals of preventing the development of heart disease and type 2 diabetes through improved nutrition and increased physical activity.

The CATCH program/curriculum involves four components:

  1. Academic classroom -- Integrated classroom approach, which has teachers integrating health and nutrition information into all subject areas (English, Science, History/Social Studies, etc.)
  2. Physical Education/Sports -- Increased moderate and vigorous activity during physical education class periods. This involves doing away with activities that require standing in line as well as elimination games (where players are taken out of the game [eliminated] one or more at a time) and choosing activities where children stay in motion.
  3. Food Services -- Efforts focus on changes in food selection and preparation for healthier options.
  4. Family -- Family nights promote the program and motivate the family and child. Homework assignments strive to encourage parents alongside their children.

CATCH success stories

As a result of the initial CATCH school program's success, the committee has now been instrumental in implementing the CATCH program in six schools in Nueces County. The CATCH program implemented both the Walk Across Texas for Schools program (see http://walkacrosstexas.tamu.edu/wat_schools/wat_schools.htm) and the Better Living for Texans (BLT) program to fulfill the four components listed above.

In fact, the Food Services Departments in the Robstown schools no longer serve any fried foods in their cafeteria lines. All foods are identified as "Go," "Slow," or "Whoa" foods, which reinforces what kids are learning about nutrition in the classroom. Additionally, as a direct result of the excitement surrounding the Walk Across Texas (W.A.T.) Program implemented in many of the schools:

The success of the CATCH program has also motivated the parents involved in these schools:

Note: Senate Bill 19 requires that by the year 2007 public schools must have coordinated/integrated school health programs. CATCH is one of 2 programs currently approved by the Texas Education Agency (TEA) to satisfy senate bill 19, see http://www.tea.state.tx.us/taa/curr040903.html for more information on approved programs in Texas.

An action plan requires action...

Some of the most recent programs implemented to date in Nueces County's efforts to prevent childhood overweight, diabetes, and heart disease were two children's nutrition expos and health fairs and a kick-off event for the Week of the Young Child. Maria Gutierrez (Extension Program Specialist) and Talma Benavides worked together to strategize, not only how to have nutrition education at these events, but how to focus on the often under-emphasized physical activity component.

Here are some of the highlights of these events:

February Children's Nutrition Expo and Health Fair

An important and unique aspect of both this expo/health fair and the Week of the Young Child Kick-off Event was the location -- a baseball stadium (Aviator Stadium) -- which presented an ideal setting for physical activity events. Some of the activities presented at the February expo/health fair were as follows:

March Children's Nutrition Expo & Health Fair

This expo/health fair was held at the convention center and was part of the Nueces County Medical Society's Annual Health Fair. (Note: CBHEC helped subsidize the booth space and because of the leadership provided by the Texas AgriLife Extension Service and the resulting success, CBHEC has offered to double their investment in the coming year.) The event was kicked off with a "Families in Motion" walk, and children who registered for the walk with their parents received a free pedometer. A sampling of other activities at the expo/fair included the following:

For additional information on this events see the news release story from writer, Linda Anderson, at http://agnews.tamu.edu/dailynews/stories/CFAM/Apr0204a.htm.

Week of the Young Child Kick-off Event

Over 325 pre-K aged children (from 2 day cares, 3 CATCH schools, and 1 pre-k school) participated in this event meeting at the parking lot of Aviator Stadium. Both the Mayor and a candidate for Texas State Representative kicked off the event. The event was set up so that each school provided/manned 5 stations, resulting in a total of 30 stations in which the children could be involved. Children went in 5-station rotations to cover them all. Some examples included:

Finally, CCAPWell has recently been approached by the Texas Department of Health to act as the advisory for a CDC funded needs assessment of Nueces County. This is the most current on-going strategy that Nueces County is taking in the fight against childhood overweight and other health concerns.

As Ms. Benavides put it "Nueces County is ripe for education in this area." This is in no small part due to her work, approach, and vision for the health of Nueces County children and families. These and/or other similar strategies could be successfully implemented in other counties.

Best Practices for Increased Levels of Physical Activity:
Reported recommendations for communities, policy makers, and public health providers

Physical activity has been linked to physical, as well as, behavioral, social, and social environmental correlates. "Therefore, the role of community-based interventions to promote physical activity has emerged as a critical piece of an overall strategy to increase physical activity behaviors among people of the United States (Task Force on Community Preventive Services, 2002)." With the support of the U.S. Department of Health and Human Services (DHHS), Centers for Disease Control (CDC) staff, and in collaboration with public and private partners, recommendations for communities, policy makers, and public health providers have been reported through an independent, nonfederal task force. This Community Preventive Services Task Force is developing the Guide to Community Preventive Services (i.e., the Community Guide), which will also include recommendations regarding nutrition interventions, which should be available by the end of this year (2004).

Extensive research reviews and evaluations of qualifying studies with reputable execution resulted in the Task Force "strongly recommending" or "recommending" the following six interventions to increase levels of physical activity.

Two informational approaches (Informational approaches are those approaches used to change knowledge and attitudes about the benefits of and opportunities for physical activity within a community.):

  1. Communitywide campaigns -- Large-scale, highly visible, multi-component campaigns directing their messages to large audiences using a variety of approaches, including television, radio, newspapers, movie theaters, billboards, and mailings.
  2. Point-of-decision prompts to encourage use of stairs -- Motivational information provided at the place where an individual is likely to be making a choice for action. For example, by locating signs close to elevators and escalators, people are encouraged to use safe and accessible stairs as a physically active alternative to using the elevator or escalator.

Three behavioral and social approaches (Behavioral and social approaches are those approaches used to teach people the behavioral management skills necessary both for successful adoption and maintenance of behavior change, and for creating social environments that facilitate and enhance behavioral change.):

  1. School-based physical education -- Modifying school curricula and policies, and increasing the amount of time students spend in moderate to vigorous activity while in physical education (PE) class. This can be accomplished either by increasing the amount of time spent in PE class or by increasing students' activity level during PE class.
  2. Social support interventions in community settings -- Increasing physical activity by creating or strengthening social networks, e.g., setting up a buddy system, contracting with another person to complete specified limits/goals of physical activity, establishing walking groups, etc.
  3. Individually adapted health behavior change -- Tailoring programs to a person's specific interests or readiness to make a change in physical activity habits. Teaching behavioral skills, such as goal setting, building social support, self-rewards, problem solving, and relapse prevention all assist individuals in learning to incorporate physical activity into their daily routine.

One environmental and policy approach (Environmental and policy approaches are those approaches used to change the structure of physical and organizational environments to provide safe, attractive, and convenient places for physical activity.):

  1. Creation of or enhanced access to places for physical activity combined with informational outreach activities -- Ensuring that the physical environment is conducive to physical activity, such that places where people can be physically active are readily available, accessible, and acceptable. Examples include:
    • attractive sidewalks
    • safe stairwells
    • walking or biking trails
    • exercise facilities in the community and/or workplace.

Additionally, informational outreach strives to make people aware of available resources, encourages them to take local action, or provide training, seminars, counseling, or risk screening so that resources are well used. The goal is to improve quality of life and achieve livable communities.

(Adapted from Centers for Disease Control and Prevention, 2003; Centers for Disease Control and Prevention, 2001; Kahn et. al., 2002).

In addition to these recommendations, intervention recommendations are still in progress for the following:

The Task Force categorized five other intervention strategies as having insufficient evidence available in scientific literature to determine effectiveness. These intervention strategies included the following:

  1. Classroom-based health education that focuses on information sharing and behavioral change.
  2. Mass media campaigns.
  3. Classroom-based health education that encourages young people to reduce television viewing and video game playing (although research did suggest that this strategy reduced adiposity, it just didn't necessarily increase physical activity levels [Taskforce for Community Preventive Services, 2002]).
  4. College-level physical education and health education.
  5. Family-based social support (Centers for Disease Control and Prevention, 2003).

This notation of insufficient evidence does not mean these strategies are necessarily ineffective; it just means that more research needs to be done to determine their effectiveness or ineffectiveness.

"Choosing interventions that are well matched to local needs and capabilities and then carefully implementing those interventions are vital steps for increasing physical activity at the community level (Task Force on Community Preventive Services, 2002)." In setting priorities for the selection of interventions to meet local objectives the above recommendations should be considered along with local information, such as:

"Taking into consideration local goals and resources, the use of strongly recommended and recommended interventions [see above] should be given priority for implementation (Task Force on Community Preventive Services, 2002)."

Active Play, Urban Planning, Accessibility, and Safety: Something to Think About...

"Many have long viewed playgrounds as providing the necessary spaces for children's play...while children do make substantial use of playgrounds for play, streets often serve as even more attractive playgrounds, of sorts, for children. Streets are valued in large part because they are so proximate to children's homes: they are close enough so that travel time to and from the play space is limited, a factor that is crucial when considering the children's lives are guided by time constraints that are established by their parents. Streets are available as play areas during those often brief periods when children are not obliged to be anywhere or do anything, such as between the end of the school day and dinner and between dinner and sundown. Therefore...streets are important social environments for children, places that are easily accessible for meetings. They are amongst the few environments children have that are relatively free of play rules -- parents often constrain noise levels and types of play in fenced backyards...[and often streets are] more interesting spaces than playgrounds... {offering} a host of features that, to a child, offer up an endless variety of opportunities for creative play and imagination. These features include curbs, gutters, sidewalks, trees, parked cars, fences, mailboxes, walls, and interesting passersby (Moore, 1987)."

Strategies and Best Practices from Around the Country:
Program ideas for your community

The following is a listing of strategies and best practices used around the country. Because each community make-up and layout is different, some of these strategies will work well in your community, while others may not. Consider your locality as you consider these practices. Start by viewing the Texas "Strategic Plans for Obesity Prevention" and reading the "Specific Strategies" section in particular found at http://www.tdh.state.tx.us/phn/obesity-plan.pdf. This strategic plan (see overview) can be a guide as you do planning with partners in your county. Also, see the handout in this issue of HealthHints entitled "Ten Recommendations for School and Community Programs Promoting Physical Activity Among Young People" (PDF).

Target Audience

Your target audience(s) may include any or all of the following:

Community Efforts: Advocacy, Awareness, and Availability Education

Community Efforts: Accessibility and Safe Transportation

Community Efforts: Breastfeeding

Community Efforts: 5-A-Day

Community Efforts: Food Industry

Community Efforts: Health Care Industry

School Efforts: Legislation

Use the California Senate Bill 19 (2001) as a model for healthy school nutrition and physical activity. This legislation sets standards for meal composition (e.g. 35% calories from fat, 10% calories from saturated fat, no more than 35% sugar by weight, limited drink sales [other than water, milk, and fruit juice], etc.).

Extend the Texas Senate Bill 19 (77th Legislative Session) to mandate comprehensive school health in grades K-12, add monitoring and compliance, and provide training for staff at school districts and individual schools.

Follow the recommendations of the Center for Health Improvement's Health Policy Coach, including:

(See the Texas Strategic Plan for Obesity Prevention at http://www.tdh.state.tx.us/phn/obesity-plan.pdf for more information on the above legislative strategy suggestions.)

Advocate for schools to refuse to sign "pouring rights" contracts (i.e., contracts that require schools to serve only the products of the company contracted with, for example Coca Cola or Pepsi) (Cox, 2001a).

School Efforts: Partnering with Parents and the Community

School Efforts: Staff Focus

School Efforts: Student Focus

(The above section was adapted from the Colorado Department of Public Health and Environment, Best practices: Obesity Prevention for Children and Youth, 2003 except where otherwise noted).

Strategic Plan for Prevention of Obesity in Texas: An Overview

Vision: All Texans have a healthy weight through physical activity and healthy eating.

Mission: To reduce the burden on weight related disease by decreasing the prevalence of obesity.

Goals:

  1. Increase awareness of obesity as a public health issue that impacts the quality of life of families.
  2. Mobilize families, schools, and communities to create opportunities to choose lifestyles that promote healthy weight.
  3. Promote policies and environmental changes that support healthful eating habits and physical activity.
  4. Monitor obesity rates and related behaviors and health conditions for planning, evaluation and dissemination activities (Texas Department of Health, 2003).

Strategies for Success

When designing your approach to the reduction and prevention of childhood overweight, based on the major learning theories and principles of behavior change, the following strategies for success are recommended:

Joining/Partnering with Others:
How to NOT "reinvent the wheel"

As many of us just begin down this road to prevent childhood overweight, it is important to partner with others and join together to avoid "reinventing the wheel." There are many ongoing programs already established that can be infused with messages for increased physical activity and healthful eating. One example of this type of activity is El Dia de los Niños (Celebrating Young Americans), a traditional Latin American holiday celebrated annually since April 30, 1998. It is a day for parents, families, and communities to value and uplift Latino children and all other children in the United States. This is a day to encourage family and community activities -- an excellent avenue to begin to provide messages about childhood overweight, it's relationship to disease, and the benefits of increased physical activity and healthful eating to your community. This initial step could be a small step that could carry over into future programs as you meet clientele where they are. Materials for El Dia de los Niños can be found at http://www.nlci.org/activity/dlnsplash.htm. Texas contacts for El Dia de los Niños can also be found at this site.

Another idea is to get involved in ongoing/established annual health fairs. Health fairs are a great way to raise community awareness regarding downsizing food portions and increasing physical activity. For health fair ideas, see the Physical and Nutrition Activities handout (PDF) inserted in this issue of HealthHints.

There are also programs that have already been designed for your use with all the components and key resources and people at your fingertips. Some of these programs can be further adapted to meet the clientele needs of your community. A few suggestions include, but are not limited to:

W.A.T. (Walk Across Texas)

Walk Across Texas is a program created by the Texas AgriLife Extension Service in 1996 to help you establish the habit of regular physical activity. From border to border, you and/or your team, can walk 830 miles across the state, seeing your progress across the state on-line, or on a Texas road map.

Most people start by walking as a member of a team of eight for eight weeks. Children could walk with family, a church group, with their schools, etc. Then, after that, they can transfer their mileage from those eight weeks to the "By Yourself" option and continue walking across the state on their own.

The Walk Across Texas program also includes school teams. In fact, in Bee County, Maria Guiterrez worked with the now former county FCS agent to get volunteer parents to walk with children during lunch periods. This freed up teachers during this time, making it a very popular and successful endeavor. Classrooms competed for miles walked across Texas, entering their miles on the W.A.T. website. Children were also allowed to walk at home with their parents' permission, and they could add these miles as well as those walked by parents or other family members at the end of the week as bonus miles.

Additionally, Carolyn McFarlin, CEA-FCS in Grayson County has been working with schools on an expanded version of W.A.T. where English teachers have the children write a log of their "travels" across Texas, Math teachers have the children enter class data on-line, and Social Studies teachers have the children write reports on "places they encounter" as they "walk across Texas." Eventually, these ideas will be available for replication on the W.A.T. website.

For more information about how to get involved, see the Walk Across Texas website at http://walkacrosstexas.tamu.edu.

AOM (America on the Move)

America On the Move is a national initiative dedicated to helping individuals and communities across our nation make positive changes to improve health and quality of life. By focusing on individuals and communities, AOM strives to support healthy eating and active living habits in our society. AOM creates and supports an integrated grassroots network of state Affiliates to build communities that support individual behavior changes. AOM also encourages public and private partnerships at the national, state, and local level to build the capacity, reach, and support needed for individual and community behavior change.

The AOM message is about energy balance -- stopping weight gain by creating a balance between the amount of energy burned and the amount of food consumed throughout a normal day. The message is simple: move more and eat less. Making these 2 small changes daily is all it takes...

With these two simple strategies, individuals can prevent weight gain and begin to see big results (America on the Move, 2004)

To learn more about AOM and get the contact information for Texas affiliates already participating, see the AOM website at http://americaonthemove.org/.

Heart's N Parks

The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health has teamed up with the National Parks and Recreation Association (NRPA) to offer a nationwide program called Hearts N' Parks. Park and recreation departments and other community-based organizations receive assistance from NHLBI on providing activities for kids and adults that encourage healthy lifestyle choices. The goals are to reduce obesity and the risk of heart disease by encouraging nutritious eating habits and regular physical activity. Kids may go on field trips to local grocery stores and restaurants to learn how to make healthy selections and read food labels. They might participate in soccer, bowling, swimming, or hiking. The program emphasizes non-competitive activities where everyone joins in the fun (Torgan, 2002).

For more information on Hearts N' Parks see the National Heart, Lung, and Blood Institute website at http://www.nhlbi.nih.gov/health/prof/heart/obesity/hrt_n_pk/.

CATCH (Coordinated Approach To Child Health)

As discussed in the model from Nueces County, CATCH, A Coordinated Approach to Child Health, is a blend of physical education, classroom curriculum, nutrition awareness, student-directed activities, and Physical Education equipment designed to promote and maintain cardiovascular health in children, grades K-8.

CATCH began as a research study founded by the National Heart, Lung, and Blood Institute. Its purpose was to show the direct link between school health and physical education in developing healthier behavior among children, grades 3-5. With more than 600 school programs tested and implemented to date, CATCH continues to impact students long after they complete the coursework. Published in the Journal of the American Medical Association, results indicate that student intake of total fat and saturated fat was reduced while the intensity of physical activity performed both inside and outside school increased (Flaghouse, 2004).

For more information on CATCH programs in Texas see http://www.sph.uth.tmc.edu/catch/.

Potential Partners and Coalition Members

The level of change required for an issue as major as childhood overweight requires a committee or coalition composed of community leaders willing to invest considerable time to making changes at a number of different levels. The people on such a committee/coalition must be those who have contact with many people within the community and in a variety of community organizations/settings if family behavior is to change. We must include influential people (those to whom others look to for answers when new things are being implemented) from schools, parks and recreation, health care, churches, WIC, BLT, ENP, civic clubs, 4-H, Boy/Girl Scouts, etc. We must also involve media personnel to have wide dissemination of the "move more and eat less" message. If a coalition includes these types of individuals from these types of organizations, changes in eating and physical activity are likely to happen more quickly (Rogers, 2003).

The following is a list of some of the key people and organizations you may want to consider joining with or asking to become a part of your local coalition or committee for childhood overweight prevention:

  • Agriculture and 4-H Agents (in addition to FCS Agents)
  • American Cancer Society
  • American Dietetic Association
  • American Heart Association
  • Better Living for Texans (BLT)
  • Boys and Girls Clubs
  • Boy and Girl Scouts
  • Chamber of Commerce
  • Chefs
  • Church groups
  • Civic Clubs (e.g. Rotary, Lions Club, Pilot, etc.)
  • Concessionaires at sporting events
  • County officials (Mayors office, Councilmen/women, etc.)
  • Daycares
  • Department of Transportation and Planning
  • Dieticians
  • Doctors offices
  • Expanded Nutrition Program (ENP)
  • Farmers market representatives/personnel
  • Fitness gyms, golf courses, other recreational facilities
  • 4-H
  • Grocery stores
  • Head Start
  • Health clinics
  • Health department
  • Hospitals
  • Hospital auxiliary groups/clubs (e.g., pink ladies)
  • Individual members of the community with shared interest
  • Media personnel
  • Minority health organizations
  • National Heart, Lung, and Blood Institute
  • Parks and Recreation Department
  • Parent-Teacher Associations (PTAs)
  • Plant nursery personnel/Master Gardeners
  • Restaurants
  • Schools, school board members, school nurses
  • Sporting goods stores
  • WIC
  • YMCA

Resources: Helps to get you started in your community

The following resources are available on-line and may act as helps in generating ideas or implementing a specific program targeted at preventing or reducing childhood overweight in your community:

References

Acknowledgment
It is with great appreciation that we acknowledge the contributions of both Talma Benevides, Nueces County Extension Agent - Family and Consumer Sciences, and Maria Gutierrez, Extension Program Specialist, to this issue of the HealthHints newsletter. We acknowledge you not only for the hours spent in meeting about projects and programs, but also for your continuous efforts to serve Texas, which have provided a clear model for others to follow in the area of childhood overweight prevention. Thank you.

Download PDF version of this newsletter:

Special Series on Childhood Overweight

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Last updated: January 7, 2008

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